Tobacco retailer density and smoking behaviour: how are exposure and outcome measures classified? A systematic review.

INTRODUCTION: To date only a limited number of reviews have focused on how exposure and outcome measures are defined in the existing literature on associations between tobacco retailer density ('density') and smoking behaviour ('smoking'). Therefore this systematic review classified and summarised how both density and smoking variables are operationalised in the existing literature, and provides several methodological recommendations for future density and smoking research. METHODS: Two literature searches between March and April 2018 and April 2022 were conducted across 10 databases. Inclusion and exclusion criteria were developed and keyword database searches were undertaken. Studies were imported into Covidence. Cross-sectional studies that met the inclusion criteria were extracted and a quality assessment was undertaken. Studies were categorised according to the density measure used, and smoking was re-categorised using a modified classification tool. RESULTS: Large heterogeneity was found in the operationalisation of both measures in the 47 studies included for analysis. Density was most commonly measured directly from geocoded locations using circular buffers at various distances (n = 14). After smoking was reclassified using a smoking classification tool, past-month smoking was the most common smoking type reported (n = 26). CONCLUSIONS: It is recommended that density is measured through length-distance and travel time using the street network and weighted (e.g. by the size of an area), or by using Kernel Density Estimates as these methods provide a more accurate measure of geographical to tobacco and e-cigarette retailer density. The consistent application of a smoking measures classification tool, such as the one developed for this systematic review, would enable better comparisons between studies. Future research should measure exposure and outcome measures in a way that makes them comparable with other studies. IMPLICATIONS: This systematic review provides a strong case for improving data collection and analysis methodologies in studies assessing tobacco retailer density and smoking behaviour to ensure that both exposure and outcome measures are clearly defined and captured. As large heterogeneity was found in the operationalisation of both density and smoking behaviour measures in the studies included for analysis, there is a need for future studies to capture, measure and classify exposure measures accurately, and to define outcome measures in a manner that makes them comparable with other studies.

Strategies to integrate oral health into primary care: a systematic review.

OBJECTIVES: Integration of oral health into primary care has been proposed as a primary healthcare approach for efficient and sustainable delivery of oral health services, and the effective management of oral diseases. This paper aimed to synthesise evidence on the effectiveness of strategies to integrate oral health into primary care. DESIGN: Systematic review. DATA SOURCES: MEDLINE, CINAHL, Embase, Scopus, ProQuest, Cochrane and Google Scholar were searched without date limits until the third week of June 2022. Reference lists of eligible studies were also searched. Experts in the field and existing professional networks were consulted. ELIGIBILITY CRITERIA: Only studies that evaluated integration strategies were included in the review. Eligibility was restricted to English language studies published in academic peer-reviewed journals. DATA EXTRACTION AND SYNTHESIS: Two reviewers independently extracted data and performed the risk of bias assessments. A narrative synthesis approach was used to report review findings. Heterogeneity among included studies precluded a meta-analysis. RESULTS: The search identified 8731 unique articles, of which 49 were included in the review. Majority of the studies explored provision of oral healthcare by primary care professionals in primary care settings, where integration was primarily via training/education and/or policy changes. Most studies reported results favouring the integration strategy, such as improvements in referral pathways, documentation processes, operating efficiencies, number of available health staff, number of visits to non-dental primary care professionals for oral health issues, proportion of children receiving fluoride varnish applications/other preventive treatment, proportion of visits to an oral health professional and dental caries estimates. CONCLUSION: The findings from this review demonstrate that the majority of identified strategies were associated with improved outcomes and can be used to inform decision-making on strategy selection. However, more research and evaluation are required to identify best practice models of service integration. PROSPERO REGISTRATION NUMBER: CRD42020203111.

Patterns and predictors of public dental service utilisation among refugees in Victoria, Australia: a latent profile and multilevel analysis.

BACKGROUND: The purpose of the study was to explore, analyse, and describe the patterns of public dental service utilisation among the refugee populations in Victoria, Australia, and determine their predictors at the individual and contextual levels. METHODS: Data on the refugees who attended Victorian public dental services between July 2016 to June 2020 was gathered from the Dental Health Program dataset. Latent profile analysis was used to identify discrete groups among the refugee clientele with similar mean utilisation patterns across six indicator variables describing the attributes of dental services received and the site of care provision, over the study period. Multilevel multinomial logistic regression analysis was performed to examine the individual and contextual level correlates of the identified utilisation patterns. RESULTS: Six distinct profiles of public dental service utilisation were identified among the study population (n = 25,542). The largest group comprised refugees predominantly using restorative services under general course of care (38.10%), followed by extraction services under emergency course of care (23.50%). Only a small proportion were estimated as having a higher mean utilisation of preventive services under general course of care (9.10%). Multilevel analysis revealed that the following variables had a significant association with refugee utilisation pattern: at the individual-level - demographic and ethnic attributes including age, gender, region of birth, preferred language for communication, use of language interpreter services, and type of eligibility card; at the contextual-level - characteristics of refugees' neighbourhood of residence including urbanicity, socioeconomic disadvantage, delivery of Refugee Health Program at the community health centres, and spatial accessibility to public dental services via driving and public transit modes of travel. CONCLUSIONS: The study represents a significant step towards the development of an evidence-based knowledge around public dental service utilisation among Victorian refugees. Overall, the study findings reiterate the critical need for targeted strategies to promote the importance of routine dental visits, oral disease prevention, and timely intervention among refugee groups.

Gender differences in the association between malocclusion traits and oral health-related quality of life in Finnish adults.

We aimed to evaluate the gender-specific associations of malocclusion traits with oral health-related quality of life (OHRQoL) among Finnish adults. Data were obtained from the Health 2000 Survey, Finland. Included participants (n = 3993) were ≥30 years old with OHRQoL and occlusion data. OHRQoL was measured using the 14-item Oral Health Impact Profile (OHIP-14). OHIP-14 severity mean score, prevalence of impacts, and means of seven dimensions were outcomes. Explanatory variables were any malocclusion trait, increased overjet, negative overjet, open bite, deep bite, and crossbite/scissor bite. Logistic (prevalence) and cumulative (severity) regression models were adjusted for age, decayed teeth, deep periodontal pocket, occluding pairs, orthodontic treatment, and self-perceived health. Gender modified the association between any malocclusion trait and OHRQoL, with the association being stronger in females. Females without any malocclusion trait (OR = 1.62, 95% CI = 1.14-2.28) or without crossbite/scissor bite (OR = 1.68, 95% CI = 1.16-2.43) had better OHRQoL (lower prevalence) than those with malocclusions. Males without increased overjet (OR 1.50, 95% CI = 1.04-2.17) had lower mean OHIP-14 severity score than males with increased overjet, after adjustments. The association between psychological and physical disability and malocclusion traits was different between males and females. Gender differences in the impact of malocclusion traits should be considered when assessing orthodontic treatment need.

Differences in complete denture longevity and replacement in public and private dental services: A propensity score-matched analysis of subsidised dentures in adult Australians across 20 years.

OBJECTIVES: To examine the differences in treatment outcomes for patients who received subsidized complete dentures in private dental clinics and in public dental clinics over 20 years in Victoria, Australia. METHODS: Between 2000 and 2019, 187 227 complete dentures were provided to eligible public patients by the Victorian public dental system. Of these, approximately 52% were provided to public patients in private clinics through the voucher system. Of the 97 107 participants who received denture care in private clinics, 70 818 were matched 1:1 by propensity score (PS) quantiles with participants who received denture care in public clinics. The PS matching balanced the characteristics between these two groups. Subsequently, a conditional logistic regression model investigated the binary outcome of denture replacement whilst a conditional Poisson regression modelled the number of years to denture replacement. A frailty Cox regression after PS matching investigated denture survival over time. RESULTS: Dentures provided in public clinics had a mean time to replacement of 5.5 years (SD: 34.0) and 25.9% were replaced during the observation period. In the first year of denture service, incidence rate per person year (IR) for complete denture replacement in public clinics was 0.04 (95% CI: 0.04-0.04). Dentures provided in private clinics had a mean time to replacement of 6.5 years (SD: 3.8) with 29.4% replaced during the observation period. In the first year of denture service, the IR for complete denture replacement in private clinics was 0.02 (95% CI: 0.02-0.02), which was less than half that of the public IR. Multivariate analyses found that although private dentures were more likely to be replaced during the observation period than those provided in the public sector (odds ratio [OR]: 1.31, 95% CI: 1.28-1.35, p < .001), they had greater longevity (incidence rate ratio [IRR]: 1.23, 95% CI: 1.23-1.24, p < .001). Longer longevity of private dentures was also supported by the frailty Cox regression showing that private dentures had a reduced hazard of denture replacement over time (better survival) in comparison to public dentures (hazard ratio [HR]: 0.94, 95% CI: 0.92-0.97, p < .001). Probabilistic sensitivity analysis supported the study findings. CONCLUSIONS: Increased denture longevity, higher rates of denture replacement and lower rates of early denture replacement were associated with receiving denture care in private clinics as compared with dentures provided in the public sector.

Factors associated with access to dental care among refugees: A systematic review of quantitative studies.

OBJECTIVES: To identify, appraise and synthesize the published evidence from quantitative studies on the individual and contextual-level factors determining access to dental care among refugees worldwide. METHODS: A systematic literature search was conducted until the last week of February 2022 in four electronic databases - MEDLINE, Embase, Web of Science (all databases) and APA PsycINFO - without any restrictions. Quantitative studies published in English language and meeting the a priori eligibility criteria were reviewed and data extracted. Quality assessment was conducted using the National Institutes of Health tool. The identified factors were stratified according to the framework of the Behavioural Model of Health Services Use, and the evidence related to each of these factors was summarized in tables. Narrative synthesis of the findings was conducted. RESULTS: The search retrieved 6776 unique records, of which 69 were deemed eligible for full-text screening and nine studies were included in the final data analysis and synthesis. The studies were rated to be of 'fair' quality at best. Self-reported previous dental visits was the most commonly used measure of access. Associations between individual-level factors and dental care access were most frequently examined (predisposing [n = 6], need [n = 2] and enabling [n = 1]), while the contextual-level factors were rarely examined (predisposing and enabling [n = 1, each]). CONCLUSIONS: Individual-level predisposing factors, such as English language proficiency, education, health and dental literacy and acculturation and integration, were shown to be significantly associated with refugees' access. There is limited evidence to determine the effect of individual enabling and need and contextual factors.

Disparities in spatial accessibility to public dental services relative to estimated need for oral health care among refugee populations in Victoria.

OBJECTIVES: To examine the spatial accessibility to public dental services (PDS) relative to the estimated oral health needs of refugee populations within the state of Victoria, Australia. METHODS: The study employed enhanced two-step floating catchment area method to measure spatial accessibility to PDS by driving and public transit modes at statistical area level 2 (SA2). Principal component analysis of select census-derived socioeconomic variables specific to the refugee population was conducted to derive an area-based indicator of refugee oral health needs, also at SA2 level. Individual indices were then developed for each of these components using standardized z-scores. Finally, an integrated need-accessibility index was developed to identify low-accessibility areas associated with high needs. RESULTS: The results show clear contrast in spatial accessibility to PDS for the refugee populations between metropolitan and rural areas as well as between driving and public transit modes. There are critical limitations in accessibility for refugees living in the rural areas and those dependent on public transit mode for travel. Also, there is evident disparity between the estimated oral health needs of refugees in metropolitan and rural areas. Overall, approximately 29% of all SA2s with refugee population are in the 'High' needs category, which comprise 19.8% of the total Victorian refugee population. Integrating accessibility and oral health needs measures revealed that about 30% and 18% of refugee population are identified as under-serviced, when considering driving and public transit modes respectively. CONCLUSION: The findings provide implications for researchers and policy makers to address the inequalities in access to PDS among the refugee population in Victoria. The methodology outlined in this study provides a complementary approach in planning oral health service provision in the absence of population level data at a small-area scale on access to dental services or need for oral health care.

The association of travel distance and severity of odontogenic infections.

BACKGROUND: Odontogenic infections (OI) are a preventable disease commonly managed in a tertiary hospital setting. Prevention of severe infections and hospitalisation relies on timely access to primary dental care. This study outlines the pre-hospital treatment of patients presenting to hospital with OIs and the association between travel distance from the patients' residence to a tertiary hospital oral and maxillofacial surgical (OMS) unit. METHODS: This study analysed patients who initially presented hospital with an OI. Patient demographics, pre-hospital treatment, and clinical markers of severity were recorded. The travel distance from the patient's residence to the hospital was recorded in kilometers, along with any inter-hospital transfer via road/air ambulance. RESULTS: Two hundred twenty-seven patients were included in this study, 17.2% required an inter-hospital transfer. Of these patients, 70.3% had prior treatment before hospitalisation, and antibiotics without source control was the most frequent treatment (83.1%). The mean travel distance for patients with more severe markers of infection significantly greater than patients with minor infections (p = < .001). Patients who required an inter-hospital transfer accounted for most cases with airway compromise requiring ICU admission. CONCLUSION: This study found that most patients presenting to hospital with an OI had received antibiotics alone as treatment before hospitalisation. The travel distance from a tertiary hospital with OMS services had a significant correlation to more severe infections. This has important public health implications for the allocation of preventative dental services, and patient access to OMS services.

An overview of methodological approaches in systematic reviews.

AIM: The aim of this overview is to identify and collate evidence from existing published systematic review (SR) articles evaluating various methodological approaches used at each stage of an SR. METHODS: The search was conducted in five electronic databases from inception to November 2020 and updated in February 2022: MEDLINE, Embase, Web of Science Core Collection, Cochrane Database of Systematic Reviews, and APA PsycINFO. Title and abstract screening were performed in two stages by one reviewer, supported by a second reviewer. Full-text screening, data extraction, and quality appraisal were performed by two reviewers independently. The quality of the included SRs was assessed using the AMSTAR 2 checklist. RESULTS: The search retrieved 41,556 unique citations, of which 9 SRs were deemed eligible for inclusion in final synthesis. Included SRs evaluated 24 unique methodological approaches used for defining the review scope and eligibility, literature search, screening, data extraction, and quality appraisal in the SR process. Limited evidence supports the following (a) searching multiple resources (electronic databases, handsearching, and reference lists) to identify relevant literature; (b) excluding non-English, gray, and unpublished literature, and (c) use of text-mining approaches during title and abstract screening. CONCLUSION: The overview identified limited SR-level evidence on various methodological approaches currently employed during five of the seven fundamental steps in the SR process, as well as some methodological modifications currently used in expedited SRs. Overall, findings of this overview highlight the dearth of published SRs focused on SR methodologies and this warrants future work in this area.

Longevity of complete dentures after relines: A 20-year population based retrospective study of 187,227 publicly insured adults.

OBJECTIVES: To evaluate the incidence of the first complete denture reline in a population of publicly insured adults and to assess its association with complete denture longevity. METHODS: The records of 187,227 Australian adults who accessed subsidized complete denture treatment through public clinics were assessed. The number of years from denture issue to denture replacement was modelled using Poisson regression. RESULTS: Over 20 years, 5.9% of participants received at least one reline. The incidence rate (IR) for relines was highest in the first year of denture life, (IR: 0.031, 95%CI 0.030 to 0.032) and decreased as dentures increased in age. Dentures receiving an early reline (within 12 months of denture issue) had a mean longevity of 5.03 years (SD: 3.76) and dentures which received a late reline had a mean longevity of 7.12 years (SD: 3.32). Multivariate Poisson regression found that dentures which received an early reline were associated with a 2% reduction in denture longevity in comparison to those who did not receive a reline (IRR: 0.98, 95%CI: 0.97 to 0.99, p<0.001). Dentures which received a late reline were associated with a 15% increase in longevity in comparison to dentures which received no reline (IRR: 1.15, 95%CI: 1.13 to 1.16, p<0.001). CONCLUSION: The incidence of relining in this population was low. The results show that the timing of a reline during a denture's life modulates its effect on denture longevity. Denture longevity was prolonged in those receiving a late reline and was reduced in those receiving an early reline. CLINICAL SIGNIFICANCE: Relines performed after at least 12 months of denture issue can be expected to increase the longevity of complete dentures. This effect was not observed for relines performed within the first 12 months of denture provision.

Curriculum mapping of health promotion competencies in dental and oral health training programmes in Australia.

ISSUE ADDRESSED: Dental diseases are chronic conditions that place a significant burden on the population's health; however, they are mostly preventable using a range of health promotion strategies Health promotion is a core competency for all dental and oral health graduates, but little is known about what health promotion content is taught in undergraduate degrees. The aim of this study was to explore the dental and oral health content in Australian undergraduate dental and oral health degrees and map against the last two versions of the Australian Dental Council (ADC) health promotion competencies. METHODS: All ADC-accredited dental and oral health courses delivered at Australian universities in 2019 were eligible to be included. Key words were used to locate subjects within the courses that contained health promotion content. This was analysed and ranked against the last two versions (2011 and 2016) of the ADC health promotion competencies. The competencies were then ranked using Blooms updated "six levels of thinking." RESULTS: Seven oral health and eight dental courses were mapped. The number of health promotion subjects in courses varied substantially; the percentage of subjects that contained health promotion in oral health courses ranged from 30% to 75% and 16% to 60% for dental courses. All oral health courses were explicitly meeting the current ADC health promotion competencies, however, only half of the dental courses met the competency standards. CONCLUSION: Curriculum mapping provided a snapshot of the health promotion content within dental and oral health degrees in Australia. Evaluations of the extent to which these courses meet the ADC competencies provide useful information for students, clinicians and policy makers. SO WHAT?: This study provides evidence that health promotion training is occurring at varying levels. However, in dentistry, not all the ADC health promotion competencies are being met. A change is needed in the ADC health promotion competencies and ethos of academics involved in the development of curriculum to include and give appropriate attention to health promotion theory, especially advocacy. This will enable future dental professionals to advocate for a range of oral health promotion activities such as water fluoridation, universal dental care and sugar-sweetened beverage taxes.

Identifying tobacco retailers in the absence of a licensing system: lessons from Australia.

OBJECTIVES: To estimate the proportion of retailers that sell tobacco in the absence of appropriate local government oversight, and to describe the characteristics by which they differ from those that can expect to receive such oversight. METHODS: A database of listed tobacco retailers was obtained from a regional Victorian local government. Potential unlisted tobacco retailers were added using online searches, and attempts to visit all retailers were undertaken. GPS coordinates and sales type information of retailers that sold tobacco were recorded and attached to neighbourhood-level data on socioeconomic disadvantage and smoking prevalence using ArcMap. Logistic regression analyses, χ2 tests and t-tests were undertaken to explore differences in numbers of listed and unlisted retailers by business and neighbourhood-level characteristics. RESULTS: Of 125 confirmed tobacco retailers, 43.2% were trading potentially without government oversight. Significant differences were found between listed and unlisted retailers by primary business type (p<0.001), and sales type (p<0.001) but not by the other characteristics. CONCLUSIONS: The database of tobacco retailers was inaccurate in two ways: (1) a number of listed retailers no longer operated or sold tobacco, and (2) 43.2% of businesses confirmed as selling tobacco were missing. As no form of licensing system exists in Victoria, it is difficult to identify the number of retailers operating, or to determine how many receive formal regulatory oversight. A positive licensing system is recommended to regulate the sale of tobacco and to generate a comprehensive database of retailers, similar to that which exists for food registration, gaming and liquor-licensed premises.

Complete denture replacement: a 20-year retrospective study of adults receiving publicly funded dental care.

PURPOSE: There is little evidence as to what is the appropriate replacement interval for complete dentures. The aim of this study was to determine the longevity of complete dentures in a population of publicly insured adults across a 20 year observation period. METHODS: The records of 187,227 Australian adults who accessed complete denture treatment through public clinics between 2000-2019 were assessed. Time to denture replacement was modelled using a Weibull regression and a competing risk regression to adjust for the competing risk of mortality. RESULTS: Over a 20-year period, 27.7% of dentures were replaced, with a mean longevity of 6.06 (SD: 3.93) years. Pairs of complete dentures had greater mean longevity than single dentures (p<0.001). Approximately 4.6% of dentures provided were replaced within 2 years; 18.4% were replaced between 2 and 10 years and 4.6% of replacements occurred after 10 years.Over 70% of adults who received a complete denture did not replace it during the observation period. Dentures provided by denturists had higher levels of replacement than those made by dentists. Participants over 80 years of age had lower rates of denture replacement. Low socio-economic status and living outside a major city were associated with reduced rates of replacement for dentures under 10 years of age. CONCLUSION: Complete dentures were commonly replaced after 6 years of service. Pairs of dentures lasted longer than single dentures.

Oral health surveillance in Australia: the need for ongoing data to inform public health decision-making.

Surveillance of people's health takes on an important meaning in the practice of public health because it allows monitoring of diseases and prompt response to change in proportions and rates at which diseases occur in populations. Improving health of populations requires establishment of an effective public health system. Population level data and analysis is critically important in government policy and program development and monitoring. Lack of or inadequate information about the health of populations leads to ineffective policies that may often attenuate health problems instead of solving them. Australia's current oral health surveillance is mostly through ad hoc sentinel surveys, which lack recency in time. This position paper is to present the need for real-time oral health surveillance in Australia, which can be used to inform health decision-making in a timely manner.

Oral health interventions for older people in residential aged care facilities: a protocol for a realist systematic review.

INTRODUCTION: Poor oral health among older people is a global problem impacting on health and well-being. The economic cost to the health system is significant. An ageing population is intensifying the urgency for action. However, poor oral health, particularly for those in residential aged care facilities, continues to be highly resistant to resolution. The overall aims of this realist review are to: (A) explore and synthesise evidence on oral health interventions for older people in residential aged care facilities, (B) produce a causal theory on how contextual factors and mechanisms interact to produce outcomes, and (C) produce guidelines/policies to inform high-quality oral health interventions to improve older people's oral health in residential aged care facilities. METHODS AND ANALYSIS: The review is guided by the RAMESES publication standards for realist synthesis. Participants include older people in residential aged care facilities, the aged care workforce, carers and families. Interventions include oral healthcare, oral health education, policy interventions and oral health promotion. The five-step realist review process of Pawson et al will guide the review: clarification of scope and development of initial framework, systematic searches, study appraisal and data extraction, synthesising evidence, drawing conclusions, and dissemination, implementation and evaluation. Expert input with key stakeholders will occur through a blog. Stakeholders will examine consistencies across studies and an explanatory causal theory will be developed to guide policy and practice. ETHICS AND DISSEMINATION: Formal ethical approval was granted by the La Trobe University Ethics Committee HREC 20144. The developed theory will guide education, practice and policy decisions about interventions and the factors that impact on implementation. Using an integrated knowledge translation approach, traditional research outputs such as international conference presentations and publications will be supplemented with stakeholder forums, infographics, blogs, social media postings, webinars, podcasts and writing for web-based independent outlets. PROSPERO REGISTRATION NUMBER: CRD42021155658.

Tobacco retailer density and smoking behavior in a rural Australian jurisdiction without a tobacco retailer licensing system.

INTRODUCTION: An emerging body of research has developed around tobacco retailer density and its contribution to smoking behavior. This cross-sectional study aimed to determine the association between tobacco retailer density and smoking behavior in a rural Australian jurisdiction without a tobacco retailer licensing system in place. METHODS: A local government database (updated 2018) of listed tobacco retailers (n=93) was accessed and potential unlisted tobacco retailers (n=230) were added using online searches. All retailers (n=323) were visited in 2019 and GPS coordinates of retailers that sold tobacco (n=125) were assigned to suburbs in ArcMap. A community survey conducted in the Local Government Area provided smoking and sociodemographic data amongst adult respondents (n=8981). Associations between tobacco retailer density (calculated as the number of retailers per km2 based on respondents' suburb of residence) and daily, occasional and experimental smoking were assessed using multilevel logistic regression analysis. Separate models with and without covariates were undertaken. RESULTS: Without adjusting for possible confounders, living in suburbs with greater retailer density did not increase the odds of daily smoking (OR=1.01; 95% CI: 0.92-1.12), occasional smoking (OR=1.05; 95% CI: 0.94-1.18), or experimental smoking (OR=0.98; 95% 0.92- 1.05). However, after adjustment, living in suburbs with greater retailer density increased the odds of occasional smoking behavior (AOR=1.37; 95% CI: 1.10-1.71) but not daily or experimental smoking. CONCLUSIONS: This study found a significant positive association between tobacco retailer density and the likelihood of occasional smoking in a rural Australian jurisdiction without a tobacco retailer licensing system in place. The findings strengthen calls for the introduction of a comprehensive, positive tobacco retailer licensing system to provide a framework for improving compliance with legislation and to reduce the overall availability of tobacco products in the community.

Oral health academics' conceptualisation of health promotion and perceived barriers and opportunities in dental practice: a qualitative study.

BACKGROUND: Oral diseases place a significant burden on individual and population health. These diseases are largely preventable; health promotion initiatives have been shown to decrease the disease rates. However, there is limited implementation of health promotion in dentistry, this could be due to a number of factors; the ethos and philosophy of dentistry is focused on a curative, individualised approach to oral diseases, confusion around health promotion as a concept. Oral health academics are well placed to implement health promotion, training of these professionals needs to include prevention, as training influences dental practice. However, there is a little understanding about how oral health academics (dental professionals who educate dental and oral health students) view health promotion. The aim of this exploratory study is to understand how oral health academics conceptualise health promotion and perceive the barriers and possible opportunities for health promotion implementation in dental practice. METHODS: Nominal group technique (NGT), a highly structured face-to-face meeting, was conducted with 24 oral health academics to explore how they conceptualize health promotion and the barriers and opportunities for health promotion in practice. An additional 4 questions were emailed to oral health educators after the NGT meeting to gather additional data, 6 oral health academics were involved. The data was analyzed using thematic analysis. RESULTS: Three board themes were identified: "Knowledge, ideas and concepts of health promotion", "Challenges to health promotion", "Opportunities for health promotion practice". The oral health academics in this study discussed health promotion in a holistic way, however, health education and behaviour change were mentioned more than other aspects of health promotion. The structure of dental practice specifically the curative approach that underpins dentistry and the lack of funding, and value placed on health promotion could act as a challenge to health promotion being implemented in practice. There has been a shift towards prevention in dentistry, however the participants acknowledge there needs to be a change in the curative culture of the profession. Collaboration with other health professionals and using a common risk factor approach were the identified opportunities for health promotion practice. CONCLUSIONS: Oral health academics have a holistic understanding of health promotion, but still focus more on behavioural approaches which is common within dentistry. For a change to occur in health promotion practice a change in the structure, curative approach and funding model of dentistry is required. Collaboration with other health professionals is an opportunity to be capitalised on. Training of future dental professionals is the perfect place to start to implement the changes and opportunities for health promotion presented in this paper.

Longevity of complete dentures: A systematic review and meta-analysis.

STATEMENT OF PROBLEM: Patients and clinicians are aware of the efficacy and benefits of complete dentures, but evidence regarding their longevity is limited. PURPOSE: The purpose of this systematic review was to examine the literature describing the longevity of complete dentures and to review variations in longevity by denture type and duration of follow-up. MATERIAL AND METHODS: Four electronic databases were searched by using key terms: MEDLINE, CINAHL (EBSCO), Dentistry and Oral Sciences Databases, and The Cochrane Library. Studies meeting the inclusion criteria were reviewed according to an established protocol and data extracted. Reference lists of identified studies were examined. Risk of bias was assessed by using the AXIS tool. Weighted means and weighted standard deviations were calculated. Pooled complete denture failure proportions were estimated by using random effects models based on the DerSimonian and Laird method. RESULTS: The search yielded 21 607 unique abstracts, of which 273 met the inclusion criteria. Assessment of the full-text articles reduced this number to 42. Of these, 24 studies were rated as having low risk of bias and 18 as very low. The weighted mean ±standard deviation longevity of maxillary complete dentures was 10.3 ±3.8 years, of mandibular dentures was 8.6 ±2.6 years, and of both maxillary and mandibular dentures was 10.8 ±4.7 years. The pooled failure proportion for complete dentures observed for 2 years or less was 0.05 (95% confidence interval [CI]: 0.00-0.10), 5 to 6 years was 0.12 (95% CI: 0.08-0.16), and 10 years or more was 0.41 (95% CI: 0.28-0.53). CONCLUSIONS: Complete dentures, fabricated primarily in university settings, were found to have a weighted mean ±standard deviation longevity of 10.1 ±4.0 years. The failure rate of these prostheses increased with denture age, and the longevity of maxillary dentures was greater than that of mandibular dentures.

Levels of support for the licensing of tobacco retailers in Australia: findings from the National Drug Strategy Household Survey 2004-2016.

BACKGROUND: Assessing public opinion towards tobacco policies is important, particularly when determining the possible direction of future public health policies. The aim of this study was to describe the implementation of tobacco retailer licensing systems by state and territory governments in Australia, and to use the National Drug Strategy Household Survey (NDSHS) to assess levels of public support for a retailer licensing system in each jurisdiction over time and by a range of socio-demographic and behavioural attributes. METHODS: National and state/territory estimates of public support for a tobacco retailer licensing system were derived as proportions using NDSHS data from 2004 to 2016. The effect of one's jurisdiction of residence on the likelihood of supporting such an initiative in 2016 was assessed using logistic regression while controlling for various socio-demographic and behavioural characteristics. RESULTS: Public support for a tobacco retailer licensing system ranged from a high of 67.2% (95% CI 66.5-67.9%) nationally in 2007 and declined to 59.5% (95% CI 58.9-60.2%) in 2016. In 2016, support was greatest amongst those from Tasmania, those aged 50 years and older, females, those from the least disadvantaged areas, those living in major cities, never-smokers and never-drinkers. After adjusting for the socio-demographic and behavioural attributes of respondents, those from Queensland were significantly less likely to support a licensing system (adjusted OR = 0.85, 95% CI 0.77-0.94) compared to those from other jurisdictions, while those from Tasmania were significantly more likely to support a licensing system compared to those from other jurisdictions (adjusted OR = 1.29, 95% CI 1.09-1.52). CONCLUSIONS: A clear majority of the public support a tobacco retailer licensing system, regardless of whether or not such a system is already in place in their jurisdiction of residence. Tobacco control initiatives other than a retailer licensing system may explain some of the residual variations in support observed between jurisdictions.

The Psychological Models of Health-related Behavior in Understanding Sugars Intake in Adults: A Review.

Free sugars intake plays a major role in dental caries formation and other general health issues such as obesity. Therefore, interventions, which assist individuals or populations in the control of their free sugars intake, are of central importance in caries prevention strategies. There is good evidence that behavioral interventions benefit from a foundation in conceptual theories of behavior change founded on empirical data. In this review, we discuss the future application of seven theories, including six common psychological theories in predicting and developing interventions to reduce free sugars intake related to dental caries among adults. For each model, we summarize its key features and the data derived from its application in general and oral health settings and make recommendations for future research. We searched Medline, PsycINFO, Global Health, PubMed, and Embase databases to identify items dealing with dental caries, adults, sugars intake, and six psychological theories. These included the Transtheoretical Model of Change, Theory of Planned Behavior, Social Cognitive Theory, Information-Motivation-Behavioral Skills model, PRIME Theory, and Behavior Change Wheel theories. We searched literature published in the last 10 years, and priority was given to systematic reviews and randomized control trials. Although there is extensive literature on the application of the six psychological theories, there is a gap in knowledge about their effectiveness in reducing free sugars intake related to dental caries among adults. There is a need for better-designed trials of interventions based on the clear operationalization of psychological constructs to reduce sugars intake among the adult population.