Do dental anxiety and satisfaction with dental professionals modify the association between affordability and dental service use? A population-based longitudinal study of Australian adults.

OBJECTIVES: This study aimed to assess the association between affordability in terms of difficulty paying dental bills in Australian dollars and dental service use in the presence of sociodemographic confounders, and to assess the role of dental anxiety and satisfaction with dental professionals as mediators. The second aim was to investigate how dental anxiety and satisfaction with dental professionals modify the association between affordability and use of dental services in Australian adults. METHODS: Longitudinal data from the Australian National Study of Adult Oral Health (2004-06 and 2017-18) was used. Poisson regression and path analysis were conducted to determine the association between affordability and frequency of use of dental services. Effect measure modification (EMM) analysis was performed by stratification of dental anxiety and satisfaction with dental professionals. RESULTS: The study included 1698 Australian adults and identified that the prevalence of low frequency of dental visits was 20% more for those who had difficulty paying dental bills. Adults with dental anxiety (prevalence ratio [PR] = 1.14) and those who were dissatisfied with dental professionals (PR = 1.17) had a higher prevalence of low frequency of dental visits in the presence of difficulty paying dental bills. This indicated that dental anxiety and dissatisfaction with dental professionals were effect modifiers on this pathway. CONCLUSIONS: Adults who experience dental anxiety and dissatisfaction with dental professionals are more likely to avoid dental visits when faced with difficulty paying dental bills. However, it is important to note that these associations do not necessarily imply a causal relationship.

Promoting regular parental supervised toothbrushing: An additive intervention design adopting the Health Action Process Approach.

The study aimed to test the efficacy of the core elements of the Health Action Process Approach (HAPA) in an intervention among parents to promote regular supervised toothbrushing of preschool-aged children. The pre-registered study (https://osf.io/fyzh3/) tested the effects of an intervention employing information provision, behavioural instruction, implementation intention and mental imagery techniques, adopting a randomised controlled design in a sample of Australian parents of preschoolers (N = 254). The intervention used an additive design with four conditions-education, self-efficacy, planning and action control-progressively layered to show the cumulative impact of incorporating self-efficacy, planning and action control strategies with a foundational education component. The intervention was delivered online, and participants completed self-report measures of parental supervised toothbrushing and HAPA-based social cognition constructs pre-intervention and 4 weeks post-intervention. Although no significant intervention effects on behaviour were observed, mixed-model analyses of variance (ANOVAs) revealed an increase in intention and task self-efficacy within the action control condition and an increase in action planning in both the action control and planning conditions from pre-intervention to follow-up. Despite no anticipated changes in behaviour, these findings endorse the use of theory- and evidence-based behaviour change strategies to inspire change in HAPA-based determinants of parental supervised toothbrushing: intention, action planning and task self-efficacy.

Theories, Models, Frameworks, Guidelines, and Recommendations for Trauma-Informed Oral Healthcare Services: A Scoping Review.

BACKGROUND: Traumatic life experiences (TLE) are common and can affect a person's physical being and health-related behaviors, including those related to oral health. This scoping review aimed to identify evidence exploring the implementation and provision of trauma-informed care (TIC) in oral health services delivery. METHODS: Arksey and O'Malley's framework with enhancements proposed by Levac et al. and Peters et al. was used. Studies were selected based on a preset inclusion and exclusion criteria and the population/concept/context framework. Primary charting of descriptive data was conducted, followed by thematic analysis to identify ideas common within the included literature. Searches were conducted in Medline (via Ovid), APA PsycINFO (via Ovid), Embase (Elsevier), Scopus, CINAHL (via EBSCO), and Cochrane databases. Google Scholar and ProQuest were used to identify grey literature. RESULTS: The search identified 251 records, with fifteen records meeting the inclusion criteria. Limited models, frameworks, and recommendations for trauma-informed practices in oral health services were identified. Recommendations for TIC practices were identified, and clinical practice adjustments for dental practitioners were described to improve service delivery for patients who may have experienced trauma. Avenues for future research were identified. CONCLUSIONS: Limited evidence exists to guide trauma-informed practice in oral health service delivery. This scoping review highlights the need for further research into approaches and practices of TIC for oral health services delivery to assess their efficacy and the need to develop evidence-based TIC frameworks to meet the unique needs of oral health service providers and populations.

Passive Smoking and Oral Health of Infants, Preschoolers, and Children: A Systematic Review.

INTRODUCTION: Almost half of the world's children experience passive smoking, which is linked to numerous oral health conditions. The aim is to synthesize data on the impact of passive smoking on oral health of infants, preschoolers, and children. AIMS AND METHODS: A search was conducted across Medline (via EBSCOhost), PubMed, and Scopus up to February 2023. Risk of bias was assessed according to the Newcastle-Ottawa Scale (NOS). RESULTS: The initial search produced 1221 records and after removal of duplicates, screening by title and abstract, and full-text assessment, 25 studies were eligible for review and data extraction. The majority of studies (94.4%) found a correlation between passive smoking and increased prevalence of dental caries with three studies suggesting a dose-response relationship. Prenatal passive smoking exposure in 81.8% of studies indicated an increased dental caries experience compared to postnatal exposure. Low parental education, socioeconomic status, dietary habits, oral hygiene, and gender affected the level of environmental tobacco smoke (ETS) exposure and dental caries risk. CONCLUSIONS: The results of this systematic review strongly suggest a significant association between dental caries in the deciduous dentition and passive smoking. Early intervention and education on the effects of passive smoking on infants and children will allow for the improvement in oral health outcomes and reduction in smoking-associated systemic conditions. The results justify all health professionals paying more attention to passive smoking when conducting pediatric patient histories, contributing to improved diagnosis and appropriate treatment planning with more suitable follow-up schedules. IMPLICATIONS: The evidence from this review that environmental tobacco smoke and passive smoking is a risk factor for oral health conditions, both prenatally and postnatally during early childhood, justifies all health professionals paying more attention to passive smoking when conducting pediatric patient histories. Early intervention and appropriate parental education regarding the effects of secondhand smoke on infants and children will allow for the minimization of dental caries, improvement in oral health outcomes and overall reduction in smoking-associated systemic conditions for the children exposed.

A 3-year qualitative evaluation of interprofessional team-based clinical education at an Australian dental school.

PURPOSE/OBJECTIVES: This article describes a qualitative evaluation of interprofessional (IP) team-based treatment planning (TBTP) involving dentistry, oral health therapy, dental prosthetics, and dental technology students at the Griffith University School of Dentistry and Oral Health (DOH). Using the same data from a recently published article that looked solely at the quantitative evaluation of TBTP, this article focuses on the qualitative evaluation of TBTP. This evaluation explores the contextual meaning related to the previously published aspects of TBTP that contributed positively toward oral health students' IP clinical learning and identifies themes reflecting students' IP clinical experience. METHODS: Thematic analysis of transcripts from nine focus groups, comprised of 46 final year students and open-ended questions collected from 544 students through an online instrument from 2012 to 2014, explored the question: "What is the contribution of IP student team-based processes on students' perceptions of IP learning and practice at DOH?" RESULTS: Responses from online participants and student focus groups revealed three major themes: useful role learning, communication confidence, and pro-active collaborative teamwork. Throughout each of these themes, students stated they possessed a confidence in collaborating with other oral health students as exhibited through an understanding of profession-specific and IP roles, self-assurance in communicating, and teamwork skills. CONCLUSION: Aspects of TBTP that contributed positively toward students' IP clinical learning and practice were meaningfully identified.

Factors associated with regular dental attendance by aged adults: A systematic review.

OBJECTIVES: To determine factors influencing regular dental attendance in aged adults 65 and over according to Andersen's Behavioural Model. BACKGROUND: Regular attendance for dental visits is vital to improve and maintain oral health, quality of life and general well-being. Aged adults 65 years and older experience barriers to regular dental attendance, which in turn leads to an increased risk for oral diseases. MATERIALS AND METHODS: An electronic search was undertaken in April 2021 in Cochrane, Embase, Medline, Cinahl, Dentistry & Oral Science Source via EBSCOhost and Embase for papers on factors influencing the frequency of attendance by older people. Risk of bias was assessed according to the Newcastle-Ottawa Scale for cohort and case-control studies, and with modified version of this tool for cross-sectional studies. Frequency effect size was calculated for factors described in Andersen's Behavioural Model (predisposing, enabling and needs-related). RESULTS: Twenty-one studies were eligible for inclusion. Factors frequently investigated affecting regular dental attendance included: age, gender, education (predisposing); income, and social support (enabling); and remaining teeth, pain, perceived health (needs-related). Income was the only factors with a 100% positive association with regular dental attendance. CONCLUSIONS: This systematic review confirms the complex interconnectedness of several factors and dental attendance in older adults. A number of factors were identified which warrant further investigation to improve access to dental care to socio-economically vulnerable older populations.

A 3-year quantitative evaluation of interprofessional team-based clinical education at an Australian dental school.

PURPOSE/OBJECTIVES: Clinical educational challenges led to the Griffith University School of Dentistry and Oral Health (DOH) introducing interprofessional team-based treatment planning (TBTP). This paper evaluates the interprofessional contribution made to student clinical learning and experience among dentistry, oral health therapy, dental prosthetics, and dental technology students. METHODS: A mixed methodology approach targeting 845 students collected data annually employing a prevalidated online instrument from 2012 to 2014 to answer the question: "What is the contribution of interprofessional student team-based processes on students' perceptions of interprofessional practice at DOH?" RESULTS: A representative study sample with a 64.4% response rate (N = 544) reported TBTP creating a supportive environment for interprofessional clinical learning. Significant improvements in learning shared across disciplines indicated improvements in mutual respect, understanding roles, and constructive communication enhancing teamwork. There were increasing significant correlations between shared learning and positive clinical experiences from 2012 (r = .642, p < .000) to 2013 (r = .678, p < .000) and 2014 (r = .719, p < .000). A combination of TBTP predictors accounted for 53% of the variance in clinical learning and experience in 2014 compared to 40% in 2012. CONCLUSION: Learning with other students, developing teamwork abilities, improved communication skills, and respect for other oral health professions were aspects of TBTP that positively impacted clinical learning and practice at DOH. Further study would assist to determine specific elements that made the greatest contribution to student learning experiences.

Predicting dental caries increment using salivary biomarkers in a remote Indigenous Australian child population.

BACKGROUND: The burden of childhood dental caries amongst Indigenous Australians is higher than in other Australians. Because of differences in lifestyle and the evolutionary history of the oral microbiota, associated risk indicators may differ. Here, we evaluate associations between caries increment, salivary biomarkers and baseline caries among children aged 5-17 years residing in a remote rural Indigenous community. METHODS: This study was part of a trial assessing cost-effectiveness of an intervention to prevent dental caries among children. Baseline epidemiology and application of topical caries-preventive measures was conducted in 2015, followed-up in 2016 and 2017. Children who did not consent or failed to attend the prevention visits but did attend for follow-up epidemiology constituted a natural comparison group for evaluating the intervention. Saliva flow, pH, buffering and bacterial loads were measured at all visits. Caries was scored by the International Caries Detection and Assessment system. Outcome was caries increment. Explanatory variables were sex, being in experimental or comparison group, baseline caries, saliva flowrate and buffering, pH, and salivary loads of mutans streptococci (MS), Lactobacilli (LB), and yeast. Chi Square tests compared caries incidence in relation to explanatory variables and Generalised Linear Models explored associations between explanatory and outcome variables. RESULTS: Of 408 participants at baseline, only 208 presented at 2-year follow-up. Of caries-free children at baseline, significantly fewer had incipient (p = 0.01) and advanced (p = 0.04) caries after two years. Children in the experimental group experienced fewer tooth surfaces with advanced caries (p = 0.02) than comparison children. Having caries at baseline (p = 0.02) and low salivary flow-rates (p < 0.001) saw a significant increase in advanced caries after two years. Children with high salivary loads of MS (p = 0.03) and LB (p = 0.004) experienced more advanced carious surfaces. Multivariable analysis revealed 58% reduction (p = 0.001) in advanced caries among children with high salivary flow rates. Caries increment was 61% (p = 0.03) more for incipient and 121% (p = 0.007) more for advanced caries among children who harboured higher loads of MS. CONCLUSION: As with other ethnicities, children with low salivary flow and those with high MS had higher incipient and advanced caries increments after two years. Such risk assessments facilitate targeted preventive interventions for such communities. TRIAL REGISTRATION: Australian New Zealand Clinical Trials Registry (ANZCTR), No: ACTRN12615000693527: 3 July 2015.

Social-cognitive predictors of parental supervised toothbrushing: An application of the health action process approach.

BACKGROUND: We examined the social cognition determinants of parental supervised toothbrushing guided by the health action process approach (HAPA). METHODS: In a prospective correlational survey study, participants (N = 185, 84.3% women) completed HAPA social cognition constructs at an initial time point (T1), and 12 weeks later (T2) self-reported on their parental supervised toothbrushing behaviour, toothbrushing habit, and action control. RESULTS: Structural equation models exhibited adequate fit with the data when past behaviour and habit were either excluded or included. Intention, self-efficacy, planning, and action control were predictors of parental supervised toothbrushing; intention predicted action planning and coping planning; and self-efficacy and attitude were predictors of intention. Indirect effects of social cognition constructs through intentions, and intentions through planning constructs were also observed. Inclusion of past behaviour and habit attenuated model effects. CONCLUSION: Results indicate that parental supervised toothbrushing is a function of motivational and volitional processes. This knowledge can be used to inform behaviour change interventions targeting parental supervised toothbrushing.

Theoretical evidence explaining the relationship between socio-demographic and psychosocial barriers on access to oral health care among adults: A scoping review.

OBJECTIVES: Current global models for oral health care are outdated. Out of pocket payments and exclusion from most national health systems has created a gap for access of services by socio-economically vulnerable adults. Our objective is to understand barriers to access and the causal associations between barriers to care. DATA: All study designs with a theoretical/conceptual framework to explain access and barriers among adults were included. SOURCES: 6 electronic databases (PubMed, Medline (EBSCO), CINAHL, Embase, Web of Science) including grey literature searches (ProQuest) and expert consultation. The identified studies were then analysed using narrative synthesis and NVivo. STUDY SELECTION/RESULTS: 40 studies using a theoretical framework to explain access among adults were identified. Andersen's behavioural model was most used. Cost was the primary causal factor that perpetuated the effect of other barriers. Associations were found between age and education level, cost and need, cost and dental anxiety. Study design and analysis used to identify these associations had limitations in determining causality. CONCLUSION: Oral health access research is based in theory, leading to the identification of socio-demographic and psychosocial barriers and their relationships. However, a lack of explanation of causal associations persists. This review recognises the importance of understanding the cause of barriers in addition to their nature. Appropriate study designs and analysis considering the impact of time varying factors on access is required. Empirical analysis needs to focus on the role of confounders and mediators to determine causality successfully. To achieve this a theory driven causal model has been proposed.

Carious lesions in permanent dentitions are reduced in remote Indigenous Australian children taking part in a non-randomised preventive trial.

We tested the effect of an annual caries preventive intervention, delivered by a fly-in/fly-out oral health professional team, with Indigenous children residing in a remote Australian community. Around 600 Indigenous children aged 5 to 17 years were invited to participate at baseline, of who 408 had caregiver consent. One hundred and ninety-six consented to the epidemiological examination and intervention (Intervention group) and 212 consented to the epidemiological examination only (Comparison group). The intervention, which occurred annually, comprised placement of fissure sealants on suitable teeth, and application of povidone-iodine and fluoride varnish to the whole dentition, following completion of any necessary restorative dental treatment. Standard diet and oral hygiene advice were provided. Caries increment (number of tooth surfaces with new dental caries) in both deciduous and permanent dentitions was measured at the 2-year follow-up. Comparison group children had significantly higher number of new surfaces with advanced caries in the permanent dentition than the Intervention group (IRR = 1.61; 95% CI: 1.02-2.54; p = 0.04); with a preventive fraction of 43%. The effect of intervention remained significant with children in the Comparison group developing significantly more advanced caries lesions in the permanent dentition than the Intervention group children in the adjusted multivariable analysis (IRR = 2.21; 95% CI: 1.03-4.71). Indigenous children exposed to the intervention had less increment in advanced dental caries in the permanent dentition than those not exposed to the intervention.

Impact of demographics and appointment characteristics on patient attendance in a university dental clinic.

INTRODUCTION: Failed patient attendance in a university dental clinic is detrimental to the student learning experience, the university as a business, and to members of the public awaiting urgent dental treatment. PURPOSE: This study aimed to identify the demographic, appointment characteristics, and time-related factors associated with patient attendance in a university dental clinic from 2015 to 2019. METHODS: A 5-year retrospective analysis was conducted in 2020 on data extracted from the Griffith University Dental Clinic patient management system. Following data cleaning and categorization, the dataset was downloaded into SPSS for statistical analysis. Frequencies, odds ratio, and chi squared were used to determine the demographic and time-related factors of patients who had completed, cancelled, and failed to attend (FTA) appointments. RESULTS: A total of 23.4% of appointments were cancelled, and 6.6% were FTA. Demographics associated with cancellations include females, adults aged 25 to 44, and private paying patients. FTA were higher in young adults aged 19 to 24, low to mid-range socioeconomic status (SES) and those eligible for publicly funded dental treatment. Mondays and Fridays experienced the greatest number of FTA and cancellations, respectively. Emergency appointments had the greatest attendance rates and endodontic procedures the lowest. CONCLUSION: The loss of clinical teaching hours, resources, and revenue necessitates the implementation of targeted strategies to minimize cancellations and FTA based on demographic and appointment characteristics that may render individual as high risk for failed attendance.

Biocultural Drivers of Salivary Microbiota in Australian Aboriginal and Torres Strait Islander Children.

Australian Aboriginal and Torres Strait Islander children experience unacceptably high rates of dental caries compared to their non-Indigenous Australian counterparts. Dental caries significantly impacts the quality of life of children and their families, particularly in remote communities. While many socioeconomic and lifestyle factors impact caries risk, the central role of the oral microbiota in mediating dental caries has not been extensively investigated in these communities. Here, we examine factors that shape diversity and composition of the salivary microbiota in Aboriginal and Torres Strait Islander children and adolescents living in the remote Northern Peninsula Area (NPA) of Far North Queensland. We employed 16S ribosomal RNA amplicon sequencing to profile bacteria present in saliva collected from 205 individuals aged 4-17 years from the NPA. Higher average microbial diversity was generally linked to increased age and salivary pH, less frequent toothbrushing, and proxies for lower socioeconomic status (SES). Differences in microbial composition were significantly related to age, salivary pH, SES proxies, and active dental caries. Notably, a feature classified as Streptococcus sobrinus increased in abundance in children who reported less frequent tooth brushing. A specific Veillonella feature was associated with caries presence, while features classified as Actinobacillus/Haemophilus and Leptotrichia were associated with absence of caries; a Lactobacillus gasseri feature increased in abundance in severe caries. Finally, we statistically assessed the interplay between dental caries and caries risk factors in shaping the oral microbiota. These data provide a detailed understanding of biological, behavioral, and socioeconomic factors that shape the oral microbiota and may underpin caries development in this group. This information can be used in the future to improve tailored caries prevention and management options for Australian Aboriginal and Torres Strait Islander children and communities.

Response of Salivary Microbiota to Caries Preventive Treatment in Aboriginal and Torres Strait Islander Children.

A once-annual caries preventive (Intervention) treatment was offered to Aboriginal and Torres Strait Islander schoolchildren-a population with disproportionately poorer oral health than non-Indigenous Australian children-in the Northern Peninsula Area (NPA) of Far North Queensland (FNQ), which significantly improved their oral health. Here, we examine the salivary microbiota of these children (mean age = 10 ± 2.96 years; n = 103), reconstructing the bacterial community composition with high-throughput sequencing of the V4 region of bacterial 16S rRNA gene. Microbial communities of children who received the Intervention had lower taxonomic diversity than those who did not receive treatment (Shannon, p < 0.05). Moreover, the Intervention resulted in further decreased microbial diversity in children with active carious lesions existing at the time of saliva collection. Microbial species associated with caries were detected; Lactobacillus salivarius, Lactobacillus reuteri, Lactobacillus gasseri, Prevotella multisaccharivorax, Parascardovia denticolens, and Mitsuokella HMT 131 were significantly increased (p < 0.05) in children with severe caries, especially in children who did not receive the Intervention. These insights into microbial associations and community differences prompt future considerations to the mechanisms behind caries-preventive therapy induced change;  important for understanding  the long-term implications of like treatment to improve oral health disparities within Australia. Trial registration: ANZCTR, ACTRN12615000693527. Registered 3 July 2015, https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=368750&isReview=true.

Parental social-cognitive correlates of preschoolers' oral hygiene behavior: A systematic review and meta-analysis.

BACKGROUND: Regular and consistent parental involvement in children's oral hygiene practices is crucial to prevent oral diseases in young children. This emphasizes the need for interventions targeting parental-supervised oral hygiene behavior. To inform the design of future interventions, this meta-analysis aimed to identify the parental social-cognitive factors associated with oral hygiene behavior of preschoolers. METHOD: Five bibliographic databases were searched. A study was eligible for inclusion when it reported an association between a parental social-cognitive factor and an oral hygiene behavior in the targeted age cohort. Meta-analyses were performed when there were at least four independent effect sizes (k > 3). RESULTS: Of the 5945 records identified, 25 studies contained eligible data to be included in four meta-analyses: attitude (k = 12); self-efficacy (k = 12); intention (k = 6), and sense of coherence (k = 5). The results showed that greater frequency of preschoolers' oral hygiene behavior is significantly associated with parental attitudes (r+ = 0.18), self-efficacy (r+ = 0.34), and intention (r+ = 0.29), and not significantly associated with parental sense of coherence (r+ = 0.08). CONCLUSION: Self-efficacy, attitudes, and intention were identified as significant correlates of parental-supervised oral hygiene behavior. However, this is a limited evidence base and many social-cognitive factors, such as self-regulatory processes including planning and action control, have yet to be explored in this context. The significant social-cognitive correlates identified in this study, as well as potential other self-regulatory factors, should be targeted in future intervention studies aimed at improving this important preventive behavior.

A systematic review of dietary acids and habits on dental erosion in adolescents.

BACKGROUND: Dental erosion is the dissolution of dental hard tissues caused by acids of a non-bacterial origin. Dietary acids are considered the predominant and most controllable factor. AIM: To synthesise the literature on the effects of dietary acids and habits on dental erosion in the permanent dentition of 10- to 19-year-old adolescents. MATERIALS AND METHODS: An electronic literature search was undertaken in Cochrane, MEDLINE, CINAHL, Dentistry & Oral Sciences Source via EBSCOhost, and Embase with no restriction on the date of publication. RESULTS: The initial search identified 449 articles, and 338 remained after removal of duplicates. Seventy-seven articles remained after screening of titles and abstracts, and 52 were eligible for the full-text review. A considerable variety of beverages, food, and dietary habits were reported as risk factors for dental erosion. The most consistent findings implicated the erosive potential of carbonated beverages and the consumption of acidic drinks at bedtime. CONCLUSIONS: Although results were not consistent between cohort and cross-sectional studies, this review suggests certain dietary risk factors may contribute to dental erosion in adolescents. There is a need for more high-quality cohort studies to establish more conclusive evidence on the role of dietary acids and habits on dental erosion.

Surface-Specific Caries Preventive Effect of an Intervention Comprising Fissure Sealant, Povidone-Iodine and Fluoride Varnish in a Remote Indigenous Community in Australia.

This study evaluates the effect of a topical intervention comprising of fissure sealant, povidone-iodine, and fluoride varnish in preventing caries on occlusal, approximal, and smooth surfaces. This three-year clinical trial was conducted in a remote Indigenous community of Australia. All schoolchildren (age range: 4-17) were invited to participate; those with parental consents to receive three-annual epidemiological examinations and interventions constituted the experimental group, while those with consents for only the epidemiological examination formed a comparison group. The intervention group received an annual application of fissure sealant, povidone-iodine and fluoride varnish for two consecutive years along with the restoration of any cavitated lesions, while the comparison group did not receive any intervention except for the usual care that included emergency treatment and restorations. Incipient and advanced caries were recorded in the permanent dentition while data on confounding variables were collected through questionnaires. Caries increment and progression were the outcome variables. A total of 408 children participated in the baseline examination, 208 finished the study. After adjusting for confounders, the prevented fraction (PF) on occlusal surfaces for advanced caries in the experimental group was 76.1% (mean difference- -0.35, 95% CI: -0.67-0.04), while the PF for progression from incipient to advanced caries was 100%(mean difference- -0.30, 95% CI: -0.52-0.09). The mean number of smooth surfaces that progressed from incipient to advanced caries in the comparison group was more than twice that of the experimental group, the mean difference was -0.25 (95% CI: -0.46--0.03) with a PF of 61%. The intervention was only effective in preventing advanced caries on occlusal surfaces and in halting the progression of caries on occlusal and smooth surfaces but not on approximal caries.

Demonstration of high value care to improve oral health of a remote Indigenous community in Australia.

BACKGROUND: The oral health of Indigenous children in remote communities is much worse than other population groups in Australia. Providing and maintaining an oral health service is challenging due to the remoteness of communities, the associated high cost, and the low retention of clinical staff. An annual preventive intervention delivered by fly-in clinicians may be a more cost-effective way to manage this problem. In this analysis we estimate the cost-effectiveness of an annual professional intervention for the prevention of dental caries in children of a remote Indigenous community in Far North Queensland. METHODS: A cost-effectiveness analysis was conducted based on an annual preventive intervention protocol. This included treating all dental decay in those with disease, applying fissure sealants, a disinfectant swab, fluoride varnish and providing oral hygiene instructions and dietary advice to all participating school children. This study included an intervention group and a natural comparison group and both groups were followed-up for 2 years after the initial preventive intervention. A Markov model was built to assess the cost-effectiveness of the intervention compared with the usual care. Costs of treatment from the Queensland Department of Health were used and effectiveness was measured as quality-adjusted life years (QALYs) with the CHU-9D. One-way and probabilistic sensitivity analyses were conducted to identify key drivers and quantify uncertainty. RESULTS: The preventive intervention was found to be highly cost-effective. The incremental cost per QALY gained was AU$3747. Probability of new caries and seeking treatment were identified as the main drivers of the model. In probabilistic sensitivity analysis intervention was cost effective in 100% of simulations. CONCLUSION: An annual preventive intervention for remote Indigenous communities in Australia is a highly cost-effective strategy to prevent dental caries and improve the quality of life of children.

Effect of family characteristics on periodontal diseases in children and adolescents-A systematic review.

AIM: To synthesize the literature on the influence of family/parents characteristics on periodontal diseases in children and adolescents. METHODS: An electronic search for relevant literature published between 2007 and 2017 was undertaken in PubMed, Embase, Cinahl and Cochrane databases; the search was updated in April 2018. Two reviewers independently reviewed the abstracts of these; of which, 43 articles were reviewed in full. RESULTS: Of the 746 retrieved titles, 649 remained after removing duplicates. Thirty articles met the inclusion criteria, and 13 were excluded. Also, two were included from the updated search. Data from the reviewed articles indicate that all three indicators of parent's socioeconomic status (income, education and occupation) are significantly associated with periodontal diseases in children. Better periodontal status was observed in children of parents with higher SES than those whose parents were of lower SES. Although the association between parent's smoking practices, level of periodontal diseases and children's periodontal status was explored only in few studies, findings indicate that children exposed to passive smoking and having parents with periodontal diseases are more likely to present with periodontal diseases as well. CONCLUSIONS: Most of the studies considered socioeconomic factors and had not attempted to explore the impact of parental psychosocial variables on periodontal diseases in children. The literature indicates that these variables significantly influence health practices, including oral hygiene practices, which could ultimately affect periodontal health. More studies are required to explore the association of these variables with periodontal outcomes in children.

The effect of midazolam as premedication on the quality of postoperative recovery after laparotomy: a randomized clinical trial.

PURPOSE: Despite the uncertain effects of anxiolytic premedication with benzodiazepines on the quality of postoperative recovery, perioperative benzodiazepine administration is still a common practice in many hospitals. We evaluated the effect of premedication with midazolam on the quality of recovery in hospitalized patients undergoing a laparotomy. METHODS: We conducted a single-centre randomized placebo-controlled, double-blinded clinical trial from July 2014 to September 2015. We included 192 patients aged > 18 yr scheduled for elective laparotomy with a planned postoperative stay of ≥ three days. Participants were randomized into two groups to receive either midazolam 3 mg or sodium chloride 0.9% intravenously as premedication prior to surgery. Patients were followed up for up to one week after surgery. The primary outcome was the Quality of Recovery-40 (QoR-40) score on postoperative day (POD) 3. The secondary outcomes included the QoR-40 score on POD 7, and the State-Trait Anxiety Inventory, State-Trait Anger Scale, Multidimensional Fatigue Inventory, and the Hospital Anxiety and Depression Scale scores. RESULTS: The mean (standard deviation) postoperative QoR-40 scores on POD 3 were not significantly different in the midazolam group compared with controls [166.4 (17.0) vs 163.9 (19.8), respectively; mean difference, 2.3; 95% confidence interval, - 2.9 to 8.4; P = 0.35]. There were no between-group differences in any of the secondary outcomes. CONCLUSIONS: Administration of midazolam as premedication for laparotomy patients did not improve the quality of recovery up to one week after surgery. General prescription of midazolam as premedication can be questioned and might only suit some patients. TRIAL REGISTRATION: www.clinicaltrials.gov (NCT01993459); registered 29 October, 2013.