Preliminary findings from the Oranga Niho dental student outplacement project.

OBJECTIVES: To examine stakeholder perspectives of the Bachelor of Dental Surgery 2012-2013 clinical outplacement programme with Maori Oral Health Providers (MOHPs) and inform the programme's ongoing development. DESIGN: A mixed methods kaupapa Maori action research project. SETTING: Six North Island MOHPs and the University of Otago Faculty of Dentistry. PARTICIPANTS AND METHODS: Online questionnaires were used to conduct a pre- and post-outplacement survey of dental students and a twice-yearly survey of all MOHP-based clinical supervisors. Paper questionnaires were used to survey adult clients and caregivers of child clients that the students treated. Data were analysed descriptively and thematically. MAIN OUTCOME MEASURES: 68 (61%) of the 112 eligible students completed the pre- and post-outplacement questionnaires; 31 clinical supervisor questionnaire responses were received representing all six MOHPs; and 426 client and 130 caregiver questionnaire responses were received from five MOHPs. RESULTS: 79% of students felt well prepared for outplacement and 75% indicated that they would consider working for a MOHP in future. Of the clinical supervisors, 93% indicated that the students were adequately prepared for outplacement, and 68%, that they would recommend one or more students for employment. However, 58% associated the outplacements with decreased productivity. More than 97% of adult clients and caregivers of child clients were pleased with the care that the students provided. CONCLUSION: Recommendations for strengthening the outplacement programme included: increasing communication between the Faculty, MOHPs and students; addressing the financial cost of the programme to the MOHPs; and providing more support for clinical supervisors.

A qualitative study of the meaning of oral health and self-care for 40 Dunedin residents living on lower incomes.

BACKGROUND AND OBJECTIVES: This project extends studies of oral health cultures for lower income families by identifying the participants' meaning of oral health self-care, barriers to its attainment, and suggestions for its improvement. METHODS: Forty open-ended interviews were conducted with Dunedin residents purposively selected from a variety of ages, backgrounds and ethnicities. Transcribed interviews were analysed thematically. RESULTS: Five key themes emerged: (1) oral health understandings for self and wider family groups; (2) the complexity of understanding cost in relation to oral self-care; (3) oral self-care tools and daily oral health routines; (4) relationships with oral health workers and the meaning of good and bad care provision; and (5) the State's involvement in oral health. CONCLUSIONS: Participants valued good oral health and were knowledgeable about it, but cost was the primary barrier to care.

Ukaipo niho: the place of nurturing for oral health.

OBJECTIVES: To report on oral-health-related characteristics, beliefs, and behaviours among participants in a randomised control trial of an intervention to prevent early childhood caries (ECC) among Maori children, and to determine whether there were any systematic differences between the intervention and control groups at baseline. DESIGN: Baseline measurements from a randomised control trial (involving 222 pregnant Maori women allocated randomly to either Intervention or Delayed groups) which is currently underway. SETTING: The rohe (tribal area) of Waikato-Tainui. METHODS: Self-report information collected on sociodemographic characteristics, pregnancy details, self-reported general and oral health and health-related behaviours, and oral health beliefs. RESULTS: Other than those in the Delayed group being slightly older, on average, there were no significant differences between the two groups. Some 37.0% were expecting their first child. Most reported good health; 43.6% were current smokers, and 26.4% had never smoked. Only 8.2% were current users of alcohol. Almost all were dentate, and 57.7% described their oral health as fair or poor. One in six had had toothache in the previous year; 33.8% reported being uncomfortable about the appearance of their teeth, and 27.7% reported difficulty in eating. Dental service-use was relatively low and symptom-related; 78.9% needed to see a dentist. Overall, most of the sample believed that it was important to avoid sweet foods, visit dentists and to brush the teeth, while about half thought that using fluoride toothpaste and using floss were important. Some 38.2% felt that drinking fluoridated water was important. Oral-health-related fatalism was apparent, with 74.2% believing that most people usually get dental problems, 58.6% believing that most people will need extractions at some stage, and that most children eventually get dental caries. CONCLUSIONS: Mothers' important role in nurturing the well-being of the young child includes the protection and maintenance of the growing child's oral health (or ukaipo niho). The findings provide important insights into Maori mothers' oral health knowledge, beliefs and practices.

Self-reported oral health and dental service-use of rangatahi within the rohe of Tainui.

OBJECTIVES: To investigate the self-reported oral health and use of oral health services by rangatahi (teenagers) residing within the Waikato rohe (region) of the Waikato-Tainui tribal area. METHODS: A cross-sectional study of self-reported oral health and use of dental services by Maori teenagers. The 14-item short-form Oral Health Impact Profile (OHIP-14) was used to collect data on oral-health-related quality of life (OHRQoL). RESULTS: Just over half of the 238 survey participants (who were aged 16 to 18 years old) were male. Most brushed at least once daily. One-quarter reported hiding their smile, and just over one-fifth reported suffering from bad breath. Awareness of their current entitlement to free dental care was high, but it was lower among males. Just over one-third of participants had experienced one or more OHIP-14 impacts; that was higher among females than males, with the largest difference being apparent with the physical disability subscale, where the prevalence of impacts among females was twice that among males. The prevalence of OHIP impacts was higher among those who reported experiencing bad breath often, and significant differences were observed in all seven OHIP domains (as well as in the mean overall OHIP-14 score and in the mean number of different impacts experienced often). CONCLUSIONS: The data provide some important insghts into the oral health perceptions and concerns of young Maori.

Evidence for the polymorphic oxidation of debrisoquine and proguanil in a New Zealand Maori population.

The genetic oxidation polymorphisms of debrisoquine and proguanil were studied in a New Zealand Maori population. A bimodal distribution was observed in the 0-4 h urinary debrisoquine/4-hydroxydebrisoquine metabolic ratio. Of 101 Maori subjects phenotyped, five subjects (5%) were identified as poor metabolizers of debrisoquine, according to criteria established in studies of Caucasian populations. The prevalence of the debrisoquine poor metabolizer phenotype in the Maori appears to be similar to that reported for the Caucasian populations, but higher than that found in Asian (non-Caucasian) populations. The distribution of proguanil:cycloguanil (PG:CG) ratios obtained from 43 Maori subjects was highly skewed. Using a PG:CG ratio of 10 as the cut-off point, three Maori subjects (7%) were classified as poor metabolizers of proguanil. The incidence of the poor metabolizer phenotype of proguanil oxidation of 7% seems to be higher in Maori compared with Caucasian populations, but this is lower than the usual ranges (15-35%) reported in Asian populations.

Socioeconomic inequalities in oral health in childhood and adulthood in a birth cohort.

OBJECTIVES: To determine whether adult oral health is predicted by (a) childhood socioeconomic advantage or disadvantage (controlling for childhood oral health), or (b) oral health in childhood (controlling for childhood socioeconomic advantage or disadvantage), and whether oral health in adulthood is affected by changes in socioeconomic status (SES). METHODS: Participants in a longstanding cohort study underwent systematic dental examination for dental caries and tooth loss at ages 5 and 26 years. The examination at age 26 years included the collection of data on periodontal attachment loss and plaque level. Childhood SES was determined using parental occupation, and adult SES was determined from each study member's occupation at age 26 years. Regression models were used to test the study hypotheses. RESULTS: Complete data were available for 789 individuals (47.4% female). After controlling for childhood oral health, those who were of low SES at age 5 years had substantially greater mean DFS and DS scores by age 26 years, were more likely to have lost a tooth in adulthood because of caries, and had greater prevalence and extent of periodontitis. A largely similar pattern was observed (after controlling for childhood SES) among those with greater caries experience at age 5 years. For almost all oral health indicators examined, a clear gradient was observed of greater disease at age 26 years across socioeconomic trajectory groups, in the following order of ascending disease severity and prevalence: 'high-high', 'low-high' (upwardly mobile), 'high-low' (downwardly mobile) and 'low-low'. CONCLUSION: Adult oral health is predicted by not only childhood socioeconomic advantage or disadvantage, but also by oral health in childhood. Changes in socioeconomic advantage or disadvantage are associated with differing levels of oral health in adulthood. The life-course approach appears to be a useful paradigm for understanding oral health disparities.

Te niho waiora me te iwi Maori: dental health and the Maori people.

The standard of dental health for Maori people is still far below that of the non-Maori (Pakeha or European) in this country. Their dental health needs are not being met by the dental profession. However, by making the delivery of dentistry culturally acceptable to Maori people and making dentistry appropriate and accessible for Maori people, much can be achieved. The Maori Dental Health Clinic at the School of Dentistry has shown this in the short time of its existence. One cannot change the way in which a restoration is done, but one can change the approach in which that restoration is done. By acknowledging and recognising the importance of the whanau, the family, in the delivery of dental health services, the dental profession in this country can go a long way to improve the dental health of the Maori people. Kia ora koutou katoa.

Age-related performance of human subjects on saccadic eye movement tasks.

We measured saccadic eye movements in 168 normal human subjects, ranging in age from 5 to 79 years, to determine age-related changes in saccadic task performance. Subjects were instructed to look either toward (pro-saccade task) or away from (anti-saccade task) an eccentric target under different conditions of fixation. We quantified the percentage of direction errors, the time to onset of the eye movement (saccadic reaction time: SRT), and the metrics and dynamics of the movement itself (amplitude, peak velocity, duration) for subjects in different age groups. Young children (5-8 years of age) had slow SRTs, great intra-subject variance in SRT, and the most direction errors in the anti-saccade task. Young adults (20-30 years of age) typically had the fastest SRTs and lowest intra-subject variance in SRT. Elderly subjects (60-79 years of age) had slower SRTs and longer duration saccades than other subject groups. These results demonstrate very strong age-related effects in subject performance, which may reflect different stages of normal development and degeneration in the nervous system. We attribute the dramatic improvement in performance in the anti-saccade task that occurs between the ages of 5-15 years to delayed maturation of the frontal lobes.