Community dentistry and oral epidemiology最新文献

Background: The Periodontal Disease Self Report (PDSR) measure was originally created and psychometrically validated using a nationwide sample via online data collection. No clinical parameters were included in the prior validation of the PDSR. Thus, this study evaluated potential evidence for the clinical validity of the measure by examining associations between the PDSR scores and various clinical parameters obtained from a new sample of participants in which full-mouth periodontal examinations were conducted.

Methods: Adults from a community sample (n = 114) provided demographic information, responded to the PDSR measure and received a full-mouth clinical periodontal examination. Individual self-report items, subscale scores and total scores obtained from the PDSR were evaluated against clinical parameters of periodontitis. Regression models and receiver operating characteristic statistics were also utilised to test the ability of the PDSR to predict clinical outcomes.

Results: PDSR total scores were positively correlated with mean probing depth (r = 0.50, p < 0.01) and mean clinical attachment loss (r = 0.52, p < 0.01). After accounting for common risk factors in periodontal disease, the PDSR predicted mean probing depth (β = 0.45, 95% CI: 0.02-0.04; ΔR² = 0.19). The area under the curve for the PDSR scores distinguishing between CDC/AAP no/mild periodontitis and moderate/severe periodontitis categories was 0.71 (95% CI: 0.62-0.81).

Conclusions: Clinical data support the use of the PDSR measure as a screening tool for periodontal disease. Additionally, the PDSR may offer added utility compared to other measures due to less reliance on information obtained via clinical encounters.

Objectives: The aim was to evaluate the association between public oral healthcare procedures and change in oral health-related quality of life (OHRQoL) over 4 years among parents in the FinnBrain Cohort Study, comparing those who did not visit public oral healthcare.

Methods: The study used data on parents of young children from the FinnBrain Birth Cohort Study (www.finnbrain.fi) and healthcare centers' national patient data register. OHRQoL was measured with the 14-item Oral Health Impact Profile (OHIP-14). Of those who had answered the OHIP-14 questionnaire at gestational week (gw) 34 and 4-year time points (n = 1552), 589 had visited a public oral healthcare service. OHIP-14 severity score, two thresholds of prevalence and their changes were evaluated according to gender and public oral healthcare visits (Mann-Whitney U test, ꭓ² test, and Wilcoxon signed ranks test). Correlations between treatment procedures and OHRQoL were evaluated among those who had visited public oral healthcare service. The association between OHRQoL and its change with different treatment procedures was evaluated by using Spearman correlation coefficients.

Results: OHRQoL did not change for the majority of parents, regardless of visiting public oral healthcare services, or if they received oral healthcare treatment or only preventive procedures. Change in OHRQoL and treatment procedures showed a weak association. OHRQoL worsened most for those receiving treatment in four or more procedure groups. Changes in OHRQoL were not clinically meaningful.

Conclusions: Oral healthcare procedures seem to have a limited impact on OHRQoL changes among parents of young children.

Objectives: In Australia, although there have been some improvements, child oral health continues to be a major public health issue. The Australian Government introduced the means-tested Child Dental Benefits Schedule (CDBS) in 2014 to support access to dental services for children and adolescents aged 0-17 years from low-income families. There is a lack of evidence documenting whether the CDBS improved the dental attendance rate. This study aimed to evaluate the impact of the CDBS on dental visits among eligible children and adolescents in Australia.

Methods: The study analysed the data set from the birth cohort (B cohort) in the Longitudinal Study of Australian Children (LSAC). This is a nationally representative cohort survey collected biennially since 2004. The information on dental visits in the last 12 months was reported by the parents. A difference-in-differences analysis was used to examine 22,985 observations in the period 2008-2018. A propensity score matching (PSM) method was employed as a robustness check for the main findings.

Results: The proportion of children and adolescents eligible for CDBS in the six biennial surveys from 2008 to 2018 was 62.0%, 54.4%, 47%, 41.2%, 35.5%, and 28.9%, while the proportion of eligible individuals visiting dentists was 38.0%, 45.6%, 53.0%, 58.8%, 64.5%, and 71.1%, respectively. The analyses showed that the CDBS policy had a statistically significant and positive impact on dental visits among eligible children and adolescents. There was a 6.1-6.4 percentage point increase (p-value < 0.001) in dental visits across different specifications after the introduction of the CDBS policy.

Conclusion: The removal of financial barriers was beneficial to improve dental visits; however, the target group still faces the other remaining barriers, especially those related to inequalities in the social determinants of health, impeding the uptake of free dental services.

Objectives: To evaluate and compare the rates of antibiotic prescribing by dental practitioners across the constituent countries of the United Kingdom between March 2020 and August 2023 and to estimate the total 'excess' prescribing that occurred during this interval beyond the rates predicted based upon trends between March 2016 and February 2020.

Methods: Retrospective pharmacoepidemiological study of dental practitioners' antibiotic prescribing, by secondary analysis of population-level National Health Service dispensing data from England, Scotland, Wales and Health and Social Care dispensing data from Northern Ireland.

Results: Effective August 2023, the antibiotic items dispensed rate for each country remained in excess of that predicted based upon pre-pandemic trends. Between March 2020 and August 2023, those rates were 175.6, 227.2, 195.0 and 321.8 antibiotic items per 1000 population for England, Scotland, Wales and Northern Ireland, respectively. Those represented estimated total 'excesses' of 27.7% (95% confidence limit [CL], 14.8, 43.7), 43.3% (95% CL, 29.9, 60.0), 33.2% (95% CL, 20.4, 49.0) and 42.9% (95% CL, 27.6, 62.3). Pairwise comparisons showed statistically significant differences between England and Scotland, England and Northern Ireland, and Wales and Northern Ireland (p < 0.001), Scotland and Wales (p = 0.001), and Scotland and Northern Ireland (p = 0.009). There was no statistically significant difference between England and Wales.

Conclusions: With shared prescribing guidelines and a single professional regulatory framework, it was unsurprising that similar antibiotic prescribing trends were found across the United Kingdom. Further research is required to investigate the reasons for the differences.

Objectives: Addressing inequitable oral health access is a global priority. In Canada, community dental clinics (CDCs) play a crucial role in this endeavour, yet limited resources necessitate strategically targeting communities for interventions. Various methods exist for defining communities and measuring outcomes, but how CDCs determine their target populations is under-researched. This study aimed to explore how decision-makers planning an inner-city CDC define the population they intend to serve.

Methods: Data was collected through key informant interviews, document analysis, and field observations. Purposive sampling was employed to select key informants and documents related to clinic planning and design. The researcher was immersed in the data throughout the study, which underwent inductive content analysis facilitated by NVivo software.

Results: Analysis included semi-structured key informant interviews (n = 11), textual data from public sources and key informants (n = 9), and field observations totalling 275 hours over 1 year (2020-2021). Key informants agreed that the clinic served a "vulnerable" population, but definitions of "vulnerable" varied. Initial coding revealed two distinct patient groups with differing portrayals. Based on five patient characteristics Sossauer et al. (2019) described, one group was portrayed positively, while the other was depicted negatively.

Conclusions: This study underscores the necessity of establishing a shared understanding of "vulnerability" in interdisciplinary projects like the CDC examined here. Assumptions about community groups hold significant consequences, shaping resource allocation, programme implementation, and policy decisions. It is imperative to critically assess who is making these decisions, their conception of vulnerability, and the repercussions of these beliefs on affected communities.

Purpose: Individual behaviours are often shared within social networks (homophily), suggesting network-level interventions hold promise for health promotion. Yet, little is known about oral health homophily. This study aimed to identify individual- and network-based predictors of oral health homophily among individual's (ego) social networks of public housing residents.

Methods: Respondents self-reported demographics, oral health status and associated risk behaviours (n = 277). They named social contacts (alters), reported on relationship attributes, demographics and behavioural characteristics (n = 889). Hypothesised predictors of oral health homophily included relationship attributes (e.g., contact frequency), respondent-level and shared characteristics. Oral health homophily was modelled using multilevel (hierarchical) logistic regression evaluating model attributes (AIC) to determine gains in explanatory power.

Results: Relationship strength, including high frequency of shared meals and contact, was associated with higher odds of oral health homophily (OR [95% CI]: 1.92 [1.05, 3.52] and 1.62 [1.00, 2.63], respectively). The best performing model included daily shared meals and contact, respondent age, smoking and oral health status.

Conclusions: Oral health homophily is predicted by relationship strength and 'excellent/very good/good' oral health. Respondents with poorer oral health and a smoking history were less homophilous in oral health. Multilevel interventions targeting oral health outcomes may benefit from accounting for social relationships.

Objectives: To report the epidemiology and socioeconomic correlates of salivary gland cancers (SGCs) at global, regional and national levels by age, sex and country.

Methods: Data on the incidence and mortality of SGC for the year 2020 were extracted from the Global Cancer Observatory. The relationships between incidence and mortality rates with the human development index (HDI) and the ratio of current healthcare expenditure to gross domestic product were investigated using bivariate correlation tests. Also, projections for new cancer cases or mortalities in a specific nation or region between 2025 and 2040 were estimated by multiplying age-specific incidence or mortality rates, with the anticipated population for the years 2025-2040.

Results: In 2020, the global crude incidence and mortality rates of SGC were 0.69 and 0.29, respectively. Among the World Health Organization regions, the Americas and Africa had the highest SGC age-standardised incidence rate (ASIR) and age-standardised mortality rate (ASMR), respectively. By HDI classification, the very high HDI group had the highest SGC ASIR at 0.69, whereas the low HDI group had the highest SGC ASMR at 0.49. Among different age groups, those aged 70+ had the highest SGC incidence and mortality crude rates. Globally, males had higher SGC incidence and mortality crude rates than females. A strong negative correlation was found between HDI and SGC ASMR and the mortality-to-incidence ratio (p < 0.001). By 2040, the global incidence and mortality numbers of SGC are projected to increase by 50% and 60%, respectively.

Conclusions: These findings provide crucial insight into the global distribution and disparities in SGC care quality. Furthermore, this report has the potential to aid in the planning of SGC control initiatives.

Objective: The current Australian Pregnancy Care guidelines recommend that antenatal care providers discuss oral health, provide advice and refer women to dental professionals as needed. However, the delivery of oral health recommendations in antenatal settings appears substandard. This study aimed to identify the barriers and enablers influencing antenatal care providers' adoption of the oral health guidelines.

Methods: A qualitative study was conducted using semi-structured interviews with a purposive sample of antenatal care providers in Tasmania, Australia. Data analysis followed a thematic coding method using the Capability, Opportunity, Motivation - Behaviour (COM-B) model and Theoretical Domains Framework to identify implementation barriers and enablers and to inform recommendations.

Results: Twenty-five antenatal care providers participated (midwives n = 14, general practitioners n = 10 and obstetrician-gynaecologist n = 1). Thirty-two explanatory themes were identified and mapped directly to six COM-B constructs and 11 Theoretical Domains Framework domains. Eight main themes were identified as both impeding and enabling when viewed in different contexts: (1) perceived patient knowledge and awareness; (2) professional oral health knowledge, training and skills; (3) awareness of the guidelines on oral health; (4) patient education and professional resources; (5) interprofessional collaboration and support; (6) streamlined referral processes and access to dental services; (7) perceived outcomes of oral health interventions; and (8) perceived professional responsibility related to oral health.

Conclusions: Key strategies include improvements to the promotion and dissemination of relevant guidelines, professional education and training, and development and adoption of oral health-centred models of care to support interprofessional collaboration. Future research should focus on developing brief and sustainable interventions that address antenatal care providers' practice behaviours.

Objectives: To investigate the extent of the association of adverse childhood experiences (ACEs) with co-occurring poor self-reported oral health (SROH) and multimorbidity in middle-aged and older adults, and whether these associations differ by age and sex.

Methods: This cross-sectional study used data from 27 765 adults aged 45-85 years from the first follow-up wave (2015-2018) of the Canadian Longitudinal Study on Aging (CLSA). Four categories were generated to assess co-occurring SROH and multimorbidity: (i) good SROH, no multimorbidity; (ii) poor SROH, no multimorbidity; (iii) good SROH, multimorbidity and (iv) poor SROH and multimorbidity. Age-and sex-stratified multinomial logistic regressions were used to examine associations of ACEs (e.g. childhood maltreatment, neglect, parental death, serious illness or separation) with co-occurring poor SROH and multimorbidity, adjusted for the confounders race/ethnicity, income, level of education, smoking status and alcohol consumption.

Results: Over a third of participants reported having multimorbidity (35.3%), 10.4% reported poor SROH, and almost 30% of participants had experienced at least one ACE. There was a gradient in the association between higher ACEs and each of the health outcome categories, with the greater odds being for the co-occurrence of poor SROH and multimorbidity (OR = 1.37, 95% CI: 1.30, 1.44). The associations between ACEs and adverse health outcomes in later life were significant across age groups and sexes, with middle-aged females demonstrating the strongest associations.

Conclusions: ACEs are linked to an increased non-communicable chronic disease burden and poor oral health among middle-aged and older Canadians, highlighting the importance of prevention in early life and the focus on psychosocial factors over the life course for healthy aging.

Background: Temporomandibular dysfunction (TMD) experience might impair oral health-related quality of life (OHRQoL). Causal inference using population-based cross-sectional data is challenging given the potential for bias. Propensity Score Subclassification (PS-Subclassification) provides a tool to mitigate confounding bias. The aim of this study was to estimate the Population-Average Treatment Effect (PATE) of having TMD experience among Australian adults on OHRQoL using PS-Subclassification and statistically estimated Minimally Important Differences (MID-S).

Method: Australia's National Survey of Adult Oral Health (NSAOH) 2004-06 data were used which included a Computer Assisted Telephone Interview, mailed questionnaire and oral epidemiological examination. Data included demographics, socioeconomics, caries experience (DMFT index), periodontitis, TMD experience using the TMD Diagnostic Criteria Question, the Oral Health Impact Profile (OHIP-14) and perceived stress. Analysis steps included: (1) generating propensity scores (PS) for TMD experience probability using causal model-derived confounders while incorporating survey design elements; (2) PS-Subclassification and weighting; (3) assessing common support and group balance and (4) estimating the PATE for TMD experience on OHIP-14 overall and domains scores using complex samples GLM.

Results: Of the 4063 NSAOH participants, 397 with TMD and 3656 without TMD were included in PS-Subclassification (all data were used) and shared common support for their PS and established adequate covariate balance (SMD < 0.2). Experiencing TMD had higher OHIP-14 total scores (B = 3.498, 95% CI: 2.218-4.778) with a small MID-S (Cohen's F² = 0.03). TMD experience impaired all OHIP-14 domains (p < 0.05) with physical pain and psychological domains among the highest impaired OHIP-14 domains with a small MID-S.

Conclusion: TMD experience impaired the overall OHRQoL measured by the OHIP-14 among Australian adults with a small MID-S. Physical pain and psychological domains were among the highest impaired OHRQoL domains with a small MID-S. Clinicians and policymakers might consider these findings to support TMD screening and patient-centred management.