Showing papers by "A. John Spencer published in 2008"

Efficacy of an oral health promotion intervention in the prevention of early childhood caries.

Abstract: – Objective: Despite a marked improvement in oral health of Australian children over the last 30 years, severe early childhood caries (S-ECC) affects up to 17% of 2- to 3-year-old children with some requiring hospitalization and invasive treatment. This provided a compelling rationale to develop and test an oral health promotion programme which aimed to reduce this unnecessary suffering. The purpose of this study was to test the efficacy of an oral health promotion programme for the parents of infants, starting during the pregnancy, using a randomized controlled trial. Methods: A programme was developed around the provision of anticipatory guidance to nulliparous women (women expecting their first child) in Adelaide. Mothers in the test group received oral health promotion information during pregnancy, and later when the child reached 6 and 12 months of age. After the second round of information the test group mothers were randomized again. The information was reinforced in one of the test subgroups through a telephone consultation. There was no contact with mothers in the control group after enrolment. At the age of 20 ± 2.5 months all test and control group children were examined by a dentist. The case definition of an incidence of S-ECC was one or more upper incisor teeth being carious at the level of a cavitated or noncavitated lesion. The differences in S-ECC incidence between the test and control groups, and the test subgroups were analysed. Results: Of 649 women enroled in the programme (test group 327, control group 322), 441 had their child examined at follow-up. The incidence of S-ECC in the test group was 1.7% and in the control group 9.6% (P < 0.001). Conclusion: An oral health promotion programme based on repeated rounds of anticipatory guidance initiated during the mother’s pregnancy was successful in reducing the incidence of S-ECC in these very young children.

Tooth loss, chewing ability and quality of life.

Abstract: Middle-aged and older adults are retaining teeth and avoiding dentures, which should impact quality of life. The aims of our study were to investigate tooth loss and chewing ability and their association with oral- and general-health-related quality of life and life satisfaction. A random sample of 45- to 54-year-olds from Adelaide, South Australia, was surveyed by self-complete questionnaire in 2004–2005 (n = 879, response rate = 43.8%). Health-related quality of life was measured with the Oral Health Impact Profile 14-item version and EuroQol Visual Analogue Scale instruments and life satisfaction by the Satisfaction with Life Scale. Functional tooth units were recorded at oral examinations performed by calibrated dentists on 709 persons (completion rate = 80.7%). Number of functional teeth was positively associated with chewing ability (β = 0.31, P < 0.01). In multivariate analyses, controlling for number of functional teeth and other explanatory variables spanning dental visit pattern, dental behaviour, socio-demographics and socio-economic status, chewing ability was negatively associated with oral-health-related impacts (β = −0.37, P < 0.01) and positively associated with general health (β = 0.10, P < 0.05) and well-being (β = 0.16, P < 0.01). Chewing ability was related to oral-health-related quality of life and general health, possibly reflecting the impact of chewing on food choice and enjoyment of meals and diet, and also indicated the importance of oral health to general well-being.

Cognitive vulnerability and dental fear

Abstract: Background The Cognitive Vulnerability Model proposes that perceptions of certain characteristics of a situation are critical determinants of fear. Although the model is applicable to all animal, natural environment and situational fears, it has not yet been applied specifically to dental fear. This study therefore aimed to examine the association between dental fear and perceptions of dental visits as uncontrollable, unpredictable and dangerous.

Factors influencing the use of public dental services: An application of the Theory of Planned Behaviour

Abstract: There is limited evidence of the influence of psychosocial factors and health beliefs on public dental patient's patterns of service use in Australia The research aims were to examine associations between dental attitudes and beliefs of public dental service users and dental visiting intention and behaviour using the Theory of Planned Behaviour 517 randomly selected adult public dental patients completed a questionnaire assessing dental attitudes and beliefs which was matched with electronic records for past and future dental service use A questionnaire measured intentions, attitudes, subjective norms and perceptions of behavioural control and self-efficacy in relation to visiting public dentists A measure of dental attendance at public dental clinics was obtained retrospectively (over 3 1/2 years) and prospectively (over a one year period following the return of the questionnaire) by accessing electronic patient clinical records Participants had positive attitudes, subjective norms and self-efficacy beliefs towards dental visiting but perceived a lack of control over visiting the dentist Attitudes, subjective norms, self-efficacy and perceived control were significant predictors of intention (P < 005) Intentions, self-efficacy and past dental attendance were significant predictors of actual dental attendance (P < 005) Public dental patients held favourable attitudes and beliefs but perceived a lack of control towards dental visiting Reducing structural barriers may therefore improve access to public dental services

Changing risk factors for fluorosis among South Australian children

Abstract: – Background: Research in the last decade has shown changing exposure patterns to discretionary fluorides and declining prevalence of fluorosis among South Australian children, raising the question of how risk factors for fluorosis have changed. Objective: To examine and compare risk factors for fluorosis among representative samples of South Australian children in 1992/1993 and 2002/2003. Methods: Similar sampling strategies and data collection methods were employed in the Child Fluoride Study (CFS) Marks 1 (1992/1993) and 2 (2002/2003). Participants in each CFS round were examined for fluorosis using the Thylstrup and Fejerskov (TF) Index. Exposure history was collected for fluoride in water, toothpaste, fluoride supplements and infant formula, allowing for a fluorosis risk assessment analysis. Data were re-weighted to represent the child population at each time. Changes in prevalence of fluorosis, defined as having a TF score of 1+ on maxillary central incisors, fluoride exposure and risk factors between the two rounds were evaluated. Result: A total of 375 and 677 children participated in the 1992/1993 and 2002/2003 rounds respectively. Prevalence of fluorosis declined significantly from 45.3% to 25.9%. Reduced use of fluoride supplements and increased use of 400–550-ppm children F toothpaste were the most substantial fluoride exposure changes. Early toothpaste use, residence in fluoridated areas and fluoride supplement use were the risk factors in 1992/1993. Early toothpaste use and fluoride supplement use were not risk factors, leaving fluoridated water as the only risk factor among the common variables in 2002/2003. In an analysis stratified by the type of fluoridated toothpaste in 2002/2003, the large amount of toothpaste used was a risk factor in those who used 1000-ppm fluoridated toothpaste, and eating/licking toothpaste when toothpaste use started was a risk factor among children who used either 1000-ppm or 400–550-ppm fluoridated toothpaste. Conclusion: Introduction of the 400–550-ppm F toothpaste and use of smaller amount of toothpaste restricted risk associated with early toothpaste use. Less use and possibly a stricter fluoride supplements regimen also restricted fluorosis risk. Periodic monitoring of risk of fluorosis is required to adjust guidelines for fluoride use in caries prevention.

Projected demand and supply for dental visits in Australia: analysis of the impact of changes in key inputs

Abstract: How many dentists do we need in Australia to meet the future demand for dental visits and enable people to maintain good dental health? This report provides estimates and projections of demand and supply of dental visits, assessing the impact of changes in policy direction or social and professional trends. A range of scenarios are presented as a means of understanding current and potential future developments, in order to inform policy makers and service provision planning. This policy analysis provides revised assessments of previously published supply and demand projections, giving a vital tool to underpin future decision making.