Showing papers by "A. John Spencer published in 2009"

Dental fear and adult oral health in Australia.

Abstract: – Objective: This study aimed to investigate the association between dental fear and both dental caries and periodontal indicators. Methods: A three-stage stratified clustered sample of the Australian adult population completed a computer-assisted telephone interview followed by a clinical examination. Oral health measures were the DMFT index and its components, periodontitis and gingivitis. A total of 5364 adults aged 18–91 years were dentally examined. Results: Higher dental fear was significantly associated with more decayed teeth (DT), missing teeth (MT) and DMFT. There was an inverted ‘U’ association between dental fear and the number of filled teeth (FT). Periodontitis and gingivitis were not associated with dental fear. The association between dental fear and DMFT was significant for adults aged 18–29 and 30–44 years, but not in older ages. Dental fear was significantly associated with more DT, MT, and DMFT but with fewer FT after controlling for age, sex, income, employment status, tertiary education, dental insurance status and oral hygiene. Conclusion: This study helps reconcile some of the conflicting results of previous studies and establishes that dental fear is associated with more decayed and missing teeth but fewer FT. That people with higher dental fear have significantly more caries experience underlines the importance of identifying and then reducing dental fear as important steps in improving adult oral health.

Factors influencing caries experience among adults with physical and intellectual disabilities.

Abstract: Background: There is limited and inconsistent evidence on the influence of residential setting on caries experience of adults with physical and intellectual disabilities (PID), described here as care-recipients. Objective: To examine caries experience and associated factors among adults with PID. Methods: Mailed questionnaire survey (2005-2006) of carers of adults with PID (18-44 years) in South Australia from family homes, community housing, and institutions, and oral examinations of care-recipients recording decayed (D), missing (M) and filled (F) teeth (DMFT). Results: Carers completed questionnaires for 485 care-recipients, 267 of whom were examined (completion rate = 55.1%). The prevalence of decay (D > 0) was 16.9% and 76.3% had caries experience (DMFT > 0). In unadjusted analysis, care-recipients at institutions had a significantly higher mean DMFT than other settings. After adjusting for carer and care-recipient characteristics, there was no difference in any of the DMFT components among residential settings. However, there were statistically significant associations (OR ± 95% CI excluding unity) between decayed teeth and moderate and high intake of sweet drinks and frequency of dental visits. Higher odds of missing teeth were associated with type of disability, general anaesthetic requirement for dental treatment and low and high carer-contact. Higher odds of filled teeth were associated with age, no oral hygiene assistance (OHA) and high carer-contact. Higher odds of caries experience were associated with age and no OHA. Conclusions: Residential setting was not associated with caries experience. Modifiable risk factors were diet, frequency of dental visits, no OHA and carer-contact hours.

Life events and oral-health-related quality of life among young adults

Abstract: Life-course approaches to understanding the determinants of health have led to a greater focus on the effects of life events on health. Life events may be construed as either positive or negative, and may have differential health effects. The aims of the study were to assess the association of positive and negative life events with oral-health-related quality of life (OHRQoL). In 2005–2006, 1,859 study participants aged around 30 years old were surveyed by mailed self-complete questionnaire and invited to attend a dental examination. Data collected included life events, social support (MSPSS) and OHRQoL (OHIP-14). A total of 632 people responded (43% response). Multivariate analysis controlling for sex, education, income, dental behaviour and social support showed that the lower (OR = 0.4, 0.2–0.6) and middle tertiles (OR = 0.6, 0.4–0.9) for negative life events were associated with lower prevalence of problems related to OHRQoL compared to the higher tertile. OHRQoL among young adults was associated with negative life events, but not positive life events. This suggests that negative life events involving social readjustment need to considered as determinants of health in life-course oral epidemiology frameworks.

Changing inequalities in the distribution of caries associated with improving child oral health in Australia.

Abstract: OBJECTIVES This study aimed to document the changing distribution of and inequalities in dental caries in Australian children across the 25-year period from 1977 to 2002. METHODS Oral health data were obtained from Australia's national Child Dental Health Survey Measures of caries distribution included the Significant Caries Index and the proportions of children with high caries experience [decayed, missing and filled teeth (DMFT) > or =4], while inequality was assessed by using Gini coefficients calculated from Lorenz curves. Changes in caries distribution were compared with changes in child dmft/DMFT. RESULTS While appreciable reductions occurred in child caries experience, in terms of both mean dmft/DMFT and for those children with the poorest oral health, inequalities in the distribution of caries experience increased across the 25-year period. Inequalities in the distribution of decayed and filled teeth differed for the deciduous and permanent dentition and, in the permanent dentition, became increasingly similar in the 1990s. CONCLUSIONS Increasing inequalities in child dental caries in Australia must be interpreted in the context of declines in both mean caries experience and in the caries experience of those children with the poorest oral health. The Gini coefficient documents that the majority of the caries experience is increasingly being confined to a smaller percentage of the child population; however, this is a consequence of population-wide child oral health improvements.

Are people with dental fear under-represented in oral epidemiological surveys?

Abstract: Dental phobia is associated with poorer dental attendance so epidemiological surveys requiring participants to undertake a dental examination may result in an under-representation of participants with high dental fear. We compared the dental fear distribution of participants and non-participants in an oral examination component of a national epidemiological survey of oral health. Of 12,606 in-scope dentate people aged 15+ who completed a structured computer-assisted telephone interview (CATI) survey, 5,505 (43.7%) participated in the oral examination. Dental fear was assessed with a single-item measure in the CATI. There was a significant difference between the percentages of participants and non-participants who rated themselves as “extremely” afraid, although the absolute difference (1.9%) was small. The association between extreme dental fear and participation was significant (OR = 0.66, 95% CI = 0.56–0.77) in multivariate analyses after controlling for possible confounders. Females with extreme dental fear were also significantly less likely to undertake an oral examination. Even though people with dental fear and phobia may delay or avoid dental visits, they do not appear to be appreciably under-represented in oral epidemiological surveys.

Trends in access to dental care among Australian children

Abstract: This publication provides an analysis of the dental visiting patterns of children aged 5 to 17 years during the period 1994 to 2005. From 1994 to 2005 approximately 80 per cent of children aged 5-11 years and 75% of children aged 12-17 years visited a dentist within the previous 12 months. Private dental attendance by the younger age group increased significantly from 2002 to 2005, reflecting a decline in the utilisation of the School Dental Service. Regular access to dental care for all Australian children is vital to ensure children receive preventively-focussed care, prompt treatment of dental disease and professional advice on oral hygiene. Establishing favourable dental visiting behaviour during childhood will lead to better oral health outcomes as adults.

Relative needs index study, South Australia and New South Wales

Abstract: The demand for public dental services exceeds the capacity of available resources. Services are therefore rationed by categorising them into those seeking emergency or general dental care and then, most commonly, by chronological queuing. No evidence-based criteria or protocols exist in Australia to assess whether it's reasonable for patients to present for emergency dental care, or to prioritise those seeking general dental care who are placed on waiting lists. This publication investigates rationing dental care on the basis of patients' overall experience including reported symptoms and psychosocial impact of the oral problems. Such approaches help ration both emergency and general dental care as one step in reforming public dental care.