Publications by authors named "David S Brennan"

72 Publications

The Practice of Dentistry by Australian- and Overseas-Trained Dentists in Australia: Discriminant Analysis of key Predictors.

Int Dent J 2021 Feb 17. Epub 2021 Feb 17.

Australian Research Centre for Population Oral Health (ARCPOH), Adelaide Dental School, University of Adelaide, Adelaide, Australia.

Introduction: Overseas-trained dentists comprise at least one-fourth of the overall Australian dental workforce. This study examined characteristics and practice differences between Australian- and overseas-trained dentists to identify key predictors that best differentiate their dentistry practices.

Methods: Data for the study were from the Longitudinal Study of Dentist Practice Activity (LSDPA), a survey of a nationally representative random sample of dentists in Australia commencing in 1983-1984 and repeated every 5 years. Dentists were surveyed on a wide range of items including participant characteristics, practice patterns, practice inputs, direct demand, and productivity measures. Data were weighted to provide national estimates by age, sex, and practice type. Discriminant function analysis was used to examine the predictor variables that best distinguished between the two groups. Analysis was limited to the most recent wave of the study.

Results: A total of 1148 dentists (response rate = 67%) responded to the survey in 2009-2010; 648 cases were available for the discriminant analysis. The discriminant functions for the full sample and each of the 3 age groups (<35 years; 35-50 years; and 50+ years) were found effective to separate dentists into 2 groups (Australian and overseas), with the proportion of cases correctly classified being highest for the oldest age group (89.7% for 50+ years). Female gender, type of practice (working in public sector), and working in disadvantaged areas were significant predictors, with more prominence in the 35- to 50-year age group. Practice inputs, demand, and productivity measures offered less discriminative capacity between the dentists.

Conclusion: Overseas-trained dentists contribute towards providing dental care to underserved populations, the public sector, and in rural and remote locations. This study provided basis to argue that policies to encourage overseas-trained dentists to contribute towards areas of need locations have been successful, and key productivity measures were also similar to Australian-trained dentists.
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http://dx.doi.org/10.1016/j.identj.2021.01.002DOI Listing
February 2021

The long-term influence of orthodontic treatment on adults' psychosocial outcomes: Reflections and critique on a recent commentary.

Orthod Craniofac Res 2021 05 26;24(2):296-298. Epub 2020 Oct 26.

Australian Research Centre for Population Oral Health (ARCPOH), Adelaide Dental School, The University of Adelaide, Adelaide, SA, Australia.

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http://dx.doi.org/10.1111/ocr.12432DOI Listing
May 2021

Are trust and satisfaction similar in dental care settings?

Community Dent Oral Epidemiol 2020 12 26;48(6):480-486. Epub 2020 Jun 26.

Australian Research Centre for Population Oral Health, Adelaide Dental School, The University of Adelaide, Adelaide, SA, Australia.

Objectives: Trust and satisfaction in dental care settings are salient constructs to operationalize the concept of dentist-patient relationships (DPR). This study aimed to compare the similarity of both constructs with regard to factor structure and revise the scales for better psychometric properties.

Methods: Data analysed in the study were collected in self-complete questionnaires from a random sample of 4011 adults living in South Australia. Trust and satisfaction were assessed using the Dentist Trust Scale and the Dental Care Satisfaction scale. Items in the scales were initially examined with a split-half sample in exploratory factor analysis and cluster analysis. Factor structures of different model designs were tested on the other half sample in confirmatory factor analysis. The final model was cross-validated on the first half sample for structural invariance.

Results: Exploratory factor analysis revealed a three-factor structure consisting of 'trust', 'satisfaction' and 'distrust/dissatisfaction' (60.2% of the variance explained; Cronbach's α = 0.94, 0.81, 0.73, respectively). Cluster analysis supported the factor solution with the same three major clusters except for a single-item independent branch of the 'cost' domain from the satisfaction scale. The final model was designed with two correlated but distinct factors, 'trust' and 'satisfaction', with the modification of one inter-item covariance and deleting the least associated item (GFI = 0.96, CFI = 0.98, RMSEA = 0.06). The stability of the final model was achieved through cross-validation (P = .143, ∆CFI < 0.001).

Conclusions: Trust and satisfaction in dental care settings are unidimensionally different yet highly correlated factors concurrently. Demonstrating the discriminant and complementary functions of both constructs can justify the rationale to apply them together in further studies for DPR.
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http://dx.doi.org/10.1111/cdoe.12559DOI Listing
December 2020

Oral hygiene behaviours among Australian adults in the National Study of Adult Oral Health (NSAOH) 2017-18.

Aust Dent J 2020 06;65 Suppl 1:S79-S84

Australian Research Centre for Population Oral Health, Adelaide Dental School, The University of Adelaide, SA, Australia.

Background: This paper examines oral hygiene behaviours (tooth brushing, mouthwash use and dental floss) by a range of explanatory variables.

Methods: Explanatory variables included age, sex, region, income, area-based SES, dental insurance and visiting pattern. The data reported were collected in the interview survey in NSAOH 2017-18.

Results: A higher percentage of females brushed with toothpaste at least daily (98.0%) and used floss in the last week (62.6%) than males (94.6% and 48.5% respectively). There was an income gradient in tooth brushing. Higher percentages brushed in the high income (96.8%) than middle (96.2%) and low-income tertiles (93.6%). A higher percentage of the high-income tertile (58.2%) flossed than the lower tertile (53.3%). Those with unfavourable visit patterns had lower percentages who brushed daily (92.7%) than the intermediate (96.7%) or favourable (98.2%) groups. There was a gradient in flossing by visiting, with a lower percentage flossing for the unfavourable visiting group (38.5%) than for the intermediate (52.8%) or favourable groups (67.6%).

Conclusions: Oral hygiene behaviours were associated with gender, socioeconomic status and dental visiting. A higher percentage of women brushed and flossed than men. Lower socioeconomic status and those with unfavourable visiting patterns had lower frequencies of brushing and flossing.
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http://dx.doi.org/10.1111/adj.12769DOI Listing
June 2020

Oral health impacts among Australian adults in the National Study of Adult Oral Health (NSAOH) 2017-18.

Aust Dent J 2020 06;65 Suppl 1:S59-S66

Australian Research Centre for Population Oral Health, Adelaide Dental School, The University of Adelaide, Adelaide, South Australia, Australia.

Background: This paper examines oral health impacts of toothache experience, self-rated oral health (SROH), being uncomfortable with dental appearance, and avoiding foods in the Australian adult population.

Methods: The explanatory variables include age, sex, region, income, area-based SES, dental insurance and visiting pattern. The data were collected in the interview in NSAOH 2017-18.

Results: There were lower percentages with: toothache in the highest (14.8%) than middle (21.2%) and lower income tertiles (25.2%); fair/poor SROH in the highest (15.8%) than middle (24.1%) and lower tertiles (34.8%); uncomfortable with appearance in the highest (29.1%) than middle (35.3%) and lower tertiles (42.2%); and food avoidance in the higher (15.3%) than middle (22.9%) and lower tertiles (34.4%). There were higher percentages with: toothache in the unfavourable (32.2%) than intermediate (23.1%) and favourable (11.7%) visiting groups; fair/poor SROH in the unfavourable (44.0%) than intermediate (27.4%) or favourable (10.2%) groups; being uncomfortable about appearance in the unfavourable (47.6%) than intermediate (39.5%) or favourable (25.8%) groups; and avoiding foods in the unfavourable (34.8%) than intermediate (26.0%) or favourable (14.5%) groups.

Conclusions: Socioeconomic status and dental visiting were associated with oral health impacts. Oral health impacts were worse for those with lower income and unfavourable visiting patterns.
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http://dx.doi.org/10.1111/adj.12766DOI Listing
June 2020

Guest Editorial.

Aust Dent J 2020 06;65 Suppl 1:S3-S4

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http://dx.doi.org/10.1111/adj.12770DOI Listing
June 2020

Use of dental services among Australian adults in the National Study of Adult Oral Health (NSAOH) 2017-18.

Aust Dent J 2020 06;65 Suppl 1:S71-S78

Australian Research Centre for Population Oral Health, Adelaide Dental School, The University of Adelaide, Adelaide, South Australia, Australia.

Background: This study examines last dental visit (visiting within the last 12 months, having a last visit 5 or more years ago, attending a private dental practice) and usual visit (usually visiting for a check-up, having a dentist they usually attend).

Methods: Explanatory variables include age, gender, region, income, area-based SES and dental insurance. The data were collected in the Interview in NSAOH 2017-18.

Results: There was a dental visiting gradient by region, with lower percentages visiting in the last 12 months in remote (44.9%) and regional areas (50.8%) than major cities (58.7%). A higher percentage of the higher-income tertile made visits (63.8%) than the middle (53.7%) and lower tertiles (49.9%). There was a visiting gradient by area-based SES, with higher percentages in the higher (63.8%) and middle SES tertiles (55.2%) than the lower tertile (50.2%). Uninsured persons had lower percentages visiting (43.3%) than insured (69.7%).

Conclusions: Persons in remote locations, those with low socioeconomic status and those uninsured were disadvantaged in terms of access. They had lower percentages visiting in the last 12 months, usually visiting for a check-up, having a dentist they usually attend and higher percentages visiting 5 or more years ago.
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http://dx.doi.org/10.1111/adj.12768DOI Listing
June 2020

The long-term influence of orthodontic treatment on dental knowledge and behaviour: An Australian cohort study.

J Dent 2020 09 24;100:103345. Epub 2020 Apr 24.

Australian Research Centre for Population Oral Health (ARCPOH), Adelaide Dental School, Faculty of Health and Medical Sciences, The University of Adelaide, Corner North Terrace and George Street, Adelaide, SA 5000, Australia. Electronic address:

Objectives: Fixed orthodontic treatment (FOT) typically lasts 14-33 months, with regular appointments at short intervals to monitor changes, adjust appliances, and remotivate patients to maintain excellent oral hygiene standards to prevent dental disease. Past experiences are important influencers of dental attitudes and self-care dental behaviours in adulthood. Since FOT comprises a high frequency of appointments compared to other dental visiting, we hypothesised that previous FOT enhances dental knowledge and behaviour in later life.

Methods: This cohort study followed-up 30-year-old participants who originally took part in an oral epidemiological study when aged 13-years. Participants completed a questionnaire regarding sociodemographics, dental health behaviours, dental knowledge (prevention of caries and periodontal disease, including questions about popular myths) and FOT. Data analysis comprised un/adjusted binomial logistic regression and multivariate generalised linear regression.

Results: Data for 448 participants (56 % female, 35 % received FOT) were analysed; adjusted models controlled for sociodemographics and baseline malocclusion severity. There was no association between FOT and regular toothbrushing (Exp B: 1.35, 95% CI: 0.87-2.10), flossing (Exp B: 1.18, 95 % CI: 0.48-2.90), dental attendance within last 2 years (Exp B: 0.96, 95 % CI: 0.62-1.49) or a non-emergency dental visit (Exp B: 1.01, 95 % CI: 0.51-1.99). Non-FOT participants placed importance on a calcium-rich diet preventing caries (Exp B: 1.99, 95 % CI: 1.14-3.50, P < 0.05), while those with a baseline definite malocclusion had higher levels of knowledge about dental visiting compared to those with minimal or more severe malocclusions (P < 0.05).

Conclusion: Previous FOT appears to have limited impact on dental knowledge and may not affect long-term dental behaviours.

Clinical Significance: This 17-year follow-up study examined the influence of previous fixed orthodontic treatment on dental knowledge and behaviour later in life. Although patients have numerous and regular appointments during the course of orthodontic treatment, this does not seem to impact on either dental knowledge or behaviour in adulthood.
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http://dx.doi.org/10.1016/j.jdent.2020.103345DOI Listing
September 2020

Trust in dentist-patient relationships: mapping the relevant concepts.

Eur J Oral Sci 2020 04 10;128(2):110-119. Epub 2020 Mar 10.

Australian Research Centre for Population Oral Health, Adelaide Dental School, The University of Adelaide, Adelaide, SA, Australia.

Trust has a central role in healthcare encounters. This review explored concepts relevant to trust in dentist-patient relationships. The findings were demonstrated by drawing visual system maps for better understanding of the inherent complexity. A pragmatic approach was employed to search for evidence. The approach was initiated with a systematised searching protocol and followed by an iterative process of drawing maps and complementing references. The analysis-synthesis process found relevant key concepts and sub-concepts presented within three frameworks: the continuum of studying trust (utilisation, measurement, and establishment); beneficiaries of trust utilisation (patients, dentists, and oral health system); and a transformational model of trust development (identification-based, knowledge-based, and deterrence/calculus-based trust). Trust in dentist-patient relationships needs to be assessed in a multidisciplinary approach for interconnectedness among relevant concepts. The findings are represented in patient-centred care and quality of care with common underlying values. Despite the centrality of trust in medical/dental contexts, empirical evidence is insufficient beyond normative suggestions from previous studies. Based on the implications of thematic analysis and interpretation of the system maps, this paper can serve as a guide and source of information for further research of trust in dentist-patient relationships.
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http://dx.doi.org/10.1111/eos.12686DOI Listing
April 2020

Validation of the Health Literacy in Dentistry scale in Brazilian adults.

Int Dent J 2020 Apr 2;70(2):116-126. Epub 2019 Dec 2.

Adelaide Dental School, Australian Research Centre for Population Oral Health, University of Adelaide, Adelaide, SA, Australia.

Objectives: To perform cross-cultural adaptation and validation of the Health Literacy Dental scale (HeLD) in Brazilian adults.

Methods: The HeLD instrument was translated and cross-culturally adapted to the Brazilian Portuguese language to create longer (HeLD-29) and shorter (HeLD-14) versions. The reliability and validity of these versions were assessed in a sample of 603 adults living near six primary care units in the city of Piracicaba, São Paulo, Brazil.

Results: Both versions of HeLD demonstrated high internal reliability, acceptable convergent validity and discriminant validity. However, the confirmatory factor analysis showed that only HeLD-14 demonstrated satisfactory goodness of fit. There were associations between HeLD-14 scores and social demographic characteristics, general and oral health and oral health-related behaviours. Higher scores were observed for the total HeLD-14 and/or individual components of HeLD-14 among women, ethnic white subjects, those with high educational attainment, those with higher income, those reporting toothbrushing twice or more daily, regular dental attenders, those who usually attended for dental care for a check-up, those with excellent or very good self-ratings of general health, those with excellent or very good self-ratings of oral health, and those without tooth extraction and oral health impact.

Conclusion: The Brazilian version of HeLD-14 was demonstrated to be a reliable and valid instrument for measuring broad aspects of oral health literacy in the adult Brazilian population.
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http://dx.doi.org/10.1111/idj.12531DOI Listing
April 2020

A strife of interests: A qualitative study on the challenges facing oral health workforce policy and planning.

Health Policy 2019 11 23;123(11):1068-1075. Epub 2019 Jul 23.

Faculty of Dentistry, Oral and Craniofacial Sciences, Kings College London, London, United Kingdom.

Oral health workforce policy has often lacked systematic connections with broader health policy, and system-based reforms that would enable more effective responses to future needs of the population. The aim of the study was to better understand challenges facing oral health workforce policy and planning and identify potential solutions. In-depth interviews of 23 senior oral health leaders and/or health policy experts from 15 countries were conducted in 2016-17. Grounded theory principles using the Straussian school of thought guided the qualitative analysis. The findings identified: (i) narrow approach towards dental education, (ii) imbalances in skills, jobs and competencies, and (iii) geographic maldistribution as major challenges. An overarching theme -"strife of interests" - shed light on the tension between the profession's interest, and the needs of the population. A key aspect was the clash for power, dominance and authority within the oral health workforce and across health professions. This study argues that appreciating the history of health professions and recognising the centrality of the strife of interests is necessary in developing policies that both address professional sensitivities and are in line with the needs of the population. Integration and closer collaboration of oral health professionals with the mainstream medical and health professions has emerged as the key issue, but the solutions will be diverse and dependent on country- or context-specific scenarios.
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http://dx.doi.org/10.1016/j.healthpol.2019.07.010DOI Listing
November 2019

Obesity, dietary sugar and dental caries in Australian adults.

Int Dent J 2019 Oct 3;69(5):383-391. Epub 2019 Jun 3.

School of Medicine, College of Health and Medicine, University of Tasmania, Hobart, Tas., Australia.

Objectives: To determine the association of overweight/obesity, dental caries and dietary sugars in Australian adults.

Materials And Methods: The National Survey of Adult Oral Health (NSAOH) 2004-2006 provided data for analysis of dental caries experience. Self-reported body weight and height were used to calculate body mass index (BMI) for a subsample (n = 3,745, 89.8%) of the NSAOH data. A self-report questionnaire of 13 food items estimated the daily intake of added sugar, total sugars and total carbohydrate, using food composition estimates from the AUSNUT2011-2013. Bivariate analyses (Pearson's Chi-square with Rao-Scott adjustment and Student's t-tests) were used to determine the association of overweight/obesity, dental caries, sugar variables and putative confounders. Poisson regression models for the Decayed, Missing and Filled Teeth Index and individual measures of decayed, missing and filled teeth were constructed, with models containing BMI, dietary added sugar, total sugar and total carbohydrate, controlling for putative confounders.

Results: There was a positive association between dental caries experience and being overweight or obese compared with having normal weight or being underweight as well as between sugar consumption with all four dental caries outcome measures. When controlled for putative confounders where sugar consumption was identified as a key determinant, the statistical significance between dental caries experience and being overweight or obese disappeared. The demographic and socioeconomic factors associated with dental caries experience were age, sex, education, smoking status and usual reason for dental visit.

Conclusion: Analysis of the relationship between dental caries and obesity must include data about sugar and carbohydrate consumption.
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http://dx.doi.org/10.1111/idj.12480DOI Listing
October 2019

The long-term influence of orthodontic treatment on adults' psychosocial outcomes: An Australian cohort study.

Orthod Craniofac Res 2019 Nov 17;22(4):312-320. Epub 2019 Jun 17.

Australian Research Centre for Population Oral Health (ARCPOH), Adelaide Dental School, The University of Adelaide, Adelaide, South Australia, Australia.

Objectives: To assess the influence of orthodontic treatment on psychosocial outcomes in 30-year-olds. The research hypothesis tested was that participants previously treated orthodontically would have better psychosocial outcomes.

Setting And Sample Population: A prospective longitudinal cohort design was used to follow-up a sample of 1859 30-year-olds from Adelaide, South Australia, who had previously participated in an oral epidemiology study.

Materials And Methods: Clinical examination in 1988-1989 recorded participants' malocclusion severity. In 2005-2006, participants were invited to complete a questionnaire collecting data on socio-demographic characteristics, dental health behaviours, receipt of orthodontic treatment and psychosocial factors. Data were analysed descriptively and by linear regression models.

Results: Data for 448 participants were available; 56% of participants were female. Over a third of participants had received orthodontic treatment. Higher income earners had the best psychosocial outcomes while participants with a basic level of secondary education had the lowest. Regardless of initial malocclusion severity, orthodontic treatment was not associated with better psychosocial outcomes. Instead, a pattern of better psychosocial outcome was observed amongst untreated participants, regardless of malocclusion severity, this being significant for optimism. Adjusted models controlling for socio-demographic, dental health behaviour and malocclusion severity showed no association between orthodontic treatment and self-efficacy, health competence or social support. There was, however, a strong association with optimism.

Conclusion: There was no difference in long-term psychosocial outcomes based on orthodontic treatment. Our study does not support the contention that orthodontic treatment produces better psychosocial functioning later in life.
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http://dx.doi.org/10.1111/ocr.12327DOI Listing
November 2019

Area-level social development and indicators of public dental services in Southern Brazil.

Community Dent Oral Epidemiol 2019 06 25;47(3):274-280. Epub 2019 Mar 25.

Australian Research Centre for Population Oral Health (ARCPOH), The University of Adelaide, Adelaide, South Australia, Australia.

Objectives: This study aimed to test associations between a municipal social development indicator and indicators of public dental services; examine differences in the achievement of public dental services goals between fluoridated and nonfluoridated municipalities; and, quantify contribution of a municipal social development indicator in estimated mean differences in the public dental services indicators between fluoridated and nonfluoridated municipalities.

Methods: A secondary analysis of data from 293 municipal dental health services records from Southern Brazil between 2010 and 2015 was conducted. Multivariable log-binomial regression models were fitted to test the associations between municipal Human Development Index (HDI) and multiple public dental services indicators (proportion of public dental health service coverage, the proportion of tooth extraction among all clinical procedures, and monthly participation in supervised tooth brushing). Cut-off points for outcomes were based on state goals for public dental services. Blinder-Oaxaca decomposition analyses were performed to quantify the relative contribution of HDI in the differences in outcomes according to the municipal water fluoridation status.

Results: Municipalities within the lowest tertile of HDI had 66% lower prevalence of having insufficient public dental health service coverage (less than state goals)than those in the highest tertile of HDI (PR: 0.44; 95% CI: 0.24, 0.50). Municipalities with lowest HDI had nearly 30% higher prevalence of failing the state goals regarding the proportion of extraction and supervised tooth brushing (PR: 1.30; 95% CI: 1.20, 1.40 and PR: 1.34; 95% CI: 1.23, 1.45, respectively). Mean public dental health service coverage was higher in nonfluoridated municipalities than fluoridated municipalities, and municipal HDI explained 36% of the total estimated mean difference.

Conclusions: This study found associations between municipal social development and public dental services indicators in Southern Brazil. However, higher HDI was associated with lower public dental health service coverage, lower proportion of extraction and higher coverage of supervised tooth brushing [Correction added on 2 April 2019, after first online publication: In the preceding sentence, the text "but with a higher proportion of extraction and supervised tooth brushing" was changed to "lower proportion of extraction and higher coverage of supervised tooth brushing"]. Municipal HDI contributed significantly towards the gap in public dental coverage between fluoridated and nonfluoridated municipalities, favoring nonfluoridated municipalities. These findings have important policy implications for reducing oral health inequalities as it highlights the interplay between key oral health policies and their distribution according to municipal social development.
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http://dx.doi.org/10.1111/cdoe.12455DOI Listing
June 2019

Psychosocial factors and self-reported transitions in oral and general health.

Eur J Oral Sci 2019 06 2;127(3):241-247. Epub 2019 Feb 2.

Australian Research Centre for Population Oral Health, Adelaide Dental School, Adelaide, SA, Australia.

Psychosocial factors may explain variance in health beyond conventional indicators, such as behaviours. This study aimed to examine changes in health associated with perceived stress, social support, and self-efficacy, controlling for sociodemographic characteristics and health behaviour. A random sample of 45- to 54-yr-old subjects was surveyed in 2004-2005, with a follow-up 2 yr later. The outcomes were self-reported changes in oral and general health. Explanatory variables included stress, social support, and perceived health competence with covariates of income, gender, dentition status, toothbrushing, and smoking. Responses were collected from 986 persons (response = 44.4%). At the 2-yr follow-up, 25.6% reported worsening in oral health and 15.3% reported worsening in general health. Prevalence ratios (PR) from adjusted log-binomial regression showed an association between worsening oral health and higher perceived health competence (PR = 0.75, 95% CI: 0.57-0.99), and worsening general health was associated with perceived health competence (PR = 0.82, 95% CI: 0.72-0.94) and stress (PR = 1.17, 95% CI: 1.03-1.32). Worsening oral and general health were seen for male subjects (PR = 1.33, 95% CI: 1.06-1.68 and PR = 1.14, 95% CI: 1.01-1.29) and low income (PR = 1.40, 95% CI: 1.04-1.89 and PR = 1.20, 95% CI: 1.03-1.40). Health-related self-efficacy representing psychosocial resilience was associated with oral and general health, while stress was associated with general health. Psychosocial factors were independent predictors of change in health after controlling for sociodemographic characteristics and health behaviours.
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http://dx.doi.org/10.1111/eos.12608DOI Listing
June 2019

The influence of orthodontic treatment on dental caries: An Australian cohort study.

Community Dent Oral Epidemiol 2019 06 17;47(3):210-216. Epub 2019 Jan 17.

Australian Research Centre for Population Oral Health (ARCPOH), Adelaide Dental School, The University of Adelaide, Adelaide, South Australia, Australia.

Objective: To assess the influence of orthodontic treatment on long-term caries experience in 30-year-old South Australians. The research hypothesis that was tested was that those with previous orthodontic treatment would have lower caries experience.

Methods: In 2005-2006, a sample of 1859 30-year-olds from Adelaide, South Australia, who comprised 47% of participants who had previously taken part in an oral epidemiology study in 1988-1989, were traced from the Australian electoral roll and invited to participate in a cross-sectional study investigating long-term dental health outcomes. Participants completed a questionnaire that collected information on socio-demographic characteristics, dental health behaviours and receipt of orthodontic treatment. This was followed by clinical examination. The outcome variables were the summed decayed, missing and filled teeth (DMFT) score, and its individual components. Data were analysed using negative binomial regression.

Results: The response rate for the questionnaire was 34% (n = 632). There were no systematic differences between those who were followed up and those who were not followed up. Clinical data for 448 participants were available for analyses, representing 24% of the originally contacted individuals. By the age of 30, over a third of participants had received orthodontic treatment. Regardless of initial malocclusion classification, orthodontically treated participants had a lower DMFT score at age 30 but this did not reach statistical significance. Adjusted models controlling for socio-demographic, dental health behaviour and malocclusion status showed no associations between orthodontic treatment and decayed (Exp B: 1.00, 95% CI: 0.72-1.40), missing (Exp B: 1.00, 95% CI: 0.59-1.69), or filled teeth (Exp B: 1.18, 95% CI: 0.93-1.51) or overall DMFT (Exp B: 1.12, 95% CI: 0.88-1.41).

Conclusion: There was no difference in the long-term caries experience of South Australians aged 30 years based on past orthodontic treatment. Our study does not support the contention that those treated orthodontically have better dental health later in life.
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http://dx.doi.org/10.1111/cdoe.12446DOI Listing
June 2019

Assessment of pain-related fear in individuals with chronic painful conditions.

J Pain Res 2018 30;11:3071-3077. Epub 2018 Nov 30.

Australian Research Centre for Population Oral Health, Adelaide Dental School, The University of Adelaide, Adelaide, SA, Australia,

Background: Heightened fear and anxiety related to pain may result in emotional and behavioral avoidance responses causing disability, distress, and depression. Fear and anxiety associated with pain can potentially change the course of the pain experience. It is plausible that fear and anxiety related to pain affect the duration and frequency of pain experienced by the patient.

Aim: The study aimed to examine the applicability of the Fear of Pain Questionnaire-III (FPQ-III) in identifying who are likely to report longer duration and greater frequency of pain experience.

Methods: To test this hypothesis, a cross-sectional study was conducted with 579 individuals from a community-based sample living with chronic pain. The factor structure and validity of FPQ-III in the community-based sample were also tested.

Results: The findings suggest higher fear of severe pain but lower fear of medical pain, associated with longer duration and more frequent pain experience. The analysis also confirmed the three-factor structure of FPQ-III, demonstrating good internal consistency for fear of severe pain (0.71) and fear of medical pain (0.73) and acceptable range for fear of minor pain (0.65).

Conclusion: These findings suggest that the FPQ-III can be potentially applied to identify individuals at risk for prolonged continuous pain and as a screening tool to measure fear and anxiety related to pain.
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http://dx.doi.org/10.2147/JPR.S163751DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6280906PMC
November 2018

Socioeconomic and psychosocial associations with oral health impact and general health.

Community Dent Oral Epidemiol 2019 02 6;47(1):32-39. Epub 2018 Sep 6.

Australian Research Centre for Population Oral Health, The University of Adelaide, Adelaide, South Australia, Australia.

Background: There is debate whether both subjective and objective measures of socioeconomic status (SES) are needed to predict health, and whether these factors are explained by psychosocial characteristics. The aims were to investigate the association of socioeconomic and psychosocial variables with oral health impact and general health utility.

Methods: A random sample of 45- to 54-year-olds from Adelaide, South Australia, was surveyed by self-complete questionnaire in 2004-2005. Oral health impact was assessed using OHIP-14 and general health utility by EQ-5D. SES was determined using objective (income, education) and subjective (McArthur scale) measures. Psychosocial variables comprised social support, health self-efficacy, well-being, coping and affectivity.

Results: Data were collected from 879 participants (response rate = 43.8%). Both objective and subjective socioeconomic status measures were associated with OHIP and EQ-5D scores. Higher income and subjective social status were both associated (P < 0.05) with less oral health impact (β = -0.28 and β = -0.73, respectively) and better general health utility (both with β = 0.01, respectively). Psychosocial variables accounted for a relatively large percentage of variance in OHIP (20.7%) and EQ-5D (21.9%) scores.

Conclusions: For both oral health impact and general health utility, objective SES was significant in the presence of subjective SES. Psychosocial variables had important independent associations with both oral and general health.
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http://dx.doi.org/10.1111/cdoe.12419DOI Listing
February 2019

Variations in Australian dental therapy practice by practitioner and workplace characteristics.

Int Dent J 2018 Aug 21;68(4):235-244. Epub 2018 Feb 21.

Australian Research Centre for Population Oral Health, Adelaide Dental School, The University of Adelaide, Adelaide, SA, Australia.

Introduction: Understanding dental therapy practice across clinical settings is useful for education and service planning. This study assessed if dental therapy service provision varied according to practitioner and workplace characteristics.

Methods: Members of professional associations representing dental therapists (DT) and oral health therapists (OHT) were posted a self-complete survey collecting practitioner and workplace characteristics, together with clinical activity on a self-selected typical day of practice. Differences in service provision according to characteristics were assessed by comparing mean services per patient visit. Negative binomial regression models estimated adjusted ratios (R) of mean services per patient.

Results: The response rate was 60.6%. Of practitioners registered as an OHT or a DT, 80.0% (n = 500) were employed in general clinical practice. Nearly one-third of OHT and nearly two-thirds of DT worked in public sector dental services. Patterns of service provision varied significantly according to practice sector and other characteristics. After adjusting for characteristics, relative to private sector, public sector practitioners had higher provision rates of fissure sealants (R = 3.79, 95% confidence interval [95% CI]: 2.84-5.06), restorations (R = 3.78, 95% CI: 2.94-4.86) and deciduous tooth extractions (R = 3.58, 95% CI: 2.60-4.93) per patient visit, and lower provision rates of oral health instruction (R = 0.86, 95% CI: 0.76-0.98), fluoride applications (R = 0.43, 95% CI: 0.33-0.56), scale and cleans (R = 0.39, 95% CI: 0.34-0.45) and periodontal services (R = 0.20, 95% CI: 0.14-0.28) per patient visit.

Conclusion: Differences in service provision according to sector indicate that OHT and DT adapt to differing patient groups and models of care. Variations may also indicate that barriers to utilising the full scope of practice exist in some settings.
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http://dx.doi.org/10.1111/idj.12382DOI Listing
August 2018

Dental knowledge and dental service utilization: A 2-year follow-up study.

Community Dent Oral Epidemiol 2018 08 20;46(4):336-342. Epub 2018 Feb 20.

Australian Research Centre for Population Oral Health, Adelaide Dental School, The University of Adelaide, Adelaide, SA, Australia.

Objectives: To investigate associations of dental knowledge with dental service utilization over 2 years in South Australians aged 45-54 years.

Methods: In 2004-2005, a random sample of 2469 adults aged 45-54 years from Adelaide, South Australia, who were selected from the Australian electoral roll was surveyed. The outcome variables were the numbers of visits and dental services received over 2 years. Data were analysed using log-binomial and Poisson regression. Statistical significance was determined at P < .05.

Results: The response rates were 43.8% in the study group (n = 879) and 50.7% in the comparison group (n = 107). Oral examinations were conducted on 709 persons (81% of study group participants). Dental services data were collected from approximately 60% of participants at the end of years 1 and 2. After adjusting for sex, education, health card status, toothbrushing and inadequate dentition, higher caries knowledge and periodontal knowledge scores were associated with higher percentages of persons making dental visits (prevalence ratio, 95% CI: 1.2, 1.1-1.3 and 1.1, 1.0-1.3), and lower rates of extraction (rate ratio, 95% CI: 0.2, 0.1-0.4 and 0.4, 0.3-0.7) and endodontic services (0.5, 0.3-0.9 and 0.5, 0.3-0.7). Higher caries knowledge was associated with lower rates of fillings (0.8, 0.7-0.9) and denture services (0.1, 0.0-0.6), while higher periodontal knowledge was associated with higher numbers of visits (1.3, 1.2-1.5), and prophylaxis services (1.4, 1.1-1.8) and crowns (1.7, 1.1-2.5).

Conclusion: South Australians aged 45-54 years with higher dental knowledge had lower rates of invasive treatment over 2 years. These findings warrant policy initiatives that highlight the importance of dental knowledge in improving oral health.
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http://dx.doi.org/10.1111/cdoe.12371DOI Listing
August 2018

General health, wellbeing and oral health of patients older than 75 years attending health assessments.

Aust J Prim Health 2018 05;24(2):177-182

Australian Research Centre for Population Oral Health, Adelaide Dental School, Faculty of Health Sciences, The University of Adelaide, Adelaide, SA 5005, Australia.

Annual health assessments by general practices for community-dwelling people aged 75 years and over are important for the early intervention and monitoring of chronic health conditions, including oral disease. Uptake of the health assessment to date has been poor, and little is known of the general and oral health profile of patients. Older patients attending health assessments at general practices in South Australia were sampled for this study. Data on demographic and socioeconomic characteristics, and patients' general and oral health, were collected by mailed questionnaire from 459 respondents. By comparison with national estimates, patients attending health assessments fared worse in many of the measures, such as self-rated general health, quality of life and the prevalence of most chronic conditions, as well as their socioeconomic circumstances. Also identified were a high degree of nutritional risk and clear need for oral health treatment, with poor self-rated oral health being three-fold higher than the national age-eligible population. Patients attending health assessments would likely benefit from nutritional screening (by a validated tool) and specific assessment of their oral health and dentition, supported by appropriate referral or intervention.
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http://dx.doi.org/10.1071/PY17060DOI Listing
May 2018

General health and well-being among primary care patients aged 75+ years: Associations with living conditions, oral health and dependency.

Australas J Ageing 2018 Mar 13;37(1):E1-E6. Epub 2017 Nov 13.

Australian Research Centre for Population Oral Health, Faculty of Health and Medical Sciences, Adelaide Dental School, The University of Adelaide, Adelaide, South Australia, Australia.

Objective: Our aim was to examine the associations between general health and well-being with living conditions, oral health and degree of dependency.

Methods: We surveyed people from a primary care service and collected data on sociodemographic characteristics, general health, health utility, well-being, activities, living conditions and oral health impact.

Results: Overall, 459 participated (78% response rate). Poor general health was associated with decreased instrumental activities of daily living scores (18% of those with poor general health were independent vs 60% with good general health). Greater oral health impact was also related to poor general health. Health utility was lower for some dependency, for renting and oral health impact. Well-being was also lower for some dependency, for renting, not speaking English and oral health impact.

Conclusion: In addition to the well-known association of poor general health with dependency, our results also illustrate the potential importance of living conditions and oral health.
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http://dx.doi.org/10.1111/ajag.12475DOI Listing
March 2018

Third molor extractions among Australian adults: findings from the 2013 National Dental Telephone Interview Survey.

Int Dent J 2018 Apr 16;68(2):77-83. Epub 2017 Oct 16.

Australian Research Centre for Population Oral Health (ARCPOH), Adelaide Dental School, The University of Adelaide, Adelaide, SA, Australia.

Objectives: To identify, over the previous 12 months, whether: (i) dental insurance is associated with a higher number of third molar extractions (TME); (ii) single versus multiple TME is associated with self-rated oral health; and (iii) TME when 18-25 years of age is associated with fewer days absent from work because of dental problems.

Methodology: Australia's 2013 National Dental Telephone Interview Survey, which included: socio-demographics; and number of extractions, reasons for extractions, self-rated oral health and days absent from work because of dental problems, all in the past 12 months.

Results: The majority of TME recipients were female [56.6%, standard error (SE) = 6.0%], 18-25 years of age (63.0%, SE = 5.4%), held a tertiary qualification (73.9%, SE = 5.4%), had a total annual household income of ≥$60,000 (58.3%, SE = 6.4%), were dentally insured (52.6%, SE = 6.2%) and received multiple TME (60.9%, SE = 8.5%). Number of TME was associated with having dental insurance [B = 0.97: 95% confidence interval (95% CI): 0.5-1.5] and days of work absence because of dental problems (B = 1.10; 95% CI: 0.26-1.94). Receiving single TME versus multiple TME was not associated with self-rated oral health (B = -0.25; 95% CI: -0.76 to 0.25). Receiving TME when 18-25 years of age versus when older than 25 years of age was not associated with days absent from work because of dental problems (B = 0.48; 95% CI: -0.37 to 2.33).

Conclusion: Dental insurance was associated with a higher TME count without improving self-reported oral health in the short-term. Using age as a justification for prophylactic TME might be questionable because, receiving TME when 18-25 years of age versus when older than 25 years of age did not reduce days absent from work because of dental problems.
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http://dx.doi.org/10.1111/idj.12330DOI Listing
April 2018

Influence of Fear of Pain and Coping Strategies on Health-Related Quality of Life and Patient-Anticipated Outcomes in Patients With Chronic Pain: Cross-Sectional Study Protocol.

JMIR Res Protoc 2017 Sep 8;6(9):e176. Epub 2017 Sep 8.

Australian Research Centre for Population Oral Health, Adelaide Dental School, The University of Adelaide, Adelaide, Australia.

Background: Fear of pain and coping strategies are emotional-behavioral responses to pain and are known to play an important role in the development and maintenance of pain. It is highly likely that fear of pain and coping strategies influence each other, potentially affecting the course of chronic pain. To our knowledge, the relationship between pain, fear of pain and coping strategies, and how they influence patient-anticipated outcomes and health-related quality of life, have not been investigated.

Objective: The aims of this study are to test (1) if both fear of pain and/or coping strategies are sufficient causes for maintaining pain; and (2) whether fear of pain influences coping strategies and pain intensity. The study will also examine the impact of fear of pain and coping strategies on health-related quality of life and patient-anticipated outcomes.

Methods: The cross-sectional study will be conducted using an online survey. The Fear of Pain Questionnaire-III (FPQ-III), the Brief Coping Inventory (COPE), and EuroQoL-5d (EQ-5D) validated questionnaires will be used to collect data. Information pertaining to demographic factors, pain-related factors, and patient-anticipated outcomes will also be collected. The study has ethics approval from the Human Research Ethics Committee of the University of Adelaide. Study participants will be individuals aged 18 years and above who are experiencing chronic pain (ie, pain lasting more than 6 months). Effect measure modification technique (EMMM) will be used to examine if fear of pain acts as a moderator or mediator between coping strategies and pain. Simple and multinomial logistic regression analysis will be used to examine the effect of fear of pain and coping strategies on health-related quality of life and patient-anticipated outcomes.

Results: Recruitment began July 2017 and it is anticipated that data collection will be completed by October 2017. Findings from this study will help to extend our understanding of fear of pain and coping strategies, their interaction, and their impact on health-related quality of life and patient-anticipated outcomes.

Conclusions: Fear of pain and coping strategies have significant influence on the experience of chronic pain and its course. This study will help enhance our understanding of the relationship between fear of pain and coping strategies, which may help in developing patient-centered care practices.
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http://dx.doi.org/10.2196/resprot.8205DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5610352PMC
September 2017

The Life Story Experience of "Migrant Dentists" in Australia: Potential Implications for Health Workforce Governance and International Cooperation.

Int J Health Policy Manag 2017 06 1;6(6):317-326. Epub 2017 Jun 1.

Australian Research Centre for Population Oral Health, School of Dentistry, The University of Adelaide, Adelaide, SA, Australia.

Background: The migration of dentists is a major policy challenge facing both developing and developed countries. Dentists from over 120 countries migrate to Australia, and a large proportion are from developing countries. The aim of the study was to assess the life story experience (LSE) of migrant dentists in Australia, in order to address key policy challenges facing dentist migration.

Methods: A national survey of all migrant dentists resident in Australia was conducted in 2013. Migrant experiences were assessed through a suite of LSE scales, developed through a qualitative-quantitative study. Respondents rated experiences using a five-point Likert scale.

Results: A total of 1022 migrant dentists responded to the survey (response rate = 54.5%). LSE1 (health system and general lifestyle concerns in home country), LSE2 (appreciation towards Australian way of life) and LSE3 (settlement concerns in Australia) scales varied by migrant dentist groups, sex, and years since arrival to Australia (chi-square, P < .05). In a logistic regression model, migrants mainly from developing countries (ie, the examination pathway group) faced greater health system and general lifestyle concerns in their home countries (9.32; 3.51-24.72) and greater settlement challenges in Australia (5.39; 3.51-8.28), compared to migrants from well-developed countries, who obtained direct recognition of qualifications. Migrants also are more appreciative towards the Australian way of life if they had lived at least ten years in Australia (1.97; 1.27-3.05), compared to migrants who have lived for less than ten years.

Conclusion: Migrant dentists, mainly from developing countries, face challenges both in their home countries and in Australia. Our study offers evidence for multi-level health workforce governance and calls for greater consensus towards an international agenda to address dentist migration. Better integration of dentist migration with the mainstream health workforce governance is a viable and opportunistic way forward.
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http://dx.doi.org/10.15171/ijhpm.2016.135DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5458793PMC
June 2017

Exploring and modelling impacts of third molar experience on quality of life: a real-time qualitative study using Twitter.

Int Dent J 2017 Oct 24;67(5):272-280. Epub 2017 Mar 24.

Australian Research Centre for Population Oral Health (ARCPOH), Adelaide Dental School, The University of Adelaide, Adelaide, SA, Australia.

Objectives: This study had two objectives: (i) to explore and model domains describing the real-time impact of third molars (TMs) on quality of life (QoL); and (ii) to assess the percentage coverage, in some generic health-related quality of life (HRQoL) and oral health-related quality of life (OHRQoL) instruments, of the TM QoL domains identified in this study.

Methodology: A global cross-sectional sample of tweets containing 'wisdom tooth' over a 1-week period retrieved 3,537 tweets. After random quota sampling, classification and filtering, only 843 tweets were included in the thematic analysis. A TM QoL model was constructed based on the associations of the identified domains. Domains for the selected generic HRQoL and OHRQoL instruments were plotted against the domains identified in the study to calculate the percentage coverage for each.

Results: The QoL domains identified were pain (n = 348, 41%), mood (n = 173, 20%), anxiety and fear (n = 54, 7%), enjoying food (n = 41, 4%), coping (n = 37, 4%), daily activities (n = 34, 4%), sleep (n = 24, 2%), social life (n = 19, 2%), physical health (n = 17, 2%), ability to think (n = 9, 1%), self-care (n = 8, 1%) and sporting & recreation (n = 2, <1%). The Assessment Quality of Life instrument (AQoL-8D) covers 87% of the TM QoL domains, while the rest of the HRQoL and OHRQoL instruments cover 33-60%.

Conclusion: This study shows how Twitter can be used to obtain real-time QoL data, which might be used to model how TMs impact on QoL. The TM QoL domains identified in the study were generally under-represented among the generic OHRQoL instruments assessed while, the HRQoL AQoL-8D covered most of the TM QoL domains. The QoL domains identified in the study might be used to develop a new OHRQoL measure for TMs.
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http://dx.doi.org/10.1111/idj.12298DOI Listing
October 2017

Dentist age, period and cohort effects on provision of dental services in Australia: 1983-84 to 2009-10.

Community Dent Oral Epidemiol 2017 06 1;45(3):242-250. Epub 2017 Feb 1.

Australian Research Centre for Population Oral Health, The University of Adelaide, Adelaide, South Australia, Australia.

Objective: To examine age, period and cohort factors of dentists in relation to diagnostic, preventive and total dental services over time in Australia.

Method: The Longitudinal Study of Dentists' Practice Activity (LSDPA) was designed to monitor dental practice activity and service provision in Australia. Participating dentists were sampled randomly from the dental registers in Australia from 1983 to 1984, and dental services provision was collected by mailed questionnaire with a log of dental services provided over one or two typical days. The data collection has been repeated every 5 years until 2009-2010. Sample supplementation of newly registered dentists occurred at successive waves. This study focused on diagnostic, preventive and total services. The time trends in the mean rates of the services were described using a standard cohort table, and negative binomial regression was applied to estimate age, period and cohort effects.

Results: The response rates were 73%, 75%, 74%, 71%, 76% and 67% in 1983, 1988, 1993, 1998, 2003 and 2009, respectively. The mean rates of diagnostic, preventive and total services increased between 1983 and 2009 across all age groups. The period effect showed a higher rate of diagnostic (rate ratios [RR]: 1.21 in 1993 to 1.80 in 2009), preventive (RR: 1.19 in 1988 to 1.85 in 2009) and the total service (RR: 1.08 in 1988 to 1.39 in 2009) over time, compared with the reference group of 1983. Older cohorts had a lower rate, and the younger cohorts had a higher rate of diagnostic, preventive and the total number of services over the study period. The highest rate of diagnostic (RR=2.53), preventive (RR=2.44) and the total service (RR=1.52) was in those aged 25-29 years in 1983 compared with the reference group of 30-34 years in 1983.

Conclusions: Trends in dental services provision can be associated with age, period and cohort effects. The study found the rate of diagnostic, preventive and total services increased over time. Meanwhile, an increasing rate of diagnostic, preventive and the total services was observed when moving from older cohorts to younger cohorts among Australian dentists suggesting a sustained shift towards these services into the future.
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http://dx.doi.org/10.1111/cdoe.12282DOI Listing
June 2017

Work-Family Conflict Modifies the Association of Smoking and Periodontal Disease.

Int J Behav Med 2017 02;24(1):77-82

Australian Research Centre for Population Oral Health, School of Dentistry, University of Adelaide, 122 Frome Street, Adelaide, South Australia, 5005, Australia.

Purpose: The aims of the study were to assess the association of periodontal loss of attachment with smoking and work-family conflict and assess whether work-family conflict modifies the association of smoking and periodontal disease.

Method: A random sample of 45-54 year olds from metropolitan Adelaide, South Australia, was surveyed by mailed self-complete questionnaire during 2004-2005. Oral examinations were performed on persons who responded to the questionnaire, providing an assessment of periodontal status.

Results: A total of 879 responded (participation rate = 43.8 %), with n = 709 oral examinations (completion rate = 80.7 %). Prevalence of periodontal loss of attachment (LOA) of 6+ mm was higher (p < 0.05) for smokers (23.8 %) compared to non-smokers (7.8 %) among employed adults. The adjusted prevalence ratio for LOA 6+ mm was prevalence ratio (PR) = 4.9 (95 % CI 2.2-8.8) for smokers, and there was a significant interaction (p < 0.05) between smoking status and work-family conflict.

Conclusion: Work-family conflict modified the association of smoking with periodontal disease. Higher levels of work interfering with family were associated with higher levels of periodontal LOA for smokers compared with non-smokers.
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http://dx.doi.org/10.1007/s12529-016-9581-8DOI Listing
February 2017

Preventive services in Australia by patient and visit characteristics.

Int Dent J 2016 Dec 13;66(6):344-349. Epub 2016 Jun 13.

Australian Research Centre for Population Oral Health, School of Dentistry, University of Adelaide, Adelaide, South Australia, Australia.

Objectives: Growth in rates of preventive services has been linked to trends in retention of teeth and the emergence of minimal intervention approaches. In this study, we examined associations between patient-level characteristics and rates of the preventive services dental/prophylaxis and application of remineralisation agents.

Methods: A random sample of dentists in Australia was posted a self-administered questionnaire in 2009-2010. A service log was used to collect data on preventive services and patient characteristics.

Results: Responses were obtained from 1,148 dentists (response rate = 67%). Preventive service rate models, adjusted according to the age and gender of patients, indicated that insured patients had higher rates of prophylaxis [rate ratio (RR) = 1.39; 95% confidence interval (95% CI): 1.21-1.59) and remineralisation services (RR = 1.85; 95% CI: 1.46-2.33), and that emergency visits had lower rates for prophylaxis (RR = 0.26; 95% CI: 0.20-0.35) and remineralisation services (RR = 0.23; 95% CI: 0.14-0.38). Those who had 20 teeth or more demonstrated higher rates of prophylaxis (RR = 1.41; 95% CI: 1.13-1.75) and remineralisation services (RR = 1.45; 95% CI: 1.02-2.08). Those with decayed teeth had lower rates of prophylaxis (RR = 0.54; 95% CI: 0.46-0.63) and remineralisation services (RR = 0.66; 95% CI: 0.53-0.82).

Conclusions: Preventive services were associated with patient age, characteristics of visits and oral health. Patients who were worse off, in terms of attending an emergency visit for the relief of pain and having decayed teeth, had lower rates of preventive care. The findings indicate that patients most in need are missing out on the benefits of preventive dental services.
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http://dx.doi.org/10.1111/idj.12246DOI Listing
December 2016

Does self-efficacy mediate the effect of oral health literacy on self-rated oral health in an Indigenous population?

J Public Health Dent 2016 09 25;76(4):350-355. Epub 2016 May 25.

Dental School, University of Adelaide, Adelaide, South Australia, Australia.

Objectives: Mediation analyses are critical to understanding why behavioral interventions work. Health literacy is a known mediator between socio-economic factors, health behavior and oral health outcomes in various populations, explaining gradients in oral health status and outcomes. We explore whether self-efficacy (SE) mediates the association between oral health literacy (OHL) and self-rated oral health (SROH) in an Indigenous population.

Methods: Cross-sectional data collected from 278 rural-dwelling Indigenous Australians evaluated OHL, SE, SROH, socio-demographic and behavioral characteristics. OHL was measured using a validated OHL scale (HeLD-14), SE was measured using a validated SE scale and SROH was measured using a global, one-item statement. Theoretically-driven multivariable models, adjusted for age, sex, income, education, and dental service use estimated the prevalence ratios (PR) and 95 percent confidence intervals for poor SROH.

Results: The overall prevalence of poor SROH was 78.8 percent. The prevalence of low OHL was 46.0 percent, while the prevalence of low SE was 56.8 percent. Analysis showed a significant main effect of SE (PR = 2.5, 95 percent CI 1.3-4.6). SE attenuated the effects of OHL on poor SROH (from PR = 2.4 to PR = 2.0), supporting its associated role in the Indigenous population under study. Sobel and bootstrap testing confirmed the significance of the mediating effect (z = 2.2, SE 0.30, P < 0.05) and 95 percent CI (0.11-0.07) (P < 0.05) respectively.

Conclusions: Given that SE is a construct amenable to change, our results suggest that interventions that aim to improve SE may have positive impacts on SROH among this vulnerable population.
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http://dx.doi.org/10.1111/jphd.12162DOI Listing
September 2016