Publications by authors named "Liana Luzzi"

30 Publications

  • Page 1 of 1

Oral health changes among Indigenous and non-Indigenous Australians: findings from two national oral health surveys.

Aust Dent J 2021 Apr 26. Epub 2021 Apr 26.

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

Background: Historically, Indigenous Australians experienced poorer oral health than non-Indigenous Australians. We aimed to ascertain if Indigenous Australian oral health improved relative to non-Indigenous oral health between 2004-06 and 2017-18 National Surveys of Adult Oral Health (NSAOH).

Methods: Both NSAOHs were population-based cross-sectional surveys of Australian adults aged 15 years or more. In both surveys, representative samples of adults were drawn through a three-stage, stratified sample design within metropolitan and regional areas in each state/territory. Frequencies of Indigenous and non-Indigenous self-reported and clinical oral health variables were ascertained, and differences calculated, between the 2004-06 and 2017-18 NSAOHs. Ninety five percent confidence intervals were calculated and weights were used to account for the complex sampling methodology of both surveys.

Results: In 2004-06, 229 Indigenous and 13,882 non-Indigenous Australians provided self-report data, and 87 and 5418 of these had dental examinations, respectively. In 2017-18, 334 Indigenous and 15,392 non-Indigenous Australians provided self-report data, and 84 and 4937 of these had dental examinations, respectively. Between the surveys, relative to their non-Indigenous counterparts, Indigenous Australians experienced greater levels of; inadequate dentition (4.2%), experience of toothache (4.8%), problem-based dental attendance (4.5%) and 1+ teeth decayed, missing or filled (4.4%).

Conclusions: The gap between poor self-reported and clinical oral health between Indigenous and non-Indigenous Australians was greater in the more recent survey.
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http://dx.doi.org/10.1111/adj.12849DOI Listing
April 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

National Study of Adult Oral Health 2017-18: Study design and methods.

Aust Dent J 2020 06;65 Suppl 1:S5-S10

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

The National Study of Adult Oral Health (NSAOH) is Australia's third national oral examination survey of a representative sample of Australian adults. The study was undertaken primarily to describe levels of oral health in the population and to describe trends since the first survey, conducted in 1987-88. The aim of the study was to complete 7,200 examinations, necessitating approximately 15,200 completed interviews. Survey participants were selected using a multi-stage probability sampling design that began with the sampling of postcodes within states/territories in Australia. Individuals within selected postcodes were then selected by the Australian Government Department of Human Services (DHS) from the Medicare database. Following an initial opt-out period, participants were given the option to either complete the questionnaire online or to complete the questionnaire via a computer-assisted telephone interview. Participants were asked a series of questions about their oral health and dental service use and those who reported having one or more of their own natural teeth were invited to undergo a standardised oral examination. Examinations were conducted by state/territory dental practitioners who underwent prior training and calibration in survey procedures by the Australian Research Centre for Population Oral Health (ARCPOH), The University of Adelaide.
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http://dx.doi.org/10.1111/adj.12758DOI Listing
June 2020

National Study of Adult Oral Health 2017-18: participation and representativeness.

Aust Dent J 2020 06;65 Suppl 1:S11-S17

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

The National Study of Adult Oral Health (NSAOH) 2017-18 collected information from a sample of the Australian population aged 15 years and over. The Study comprised an interview questionnaire, completed by telephone or online, and an oral epidemiological examination among dentate participants. Participation in the Study was voluntary and therefore relied on the goodwill of selected participants. This paper provides a summary of participation rates for the Interview and Examination phases of the study. The potential for biased population estimates due to variation in participation rates is explored. The weighting procedure implemented to ensure the sample is representative of the target population is described and a comparison of the estimated population distributions derived from the weighted sample and the actual population distributions is provided for a range of socioeconomic characteristics. In summary, it can be concluded that estimates derived from the weighted Interview and Examination samples are valid estimates of the Australian population aged 15 years and over.
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http://dx.doi.org/10.1111/adj.12759DOI 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

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

Dentist-patient relationships and oral health impact in Australian adults.

Community Dent Oral Epidemiol 2020 08 13;48(4):309-316. Epub 2020 Apr 13.

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

Objectives: Dentist-patient relationships (DPRs) are a key component in clinical encounters with potential benefits for oral health outcomes. This study aimed to investigate whether better DPR variables are associated with higher oral health-related quality of life (OHRQoL).

Methods: A total of 12 245 adults aged 18 years or over were randomly sampled from South Australia in 2015-2016. Data were collected from self-complete questionnaires and analysed as a cross-sectional design. The outcome variable was the Oral Health Impact Profile (OHIP-14). Explanatory DPR variables included trust in dentists, satisfaction with dental care, and dental fear. Covariates comprising oral health behaviours, dental services, demographics, and socioeconomic status were included as potential confounding variables. Bivariate correlation analyses and multivariable linear regression were performed for the associations among explanatory, outcome variables and other covariates.

Results: Response data were analysed from 4220 participants (response rate = 41.9%). Unadjusted mean total scores of DPR variables and OHIP-14 were associated with most of the study participants' characteristics (P < .05). Bivariate correlations among DPR variables and OHIP-14 showed a diverse range of coefficients (|r| or |ρ|=0.22-0.67). Multivariable regression analyses in both individual/clustered block entry and full model indicated that higher satisfaction and less dental fear (B = -0.039 and 0.316, respectively in the full model) were associated with lower OHIP-14 after adjusting for possible confounders (P < .01).

Conclusions: This study found that favourable DPR variables, mainly greater satisfaction and less dental fear are positively associated with better OHRQoL. Further studies are warranted to investigate the causality and mediation/moderation of DPR variables on oral health outcomes.
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http://dx.doi.org/10.1111/cdoe.12534DOI Listing
August 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

The prevalence and severity of root surface caries across Australian generations.

Community Dent Oral Epidemiol 2019 10 4;47(5):398-406. Epub 2019 Jul 4.

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

Background: The "failure of success" theory predicts that as subsequent generations of older adults retain more teeth, those additional teeth will experience more oral disease like root surface caries. The theory in relation to root surface caries has never been tested in a cross-generational study. This study aims to compare root surface caries across generations of South Australian older adults to test the theory and explore risk indicators for root surface caries.

Methods: Data were from the baseline of two South Australian studies separated by 22 years. In both studies, stratified random samples of people aged 60+ years from Adelaide and Mount Gambier were recruited. Dental examinations were performed by trained and calibrated dentists. One of the dental examiners from the earlier study was the gold standard examiner in the second study. Risk indicators included behavioural factors, clinical oral conditions, sociodemographic and socioeconomic status. Root surface caries was assessed as untreated root surface caries (root decayed surfaces [RDS]), treated root surface caries (root filled surfaces [RFS]) and treated or untreated root surface caries (root decayed and filled surfaces [RDFS]) and was presented as the prevalence and summed count. Multivariable models for Poisson and negative binomial distributions were used to estimate prevalence ratios (PR) and mean ratios (MR), respectively, and their 95% confidence intervals (95% CI).

Results: The current generation of South Australian older adults has significantly lower RDS (PR [95% CI] = 0.65 [0.47-0.89]; MR [95% CI] = 0.51 [0.35-0.73]) and RDFS (PR [95% CI] = 0.84 [0.71-0.99]; MR [95% CI] = 0.76 [0.65-0.90]) than the previous generation. The RFS in the previous and current generation was similar. Gingival recession, irregular brushing, dental visiting for a problem and smoking were the indicators for RDS, while age, gingival recession, tooth brushing frequency, time since last dental visit and reason of visiting were the indicators for RFS or RDFS.

Conclusions: These results do not support the "failure of success" theory in relation to root surface caries among South Australian older adults. Despite the higher number of teeth retained, the current generation of older adults has less root surface caries than the previous generation. Behavioural factors remain the indicators of root surface caries across the generations.
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http://dx.doi.org/10.1111/cdoe.12459DOI Listing
October 2019

Psychometric properties of the Child Oral-care Performance Assessment Scale.

Community Dent Oral Epidemiol 2019 10 30;47(5):424-430. Epub 2019 May 30.

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

Objectives: This study aimed to assess the psychometric properties of Child Oral-care Performance Assessment Scale (COPAS).

Methods: Items for the instrument were developed and pilot tested. This questionnaire was implemented in the Australian National Child Oral Health Study 2012-2014, whose aims included the assessment of oral care performance. This nationally representative sample of 23 538 respondents with complete data was divided into five groups: a main validation group and four cross-validation groups, using blocked randomization. Two scales were constructed, full scale with 37 items (COPAS) and a partial scale with a subset of 31 items (COPAS-Partial). Internal consistency was assessed using Cronbach's alpha. Construct validity was assessed using correlation coefficients, and structural validity was ascertained in the main validation group and confirmed in the cross-validation groups using structural equation models.

Results: Cronbach's alpha for COPAS was 0.95, and for COPAS-Partial was 0.94. The convergent validity of global satisfaction with oral care and the subscales was r = 0.29-0.51, and that with the overall scales was r = 0.59 for COPAS and r = 0.59 for COPAS-Partial. COPAS (Root mean squared error of approximation (RMSEA) = 0.06, Comparative fit index (CFI) = 0.90, Tucker-Lewis index (TLI) = 0.89, and Coefficient of determination(COD) = 0.99) and COPAS-Partial (RMSEA = 0.07, CFI = 0.91, TLI = 0.90, COD = 0.97) had adequate fit. Structural invariance was present (P-value = 0.97).

Conclusion: There was acceptable structural validity, construct validity and internal consistency in the models tested for COPAS and COPAS-Partial. COPAS has potential use in the evaluation of the delivery of dental services to children.
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http://dx.doi.org/10.1111/cdoe.12476DOI Listing
October 2019

Socioeconomic gradients in toothache experience among Australian adults: A time trend analysis from 1994 to 2013.

Community Dent Oral Epidemiol 2019 08 2;47(4):324-332. Epub 2019 May 2.

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

Objectives: To identify time trend pattern in toothache and to estimate whether toothache prevalence differs by socioeconomic position and residential location over time.

Methods: Data from nine successive National Dental Telephone Interview Surveys (NDTIS) from 1994 (n = 6907) to 2013 (n = 6778) performed in Australia among individuals aged 15 years or over were used. The dependent variable was toothache reported very often, often or sometimes during the previous 12 months. Independent variables were age group, household income (tertiles), insurance/cardholder status and geographical remoteness. Prais-Winsten analyses were performed, and the average annual percentage change (AAPC) for toothache prevalence was estimated.

Results: Toothache affected slightly more than 10% of the overall population in 1994 (11.6%) and 1995 (11.4%), reaching approximately one-sixth (16.2%) of individuals in 2013. Overall, there was a significant increase in toothache prevalence over time (AAPC = 2.0% [95% CI 0.7;1.34]) and in those aged 25-44 (AAPC 2.1% [95% CI 0.6;3.6]) and 45-64 (AAPC 3.4% [95% CI 1.5;5.3]) years and markedly among those in the lowest income group (AAPC 3.4% [95% CI 0.1;6.7]). All geographic locations except for remote/very remote areas had upward toothache prevalence over time. Insured status was not associated with increased toothache prevalence during the investigated period.

Conclusions: Toothache prevalence increased from 1994 to 2013 in Australian adults particularly among the lowest socioeconomic group.
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http://dx.doi.org/10.1111/cdoe.12461DOI Listing
August 2019

Root surface caries among older Australians.

Community Dent Oral Epidemiol 2018 12 4;46(6):535-544. Epub 2018 Jul 4.

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

Objectives: Root caries has increased as a clinical problem in recent decades. However, the use of multiple waves of longitudinal follow-up data in estimating root caries increment has not been previously attempted. The aims of this study were to quantify root caries increment from a longitudinal study of older adults with 4 oral examinations over 11 years and to examine behavioural factors associated with root caries.

Methods: A secondary analysis was undertaken using data collected in 4 waves (baseline, 2-year, 5-year and 11-year) of the South Australian Dental Longitudinal Study which began in 1991/92. The study group consisted of a stratified random sample of people aged 60+ years at baseline. A total of 358 participants with complete oral examinations in all 4 waves were included. The examinations were performed by trained and calibrated dentists. Baseline behavioural risk factors (toothbrushing frequency, flossing frequency, dental visiting pattern, reason for dental visiting and tobacco smoking status) and time in years across the 4 waves were the main exposures. Baseline clinical oral conditions (gingival condition and gingival recession), demographic and socio-economic risk factors served as covariates. Root caries was measured as mean number of untreated root surfaces (root DS) and decayed/filled root surfaces (root DFS) at each wave of examinations. Multivariable multilevel growth model using linear regression analysis was used to get an estimate for root caries increment and associated oral health-related behaviours adjusting for all the covariates.

Results: Findings from the multivariable models indicated that the annual increment of root DS and root DFS were 0.07 (SE = 0.01) and 0.11 (SE = 0.02) surfaces, respectively. Irregular brushing (E [SE] = 0.25 [0.12]), visiting the dentist only for problems (E [SE] = 0.30 [0.13]) and smoking (E [SE] = 0.33 [0.12]) were risk factors for the increase in root DS. Irregular flossing and more frequent dental visit were associated with the increase in root DFS.

Conclusions: Root caries increased slowly across time among relatively healthier Australian older adults. Irregular brushing, unfavourable dental visiting and tobacco smoking were risk factors for the increase in untreated root caries, while irregular flossing and more frequent dental visiting were associated with the increase in root DFS.
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http://dx.doi.org/10.1111/cdoe.12386DOI Listing
December 2018

Root caries incidence and increment in the population - A systematic review, meta-analysis and meta-regression of longitudinal studies.

J Dent 2018 10 21;77:1-7. Epub 2018 Jun 21.

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

Objectives: Previous meta-analyses of root caries incidence and increment studies reported different estimates due to the limited number of studies, heterogeneity and variations in studies included. Currently, new publications and approaches to handle heterogeneity are available. This research aims to systematically review and meta-analyse root caries incidence and increment, and use meta-regression to analyse heterogeneity.

Sources: PUBMED and EMBASE databases were searched systematically.

Study Selection: Longitudinal studies on root caries incidence and increment, published in English language prior to 2017, were independently checked by two authors. A pooled incidence and increment of decayed/filled root surfaces (DFS) was estimated and meta-regression analysis was performed by length of follow-up (<2 years; 2years; 3-4years and ≥5years) and study type (observational population-based and clinical trial).

Data: Of 737 articles, 20 were included for meta-analysis. The annualised root caries incidence and increment were 18.25%[CI = 13.22%-23.28%] and 0.45[CI = 0.37-0.53] root DFS respectively. Length of follow-up influenced the estimates, but not the study type. The annual root DFS incidence and increment from studies <2years were 32.95%[CI = 29.13%-36.77%] and 0.64[CI = 0.38-0.89] root surfaces respectively. Studies with 5+years follow-up, the annualised root caries incidence and increment were 9.4%[CI = 3.32%-15.48%] and 0.43[CI = 0.21-0.64] root surfaces respectively.

Conclusions: Length of follow-up influenced root caries estimates due to a bias towards relatively healthier older adults retained in the study. Root caries increased over time even among the healthier older adults.

Clinical Significance: The increase in root caries, even among the healthier older adults, should be considered by both clinicians and healthcare planners/policy makers in their provision of services.
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http://dx.doi.org/10.1016/j.jdent.2018.06.013DOI Listing
October 2018

Critical review of the validity of patient satisfaction questionnaires pertaining to oral health care.

Community Dent Oral Epidemiol 2018 08 30;46(4):369-375. Epub 2018 Mar 30.

ARCPOH, Adelaide Dental School, University of Adelaide, Adelaide, SA, Australia.

Objectives: Review the validation process reported for oral healthcare satisfaction scales that intended to measure general oral health care that is not restricted to specific subspecialties or interventions.

Methods: After preliminary searches, PUBMED and EMBASE were searched using a broad search strategy, followed by a snowball strategy using the references of the publications included from database searches. Title and abstract were screened for assessing inclusion, followed by a full-text screening of these publications. English language publications on multi-item questionnaires that report on a scale measuring patient satisfaction for oral health care were included. Publications were excluded when they did not report on any psychometric validation, or the scales were addressing specific treatments or subspecialities in oral health care.

Results: Fourteen instruments were identified from as many publications that report on their initial validation, while five more publications reported on further testing of the validity of these instruments. Number of items (range: 8-42) and dimension reported (range: 2-13) were often dissimilar between the assessed measurement instruments. There was also a lack of methodologies to incorporate patient's subjective perspective. Along with a limited reporting of psychometric properties of instruments, cross-cultural adaptations were limited to translation processes.

Conclusions: The extent of validity and reliability of the included instruments was largely unassessed, and appropriate instruments for populations outside of those belonging to general adult populations were not present.
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http://dx.doi.org/10.1111/cdoe.12377DOI Listing
August 2018

The role of cognitions in short-term temporal changes in dental fear among Australian adults.

J Public Health Dent 2018 12 3;78(1):32-40. Epub 2017 Aug 3.

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

Objectives: To determine if temporal changes in dental fear over a 4-month period are predicted by changed cognitive vulnerability-related perceptions of going to the dentist.

Methods: Australian adults (n = 484) completed mailed questionnaires at baseline and follow-up, containing measures of dental fear, cognitive vulnerability-related perceptions, dental services received, and possible aversive experiences during the study period. Change in dental fear was the main outcome measure, categorized as decreased (Fear ), unchanged (Fear ), and increased (Fear ).

Results: Across the study period, 15.5 percent of people had Fear , 73.4 percent had Fear , and 11.1 percent had Fear . In a multinomial logistic regression, after controlling for participant gender, income, time since last dental visit at baseline, dental fear at baseline and experiencing an aversive event, increased vulnerability-related perceptions were significantly associated with Fear (OR = 2.83, P < 0.001) while decreased vulnerability-related perceptions were associated with Fear (OR = 0.17, P < 0.001).

Conclusions: This study found, across a relatively short 4-month period, that increased vulnerability-related perceptions of visiting the dentist predicted increased dental fear while decreased vulnerability-related perceptions predicted decreased dental fear. More appropriate study designs, such as longitudinal designs, and longer follow-up periods are needed to determine the possible causal nature of these associations.
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http://dx.doi.org/10.1111/jphd.12232DOI Listing
December 2018

Root caries experience among Australian adults.

Gerodontology 2017 Sep 10;34(3):365-376. Epub 2017 May 10.

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

Background: Increase in life expectancy and tooth retention in contemporary Australian adults may increase population-level burden of having root caries. This study aimed to describe patterns and evaluate associations of root caries with socio-demographic, socio-economic, clinical and behavioural factors.

Methods: A secondary analysis was undertaken using data from the National Survey of Adult Oral Health 2004-2006, which included 5505 randomly general adults 15+ years old. Participants underwent an oral examination and completed an interview and a questionnaire. Prevalence and mean number of decayed/filled root (root DFS), untreated root (root DS), filled root (root FS), gingival recession, oral hygiene and gingival status were derived from examinations. Socio-demographic, socio-economic and behavioural factors were self-reported. Multivariable models were generated to estimate prevalence ratios (PR), mean ratios (MR) and confidence intervals (95% CI), adjusting for number of surfaces with gingival recession. Additional analysis for older adults 60+ years old was presented.

Results: The prevalence of root caries was 25.3% (CI=23.6-27.1) and 62.0% [CI=58.7-65.1] among general and older adults, respectively. Risk factors found were similar in both populations. Smokers had higher prevalence and mean number of root DFS, DS and FS than never-smokers. In contrast with poor oral hygiene, high income and frequent brushing were significantly associated with lower mean root DS. Frequent dental visiting was associated with higher root FS and DFS.

Conclusions: Root caries affected about a quarter of Australian general adults and more than a half of older adults. People who were smokers presented a significantly higher prevalence and severity of root caries.
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http://dx.doi.org/10.1111/ger.12275DOI Listing
September 2017

Having fewer than 21 teeth associated with poorer general health among South Australians.

J Public Health Dent 2017 Jun 13;77(3):216-224. Epub 2017 Feb 13.

Flinders Health Economics Group & Palliative Care Clinical Studies Collaborative, Flinders University, Adelaide, Australia.

Objective: To explore whether having less than 21 teeth is associated with poorer general health in a representative population sample of South Australians.

Methods: Data were from a cross-sectional state-based survey, conducted from September to December 2013. Complete data were available for 2,908 participants (58 percent response rate). General health-related quality of life (HrQOL), as measured by the EuroQol instrument (EQ-5D-5L), was the main outcome measure. Total disutility scores were calculated, with the five individual EQ-5D dimensions then dichotomized into "no problems" and "at least one problem." The main explanatory variable was self-reported missing teeth, as assessed by having <21 teeth versus 21+ teeth in a questionnaire.

Results: Overall, disutility was low (0.09) (ranges from 0 to 1, with high scores indicating poorer general health). In multivariable analysis, total disutility was positively associated with older age, lower annual household income, lower levels of physical activity, being a current tobacco smoker, receiving mental health treatment and <21 teeth. When individual dimensions were considered, missing teeth remained significantly associated with mobility problems (PR 1.26, 95 percent CI 1.06, 1.50) and pain/discomfort (PR 1.16, 95 percent CI 1.06, 1.27).

Conclusions: Missing teeth was associated with poor general health status as measured by EQ-5D-5L disutility. The relationship was especially evident with respect to mobility and pain/discomfort. The findings emphasize the importance of oral health as predictors of general health.
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http://dx.doi.org/10.1111/jphd.12200DOI Listing
June 2017

Inequalities in Tooth Decay in Australian Children by Neighbourhood Characteristics and Indigenous Status.

J Health Care Poor Underserved 2016 ;27(1A):161-177

Objective: Tooth decay is related to poverty, measured at individual and neighbourhood levels. It is however uncertain if living in an advantaged neighbourhood reduces tooth decay similarly in Australian Indigenous and non-Indigenous children.

Methods: This study describes tooth decay by neighbourhood characteristics and Indigenous status, and examines inequalities by Indigenous status.

Results: In deciduous dentition the percentage of children with tooth decay and untreated decay decreased on average 26% and 20% respectively in the non-Indigenous sample from poor to affluent neighbourhoods. In Indigenous children tooth decay and untreated decay decreased on average 6% and 8%, respectively, from poor to affluent neighbourhoods.

Conclusion: While all children from affluent areas had less tooth decay, the gap between non-Indigenous and Indigenous children remained significant across neighbourhood characteristics. This suggests that both universal and targeted prevention programs should be considered for all Indigenous children irrespective of where they live.
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http://dx.doi.org/10.1353/hpu.2016.0045DOI Listing
April 2018

Changes in Area-level Socioeconomic Status and Oral Health of Indigenous Australian Children.

J Health Care Poor Underserved 2016 ;27(1A):110-124

Objective: Dental diseases have shown to be influenced by area-level socioeconomic status. This study aims to assess the effects of change in area-level SES on the oral health of Australian Indigenous children.

Methods: Data were collected from a national surveillance survey for children's dental health at two points of time (2000-2002/2007-2010). The study examines caries experienced by area-level SES and whether changes in area-level SES (stable-high, upwardly-mobile, downwardly-mobile and stable low) affects caries experience.

Results: Dental caries in both the deciduous and permanent dentition increased significantly among Indigenous children during the study period. In stable low-SES areas, the experience of decayed, missing and overall dmft/DMFT in both dentitions was highest compared with other groups at both Time 1(2.15 vs 1.61, 1.77, 1.87 and 0.86 vs 0.55, 0.67, 0.70 respectively) and Time 2 (3.23 vs 2.08, 2.17, 2.02 and 1.49 vs 1.18, 1.21 respectively).

Conclusion: A change in area-level SES was associated with experience of dental disease among Indigenous Australian children.
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http://dx.doi.org/10.1353/hpu.2016.0034DOI Listing
April 2018

Inequalities in Tooth Decay in Australian Children by Neighbourhood Characteristics and Indigenous Status.

J Health Care Poor Underserved 2016 Feb;27(1 Suppl):161-77

Objective: Tooth decay is related to poverty, measured at individual and neighbourhood levels. It is however uncertain if living in an advantaged neighbourhood reduces tooth decay similarly in Australian Indigenous and non-Indigenous children.

Methods: This study describes tooth decay by neighbourhood characteristics and Indigenous status, and examines inequalities by Indigenous status.

Results: In deciduous dentition the percentage of children with tooth decay and untreated decay decreased on average 26% and 20% respectively in the non-Indigenous sample from poor to affluent neighbourhoods. In Indigenous children tooth decay and untreated decay decreased on average 6% and 8%, respectively, from poor to affluent neighbourhoods.

Conclusion: While all children from affluent areas had less tooth decay, the gap between non-Indigenous and Indigenous children remained significant across neighbourhood characteristics. This suggests that both universal and targeted prevention programs should be considered for all Indigenous children irrespective of where they live.
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http://dx.doi.org/10.1353/hpu.2016.0045DOI Listing
February 2016

Changes in Area-level Socioeconomic Status and Oral Health of Indigenous Australian Children.

J Health Care Poor Underserved 2016 Feb;27(1 Suppl):110-24

Objective: Dental diseases have shown to be influenced by area-level socioeconomic status. This study aims to assess the effects of change in area-level SES on the oral health of Australian Indigenous children.

Methods: Data were collected from a national surveillance survey for children's dental health at two points of time (2000-2002/2007-2010). The study examines caries experienced by area-level SES and whether changes in area-level SES (stable-high, upwardly-mobile, downwardly-mobile and stable low) affects caries experience.

Results: Dental caries in both the deciduous and permanent dentition increased significantly among Indigenous children during the study period. In stable low-SES areas, the experience of decayed, missing and overall dmft/DMFT in both dentitions was highest compared with other groups at both Time 1(2.15 vs 1.61, 1.77, 1.87 and 0.86 vs 0.55, 0.67, 0.70 respectively) and Time 2 (3.23 vs 2.08, 2.17, 2.02 and 1.49 vs 1.18, 1.21 respectively).

Conclusion: A change in area-level SES was associated with experience of dental disease among Indigenous Australian children.
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http://dx.doi.org/10.1353/hpu.2016.0034DOI Listing
February 2016

Income-related inequalities in inadequate dentition over time in Australia, Brazil and USA adults.

Community Dent Oral Epidemiol 2015 Jun 22;43(3):217-25. Epub 2015 Jan 22.

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

Objective: To assess changes over time of the absolute and relative household income-related inequalities in inadequate dentition (ID) among Australians, Brazilians and USA adults.

Methods: This study used nationwide oral health survey data from Australia (n = 1200 in 1999; n = 2729 in 2005), Brazil (n = 13 431 in 2003; n = 9779 in 2010) and USA (n = 2542 in 1999; n = 1596 in 2005). Absolute income inequalities were calculated using Absolute Concentration Index (ACI) and Slope Index of Inequality (SII), while relative inequalities were calculated using Relative Concentration Index (RCI) and Relative Index of Inequality (RII).

Results: Prevalence of ID in the studied period dropped from 8.7% to 3.1% in Australia; from 42.1% to 22.4% in Brazil; and remained stable in USA, nearly 8.0%. Absolute income inequalities were highest in Brazil, followed by the USA and Australia; relative inequalities were lower in Brazil than in Australia and the USA. ID was higher among Brazilian females (2010) and for the poorest group in all countries and periods. A remarkable reduction in absolute inequalities were found in Australia [Slope Index of Inequality (SII) and AIC 60%] and in Brazil (SII 25%; ACI 33%) while relative inequalities increased both in Australia (RCI and RII 40%) and in Brazil (RCI 24%; RII 38%). No changes in absolute and relative income inequalities were found in the USA.

Conclusion: There were still persistent absolute and relative income inequalities in ID in all examined countries. There has been a reduction in absolute income inequalities in ID but an increase in relative income inequalities.
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http://dx.doi.org/10.1111/cdoe.12144DOI Listing
June 2015

Trends in dental visiting avoidance due to cost in Australia, 1994 to 2010: an age-period-cohort analysis.

BMC Health Serv Res 2013 Oct 3;13:381. Epub 2013 Oct 3.

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

Background: The cost of dental care may be a barrier to regular dental attendance with the proportion of the Australian population avoiding or delaying care due to cost increasing since 1994. This paper explores the extent to which age, period and cohort factors have contributed to the variation in avoiding or delaying visiting a dentist because of cost.

Methods: Data were obtained from four national dental telephone interview surveys of Australian residents aged five years and over conducted in 1994, 1999, 2004 and 2010 (response rates 48%-72%). The trend in the percentage of persons avoiding or delaying visiting a dentist because of cost was analysed by means of a standard cohort table and more formal age-period-cohort analyses using a nested models framework.

Results: There was an overall increase in the proportion of people avoiding or delaying visiting a dentist indicating the presence of period effects. Financial barriers were also associated with age such that the likelihood of avoiding because of cost was highest for those in their mid-late twenties and lowest in both children and older adults. Cohort effects were also present although the pattern of effects differed between cohorts.

Conclusion: The findings of this study suggest that, in addition to the increase in costs associated with dental care, policies targeting specific age groups and income levels may be contributing to the inequality in access to dental care.
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http://dx.doi.org/10.1186/1472-6963-13-381DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3851774PMC
October 2013

Families and their use of dental services.

Aust Dent J 2012 Mar;57(1):103-8

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

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http://dx.doi.org/10.1111/j.1834-7819.2011.01668.xDOI Listing
March 2012

Social inequality in use of dental services: relief of pain and extractions.

Aust N Z J Public Health 2008 Oct;32(5):444-9

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

Objectives: The aim of this study was to assess social inequality in use of dental services by examination of visiting for relief of pain and receipt of extractions.

Methods: Data were collected in the period of 2004-06, from a stratified clustered sample of Australians aged 15+ years, using a computer-aided telephone interview. Analysis was restricted to n=10,099 dentate adults.

Results: Visiting for relief of pain varied by age, country of birth, education and income with lower odds (Odds ratio, 95%CI) among 55-74 (0.43, 0.35-0.54) and 75+ year-olds (0.22, 0.15-0.33) compared to the 15-34 year-olds, lower odds among Australian-born persons (0.82,0.69-0.98) compared to those born overseas, higher odds for those with no post-secondary education (1.31, 1.07-1.61) and with TAFE, trade or other qualifications (1.34, 1.09-1.66) compared to university qualified, and for those in the <$20,000 income group (1.61, 1.23-2.12), the $20,000-<$40,000 (1.53, 1.20-1.96) and the $40,000-<$60,000 group (1.33, 1.02-1.72) compared to <$80,000+. Receipt of extractions varied by age, sex, qualifications and income, with lower odds of extraction among persons of 75+ years (0.61,0.40-0.93) compared to the youngest age group, higher odds among males (1.34, 1.13-1.59) compared to females, those with no post-secondary education (1.59, 1.27-1.99) and with TAFE, trade or other qualifications (1.49, 1.21-1.84) compared to university qualified, and for the income groups <$20,000 (3.06, 2.27-4.12), $20,000-<40,000 (2.37, 1.80-3.12) and $40,000-<60,000 (1.94 1.47-2.55) compared to the $80,000+ income group.

Conclusions: The results indicate social inequality in provision of dental services and suggest an urgent need for the dental profession and governments to address this inequality.
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http://dx.doi.org/10.1111/j.1753-6405.2008.00277.xDOI Listing
October 2008

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

BMC Health Serv Res 2008 Apr 30;8:93. Epub 2008 Apr 30.

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

Background: 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.

Methods: 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.

Results: 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 < 0.05). Intentions, self-efficacy and past dental attendance were significant predictors of actual dental attendance (P < 0.05).

Conclusion: 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.
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http://dx.doi.org/10.1186/1472-6963-8-93DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2390532PMC
April 2008

Dental service patterns among private and public adult patients in Australia.

BMC Health Serv Res 2008 Jan 3;8. Epub 2008 Jan 3.

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

Background: While the majority of dental care in Australia is provided in the private sector those patients who attend for public care remain a public health focus due to their socioeconomic disadvantage. The aims of this study were to compare dental service profiles provided to patients at private and public clinics, controlling for age, sex, reason for visit and income.

Methods: Data were collected in 2004-06, using a three-stage, stratified clustered sample of Australians aged 15+ years, involving a computer-assisted telephone interview (CATI), oral examination and mailed questionnaire. Analysis was restricted to those who responded to the CATI.

Results: A total of 14,123 adults responded to the CATI (49% response) of whom 5,505 (44% of those interviewed) agreed to undergo an oral epidemiological examination. Multivariate analysis controlling for age, sex, reason for visit and income showed that persons attending public clinics had higher odds [Odds ratio, 95%CI] of extraction (1.69, 1.26-2.28), but lower odds of receiving oral prophylaxis (0.50, 0.38-0.66) and crown/bridge services (0.34, 0.13-0.91) compared to the reference category of private clinics.

Conclusion: Socio-economically disadvantaged persons who face barriers to accessing dental care in the private sector suffer further oral health disadvantage from a pattern of services received at public clinics that has more emphasis on extraction of teeth and less emphasis on preventive and maintenance care.
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http://dx.doi.org/10.1186/1472-6963-8-1DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2246120PMC
January 2008