Complex associations exist among socioeconomic status (SES) in early life, beliefs about oral health care (held by individuals and their parents), and oral health–related behaviors. The pathways to ...poor adult oral health are difficult to model and describe, especially due to a lack of longitudinal data. The study aim was to explore possible pathways of oral health from birth to adulthood (age 38 y). We hypothesized that higher socioeconomic position in childhood would predict favorable oral health beliefs in adolescence and early adulthood, which in turn would predict favorable self-care and dental attendance behaviors; those would lead to lower dental caries experience and better self-reported oral health by age 38 y. A generalized structural equation modeling approach was used to investigate the relationship among oral health–related beliefs, behaviors in early adulthood, and dental health outcomes and quality of life in adulthood (age, 38 y), based on longitudinal data from a population-based birth cohort. The current investigation utilized prospectively collected data on early (up to 15 y) and adult (26 and 32 y) SES, oral health–related beliefs (15, 26, and 32 y), self-care behaviors (15, 28, and 32 y), oral health outcomes (e.g., number of carious and missing tooth surfaces), and oral health–related quality of life (38 y). Early SES and parental oral health–related beliefs were associated with the study members’ oral health–related beliefs, which in turn predicted toothbrushing and dental service use. Toothbrushing and dental service use were associated with the number of untreated carious and missing tooth surfaces in adulthood. The number of untreated carious and missing tooth surfaces were associated with oral health–related quality of life. Oral health toward the end of the fourth decade of life is associated with intergenerational factors and various aspects of people’s beliefs, SES, dental attendance, and self-care operating since the childhood years.
This study aimed to identify barriers and enablers for dentists managing non-cavitated proximal caries lesions using non- or micro-invasive (NI/MI) approaches rather than invasive and restorative ...methods in New Zealand, Germany and the USA.
Semi-structured interviews were conducted, focusing on non-cavitated proximal caries lesions (radiographically confined to enamel or the outer dentine). Twelve dentists from New Zealand, 12 from Germany and 20 from the state of Michigan (USA) were interviewed. Convenience and snowball sampling were used for participant recruitment. A diverse sample of dentists was recruited. Interviews were conducted by telephone, using an interview schedule based on the Theoretical Domains Framework (TDF).
The following barriers to managing lesions non- or micro-invasively were identified: patients' lacking adherence to oral hygiene instructions or high-caries risk, financial pressures and a lack of reimbursement for NI/MI, unsupportive colleagues and practice leaders, not undertaking professional development and basing treatment on what had been learned during training, and a sense of anticipated regret (anxiety about not restoring a proximal lesion in its early stages before it progressed). The following enablers were identified: the professional belief that remineralisation can occur in early non-cavitated proximal lesions and that these lesions can be arrested, the understanding that placing restorations weakens the tooth and inflicts a cycle of re-restoration, having up-to-date information and supportive colleagues and work environments, working as part of a team of competent and skilled dental practitioners who perform NI/MI (such as cleaning or scaling), having the necessary resources, undertaking ongoing professional development and continued education, maintaining membership of professional groups and a sense of professional and personal satisfaction from working in the patient's best interest. Financial aspects were more commonly mentioned by the German and American participants, while continuing education was more of a focus for the New Zealand participants.
Decisions on managing non-cavitated proximal lesions were influenced by numerous factors, some of which could be targeted by interventions for implementing evidence-based management strategies in practice.
To describe the occurrence of dental caries at the person, tooth and tooth surface level from childhood to early mid-life.
No studies have reported on age and caries experience in a population-based ...sample through the first half of life.
Prospective cohort study of a complete birth cohort (n = 1,037) born in 1972/73 in Dunedin, New Zealand. Dental examinations were conducted at ages 5, 9, 15, 18, 26, 32 and 38, and participation rates remained high. Surface-level caries data were collected at each age (WHO basic methods). Statistical analyses and graphing of data were undertaken using Intercooled Stata Version 10.
Data are presented on dental caries experience in the permanent dentition at ages 9, 15, 18, 26, 32 and 38. Percentile curves are charted and reported for person-level caries experience. Data are also presented on the number of decayed teeth and tooth surfaces, (including root surfaces at age 38), as a function of the number of teeth and surfaces present, respectively. Across the cohort, the number of tooth surfaces affected by dental caries increased by approximately 0.8 surfaces per year (on average), while the percentage of at-risk tooth surfaces affected by caries increased by approximately 0.5% per year, with negligible variation in that rate throughout the observation period.
These unique data show clearly that dental caries continues as a disease of adulthood, remaining important beyond childhood and adolescence and that rates of dental caries over time remain relatively constant.
Background
This study aimed to investigate the impact of self‐reported dental trauma on oral‐heath‐related quality of life (OHRQoL) of young adults and determine whether personality characteristics ...influenced how it was reported.
Method
A cross‐sectional study was carried out using a sample of 435 university students. A questionnaire sought data on previous dental trauma. OHRQoL was assessed using the short‐form of the oral health impact profile (OHIP‐14); the outcome being one or more impacts occurring ‘fairly often’/‘very often’. Personality was assessed using the Positive and Negative Affect Scale (PANAS).
Results
The participation rate was 87.2%. Dental trauma experience was reported by 110 participants (25.3%), and 242 (55.6 %) indicated previous dental caries experience. Among those with dental trauma history, one or more OHIP‐14 impacts was reported by 29.1% (with 21.2% among those with no history). Impact prevalence was higher among those who had previous dental caries experience (29.8%) than among those who had not (14.7%; P < 0.001). Higher PANAS negative affect scores were observed among those reporting one or more OHIP‐14 impacts (P < 0.001).
Conclusion
While dental trauma does not appear to have a negative impact on OHRQoL in young adults, past dental caries experience does. Negative emotionality influences self‐reported oral health.
US data on the validity and reliability of the short-form Family Impact Scale (FIS-8; a scale for measuring the impact of a child's oral condition on his/her family) are lacking.
Cross-sectional ...analysis of data on four-year-old US children taking part in a multi-center cohort study. For child-caregiver dyads recruited at child age 12 months, the impact of the child's oral condition on the family was assessed at age 48 months using the FIS-8, with a subsample of 422 caregivers (from 686 who were approached). Internal consistency reliability was assessed using Cronbach's α, with concurrent validity assessed against a global family impact item ("How much are your family's daily lives affected by your child's teeth, lips, jaws or mouth?") and a global oral health item ("How would you describe the health of your child's teeth and mouth?").
Cronbach's alpha was 0.83. Although gradients in mean scores across ordinal response categories of the global family impact item were inconsistent, there were marked, consistent gradients across the ordinal categories of the global item on the child's oral health, with scores highest for those rating their child's oral health as 'Poor'.
While the findings provide some evidence for the utility of the FIS in a US child sample, the study's replication in samples of preschoolers with greater disease experience would be useful.
Objective
To examine the factor structure and other psychometric characteristics of the most commonly used child oral‐health‐related quality‐of‐life (OHRQoL) measure (the 16‐item short‐form CPQ11‐14) ...in a large number of children (N = 5804) from different settings and who had a range of caries experience and associated impacts.
Methods
Secondary data analyses used subnational epidemiological samples of 11‐ to 14‐year‐olds in Australia (N = 372), New Zealand (three samples: 352, 202, 429), Brunei (423), Cambodia (244), Hong Kong (542), Malaysia (439), Thailand (220, 325), England (88, 374), Germany (1055), Mexico (335) and Brazil (404). Confirmatory factor analysis (CFA) was used to examine the factor structure of the CPQ11‐14 across the combined sample and within four regions (Australia/NZ, Asia, UK/Europe and Latin America). Item impact and internal reliability analysis were also conducted.
Results
Caries experience varied, with mean DMFT scores ranging from 0.5 in the Malaysian sample to 3.4 in one New Zealand sample. Even more variation was noted in the proportion reporting only fair or poor oral health; this was highest in the Cambodian and Mexican samples and lowest in the German sample and one New Zealand sample. One in 10 reported that their oral health had a marked impact on their life overall. The CFA across all samples revealed two factors with eigenvalues greater than 1. The first involved all items in the oral symptoms and functional limitations subscales; the second involved all emotional well‐being and social well‐being items. The first was designated the ‘symptoms/function’ subscale, and the second was designated the ‘well‐being’ subscale. Cronbach's alpha scores were 0.72 and 0.84, respectively. The symptoms/function subscale contained more of the items with greater impact, with the item ‘Food stuck in between your teeth’ having greatest impact; in the well‐being subscale, the ‘Felt shy or embarrassed’ item had the greatest impact. Repeating the analyses by world region gave similar findings.
Conclusion
The CPQ11‐14 performed well cross‐sectionally in the largest analysis of the scale in the literature to date, with robust and mostly consistent psychometric characteristics, albeit with two underlying factors (rather than the originally hypothesized four‐factor structure). It appears to be a sound, robust measure which should be useful for research, practice and policy.
Radiography is a regularly used and accepted adjunct to visual examination in the diagnosis of dental caries. It is assumed that not using radiographs can lead to underestimation of dental caries ...experience with most reports having involved studies of young adults or adolescents, and been focused on the permanent dentition. The aim of this study was to determine the relative contributions of bitewing radiography and clinical examination in the detection of dental caries in primary molars and to determine whether those contributions differ according to caries experience.
A cross-sectional study was conducted, involving examinations undertaken in dental clinics. Bitewing radiographs taken at the time of the clinical examination were developed and read later, with the data from those used at the analysis stage to adjust the caries diagnosis for the mesial, occlusal and distal surfaces of the primary molar teeth. Children's clinically determined dmfs score was used to allocate them to one of three caries experience groups (0 dmfs, 1-8 dmfs, or 9+ dmfs).
Of the 501 three-to-eight-year-old children examined, nearly three-quarters were younger than six. Caries prevalence and mean dmfs after clinical examination alone and following radiographs were 63.1% and 4.6 (sd, 6.2), and 74.7% and 5.8 (sd, 6.5) respectively. Among children with a dmfs of 1-8, the number of lesions missed during the clinical examination was greater than the number of 106 (25.6%) in children with a dmfs of 9+. In the 185 children with no apparent caries at clinical examination, 124 lesions were detected radiographically, among 58 (46.8%) of those.
Taking bitewing radiographs in young children is not without challenges or risks, and it must be undertaken with these in mind. Diagnostic yields from bitewing radiographs are greater for children with greater caries experience. The findings of this study further support the need to consider using bitewing radiographs in young children to enhance the management of lesions not detected by a simple visual examination alone.
ACTRN12614000844640 .
ABSTRACT
Introduction
The demands of operational deployment mean that defense force personnel must be dentally fit. Although medical evacuation for dental causes should be avoided, dental emergencies ...are a major non-combat-related contributor to withdrawal from deployment. Information on the oral health status of recruits and officer cadets entering the New Zealand Defence Force (NZDF) is scarce, yet it is useful for service and workforce planning. We investigated oral health status and its associations in new recruits and officer cadets entering the NZDF over a 13-month period.
Materials and Methods
This study used data from recruits’ initial dental examination (including baseline forensic charting), posterior bitewing radiographs, orthopantomograph radiograph, and a socio-dental questionnaire. The impaction status of third molar teeth was evaluated. Ethical approval was obtained from the University of Otago Ethics Committee (reference number D18/200) and the NZDF Organisational Research Committee.
Results
Of the 874 (83%) of the 1,053 recruits (age range 17-59 years) who participated, one in five were Māori. Nearly two-thirds were Army recruits. Caries prevalence was almost 70%. Mean Decayed, Missing, and Filled Teeth (DMFT) (3.0 overall) was higher among females and Māori. Few teeth were missing due to caries. Third molars were common, seen in 745 (88.3%). One in four maxillary third molars (but only one in six mandibular ones) had fully erupted. The most common type of impaction among mandibular third molars was the mesioangular type, followed by vertical, horizontal, and distoangular. Almost 60% of recruits had one or more potentially problematic third molars. The prevalence was highest in the youngest age groups, those of medium or low socioeconomic status and in Army or Navy recruits.
Conclusions
Recruits’ oral health was acceptable, but potentially problematic third molars were common, indicating a need for careful assessment (and their possible removal) before operational deployment.
While the use of adult oral-health-related quality-of-life (OHRQoL) measures in supplementing clinical indicators has increased, that for children has lagged behind, because of the difficulties of ...developing and validating such measures for children. This study examined the construct validity of the Child Perceptions Questionnaire (CPQ11-14) in a random sample of 12- and 13-year-old New Zealanders. It was hypothesized that children with more severe malocclusions or greater caries experience would have higher overall (and subscale domain) CPQ11-14 scores. Children (N = 430) completed the CPQ11-14 and were examined for malocclusion (Dental Aesthetic Index) and dental caries. There was a distinct gradient in mean CPQ11-14 scores by malocclusion severity, but there were differences across the four subscales. Children in the worst 25% of the DMFS distribution had higher CPQ11-14 scores overall and for each of the 4 subscales. The construct validity of the CPQ11-14 appears to be acceptable.
Objective
This study aims to assess the validity of four self-reported questions for measuring periodontitis in a birth cohort.
Methods
Full-mouth periodontal examinations (three sites/tooth) were ...undertaken at age 38 in a complete birth cohort born in 1972/1973 in New Zealand. Four self-reported periodontal screening questions were included (“Do you think you have gum disease”; “Has a dental professional ever told you that you have lost bone around your teeth”; “Have you ever had scaling, root planing, surgery, or other treatment for gum disease” and “Have you ever had any teeth that have become loose by themselves without some injury”), and the sensitivity and specificity of those self-reported items were calculated for individual questions and using a multivariable binary logistic regression model. Generalised linear models were used to compare relative risks for periodontitis and smoking, using the (a) clinical measures and (b) self-reported questions.
Results
Among the 895 who had periodontal examinations, the prevalence of periodontitis was 43.7, 22.8 and 12.0 %, respectively, for one or more sites with ≥4, ≥5 and ≥6 mm clinical attachment loss (AL). The specificity of the four self-reported questions was high (82–94 %), but the sensitivity was low for all, except the question: “Do you think you have gum disease”. The four questions’ highest combined sensitivity + specificity value was 1.33 for one or more sites with ≥4 mm AL, with the area under the receiver operating characteristic (ROC) curve being greatest for one or more sites with ≥6 mm AL, at 0.84. For the smoking–periodontitis association, the estimates of relative risk for periodontitis among smokers were as follows: (a) 1.81, 2.88 and 5.79, respectively, clinically determined to have one or more sites with ≥4, ≥5 and ≥6 mm AL and (b) 2.19, 2.17, 1.23 and 1.89, respectively, for the four self-reported questions.
Conclusion
The four self-reported periodontal screening questions performed adequately in identifying clinically determined periodontal disease, and they showed moderate validity when used together as a set. However, the strength of the association between smoking and periodontitis was underestimated when they were used instead of clinically determined periodontal disease.
Clinical relevance
These findings suggest that clinical examinations remain to be the desired approach for periodontal surveys, but where resource constraints preclude those, self-reported methods can provide useful information; after all, some periodontal information is better than none at all.
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