RESUMEN
OBJECTIVES: The management of early childhood caries is challenging and the impacts of its treatment on child oral health-related quality of life (COHRQoL) and dental anxiety among Australian Aboriginal children is relatively unknown. The aim of the study was to compare the impact on COHRQoL and dental anxiety after approximately 12 months among Aboriginal children treated for early childhood caries (ECC) using the Atraumatic Restorative Treatment and the Hall Technique (ART/HT: test) or standard care (control). METHODS: Consenting Aboriginal communities in the North-West of Western Australia were randomized into early (test) or delayed (control) intervention for the management of ECC. Children and parents/carers completed a questionnaire at baseline and at follow-up. The questionnaire sought information on COHRQoL using the proxy-reported Early Childhood Oral Health Impact Scale (ECOHIS) and the self-reported Caries Impacts and Experiences Questionnaire for Children (CARIES-QC). The test group was provided with the ART/HT care at baseline while the control group was advised to seek care through the usual care options available within the community. At follow-up, both groups were offered care using the ART/HT approach. Changes in the mean scores from baseline to follow-up within groups were evaluated using appropriate paired (t-test, Wilcoxon paired test), and between groups with unpaired tests (t-test). Multivariate regression analysis after multiple imputations of missing data used generalized estimating equation (GEE) controlling for clustering within communities. RESULTS: Twenty-five communities and 338 children (mean age = 3.6 years, sd 1.7) participated in the study (test = 177). One child was excluded from the analysis because of a missing questionnaire and clinical data at baseline and follow-up. At baseline, test group children were older (test = 3.8 years, 95% CI 3.6-4.1;control = 3.3 years, 95% CI 3.1-3.6) and had higher caries experience (test dmft = 4.4, 95% CI 3.8-5.0;control dmft = 3.1, 95% CI 2.5-3.7), but there was no significant difference in COHRQoL or anxiety levels between the groups. At follow-up, parents in the delayed intervention reported worsening of COHRQoL (70% worsening of the family impact section of the ECOHIS and 37% worsening of the total ECOHIS scale), and there was an 8% reduction in child dental anxiety among the early treatment group. CONCLUSIONS: The application of the ART/HT approaches was feasible, effective, and impacted positively on child oral health-related quality of life and child dental anxiety among Aboriginal children in remote communities. The model of care as tested in this study should be further developed for inclusion in main-stream service delivery programmes.
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Tratamiento Restaurativo Atraumático Dental , Caries Dental , Niño , Preescolar , Humanos , Australia , Ansiedad al Tratamiento Odontológico/terapia , Tratamiento Restaurativo Atraumático Dental/métodos , Caries Dental/terapia , Salud Bucal , Calidad de Vida , Nativos de Hawái y Otras Islas del PacíficoRESUMEN
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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Atención Dental para Niños , Psicometría , Australia , Niño , Atención Dental para Niños/estadística & datos numéricos , Humanos , Reproducibilidad de los Resultados , Encuestas y Cuestionarios/normasRESUMEN
PURPOSE: This study aimed to estimate the association between the number of teeth and general quality of life in adults. METHODS: A population-based study was conducted with 1720 individuals aged 20-59 years residing in Florianópolis, Brazil, in 2009. Data were collected at participants' households using a structured questionnaire. In 2012, a second wave was undertaken with 1222 individuals. Oral examinations were performed for number of teeth, prevalence of functional dentition (≥21 natural teeth), and shortened dental arch (SDA), which were considered the main exposures. General quality of life was the outcome and was assessed with the WHO Abbreviated Instrument for Quality of Life (WHOQOL-BREF). Covariates included sociodemographic factors, health-related behaviors, and chronic diseases. Multivariable linear regression models were performed to test the associations between the main exposures and the outcome adjusted for covariates. RESULTS: In 2012, 1222 individuals participated in the study (response rate = 71.1%). Having more teeth was associated with greater scores on physical domain of the WHOQOL-BREF [ß = 0.24 (95% CI 0.01; 0.46)] after adjustment for covariates. Absence of functional dentition was associated with lower scores on the physical domain [ß = -3.94 (95% CI -7.40; -0.48)] in the adjusted analysis. There was no association between both SDA definitions and the domains of general quality of life. CONCLUSIONS: Oral health as measured by tooth loss was associated with negative impacts on general quality of life assessed by the WHOQOL-BREF. There was a lack of evidence that SDA is a condition that negatively affects general quality of life.
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Salud Bucal/estadística & datos numéricos , Calidad de Vida/psicología , Pérdida de Diente/patología , Adulto , Brasil/epidemiología , Femenino , Humanos , Masculino , Persona de Mediana Edad , Encuestas y Cuestionarios , Adulto JovenRESUMEN
In 2010, the World Health Organization Global Code of Practice for International Recruitment of Health Personnel (the WHO Code) was adopted by the 193 Member States of the WHO. The WHO Code is a tool for global diplomacy, providing a policy framework to address the challenges involved in managing dentist migration, as well as improving the retention of dental personnel in source countries. The WHO Code recognizes the importance of migrant dentist data to support migration polices; minimum data on the inflows, outflows and stock of dentists are vital. Data on reasons for dentist migration, job satisfaction, cultural adaptation issues, geographic distribution and practice patterns in the destination country are important for any policy analysis on dentist migration. Key challenges in the implementation of the WHO Code include the necessity to coordinate with multiple stakeholders and the lack of integrated data on dentist migration and the lack of shared understanding of the interrelatedness of workforce migration, needs and planning. The profession of dentistry also requires coordination with a number of private and nongovernmental organizations. Many migrant dentist source countries, in African and the South-Asian WHO Regions, are in the early stages of building capacity in dentist migration data collection and research systems. Due to these shortcomings, it is prudent that developed countries take the initiative to pursue further research into the migration issue and respond to this global challenge.
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Odontólogos/estadística & datos numéricos , Emigración e Inmigración/estadística & datos numéricos , Odontólogos/psicología , Odontólogos/provisión & distribución , Países Desarrollados/estadística & datos numéricos , Países en Desarrollo/estadística & datos numéricos , Salud Global , Humanos , Satisfacción en el TrabajoRESUMEN
OBJECTIVES: To assess income-based life-course models between the age of 13 and 30 years and caries in young adults. METHODS: In 1988-89, n = 7673 South Australian school children aged 13 years were sampled with n = 4604 children (60.0%) and n = 4476 parents (58.3%) returning questionnaires. In 2005-06, n = 632 baseline study participants aged 30 years responded (43.0% of those traced and living in Adelaide). Life-course models representing critical period, cumulative risk and social mobility were constructed using income tertiles at ages 13 and 30 years. Critical period was evaluated by comparing the low tertile with the middle and higher tertiles at age 13. Cumulative risk was evaluated by coding the low tertile as 2, the middle tertile as 1 and highest tertile as 0, and summing to produce a cumulative risk score categorized into lower (score 0-1), moderate (score of 2) and higher risk (scores 3-4). Social mobility was classified using tertiles into stable disadvantaged, downwardly mobile, stable middle income, upwardly mobile and stable advantaged. RESULTS: Models adjusting for sex, visiting and toothbrushing at age 30 showed no association between caries at age 30 and low income at age 13 years (critical period model). Compared to the low cumulative risk group based on income, decayed teeth (RR = 1.6) and missing teeth (RR = 7.2) were higher (P < 0.05) in the higher risk group, and missing teeth (RR = 6.0) were higher in the moderate risk group (cumulative risk model). There were more (P < 0.05) decayed teeth in the disadvantaged (RR = 3.1) and stable middle income groups (RR = 2.2), more missing teeth for those classified as disadvantaged (RR = 6.4), stable middle (RR = 6.3) and downwardly mobile (RR = 2.8), and higher DMFT for the disadvantaged group (RR = 1.5) compared to the upwardly mobile group (social mobility model). CONCLUSIONS: Socioeconomic advantage and upward mobility were associated with fewer decayed and missing teeth at age 30 years. Life-course models of cumulative risk and social mobility influenced oral health outcomes across childhood to adulthood.
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Caries Dental/epidemiología , Renta/estadística & datos numéricos , Adolescente , Adulto , Factores de Edad , Caries Dental/economía , Femenino , Humanos , Masculino , Factores Socioeconómicos , Australia del Sur/epidemiología , Encuestas y Cuestionarios , Adulto JovenRESUMEN
OBJECTIVES: To find an association between self-reported change in oral health and dental treatment volume. METHODS: Baseline data were obtained from the Tasmanian component of the National Survey of Adult Oral Health 2004-06 and 12-month follow-up data from service use logbooks and mail self-complete questionnaires. The global oral health transition statement indicated change in oral health. Many putative confounders were analyzed and Poisson regression with robust variance estimation was used to calculate the prevalence ratios and 95 percent confidence intervals for bivariate- and multivariate-adjusted relationships. RESULTS: One-eighth (12.4 percent) of the participants reported that their oral health had improved. Over half visited a dentist (n=176, 52.6 percent), of whom 105 received less than six dental services and 71 received six or more dental services. Baseline oral disease (P=0.01), having a treatment need (P<0.01), usually visiting a dentist for a problem (P<0.05), and having a lot of difficulty paying a $100 dental bill (P=0.01) were significantly associated with the same or worsening oral health. The regression model indicated that having six or more dental services (P<0.01) was significantly associated with improvement in oral health, indicating a threshold effect. Usually visiting a dentist for a check-up was significantly associated with improvement in oral health (P<0.01). CONCLUSION: Having six or more dental services was significantly associated with a greater self-reported improvement in oral health than having less than six dental services. The greater prevalence ratios with increasing dental service volume suggested a threshold effect.
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Servicios de Salud Dental/estadística & datos numéricos , Salud Bucal , Autorrevelación , Adulto , Humanos , TasmaniaRESUMEN
BACKGROUND: Psychosocial factors largely external to the individual--such as social support and those that are inherently dispositional, like optimism--may both play a role in determining oral health outcomes and serve to buffer the effect of each other. PURPOSE: The aim of this study was to assess associations of social support and optimism on oral health. METHOD: In 2005-2006, n = 1,859 persons around 30 years old were surveyed to collect data on social support, optimism, oral health-related quality of life, and caries experience. RESULTS: Unadjusted analyses found high social support associated (P < 0.05) with fewer (mean ± SE) decayed teeth (0.6 ± 0.1) and less negative impact on quality of life (2.7 ± 0.2) compared to low support (1.0 ± 0.2 and 4.5 ± 0.4 respectively). High optimism was associated with fewer missing teeth (2.1 ± 0.2) and less negative impact on quality of life (2.1 ± 0.2) compared to low optimism (2.9 ± 0.2 and 3.8 ± 0.2, respectively). Multivariate regressions adjusted for dental visiting, toothbrushing, sex, income, work status and education showed social support and optimism had (P < 0.05) negative associations with missing teeth (ß = -1.0) and caries experience (ß = -1.5) for high support/high optimism compared to low support/low optimism. All three non-reference combinations of support/optimism showed negative associations (ß = -1.6 to -2.4) with impact of problems compared to low support/low optimism. CONCLUSIONS: Social support and optimism were associated with oral health. Impact of dental problems showed buffering of high support when optimism was low, and high optimism when support was low.
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Caries Dental/psicología , Salud Bucal , Personalidad/fisiología , Calidad de Vida/psicología , Apoyo Social , Adolescente , Encuestas de Salud Bucal , Femenino , Humanos , Masculino , Factores Socioeconómicos , Encuestas y CuestionariosRESUMEN
PURPOSE: Life-course approaches to understanding the determinants of health have led to a greater focus on the effects of life events on health. Life events may be construed as either positive or negative, and may have differential health effects. The aims of the study were to assess the association of positive and negative life events with oral-health-related quality of life (OHRQoL). METHODS: In 2005-2006, 1,859 study participants aged around 30 years old were surveyed by mailed self-complete questionnaire and invited to attend a dental examination. Data collected included life events, social support (MSPSS) and OHRQoL (OHIP-14). A total of 632 people responded (43% response). RESULTS: Multivariate analysis controlling for sex, education, income, dental behaviour and social support showed that the lower (OR = 0.4, 0.2-0.6) and middle tertiles (OR = 0.6, 0.4-0.9) for negative life events were associated with lower prevalence of problems related to OHRQoL compared to the higher tertile. CONCLUSIONS: OHRQoL among young adults was associated with negative life events, but not positive life events. This suggests that negative life events involving social readjustment need to considered as determinants of health in life-course oral epidemiology frameworks.