Adult Oral Health Research Articles

The relationship between sense of coherence and oral health-related quality of life among medical and dental students in India: A cross-sectional study

Objectives: To assess the sense of coherence (SOC) and oral health-related quality of life (OHRQoL) and evaluate the relationship between the two parameters among medical and dental students. Materials and Methods: This cross-sectional online survey was conducted among 210 medical and dental students in the district of Kottayam in Kerala, India. A stratified random sampling technique based on the year of study was employed. The sample size was calculated based on a pilot study conducted among 20 medical and 20 dental students. Mann–Whitney U-test, Kruskal–Wallis test, and Spearman’s correlation test were used for statistical analysis. Results: The SOC and OHRQoL were higher among dental students than medical students. Those exposed to clinical postings presented with a higher SOC than the preclinical students. Furthermore, SOC was negatively correlated with the oral health impact among the clinical category of students (P < 0.05). Conclusion: Health is dependent on the individual and other physical, biological, and psychosocial factors. The concept of sense of coherence (SOC) is a psychosocial determinant of oral health in adults. A strong association between SOC and oral health-related quality of life has been established. In this study, OHRQoL was associated with the SOC among medical and dental students. Clinical category of students expressed a high SOC and better OHRQoL. Although the clinical category of students asserted a better quality of life, their stress level needs to be minimized. Health promotion and prevention of psychosocial symptoms should be included in the medical and dental curriculum.

The Effectiveness of Oral Health Education Among Non-dental Healthcare Professionals in Jeddah, Saudi Arabia: A Quasi-experimental Study.

The purpose of the study was to evaluate the level of oral health knowledge and practices among non-dental health professionals and to evaluate the effectiveness of oral health education provided to them. A convenience sample was recruited from non-dental healthcare professionals in Jeddah, Saudi Arabia. A self-administered questionnaire was distributed to participants to evaluate their oral health knowledge and behavior. Then, oral health educational material (a video) that was specifically developed for the study was sent to all participants to educate them about some oral health information related to adult oral health, oral signs of some systemic diseases, and the oral side effects of some medications. Two weeks later, the same questionnaire was sent to these participants to assess the effectiveness of the oral health education provided to them. The pre-intervention questionnaire results revealed a lack of oral health knowledge and inadequate oral health practices among the participants. After the intervention, the level of knowledge improved significantly from 6.4±2.2 to 10.4±3.8 out of 16 (p <0.001). The oral health education intervention used in the current study was effective in improving oral health knowledge among non-dental healthcare professionals.

The oral health landscape in Singapore: A commentary on key features, challenges and future policies.

Over the last decade, Singapore has grappled with substantial healthcare challenges, chiefly a bourgeoning aging population and a mounting burden of chronic diseases. The oral health landscape has also changed, with the Ministry of Health placing a greater focus on a life-course approach supported by policies that facilitate Singaporeans to receive dental care appropriately and affordably. A pivotal oral health policy is the National Dental Strategy, a comprehensive framework governing dental services in the public sector. This strategy encompasses aspects such as financing, workforce management, and capacity considerations. To facilitate affordability and accessibility to dental services in the public sector, the government extends subsidies to reduce out-of-pocket costs. Those attending private dental clinics also benefit from the Community Health Assist Scheme, introduced in 2012, which alleviates treatment costs for enrolled Singaporeans. Furthermore, additional age-banded subsidies have been introduced for older Singaporeans born before 1960, enhancing financial support when accessing dental services in both private and public sectors. In 2019, a national adult oral health survey was commissioned to gauge the oral health status of Singaporeans aged 21 and above. The findings reported 34.8% having untreated dental caries, and 15.7% and 41.2% experiencing moderate and severe periodontitis, respectively. While over half (53.9%) of respondents visited the dentist at least annually, about 60% of eligible individuals did not utilize their government dental subsidies. In response, the Ministry of Health is committed to strengthening oral disease prevention, integrating oral health into general healthcare services, expanding dental financing schemes to enhance service utilization, improving the quality and transparency of dental care, and leveraging advancements in tele-dentistry and other modes of dental services. It is imperative to adapt Singapore's oral health policies and service delivery models to meet the evolving needs of the population and ensure a sustainable, equitable and resilient oral healthcare system.

Routine Dental Polishing for Oral Health

What Is the Issue?&#x0D; &#x0D; Professional dental care is important to help maintain oral health. Routine dental cleaning usually includes both scaling and polishing. Scaling is the removal of plaque and tartar from the crown and root surfaces of teeth. Polishing is the removal of residual plaque and external stains from the teeth.&#x0D; To support decisions about the optimal components for professional dental cleaning, it is important to understand the potential benefits and harms of routine dental polishing when compared to no routine dental polishing.&#x0D; &#x0D; What Did We Do?&#x0D; &#x0D; We searched for clinical and cost-effectiveness literature comparing routine dental polishing with no routine dental polishing. We also looked for evidence-based guidelines that provide recommendations about the use of routine dental polishing for the maintenance of oral health in adults and children.&#x0D; An information specialist conducted a search of peer-reviewed and grey literature sources published between January 1, 2018, and September 28, 2023.&#x0D; Documents were excluded if we could not isolate the effects of dental polishing from other dental procedures or if polishing techniques were used for a purpose other than the routine polishing of teeth.&#x0D; &#x0D; What Did We Find?&#x0D; &#x0D; We did not find any studies directly evaluating the clinical or cost-effectiveness of routine dental polishing versus no routine dental polishing, or guidelines about the use of routine dental polishing, that met the inclusion criteria for this review.&#x0D; We identified limited literature that examines the combined effects of routine scaling and polishing. Research is needed that distinguishes the effects of routine dental polishing from the effects of other dental procedures.&#x0D; &#x0D; What Does This Mean?&#x0D; &#x0D; Without comparative clinical or cost-effectiveness evidence about routine dental polishing versus no routine dental polishing, decision-makers may also wish to consider that patients value routine scaling and polishing, and that the cost of dental care may be a barrier to visiting the dentist for some people.&#x0D; New polishing methods, such as air powder polishing, may also be useful to consider when making decisions about routine polishing to support dental health. These methods include some of the benefits of scaling and may present opportunities to reduce periodontal inflammation or the length of a dental appointment.&#x0D;

Education mediates the relationship of parental socioeconomic status with subjective adult oral health

BackgroundEvidence shows that both socioeconomic status (SES) during childhood and education are associated with adult oral health. However, whether the range of opportunities families have regarding their children’s education mediate the effect of childhood disadvantage on oral health later in life remains unknown. The aim of this study was to evaluate the mediating role of education in the association between parental SES and subjective oral health status in middle adulthood.MethodsData from 6703 members of the British Cohort Study 1970 were analyzed. Parental SES was measured using the 7-class National Statistics Socio-Economic Classification (NS-SEC) at age 10 years. Five measures of education (type of high school, highest qualification, age left full-time education, status of institution and field of study) were obtained from ages 16 and 42 years. Subjective oral health was measured with a single global item at age 46 years. Causal mediation analysis was performed, using a weighting-based approach, to evaluate how much of the effect of parental SES on subjective oral health was mediated by the measures of education separately and jointly.ResultsOverall, 23.6% of individuals reported poor oral health. Parental SES was associated with every measure of education, and they were also associated with subjective oral health in regression models adjusted for confounders. The effect of parental SES on subjective oral health was partially mediated by each measure of education, with a proportion mediated of 53.2% for the institution status, 46.5% for the field of study, 42.8% for the school type, 38.9% for the highest qualification earned and 38.4% for the age when full-time education was discontinued. The proportion of the effect of parental SES on subjective oral health jointly mediated by all measures of education was 81.1%.ConclusionThis study found a substantial mediating role of education in the association between parental SES and subjective oral health in middle adulthood.

Establishing New Policies and Priorities for Older Adult Oral Health Care

Establishing New Policies and Priorities for Older Adult Oral Health Care

Role of nutritional supplements on oral health in adults - A systematic review.

Purpose: The word 'diet' usually encompasses the consumption of food that includes all the necessary nutrients required for the optimal functioning of the body. Nutritional supplements hold a supreme position due to the demanding lifestyles or medical conditions in this current era. Although medical literature has sufficient evidence exploring the effect of nutrients on general health, this systematic review aimed at specifically evaluating the role of nutritional supplements on oral health in adults. Methods: PRISMA guidelines were followed in conducting this systematic review where four electronic databases including Scopus, PubMed, EMBASE, and Web of Science were reviewed. Based on the inclusion criteria, four studies exploring the effect of oral nutritional supplements on oral health among the adult population were included in this systematic review. Results: This review generated evidence suggesting a positive effect of nutritional supplements on oral health. These findings were depicted in the form of a reduction in plaque scores, probing depths, gingival inflammation, and greater improvement in periodontal healing among individuals with higher intakes of nutritional supplements within recommended doses. Conclusions: The systematic review outlines the positive impact of consuming nutritional supplements in the recommended dosage on oral health.Additionally, this review stresses the necessity for interventional studies to further investigate the effects of nutritional supplements on oral health, particularly in regard to periodontal healing. PROSPERO registration: CRD42021287797 (27/11/2021).

Assessing the Oral Health Status and Oral Health Literacy among Adult Population Visiting the Dental College in Aurangabad – A Cross Sectional Study

Detecting patients with insufficient oral health literacy (OHL) and enhancing communication between healthcare providers and patients is crucial in addressing the prevalence of preventable diseases and the reluctance to adopt healthy practices. This research endeavors to examine the correlation between OHL and specific socio-demographic factors, as well as adult oral health status of people residing in Aurangabad, Maharashtra, India. MATERIALS AND METHODS: The Rapid Estimate of Adult Literacy in Dentistry (REALD-30) was used to evaluate 150 participants who were chosen at random from the outpatient department of Shri Chatrapathi Shahu Maharaj Shikshan Sanstha (CSMSS). Using the 1997 World Health Organization oral health survey proforma, the demographic information and dental health status of each assessed individual were recorded. The Kruskal-Wallis test, correlations, analysis of variance, and t-tests were used in the statistical study. RESULTS: Statistically, there were no significant associations noticed between gender, age, or ethnicity and REALD30 scores. However, notable associations were observed between specific oral health-related factors and the obtained REALD scores, including temporomandibular joint (TMJ) problems, prevalence of prosthetic needs, loss of attachment scores and CPI (Community Periodontal Index). Additionally, REALD-30 scores exhibited negative correlations in Dental Aesthetic Index (DAI) and DMFT (Decayed, Missing, and Filled Teeth) values. CONCLUSION: Sex, age, and ethnicity did not show associations with oral health literacy (OHL) within this sampled population from Aurangabad. However, a noteworthy association was identified between OHL and oral health status, revealing that lower OHL levels were linked to a deteriorating oral health status. Considering these findings, OHL instruments are crucial screening tools to determine who or what groups is most vulnerable to poor dental health.

Delivering oral healthcare for people with cystic fibrosis: A survey of dental practitioners in Ireland

AbstractBackgroundCystic fibrosis (CF) is the most common autosomal recessive condition in Caucasian populations globally. To date, there has been very little research conducted into the oral health of adults with CF possibly due to historic premature mortality. The purpose of this survey was to ascertain knowledge, attitude and practices among dental professionals regarding the oral health of people with cystic fibrosis (PWCF) as part of a larger study being conducted in Ireland.MethodsA cross‐sectional survey of dental practitioners in Ireland was conducted via an online questionnaire. The survey contained close‐ended questions, and clinical scenarios which allowed for both close‐ended and free text responses in relation to the provision of dental treatment for PWCF. Data was subject to descriptive data analysis using IBM SPSS 29.ResultsThe results from the survey indicate a wide variety in the knowledge, attitudes and practices of dental practitioners regarding the oral health of PWCF. There is significant variation in the provision of dental treatment and the conditions under which such treatment is provided.ConclusionThere is a paucity of information and guidelines specific to this vulnerable population which can make the provision of dental treatment challenging for practitioners. Dental professionals may benefit from continuing professional development and further education targeting patient‐specific populations.

Burden, Trends, and Inequality of Dental Caries in the U.S., 1990–2019

Over the past 2 decades in the U.S., the reduced burden and narrowed inequality in oral health among children are in stark contrast with the high burden and widening inequality in adult oral health. This study aimed to explore the burden, trends, and inequalities of untreated caries in permanent teeth in the U.S. during 1990-2019. Data on burden of untreated caries in permanent teeth were extracted from the Global Burden of Disease Study 2019. A set of advanced analytical methods were applied to provide an in-depth characterization of the epidemiologic profile of dental caries in the U.S. Analyses were conducted during April 2022-October 2022. In 2019, age-standardized incidence and prevalence of untreated caries in permanent teeth were respectively 39,111.7 (95% uncertainty interval=35,073.0-42,964.9) and 21,722.5 (95% uncertainty interval=18,748.7-25,090.3) per 100,000 person-years. Population growth was the primary driver of the increased caries cases, which contributed 31.3% and 31.0% of the increase in the number of incident and prevalent caries cases, respectively, during 1990-2019. The highest caries burden was noted in Arizona, West Virginia, Michigan, and Pennsylvania. The slope index of inequality remained stable (p=0.076), whereas the relative index of inequality increased significantly (average annual percent change=0.04, p<0.001) in the U.S. The burden of untreated caries in permanent teeth remained significant with a widening cross-state inequality during 1990-2019. The oral healthcare system in the U.S. needs to prioritize health promotion and prevention with a focus on expanding access, affordability, and equity.

The intersections of socioeconomic position, gender, race/ethnicity and nationality in relation to oral conditions among American adults.

The objective of the study was to evaluate how gender, socioeconomic position (SEP), race/ethnicity and nationality intersect to structure social inequalities in adult oral health among American adults. Data from adults aged 20 years or over who participated in the National Health and Nutrition Examination Survey (NHANES) 2009-2018 were analysed. The outcomes were poor self-rated oral health and edentulism among all adults (n= 24 541 and 21 446 participants, respectively) and untreated caries and periodontitis among dentate adults (n= 16 483 and 9829 participants, respectively). A multilevel analysis of individual heterogeneity and discriminatory accuracy (MAIHDA) was conducted for each outcome, by nesting individuals within 48 intersectional strata defined as combinations of gender, SEP, race/ethnicity and nationality. Intersectional measures included the variance partition coefficient (VPC), the proportional change in variance (PCV) and predicted excess probability due to interaction. Substantial social inequalities in the prevalence of oral conditions among adults were found, which were characterized by high between-stratum heterogeneity and outcome specificity. The VPCs of the simple intersectional model showed that 9.4%-12.7% of the total variance in the presentation of oral conditions was attributed to between-stratum differences. In addition, the PCVs from the simple intersectional model to the intersectional interaction model showed that 84.1%-97.1% of the stratum-level variance in the presentation of oral conditions was attributed to the additive effects of gender, SEP, race/ethnicity and nationality. The point estimates of the predictions for some intersectional strata were suggestive of an intersectional interaction effect. However, the 95% credible intervals were very wide and the estimations inconclusive. This analysis highlights the value of the intersectionality framework to understand heterogeneity in social inequalities in oral health. These inequalities were mainly due to the additive effect of the social identities defining the intersectional strata, with no evidence of interaction effects.

Factors associated with self-rated oral health in adults with hemodialysis

Resumo Introdução Pacientes com insuficiência renal crônica podem apresentar prejuízos em sua saúde bucal em decorrência da própria doença, do tratamento e das alterações de estilo de vida associadas. Objetivo Avaliar os fatores associados à autoavaliação de saúde bucal ruim entre adultos com insuficiência renal crônica submetidos à hemodiálise. Método Estudo transversal com 243 adultos submetidos à hemodiálise em um hospital do sul de Minas Gerais nos anos de 2013 e 2014. O desfecho foi avaliado pelo autorrelato da condição bucal dicotomizada em boa (ótima/boa) e ruim (regular/ruim/péssima). As variáveis independentes incluíram condições sociodemográficas, saúde geral, saúde bucal e uso de serviços odontológicos, a partir de informações coletadas por meio de questionário. A associação entre o desfecho e as variáveis independentes foi testada por meio de modelos logísticos múltiplos com inclusão hierarquizada de variáveis. Resultados A prevalência de autoavaliação de saúde bucal ruim foi de 35,4%. Os mais jovens (p = 0,015), os que se submetem à hemodiálise há menos tempo (p = 0,016), têm halitose (p &lt;0,001), necessitam de tratamento odontológico (p &lt;0,001) e tiveram a última consulta odontológica por motivo diferente de dor (p = 0,027) expressaram maiores chances de autoavaliação de saúde bucal ruim, independentemente de condições sociodemográficas e de saúde. Conclusão Condições sociodemográficas, tempo em hemodiálise, agravos à saúde bucal e uso de serviços odontológicos influenciaram a autoavaliação da saúde bucal dos adultos submetidos à hemodiálise.

Validation of the French version of the ICHOM adult oral health standard set.

The ICHOM Adult Oral Health Standard Set (AOHSS) recently developed by the ICHOM Oral Adult Health Working Group is a standard set of outcomes designed for its collection in clinical practice in dental health. The outcome standard set is made up of clinical-reported outcome measures (CROMs) and patient-reported outcome measures (PROMs). The purpose of this study was to translate and cross-culturally adapt the PROM section of the Standard Set in French for France to enable comprehensive evaluation of the patients' oral health quality of life in a French population. The questionnaire was translated following the guidelines of the International Society for Pharmacoeconomics and Outcome Research (ISPOR). We included patients consulting in a dentistry clinic (n = 127) and seeking dental care. The PROM and CROM data were collected from all patients. Both reliability and the internal consistency were evaluated. The ICHOM AOHSS was successfully translated into French. We sampled and surveyed 126 patients in a dentistry clinic in France using the French translation of the ICHOM AOHSS. Cronbach's α was calculated to measure the internal consistency. The resulting Cronbach's α was 0.8, indicating acceptable homogeneity. The French version of the ICHOM AOHSS shows acceptable psychometric properties in terms of reliability and internal consistency. This translation is suitable for its implementation in a French-speaking patient population.

A longitudinal assessment of chronic periodontitis in Australian adults.

The study aimed to estimate the incidence/progression and reversal of chronic periodontitis and to identify factors associated with chronic periodontitis in Australian adults over a 12-year period. Data were obtained from the longitudinal component of the National Study of Adult Oral Health (NSAOH) in 2004-2006, and repeated data, among the same adults, in 2017-2018. NSAOH 2004-2006 was a population-based study of Australian adults aged 15+ years. The American Academy of Periodontology/European Federation of Periodontology case definitions were used, and then compared with two other case definitions. Multivariable Poisson regression models were used to estimate incidence rate ratios (IRRs) and reversal rate ratio (RRRs) of periodontitis. A total of 775 dentate Australian adults had dental examinations at both times. The proportion of incidence/progression and reversal among Australian adults was 56.4% and 11.0%, respectively. Tobacco smokers presented with more than three times higher incidence (IRR: 3.32, 95% CI: 1.50-7.60) and lower reversals (RRR: 0.94, 95% CI: 0.39-0.98) than those who had never smoked. Cessation of smoking was positively associated with periodontitis reversal. The total incidence/progression was 471.7/10,000 person-years, with reversal being 107.5/10,000 person-years. The average number of teeth lost due to periodontal disease was 1.9 in 2017-2018. Being male and not having periodontal treatment were significant risk markers for the incidence/progression of periodontitis. Smoking is a risk factor for periodontitis. Cessation of smoking is an effective means of reducing the incidence and progression of chronic periodontitis, to reduce the risk of tooth loss, and to improve overall periodontal health.

Modernizing the Management of Older Adult Oral Health

Modernizing the Management of Older Adult Oral Health

Immigrants experience oral health care inequity: findings from Australia's National Study of Adult Oral Health.

Oral health service utilization contributes to positive oral health and indicates realised access to services. The study aimed to describe patterns of oral health service use among overseas-born and Australian-born populations and assess equity in access to services. The study used data from Australia's National Study of Adult Oral Health 2017-2018 and was guided by the Aday and Andersen framework of access to health and Australia's National Oral Health Plan. Descriptive analyses of service use by perceived need, enabling and predisposing factors were compared between four groups: Australian-born and overseas-born who mainly speak English and Australian-born and overseas-born who mainly speak a language other than English. Overseas-born who mainly speak a language other than English experienced greater oral health care inequity, largely driven by financial difficulty (avoided care due to cost: 42% vs 27%-28%; avoided/delayed visiting due to cost: 48% vs. 37%-38%; cost prevented treatment: 32% vs. 18%-24%). The most favourable visiting patterns were among the Australian-born population who speak a language other than English. The study shows clear inequity experienced among immigrants in accessibility as measured through indicators of oral health care utilization and factors related to inequity, such as the ability to pay for services.

Assessment of adult oral health literacy among patients visiting Government dental college, Shimla, Himachal Pradesh

Background: The major role of oral health literacy (OHL) lies in the utilization of health services as low literacy leads to reduced participation and engagement in preventive health programs. Aim: This study aimed to assess the adult OHL among patients visiting the Tertiary care institute in north India. Materials and Methods: The source of data for this descriptive qualitative study was patient visiting the outpatient department. Data collection procedure included information obtained from the subject recorded on a structured pro forma using OHL-Adults Questionnaire. Mann–Whitney U test, Kruskal–Wallis test with post hoc Bonferroni test, and Spearman's rho correlation were applied. Multiple logistic regressions were used and the dependent variable (OHL) was regressed for predicted independent variables. Parameter estimate of inadequate and marginal OHL for various predictor variables was regressed considering the adequate OHL as standard reference. Results: The inadequate literacy score was statistically significant for age, educational qualification, and number of times of visit to dentist in lifetime in the final regression model. The marginal score was significant for age, educational qualification, and frequency of visit to dentist in the final regression model. Conclusion: Total dental visit in lifetime is an important indicator for better OHL in this study. Orientation of oral health promotion programs requires due importance for both the marginal and inadequate OHL.

The Role of Area Deprivation in Explaining Ethnic Inequalities in Adult Oral Health in England.

The circumstances of the area where people live may affect their health and ethnic minority groups are often overrepresented in deprived areas. This study explored ethnic inequalities in adult oral health and the contribution of area deprivation to explain such inequalities. Data from 15667 adults across 8 ethnicities (White British, Irish, Black Caribbean, Black African, Indian, Pakistani, Bangladeshi, Chinese) in the Health Survey for England 2010/2011 were analysed. Oral health was indicated by having a non-functional dentition, poor self-rated oral health and oral impacts on daily activities. Survey logistic regression and the Blinder-Oaxaca decomposition method were used. There were ethnic inequalities in the non-functional dentition, but not in self-rated oral health or oral impacts. Compared to White British adults (19.7%, 95% CI: 18.9, 20.6), a non-functional dentition was more common in Irish (33.1%, 95% CI: 25.9, 41.2) and less common in Black Caribbean (14.9%, 95% CI: 9.9, 21.7), Black African (6.9%, 95% CI: 3.9, 11.9), Indian (10.5%, 95% CI: 6.3, 17.2), Pakistani (7.2%, 95% CI: 4.5, 11.5), Bangladeshi (12.7%, 95% CI: 4.3, 32.3) and Chinese (2.2%, 95% CI: 0.6, 7.9) adults. In decomposition analysis, observed population characteristics explained over half of the ethnic inequalities in the non-functional dentition. Age, area deprivation and SEP were the main contributors, although results varied by ethnicity. Ethnic inequalities in adult oral health varied according to oral health measure and ethnicity. Area deprivation and SEP contributed to, but did not fully, explain such inequalities.

The association of food insecurity with tooth decay and periodontitis among middle-aged and older adults in the United States and Korea.

Food insecurity is an important social determinant of health, but there is limited understanding of its relationship with adult oral health. This study examined the associations between food insecurity and dental diseases (caries and periodontitis) among middle-aged and older adults in the United States and South Korea. This study focused on middle-aged (40-59 years) and older adults (>59 years) who participated in the 2011-2016 US National Health and Nutrition Examination Surveys (NHANES) or the 2013-2015 South Korean NHANES. The exposure was food insecurity severity (food secure/early-stage food insecurity/middle-stage or severe food insecurity) assessed using the 18-item US Household Food Security Survey Module. The two outcomes were any untreated tooth decay and periodontitis measured using the Modified Community Periodontal Index of Treatment Needs. Covariate-adjusted odds ratios (OR) with 95% confidence intervals (CI) were generated using multivariable logistic regression models. Middle or severe food insecurity was associated with significantly higher odds of having untreated tooth decay than no food insecurity, but only among middle-aged adults in the United States (OR: 1.4, 95% CI 1.2, 1.9; P= .037) and Korea (OR=1.8; 95% CI:1.0, 3.2; P= .036) and older adults in the United States (OR: 2.6, 95% CI 1.7, 4.0; P< .001). The associations between food insecurity and periodontitis were inconsistent across age group and country. Differing cultural norms and access to dental services in the United States and South Korea may influence the relationship between food insecurity and oral health. Future research should explore how addressing food insecurity could help to promote the oral health of middle-aged and older adults in diverse sociocultural contexts.

Access to dental care barriers and poor clinical oral health in Australian regional populations.

This paper investigated the associations between oral health with behavioural, demographic, periodontitis risk, financial and access to dental care barriers and compared the results in three Australian regional areas. Data were obtained from the Australian National Study of Adult Oral Health (2017-18). Oral health status was measured using DMFT-score, and mean numbers of decayed, missing or filled teeth and periodontitis prevalence using the Center for Disease Control and Prevention (CDC) and the American Academy of Periodontology (AAP) Periodontal Classification. The analysis included these dependent variables by three regional areas, seven socio-demographic variables, two periodontal disease risk factors, two preventive dental behaviours, two barriers to dental care and three access to dental care variables. Of the 15,731 people interviewed, 5,022 were examined. There was no significant difference in periodontitis prevalence between the regions. All the socio-demographic characteristics, periodontal disease risk factors and preventive dental behaviours were significantly associated with at least one of the dental caries indicators. In multivariable analysis, there was no significant association between regional location with any of the four clinical dental caries variables. Poorer oral health outside major cities was associated with household income, education level, higher smoking, usual reason for and frequency of dental visiting.