Objective

To explore rates of hospitalized head injury among older Australians by a range of risk indicators.

Design

Head injury data for 60+‐year‐olds were obtained from the Australian Institute of Health and Welfare Hospital Morbidity Database from 1998/1999 to 2004/2005. Poisson regression modeling was used to examine head injury rates in relation to age, sex, Indigenous status, location, and injury type.

Results

Rates of hospitalized head injury among the older population increased 1.4‐fold between 1998/1999 (582.8 per 100 000) and 2004/2005 (844.3 per 100 000) (p<0.001). Those aged 85+ years had 10.8 times the rate of their 60–64‐year‐old counterparts (95% CI 10.6 to 11.0) after adjustment for other covariates. Men had 1.1 times the rate of women (95% CI 1.1 to 1.2), and those living in rural/remote areas had 3.1 times the rate of their metropolitan‐dwelling counterparts (95% CI 3.0 to 3.1). Those identifying themselves as Indigenous had 1.7 times the rate of non‐Indigenous persons (95% CI 1.6 to 1.8). The most prevalent injuries were open wounds of the head (38.0%), followed by superficial injuries (24.7%) and intracranial trauma (18.3%). Falls accounted for 81.4% of all head injury admissions.

Conclusions

The oldest old were disproportionately represented among those sustaining hospitalized head injuries, along with men, those living in rural/remote areas, and Indigenous persons. Given the increasing proportion of older people in Western societies and the costs of treating hospitalized head injuries, the ability to reduce risk of such trauma in this age group is of critical public health importance.

Background

Social and emotional well-being is an important component of overall health. In the Indigenous Australian context, risk indicators of poor social and emotional well-being include social determinants such as poor education, employment, income and housing as well as substance use, racial discrimination and cultural knowledge. This study sought to investigate associations between oral health-related factors and social and emotional well-being in a birth cohort of young Aboriginal adults residing in the northern region of Australia's Northern Territory.

Methods

Data were collected on five validated domains of social and emotional well-being: anxiety, resilience, depression, suicide and overall mental health. Independent variables included socio-demographics, dental health behaviour, dental disease experience, oral health-related quality of life, substance use, racial discrimination and cultural knowledge.

Results

After adjusting for other covariates, poor oral health-related items were associated with each of the social and emotional well-being domains. Specifically, anxiety was associated with being female, having one or more decayed teeth and racial discrimination. Resilience was associated with being male, having a job, owning a toothbrush, having one or more filled teeth and knowing a lot about Indigenous culture; while being female, having experienced dental pain in the past year, use of alcohol, use of marijuana and racial discrimination were associated with depression. Suicide was associated with being female, having experience of untreated dental decay and racial discrimination; while being female, having experience of dental disease in one or more teeth, being dissatisfied about dental appearance and racial discrimination were associated with poor mental health.

Conclusion

The results suggest there may be value in including oral health-related initiatives when exploring the role of physical conditions on Indigenous social and emotional well-being.

Objectives

To determine oral health literacy (REALD-30) and oral health literacy-related outcome associations, and to calculate if oral health literacy-related outcomes are risk indicators for poor self-reported oral health among rural-dwelling Indigenous Australians.

Methods

468 participants (aged 17-72 years, 63% female) completed a self-report questionnaire. REALD-30 and oral health literacy-related outcome associations were determined through bivariate analysis. Multivariate modelling was used to calculate risk indicators for poor self-reported oral health.

Results

REALD-30 scores were lower among those who believed teeth should be infrequently brushed, believed cordial was good for teeth, did not own a toothbrush or owned a toothbrush but brushed irregularly. Tooth removal risk indicators included being older, problem-based dental attendance and believing cordial was good for teeth. Poor self-rated oral health risk indicators included being older, healthcare card ownership, difficulty paying dental bills, problem-based dental attendance, believing teeth should be brushed infrequently and irregular brushing. Perceived need for dental care risk indicators included being female and problem-based dental attendance. Perceived gum disease risk indicators included being older and irregular brushing. Feeling uncomfortable about oro-facial appearance risk indicators included problem-based dental attendance and irregular brushing. Food avoidance risk indicators were being female, difficulty paying dental bills, problem-based dental attendance and irregular brushing. Poor oral health-related quality of life risk indicators included difficulty paying dental bills and problem-based dental attendance.

Conclusions

REALD-30 was significantly associated with oral health literacy-related outcomes. Oral health literacy-related outcomes were risk indicators for each of the poor self-reported oral health domains among this marginalised population.

Background

Oral health impairment comprises three conceptual domains; pain, appearance and function. This study sought to: (1) estimate the prevalence of severe oral health impairment as assessed by a summary oral health impairment measure, including aspects of dental pain, dissatisfaction with dental appearance and difficulty eating, among a birth cohort of Indigenous Australian young adults (n = 442, age range 16-20 years); (2) compare prevalence according to demographic, socio-economic, behavioural, dental service utilisation and oral health outcome risk indicators; and (3) ascertain the independent contribution of those risk indicators to severe oral health impairment in this population.

Methods

Data were from the Aboriginal Birth Cohort (ABC) study, a prospective longitudinal investigation of Aboriginal individuals born 1987-1990 at an Australian regional hospital. Data for this analysis pertained to Wave-3 of the study only. Severe oral health impairment was defined as reported experience of toothache, poor dental appearance and food avoidance in the last 12 months. Logistic regression models were used to evaluate effects of demographic, socio-economic, behavioural, dental service utilisation and clinical oral disease indicators on severe oral health impairment. Effects were quantified as odds ratios (OR).

Results

The percent of participants with severe oral health impairment was 16.3 (95% CI 12.9-19.7). In the multivariate model, severe oral health impairment was associated with untreated dental decay (OR 4.0, 95% CI 1.6-9.6). In addition to that clinical indicator, greater odds of severe oral health impairment were associated with being female (OR 2.0, 95% CI 1.2-3.6), being aged 19-20 years (OR 2.1, 95% CI 1.2-3.6), soft drink consumption every day or a few days a week (OR 2.6, 95% 1.2-5.6) and non-ownership of a toothbrush (OR 1.9, 95% CI 1.1-3.4).

Conclusions

Severe oral health impairment was prevalent among this population. The findings suggest that public health strategies that address prevention and treatment of dental disease, self-regulation of soft drink consumption and ownership of oral self-care devices are needed if severe oral health impairment among Indigenous Australian young adults is to be reduced.

Background

A prospective Aboriginal Birth Cohort (ABC) study has been underway in Australia's Northern Territory since 1987. Inclusion of oral epidemiological information in a follow-up study required flexible and novel approaches with unconventional techniques. Documenting these procedures may be of value to researchers interested in including oral health components in remotely-located studies. The objectives are to compare and describe dental data collection methods in wave III of the ABC study with a more conventional oral health investigation.

Methods

The Australian National Survey of Adult Oral Health (NSAOH) was considered the 'conventional' study. Differences between this investigation and the dental component of the ABC study were assessed in terms of ethics, location, recruitment, consent, privacy, equipment, examination, clinical data collection and replication. In the ABC study, recording of clinical data by different voice recording techniques were described and assessed for ease-of-use portability, reliability, time-efficiency and cost-effectiveness.

Results

Conventional investigation recruitment was by post and telephone. Participants self presented. Examinations took place in dental clinics, using customised dental chairs with standard dental lights attached. For all examinations, a dental assistant recorded dental data directly onto a laptop computer. By contrast, follow-up of ABC study participants involved a multi-phase protocol with reliance on locally-employed Indigenous advocates bringing participants to the examination point. Dental examinations occurred in settings ranging from health centre clinic rooms to improvised spaces outdoors. The dental chair was a lightweight, portable reclining camp chair and the dental light a fire-fighter's head torch with rechargeable batteries. The digital voice recorder was considered the most suitable instrument for clinical dental data collection in the ABC study in comparison with computer-based voice-recording software.

Conclusion

Oral health examinations among indigenous populations residing in predominantly remote locations are more logistically challenging than are surveys of the general population. However, lack of resources or conventional clinical infrastructures need not compromise the collection of dental data in such studies. Instead, there is a need to be flexible and creative in establishing culturally-sensitive environments with available resources, and to consider non-conventional approaches to data gathering.

Background

Adults receive dental general anaesthetic (DGA) care when standard dental treatment is not possible. Receipt of DGA care is resource-intensive and not without risk. This study explores DGA receipt among 15+-year-old Australians by a range of risk indicators.

Methods

DGA data were obtained from Australia's Hospital Morbidity Database from 1998–1999 to 2004–2005. Poisson regression modeling was used to examine DGA rates in relation to age, sex, Indigenous status, location and procedure.

Results

The overall DGA rate was 472.79 per 100,000 (95% CI 471.50–474.09). Treatment of impacted teeth (63.7%) was the most common reason for DGA receipt, followed by dental caries treatment (12.4%), although marked variations were seen by age-group. After adjusting for other covariates, DGA rates among 15–19-year-olds were 13.20 (95% CI 12.65–13.78) times higher than their 85+-year-old counterparts. Females had 1.46 (95% CI 1.45–1.47) times the rate of their male counterparts, while those living in rural/remote areas had 2.70 (95% CI 2.68–2.72) times the rate of metropolitan-dwellers. DGA rates for non-Indigenous persons were 4.88 (95% CI 4.73–5.03) times those of Indigenous persons. The DGA rate for 1+ extractions was 461.9 per 100,000 (95% CI 460.6–463.2), compared with a rate of 23.6 per 100,000 (95% CI 23.3–23.9) for 1+ restorations.

Conclusion

Nearly two-thirds of DGAs were for treatment of impacted teeth. Persons aged 15–19 years were disproportionately represented among those receiving DGA care, along with females, rural/remote-dwellers and those identifying as non-Indigenous. More research is required to better understand the public health implications of DGA care among 15+-year-olds, and how the demand for receipt of such care might be reduced.

Background

Children receive dental general anaesthetic (DGA) care when standard dental treatment is not possible. Receipt of DGA care is resource-intensive and not without risk. This study examines trends in receipt of DGA care among Australian children.

Methods

Child DGA data were obtained from the Australian Institute of Health and Welfare Hospital Morbidity Database for 1993–2004. Poisson regression modelling was used to examine DGA rates in relation to age, sex, Indigenous status, location, year and procedure.

Results

There was a 3-fold increase in DGA rates from 1993–1994 (215.8 ± 2.9 per 100,000) to 2003–2004 (731.4 ± 5.3 per 100,000) (P < 0.001). Across all years, children who were aged 0–4 years, male or rural/remote-dwelling had higher DGA rates than their 5–9-year-old, female or metropolitan-dwelling counterparts respectively. There was a 7.0-fold increase in the rate of Indigenous admissions from 1993–1994 (116.5 ± 10.2 per 100,000) to 2003–2004 (806.6 ± 25.7 per 100,000). Extraction rates increased 4.9-fold from 1993–1994 (109.2 ± 2.9 per 100,000) to 2003–2004 (540.0 ± 4.5 per 100,000), while restoration rates increased 3.3-fold in the same observation period (139.5 ± 2.3 per 100,000 in 1993–1994 to 462.6 ± 4.2 per 100,000 in 2003–2004). For admissions in which one or more extractions were received, Indigenous rates were 47% greater than non-Indigenous rates after adjusting for other covariates.

Conclusion

Child DGA rates in Australia are increasing. Children who are pre-school-aged, male, Indigenous or living in a rural/remote location are disproportionally represented among those receiving such care. There are higher rates of extractions as opposed to more conservative procedures, particularly among Indigenous children.

Background

Indigenous Australians suffer substantially poorer oral health than their non-Indigenous counterparts and new approaches are needed to address these disparities. Previous work in Port Augusta, South Australia, a regional town with a large Indigenous community, revealed associations between low oral health literacy scores and self-reported oral health outcomes. This study aims to determine if implementation of a functional, context-specific oral health literacy intervention improves oral health literacy-related outcomes measured by use of dental services, and assessment of oral health knowledge, oral health self-care and oral health- related self-efficacy.

Methods/design

This is a randomised controlled trial (RCT) that utilises a delayed intervention design. Participants are Indigenous adults, aged 18 years and older, who plan to reside in Port Augusta or a nearby community for the next two years. The intervention group will receive the intervention from the outset of the study while the control group will be offered the intervention 12 months following their enrolment in the study. The intervention consists of a series of five culturally sensitive, oral health education workshops delivered over a 12 month period by Indigenous project officers. Workshops consist of presentations, hands-on activities, interactive displays, group discussions and role plays. The themes addressed in the workshops are underpinned by oral health literacy concepts, and incorporate oral health-related self-efficacy, oral health-related fatalism, oral health knowledge, access to dental care and rights and entitlements as a patient. Data will be collected through a self-report questionnaire at baseline, at 12 months and at 24 months. The primary outcome measure is oral health literacy. Secondary outcome measures include oral health knowledge, oral health self-care, use of dental services, oral health-related self-efficacy and oral health-related fatalism.

Discussion

This study uses a functional, context-specific oral health literacy intervention to improve oral health literacy-related outcomes amongst rural-dwelling Indigenous adults. Outcomes of this study will have implications for policy and planning by providing evidence for the effectiveness of such interventions as well as provide a model for working with Indigenous communities.

Background

Indigenous Australians experience an overwhelming burden of chronic disease, including cardiovascular diseases. Periodontal disease (inflammation of the tissues surrounding teeth) is also widespread, and may contribute to the risk of cardiovascular diseases via pathogenic inflammatory pathways. This study will assess measures of vascular health and inflammation in Indigenous Australian adults with periodontal disease, and determine if intensive periodontal therapy improves these measures over a 12 month follow-up. The aims of the study are: (i) to determine whether there is a dose response relationship between extent and severity of periodontal disease and measures of vascular health and inflammation among Indigenous Australian adults with moderate to severe periodontal disease; and (ii) to determine the effects of periodontal treatment on changes in measures of vascular health and inflammation in a cohort of Indigenous Australians.

Methods/Design

This study will be a randomised, controlled trial, with predominantly blinded assessment of outcome measures and blinded statistical analysis. All participants will receive the periodontal intervention benefits (with the intervention delayed 12 months in participants who are randomised to the control arm). Participants will be Indigenous adults aged ≥25 years from urban centres within the Top End of the Northern Territory, Australia. Participants assessed to have moderate or severe periodontal disease will be randomised to the study's intervention or control arm. The intervention involves intensive removal of subgingival and supragingival calculus and plaque biofilm by scaling and root-planing. Study visits at baseline, 3 and 12 months, will incorporate questionnaires, non-fasting blood and urine samples, body measurements, blood pressure, periodontal assessment and non-invasive measures of vascular health (pulse wave velocity and carotid intima-media thickness). Primary outcome measures are pulse wave velocity and carotid intima-media thickness.

Discussion

The study will assess the periodontal-cardiovascular disease relationship among Indigenous Australian adults with periodontal disease, and the effectiveness of an intervention aimed at improving periodontal and cardiovascular health. Efforts to understand and improve Indigenous oral health and cardiovascular risk may serve as an important means of reducing the gap between Indigenous and non-Indigenous health in Australia.

Trial Registration

Australia and New Zealand Clinical Trials Register (ANZCTR): ACTRN12610000817044