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Item Metadata only Decision-Making on Extracting Impacted Third Molars: Information for Dental Practitioners(Dental Practice Education Research Unit, The University of Adelaide, 2018) Hanna, K.M.Third molar surgery is the most commonly performed oral surgical procedure with most of the young adults having one or more impacted third molars. When impacted third molars are associated with pathology or recurrent symptoms, there is a consensus among clinicians about the need for extraction. However, there is a debate regarding the need for prophylactically removing asymptomatic disease- free impacted third molars.Item Metadata only Socioeconomic Status and Toothbrushing in Indigenous and Non-Indigenous Australian Children(SAGE Publications, 2023) Fernando, C.; Ha, D.H.; Do, L.G.; Tadakamadla, S.K.Introduction: Dental caries in children is a multifactorial and complex condition. Toothbrushing helps maintain good oral hygiene and delivers fluoride. However, determinants of toothbrushing could vary based on Indigenous status. Objective: This study aimed to assess the association between socioeconomic status and adequate toothbrushing practice (brushing twice or more a day) in Indigenous and nonIndigenous Australian children. Methods: Data were acquired from the National Child Oral Health Survey (NCOHS) 2012 to 2014. NCOHS administered questionnaires to parents of a representative sample of 24,215 Australian children aged 5 to 14 y recruited using a complex sampling method. Data on the frequency of toothbrushing and socioeconomic status were collected through the questionnaires. Statistical analysis was conducted progressively from bivariate to multivariable regression modeling, stratified by Indigenous status. Results: Just over half of Indigenous children and over two-thirds of nonIndigenous children reported adequate toothbrushing. The prevalence of adequate brushing (twice or more a day) was 42% (95% confidence interval [CI], 1.10–1.84) higher among children with an overseas-born parent than those with Australianborn parents. Among non-Indigenous children, sex and age, parents’ country of birth, number of children in the family, and other family socioeconomic indicators (education, income, private health insurance) were associated with adequate toothbrushing. The prevalence of adequate brushing was 1.09 (95% CI, 1.03–1.15) and 1.15 (95% CI, 1.10–1.21) times higher when their parent possessed vocational training and tertiary education, respectively, compared to those children whose parents had school-level education. Conclusions: There were differences in patterns of socioeconomic disparities for toothbrushing practices between Indigenous and non-Indigenous Australian children. Knowledge Transfer Statement: To promote positive toothbrushing practices in children, dental clinicians and public health professionals must be aware of the determinants of toothbrushing practices. Socioeconomic disparities in toothbrushing frequency were more apparent in non-Indigenous children. These results will help develop population-specific interventions that tackle the determinants to help improve oral hygiene behavior in Indigenous and non-Indigenous children.Item Open Access The Indigenous Australian Human Papillomavirus (HPV) Cohort Study 2, Continuation for 5 to 10 Years: Protocol for a Longitudinal Study(JMIR Publications, 2023) Hedges, J.; Sethi, S.; Garvey, G.; Whop, L.J.; Canfell, K.; Dodd, Z.; Larkins, P.; Antonsson, A.; Smith, M.A.; Mittinty, M.; Leane, C.; Reid, N.; Ooi, E.H.; Ju, X.; Logan, R.; Jamieson, L.Background: Human papillomavirus (HPV) infection, a common sexually transmitted disease, is associated with cancers of the cervix, vulva, vagina, penis, anus, and head and neck. Oropharyngeal squamous cell carcinoma (OPSCC; throat cancer) is a type of cancer involving the head and neck area that is rapidly increasing across the globe. There are higher rates of OPSCC among Indigenous populations relative to non–Indigenous Australian populations, although the HPV-attributable fraction remains unknown. For the first time at a global level, we plan to extend an Indigenous Australian adult cohort to monitor, screen, and ultimately prevent HPV-associated OPSCC and to undertake extensive cost-effectiveness modelling around HPV vaccination. Objective: This study aims to (1) extend follow-up to a minimum of 7 years post recruitment to describe the prevalence, incidence, clearance, and persistence of oral HPV infection; and (2) conduct clinical examinations of the head and neck, oral cavity, and oropharynx and collect saliva samples for early-stage OPSCC testing. Methods: We will continue to implement a longitudinal design for the next study phase, where we will ascertain the prevalence, incidence, clearance, and persistence of oral HPV infection at 48, 60, and 72 months; undertake clinical examinations/saliva assessments to detect early-stage OPSCC; and refer for treatment. The primary outcome measures are changes in oral HPV infection status, biomarker measures of early HPV-related cancer, and clinical evidence of early-stage OPSCC. Results: Participant 48-month follow-up will commence in January 2023. The first results are expected to be submitted for publication 1 year after 48-month follow-up begins. Conclusions: Our findings have potential to change the way in which OPSCC among Australian Indigenous adults is managed, with desired impacts including cost-savings on expensive cancer treatments; improved nutritional, social, and emotional outcomes; and improved quality of life for both Indigenous adults and the Indigenous community more broadly. Continuing a large, representative Indigenous adult cohort to track oral HPV infection and monitor early OPSCC is essential to yield critical information to include in the management armamentarium of health and well-being recommendations for Australia’s First Nations.Item Open Access Self-reported oral health status, edentulism and all-cause mortality risk in 12 809 Australian older adults: a prospective cohort study(Wiley, 2024) Khan, S.; Chen, Y.; Crocombe, L.; Ivey, E.; Owen, A.J.; McNeil, J.J.; Woods, R.L.; Wolfe, R.; Freak-Poli, R.; Britt, C.; Gasevic, D.Objective: To investigate the association between oral health status and all-cause mortality in older adults using prospective cohort study design. Setting and Participants: In total, 12 809 adults aged ≥70 years (54.3% females) were participants of the ASPREE Longitudinal Study of Older Persons (ALSOPs). Methods: Participants self-reported the presence of natural teeth and oral health status. The association of self-reported oral health, edentulism and the integrative measure of the two with all-cause mortality were explored using the Cox-regression models adjusted for age, gender, socio-economic status, health-related behaviours, weight status, aspirin and polypharmacy. Hazard ratios (HRs) and 95% confidence intervals (CIs) were reported. Results: In total, 22.2% of participants reported edentulism and 13.8% had fair/poor oral health. After adjustment for confounders, risk of all-cause mortality was higher among those with edentulism (vs. no edentulism) HR (95% CI) 1.43 (1.18, 1.73); and those with edentulism and reporting poor/fair oral health HR (95% CI) 1.69 (1.02, 2.82), or with no edentulism but reporting poor/fair oral health HR (95% CI) 1.46 (1.19-1.80) vs. no edentulism and reporting good/very good/excellent oral health. No association was observed between self-reported oral health alone and all-cause mortality. Conclusions: The risk of all-cause mortality was 69% higher among older adults reporting both edentulism and poor/fair oral health compared with those with teeth and more favourable self-reported oral health. © 2023 Australian Dental Association.Item Open Access A bibliometric analysis of Community Dentistry and Oral Epidemiology: Fifty years of publications(Wiley, 2024) Nath, S.; Thomson, W.M.; Baker, S.R.; Jamieson, L.M.OBJECTIVES: In celebration of the journal's 50th anniversary, the aim of the study was to review the whole collection of Community Dentistry and Oral Epidemiology (CDOE) publications from 1973 to 2022 and provide a complete overview of the main publication characteristics. METHODS: The study used bibliometric techniques such as performance and science mapping analysis of 3428 articles extracted from the Scopus database. The data were analysed using the 'Bibliometrix' package in R. The journal's scientific production was examined, along with the yearly citation count, the distribution of publications based on authors, the corresponding author's country and affiliation and citation count, citing source and keywords. Bibliometric network maps were constructed to determine the conceptual, intellectual and social collaborative structure over the past 50 years. The trending research topics and themes were identified. RESULTS: The total number of articles and average citations has increased over the years. D Locker, AJ Spencer, A Sheiham and WM Thomson were the most frequently published authors, and PE Petersen, GD Slade and AI Ismail published papers with the highest citations. The most published countries were the United States, United Kingdom, Brazil and Canada, frequently engaging in collaborative efforts. The most common keywords used were 'dental caries', 'oral epidemiology' and 'oral health'. The trending topics were healthcare and health disparities, social determinants of health, systematic review and health inequalities. Epidemiology, oral health and disparities were highly researched areas. CONCLUSION: This bibliometric study reviews CDOE's significant contribution to dental public health by identifying key research trends, themes, influential authors and collaborations. The findings provide insights into the need to increase publications from developing countries, improve gender diversity in authorship and broaden the scope of research themes.Item Open Access Differential network analysis of oral microbiome metatranscriptomes identifies community scale metabolic restructuring in dental caries(Oxford University Press (OUP), 2022) Espinoza, J.; Torralba, M.; Leong, P.; Saffery, R.; Bockmann, M.; Kuelbs, C.; Singh, S.; Hughes, T.; Craig, J.; Nelson, K.; Dupont, C.; Brenner, D.Dental caries is a microbial disease and the most common chronic health condition, affecting nearly 3.5 billion people worldwide. In this study, we used a multiomics approach to characterize the supragingival plaque microbiome of 91 Australian children, generating 658 bacterial and 189 viral metagenome-assembled genomes with transcriptional profiling and gene-expression network analysis. We developed a reproducible pipeline for clustering sample-specific genomes to integrate metagenomics and metatranscriptomics analyses regardless of biosample overlap. We introduce novel feature engineering and compositionally-aware ensemble network frameworks while demonstrating their utility for investigating regime shifts associated with caries dysbiosis. These methods can be applied when differential abundance modeling does not capture statistical enrichments or the results from such analysis are not adequate for providing deeper insight into disease. We identified which organisms and metabolic pathways were central in a coexpression network as well as how these networks were rewired between caries and caries-free phenotypes. Our findings provide evidence of a core bacterial microbiome that was transcriptionally active in the supragingival plaque of all participants regardless of phenotype, but also show highly diagnostic changes in the ways that organisms interact. Specifically, many organisms exhibit high connectedness with central carbon metabolism to Cardiobacterium and this shift serves a bridge between phenotypes. Our evidence supports the hypothesis that caries is a multifactorial ecological disease.Item Open Access Comparison of the Early Childhood Oral Health Impact Scale (ECOHIS-4D) and Child Health Utility Index (CHU-9D) in children with oral diseases(Wiley, 2024) Weerasuriya, S.R.; Hettiarachchi, R.M.; Kularatna, S.; Rohde, A.; Arrow, P.; Jamieson, L.; Tonmukayakul, U.; Senanayake, S.OBJECTIVE: Accurate assessment of child oral health is important for guiding economic evaluations and informing healthcare decision-making. Early Childhood Oral Health Impact Scale (ECOHIS-4D) is a preference-based instrument that measures the oral health-related quality of life of young children. The aim of this study was to compare the utility scores of ECOHIS-4D and Child Health Utility Index (CHU-9D), against an oral health indicator to evaluate which utility score corresponds better with the oral health indicator. METHOD: The ECOHIS-4D and CHU-9D were applied to 314 parent/child dyads from preschools in a primary healthcare setting in Perth, Western Australia. Four parameters were used to assess which instrument corresponds better with the oral health indicator (decayed, missing and filled teeth score-dmft score): (i) discrimination, the ability to discriminate between different clinical severity groups, (ii) external responsiveness, how much the utility values relate to the changes in dmft scores, (iii) correlation, the association between the two instruments and the related dimensions and (iv) differences in the utility values across the two instruments. RESULTS: Most participants (81%) were 2-6 years old, and nearly 50% had a dmft score <3. ECOHIS-4D demonstrated a superior ability to differentiate between dmft severity groups and respond to changes in dmft scores. A significant weak correlation was observed between dmft and ECOHIS-4D (-0.26, 95%, CI -0.36 to -0.15) compared to a non-significant very poor correlation between dmft and CHU-9D (0.01, 95% CI -0.12 to 0.10). The utility scores of the two instruments had relatively good agreement towards good health and weak agreement towards poor health. CONCLUSIONS: ECOHIS-4D, the oral health-specific instrument, is more sensitive in assessing children's oral health-related quality of life than the generic CHU-9D. Thus, ECOHIS-4D is more appropriate for utility estimates in economic evaluations of oral health-related interventions and resource allocation decision-making.Item Open Access Early Childhood Caries Intervention in Aboriginal Australian Children: A Cross-in Randomized Trial(SAGE Publications, 2024) Ju, X.; Mittinty, M.N.; Smithers, L.; Jamieson, L.Introduction: Early childhood caries (ECC) is the strongest predictor of dental caries in adulthood. Indigenous children have higher levels of ECC compared with non-Indigenous children. The study aimed to estimate the efficacy of an ECC intervention among Aboriginal Australian children. Methods: Baby Teeth Talk was an outcome assessor-blinded, closed-cohort cross-in randomized controlled trial conducted in South Australia, Australia. We randomly allocated 448 women pregnant with an Aboriginal child to either an immediate (II) or delayed (DI) intervention group between January 2011 and May 2012. The immediate intervention comprised (1) provision of dental care to mothers during pregnancy; (2) application of fluoride varnish to teeth of children at ages 6, 12; and 18 mo; (3) motivational interviewing delivered in conjunction; and (4) anticipatory guidance. Mothers/children in the DI group received the same intervention commencing when the child was 24 mo of age. The outcomes were assessed by the number of decayed, missing, and filled teeth (dmft) in children aged 24, 36, and 60 mo. Regression-based approaches with generalized linear mixed effect (log-Poisson) model characterized the mean dmft to estimate risk ratios (RRs) and 95% confidence intervals (95% CIs). Results: A total of 223 participants were randomly allocated to the II group and 225 to the DI group. Three hundred sixty-five children (178 II, 187 DI) received at least 1 dental clinical examination at 24, 36, and 60 mo of follow-up. The mean dmft was lower in the II group (0.48, 1.32, and 2.06) than in the DI group (0.82, 1.90, and 3.29) at each time point, respectively. The direct ECC intervention effect was to prevent/decrease dental decay experience (dmft) occurrence by 84% (RR = 1.84, 95% CI: 1.20-2.48) after adjusting for all covariates. Conclusions: Our analysis indicated that the time-varied ECC intervention had immediate and longer-term effects on the prevention of ECC among Indigenous Australian children. Knowledge Transfer Statement: The study aimed to estimate the efficacy of an early childhood caries (ECC) intervention among Aboriginal Australian children. The findings indicated that the culturally appropriate ECC intervention is effective for the preventive of ECC and can be used by clinicians, educators, and policy makers when planning an ECC intervention, so as to prevent and reduce ECC and meet identified oral health needs across the Australian population, which is important for preventive dental care.Item Open Access Oral Health Inequities among CALD and Non-CALD Older Australians: A Decomposition Analysis(MDPI AG, 2023) Jamieson, L.; Mejia, G.; Luzzi, L.; Ju, X.Background: Among Australia’s older population, the burden of oral disease is disproportionality borne by culturally and linguistically diverse (CALD) communities. This study aims to examine changes in untreated decay surfaces (DS) between 2004–2006 and 2017–2018 among older CALD and non-CALD Australians. Methods: Data were sourced Australian national oral health surveys conducted in 2004–2006 and 2017–2018. An Oaxaca–Blinder decomposition analysis was used to assess the contribution of socio-demographics and dental behaviours. Results: A total of 246 CALD and 2853 non-CALD dentate participants aged 60+ years took part in 2004–2006, and 363 and 4278 in 2017–2018, respectively. There were increases in mean DS for both CALD (0.74 to 1.42) and non-CALD (0.72 to 1.50) groups between 2004–2006 and 2017–2018. The decomposition model showed that, for CALD participants in 2004–2006 with untreated DS, 40% of the contribution was from not having dental insurance; nearly three-quarters of the contribution was from last dental visit being over one year ago (72.9%) in 2017–2018. Among non-CALD participants in 2017–2018 with untreated DS, 42.5% of the contribution was from the last dental visit being over one year ago. Conclusions: Our findings suggest that social determinants, including increased access to dental insurance, could mitigate the oral health inequities observed.Item Open Access pH-Responsive Biomaterials for the Treatment of Dental Caries - A Focussed and Critical Review(MDPI AG, 2023) He, Y.; Vasilev, K.; Zilm, P.Dental caries is a common and costly multifactorial biofilm disease caused by cariogenic bacteria that ferment carbohydrates to lactic acid, demineralizing the inorganic component of teeth. Therefore, low pH (pH 4.5) is a characteristic signal of the localised carious environment, compared to a healthy oral pH range (6.8 to 7.4). The development of pH-responsive delivery systems that release antibacterial agents in response to low pH has gained attention as a targeted therapy for dental caries. Release is triggered by high levels of acidogenic species and their reduction may select for the establishment of health-associated biofilm communities. Moreover, drug efficacy can be amplified by the modification of the delivery system to target adhesion to the plaque biofilm to extend the retention time of antimicrobial agents in the oral cavity. In this review, recent developments of different pH-responsive nanocarriers and their biofilm targeting mechanisms are discussed. This review critically discusses the current state of the art and innovations in the development and use of smart delivery materials for dental caries treatment. The authors’ views for the future of the field are also presented.Item Open Access Correlates of poor oral health related quality of life in a cohort of people who use methamphetamine in Australia(Springer Science and Business Media LLC, 2023) Abdelsalam, S.; Livingston, M.; Quinn, B.; Agius, P.A.; Ward, B.; Jamieson, L.; Dietze, P.Objectives: Methamphetamine use impacts oral health, but little is known about its impacts on oral health related quality of life (OHRQoL). In this study we examined OHRQoL in a cohort of people who use methamphetamine and assessed associations with sociodemographic, behavioural, psychosocial and dental service utilisation correlates. A secondary aim was to examine the relationship between methamphetamine route of administration and OHRQoL, to test whether smoking the drug is associated with reduced OHRQoL. Methods: Cross-sectional analysis was performed, using data from VMAX, a cohort of people who use methamphetamine at least monthly in Victoria, Australia (n=194). Utilising the oral health impact profile (OHIP-14), we assessed three OHRQoL outcomes: OHIP-14 prevalence, OHIP-14 extent and OHIP-14 severity. Regression analyses examined associations between independent variables and the three OHIP-14 outcome measures. Results: A significant segment of the cohort (35%) reported poor OHRQoL. Overall, no statistically significant association was detected between methamphetamine route of administration and the three OHIP-14 outcomes. Participants living in rural areas, with moderate-to-severe self-reported depression and with methamphetamine dependence had significantly worse OHRQoL levels, which persisted after adjusting for other covariates. Conclusion: Overall, VMAX cohort participants reported reduced OHRQoL levels. Our findings highlight the need for upstream interventions to improve the OHRQoL of people who use methamphetamine, with specific focus on those living in rural locations. Further research on the links between OHRQoL and mental health among people who use methamphetamine is required.Item Open Access Income and Oral and General Health-Related Quality of Life: The Modifying Effect of Sense of Coherence, Findings of a Cross-Sectional Study(Springer Nature, 2023) Zakershahrak, M.; Chrisopoulos, S.; Luzzi, L.; Jamieson, L.; Brennan, D.Objectives: To investigate whether a strong sense of coherence (SOC) modifes the association between low-income and oral and general health-related quality of life (OHRQoL and HRQoL, respectively) among a South Australian population sample; and to explore the main and interaction efects of income and SOC on OHRQoL and HRQoL. Methods: Baseline data from the Dental Care and Oral Health Study (DCOHS, a South Australian representative study, 2015–2016) were used for cross-sectional analysis (n=3,786). Four multivariable factorial ANOVA models were applied to assess the efect measure modifcation, main efects, and interaction of income and SOC on OHRQoL (measured using the OHIP-14) and HRQoL (measured using the EQ-5D-3L). Results: Income and SOC had small main efects on OHRQoL. Income had a small efect and SOC had an intermediate efect on HRQoL, meaning that individuals with strong SOC had better OHRQoL and HRQoL in all income categories. Also, high-income participants had better OHRQoL and HRQoL. The interaction between income and SOC was statistically signifcant on HRQoL. Among participants from low-income group, those with strong SOC had better OHRQoL (mean=8.8, 95% CI[7.9, 9.7]) and HRQoL (mean=1.1, 95% CI[1.0, 1.3]) than others with weak SOC (OHIP-14 mean=12.7, 95% CI[11.7, 13.6]) and (EQ-5D-3L mean=2.0, 95% CI[1.9, 2.2]). Conclusion: The findings showed the main effects and interaction between SOC and income on OHRQoL and HRQoL. Income had different effects on OHRQoL and HRQoL depending on whether SOC was strong or weak. Findings suggested that strong SOC modified the association between low-income and OHRQoL and HRQoL.Item Open Access Natural History of Oral HPV Infection among Indigenous South Australians(MDPI AG, 2023) Ju, X.; Sethi, S.; Antonsson, A.; Hedges, J.; Canfell, K.; Smith, M.; Garvey, G.; Logan, R.M.; Jamieson, L.M.This study aims to describe the natural history of and identify the risk factors associated with oral human papillomavirus (HPV) infections in an Australian Indigenous cohort. A longitudinal cohort study design, with baseline (2018), 12-month, and 24-month data obtained from Indigenous Australians aged 18+ years in South Australia, was performed. Face-to-face interviews were conducted, and saliva samples for HPV testing were collected at each time point. Basic descriptive analyses were conducted to calculate prevalence, incidence, persistence, clearance, and incidence proportions of any HPV infection. Multivariable logistic regression analyses with adjusted prevalence ratios (PRs) were conducted to identify risk factors associated with oral HPV infection. Among 993 participants with valid saliva samples, 44 HPV types were identified. The prevalence of infection with any oral HPV infection was 51.3%, high-risk HPV was 11%, and types implicated in Heck’s disease (HPV 13 or 32) was 37.4%. The incidence, persistence, and clearance of any and high-risk HPV infections were 30.7%, 11.8% and 33.3% vs. 9.3%, 2.8%, and 9%, respectively. Our findings indicate that the prevalence, incidence, and persistence of oral HPV infection in a large sample of Indigenous Australians were high, and clearance was low. Oral sex behaviours and recreational drug use were risk factors associated with incident high-risk HPV infection.Item Metadata only Private Dental Care Benefits Non-Indigenous Children More Than Indigenous Children(SAGE Publications, 2020) Nair, R.; Luzzi, L.; Jamieson, L.; Spencer, A.; Hanna, K.; Do, L.Introduction: Various arrangements for funding health care facilities can have different levels of performance of care provision on different groups of people. Such differential performance of oral care is not previously known concerning Indigenous communities. Objective: This study aimed to assess the effect of visiting a public or private dental care facility on the performance of oral care experienced by Indigenous versus non-Indigenous children in Australia. Methods: Data from the National Child Oral Health Survey were used with a representative sample of children from all the states and territories of Australia. The performance of oral care was measured with the Child Oral Care Performance Assessment Scale (COPAS), which contains 37 items from 9 domains (Effective, Appropriate, Efficient, Responsive, Accessible, Safe, Continuous, Capable, and Sustainable) with a score ranging from 0 to 148. Mixed effects models that accounted for stratum and sampling weights were used for the stratified analyses (Indigenous vs. non-Indigenous) that assessed the effect of public versus private care on the COPAS. Relative excess risk due to interaction was calculated to assess effect modification. Results: Among the Indigenous children, private care was similar to public care (regression coefficient [RC] = −1.27, 95% CI = −9.5 to 6.97), whereas private care was higher than public care among non-Indigenous children (RC = 4.60, 95% CI = 3.67 to 6.18). This trend was similar among the 9 domains of the COPAS as well, except for Effectiveness, which was similar for private and public facilities among non-Indigenous children (RC = −0.03, 95% CI = −0.29 to 0.23). Based on the continuous COPAS score, effect modification was 4.46 (95% CI = 0.11 to 8.82) on the additive scale and 1.06 (1.01, 1.13) on the multiplicative scale. The relative excess risk due to interaction reported an excess chance of 1.17 (95% CI = 0.01 to 0.33), which was consistent with the stratified analyses and effect modification measured with the continuous score. Conclusion: Thus, this study found a higher performance of oral care in private care locations among non- Indigenous children versus Indigenous children. Knowledge Transfer Statement: The findings caution policy makers and other stakeholders that moving oral care from public to private care facilities can increase the inequity faced by Indigenous children in Australia.Item Metadata only Atraumatic Restorative Treatments in Australian Aboriginal Communities: A Cluster-randomized Trial(SAGE Publications, 2020) Arrow, P.; Piggott, S.; Carter, S.; McPhee, R.; Atkinson, D.; Mackean, T.; Kularatna, S.; Tonmukayakul, U.; Brennan, D.; Nanda, S.; Palmer, D.; Jamieson, L.INTRODUCTION: The management of early childhood caries (ECC) is challenging. OBJECTIVES: A model of care based on Atraumatic Restorative Treatment and the Hall Technique (ART-HT) to manage ECC was evaluated among remote Aboriginal communities in Australia. METHODS: Aboriginal communities in the North-West of Western Australia were invited to participate and consenting communities were randomized into early or delayed intervention for the management of ECC. Children were examined at baseline and at the 11-mo follow-up. The early intervention group (test) was provided with the ART-based dental care at baseline while the delayed intervention group (control) was advised to seek care through the usual care options available within the community. At follow-up, both groups were examined by calibrated examiners, and were offered care using the ART-HT approach. Changes from baseline to follow-up in caries experience were tested using paired tests. Multivariate analysis after multiple imputation of missing data used generalised estimating equation (GEE) controlling for clustering within communities. RESULTS: A total of 25 communities and 338 children (mean age = 3.6 y, SD 1.7) participated in the study (test = 177). At follow-up, 231 children were examined (68% retention, test = 125). At follow-up, children in the test group had more filled teeth (test filled teeth = 1.2, control filled teeth = 0.2, P < 0.001) and decreased levels of decayed teeth (mean test = 0.7 fewer teeth with decay, mean control = 1.0 more tooth with decay, P < 0.001). GEE analysis controlled for baseline caries experience, age, sex, and community water fluoride levels found increased rates of untreated decayed teeth (RR = 1.4, P = 0.02) and decreased rates of filled teeth (RR = 0.2, P < 0.001) at follow-up among the control group. CONCLUSION: A model of care relying on the principles of minimally invasive atraumatic approaches enabled the delivery of effective dental services to young children (<6 y) in remote Aboriginal Australian communities resulting in increased levels of care and improved oral health. KNOWLEDGE TRANSFER STATEMENT: This cluster-randomized trial tested a multi-component model of dental care to young children with ECC in remote Aboriginal communities in Australia. The intervention, based on the atraumatic approaches using minimally invasive techniques encompassing preventive care, Atraumatic Restorative Treatment and the Hall Technique (ART-HT), delivered more restorative care and reduced the incidence of caries. This model of care was more effective than available standard care and should be incorporated into mainstream service delivery programs.Item Open Access Does the contribution of modifiable risk factors on oral health inequities differ by experience of negative life events among Indigenous Australian adults?(Public Library of Science (PLoS), 2023) Jamieson, L.; Hedges, J.; Paradies, Y.; Ju, X.; Keramat, S.A.Objective Although the prevalence of poor self-rated oral health and experience of negative life events among Indigenous adults is high, the contribution of modifiable risk factors is unknown. We aimed to estimate the contribution of modifiable risk factors in poor self-rated oral health among Indigenous Australian adults with high and low experience of negative life events using decomposition analysis. Methods The study utilised a cross-sectional design, with data from a large convenience study of Indigenous adults in South Australia. Participants were stratified based on a median split of negative life events in the last 12 months. The outcome was the proportion of fair/poor selfrated oral health (SROH). Independent variables included experience of racism, sex, age, geographic location, car ownership, and time since last dental visit. Results Of the 1011 participants, the proportion with fair poor self-rated oral health was 33.5% (95% CI 30.5 to 36.4) and the proportion who had experienced 3+ negative life events in the past 12 months was 47.3% (95% CI 43.7 to 50.9). More than half the contribution in fair/poor selfrated oral health among Indigenous adults with a higher magnitude of negative life events was from experience of racism (55.3%, p<0.001), followed by residential location (19.9%), sex (9.7%) and car ownership (9.8%). Conclusions The contributions of modifiable risk factors in poor self-rated oral health among Indigenous adults with different exposures to negative life events differed substantially. Targets to reduce racism will decrease oral health inequities for both groups, however Indigenous adults who have experienced substantial negative life events require additional focus on provision of culturally safe dental care.Item Metadata only Quantitative PCR overestimation of DNA in samples contaminated with tin(Wiley, 2023) Bonsu, D.N.O.; Higgins, D.; Simon, C.; Goodwin, C.S.; Henry, J.M.; Austin, J.J.Metals can pose challenges while conducting forensic DNA analysis. The presence of metal ions in evidence-related DNA extracts can degrade DNA or inhibit PCR as applied to DNA quantification (real-time PCR or qPCR) and/or STR amplification, leading to low success in STR profiling. Different metal ions were spiked into 0.2 and 0.5 ng of human genomic DNA in an “inhibition study” and the impact was evaluated by qPCR using the Quantifiler™ Trio DNA Quantification Kit (Thermo Fisher Scientific) and an in-house SYBR Green assay. This study reports on a contradictory finding specific to tin (Sn) ions, which caused at least a 38,000-fold overestimation of DNA concentration when utilizing Quantifiler Trio. This was explained by the raw and multicomponent spectral plots, which indicated that Sn suppresses the Quantifiler Trio passive reference dye (Mustang Purple™, MP) at ion concentrations above 0.1 mM. This effect was not observed when DNA was quantified using SYBR Green with ROX™ as the passive reference, nor when DNA was extracted and purified prior to Quantifiler Trio. The results show that metal contaminants can interfere with qPCR-based DNA quantification in unexpected ways and may be assay dependent. The results also highlight the importance of qPCR as a quality check to determine steps for sample cleanup prior to STR amplification that may be similarly impacted by metal ions. Forensic workflows should recognize the risk of inaccurate DNA quantification of samples that are collected from substrates containing tin.Item Metadata only Oral health profile of Australian children from different immigrant backgrounds(Dennis Barber, 2023) Soares, G.H.; Jamieson, L.; Kumar, S.; Mejia, G.Objectives: To profile the oral health of Australian children from different immigrant backgrounds. Method: Cross-sectional data for Australian children were obtained from the 2012-14 National Child Oral Health Study (NCOHS). Three categories of immigrant status were created based on parents' country of birth and language (non-immigrant, non-visible immigrant, and visible immigrant). Descriptive analyses reported weighted estimates for experience of dental caries, self-rated oral health, and dental services utilisation separately for children aged 5-9 years and 10-14 years. Results: The sample comprised 10,610 children aged 5-9 years (3,605 from immigrant backgrounds), and 8,741 children aged 10-14 years (3,074 from immigrant backgrounds). Children from non-visible immigrant backgrounds presented worse dental service utilisation and poorer self-rated oral health than children from non-immigrant and visible immigrant families. Greater inequalities in dental caries experience were observed in the 5-9-year-olds. Untreated caries was substantially higher among visible immigrant children aged 5-9 years (38.8%, 95% CI: 35.5-42.3) than non-immigrant (24.9%, 95% CI: 23.4-26.6) and non-visible immigrant children (21.0%, 95% CI: 17.7-24.7). Conclusions: Australian children from immigrant families constitute a highly heterogeneous group with substantial discrepancies in oral health outcomes.Item Metadata only Australians support for policy initiatives addressing unhealthy diet: a population-based study(Oxford University Press (OUP), 2023) Gupta, A.; Raine, K.D.; Moynihan, P.; Peres, M.A.To inform public health policy implementation in Australia, our study investigated the level of public support for six policy initiatives addressing unhealthy diet. The policy initiatives included taxing soft drinks and energy drinks, taxing less healthy food and beverage purchases, zoning to restrict the supply of junk foods near schools, prohibiting advertising and promotion of less healthy food and beverages to children under the age of 16 and restricting sugar-sweetened beverages from vending machines in schools, and public places. Data from a cross-sectional population-based study for 4040 Australians aged 15+ years, were analysed. A high overall support across all policy initiatives was observed. Nearly three-quarter of public support was observed for policy initiatives targeting children (zoning to restrict the supply of junk food near schools, prohibiting advertising and promotion of less healthy food and beverages to children under the age of 16 and restricting sugars-sweetened beverages from vending machines in schools), and half of Australians supported policy initiatives of taxing soft drinks and energy drinks and taxing less healthy food and beverage purchases. Australian women and those with tertiary level of education were more likely to support public health initiatives targeting children and all policy initiatives respectively. Interestingly, young adults expressed low level of support for all policy initiatives. The study demonstrated considerable public support for policy initiatives focussed on protecting children from unhealthy diet in Australia. Framing, designing and implementing policies targeting children is potentially a good starting point for policymakers to create a health promoting food environment.Item Metadata only Trajectories of child free sugars intake and dental caries - a population-based birth cohort study(Elsevier BV, 2023) Ha, D.H.; Nguyen, H.V.; Bell, L.K.; Devenish-Coleman, G.; Golley, R.K.; Thomson, W.M.; Manton, D.J.; Leary, S.D.; Scott, J.A.; Spencer, J.; Do, L.G.Objectives: To investigate the association between trajectories of free sugars intake during the first five years of life and dental caries experience at five years. Methods: Data from the SMILE population-based prospective birth cohort study, collected at one, two and five years old, were used. A 3-days dietary diary and food frequency questionnaire were used to estimate free sugars intake (FSI) in grams. The primary outcomes were dental caries prevalence and experience (dmfs). The Group- Based Trajectory Modelling method was used to characterize three FSI trajectories (‘Low and increasing’; ‘Moderate and increasing’; and ‘High and increasing’), which were the main exposures. Multivariable regression models were generated to compute adjusted prevalence ratios (APR) and rate ratios (ARR) for the exposure, controlling for socioeconomic factors. Results: The prevalence of caries was 23.3%, with a mean dmfs of 1.4, and a median of 3.0 among those who had caries. There were clear gradients of caries prevalence and experience by the FSI trajectories. The ‘High and increasing’ had an APR of 2.13 (95%CI 1.23-3.70) and ARR of 2.77 (95%CI 1.45-5.32) against the ‘Low and increasing’. The ‘Moderate and increasing’ group had intermediate estimates. A quarter of the caries cases could have been prevented if the whole study sample had been in the ‘Low and increasing’ FSI trajectory. Conclusion: A sustained, high trajectory of FSI from a young age was positively associated with child dental caries. Measures to minimise consumption of free sugars must commence early in life. Clinical significance: The study has provided high level evidence to inform clinicians’ decisions in promoting a healthy dietary pattern for young children.