The goal of this study was to review Maori oral health services utilising a kaupapa Maori framework. The aims of the study were to identify the issues in the development, implementation and operation of Maori dental health services within each of the three types of Maori health providers (mainstream, iwi-based, partnership). The three Maori oral health services are: (i) Te Whare Kaitiaki, University of Otago Dental School, Dunedin. (ii) Te atiawa Dental Service, New Plymouth. (iii) Tipu Ora Dental Service, in partnership with the School Dental Service, Lakeland Health, Rotorua. Method: A literature review of kaupapa Maori research was undertaken to provide the Maori framework under which this study was conducted. The kaupapa Maori methodology utilised the following criteria: (i) Rangatiratanga: The assertion of Maori leadership; (ii) Whakakotahitanga: A holistic approach incorporating Te Whare Tapa Wha; (iii) Whakapapa: The origins and development of oranga niho; (iv) Whakawhanuitanga: Recognising and catering for the diverse needs of Maori; (iv) Whanaungatanga: Culturally appropriate forms of relationship management; (v) Maramatanga: Raising Maori awareness, health promotion and education; and (vi) Whakapakiri: Recognising the need to the build capacity of Maori health providers. Ethical approval was granted by the Otago, Bay of Plenty and Taranaki Ethics Committees to undertake interviews and focus groups with Maori oral health providers in Dunedin, Rotorua and New Plymouth. Information was also sought from advisors and policy analysts within the Ministry of Health. A valuable source of information was hui korero (speeches and/or discussion at Maori conferences). An extensive literature was undertaken including an historical search of material from private archives and the now defunct Maori Health Commission. Results: An appropriate kaupapa Maori methodology was developed which provided a Maori framework to collate, describe, organise and present the information on Maori oral health. In te ao tawhito (the pre-European world of the Maori) there was very little if any dental decay. In te ao hou (the contemporary world of the Maori) Maori do not enjoy the same oral health status as non-Maori across all age groups. The reasons for this health disparity are multifactorial but include the social determinants of health, life style factors and the under-utilisation of health services. In order to address the disparities in Maori oral health, Maori providers have been very eager to establish kaupapa Maori oral health services. The barriers to the development, implementation, and operation of a kaupapa Maori oral health service are many and varied and include access to funding, and racism. Maori health providers have overcome the barriers through two strategies: firstly, the establishment of relationships within both the health sector and the Maori community; and secondly, through their passion and commitment to oranga niho mo te iwi Maori (oral health for all Maori). The outcome of this review will contribute to Maori health gain through the recognition of appropriate models and strategies which can be utilised for the future advancement of Maori oral health services, and hence to an improvement in Maori oral health status. Conclusion: This review of Maori oral health services has found that there are oral health disparities between Maori and non-Maori New Zealanders. In an effort to overcome these disparities Maori have sought to provide kaupapa Maori oral health services. Whilst there is a diversity in the provision of Maori oral health services, kaupapa Maori services have been developed that are appropriate, effective, accessible and affordable. They must have the opportunity to flourish.

Background: Teeth affected by apical periodontitis (AP) that could be retained by root canal therapy (RCT) are increasingly being extracted and replaced with implant-supported crowns (ISC). Objectives: 1) To investigate preferences of dentists and patients towards retaining a tooth with AP using RCT versus its extraction followed by, no replacement, replacement with an ISC, or with a partial fixed or removable denture. 2) To investigate patients’ preferred role and dentists’ ethical responsibilities in decision-making. Methods: A mail-out survey (sent to: dental specialists, n=195, response rate=39%; patients, n=434, response rate=43%) and a web-based survey (general dentist sample, n=304, response rate =15%) were used to collect data. Statistical bivariate and multivariate analyses were undertaken with P set at < 0.05 with Bonferroni adjustment as necessary. Results: RCT or ISC were the most selected treatment choices for dentists, while the preference for RCT was reduced for teeth treated previously with RCT. Dentists’ preferences were associated with their specialty as well as clinical experience in endodontics and/or implant dentistry. Patients’ stated general preference for saving teeth was associated with higher self-rated oral health, frequent dental check-ups, and higher socio-demographic factors. Those with higher education, regular dental visits and previous experience of RCT preferred to undergo RCT for future treatment in comparison to those who never experienced RCT. Patients preferred a collaborative role with their dentists in making treatment decisions and valued the retention of natural teeth very highly. They also felt that communication with and trust in their dentist was paramount. Conclusion: Dentists should establish rapport with patients in a milieu that values and respects the patients’ autonomy. By following the highest standards of evidence-based care, and transferring unbiased information on treatment options and associated risks/benefits, it is highly probable that dental care will be delivered in a more ethical manner than would otherwise be possible.

Background: Teeth affected by apical periodontitis (AP) that could be retained by root canal therapy (RCT) are increasingly being extracted and replaced with implant-supported crowns (ISC). Objectives: 1) To investigate preferences of dentists and patients towards retaining a tooth with AP using RCT versus its extraction followed by, no replacement, replacement with an ISC, or with a partial fixed or removable denture. 2) To investigate patients’ preferred role and dentists’ ethical responsibilities in decision-making. Methods: A mail-out survey (sent to: dental specialists, n=195, response rate=39%; patients, n=434, response rate=43%) and a web-based survey (general dentist sample, n=304, response rate =15%) were used to collect data. Statistical bivariate and multivariate analyses were undertaken with P set at < 0.05 with Bonferroni adjustment as necessary. Results: RCT or ISC were the most selected treatment choices for dentists, while the preference for RCT was reduced for teeth treated previously with RCT. Dentists’ preferences were associated with their specialty as well as clinical experience in endodontics and/or implant dentistry. Patients’ stated general preference for saving teeth was associated with higher self-rated oral health, frequent dental check-ups, and higher socio-demographic factors. Those with higher education, regular dental visits and previous experience of RCT preferred to undergo RCT for future treatment in comparison to those who never experienced RCT. Patients preferred a collaborative role with their dentists in making treatment decisions and valued the retention of natural teeth very highly. They also felt that communication with and trust in their dentist was paramount. Conclusion: Dentists should establish rapport with patients in a milieu that values and respects the patients’ autonomy. By following the highest standards of evidence-based care, and transferring unbiased information on treatment options and associated risks/benefits, it is highly probable that dental care will be delivered in a more ethical manner than would otherwise be possible.

Thesis (Ph. D.)--University of Michigan, 1979. / eContent provider-neutral record in process. Description based on print version record. Includes bibliographical references (leaves 298-309).

Early childhood caries is a condition of rapidly progressing rampant dental caries in infants and young children. It is considered as a major public health problem affecting pre-school children and it is the most common dental disease which affects 28% of children within two to five years of age. ECC not only induces pain and discomfort, but can also affect communication, nutrition status, learning abilities, speech and quality of life, which may progress into adulthood and pose a heavy burden on the healthcare system in long-term. In Hong Kong, over 50% of children were affected by dental caries in 2001 but over 70% of children had never been to a dentist for a regular check up at age five. Thus, much of the tooth decay was remained undetected and untreated. Dental caries can be preventable and achievable. Collaboration between families, early care and health care professionals is required to promote effective oral health care. Numerous studies have found that educational programs and workshops are effective in promoting oral health and can provide children a lifelong opportunity to be free from preventable oral disease. In order to promote oral health to achieve the mission of the Department of Health in Hong Kong- at least 65% of 5 years old children are free from caries by the year 2020, an evidence-based guideline for a community-based programme in oral health education was developed in the proposed setting after a critical appraisal of the reviewed evidence. The comprehensive intervention plan, including communication plan with stakeholders, training of staffs and pilot testing will be carried out to facilitate the implementation of the innovation. The oral health programme will be evaluated for its effectiveness in achieving the patient outcomes, health providers’ outcomes and system outcomes in the proposed settings. / published_or_final_version / Nursing Studies / Master / Master of Nursing

BACKGROUND: Researchers in the fields of health, education and psychology have established a causal relationship between levels of education and both health status and its management amongst adults and children. This has resulted in largescale ‘health literacy’ intervention programmes. The relationship between oral health literacy (OHL), health status and management is less understood. Indeed, ‘OHL’ is a relatively new field with limited research to date in Asia. Measurements of OHL on the whole have focused on the match or mismatch between reading fluency, vocabulary, background knowledge, and oral and written communication demands. While it may be difficult or impractical to comprehensively capture and measure all possible dimensions of OHL, several instruments have been developed to date, albeit mostly in English dominant contexts. OBJECTIVES: The major objectives of this study were to: a) to describe the relationship between caregiver reading habits and their OHL, and their child’s oral health status; b) assess the functional OHL levels of primary caregivers in an Asian population using two new instruments; c) to describe the relationship between caregiver OHL and the oral health status of their children. METHODS: A cross-sectional study using two locally-developed and validated OHL instruments; Hong Kong Rapid Estimate of Adult Literacy in Dentistry-30 (HKREALD-30) and Hong Kong OHL Assessment Task for Paediatric Dentistry (HKOHLAT-P) was adopted. A random sample of 301 child/caregiver dyads was recruited from kindergartens in Hong Kong Island. Data included: socio-demographic information; caregivers’ self-reported reading habits and OHL levels; and child oral health status as a) dental caries experience - number of decayed, missing and filled teeth (dmft); and b) oral hygiene status - by the Visible Plaque Index (VPI). RESULTS: Caregivers’ reported reading of print Chinese was significantly associated with their OHL scores: HKREALD-30 and HKOHLAT-P (p<0.01). No associations were found between caregiver’s reading habits and their children’s oral health status (p>0.05). Both OHL assessment tasks were associated with children’s oral health status. Both HKOHLAT-P and HKREALD-30 remained associated with dmft in the adjusted negative binomial regression models (accounting for socio-demographics), but HKOHLAT-P had a stronger association (IRR 0.97, P=0.02 versus 0.96, P=0.03). HKOHLAT-P was associated with VPI in the adjusted model (IRR 0.90, P<0.05), but no significant association between HKREALD-30 and VPI was evident. CONCLUSIONS AND IMPLICATIONS: Caregivers’ habits of reading print and digital texts were significantly associated with their OHL scores. No significant associations were found between caregivers’ reading habits and their children’s oral health status, indicating that reading habits is a different attribute that may not directly affect their child’s oral health. Caregivers’ functional OHL was associated with their children’s oral health status in Hong Kong. A comprehension task tool (HKOHLAT-P) was more robust in determining such associations when compared to a simple word recognition based test (HKREALD-30). / published_or_final_version / Dentistry / Doctoral / Doctor of Philosophy

The purpose of this study was to determine the relationship between oral health status and body mass index for residents in a Transitional Care Center. The population utilized in this study were 193 males and females between the ages of 16-98 years old who were admitted to the Transitional Care Center at Columbus Regional Hospital in Columbus, Indiana. The researcher obtained informed consent from each participant upon admission to the subacute unit. The information used for this study was obtained from the Minimum Data Set located in each resident's medical record. Subjects were divided in two groups according to age, less than 75 years old and > 75 years old to determine whether age had an effect on oral health status and body mass index.The conclusion was that there was a difference between males and females. Women had a higher BMI than males for both age groups. Participants less than 75 years old were more likely to have a higher body mass index compared with subjects > 75 years of age. Seventy-four percent of those aged > 75 years old wore dentures or a removable bridge compared with 56% of younger subjects (< 75 years old).Although no statistically significant relationship was found between oral health status and body mass index, a trend was noted. As the number of oral health problems increased for individuals, body mass index decreased. The types and prevalence of specific oral health problems were reported indicating a need for further research into relationship between obesity, oral health, lifestyle factors, availability of dental care, and nutrient intakes for the elderly population. / Department of Family and Consumer Sciences

Ätstörningar som anorexia nervosa (AN) och bulimia nervosa (BN) innebär ett folkhälsoproblem som kan orsaka oral ohälsa Studiens syfte: Syftet med denna litteraturstudie var att undersöka vilka orala problem som förekommer vid AN och BN. Material och metod: Studien genomfördes i form av en litteraturstudie. Material samlades in via sökningar i databasen Web of Science. Resultatet baserades på en sammanställning av sju vetenskapliga artiklar. Resultat: Resultatet visade att ett flertal studier har redovisat förekomst av orala förändringar vid diagnoserna AN och BN. Mest förekommande var dentala erosioner och hypertrofi av glandula parotis. Men även förekomst av karies, parodontal sjukdom samt orala slemhinneförändringar och infektioner framgick. Slutsats: Slutsatsen med denna studie visar att de mest förekommande orala problemen som uppstår vid AN och BN är dentala erosioner samt hypertrofi av salivkörtlarna, även orala slemhinneförändringar och infektioner förekommer. / Eating disorders such as anorexia nervosa (AN) and bulimia nervosa (BN) represents public health problem that may cause poor oral health. Objective: The aim of this study was to examine the side effects that arise in the oral health with AN and BN. Material and methods: The study was carried out as a literature review. The data was collected through searches in the database “Web of Science”. The final result was based on the findings of seven scientific articles. Results: The results showed that several studies have reported the occurrence of oral changes in the diagnoses of AN and BN. Dental erosions and hypertrophy of the parotid gland were the most common oral changes. The presence of caries, periodontal disease, oral mucosal lesions and infections also appeared. Conclusion: The conclusion of this study is that the most common oral problems associated with AN and BN are dental erosions, hypertrophy of the salivary glands, and oral mucosal lesions. Infections may also appear.

Background Health-related quality of life (HRQoL) measures have become important when determining health priorities, but only five longitudinal studies limited to older adults and/or to subjects with an oral disadvantage have investigated the association between routine dental care and HRQoL. The aims in this study were to determine if dentist visiting or the volume, complexity and cost of general dental care, and baseline oral HRQoL and treatment need were associated with changes in HRQoL, and/or modify the impact of dental care on changes in HRQoL. Methods The project was an observational prospective cohort study of a sample of randomly selected dentate adult Tasmanians surveyed in 2006 and followed over a one-year period. The collection procedures comprised a computer-assisted telephone interview, an oral epidemiological examination, a baseline mail self-complete questionnaire, a service use log book, and a twelve-month mail self-complete questionnaire. Change in HRQoL was measured by change in the summary measure of the Oral Health Impact Profile (OHIP-14 severity) and change in the EuroQol index (EQ-5D), global oral and general transition statements, and follow-up OHIP-14 severity. Results From 1,745 eligible household numbers, 59.7% were interviewed, of whom 43.7% received epidemiological examinations. Of those, over three-quarters (77.4%) completed the baseline mail questionnaire. Nearly three-quarters of those who completed the baseline self-complete questionnaires completed the twelve-month follow-up questionnaire (73.5%). More than half of the respondents (53.8%) visited a dental practitioner, the vast majority of whom (94.9%) saw a private sector dentist. The most common types of dental care received were diagnostic, preventive and restorative services When the dependent variable was change in mean OHIP-14 severity, visiting a dentist was associated with a statistically significant worsening of oral HRQoL after adjusting for confounders. In contrast, visiting a dentist was associated with a significant improvement in quality of life when the dependent variable was the global oral health transition statement, although that association was not homogeneous. The global general health transition statement showed an unfavourable association of dental visits, although it was not statistically significant. Follow-up OHIP-14 dental attendance was associated with worsening QoL, although the association was not statistically significant. When change in HRQoL was measured by the global general health transition statement, high compared to low volume of dental care had a statistically significant favourable influence on HRQoL, although there was effect modification. With the global oral health transition statement, high complexity dental care was associated with a statistically significant worsening of HRQoL, while high cost dental care was associated with a statistically significant improvement of HRQoL. Across all measures of HRQoL, the survey participant factors most often subject to effect modification where those related to socio-economic status, particularly education and occupation. Conclusions The results varied according to which dependent measure of change in HRQoL was used. Dental care had a differing effect on general health compared to oral health, although the effects on general health varied considerably among some population groups. Researchers need to devise consistent definitions of health, HRQoL, oral health and oral HRQoL. / http://proxy.library.adelaide.edu.au/login?url= http://library.adelaide.edu.au/cgi-bin/Pwebrecon.cgi?BBID=1375110 / Thesis (Ph.D.) - University of Adelaide, School of Dentistry, 2009

Background Health-related quality of life (HRQoL) measures have become important when determining health priorities, but only five longitudinal studies limited to older adults and/or to subjects with an oral disadvantage have investigated the association between routine dental care and HRQoL. The aims in this study were to determine if dentist visiting or the volume, complexity and cost of general dental care, and baseline oral HRQoL and treatment need were associated with changes in HRQoL, and/or modify the impact of dental care on changes in HRQoL. Methods The project was an observational prospective cohort study of a sample of randomly selected dentate adult Tasmanians surveyed in 2006 and followed over a one-year period. The collection procedures comprised a computer-assisted telephone interview, an oral epidemiological examination, a baseline mail self-complete questionnaire, a service use log book, and a twelve-month mail self-complete questionnaire. Change in HRQoL was measured by change in the summary measure of the Oral Health Impact Profile (OHIP-14 severity) and change in the EuroQol index (EQ-5D), global oral and general transition statements, and follow-up OHIP-14 severity. Results From 1,745 eligible household numbers, 59.7% were interviewed, of whom 43.7% received epidemiological examinations. Of those, over three-quarters (77.4%) completed the baseline mail questionnaire. Nearly three-quarters of those who completed the baseline self-complete questionnaires completed the twelve-month follow-up questionnaire (73.5%). More than half of the respondents (53.8%) visited a dental practitioner, the vast majority of whom (94.9%) saw a private sector dentist. The most common types of dental care received were diagnostic, preventive and restorative services When the dependent variable was change in mean OHIP-14 severity, visiting a dentist was associated with a statistically significant worsening of oral HRQoL after adjusting for confounders. In contrast, visiting a dentist was associated with a significant improvement in quality of life when the dependent variable was the global oral health transition statement, although that association was not homogeneous. The global general health transition statement showed an unfavourable association of dental visits, although it was not statistically significant. Follow-up OHIP-14 dental attendance was associated with worsening QoL, although the association was not statistically significant. When change in HRQoL was measured by the global general health transition statement, high compared to low volume of dental care had a statistically significant favourable influence on HRQoL, although there was effect modification. With the global oral health transition statement, high complexity dental care was associated with a statistically significant worsening of HRQoL, while high cost dental care was associated with a statistically significant improvement of HRQoL. Across all measures of HRQoL, the survey participant factors most often subject to effect modification where those related to socio-economic status, particularly education and occupation. Conclusions The results varied according to which dependent measure of change in HRQoL was used. Dental care had a differing effect on general health compared to oral health, although the effects on general health varied considerably among some population groups. Researchers need to devise consistent definitions of health, HRQoL, oral health and oral HRQoL. / http://proxy.library.adelaide.edu.au/login?url= http://library.adelaide.edu.au/cgi-bin/Pwebrecon.cgi?BBID=1375110 / Thesis (Ph.D.) - University of Adelaide, School of Dentistry, 2009