Objective: To examine the impact on dental utilisation following the introduction of a participating provider scheme (Regional and Rural Oral Health Program {RROHP)). In this model dentists receive higher third party payments from a private health insurance fund for delivering an agreed range of preventive and diagnostic benefits at no out-ofpocket cost to insured patients. Data source/Study setting: Hospitals Contribution Fund of Australia (HCF) dental claims for all members resident in New South Wales over the six financial years from l99811999 to 200312004. Study design: This cohort study involves before and after analyses of dental claims experience over a six year period for approximately 81,000 individuals in the intervention group (HCF members resident in regional and rural New South Wales, Australia) and 267,000 in the control group (HCF members resident in the Sydney area). Only claims for individuals who were members of HCF at 31 December 1997 were included. The analysis groups claims into the three years prior to the establishment of the RROHP and the three years subsequent to implementation. Data collection/Extraction methods: The analysis is based on all claims submitted by users of services for visits between 1 July 1988 and 30 June 2004. In these data approximately 1,000,000 services were provided to the intervention group and approximately 4,900,000 in the control group. Principal findings: Using Statistical Process Control (SPC) charts, special cause variation was identified in total utilisation rate of private dental services in the intervention group post implementation. No such variation was present in the control group. On average in the three years after implementation of the program the utilisation rate of dental services by regional and rural residents of New South Wales who where members of HCF grew by 12.6%, over eight times the growth rate of 1.5% observed in the control group (HCF members who were Sydney residents). The differences were even more pronounced in the areas of service that were the focus of the program: diagnostic and preventive services. Conclusion: The implementation of a benefit design change, a participating provider scheme, that involved the removal of CO-payments on a defined range of preventive and diagnostic dental services combined with the establishment and promotion of a network of dentists, appears to have had a marked impact on HCF members' utilisation of dental services in regional and rural New South Wales, Australia.

Adult Oral Health Programme: The Effect of Periodontal Treatment and the Use of a Triclosan Containing Toothpaste on Glycaemic Control in Diabetics Abstract Aim: The aim of the research study is to establish an adult oral health programme for diabetics in Majuro, Republic of the Marshall Islands in order to determine the impact of non-surgical periodontal treatment followed by the use of a triclosan containing dentifrice on the maintenance of periodontal health and glycaemic control in type 2 diabetic patients. Hypothesis: Non-surgical periodontal treatment results in improved periodontal health and better glycaemic control in diabetics and use of a triclosan containing toothpaste is effective in maintaining this improvement in diabetics. Methods: An adult oral health programme was created, within which was conducted a two-group randomised clinical trial to address the hypothesis that non-surgical periodontal treatment results in improved periodontal health and better glycaemic control in type 2 diabetics and that the use of a triclosan containing toothpaste is effective in maintaining this improvement in diabetics. In this double blind controlled trial, sixty adult patients (aged 35 to 65 years) with type 2 diabetes mellitus having a minimum of 16 teeth received non-surgical periodontal treatment. Half of the patients were randomly assigned to use a triclosan containing toothpaste, Colgate Total, and the other group a non-triclosan toothpaste, Colgate Fluoriguard. The study evaluated the improvement in periodontal health by recording Probing Pocket Depth (PPD) on 6 sites of each tooth, and the number of sites bleeding on probing (BOP) at baseline, and at 6 months and 12 months after treatment. The second part of the study evaluated the impact of improvement of periodontal health on glycaemic control in type 2 diabetics by measuring HbA1c and RBS, and also assessing the levels of C-Peptides and CRP at baseline, and at 6 months and 12 months after treatment. The study also evaluated the effectiveness of a triclosan containing toothpaste in maintaining the improvement in periodontal health after non-surgical periodontal treatment. Results: The results showed that it was feasible to establish an oral health programme for the diabetics and could improve their periodontal health, and that toothpaste containing triclosan is effective in maintaining the improved periodontal heath in type 2 diabetics. Mean PPD dropped from 2.35mm to 1.95mm in the triclosan group and from 2.49mm to 2.24 mm in the non-triclosan group and the mean number of BOP sites dropped from 4.9 to 2.8 in the triclosan group and from 4.7 to 3.2 in the fluoriguard at 12 month visits. However, the results did not show improvement of HbA1c nor RBS levels in either group. C-Peptide levels increased and C-Reactive Protein levels decreased in both groups, however, not to significant levels at 12 month visits. Conclusion: The results of this research study lead to the conclusion that treating periodontal infection has effect of periodontal health of type 2 diabetic patients and following-up with simple personal oral hygiene of regular tooth-brushing helps maintain their periodontal health. This programme also proved that this type of oral health programme is feasible and valuable for diabetics in isolated places like the Marshall Islands, where infrastructure, personnel and resources are limited to treat microvascular and macrovascular complications of diabetes. As for the effectiveness of treating periodontal infections on glycaemic control of diabetics, this study failed to support the hypothesis that non-surgical treatment plus triclosan containing toothpaste would lead to better glycaemic management through improved periodontal health.

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

Diss. (sammanfattning) Uppsala : Univ., 2001. / Härtill 5 uppsatser.

Diss. (sammanfattning) Stockholm : Karol. inst., 2004. / Härtill 4 uppsatser.

Diss. (sammanfattning) Umeå : Umeå universitet, 2006. / Härtill 5 uppsatser.

Diss. (sammanfattning) Stockholm : Karolinska institutet, 2007. / Härtill 4 uppsatser.

Diss. (sammanfattning) Stockholm : Karolinska institutet, 2006. / Härtill 4 uppsatser.

Thesis (M.S.)--University of Michigan, 1971.