Body mass index and dental caries in children and adolescents : a systematic review of literature published 2004 to 2011

The objective
The authors undertook an updated systematic review of the relationship between body mass index and dental caries in children and adolescents.
Method
The authors searched Medline, ISI, Cochrane, Scopus, Global Health and CINAHL databases and conducted lateral searches from reference lists for papers published from 2004 to 2011, inclusive. All empirical papers that tested associations between body mass index and dental caries in child and adolescent populations (aged 0 to 18 years) were included.
Results
Dental caries is associated with both high and low body mass index.
Conclusion
A non-linear association between body mass index and dental caries may account for inconsistent findings in previous research. We recommend future research investigate the nature of the association between body mass index and dental caries in samples that include a full range of body mass index scores, and explore how factors such as socioeconomic status mediate the association between body mass index and dental caries.

Preparation and characterisation of new titanium based alloys for orthopaedic and dental applications

Various types of titanium alloys with high strength and low elastic modulus and, at the same time, vanadium and aluminium free have been developed as surgical biomaterials in recent years. Moreover, porous metals are promising hard tissue implants in orthopaedic and dentistry, where they mimic the porous structure and the low elastic modulus of natural bone. In the present study, new biocompatible Ti-based alloy foams with approximate relative densities of 0.4, in which Sn and Nb were added as alloying metals, were synthesised through powder metallurgy method.
The new alloys were prepared by mechanical alloying and subsequently sintered at high temperature using a vacuum furnace. The characteristics and the processability of the ball milled powders and the new porous titanium-based alloys were characterised by X-ray diffraction, optical
microscopy and scanning electron microscopy .The mechanical properties of the new titanium alloys were examined by Vickers microhardness measurements and compression testing.

Computer aided analysis of dental radiographic images

This paper is a result of a fruitful cooperation between the computer science and the dental diagnosis experiences. The study presents a new approach of applying computer algorithms to radiographic images of dental implantation used for bone regeneration. We focus here only on the contribution of the computer assistance to the clinical research as the periodontal therapy is beyond the scope of this paper. The proposed system is based on a pattern recognition approach, directed to recognize density changes in the intra-bony affected areas of patients. It comprises different modules with new algorithms specially designed to treat the patients’ radiographic images more accurately. The system includes digitizing, detecting the complicated region of interest (ROI), defining reference area to correct any projection discrepancy of the follow up images, and finally to extract the distinguishing features of the ROI as a basis for determining the rate of new bone density accumulation. This study is applied to two typical dental cases for a patient who received two different operations. The results are very encouraging and more accurate than traditional techniques reported before.

Wait no more : the use of private dental services by welfare recipients in Australia

Dental services in Australia are available both privately and publicly. However, access to public dental services, like access to public hospital services for non-urgent treatment, is subject to a considerable waiting period. Moreover, access to public dental services is restricted to certain categories of welfare beneficiaries who qualify for a health care card. Because of the waiting time for public treatment, there is a frequent call for more public dental resources. This paper addresses the issue of what the waiting time for public dental services represents. One view largely confirmed by our research is that state governments are using the waiting time as a way of trying to push more and more people into the private sector. We find that more and more health care card holders are using the
private sector for dental services.

The impact of childhood conditions and concurrent morbidities on child health and well-being

Background. Understanding the impact of illnesses and morbidities experienced by children and adolescents is essential to clinical and population health programme decision making and intervention research. This study sought to: (1) examine the population prevalence of physical and mental health conditions for children and quantify their impact on multiple dimensions of children's health and well-being; and (2) examine the cumulative effect of concurrent conditions.

Methods. We conducted a cross-sectional school-based epidemiological study of 5414 children and adolescents aged 5–18 years, and examined parental reports of child health and well-being using the parent-report Child Health Questionnaire (CHQ) PF50 13 scales are scored on a 0–100 pt scale with clinically meaningful differences of five points and the presence of childhood conditions (illnesses and health problems).

Results. Asthma, dental, vision and allergies are the most commonly identified health problems for children and adolescents, followed by attention- and behaviour-related problems (asthma 17.9–23.2%, dental 11.9–22.7%, vision 7.2–14.7%, chronic allergies 8.8–13.9%, attention problems 5.1–13.8% and behaviour problems 5.7–12.0%). As the number of concurrent health problems increase, overall health and well-being decreases substantively with mean differences in CHQ scale scores of 14 points (−7.69 to −21.51) for physical health conditions, and 28 points (−5.15 to −33.81) for mental health conditions.

Conclusions. Children's health and well-being decreases linearly with increasing presence and frequency of health problems. Having three or more conditions concurrently significantly burdens children's health and well-being, particularly for family-related CHQ domains, with a greater burden experienced for mental health conditions than physical health conditions.

Magnitude and meaningfulness of change in SF-36 scores in four types of orthopedic surgery

Background: The Medical Outcomes General Health Survey (SF-36) is a widely used health status measure; however, limited evidence is available for its performance in orthopedic settings. The aim of this study was to examine the magnitude and meaningfulness of change and sensitivity of SF-36 subscales following orthopedic surgery.

Methods: Longitudinal data on outcomes of total hip replacement (THR, n = 255), total knee replacement (TKR, n = 103), arthroscopic partial meniscectomy (APM, n = 74) and anterior cruciate ligament reconstruction (ACL, n = 62) were used to estimate the effect sizes (ES, magnitude of change) and minimal detectable change (sensitivity) at the group and individual level. To provide context for interpreting the magnitude of changes in SF-36 scores, we also compared patients' scores with age and sex-matched population norms. The studies were conducted in Sweden. Follow-up was five years in THR and TKR studies, two years in ACL, and three months in APM.

Results: On average, large effect sizes (ES≥0.80) were found after orthopedic surgery in SF-36 subscales measuring physical aspects (physical functioning, role physical, and bodily pain). Small (0.20–0.49) to moderate (0.50–0.79) effect sizes were found in subscales measuring mental and social aspects (role emotional, vitality, social functioning, and mental health). General health scores remained relatively unchanged during the follow-up. Despite improvements, post-surgery mean scores of patients were still below the age and sex matched population norms on physical subscales. Patients' scores on mental and social subscales approached population norms following the surgery. At the individual level, scores of a large proportion of patients were affected by floor or ceiling effects on several subscales and the sensitivity to individual change was very low.

Conclusion: Large to moderate meaningful changes in group scores were observed in all SF-36 subscales except General Health across the intervention groups. Therefore, in orthopedic settings, the SF-36 can be used to show changes for groups in physical, mental, and social dimensions and in comparison with population norms. However, SF-36 subscales have low sensitivity to individual change and so we caution against using SF-36 to monitor the health status of individual patients undergoing orthopedic surgery.

Absolute versus relative difference measures of priming: Which is appropriate when baseline scores change with age?

It is often of theoretical interest to know if implicit memory (repetition priming) develops across childhood under a given circumstance. Methodologically, however, it is difficult to determine whether development is present when baseline performance for unstudied items improves with age. Calculation of priming in absolute (priming=studied - unstudied) or relative-to-baseline terms can lead to different conclusions. In first noting this problem, Parkin (1993) suggested using the Snodgrass (1989a) calculation of relative priming [priming=(studied - unstudied)/(maximum - unstudied)], and most developmental studies have since adopted this procedure. Here, we question the Snodgrass method because the Snodgrass method's results are not replicated in the picture identification task when baselines are equated experimentally across age groups. Instead, results support an absolute measure of priming. Theoretically, we argue against its core assumption; namely, that children and adults always lie on the same learning curve, with an equal maximum performance level and equal rate of learning.

Australian dental policy reform and the use of dental therapists and hygienists

Oral diseases including dental caries and periodontal disease are among the most prevalent and costly diseases in Australia today. Around 5.4% of Australia’s health dollar is spent on dental services totalling around $2.6 billion, 84% of which are delivered through the private sector (AIHW 2001). The other 16% is spent providing public sector services in varied and inadequate ways. While disease rates among school children have declined significantly in the past 20 years the gains made among children are not flowing on to adult dentitions and our aging population will place increasing demands on an inadequate system into the future (AHMAC 2001). Around 50% of adults do not received regular care and this has implications for widening health inequalities as the greatest burden falls on lower income groups (AIHW DSRU 2001). The National Competition Policy agenda has initiated, Australia-wide, reviews of dental legislation applying to delivery of services by dentists, dental specialists, dental therapists and hygienists and dental technicians and prosthetists. The review of the Victorian Dentists Act 1972, was completed first in 1999, followed by the other Australian states with Queensland, the ACT and the Northern Territory still developing legislation. One of the objectives of the new Victorian Act is to ‘…promote access to dental care’. This study has grown out of the need to know more about how dental therapists and hygienists might be utilised to achieve this and the legislative frameworks that could enable such roles. This study used qualitative methods to explore dental health policy making associated with strategies that may increase access to dental care using dental therapists and hygienists. The study used a multiple case study design to critically examine the dental policy development process around the Review of the Dentists Act 1972 in Victoria; to assess legislative and regulatory dental policy reforms in other states in Australia and to conduct a comparative analysis of dental health policy as it relates to dental auxiliary practice internationally. Data collection has involved (I) semi-structured interviews with key participants and stakeholders in the policy development processes in Victoria, interstate and overseas, and (ii) analysis of documentary data sources. The study has taken a grounded theory approach whereby theoretical issues that emerged from the Victorian case study were further developed and challenged in the subsequent interstate and international case studies. A component of this study has required the development of indicators in regulatory models for dental hygienists and therapists that will increase access to dental care for the community. These indicators have been used to analyse regulation reform and the likely impacts in each setting. Despite evidence of need, evidence of the effectiveness and efficiency of dental therapists and hygienists, and the National Competition Policy agenda of increasing efficiency, the legislation reviews have mostly produces only minor changes. Results show that almost all Australian states have regulated dental therapists and hygienists in more prescriptive ways than they do dentists. The study has found that dental policy making is still dominated by the views of private practice dentists under elitist models that largely protect dentist authority, autonomy and sovereignty. The influence of dentist professional dominance has meant that governments have been reluctant to make sweeping changes. The study has demonstrated alternative models of regulation for dental therapists and hygienists, which would allow wider utilisation of their skills, more effective use of public sector funding, increased access to services and a grater focus on preventive care. In the light of theses outcomes, there is a need to continue to advocate for changes that will increase the public health focus of oral health care.

The effects of phonological and morphological training on speech perception scores and grammatical judgments in deaf and hard-of-hearing children

Seventeen primary school deaf and hard-of-hearing children were given two types of training for 9 weeks each. Phonological training involved practice of /s, z, t, d/ in word final position in monomorphemic words. Morphological training involved learning and practicing the rules for forming third-person singular, present tense, past tense, and plurals. The words used in the two training types were different (monomorphemic or polymorphemic) but both involved word final /s, z, t, d/. Grammatical judgments were tested before and after training using short sentences that were read aloud by the child (or by the presenter if the child was unable to read them). Perception was tested with 150 key words in sentences using the trained morphemes and phonemes in word final position. Grammatical judgments for sentences involving the trained morphemes improved significantly after each type of training. Both types of training needed to be completed before a significant improvement was found for speech perception scores. The results suggest that both phonological and morphological training are beneficial in improving speech perception and grammatical performance of deaf and hard-of-hearing children and that both types of training were required to obtain the maximum benefit.

Separating the contributions of hearing, lexical knowledge and speech production to speech perception scores in children with hearing impairments.

Open-set word and sentence speech-perception test scores are commonly used as a measure of hearing abilities in children and adults using cochlear implants and/or hearing aids. These tests are usually presented auditorily with a verbal response. In the case of children, scores are typically lower and more variable than for adults with hearing impairments using similar devices. It is difficult to interpret children's speech-perception scores without considering the effects of lexical knowledge and speech-production abilities on their responses. This study postulated a simple mathematical model to describe the effects of hearing, lexical knowledge, and speech production on the perception test scores for monosyllabic words by children with impaired hearing. Thirty-three primary-school children with impaired hearing, fitted with hearing aids and/or cochlear implants, were evaluated using speech-perception, reading-aloud, speech-production, and language measures. These various measures were incorporated in the mathematical model, which revealed that performance in an open-set word-perception test in the auditory-alone mode is strongly dependent on residual hearing levels, lexical knowledge, and speech-production abilities. Further applications of the model provided an estimate of the effect of each component on the overall speech-perception score for each child.

Theory of planned behaviour and implementation intentions in dental attendance

The thesis used a model of health behaviour to examine the predictors of dental attendance. Older respondents who had strong intentions, low perceived vulnerability, stable plans to attend, and were influenced by significant others were more likely to have attended the dentist for preventive care in the last 12 months. The portfolio concludes that attachment theory is a useful conceptual framework for enhancing our understanding of the antecedents and consequences of childhood sexual abuse.