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Background: This study aims to investigate the mediating pathways of oral health literacy (OHL) and oral health‐related behaviours on the relationship between education and self‐reported tooth loss among Australian adults. Methods: Data used for studying the effects of mediating pathways are from the National Dental Telephone Interview Survey 2013, a random sample survey of Australian adults aged 18+ years. To study the mediating effects, we use counterfactual‐based analysis. To decompose the effect of multiple mediator's alternate, to natural effect, methods such as interventional effects have been proposed. In this paper, we use these approaches to decompose the effect between education, OHL and oral health‐related behaviours on self‐reported tooth loss. Sensitivity analysis was performed for unmeasured confounding with multiple mediators. Results: Data were available for 2936 Australian adults. The prevalence of persons with ≥12 self‐reported tooth loss was approximately 15%. The average total causal effect from the low education group was nearly 150%, and the interventional indirect effect through OHL and the dependence of oral health‐related behaviours on OHL to more than 12 missing teeth were 20% and 120%, respectively, higher than in the high education group. Sensitivity analysis indicated if the difference in the prevalence of unmeasured confounder is as big as 6% the direct effect and the indirect effect remains as observed. Conclusions: An additional two‐fifths reduction on having more than 12 missing teeth for Australian adults with lower education level could be achieved if the proportion of lower OHL was decreased and optimal dental behaviours were increased. [ABSTRACT FROM AUTHOR]

Objectives: The literature describing the oral health of people with Multiple Sclerosis (MS) is scant and the findings equivocal. The aim of this study was to describe the oral health and oral self‐care behaviours of people living with MS and compare it to the Australian population. Methods: Participants enrolled with the Australian MS Longitudinal Study (AMSLS) were invited to participate in the survey using an online or paper‐based questionnaire. Data were collected on level of disability, oral health, oral self‐care and factors influencing attendance for oral health care. Results: Completed questionnaires were received for 1523 respondents. Over one‐fifth (n = 320; 22%) rated their oral health as fair or poor, and more than half (n = 840; 57%) reported toothache in the last 12 months. These proportions were higher than those for the general Australian adult population (oral health prevalence ratio (PR) = 1.25 [1.12, 1.40]; toothache PR = 3.63 [3.39, 3.88]), and this is despite comparable or better self‐maintenance habits and dental attendance reported by respondents. People with MS reported high rates of mouth dryness (68.4%), teeth sensitivity (64.7%), change of taste (40.5%) and orofacial pain (39.0%); fewer than 10% experienced none of these. There was a lower prevalence of self‐reported need for treatment (extraction or filling) than in the Australian adult population (15.8% vs 32.9%). Conclusions: People with MS have a greater oral health burden, demonstrated by their poorer self‐reported oral health than the Australian adult population. Furthermore, they experience high rates of toothache, mouth dryness, teeth sensitivity, change of taste and orofacial pain. These findings are contrary to their self‐reported good oral self‐care and dental attendance habits and suggest some of the oral health impacts are due to MS rather than dental behaviours. [ABSTRACT FROM AUTHOR]

Objectives: This study investigated the dental attendance patterns of Australian children with and without disabilities using data from Growing up in Australia: The Longitudinal Study of Australian Children. Methods: Data on 6470 participants within two groups (B cohort [aged 12–13]: n = 3381; K cohort [aged 16–17]: n = 3089) were used for the study. Binomial regression models were fitted to examine the association between disability status and dental attendance. The models were adjusted for gender, parent's country of birth, region of residence, highest parental education and household weekly income, and multiple imputations was used for handling missing data. Results: Children with disabilities constituted 2.4% and 3.8% of the study sample in the B and K cohort, respectively. The unadjusted risk ratio of irregular (vs. regular) dental attendance between children with and without disabilities was 1.07 (95% CI 0.78–1.46) in the B cohort and 1.15 (95% CI 0.93–1.42) in the K cohort. After adjustment and imputation, the risk ratios were 1.03 (95% CI 0.76–1.41) and 1.10 (95% CI 0.89–1.36) in the B and K cohort, respectively. Conclusions: Dental attendance pattern was positively, but minimally, associated with disabilities in older children, and factors including region of residence, parental education and household income were related to disability status and dental attendance. Further studies are required to clarify the association and ascertain key factors that affect the health and wellbeing of children with disabilities. [ABSTRACT FROM AUTHOR]

Objectives: To examine the differences in treatment outcomes for patients who received subsidized complete dentures in private dental clinics and in public dental clinics over 20 years in Victoria, Australia. Methods: Between 2000 and 2019, 187 227 complete dentures were provided to eligible public patients by the Victorian public dental system. Of these, approximately 52% were provided to public patients in private clinics through the voucher system. Of the 97 107 participants who received denture care in private clinics, 70 818 were matched 1:1 by propensity score (PS) quantiles with participants who received denture care in public clinics. The PS matching balanced the characteristics between these two groups. Subsequently, a conditional logistic regression model investigated the binary outcome of denture replacement whilst a conditional Poisson regression modelled the number of years to denture replacement. A frailty Cox regression after PS matching investigated denture survival over time. Results: Dentures provided in public clinics had a mean time to replacement of 5.5 years (SD: 34.0) and 25.9% were replaced during the observation period. In the first year of denture service, incidence rate per person year (IR) for complete denture replacement in public clinics was 0.04 (95% CI: 0.04–0.04). Dentures provided in private clinics had a mean time to replacement of 6.5 years (SD: 3.8) with 29.4% replaced during the observation period. In the first year of denture service, the IR for complete denture replacement in private clinics was 0.02 (95% CI: 0.02–0.02), which was less than half that of the public IR. Multivariate analyses found that although private dentures were more likely to be replaced during the observation period than those provided in the public sector (odds ratio [OR]: 1.31, 95% CI: 1.28–1.35, p <.001), they had greater longevity (incidence rate ratio [IRR]: 1.23, 95% CI: 1.23–1.24, p <.001). Longer longevity of private dentures was also supported by the frailty Cox regression showing that private dentures had a reduced hazard of denture replacement over time (better survival) in comparison to public dentures (hazard ratio [HR]: 0.94, 95% CI: 0.92–0.97, p <.001). Probabilistic sensitivity analysis supported the study findings. Conclusions: Increased denture longevity, higher rates of denture replacement and lower rates of early denture replacement were associated with receiving denture care in private clinics as compared with dentures provided in the public sector. [ABSTRACT FROM AUTHOR]

Introduction: Studying parent‐child pair health provides the opportunity to identify risk factors and opportunities for oral health prevention and intervention focusing on the family context. The aim of this study was to describe the oral health of children aged 11‐12 years and their parents in a national sample of parent‐child dyads in Australia. Methods: The Child Health CheckPoint is a study of 11 to 12‐year‐old children and one parent nested within the Longitudinal Study of Australian Children, a nationally representative cohort study. In 2015‐16, the study collected two‐dimensional photographic intra‐oral images and was scored using visual assessments of the teeth, oral hygiene and malocclusion. Results: Of the 1874 CheckPoint families, 1396 biological parent‐child pairs had at least one oral health measure recorded. Over two‐thirds of children had moderate to severe gingival inflammation (69.7%, 95%CI 64.7‐74.9). Parents had a lower proportion of poor oral hygiene (2.1%, 95% CI 1.4‐3.0) than children (13.0%, 95% CI 11.3‐14.9). High concordance was seen in the Modified Gingival Index correlation coefficient 0.49 (95%CI 0.44‐0.53). Conclusion: The high concordance in gingival health between child‐parent pairs supports the familial and behavioural links established in previous studies. Children had poorer oral hygiene but fewer visible dental caries lesions than their parents. As dental caries is a chronic and cumulative disease, preventive interventions targeting children's oral hygiene are needed. [ABSTRACT FROM AUTHOR]

Objectives: Oral health is essential to maintaining good overall health, and access to dental care is necessary for the early detection, prevention and control of oral diseases. The COVID‐19 pandemic has seen a significant disruption in the provision of dental services globally. The aim of this study was to investigate the impact of COVID‐19 on dental services provided in Australia through the Child Dental Benefits Schedule. Methods: This study was a retrospective analysis of Medicare data on utilization of the Child Dental Benefits Schedule obtained from the Australian Government. Data were analysed for the period February to September 2020, with the number of services provided per month across five categories (diagnostic, preventive, restorative, endodontic and oral surgery) compared with the monthly average for 2019 (95% CI) and the same month for 2019. Total services by month were reported for 2017, 2018 and 2019 to compare the yearly trend with 2020. Differences in services provision by State/Territory were also described. Results: Over the period of March to September, there were 881 454 fewer dental services provided in 2020 than 2019, with the largest decline seen in April. There was a greater decline in preventive and diagnostic services, and a smaller decline in endodontic and oral surgery services. A second wave of COVID‐19 in Victoria saw 198 609 fewer dental services provided in that state from July to September 2020 than 2019. Dental service provision had still not returned to normal levels across Australia by September 2020. Conclusion: The COVID‐19 pandemic has had a significant impact on the provision of dental services to children from lower socioeconomic backgrounds who already experience higher levels of dental disease and disadvantage in accessing dental care. Although the restriction of dental services was deemed necessary in order to minimize the risk of transmission of COVID‐19 in the dental setting, the impact of these restrictions on oral health will be long lasting. Given the chronic and progressive nature of dental disease, the deferral of necessary dental care is likely to contribute to poorer oral health and long‐term problems for many Australians. [ABSTRACT FROM AUTHOR]

Aims: Evidence suggests there are geographical variations in child oral health and this has prompted research into determinants of that variation. This study aimed to investigate factors attributable to the difference in child oral health between urban and rural areas in Australia. Method: Data were from the National Child Oral Health Study 2012‐14, a population‐based study of 5‐ to 14‐year‐old children, who underwent oral epidemiological examinations by trained examiners. Caries prevalence (dmfs/DMFS > 0) and experience (dmfs/DMFS count) in the primary dentition (5‐ to 8‐year‐old) and permanent dentition (9‐ to 14‐year‐old) were calculated. Children were grouped by residential location (urban or rural areas). A parental questionnaire collected information on family socio‐economic factors, and individual health behaviours (dental access, sugar consumption and toothbrushing). Residential history was used to calculate lifetime exposure to water fluoridation (WF). Analyses were weighted to produce population‐representative estimates. The primary outcomes were assessed separately for the two groups in regression models with robust standard error estimation to estimate prevalence ratios and mean ratios and their 95% confidence intervals. Population Attributable Fractions were calculated using the population distribution of the exposures and their adjusted estimates. Results: 10 581 5‐ to 8‐year‐old and 14 041 9‐ to 14‐year‐old children were included. Caries prevalence was higher in rural than in urban areas. In multivariable models, exposure to fluoridation, reason for dental visit and consumption of sugary beverages were consistently associated with caries prevalence and experience. WF coverage attributed to differences in caries prevalence (10% vs 21%) and experience (14% vs 35%) in the permanent dentition. High consumption of sugary beverages attributed to a higher primary and permanent dental caries experience in rural than in urban areas. Dental access was also attributed to the differences between the two areas. Conclusion: Factors at both community and individual levels attributed to the observed differences in child caries prevalence and experience between urban and rural areas. [ABSTRACT FROM AUTHOR]

Background: The phenomenon of overtreatment in dentistry is under‐explored and has not been the subject of much research inquiry. Most dental care in Australia is provided by practitioners in private dental practice. This research expands understanding of how the nexus between professionalism and commercialism in dentistry is impacted by the phenomenon of overtreatment. Methods: Data were collected through recorded interviews and written reflections from private dentists working in the Australian context. The data were then examined using thematic analysis to understand common themes and reveal deeper insights. Results: A total of 20 participants were recruited for this study. Participants spoke of their experiences in practice where financial targets and pressure from practice owners to provide high‐cost treatments presented challenges to their professionalism. The participants expressed that the way in which dentistry is remunerated based on activity was a motivation towards engaging in overtreatment. The participants also spoke of finding a balance between commercialism and professionalism within private dental practice. Conclusions: Participants' reports provided insights into how the mismanagement of the commercial elements of private dental practice led to a transactional ('buyer beware') relationship between the consumers and providers of dental services, rather than a relationship founded upon professional altruism and trust. Consumer empowerment through the commercialization of dentistry has potential to be a positive influence on the patient experience in accessing dental care. However, this research has shown that the shift of power through consumerism also risks attenuating professional appreciation of the imbalanced nature of the patient‐clinician relationship in dentistry. [ABSTRACT FROM AUTHOR]

Background: There is a dearth of studies on the extent to which perceived racial discrimination shapes oral health. Following an intersectional perspective, we estimated the prevalence of perceived racial discrimination in Australia, its association with oral health impairment, and examined whether this association was more severe among low socioeconomic status (SES) groups. Methods: Data came from the 2013 National Dental Telephone Interview Survey (N = 2798), a population‐based study of Australian adults. Multivariable Poisson regression models were estimated to test the relationship between perceived racial discrimination and self‐reported oral health impairment, as well as to investigate whether the magnitude of this association was greater among low‐SES respondents. Relative Excess Risks due to Interaction (RERI) were used to indicate the presence of potentially large discrimination effects within low‐SES strata. Results: Racial discrimination in the past 12 months was reported by 11.5% of all participants. Australians reporting racial discrimination had 1.4 (95% CI 1.1, 1.7) times the prevalence of impaired oral health. The association between perceived racial discrimination and oral health impairment was stronger among low‐SES groups. The RERI was 0.55, indicating a super‐additive Effect Measure Modification (EMM) by income on the additive scale. Similar results were observed with the EMM analyses by educational attainment. Conclusion: Our findings indicate that perceived racial discrimination, as a specific form of widespread inequality, is associated with higher frequencies of oral health impairment among Australian adults. We also suggest that socially marginalized groups bear a greater burden of the oral health effects of racial discrimination. [ABSTRACT FROM AUTHOR]

Aims: Disability is a key social determinant of health. The objective of this study was to test the association between disability status and irregular dental attendance among the Australian population, and to examine whether the observed association varied among adolescents. Methods: Data on 17 501 participants from The Household, Income and Labour Dynamics in Australia (HILDA) were analysed. The main outcome examined was irregular dental attendance (two or more years since last dental visit) with disability as the primary exposure. Multivariable logistic regression models were fitted to test the associations between disability and dental attendance pattern. Models were adjusted for age, gender, country of birth, region of residence, education and income. Analysis was repeated among adolescents (15‐ to 24‐year‐old) to examine for variations in observed association. Results: One in four participants reported having a disability. Unadjusted model showed that the odds for irregular dental attendance were 1.40 times greater (95%; CI, 1.30‐1.51) in those with disability than those without disability. After adjusting for all covariates, participants with disability had 1.20 times higher odds (95%; CI 1.10‐1.30) of irregular dental attendance than those without disability. Irregular dental attendance was 1.41 times greater (95%; CI 1.10‐1.80) in those with disability aged 15‐24 years than those without disability. Conclusions: Australian individuals with disability are more likely to have irregular dental attendance than those without. [ABSTRACT FROM AUTHOR]

Objectives: Andersen's behavioural model of healthcare utilization is one of the most commonly used frameworks for help‐seeking across a broad range of health areas, including oral health. The Model has been used in a wide range of previous studies to explore and understand oral health service use among both general populations and ethnic minorities. However, no research has explored its utility in understanding refugees' and asylum seekers' oral health help‐seeking. As such, this study aimed to improve understanding of Middle Eastern refugees' and asylum seekers' oral health help‐seeking and to determine the utility of Andersen's Model in this context. Methods: Interviews were conducted with 26 participants: 20 refugees and asylum seekers, and six oral health practitioners. Results were analysed using thematic analysis. Results: The results indicated that systemic barriers were of particular concern for refugees and asylum seekers in relation to oral healthcare access. Other components supported previous research concerning the domains of the Model, with additions in relation to acculturation and previous experiences of dental care either in home or resettlement contexts. Conclusions: Overall, this study highlights the need for a tailored approach to understanding oral health help‐seeking for refugees and asylum seekers, who have particular dental care needs. Resettlement policies should consider system‐level barriers to accessing dental services when considering access to health services more generally for refugees and asylum seekers. [ABSTRACT FROM AUTHOR]

Objectives: To report on changes in dental caries experience in children of a remote Indigenous community following 6 years of passive preventive intervention (PPI) and 2 years of active preventive intervention (API). Methods: Five consecutive cross‐sectional surveys were conducted on 4‐ to 15‐year‐old school going children between 2004 and 2017 following phases of Community Water Fluoridation (CWF), post‐cessation of CWF and API. Following treatment of any cavities present, API included selective placement of fissure sealants (FS) and an annual application of povidone‐iodine (PI) and fluoride varnish (FV). The World Health Organization's (WHO) "Oral Health Surveys – Basic Methods (4th Edition)" methodology was used in the first two and the International Caries Detection and Assessment System (ICDAS‐II) in the latter three surveys. ICDAS‐II codes of 3‐6, representing advanced caries, were combined to allow comparison to the decayed component of the DMF caries index. Results: Age‐weighted mean dmft decreased by 37.7% in the deciduous (DD) and DMFT by 35% in the permanent (PD) dentitions between the pre‐ and post‐CWF surveys, followed by increases of 25% and 7.7%, respectively, between the 1‐year and 4‐year post‐CWF surveys. After 2 years of API, mean dmft decreased by 14.3% and DMFT by 7.1%. Untreated dental caries however remained a concern in the DD and PD during both phases of PPI and of API. The decline in caries experience for both dentitions following 2 years of API exceeded that for the 6‐year period of PPI. Conclusions: The annual reductions in caries experience of 7.2% (DD) and 8% (PD) during the phase of API exceeded annual decreases of 4.7% (DD) and 4.6% (PD) during the phase of PPI. Due to remoteness, cost and logistics in ensuring long‐term viability of API programmes, CWF remains necessary in this type of community. [ABSTRACT FROM AUTHOR]

Objectives: To identify time trend pattern in toothache and to estimate whether toothache prevalence differs by socioeconomic position and residential location over time. Methods: Data from nine successive National Dental Telephone Interview Surveys (NDTIS) from 1994 (n = 6907) to 2013 (n = 6778) performed in Australia among individuals aged 15 years or over were used. The dependent variable was toothache reported very often, often or sometimes during the previous 12 months. Independent variables were age group, household income (tertiles), insurance/cardholder status and geographical remoteness. Prais‐Winsten analyses were performed, and the average annual percentage change (AAPC) for toothache prevalence was estimated. Results: Toothache affected slightly more than 10% of the overall population in 1994 (11.6%) and 1995 (11.4%), reaching approximately one‐sixth (16.2%) of individuals in 2013. Overall, there was a significant increase in toothache prevalence over time (AAPC = 2.0% [95% CI 0.7;1.34]) and in those aged 25‐44 (AAPC 2.1% [95% CI 0.6;3.6]) and 45‐64 (AAPC 3.4% [95% CI 1.5;5.3]) years and markedly among those in the lowest income group (AAPC 3.4% [95% CI 0.1;6.7]). All geographic locations except for remote/very remote areas had upward toothache prevalence over time. Insured status was not associated with increased toothache prevalence during the investigated period. Conclusions: Toothache prevalence increased from 1994 to 2013 in Australian adults particularly among the lowest socioeconomic group. [ABSTRACT FROM AUTHOR]

Objective: To investigate risk indicators for untreated dental decay among Indigenous Australian children using a national representative sample. Methods: Data were from the National Child Oral Health Study 2012‐2014, which included a nationally representative sample of Indigenous Australian children aged 5‐14 years. Outcomes were the prevalence (% ds/DS >0) and severity (mean ds/DS) of untreated dental decay at the tooth surface level. Caries of the primary dentition was estimated among 5‐ to 10‐year‐olds, while that of the permanent dentition was among 8‐ to 14‐year‐olds. Independent variables included residential location, household income, frequency and age commencement of toothbrushing, sugar‐sweetened beverages (SSB) consumption, dental visiting and residential fluoridation status. Multivariable log‐Poisson regression models with robust standard error estimation were used to identify risk indicators for untreated decay. The complex sampling design was taken into account in all analyses. Results: There were 720 5‐ to 10‐year‐old and 736 8‐ to 14‐year‐old Indigenous children. Indigenous children experienced significant amount of untreated dental caries. Among 5‐ to 10‐year‐olds, % ds >0 was 43.1 (95% CI: 36.8‐49.6) and mean ds was 3.4 (95% CI: 2.4‐4.4). Among 8‐ to 14‐year‐olds, % DS >0 was 27.3 (22.3‐32.9), while mean DS was 0.8 (0.6‐1.0). In multivariable modelling, risk indicators for % ds >0 among 5‐ to 10‐year‐olds were low household income, commencing toothbrushing after 30 months of age, consuming 2+ cups of SSB per day and not residing in fluoridated areas. Risk indicators for mean ds among 5‐ to 10‐year‐olds included infrequent toothbrushing and consuming 2+ cups of SSB per day. Risk indicators for % DS >0 among 8‐ to 14‐year‐olds were low household income, while risk indicators for mean DS among 8‐ to 14‐year‐olds were residing in non‐capital city, low household income, consuming 2+ cups of SSB per day and not residing in fluoridated areas. Conclusion: Indigenous Australian children experienced significant amount of untreated dental caries. Risk indicators for untreated decay included demographic factors, socioeconomic factors, oral hygiene behaviours, dietary behaviours and environmental factors. [ABSTRACT FROM AUTHOR]

Objective: To explore dental professionals' perceptions and experiences of providing oral health care for adults with mild to moderate mental health disorders (MHD) in Perth, Western Australia. Methods: A grounded theory approach guided this research which comprised semi‐structured interviews with oral health professionals working in private and/or public dental facilities attended by adults with MHD. An iterative analysis of transcripts identified emerging issues that were organized into categories under which key themes were noted, coded, compared, discussed, reviewed and revised independently by two researchers to ensure rigour. Results: Sixteen interviews were conducted with six general dentists, three dental specialists, four oral health therapists (OHT) and three dental assistants. Barriers to providing oral health care for adults with MHD included limitations of the current model of care, often focused on treating advanced disease; limited inter‐professional collaboration; an over‐burdened public dental system and the financial constraints of private practice. Personal barriers included perceptions that people with MHD had limited capacity for self‐care and preventing oral disease. Factors that would enable oral health care included training and professional development for dental professionals to work effectively with people with MHD and a more flexible, inter‐professional approach that involved prevention and inviting family to consultations about oral health in primary health care settings. Conclusions: Our study reveals structural barriers where services often appear to be inadequately prepared to meet the oral health needs of people with MHD. This suggests the need for strategies to review current models of care and encourage and support dental professionals to provide oral health care that is inclusive, inter‐professional, focused on prevention and sensitive to the social context and lived experience of people with MHD. [ABSTRACT FROM AUTHOR]

Objective To compare the magnitude of relative oral health inequalities between Indigenous and non-Indigenous persons from Brazil, New Zealand and Australia. Methods Data were from surveys in Brazil (2010), New Zealand (2009) and Australia (2004-06 and 2012). Participants were aged 35-44 years and 65-74 years. Indigenous and non-Indigenous inequalities were estimated by prevalence ratios ( PR) and their corresponding 95% confidence intervals ( CI), adjusting for sex, age and income. Outcomes included inadequate dentition, untreated dental caries, periodontal disease and the prevalence of 'fair' or 'poor' self-rated oral health in Australia and New Zealand, and satisfaction with mouth/teeth in Brazil ( SROH). Results Irrespective of country, Indigenous persons had worse oral health than their non-Indigenous counterparts in all indicators. The magnitude of these ratios was greatest among Indigenous and non-Indigenous Australians, who, after adjustments, had 2.77 times the prevalence of untreated dental caries (95% CI 1.76, 4.37), 5.14 times the prevalence of fair/poor SROH (95% CI 2.53, 10.43). Conclusion Indigenous people had poorer oral health than their non-Indigenous counterparts, regardless of setting. The magnitude of the relative inequalities was greatest among Indigenous Australians for untreated dental decay and poor SROH. [ABSTRACT FROM AUTHOR]

Objectives To conduct cross-national comparison of education-based inequalities in tooth loss across Australia, Canada, Chile, New Zealand and the United States. Methods We used nationally representative data from Australia's National Survey of Adult Oral Health; Canadian Health Measures Survey; Chile's First National Health Survey Ministry of Health; US National Health and Nutrition Examination Survey; and the New Zealand Oral Health Survey. We examined the prevalence of edentulism, the proportion of individuals having <21 teeth and the mean number of teeth present. We used education as a measure of socioeconomic position and measured absolute and relative inequalities. We used random-effects meta-analysis to summarize inequality estimates. Results The USA showed the widest absolute and relative inequality in edentulism prevalence, whereas Chile demonstrated the largest absolute and relative social inequality gradient for the mean number of teeth present. Australia had the narrowest absolute and relative inequality gap for proportion of individuals having <21 teeth. Pooled estimates showed substantial heterogeneity for both absolute and relative inequality measures. Conclusions There is a considerable variation in the magnitude of inequalities in tooth loss across the countries included in this analysis. [ABSTRACT FROM AUTHOR]

Background Dental caries is a multifactorial condition, prevention of which requires comprehensive understanding of both contextual and compositional determinants and their population impact. Aims To investigate contextual and compositional factors associated with the prevalence of dental caries in children and to estimate the population impact of those factors. Methods Children in one Australian state were selected through stratified random sampling selection in 2010-2011. Oral epidemiological examinations provided individual-level outcomes: prevalence of dental caries in the primary (among 5- to 8-year-olds) and permanent dentitions (9- to 14-year-olds). Socioeconomic status, oral health behaviours and practices and dietary patterns were explanatory factors at the individual-level, school-level and area-level fluoridation status. Three-level multilevel multivariable models were sequentially specified for the prevalence of dental caries to estimate prevalence ratios (PR) associated with explanatory factors, adjusting for covariates and between- and within-group variances. Population attributable fraction (PAF) was estimated as the population impact of the statistically significant explanatory factors. Results Data from 2214 5- to 8-year-olds and 3186 9- to 14-year-olds from 207 schools in 16 areas were analysed. The prevalence of dental caries in the primary and the permanent dentitions was 47.1% (43.9-50.4) and 38.8% (36.1-41.6), respectively. The highest prevalence of dental caries was observed in the nonfluoridated areas. In bivariate associations, factors at three levels were associated with prevalence of dental caries. In the full models, children in the nonfluoridated areas had significantly higher prevalence of dental caries [PR for the primary: 1.29 (1.11-1.50); PR for the permanent 1.49 (1.01-2.21)] compared with children in fluoridated areas, controlling for other factors. PAF estimates indicated that lack of water fluoridation attributed to 21% and 31% of primary and permanent dental caries, respectively in this child population. Conclusion A multitude of factors had significant population impact on the prevalence of dental caries in children. Water fluoridation has a significant population impact on dental caries experience in this child population. [ABSTRACT FROM AUTHOR]