Outcomes of a co-designed, community-led oral health promotion program for Aboriginal children in rural and remote communities in New South Wales, Australia.

OBJECTIVE: Improving the oral health of Aboriginal children is an Australian priority. Public policy recommends the development of evidence-based, culturally competent oral health promotion programs. Positive health outcomes are more likely for Aboriginal people when programs are co-designed with the community and tailored to local needs. This study aims to determine the impact of a community-led oral health promotion program for Aboriginal children in rural and remote communities. BASIC RESEARCH DESIGN: Consecutive surveys. Baseline data were collected on the oral health of Aboriginal children aged five-12 years in rural and remote communities in Central Northern New South Wales in 2014. Then, an evidence-based oral health promotion program was co-designed with local Aboriginal communities. It included daily toothbrushing, water bottle program, regular application of fluoride varnish, regular distribution of toothbrushes and fluoride toothpaste and dental health education and commenced in 2016 in three schools in the region. In 2018, oral health status and oral hygiene behaviours of participating children were compared against baseline data to evaluate the program. RESULTS: There was a significant reduction in tooth decay, plaque scores and gingivitis. The mean number of teeth affected by tooth decay was 4.13, compared to 5.31 in 2014. An increase was also seen in positive oral hygiene behaviour. CONCLUSIONS: The co-design elements of the program are critical to its success. Engaging local Aboriginal communities to co-design and deliver oral health promotion can reduce the burden of tooth decay experienced by Aboriginal children.

A longitudinal workforce analysis of a Rural Clinical Placement Program for final year dental students.

BACKGROUND: There is little longitudinal evaluation of rural dental education outreach programs. This longitudinal research investigates the influence of a Rural Clinical Placement Program (RCPP) on workforce outcomes in terms of practice locations for five graduate years from the University of Sydney. METHODS: Work locations for the graduates from 2009-2013 were identified in 2015 and 2017 by rurality, using faculty contact lists, phone calls and online methods. A total of 397 graduate locations were identified out of 404 (98.2%) (267 RCPP participants and 137 non-RCPP participants). Semi-structured questionnaires were used to report on demographic and characteristic data. Univariate and multivariate statistical analyses were utilised to explore associations. RESULTS: Rural Clinical Placement Program participation in 2015 was significantly associated with an increased likelihood of working rurally (PR = 2.16), and almost two times the likelihood of rural retention in the period from 2015 to 2017 (PR = 1.93). In the multivariate analyses, both rural experience prior to the RCPP and pre-placement rural intentions were significant independent predictors of an increased likelihood for rural employment and rural retention. CONCLUSIONS: Participation in the RCPP was associated with increased rural employment and retention. Prior rural experience and pre-placement rural intentions were identified as significant independent predictors of rural employment.

Utilization of public oral health services by New South Wales teenagers, 2004-05 to 2014-15.

BACKGROUND: The aims of this study were to examine variations in levels of access to public oral health services in New South Wales by teenagers from 2004-05 to 2014-15 and to determine whether more teenagers have been treated with preventive dental items in keeping with the strategic shift statewide towards prevention and early intervention. METHODS: This study involved an analysis of a subset of the New South Wales Oral Health Data Collection for teenagers treated in the New South Wales Public Oral Health Service in the financial years 2004-05 to 2014-15. Relevant Australian Dental Association dental service item groups are reported for teenagers by year as a percentage of total visits delivered in that year. RESULTS: The utilization of the New South Wales Public Oral Health Service by teenagers has remained relatively stable over the 11 years at approximately 6%, while the provision of some preventive items increased over the time period. CONCLUSIONS: There were important differences found in access by teenagers to preventive items by socio-economic status and rurality, and these differences will be targeted over the coming years by New South Wales Public Oral Health Services and better monitored by a new electronic oral health record being implemented statewide from 2016.

Sugary drink consumption and dental caries in New South Wales teenagers.

BACKGROUND: The consumption of water, milk and various sugary drinks and their relationship with the caries experience of a random sample of teenagers aged 14 to 15 years living in New South Wales, Australia was investigated. METHODS: Data were obtained from both clinical and questionnaire components of the NSW Teen Dental Survey, 2010. The analyses allowed for various demographic and behavioural risk factors using caries experience (DMFT >0) and mean DMFT as the key outcome variables. RESULTS: Males were more likely than females to consume large volumes of sugary drinks. Consuming two or more glasses of sugary drinks per day led to significantly increased caries experience amongst this sample of 14 and 15 year olds. Factors found to be associated with elevated sugary drink consumption included family income, gender, and mother's education level. CONCLUSIONS: There is a strong correlation between increased caries experience of NSW teenagers and high levels of consumption of sugary drinks.

Pattern of distribution of Prevotella species/phylotypes associated with healthy gingiva and periodontal disease.

The purpose of the present study was to obtain diverse profiles of Prevotella species associated with gingival sites in an isolated Aboriginal and an urban community by phylogenetic analysis and to establish patterns of association of identified Prevotella species in gingival sites. Species/phylotypes identified from the phylogenetic analysis of near full-length Bacteroidetes 16S rRNA gene sequences cloned from subgingival plaque samples obtained from an Aboriginal community were compared with those from an ethnically diverse urban metropolitan population suffering from periodontal disease. Specific primer sets were designed and validated for 22 distinct Prevotella species from the 24 species/phylotypes identified from both populations. Within the isolated Aboriginal community, gingival sites in adults were colonised by a mean of 15 different Prevotella species. Prevotella sp. oral clone P4PB24, Prevotella intermedia, Prevotella oralis, Prevotella denticola and Prevotella sp. strain P4P62 had the highest association with increasing probing depth in diseased sites (p < 0.05). P. intermedia and Prevotella sp. oral clone P4PB24, the Prevotella species significantly associated with increasing probing depth in diseased gingival sites and also strongly associated with P. gingivalis load (p < 0.05) in diseased gingival sites, showed significant correlation for co-colonisation (r = 0.6). Prevotella sp. oral clone B31FD, showing strong association with P. gingivalis load (p < 0.05) in diseased gingival sites, showed no significant correlation for co-colonisation with any other Prevotella species. This study provides a comprehensive analysis of Prevotella species associated with gingival sites for the informative evaluation of the epidemiology of infection by this genus.

Clonal groups of enteropathogenic Escherichia coli isolated in case-control studies of diarrhoea in Bangladesh.

Recent case-control studies in Bangladesh showed a high prevalence of enteropathogenic Escherichia coli (EPEC) strains (identified by DNA probes for virulence genes) associated with childhood diarrhoea. However, the clonal status of these strains is not known. A total of 94 EPEC isolates from 80 children with diarrhoea and 14 healthy matched controls isolated during 1991-1992 and 1993-1994 was characterised by serogrouping, enterobacterial repetitive intergenic consensus sequence PCR, and by a biochemical fingerprinting method (the phene plate or PhP system). Twelve O serogroups were found with O114 (n = 19) and O127 (n = 23) being the dominant serogroups. Most strains of O114 belonged to the same PhP/PCR types. Strains of O127 contained 16 that produced cytolethal distending toxin (CDT) and seven that did not; both were found among patients as well as controls. Results of PCR and PhP typing showed that CDT-positive strains belonged to the same clonal group and were related to one of the two PhP/PCR types of CDT-negative O127 strains. Thirty-one EPEC strains were O non-typable and 21 strains belonged to other less prevalent serogroups. These strains belonged to diverse PhP/PCR types and did not show any similarity to the strains of two major serogroups, O114 and O127. The results suggest that two clonal groups of EPEC strains are predominantly associated with childhood diarrhoea in Bangladesh.

Evolutionary relationships of pathogenic clones of Vibrio cholerae by sequence analysis of four housekeeping genes.

Studies of the Vibrio cholerae population, using molecular typing techniques, have shown the existence of several pathogenic clones, mainly sixth-pandemic, seventh-pandemic, and U.S. Gulf Coast clones. However, the relationship of the pathogenic clones to environmental V. cholerae isolates remains unclear. A previous study to determine the phylogeny of V. cholerae by sequencing the asd (aspartate semialdehyde dehydrogenase) gene of V. cholerae showed that the sixth-pandemic, seventh-pandemic, and U.S. Gulf Coast clones had very different asd sequences which fell into separate lineages in the V. cholerae population. As gene trees drawn from a single gene may not reflect the true topology of the population, we sequenced the mdh (malate dehydrogenase) and hlyA (hemolysin A) genes from representatives of environmental and clinical isolates of V. cholerae and found that the mdh and hlyA sequences from the three pathogenic clones were identical, except for the previously reported 11-bp deletion in hlyA in the sixth-pandemic clone. Identical sequences were obtained, despite average nucleotide differences in the mdh and hlyA genes of 1.52 and 3.25%, respectively, among all the isolates, suggesting that the three pathogenic clones are closely related. To extend these observations, segments of the recA and dnaE genes were sequenced from a selection of the pathogenic isolates, where the sequences were either identical or substantially different between the clones. The results show that the three pathogenic clones are very closely related and that there has been a high level of recombination in their evolution.

A genetic polymorphism in the regulatory sequences of human CYP2E1: association with increased chlorzoxazone hydroxylation in the presence of obesity and ethanol intake.

To pursue the hypothesis that differences in the regulatory region of CYP2E1 are partially responsible for the intersubject variation in in vivo CYP2E1 activity, restriction enzyme digestion and Southern blotting of 36 human DNA samples were performed. The fractionated DNA was hybridized with a genomic probe to the upstream region of CYP2E1 from positions -2710 to -580. After digestion with the restriction enzyme XbaI, most subjects (69%) were homozygous for the expected band representing the XbaI fragment from positions -2270 to -408, whereas 31% had an unexpected, slightly larger band. Analyses of Southern blots of the same DNA samples cut by other restriction enzymes were consistent with the larger band containing an estimated 100-bp insertion and localized the mutation to a region from positions -2270 to -1672. To determine the functional significance of this mutation, in vivo CYP2E1 metabolic ability was determined in the same subjects using the 6-hydroxylation of chlorzoxazone as a probe. The presence of the insertion mutation was associated with greater CYP2E1 metabolic ability, but only among individuals who either were obese or had recently consumed ethanol (p < 0.01, both). These data are consistent with a DNA insertion that is associated with altered CYP2E1 induction. The incidence of the mutation was 31% among 65 African Americans and 6.9% among 58 Caucasians (p < 0.01). Thus, this CYP2E1 regulatory polymorphism not only enhances CYP2E1 metabolic ability, but is sufficiently common to impact susceptibility to CYP2E1-related diseases in at least two ethnic groups.