D S Brennan

University of Adelaide, Tarndarnya, South Australia, Australia

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Publications (116)178.28 Total impact

  • Australian health review: a publication of the Australian Hospital Association 07/2014; · 0.70 Impact Factor
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    ABSTRACT: The migration of dentists is a major challenge contributing to the oral health system crisis in many countries. This paper explores the origins of the dentist migration problem through a study on international dental graduates, who had migrated to Australia. Life-stories of 49 international dental graduates from 22 countries were analysed in order to discern significant themes and patterns. We focused on their home country experience, including stories on early life and career choice; dental student life; professional life; social and political life; travels; and coming to Australia. Our participants exhibited a commitment to excellence in earlier stages of life and had cultivated a desire to learn more and be involved with the latest technology. Dentists from low- and middle-income countries were also disappointed by the lack of opportunity and were unhappy with the local ethos. Some pointed towards political unrest. Interestingly, participants also carried prior travel learnings and unforgettable memories contributing to their migration. Family members and peers had also influenced participants. These considerations were brought together in four themes explaining the desire to migrate: 'Being good at something', 'Feelings of being let down', 'A novel experience' and 'Influenced by someone'. Even if one of these four themes dominated the narrative, we found that more than one theme, however, coexisted for most participants. We refer to this worldview as 'Global interconnectedness', and identify the development of migration desire as a historical process, stimulated by a priori knowledge (and interactions) of people, place and things. This qualitative study has enriched our understanding on the complexity of the dental migration experience. It supports efforts to achieve greater technical co-operation in issues such as dental education, workforce surveillance and oral health service planning within the context of ongoing global efforts on health professional migration by the World Health Organization and member states.
    Health Policy and Planning 05/2014; · 2.65 Impact Factor
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    Dana N. Teusner, Olga Anikeeva, David S. Brennan
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    ABSTRACT: Background Previous studies have reported that socioeconomically disadvantaged Australians have poorer self-rated dental health (SRDH), are less likely to be insured for dental services and are less likely to have regular dental visits than their more advantaged counterparts. However, less is known about the associations between dental insurance and SRDH. The aim of this study was to examine the associations between SRDH and dental insurance status and to test if the relationship was modified by household income. Methods A random sample of 3,000 adults aged 30-61 years was drawn from the Australian Electoral Roll and mailed a self-complete questionnaire. Analysis included dentate participants. Bivariate associations were assessed between SRDH and insurance stratified by household income group. A multiple variable model adjusting for covariates estimated prevalence ratios (PR) of having good to excellent SRDH and included an interaction term for insurance and household income group. Results The response rate was 39.1% (n = 1,093). More than half (53.9%) of the participants were insured and 72.5% had good to excellent SRDH. SRDH was associated with age group, brushing frequency, insurance status and income group. Amongst participants in the $40,000- < $80,000 income group, the insured had a higher proportion reporting good to excellent SRDH (80.8%) than the uninsured (66.5%); however, there was little difference in SRDH by insurance status for those in the $120,000+ income group. After adjusting for covariates, there was a significant interaction (p < 0.05) between having insurance and income; there was an association between insurance and SRDH for adults in the $40,000- < $80,000 income group, but not for adults in higher income groups. Conclusions For lower socio-economic groups being insured was associated with better SRDH, but there was no association for those in the highest income group. Insurance coverage may have the potential to improve dental health for low income groups.
    Health and Quality of Life Outcomes 05/2014; 12:67. · 2.27 Impact Factor
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    David S Brennan, A John Spencer
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    ABSTRACT: To assess the association of income-related social mobility between the age of 13 and 30 years on health-related quality of life among young adults. In 1988-89 n = 7,673 South Australian school children aged 13 years were sampled with n = 4,604 children (60.0%) and n = 4,476 parents (58.3%) returning questionnaires. In 2005-06 n = 632 baseline study participants responded (43.0% of those traced and living in Adelaide). Multivariate regressions adjusting for sex, tooth brushing and smoking status at age 30 showed that compared to upwardly mobile persons social disadvantage was associated (p < 0.05) with more oral health impact (Coeff = 5.5), lower EQ-VAS health state (Coeff = -5.8), and worse satisfaction with life scores (Coeff = -3.5) at age 30 years, while downward mobility was also associated with lower satisfaction with life scores (Coeff = -1.3). Stable income-related socioeconomic disadvantage was associated with more oral health impact, and lower health state and life satisfaction, while being downwardly mobile was associated with lower life satisfaction at age 30 years. Persons who were upwardly mobile were similar in health outcomes to stable advantaged persons.
    Health and Quality of Life Outcomes 04/2014; 12(1):52. · 2.27 Impact Factor
  • D S Brennan, A J Spencer
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    ABSTRACT: Background/Aims: To assess whether childhood socio-economic status modifies the relationship between childhood caries and young adult oral health. Methods: In 1988-1989, a total of 7,673 South Australian children aged 13 years were sampled, with 4,604 children (60.0%) and 4,476 parents (58.3%) responding. In 2005-2006, 632 baseline study participants responded (43.0% of those traced and living in Adelaide). Results: Adjusted analyses showed significant interactions for card status by DMFT at age 13 for decayed, missing and filled teeth at age 30, but not for DMFT. Higher DMFT at age 13 was associated with more decayed teeth at age 30 for those with no health card, while there were similar numbers of decayed teeth for card holders regardless of their DMFT at age 13. While higher DMFT at age 13 was associated with more missing teeth at age 30 for card holders, there were similar numbers of missing teeth for those with no card regardless of their DMFT at age 13. The interaction for filled teeth showed that even though higher DMFT at age 13 was associated with more fillings at age 30 for both card holders and those with no card, this relationship was more pronounced for card holders. Conclusions: SES modified the relationship between child oral health and caries at age 30 years. Card holders at age 13 were worse off in terms of their oral health at age 30 controlling for childhood oral health, supporting social causation explanations for oral health inequalities. © 2014 S. Karger AG, Basel.
    Caries Research 01/2014; 48(3):237-243. · 2.51 Impact Factor
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    Xiangqun Ju, David S Brennan, A John Spencer
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    ABSTRACT: Understanding dentists' capacity to supply dental services over time is a key element in the process of planning for the future. The aim was to identify time trends and estimate age, period and cohort effects in patients' visits supplied per dentist per year. Mailed questionnaires were collected from a random sample of Australian private general practice dentists. The response rates were 73%, 75%, 74%, 71%, 76% and 67% in 1983, 1988, 1993, 1998, 2003 and 2009, respectively. The time trends in the mean number of patient visits supplied per dentist per year (PPY) was described by using a standard cohort table and age-period-cohort analyses applying a nested general linear regression models approach. The mean number of PPY decreased across most age groups of dentists over the time of study. The age-period model showed that younger dentists (20-29 years) and older dentists (65-74 and 80-84 years) had lower PPY than middle-aged dentists, and the age-cohort model showed higher PPY among earlier cohorts, and lower PPY among more recent cohorts. The study found a period effect of declining PPY over the observation period. More recent cohorts of dentists provide lower numbers of PPY than earlier cohorts at similar ages, but the provision of PPY among these younger cohorts appeared to be stable as they moved into middle age.
    BMC Health Services Research 01/2014; 14(1):13. · 1.77 Impact Factor
  • Liana Luzzi, Sergio Chrisopoulos, David S. Brennan
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    ABSTRACT: Objectives To determine the extent to which age, period and cohort factors have contributed to variation in problem-oriented dental visiting over time. Methods Data were obtained from four National Dental Telephone Interview Surveys of Australian residents aged 5 years and over conducted in 1994, 1999, 2004 and 2010 (response rates 48–72%). The trend in the percentage of persons usually visiting the dentist for a problem was analysed by means of a standard cohort table and by a nested models framework for age–period–cohort analyses. ResultsThe percentage of persons usually visiting the dentist for a problem generally decreased over the periods examined (from 42.5% in 1994 to 31.5% in 2010). Problem visiting tended to be lower for children and adolescents compared with adult age groups at each point in time. Model fit tests revealed that the age–period–cohort model provided the best fit for the data (Hosmer–Lemeshow test statistic = 5.3; d.f. = 8; P-value = 0.72), indicating that both period and cohort factors were influential in problem visiting. Conclusion This study found similar, consistent stories for both the age–period and age–cohort models, with usually visiting for a problem tending to be higher in older age groups and older cohorts. Problem visiting tended to decline over time for most age groups and most age cohorts. Understanding patterns of dental service use over time can be used to help inform service delivery policies that promote and facilitate appropriate use of dental services.
    Community Dentistry And Oral Epidemiology 12/2013; · 1.80 Impact Factor
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    Olga Anikeeva, David S Brennan, Dana T Teusner
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    ABSTRACT: Dental insurance and income are positively associated with regular dental visiting. Higher income earners face fewer financial barriers to dental care, while dental insurance provides partial reimbursement. The aim was to explore whether household income has an effect on the relationship between insurance and visiting. A random sample of adults aged 30--61 years living in Australia was drawn from the Electoral Roll. Data were collected by mailed survey in 2009--10, including age, sex, dental insurance status and household income. Responses were collected from n = 1,096 persons (response rate = 39.1%). Dental insurance was positively associated with regular visiting (adjusted prevalence ratio (PR) = 1.18; 95%CI:1.01-1.36). Individuals in the lowest income tertile had a lower prevalence of regular visiting than those in the highest income group (PR = 0.78; 95%CI:0.65-0.93). Visiting for a check-up was less prevalent among lower income earners (PR = 0.65; 95%CI:0.50-0.83). Significant interaction terms indicated that the associations between insurance and visiting varied across income tertiles showing that income modified the effect. Household income modified the relationships between insurance and regular visiting and visiting for a check-up, with dental insurance having a greater impact on visiting among lower income groups.
    BMC Health Services Research 10/2013; 13(1):432. · 1.77 Impact Factor
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    Sergio Chrisopoulos, Liana Luzzi, David S Brennan
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    ABSTRACT: The cost of dental care may be a barrier to regular dental attendance with the proportion of the Australian population avoiding or delaying care due to cost increasing since 1994. This paper explores the extent to which age, period and cohort factors have contributed to the variation in avoiding or delaying visiting a dentist because of cost. Data were obtained from four national dental telephone interview surveys of Australian residents aged five years and over conducted in 1994, 1999, 2004 and 2010 (response rates 48% - 72%). The trend in the percentage of persons avoiding or delaying visiting a dentist because of cost was analysed by means of a standard cohort table and more formal age-period-cohort analyses using a nested models framework. There was an overall increase in the proportion of people avoiding or delaying visiting a dentist indicating the presence of period effects. Financial barriers were also associated with age such that the likelihood of avoiding because of cost was highest for those in their mid-late twenties and lowest in both children and older adults. Cohort effects were also present although the pattern of effects differed between cohorts. The findings of this study suggest that, in addition to the increase in costs associated with dental care, policies targeting specific age groups and income levels may be contributing to the inequality in access to dental care.
    BMC Health Services Research 10/2013; 13(1):381. · 1.77 Impact Factor
  • David S Brennan, A John Spencer
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    ABSTRACT: The aim was to assess the role of visit history factors between the age of 13 and 30 years on oral health-related impact. In 1988-89, n = 7 673 South Australian school children aged 13 years were sampled with n = 4 604 children (60.0%) and n = 4 476 parents (58.3%) returning questionnaires. In 2005-06, n = 632 baseline study participants responded (43.0% response of those traced and living in Adelaide). Oral health impact was measured at age 30 years using OHIP-14. Multivariate regression showed that OHIP scores were significantly higher (P < 0.05) for those with episodes of relief of pain visits once (β = 1.487) or two or more times (β = 2.883), and episodes of extraction once (β = 1.301) or two or more times (β = 3.172). Higher positive dental visit attitude scores were associated with lower OHIP scores (β = -1.265), as were being male (β = -0.637), having a job (β = -1.555) and being tertiary educated (β = -0.632). History of adverse dental events between the age of 13 and 30 years such as episodes of relief of pain visits and episodes of extraction was associated with higher impact of oral health problems at age 30 suggesting a cumulative effect.
    Community Dentistry And Oral Epidemiology 09/2013; · 1.80 Impact Factor
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    ABSTRACT: To determine if clinical oral health outcomes differ between people who reside in major city, inner regional and outer regional areas of Australia. Data from the National Survey of Adult Oral Health 2004-06 that used a clustered stratified random sampling design with telephone interviews, standardised oral epidemiological examinations and self-complete questionnaires were used to compare the clinical oral health. Decayed, missing and filled permanent teeth. Australians aged 15 years or more. Data were weighted by age, sex and regional location to the Estimated Resident Population, bivariate analysis undertaken to determine confounders and multivariate analysis completed with dental caries clinical measures as dependent variables. Inner regional people had a significantly higher decayed, missing and filled teeth than people from major cities (Estimate = 1.15, P < 0.01), but there was no difference between inner and regional areas. Older people had higher outcomes for decayed, missing and filled teeth (15.42, P < 0.01) and missing teeth (9.66, P < 0.01), but less decayed teeth (-0.37, P < 0.01), and people with the highest incomes had lower dental caries experience (-1.34, P < 0.01) and missing teeth (-1.42, P < 0.01). Dental caries experience was greater in inner regional areas than in major city areas, but not outer regional areas. Dental caries experience was similar in outer regional and major city areas.
    Australian Journal of Rural Health 06/2013; 21(3):150-7. · 1.55 Impact Factor
  • David S Brennan
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    ABSTRACT: Oral-specific measures are often preferred to examine outcomes of oral disorders. However, generic measures can add additional information, including health utility. The aim was to assess the Oral Health Impact Profile (OHIP), EuroQol (EQ-5D), and Assessment of Quality of Life (AQoL) instruments in relation to oral health in terms of their discriminative and convergent validities. Data were collected from adults, 30-61 yr of age, in Australia by mailed survey during 2009 and 2010, including the OHIP-14, the EQ-5D, and the AQoL, a range of self-reported oral health variables, and by self-rated oral and general health. Responses were collected from 1093 subjects (a response rate of 39.1%). The OHIP, the EQ-5D, and the AQoL were associated with oral health variables, with effect sizes ranging from 0.6 to 1.1 for the OHIP, from 0.3 to 0.5 for the EQ-5D, and from 0.4 to 0.6 for the AQoL. The OHIP tended to be more strongly correlated with self-rated oral health (rho = -0.5) than with general health (rho = -0.3), whilst the EQ-5D and the AQoL were less strongly correlated with oral health (rho = -0.3 and -0.3, respectively) than with general health (rho = -0.4 and -0.5, respectively). Whilst the OHIP was more sensitive to differences in oral health, the generic measures of EQ-5D and AQoL both exhibited discriminative validity and convergent validity in relation to oral health variables, supporting their use in oral health studies.
    European Journal Of Oral Sciences 06/2013; 121(3 Pt 1):188-93. · 1.42 Impact Factor
  • Article: Preface.
    Community Dentistry And Oral Epidemiology 10/2012; 40 Suppl 2:iv. · 1.80 Impact Factor
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    ABSTRACT: To investigate change in oral health in relation to use of dental services, a random sample of 45- to 54-yr-old subjects from Adelaide, South Australia, was surveyed in 2004-2005 (n = 986, response rate = 44.4%). Service use and a global oral-health transition (GOHT) statement were collected over 2 yr. Worsening in oral health was reported from the GOHT statement by 25% of persons, while improvement was reported by 30%. Prevalence ratios (PRs, 95% CI), adjusted for sex, education, health card status, and toothbrushing, showed that worsening oral health was inversely associated with dental visiting (PR = 0.5, 0.4-0.7) and with scaling and cleaning services (PR = 0.6, 0.4-0.9), whereas extractions (PR = 2.3, 1.6-3.4) and dentures (PR = 2.2, 1.3-3.7) were associated with a higher prevalence of worsening. Scaling and cleaning services were associated with improvement in oral health (PR = 1.5, 1.01-2.3), while endodontic services were inversely associated with improvement (PR = 0.3, 0.1-0.9). Worsening in oral health was associated with extractions and dentures and was inversely associated with visiting and preventive care. Improvement in oral health was associated with preventive care and was inversely associated with endodontic treatment.
    European Journal Of Oral Sciences 10/2012; 120(5):422-8. · 1.42 Impact Factor
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    ABSTRACT: Objectives: To find an association between self-reported change in oral health and dental treatment volume. Methods: Baseline data were obtained from the Tasmanian component of the National Survey of Adult Oral Health 2004-06 and 12-month follow-up data from service use logbooks and mail self-complete questionnaires. The global oral health transition statement indicated change in oral health. Many putative confounders were analyzed and Poisson regression with robust variance estimation was used to calculate the prevalence ratios and 95 percent confidence intervals for bivariate- and multivariate-adjusted relationships. Results: One-eighth (12.4 percent) of the participants reported that their oral health had improved. Over half visited a dentist (n = 176, 52.6 percent), of whom 105 received less than six dental services and 71 received six or more dental services. Baseline oral disease (P = 0.01), having a treatment need (P < 0.01), usually visiting a dentist for a problem (P < 0.05), and having a lot of difficulty paying a $100 dental bill (P = 0.01) were significantly associated with the same or worsening oral health. The regression model indicated that having six or more dental services (P < 0.01) was significantly associated with improvement in oral health, indicating a threshold effect. Usually visiting a dentist for a check-up was significantly associated with improvement in oral health (P < 0.01). Conclusion: Having six or more dental services was significantly associated with a greater self-reported improvement in oral health than having less than six dental services. The greater prevalence ratios with increasing dental service volume suggested a threshold effect.
    Journal of Public Health Dentistry 07/2012; · 1.21 Impact Factor
  • Dana N Teusner, David S Brennan, A John Spencer
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    ABSTRACT: Objective: Dental insurance status is strongly associated with service use. In models of dental visiting, insurance is typically included as an enabling factor. However, in Australia, people self-select into health insurance (privately purchased) and levels of cover for dental services are modest. Rather than enabling access, insurance status may be a "marker" for unmeasured predisposing attitudes. This study aims to explore associations between dental insurance status and visiting while adjusting for dental care attitudes. Methods: Participants (South Australians aged 45-54 years) of a 2-year prospective cohort study (2005-2007) investigating dental service use were surveyed on their attitudes to dental care and insurance status. Six attitudinal factors were assessed using a 23-item Likert scale. Bivariate associations between insurance, attitudes, visiting, and other known covariates (age, sex, and household income) were explored. A series of regression models assessed whether prevalence ratios of visiting were attenuated after controlling for attitudinal factors. Results: Response rate was 85.0 percent. Analysis was limited to dentate adults with known dental insurance status (n = 529). The majority had dental insurance (75.2%) and made regular visits (63.7%). Insurance status, visiting, and attitudinal factors were significantly associated. Controlling for covariates, insured adults, compared with the uninsured, were 57 percent more likely to make regular visits. After adjusting for attitudinal factors, the significant association between insurance and visiting persisted. Conclusion: Dental care attitudes did not confound the association between dental insurance and visiting, indicating that dental insurance status was not a "marker" for predisposing attitudes.
    Journal of Public Health Dentistry 07/2012; · 1.21 Impact Factor
  • D S Brennan, K A Singh
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    ABSTRACT: Poor dietary habits and nutritional intake are associated with a range of chronic diseases. Oral health may be directly associated with general health status, as well as related to diet. The aims are to assess dietary, self-reported oral health and socio-demographic predictors of general health status among older adults. Cross-sectional mailed survey. A random sample of adults in Adelaide, South Australia aged 60-71 years in 2008. Health status was measured using the EuroQol (EQ-5D). Compliance with dietary guidelines was measured using a 16-item index of grocery purchasing. Oral health was measured by self-reported number of teeth, oro-facial pain and sore gums. Socio-demographics included age, sex, birth place and subjective social status. Responses were collected from n=444 persons (response rate = 68.8%). The average EQ-5D score was 0.80 (se=0.01). Unadjusted analyses showed (p<0.05) EQ-5D scores were lower in the bottom tertile of compliance with dietary guidelines, for those reporting oro-facial pain, sore gums and fewer teeth, and for the lower social status group. Multivariate analyses showed (p<0.05) lower compliance with dietary guidelines was associated with poorer general health (beta=-0.10), as was oro-facial pain (beta=-0.11), sore gums (beta=-0.17), and lower social status (beta=-0.28). Socio-economic status, oral symptoms and compliance with dietary guidelines were associated with general health status.
    The Journal of Nutrition Health and Aging 05/2012; 16(5):437-41. · 2.39 Impact Factor
  • David S Brennan, Kiran A Singh
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    ABSTRACT: Gerodontology 2012; doi: 10.1111/j.1741-2358.2012.00631.x Compliance with dietary guidelines in grocery purchasing among older adults by chewing ability and socio-economic status Background:  Dietary guidelines promote good nutrition through healthy eating. Chewing deficiencies may hinder food intake while lower socio-economic status (SES) may restrict food purchasing. The aim was to examine compliance of grocery purchasing behaviour with dietary guidelines by chewing ability and SES. Methods:  Adults aged 60-71 years in Adelaide, South Australia were surveyed in 2008. Dietary guideline compliance was measured using 16 grocery purchasing items. Chewing ability was based on a 5-item Chewing Index. SES was assessed using a subjective social status rating representing where people stand in society. Results:  Responses were collected from n = 444 persons (response rate = 68.8%). Among dentate persons, 10.3% were chewing deficient and 21.3% were in the lower SES group. Prevalence ratios (PR: 95%CI) controlling for SES showed chewing deficiency was related to (p < 0.05) non-compliance with dietary guidelines in relation to bread (1.7: 1.1-2.5), juice (2.7: 1.6-4.5), tinned fruit (2.9: 1.5-5.6), yoghurt (2.1: 1.2-3.7) and tinned fish (1.5: 1.2-1.9). Conclusions:  Chewing deficiency was associated with lower compliance with dietary guidelines in relation to fibre, sugar, fat and salt. Chewing deficiency may have a direct effect on diet as well as reflect a clustering of risk in relation to a range of health behaviours.
    Gerodontology 02/2012; · 1.83 Impact Factor
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    Kiran A Singh, David S Brennan
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    ABSTRACT: This study evaluates associations between oral health-related factors and chewing ability, and quantifies the risk contributed by each factor. Chewing ability and information on number of teeth, dentures and dental problems over the last 12 months were collected by mailing questionnaires to a random sample of 60- to 71-year-olds from Adelaide, South Australia. Logistic regression was used to model oral status and oral symptoms as predictors of chewing disability, and to estimate the population-attributable fraction. A total of 444 persons responded (response rate = 68.8%). Among dentate subjects, 10.3% were chewing-deficient, with chewing disability more prevalent (p < 0.05) among those with <21 teeth (26.4%), dentures (20.4%), painful aching in the mouth (25.4%), pain in the face (16.7%), broken/chipped teeth (15.6%), sensitive teeth (14.1%), loose teeth (37.1%), and sore gums (18.0%). Adjusted Odds ratios (OR) showed inadequate dentition (OR = 4.20), painful aching in the mouth (OR = 4.88), and presence of loose teeth (OR = 4.70) were associated with chewing disability (p < 0.01), and their population attributable fractions were 18.5%, 15.1% and 7.8% respectively. Loose teeth, number of teeth and pain in the mouth were associated with chewing disability, with an inadequate dentition and pain in the mouth contributing most to chewing disability in this population.
    Gerodontology 02/2012; 29(2):106-10. · 1.83 Impact Factor
  • Public Health Association of Australia Conference, Adelaide, South Australia; 01/2012