Melbourne Dental School - Research Publications

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    Breastmilk influences development and composition of the oral microbiome
    Butler, CA ; Adams, GG ; Blum, J ; Byrne, SJ ; Carpenter, L ; Gussy, MG ; Calache, H ; Catmull, D ; Reynolds, EC ; Dashper, SG (TAYLOR & FRANCIS LTD, 2022-12-31)
    BACKGROUND: Human microbiomes assemble in an ordered, reproducible manner yet there is limited information about early colonisation and development of bacterial communities that constitute the oral microbiome. AIM: The aim of this study was to determine the effect of exposure to breastmilk on assembly of the infant oral microbiome during the first 20 months of life. METHODS: The oral microbiomes of 39 infants, 13 who were never breastfed and 26 who were breastfed for more than 10 months, from the longitudinal VicGeneration birth cohort study, were determined at four ages. In total, 519 bacterial taxa were identified and quantified in saliva by sequencing the V4 region of the bacterial 16S rRNA genes. RESULTS: There were significant differences in the development of the oral microbiomes of never breastfed and breastfed infants. Bacterial diversity was significantly higher in never breastfed infants at 2 months, due largely to an increased abundance of Veillonella and species from the Bacteroidetes phylum compared with breastfed infants. CONCLUSION: These differences likely reflect breastmilk playing a prebiotic role in selection of early-colonising, health-associated oral bacteria, such as the Streptococcus mitis group. The microbiomes of both groups became more heterogenous following the introduction of solid foods.
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    Validity of short food questionnaire items to measure intake in children and adolescents: a systematic review
    Golley, RK ; Bell, LK ; Hendrie, GA ; Rangan, AM ; Spence, A ; McNaughton, SA ; Carpenter, L ; Allman-Farinelli, M ; de Silva, A ; Gill, T ; Collins, CE ; Truby, H ; Flood, VM ; Burrows, T (WILEY, 2017-02)
    BACKGROUND: Short food questions are appealing to measure dietary intakes. METHODS: A review of studies published between 2004 and 2016 was undertaken and these were included in the present study if they reported on a question or short item questionnaire (≤50 items, data presented as ≤30 food groups) measuring food intake or food-related habits, in children (aged 6 months to 18 years), and reported question validity or reliability. Thirty studies met the inclusion criteria. RESULTS: Most questions assessed foods or food groups (n = 29), with the most commonly assessed being fruit (n = 22) or vegetable intake (n = 23), dairy foods and discretionary foods (n = 20 studies each). Four studies assessed food habits, with the most common being breakfast and meal frequency (n = 4 studies). Twenty studies assessed reliability, and 25 studies determined accuracy and were most commonly compared against food records. Evaluation of question performance relied on statistical tests such as correlation. CONCLUSIONS: The present study has identified valid and reliable questions for the range of key food groups of interest to public health nutrition. Questions were more likely to be reliable than accurate, and relatively few questions were both reliable and accurate. Gaps in repeatable and valid short food questions have been identified that will provide direction for future tool development.
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    Feasibility and development of a cariogenic diet scale for epidemiological research
    Amezdroz, E ; Carpenter, L ; Johnson, S ; Flood, V ; Dashper, SG ; Calache, H ; Gussy, M ; Waters, E (WILEY, 2019-05)
    BACKGROUND: Diet cariogenicity plays a major role as both a protective and risk factor in the development of early childhood caries (ECC). AIM: Develop a scale measuring the cariogenicity of foods and beverages and employ it to describe the cariogenicity of young children's diets and predict dental caries outcomes. DESIGN: Scores of cariogenicity and consumption frequency were applied to food frequency questionnaire (FFQ) collected from an Australian children's cohort study with three time-points of data. One-way ANOVA, with post hoc Tukey test compared mean cariogenic scale measured at 18 months between the subsample of children with caries classification at age 5 years. RESULTS: At 6 months, children's mean cariogenic score was 10.05, increasing to 34.18 at 12 and 50.00 at 18 months. Mean cariogenic scale score at 18 months was significantly higher in children with advanced disease at 5 years (mean scale score: 59.0 ± 15.9) compared to those that were healthy (mean score 47.7 ± 17.5, P = 0.007) or had mild-moderate disease (mean score 48.2 ± 17.3, P = 0.008). CONCLUSIONS: The cariogenic diet scale provides a useful indication of the increasing cariogenicity of children's diets with age and highlights the incorporation of discretionary choice foods and beverages into the diets of young children much earlier than nutritionally recommended.
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    Nutrition and oral health in early childhood: associations with formal and informal childcare
    Carpenter, L ; Gibbs, L ; Magarey, A ; Dashper, S ; Gussy, M ; Calache, H (CAMBRIDGE UNIV PRESS, 2021-04)
    OBJECTIVE: To examine associations between childcare type and nutrition and oral health indicators. DESIGN: Cross-sectional data extracted from a longitudinal birth cohort. Parent-completed FFQ and questions regarding oral health and childcare use. The associations between childcare type, classified into four groups: parent care only (PCO), formal childcare only (FCO), informal childcare only (ICO) or combination of care (F&I), and nutrition and oral health indicators were examined. SETTING: Home and childcare. PARTICIPANTS: Families with children aged 3 years (n 273) and 4 years (n 249) in Victoria, Australia. RESULTS: No associations were observed between childcare type and core food/beverage consumption or oral health indicators. For discretionary beverages, compared with children receiving PCO at age 3 years, children in FCO or F&I were less likely to frequently consume fruit juice/drinks (FCO: adjusted OR (AOR) 0·41, 95 % CI 0·17, 0·96, P = 0·04; F&I: AOR 0·32, 95 % CI 0·14, 0·74, P = 0·008). At age 4 years, children receiving FCO or ICO were less likely to consume sweet beverages frequently compared with children receiving PCO: fruit juice/drink (ICO: AOR 0·42, 95 % CI 0·19, 0·94, P = 0·03; FCO: AOR 0·35, 95 % CI 0·14, 0·88, P = 0·03) and soft drink (ICO: AOR 0·23, 95 % CI 0·07, 0·74, P = 0·01; FCO: AOR 0·14, 95 % CI 0·03, 0·76, P = 0·02). CONCLUSIONS: Associations between childcare type and discretionary beverage intake were observed. Investigation into knowledge, attitudes and activities in formal and informal childcare settings is required to explore different health promotion practices that may influence nutrition and oral health.
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    Evaluation of the childhood obesity prevention program Kids - 'Go for your life'
    de Silva-Sanigorski, A ; Prosser, L ; Carpenter, L ; Honisett, S ; Gibbs, L ; Moodie, M ; Sheppard, L ; Swinburn, B ; Waters, E (BMC, 2010-05-28)
    BACKGROUND: Kids--'Go for your life' (K-GFYL) is an award-based health promotion program being implemented across Victoria, Australia. The program aims to reduce the risk of childhood obesity by improving the socio-cultural, policy and physical environments in children's care and educational settings. Membership of the K-GFYL program is open to all primary and pre-schools and early childhood services across the State. Once in the program, member schools and services are centrally supported to undertake the health promotion (intervention) activities. Once the K-GFYL program 'criteria' are reached the school/service is assessed and 'awarded'. This paper describes the design of the evaluation of the statewide K-GFYL intervention program. METHODS/DESIGN: The evaluation is mixed method and cross sectional and aims to: 1) Determine if K-GFYL award status is associated with more health promoting environments in schools/services compared to those who are members only; 2) Determine if children attending K-GFYL award schools/services have higher levels of healthy eating and physical activity-related behaviors compared to those who are members only; 3) Examine the barriers to implementing and achieving the K-GFYL award; and 4) Determine the economic cost of implementing K-GFYL in primary schools. Parent surveys will capture information about the home environment and child dietary and physical activity-related behaviors. Environmental questionnaires in early childhood settings and schools will capture information on the physical activity and nutrition environment and current health promotion activities. Lunchbox surveys and a set of open-ended questions for kindergarten parents will provide additional data. Resource use associated with the intervention activities will be collected from primary schools for cost analysis. DISCUSSION: The K-GFYL award program is a community-wide intervention that requires a comprehensive, multi-level evaluation. The evaluation design is constrained by the lack of a non-K-GFYL control group, short time frames and delayed funding of this large scale evaluation across all intervention settings. However, despite this, the evaluation will generate valuable evidence about the utility of a community-wide environmental approach to preventing childhood obesity which will inform future public health policies and health promotion programs internationally. TRIAL REGISTRATION: ACTRN12609001075279.
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    Natural history of dental caries in very young Australian children
    Gussy, M ; Ashbolt, R ; Carpenter, L ; Virgo-Milton, M ; Calache, H ; Dashper, S ; Leong, P ; de Silva, A ; de Livera, A ; Simpson, J ; Waters, E (WILEY, 2016-05)
    BACKGROUND: Whilst the global burden of caries is increasing, the trajectory of decay in young children and the point at which prevention should occur has not been well established. AIM: To identify the 'natural history' of dental caries in early childhood. DESIGN: A birth cohort study was established with 467 mother/child dyads followed at 1, 6, 12, 18, and 36 months of age. Parent-completed surveys captured demographic, social, and behavioural data, and oral examinations provided clinical and data. RESULTS: Eight per cent of children (95% confidence interval (CI): 5-12%) at 18 months and 23% (95% CI: 18-28%) at 36 months experienced decay. Interesting lesion behaviour was found between 18 and 36 months, with rapid development of new lesions on sound teeth (70% of teeth, 95% CI: 63-76%) and regression of many lesions from non-cavitated lesions to sound (23% of teeth, 95% CI: 17-30%). Significant associations were found between soft drink consumption and lesion progression. CONCLUSIONS: Findings suggest optimal time periods for screening and prevention of a disease which significantly impacts multiple health and well-being outcomes across the life course.
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    Developing a model to assess community-level risk of oral diseases for planning public dental services in Australia
    de Silva, AM ; Gkolia, P ; Carpenter, L ; Cole, D (BMC, 2016-03-31)
    BACKGROUND: Poor oral health is a chronic condition that can be extremely costly to manage. In Australia, publicly funded dental services are provided to community members deemed to be eligible-those who are socio-economically disadvantaged or determined to be at higher risk of dental disease. Historically public dental services have nominally been allocated based on the size of the eligible population in a geographic area. This approach has been largely inadequate for reducing disparities in dental disease, primarily because the approach is treatment-focused, and oral health is influenced by a variety of interacting factors. This paper describes the developmental process of a multi-dimensional community-level risk assessment model, to profile a community's risk of poor oral health. METHODS: A search of the evidence base was conducted to identify robust frameworks for conceptualisation of risk factors and associated performance indicators. Government and other agency websites were also searched to identify publicly available data assets with items relevant to oral diseases. Data quality and analysis considerations were assessed for the use of mixed data sources. RESULTS: Several frameworks and associated indicator sets (twelve national and eight state-wide data collections with relevant indicators) were identified. Determination of the system inputs for the Model were primarily informed by the World Health Organisation's (WHO) operational model for an Integrated Oral Health-Chronic Disease Prevention System, and Australia's National Oral Health Plan 2004-2013. Data quality and access informed the final selection of indicators. CONCLUSIONS: Despite limitations in the quality and regularity of data collections, there are numerous data sources available that provide the required data inputs for community-level risk assessment for oral health. Assessing risk in this way will enhance our ability to deliver appropriate public oral health care services and address the uneven distribution of oral disease across the social gradient.
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    Temporal development of the oral microbiome and prediction of early childhood caries
    Dashper, SG ; Mitchell, HL ; Le Cao, K-A ; Carpenter, L ; Gussy, MG ; Calache, H ; Gladman, SL ; Bulach, DM ; Hoffmann, B ; Catmull, D ; Pruilh, S ; Johnson, S ; Gibbs, L ; Amezdroz, E ; Bhatnagar, U ; Seemann, T ; Mnatzaganian, G ; Manton, DJ ; Reynolds, EC (NATURE PUBLISHING GROUP, 2019-12-24)
    Human microbiomes are predicted to assemble in a reproducible and ordered manner yet there is limited knowledge on the development of the complex bacterial communities that constitute the oral microbiome. The oral microbiome plays major roles in many oral diseases including early childhood caries (ECC), which afflicts up to 70% of children in some countries. Saliva contains oral bacteria that are indicative of the whole oral microbiome and may have the ability to reflect the dysbiosis in supragingival plaque communities that initiates the clinical manifestations of ECC. The aim of this study was to determine the assembly of the oral microbiome during the first four years of life and compare it with the clinical development of ECC. The oral microbiomes of 134 children enrolled in a birth cohort study were determined at six ages between two months and four years-of-age and their mother's oral microbiome was determined at a single time point. We identified and quantified 356 operational taxonomic units (OTUs) of bacteria in saliva by sequencing the V4 region of the bacterial 16S RNA genes. Bacterial alpha diversity increased from a mean of 31 OTUs in the saliva of infants at 1.9 months-of-age to 84 OTUs at 39 months-of-age. The oral microbiome showed a distinct shift in composition as the children matured. The microbiome data were compared with the clinical development of ECC in the cohort at 39, 48, and 60 months-of-age as determined by ICDAS-II assessment. Streptococcus mutans was the most discriminatory oral bacterial species between health and current disease, with an increased abundance in disease. Overall our study demonstrates an ordered temporal development of the oral microbiome, describes a limited core oral microbiome and indicates that saliva testing of infants may help predict ECC risk.
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    Cluster randomised trial of a school-community child health promotion and obesity prevention intervention: findings from the evaluation of fun 'n healthy in Moreland!
    Waters, E ; Gibbs, L ; Tadic, M ; Ukoumunne, OC ; Magarey, A ; Okely, AD ; de Silva, A ; Armit, C ; Green, J ; O'Connor, T ; Johnson, B ; Swinburn, B ; Carpenter, L ; Moore, G ; Littlecott, H ; Gold, L (BMC, 2017-08-03)
    BACKGROUND: Multi-level, longer-term obesity prevention interventions that focus on inequalities are scarce. Fun 'n healthy in Moreland! aimed to improve child adiposity, school policies and environments, parent engagement, health behaviours and child wellbeing. METHODS: All children from primary schools in an inner urban, culturally diverse and economically disadvantaged area in Victoria, Australia were eligible for participation. The intervention, fun 'n healthy in Moreland!, used a Health Promoting Schools Framework and provided schools with evidence, school research data and part time support from a Community Development Worker to develop health promoting strategies. Comparison schools continued as normal. Participants were not blinded to intervention status. The primary outcome was change in adiposity. Repeated cross-sectional design with nested longitudinal subsample. RESULTS: Students from twenty-four primary schools (clusters) were randomised (aged 5-12 years at baseline). 1426 students from 12 intervention schools and 1539 students from 10 comparison schools consented to follow up measurements. Despite increased prevalence of healthy weight across all schools, after 3.5 years of intervention there was no statistically significant difference between trial arms in BMI z score post-intervention (Mean (sd): Intervention 0.68(1.16); Comparison: 0.72(1.12); Adjusted mean difference (AMD): -0.05, CI: -0.19 to 0.08, p = 0.44). Children from intervention schools consumed more daily fruit serves (AMD: 0.19, CI:0.00 to 0.37, p = 0.10), were more likely to have water (AOR: 1.71, CI:1.05 to 2.78, p = 0.03) and vegetables (AOR: 1.23, CI: 0.99 to 1.55, p = 0.07), and less likely to have fruit juice/cordial (AOR: 0.58, CI:0.36 to 0.93, p = 0.02) in school lunch compared to children in comparison schools. More intervention schools (8/11) had healthy eating and physical activity policies compared with comparison schools (2/9). Principals and schools highly valued the approach as a catalyst for broader positive school changes. The cost of the intervention per child was $65 per year. CONCLUSION: The fun n healthy in Moreland! intervention did not result in statistically significant differences in BMI z score across trial arms but did result in greater policy implementation, increased parent engagement and resources, improved child self-rated health, increased fruit, vegetable and water consumption, and reduction in sweet drinks. A longer-term follow up evaluation may be needed to demonstrate whether these changes are sustainable and impact on childhood overweight and obesity. CLINICAL TRIAL REGISTRATION: ACTRN12607000385448 (Date submitted 31/05/2007; Date registered 23/07/2007; Date last updated 15/12/2009).