Caries and less acceptable appearance showed a negative impact, while mild fluorosis had a positive impact on child and parental OHRQoL.

Previous studies among older adults have demonstrated that oral disease frequently leads to dysfunction, discomfort, and disability. This study aimed to assess variations in the social impact of oral conditions among six strata of people aged 65 years and older: residents of metropolitan Adelaide and rural Mt Gambier, South Australia; residents of metropolitan Toronto-North York and non-metropolitan Simcoe-Sudbury counties, Ontario, Canada; and blacks and whites in the Piedmont region of North Carolina (NC), United States. Subjects were participants in three oral epidemiological studies of random samples of the elderly populations in the six strata. Some 1,642 participants completed a 49-item Oral Health Impact Profile (OHIP) questionnaire which asked about impacts caused by problems with the teeth, mouth, or dentures during the previous 12 months. The percentage of dentate people reporting impacts fairly often or very often was greatest among NC blacks for 41 of the OHIP items. Two summary variables of social impact were used as dependent variables in bivariate and multivariate least-squares regression analyses. Among dentate people, mean levels of social impact were greatest for NC blacks and lowest for NC whites, while people from South Australia and Ontario had intermediate levels of social impact (P < 0.01). Missing teeth, retained root fragments, root-surface decay, periodontal pockets, and problem-motivated dental visits were associated with higher levels of social impact (P < 0.05), although there persisted a two-fold difference in social impact across the six strata after adjustment for those factors Among edentulous people, there was no statistically significant variation in social impact among strata. The findings suggest that there are social and cultural factors influencing oral health and its social impact, and that those factors differ most between dentate blacks and whites in NC.

This study helps reconcile some of the conflicting results of previous studies and establishes that dental fear is associated with more decayed and missing teeth but fewer FT. That people with higher dental fear have significantly more caries experience underlines the importance of identifying and then reducing dental fear as important steps in improving adult oral health.

Dental service rates were influenced by large number of small effects from a wide range of dentist, practice and patient factors. Socio-economic and geographic barriers may need broad policy innovations to be addressed, but factors such as insurance and visit type have the potential to be altered to achieve better service outcomes and there is scope for research into clinical outcomes to improve the knowledge upon which treatment decisions are based.

Purpose -This article aims to discuss issues related to service quality in the hotel industry. It highlights unique aspects of hotel work and the implications for service delivery, and discusses methods used to measure service quality and expectations. Design/methodology/approach -Through an assessment of the extensive body of literature on quality service in general and within hotel contexts, some key themes emerge which have been explored in detail. Much of the analysis focuses on how the body of knowledge has developed over time and points to strengths and weaknesses in the literature. Findings -There has been much debate about what constitutes quality service and more specifically how this applies to the hotel industry. The industry is a dynamic one in which the guest dictates the pace and type of service, and in which increasing competitiveness has resulted in satisfactory service being the minimum expectation of guests. Different measurements of service expectations have been proposed for the hotel industry but the most promising is the quality function deployment (QFD) approach, which treats service as a process in which the guest's expectations are measured at every stage in order to create service that meets and potentially exceeds their expectations. Practical implications -The highlighted differences between hospitality, hotel and other service organisations indicate where managers and researchers need to place their emphasis in order to enhance the level of service quality. Originality/value -The paper adds new urgency to the need to develop effective measures and understanding of the hospitality and in particular the hotel experience.