Effectiveness of “Oral Health Care for Children with Autism Spectrum Disorder Module” in Improving Tooth-Brushing Practice among Children with Autism Spectrum Disorder in Hospital Universiti Sains Malaysia

@#Introduction: Autism spectrum disorder (ASD) is associated with behavioural problems which may affect children’s oral health statuses. Caregivers have crucial roles in caring for these children’s oral health. Thus, this study is aimed to evaluate the effectiveness of the Oral Health Care for Children with ASD (OHASD) Module in improving caregivers’ tooth-brushing difficulties in children ASD. Methods: Quasi-experimental study on caregivers of children with ASD aged 7 to 12 years who were registered at the Psychiatry Clinic Hospital Universiti Sains Malaysia (USM), Kelantan. The sociodemographic data obtained, and behavioural problems were assessed. Tooth-brushing difficulties were evaluated at pre- and six months post-intervention using OHASD Module. Data were analysed using IBM SPSS 26.0. Results: A total of 32 Malay children with ASD including their caregivers participated in this study. Caregivers were mostly mothers (78.1%) and children were mostly boys (84.4%), with mean age (SD) of 39.1 (4.19) and 8.8 (1.52) years respectively. Parent-reported questionnaire using the Modified Checklist for Autism in Toddlers (M-CHAT) showed 65.6% of children were highly sensitive to noises, 53.1% sometimes stared at nothing or wandered without purpose and 59.4% were unable to imitate caregivers’ faces. Significant differences between pre- and post-intervention for items; children who liked to close their mouths, turn their heads in different directions, did not understand the purpose of tooth-brushing (P<0.05). Conclusion: OHASD Module is useful in assisting caregivers in practising daily tooth-brushing of children with ASD.

Dental Anomalies and Muscle Segment Homeobox1 Gene Polymorphism in Nonsyndromic Cleft Lip with or without Palate Children

@#This study aims to determine the prevalence of dental anomalies and MSX1 gene 799G>T polymorphism and its association with non-syndromic cleft lip with or without palate (NSCLP) attending Hospital Universiti Sains Malaysia. Clinical and radiological assessments on 37 NSCL±P patients and 80 non-cleft children were done to detect dental anomalies. The buccal cells were collected and polymerase chain reaction restriction fragment length polymorphism (PCR-RFLP) was used to identify polymorphism. NSCL±P was higher among males (54%) and mostly unilateral cleft lip and palate (51.3%). The prevalence of dental anomalies in morphology in NSCL±P was 18.9% (95% CI: 5.7%, 32.2%) and non-cleft was 6.3% (95% CI: 0.8%, 11.7%). Hypodontia in NSCLP was 75% (95% CI: 61.2%, 90.2%) and non-cleft was 7.5% (95% CI: 1.6%, 13.4%). There was a significant association between NSCLP and anomalies in morphology (P= 0.04; OR=3.5)) and number (P< 0.01; OR= 40). There was an absence of rare 799G>T polymorphism in all NSCL±P and non-cleft children indicating that all samples contain common 799G polymorphism. In conclusion, the prevalence of dental anomalies in morphology and number was significantly higher in NSCL±P compared to non-cleft children. However, it was not significantly associated with MSX1 799G>T polymorphism.

Oral Health Status and Salivary Parameters in Stroke Patients at a Tertiary Hospital

@#Introduction: Dental caries and impaired salivary function are very common but undertreated. The aim of this study was to investigate the oral health status and salivary parameters of stroke patients. Methods: A cross-sectional study was carried out on 54 stroke and 54 non-stroke patients attending rehabilitation treatment at Hospital Universiti Sains Malaysia. Decay, Missing and Filled Teeth (DMFT) index and plaque scores were used to evaluate patients’ oral health. Salivary parameters such as salivary cortisol, salivary flow rate, pH and buffering capacity were measured. Salivary cortisol was analysed using Cobas E6000 automated immunoassay. Results: Among the 54 stroke patients, the majority were Malays 72.2% and 63.0% were male, with a mean age of 48.1 (14) years. There was a significant difference of dental caries between stroke patients, at 17.6 (4.26), compared to 15.7 (5.38) for non-stroke patients (p=0.042). Only 53.7% of stroke patients had good oral hygiene, compared to, 85.2% among non-stroke patients’ (p-value= 0.001). Salivary parameters showed no significant differences (p>0.05). However salivary cortisol levels were higher in stroke patients 5.2(5.1) nmol/L) than in non-stroke patients 4.0 (3.6) nmol/L). There was no significant correlation between salivary parameters and DMFT index (P>0.05). Conclusion: Stroke patients had more dental caries and poor oral hygiene compared to non-stroke patients. Salivary parameters showed no significant difference between stroke and non-stroke patients.

Towards Healthy Adolescents: A Review of Smoking Impact According to Dental Perspectives

@#Nowadays, tobacco companies target to recruit new smokers among adolescents due to this age group was easy to be influenced by smoking behaviours. This narrative review aimed to explore the possible impact of smoking among adolescents. Knowing the negative impacts of smoking might result in avoiding continuing the habit or preventing from initiation of the habit. The literature search on PubMed, SCOPUS, and Epistemonikos database with related search terms of “adolescents”, “smoking” and “impact”. Only papers published within the year 2017 to 2021 and in the English language were included. However, articles without full text were excluded from this review. Fourteen articles were selected and divided impacts into three categories which are effect on oral health, effect on general health and other impacts. Possible impacts of smoking among adolescents were identified, and it could be beneficial in the development of customized smoking prevention or smoking cessation intervention for adolescents.

Knowledge and Attitude towards Dental Unit Waterline System Decontamination among Undergraduate and Postgraduate Dental Students in Universiti Sains Malaysia

@#Introduction: Dental unit waterline system (DUWLS) decontamination is an important infection control in dental practice. This study aimed to determine knowledge and attitude towards DUWLS decontamination and its associated factors among undergraduate and postgraduate dental students in Universiti Sains Malaysia. Methods: A cross-sectional study was conducted using a validated questionnaire administered online using Google Forms to assess the knowledge and attitude of dental students towards DUWLS decontamination. Descriptive and inferential statistics using independent t-test, Pearson, and Spearman correlation were carried out using SPSS version 24.0. Results: A total of 169 dental students participated in the study, and the majority were female (71.6%) and Malay (59.2%). The mean (SD) age was 23.2 (0.93) and 34.4 (2.65), for the undergraduates and postgraduates, respectively. The mean (SD) knowledge scores for the undergraduates and postgraduates were 11.6 (4.23) and 18.0 (2.82), respectively, whereas the mean attitude scores were 51.3 (7.86) and 54.6 (4.74), respectively. The postgraduates had significantly higher mean knowledge and attitude scores than the undergraduates (p<0.001). The significant factors associated with the undergraduates’ knowledge were received information and guidance and their personal experience in managing DUWLS (p<0.05). However, only received information on DUWLS was significantly associated with the postgraduate’s knowledge score (p=0.011). Age factor had a significant association with the attitude score among the postgraduates (p=0.014). Conclusion: The knowledge regarding DUWLS decontamination was relatively moderate in both groups. However, both groups showed a favourable attitude towards DUWLS decontamination. Significantly higher knowledge and attitude scores were presented among the postgraduates than the undergraduates.

Association between Oral Health Knowledge, Attitude and Practice with Dental Plaque Maturity Status among Adolescents in Kota Bharu, Kelantan

@#Introduction: School students are young adolescents who are in a period of acquiring good oral hygiene habits that are practised as they grow up. This study aimed to determine the association between oral health knowledge, attitude and practices (KAP) of the adolescents and their dental plaque maturity status. Methods: A cross-sectional study was conducted among 174 school students aged 13 to 14 years in Kota Bharu, Kelantan. The oral health knowledge, attitude and practices were assessed by self-administered questionnaires, while the dental plaque maturity status was assessed using GC Tri Plaque ID gel TM (TPID). The data were analysed using IBM SPSS version 24.0. Results: The mean (SD) for knowledge and attitude score of the students were 4.69 (1.44) and 3.63 (0.63), respectively. The mean (SD) dental plaque maturity score (DPMS) of the students was 1.02 (0.55). Students who had answered correctly on sugar and practised tooth brushing twice daily had significantly lower mean DPMS as compared to those who had answered incorrectly and practised tooth brushing less than twice daily (p<0.05). Conclusion: Adolescents participated in this study had moderate oral health knowledge and good oral health attitude. Correct knowledge regarding sugar and toothbrushing routines of at least twice a day significantly associated with the dental plaque maturity status.

Understanding the Behavioral Problems and Oral Health Status of Children With Autism Spectrum Disorder: A Narrative Review

@#Autism Spectrum Disorder (ASD) is a neurodevelopment disorder with an unidentified etiology and wide-ranging functional impact. This narrative review aimed to identify various behaviours and oral health problems among children with ASD, recognize the barriers towards oral health care, and identify the strategies for oral health care management. Online databases (Scopus, PubMed and Google Scholar) were used by using various search terms. All types of articles with different level of evidence were included. Articles which were not in English and were not available in full text were excluded. Various behavioural problems among ASD contributed to various oral healthcare challenges that lead to compromise oral health status. Caregivers and dental professionals have to identify these problems towards strategizing an effective oral health management for them. Therefore, this narrative review provide an insight towards controlling the oral health problems faced through preventative and practical approach for the chidlren with ASD.

Oral Health Status of Visually Impaired Children and Oral Health Knowledge, Attitude and Practice of their Caregivers at Hospital Universiti Sains Malaysia: A Preliminary Study

@#Introduction: Oral health status among visually impaired (VI) children have shown to be poorer when compared with their normal peers. This preliminary study aimed to determine the oral health status of VI children and knowledge, attitudes and practices of their caregivers. Methods: A preliminary, cross sectional study were conducted on VI children and their caregivers attending Ophthalmology clinic Hospital USM. The assessment of oral hygiene was done using Sillness-Loe plaque index and dental caries using DMFT/dft index. Self-administered, validated questionnaires on knowledge, attitudes and practice towards a child’s oral health was distributed to the caregivers. Results: A total of 27 VI children along with their caregivers participated in this study. The mean age of VI children and their caregivers was 11.4(3.05) and 41.7(7.10) respectively. The children showed a fair oral hygiene status. The median(IQR) for caries experience for deciduous teeth (dft) and permanent teeth (DMFT) was 0.0(5.00) and 1.0(4.00) respectively. Caries prevalence among VI children was high at 85.2% (95% CI:70.86% - 99.51%). The caregivers showed a relatively good attitude and practice towards their child’s oral health with mean(SD) score of 23.2(2.95) out of 28 and 12.8(2.15) out of 19 respectively in comparison to low oral health knowledge of 5.5(1.50) out of 11. Conclusion: The oral hygiene status was fair with high prevalence of dental caries. Based on the score, although the caregivers showed to have minimal understanding on children’s oral health, their attitude and practice towards children’s oral health are relatively high.

The Association between Smoking and Periodontal Health Status among Army Personnel in North-East Malaysia

@#Introduction: Smoking is a common risk factor for periodontal disease and other chronic diseases. This study was conducted to determine the prevalence of smoking among army personnel and its association with periodontal health status. Methods: A cross-sectional study was carried out among randomly selected 233 army personnel in 8th Brigade Infantry, Kelantan. A face validated self-administered Bahasa Malaysia questionnaire was used for data collection. Periodontal examination was done using Community Periodontal Index (CPI) and coded as ‘0’ for healthy; ‘1’ for bleeding observation; ‘2’ for detection of calculus; ‘3’ for probing of 4-5mm pocketing and ‘4’ for probing of 6mm or more pocketing. Results: All respondents (n=233) were male, the majority (92.7%) Malays, not married (60.5%) with the mean (SD) age of 25.8 (5.06) years. The prevalence of smoking among army personnel was 76.0% (95% CI: 70.4, 81.5). Almost all (97.4%) have some degree of periodontal disease. The non-smoker, ex-smoker and smoker groups were highest for having calculus with a percentage of 40.5%, 57.1%, and 57.1%, respectively. No significant association was found between smoking status (ever-smoker and non-smoker) and periodontal pocketing (CPI 0-2 and CPI 3-4) (p=0.960). However, the ever-smokers (93.2%) significantly higher percentage for the need of invasive treatment (CPI >2) compared to the non-smokers (76.2%) (p=0.002). Conclusion: The prevalence of smoking among army personnel in North-East Malaysia was high, with most of them have some degree of periodontal disease. Smoking cessation intervention should be strategized in the military community to reduce the burden of care for chronic diseases.

The association of allergy and chronic suppurative otitis media: A study in a tropical country

@#Objective: Chronic suppurative otitis media (CSOM) usually begins as a spontaneous perforation of tympanic membrane due to an acute infection of the middle ear. This study was aimed to evaluate the association between allergy and CSOM. Methods: A case-control study was carried out among patients with CSOM (cases) and controls were those with no ear pathology. The presence of CSOM was made through a medical history and otoscopic examination. Allergen testing was done by the skin prick test. Results: In all 124 subjects were recruited in this study with equal number of the cases and controls. The commonest positive reaction in the skin prick test in both groups was to house dust mites. Among CSOM cases, half (50%) of them had an allergy to Blomia tropicalis and 48.4% to Dermatophagoides while in the control group, 27.4% to Dermatophagoides and 25.8% to B. tropicalis. There were significant associations between CSOM and allergy to B. tropicalis (p=0.005), Dermatophagoides (p=0.016) and Felis domesticus (p=0.040). The prevalence of allergy at 95% confidence interval (95%CI) in CSOM and control groups were demonstrated as 59.7% (95%CI: 47.5, 71.9) and 30.6 % (95%CI: 19.1, 42.1) respectively. There was a significant association between allergy and CSOM (p=0.001). Conclusion: Indoor allergens are the most prevalent in our environment and therefore good control may difficult to achieve. The hypersensitivity states of the subject are likely to have a role in the pathogenesis of CSOM especially in the tropical countries where allergy occurs perennially.

Adaptation and Validation of the Malay Version of the Index of Dental Anxiety and Fear (IDAF-4C+) for Malaysian Secondary School Children

Background: Many questionnaires have been developed to measure dental anxiety andfear. Among them is the Index of Dental Anxiety and Fear Scale (IDAF-4C+), which consists of adental anxiety and fear module (IDAF-4C), a phobia module (IDAF-P) and a stimulus module(IDAF-S). The objective of this research was to report the adaptation and validation of the IDAF-4C+ for Malaysian secondary school children.Methods: This was a cross‑sectional validation study. The original English version of theIDAF-4C+ was translated into Malay, back-translated, and then sent for content validation via anexpert validation and face validation by the target student population. Three hundred and seventyquestionnaires were then distributed among 16-year-old school children. Confirmatory factoranalysis (CFA) was conducted for the IDAF-4C module using a bootstrapped maximum likelihoodestimator. Spearman’s rank correlation was used to assess the relationship between the IDAF‑Sand IDAF-4C modules. Intraclass correlation (ICC) was used to determine the stability of theIDAF-S and IDAF-4C modules, while kappa values were used for the IDAF-P module.Results: The response rate was 86.5% for CFA and 76.9% for stability. CFA showed theexistence of only one factor with a reliability estimate of 0.921, obtained via Raykov’s procedure.All items in the IDAF-S module were significantly correlated with the IDAF-4C module (P <0.001). The IDAF-S and IDAF-4C modules were stable, as determined via a two-way mixed modelwith absolute agreement, a single measure and a Case 3 ICC (A, 1). The IDAF-P module showedsatisfactory stability, as assessed via kappa values.Conclusion: The Malay version of the IDAF-4C+ is valid and reliable in measuring dentalanxiety and fear among Malaysian secondary school children.

Effect of oral health education programme on oral health awareness and plaque maturity status among hearing-impaired children

@#Many studies have indicated that hearing-impaired (HI) children have poor oral hygiene mainly contributed by difficulties in communication. The objectives of the study were to assess the difficulties experienced by HI children during dental visit and the effectiveness of “Oral Health Care for the Hearing-Impaired” (OCHI) programme in improving the oral health knowledge and practice, and reducing the dental plaque maturity scores among HI children. A community intervention study was conducted and training of trainers (TOT) was done to train the teachers in delivering oral health education (OHE) and practices by using developed booklet and video. The difficulties faced by the HI children during dental visit, and the oral health knowledge and practice (OHKP) were assessed by face-to -face interview with HI children whilst the dental plaque maturity was assessed using GC Tri Plaque ID Gel™ (TPID) during pre-intervention, post-intervention-1 and post-intervention-2. Data were analysed using SPSS version 22. Among the teachers, there was an increase in the mean (SD) total knowledge and attitude score during post-TOT compared to pre-TOT, 46.1 (2.44) and 43.7 (4.01); (p<0.001) and 16.7 (2.11) and 14.3 (2.38); (p<0.001) respectively. For the oral health practice, there were positive changes in practice among teachers during post-TOT compared to pre-TOT. There were also significant changes in mean knowledge scores of HI children with time (p=0.003) and the plaque maturity scores were significantly reduced during post-intervention-1 and post-intervention-2. Thus, the OCHI programme was effective in improving oral hygiene among HI children. However, the inconsistent pattern was observed for their oral health practices that need further research..

Probable carpal tunnel syndrome and its coping strategies among clinical dental support staff in Hospital Universiti Sains Malaysia

Prolonged work with highly repetitious flexion and extension of the wrist and forceful grip task were shown to increase the risk of developing carpal tunnel syndrome (CTS) among dental personnel. The present study was carried out to determine the prevalence, risk factors and coping strategies of probable CTS among clinical dental support staff in Hospital Universiti Sains Malaysia (HUSM). A cross-sectional study was conducted and a set of questionnaire consisting of socio-demographic status, work-related and psychosocial risk factors and coping strategies was distributed. Ninety-five clinical dental support staff completed and returned the questionnaire with a response rate of 80.5%. The prevalence of probable CTS was 38.9%, with the highest prevalence was found among dental surgery assistants (40.5%) followed by dental technologists (29.7%). There was no significant association between work-related or psychosocial risk factors with probable CTS (p>0.05). Most of the respondents with symptoms of CTS chose religion as the coping mechanism; mean 7.11 (SD 1.13). Awareness training should be emphasized among clinical dental support staff on the prevention of CTS.

Salivary parameters, dental caries experience and treatment needs of hearing-impaired children in a special school for deaf in Kelantan, Malaysia

Dental caries is the main oral health problem in hearing-impaired (HI) children and remains the most neglected need. The present study aimed to determine caries prevalence and treatment needs in HI children and the association with salivary parameters. A cross-sectional study was conducted on 63 HI children aged between 7-14 years who attended a special school for the deaf. Clinical oral examination was done and salivary parameters (resting flow rate and resting pH) were measured. Caries experience was charted using the index of decay-filled teeth (dft) and Decay-Missing-Filled Teeth (DMFT) for primary and permanent dentition respectively. Data were analysed using SPSS version 12.0. The mean age was 11.5 (SD 2.39) years and 53.8% were female. Dental caries prevalence was 88.0% (95% Cl: 73.0, 100.0) in primary dentition and 85.0% (95% Cl: 73.0, 96.0) in permanent dentition. The mean dft was 6.1 (SD 4.14) and the mean DMFT was 4.9 (SD 3.28). The mean resting flow rate was 0.14 (SD 0.08) ml/min while mean pH was 6.8 (SD 0.79). Both pit and fissure sealants and restorations were the highest (83.1%) treatment needs. Only 3.1% of the children did not require any treatment. There were no significant association between both salivary flow rate and salivary pH with caries experience in the primary (p=0.342, p=0.610 respectively) and permanent (p= 0.99, p=0.70 respectively) teeth. In conclusion, children with HI have high caries prevalence and unmet need for dental treatments. Salivary pH and resting flow rate of the children were not associated with their caries experience.