Findings from the 2019 nationally representative oral health survey for adults in Singapore.

OBJECTIVES: The aim of this study was to present key findings from the 2019 national adult oral health survey in Singapore (NAOHS). METHODS: A multi-stage stratified sampling method was used to recruit participants for a representative national adult oral health survey. A total of 12 212 households were randomly selected from the National Database on Dwellings in Singapore. Within each household eligible persons aged ≥65 years were automatically invited to participate while a Kish selection method was used to invite those between 21 and 64 years old. The survey comprised a face-to-face interview questionnaire and a clinical examination which recorded details of tooth loss, DMFT, DMFS and prevalence of periodontal disease according to the CPITN and the US CDC-AAP classifications. Weighted analysis was performed to adjust for oversampling, non-response and post-stratification. Multivariate regression with backward stepwise selection was carried out to identify predictors of chronic periodontal disease and untreated dental caries. RESULTS: Six hundred and sixty-three participants completed both the questionnaires and the clinical examination. The prevalence of edentulousness was 2.7%. Of participants, 34.8% presented with untreated dental caries with a higher proportion found in those who were aged ≥60 years, of Malay ethnicity, living in 1-2-room public housing and who only visited the dentist when there was a problem. Mean DMFS and DMFT indices were 24.7 and 7.9 respectively. Based on the CDC-AAP classification, the prevalence of moderate-severe chronic periodontitis was 56.9% and increased with age, with a higher proportion in males. Participants with untreated dental caries were more likely to have moderate or severe periodontal disease. CONCLUSIONS: Survey findings showed high prevalence of dental caries and periodontal disease, at 34.8% and 77.6% respectively. A clear socio-economic gradient in the distribution of tooth loss, untreated dental caries and moderate-to-severe periodontitis was observed.

Oral health knowledge, attitudes and behaviours of adults: Findings from a National Oral Health Survey in Singapore.

OBJECTIVES: Prevention complements the curative management of oral diseases. Effective preventive interventions involve the adoption of oral health promoting behaviours. Little is known about the awareness of oral disease and its prevention among Singaporean adults as well as their prevailing oral health attitudes and behaviours. The aim of the study was to describe the oral health knowledge, attitudes and behaviours of adults in Singapore. METHODS: A random sample of adults (≥21 years old) in Singapore was selected to complete an interviewer-administered questionnaire. The questionnaire gathered information about their knowledge of the aetiology, signs and symptoms as well as prevention of dental caries and periodontal disease; attitudes about the value of teeth, locus of control in maintaining oral health and oral health behaviours including toothbrushing, flossing and dental attendance. RESULTS: A total of 1196 adults of weighted mean age 48 years old with almost equal proportions of males and females responded to the questionnaire. Participants were more unaware about the causes of periodontal disease (25.7%) than dental caries (4%). While more than 90% of participants felt that healthy teeth were important and could affect their overall health, many (67.0%) felt it was natural to lose their teeth with old age. Among the participants, 83.5% brushed their teeth twice a day; 41.9% flossed their teeth and 53.9% visited the dentist at least once a year. CONCLUSIONS: The study findings showed good knowledge around dental caries but some gaps around periodontal disease. It also found that participants perceived having limited control over preventing tooth loss. Irregular dental attendance and poor denture wearing habits were also noted. The findings shed light on key areas to focus on through oral health promotion to improve overall oral health.

The role of academic health science systems in the transformation of dentistry: The Singapore experience.

Clinicians and researchers have traditionally worked in independent silos, with limited collaboration to rapidly translate discovery into clinical practice. At institutional level, hospitals and universities have also tended to work independently with limited success in leveraging each other's strengths with a view to improving population health. The consequences include fragmentation of clinical services, poor communication between researchers and clinicians, lengthy delays in identification of clinical problems requiring innovative solutions through research and a generation of clinicians who are not well equipped with all the skills to address future health needs. Academic Health Science Systems (AHSS) have been proposed as a mechanism for driving effective collaboration between academia and clinical services. There are examples of well established AHSS and the benefits have been articulated. In Singapore, three AHSS have been established over the past 15 years. National dental specialty centres and one dental school have been embedded in AHSS and have well established multi-disciplinary collaboration across clinical and academic domains. The aim of this commentary is to describe the concept of an AHSS and some of the areas where dentistry in Singapore has been transformed by having key dental institutions embedded in an AHSS.

The Clinical Effectiveness of Alveolar Ridge Preservation in the Maxillary Anterior Esthetic Zone-A Retrospective Study.

PURPOSE: The primary aim was to investigate whether ridge preservation done at extraction will preserve at least 6 mm of alveolar ridge width in the anterior maxillary zone and obviate the need for secondary bone augmentation during implant insertion. METHODS: Sixty patients with single implants placed in the anterior maxillary zone were classified in two groups. In the test group, 40 patients underwent ridge preservation at the time of tooth extraction, while the remaining 20 patients in the control group did not. Preimplant CBCT was evaluated to investigate if at least 6 mm of alveolar ridge width existed before implant insertion. The records were studied to investigate if secondary bone augmentation was done during implantation. RESULTS: The mean patient age was 48.4 years. In the test group, mean healing time before implant placement was 5.0 ± 3.7 months (2 to 22 months); in the control groups, 13.0 + 12.7 months (1.2 to 38 months). In the test group, 82.5% of the subjects had a preimplant alveolar ridge width measuring at least 6 mm. In comparison, only 35% of the subjects in the control group had a preimplant alveolar ridge width measuring at least 6 mm. The odds of having at least 6 mm preimplant alveolar ridge width was significantly higher than the control group (p < 0.001). The need for secondary augmentation in the esthetic zone was less in the test group, the difference was not significant (p = 0.218). Within the test group, subjects received either xenografts or allografts as the ridge preservation material. There was no significant difference in the alveolar ridge width between these two materials (p = 1) CONCLUSION: Ridge preservation was effective in providing a sufficient ridge width in the anterior maxilla at the time of implantation and reduced the need for further bone augmentation. CLINICAL SIGNIFICANCE: The results of this study give the clinician insight into whether ridge preservation is required during extraction in the anterior maxilla in preparation for an implant restoration. (J Esthet Restor Dent 29:137-145, 2017).

A rational approach to dental management of patients on bisphosphonates.

There has been a lot of focus on osteonecrosis of the jaws associated with the usage of bisphosphonates both in dental and medical literature in recent years. However, the exact pathogenesis of bisphosphonate-related osteonecrosis of the jaws remains unclear. Against the background of emerging evidence of an evolving condition, it is not surprising that there is a lack of robust evidence-based recommendations on dental treatment of patients on bisphosphonates. This paper seeks to provide a rational approach to the dental management of patients on bisphosphonates based on current literature.

Immediate repair of transected inferior alveolar nerves in sagittal split osteotomies.

BACKGROUND: Injury to the inferior alveolar nerve (IAN) in orthognathic surgery is a well-documented complication with the incidence of IAN transection in sagittal split osteotomies (SSOs) ranging from 1.3% to 7.0%. PATIENTS AND METHODS: We describe our clinical experience with 3 cases of immediate microneural repair of IANs transected during SSO. RESULTS: Three cases of IAN transection (2 Sunderland degree V injuries, and 1 degree VI injury) that occurred during SSO were microsurgically repaired immediately by a trained microsurgeon. The other orthognathic surgery sites were positioned and fixed before the nerve repair commenced, and fixation of the nerve injury site was completed by the microsurgeon after nerve repair. All 3 patients were followed for at least 1 year with neurosensory testing, and showed recovery to mild or no sensory impairment. None had functional problems such as drooling, lip-biting, or speech difficulties at 1 year after surgery. CONCLUSION: Immediate nerve repair for transected IANs during SSO may be a feasible option, but requires the availability of a microsurgeon, instrumentation, and operating-room time.

Bisphosphonate-related osteonecrosis of the jaws.

The purpose of this paper is to highlight an emerging phenomenon of osteonecrosis of the jaws that occurs in some patients who are on long-term bisphosphonate therapy. The condition can appear spontaneously or as a result of trauma, and is difficult to treat. Dental surgeons must be aware of patients who are at risk and institute appropriate preventive care. It is also important to recognize the condition when it does appear and refer appropriately. We present the first local case series of the condition showing varied clinical presentations and treatments.