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.

Who to Be Treated: Nomogram Using Self-Reported Periodontal Screening Instrument among English-Speaking Adults in Multi-Ethnic Singapore.

Periodontal disease is a major public health problem. This study aimed to develop a nomogram using a self-reported periodontitis screening instrument in predicting severe periodontitis (SP), defined by the World Workshop on Classification of Periodontal and Peri-Implant Diseases and Conditions, and evaluate its utility in clinical setting. An Akaike information criterion selected multivariable model was developed to predict SP using a self-reported questionnaire, with a nomogram developed based on its regression coefficients. Discriminatory capability was evaluated by Receiver-operating characteristic curve. Ability to predict SP of individual patients was evaluated with bootstrapping. Decision curve analysis (DCA) was performed to evaluate its potential clinical utility by evaluating clinical net benefit at different thresholds. 58.1% of 155 participants were classified with SP. Older males without tertiary education, with 'loose teeth', 'bone loss' and 'mouth rinse use' had higher SP risk. The nomogram showed excellent discriminatory capability with Area under Curve of 0.83 (95% CI = (0.76, 0.89)), good calibration (intercept = 0.026) and slight overestimation of high risk and underestimation of low risk (slope = 0.834). DCA showed consistent clinical net benefit across the range of thresholds relative to assumption of 'no patient' or 'all patient' with SP. Our nomogram using a self-reported periodontitis instrument is useful in SP screening in English-speaking Singaporean adults.

Self-assembly of dental surface nanofilaments and remineralisation by SnF2 and CPP-ACP nanocomplexes.

Dental caries, erosion and hypersensitivity are major public health problems. SnF2 is used widely in oral care products to help prevent/treat these conditions. Casein phosphopeptide-stabilised amorphous calcium phosphate nanocomplexes (CPP-ACP) are a biomimetic nanotechnology of salivary phosphopeptide-ACP complexes that deliver bioavailable calcium and phosphate ions to promote dental remineralisation (repair). We show here using in vitro studies and a double-blind, randomised controlled, cross-over design in situ clinical trial that SnF2 and CPP-ACP interact to form a nanofilament coating on the tooth surface and that together they are superior in their ability to promote dental remineralisation. Sn(II) by cross-linking the CPP-ACP helps to stabilise the complexes which improves delivery to the tooth surface and enhances binding and ion incorporation into tooth mineral. The combination of SnF2 and CPP-ACP in oral care products may significantly improve their efficacy in prevention/treatment of dental caries/erosion and hypersensitivity.

Oral microbial biofilm models and their application to the testing of anticariogenic agents.

OBJECTIVES: This review paper evaluates the use of in vitro biofilm models for the testing of anticariogenic agents. DATA: Caries is a biofilm-mediated oral disease and in vitro biofilm models have been widely utilised to assess how anticariogenic or antimicrobial agents affect the de/remineralisation process of caries. The use of enamel or dentine substrata has enabled the assessment of the relationship between bacterial activity and caries lesion initiation and progression and how this relationship could be affected by the agent under study. SOURCES: Only papers published in the English literature were reviewed. STUDY SELECTION: Both 'open' and 'closed' biofilm systems utilising either single or multiple-species as defined or undefined inocula are analysed. CONCLUSIONS: There is a wide variety of in vitro biofilm models used in the assessment of anticariogenic agents. A reproducible model that mimics the shear forces present in the oral environment, and uses a defined multiple-species inocula on tooth substrates can provide valuable insight into the effectiveness of these agents. CLINICAL RELEVANCE: Biofilm models are important tools for the testing of the mechanism of action and efficacy of novel anticariogenic agents. Results from these experiments help facilitate the design of randomised, controlled clinical trials for testing of efficacy of the agents to provide essential scientific evidence for their clinical use.

Anti-caries effect of CPP-ACP in irradiated nasopharyngeal carcinoma patients.

OBJECTIVE: The aim of this study was to determine the effect of casein phosphopeptide-amorphous calcium phosphate (CPP-ACP) on caries progression in irradiated nasopharyngeal carcinoma (NPC) patients. METHODS: Twenty-one males and three females (median age, 50 years) were randomized into two groups before radiotherapy. Subjects had at least eight teeth after oral health clearance. The test group used 0.4 % stannous fluoride gel and a crème containing 10 % CPP-ACP daily; the control group used a similar crème without CPP-ACP and otherwise identical care. Subjects applied the crème three times daily and fluoride gel once daily. Caries status, saliva and plaque parameters were measured pre-radiotherapy, at 2 weeks and 3 months post-radiotherapy. RESULTS: Baseline International Caries Detection and Assessment System (ICDAS) scores were 0-1126 surfaces (93.9 %), 1-28 surfaces (2.3 %), 2-40 surfaces (3.3 %) and 3-6 surfaces (0.5 %) for the control and 0-1186 surfaces (95.6 %), 1-31 surfaces (2.5 %), 2-15 surfaces (1.2 %) and 3-8 surfaces (0.7 %) for the test group. Twenty-two subjects returned at 3 months post-radiotherapy with reduced plaque pH, salivary flow, pH and buffering capacity. Nine test and 8 control subjects developed 32 and 59 new caries lesions, respectively. Test subjects showed lower caries progression than the controls: all surfaces (OR 0.51, 95 % CI 0.17∼1.59), occlusal (OR 0.20, 95 % CI 0.03∼1.29) and smooth surfaces (OR 0.61, 95 % CI 0.16∼2.38). The difference was not statistically significant. CONCLUSION: Application of CPP-ACP did not significantly reduce caries progression in NPC patients in the first 3 months after radiotherapy as compared to controls. CLINICAL RELEVANCE: Adjunct use of CPP-ACP with stannous fluoride gel in irradiated NPC patients gave comparable results compared to stannous fluoride gel alone in reducing caries progression.

Factors influencing resonance frequency analysis assessed by Osstell mentor during implant tissue integration: I. Instrument positioning, bone structure, implant length.

AIM: To monitor longitudinally the development of implant stability of SLA Straumann tissue-level implants using resonance frequency analysis (RFA) and to determine the influence of instrument positioning, bone structure and implant length on the assessment of RFA. MATERIAL AND METHODS: Thirty-two healthy adult patients received either 8 mm, v4.1 mm Straumann Standard Plus tissue-level implants (n=16: Group A) or 10 mm, v4.1 mm Straumann Standard Plus tissue-level implants (n=16: Group B). During healing, RFA was performed on Weeks 0,1, 2, 3, 4, 5, 6, 8 and 12. The implants were restored after 10 weeks (impression taking) and 12 weeks. In addition, probing depth, presence of plaque and bleeding on probing were assessed. Implant stability quotient (ISQ) values of Groups A and B were compared using unpaired t-tests and longitudinally applying paired t-tests between Week 0 and the subsequent time points. RESULTS: Positioning of the Osstell mentor device did not affect the ISQ values. Generally, ISQ values increased continuously during healing from a mean of 65.1 (SD 16.97) to 74.7 (SD 5.17) (significantly from Week 0 to Weeks 6, 8 and 12). Lower bone density (Type III or IV) resulted in significantly lower ISQ values up to Week 8. Implant length affected the increase in ISQ values over time. While no significant increase was observed with 10 mm implants, ISQ values of 8 mm implants increased significantly from Week 0 to Weeks 6, 8 and 12. CONCLUSIONS: Using Osstell mentor, ISQ values are reproducible irrespective of instrument positioning. ISQ values are affected by the bone structure and implant length. Hence, no predictive values can be attributed to implant stability.

A 5-year retrospective study of fixed partial dentures: success, survival, and incidence of biological and technical complications.

The aim of this retrospective study was to determine the probability of success and survival as well as the incidences of specific biological and technical complications associated with fixed partial dentures (FPDs). All patients fitted with FPDs at the National Dental Center, Singapore, in the previous 5-8 years were identified through electronic records and contacted to return for a clinical examination by a prosthodontist. Eighty-five patients with a total of 99 FPDs were examined, and a satisfaction survey was also conducted. Fifty-eight (58.6%) of the FPDs were successes requiring no intervention. Thirty-two (32.3%) remained in situ but suffered some complications, while nine (9.1%) were deemed failures as they had to be removed. Of the 32 complications, one (1%) showed increased mobility due to progressive periodontitis, four (4%) had lost vitality, two (2%) required recementation, two (2%) showed recurrent caries, and 23 (23.2%) exhibited partial ceramic fractures. The 5-year probability of success was between 62.5% (95% confidence interval [CI]: 52.7, 71.2) and 68% (95% CI: 59.5, 76.0), while the 5-year probability of survival was 92.3% (95% CI: 86.5, 96.6). The incidence of caries was 5.8% (95% CI: 2.5, 11.8), and the 5-year risk for loss of abutment vitality was 4.4% (95% CI: 1.5, 9.5). FPDs with non-vital abutments and those of a longer span (5 or more units) were more likely to suffer a complication or failure.