Prevalence of adenoid hypertrophy among 12-year-old children and its association with craniofacial characteristics: a cross-sectional study.

BACKGROUND: Identifying the prevalence of adenoid hypertrophy (AH) and craniofacial factors associated with this condition requires studies with random sampling from the general population, and multiple criteria can be used for assessing AH on lateral cephalometric radiograph (LCR). The present analysis represents the first report performed according to these requirements in a large cross-sectional sample of children. METHODS: LCRs of 517 12-year-old children (286 males, 231 females) randomly selected from the general population were retrospectively retrieved. AH was defined using three criteria (At/Nd, Ad-Ba/PNS-Ba, 1-Npaa/Npa), and twelve craniofacial variables were measured (SNA, SNB, ANB, Wits, Cd-Gn, MnP^SN, MxP^MnP, TPFH/TAFH, OPT^SN, C2ps-C4pi^SN, H-CV, H-FH). Skeletal characteristics were compared between children with and without AH using Mann-Whitney U test. Binary logistic regression (adjusted for sex and skeletal growth) was used to independently quantify the association between craniofacial factors and AH. RESULTS: The prevalence of children with AH was 17.6% (according to At/Nd), 19.0% (according to Ad-Ba/PNS-Ba), and 13.9% (according to 1-Npaa/Npa). Children with AH presented greater antero-posterior jaw discrepancy (larger ANB, smaller SNB), greater mandibular divergence (larger MnP^SN), forward head posture (larger OPT^SN and C2ps-C4pi^SN), and anteriorly positioned hyoid bone (larger H-CV). Larger SNA (OR = 1.39-1.48), while smaller SNB (OR = 0.77-0.88) and Wits (OR = 0.85-0.87), were associated with greater likelihood of having AH, independently from the assessment method used. CONCLUSIONS: The prevalence of children with AH ranged from 13.9 to 19.0% based on LCR. Greater antero-posterior maxillo-mandibular discrepancy and mandibular retrusion were independently associated with higher likelihood of having AH.

Low-density lipoprotein cholesterol in adolescents and young adults with type 1 diabetes: Data from the Australasian Diabetes Data Network registry.

AIM: To determine low-density lipoprotein cholesterol (LDL-C) screening frequency and levels, and factors associated with elevated LDL-C, in Australasian youth with type 1 diabetes (T1D). METHODS: Data were extracted from the Australasian Diabetes Data Network (ADDN), a prospective clinical quality registry, on all T1D healthcare visits attended by young people aged 16-25 years (with T1D duration of >1 year) between January 2011 and December 2020. The primary outcomes were elevated LDL-C > 2.6 mmol/L (100 mg/dL) and threshold for treatment: >3.4 mmol/L (130 mg/dL), according to consensus guidelines. Multivariable Generalised Estimated Equations (GEE) were used to examine factors associated with elevated LDL-C across all visits. RESULTS: A cohort of 6338 young people (52.6% men) were identified, of whom 1603 (25.3%) had ≥1 LDL-C measurement documented. At last measurement, mean age, age at T1D diagnosis and T1D duration were 18.3 ± 2.4, 8.8 ± 4.5 and 8.9 ± 4.8 years, respectively. LDL-C was elevated in 737 (46.0%) and at the treatment threshold in 250 (15.6%). In multivariable GEE elevated LDL-C continuously was associated with older age (OR = 0.07; 0.01-0.13, p = 0.02), female sex (OR = 0.31; 0.18-0.43; p < 0.001), higher HbA1c (OR = 0.04; 0.01-0.08; p = 0.01) and having an elevated BMI (OR = 0.17, 0.06-0.39, p < 0.001). CONCLUSIONS: LDL-C screening and levels are suboptimal in this cohort, increasing future cardiovascular complication risk. There is an urgent need to understand how healthcare services can support improved screening and management of dyslipidaemia in this population.

Caries-preventive effectiveness of two different fluoride varnishes: A randomised clinical trial in patients with multi-bracketed fixed orthodontic appliances.

BACKGROUND: Patients with multi-bracketed fixed orthodontic appliances are at a higher risk of developing enamel demineralisation. AIM: To compare the efficacy of the quarterly application of two varnishes in preventing white spot lesions (WSLs) during multi-bracketed fixed orthodontic treatment. DESIGN: Ninety-nine patients were randomly allocated into three intervention groups: Group A-standard oral hygiene instructions (OHI); Group B-5% sodium fluoride (NaF) varnish with standard OHI; and Group C-NaF plus tricalcium phosphate varnish with standard OHI. The outcome was assessed at 6-monthly intervals using a quantitative laser fluorescence device, clinical evaluation and photographic evaluation on six maxillary anterior teeth. A logistic regression model using generalised estimating equations with the intervention group, time and their interaction was used to compare the occurrence of WSLs, whereas the independent-samples Kruskal-Wallis test was used to compare the means of fluorescent values among different groups at p = .05. RESULTS: Generalised estimating equations (with intervention and time as predictors) showed that only the effect of time was found to be significant (p < .001), whereas there was no significant difference among the three intervention groups (p = .305) using clinical assessment or photographic assessment (p = .599). At the 18-month follow-up, sodium fluoride (NaF) varnish with standard OHI was shown to reduce the odds of WSLs by 55% (p = .200), and NaF plus tricalcium phosphate varnish with standard OHI by 42% (p = .327). CONCLUSION: The study failed to demonstrate that the quarterly application of both the study varnishes with OHI provided additional benefits compared with standard OHI alone in preventing WSLs, taking the effect of time of follow-up into consideration. There were higher odds of developing WSLs with an increased duration of orthodontic treatment.

Minimally important differences in oral health-related quality of life after fixed orthodontic treatment: a prospective cohort study.

BACKGROUND: The minimally important difference (MID, the smallest difference that patients perceive as beneficial) has been proposed to assess whether study results are clinically meaningful, reducing the shortcoming of P-values-based approaches in the assessment of clinical outcomes. The post-treatment changes and the MID in Oral Health-Related Quality of Life (OHRQoL) among adults undergoing fixed orthodontic treatment were investigated. METHODS: Ninety-two patients (29.1 ±â€…6.3 years old, 18 males and 74 females) were prospectively included. Oral Health Impact Profile (OHIP-14) and United Kingdom Oral Health-related Quality of Life (OHQoL-UK) were used to assess OHRQoL at baseline and post-treatment (50.8 ±â€…15.7 months). Global Transition Rating (GTR) was used to assess oral health/well-being, Peer Assessment Review (PAR), and Index of Complexity, Outcome and Need (ICON) were used to assess occlusion. Wilcoxon signed-rank test was used to assess changes in OHRQoL and occlusion, Kruskal-Wallis one-way ANOVA and Mann-Whitney U-test were used to assess associations between OHRQoL and oral health/well-being or occlusion. MID for OHIP-14 and OHQoL-UK was estimated via anchor-based (PAR, ICON, GTR) and distribution-based approach (effect size, standardized response mean, standard error of measurement). RESULTS: The median OHIP-14 and OHQoL-UK post-treatment scores were significantly changed, indicating improved OHRQoL. Based on the agreement between different methods, the MID of OHIP-14 and OHQoL-UK were at least 15 and 6 scale points, corresponding to a large effect size (1.5-1.7). CONCLUSIONS: Orthodontic treatment had a positive long-term impact on OHRQoL. MID for the OHIP-14 and OHQoL-UK provide guidance to interpreting the impact of orthodontic treatment on the OHRQoL of patients.

Validation of clinical photography and a laser fluorescence device for assessment of enamel demineralization during multi-bracketed fixed orthodontic treatment.

AIM: To compare the validity of DIAGNOdent pen™ 2190 and clinical photographs in the diagnosis (presence or absence) and assessment of white spot lesions (WSLs) during multi-bracketed fixed orthodontic treatment. METHODS: A total of 1607 readings from 99 patients were obtained using DIAGNOdent pen™ 2190, clinical photographs, and visual assessment criteria to assess WSLs at 6 -, 12- and 18 months after bonding of brackets. Receiver operating characteristic curves were constructed, and areas under the curve (AUC) were calculated to assess the presence or absence of WSLs and distinguish the severity of WSLs as slight or severe. Sensitivities, specificities, and AUC were calculated for outcomes at an alpha of 0.05 and 95% confidence intervals (CIs). RESULTS: The values of sensitivity and specificity of DIAGNOdent pen™ 2190 were found to be 0.78 and 0.83, respectively, to distinguish presence/absence of WSLs with good accuracy (AUC= 0.855; 95% CI: 0.820-0.889) and for digital photographs, accuracy was excellent (AUC= 0.973, 95% CI: 0.956-0.991) with sensitivity and specificity of 0.96 and 0.99, respectively. However, the accuracy of DIAGNOdent pen™ 2190 was poor (AUC= 0.543, 95% CI: 0.418-0.668) in delineating slight and severe WSLs with a sensitivity of 0.31 and specificity of 0.83; while the values of sensitivity and specificity for distinguishing slight or severe lesions for clinical photographs were 0.96 and 0.99, respectively with excellent accuracy (AUC=0.978, 95% CI: 0.936-1.000). CONCLUSIONS: Clinical photographs had better validity than DIAGNOdent pen™ 2190 in diagnosis and assessment of severity of demineralized lesions during multi-bracketed fixed orthodontic treatment.

Prevention of demineralization during multi-bracketed fixed orthodontic treatment: An overview of systematic reviews.

BACKGROUND: Demineralization during multi-bracketed fixed orthodontic treatment is a well-known problem. AIM: To systematically evaluate the evidence for the prevention of enamel demineralization during multi-bracketed fixed orthodontic treatment. DESIGN: Systematic reviews (with or without meta-analysis) that have appraised the primary studies on the prevention of demineralization during multi-bracketed fixed orthodontic treatment were searched systematically and included as per pre-defined eligibility criteria. The risk of bias of the included reviews was assessed by two authors using the ROBIS tool and AMSTAR-2 tool. RESULTS: Twenty-nine reviews conducted on 128 exclusive primary studies were included for the present overview; 23 of these reviews were assessed to be of a high risk of overall bias, 5 were of low risk, and 1 review was of unclear risk of bias. CONCLUSIONS: Predominantly, the published reviews have focused on fluorides, whereas some reviews have also studied the role of casein phosphopeptide-amorphous calcium phosphate (CPP-ACP), reminder therapy, lasers, and sealants. Professional fluorides, sealants, reminder therapy, and lasers might be valuable interventions to prevent demineralization during orthodontic treatment based on the conclusions of reviews with high quality; however, further studies are required to elucidate the role of CPP-ACP, chlorhexidine varnish, and powered toothbrushes.

The Efficacy of a Multi-Theory-Based Peer-Led Intervention on Oral Health Among Hong Kong Adolescents: A Cluster-Randomized Controlled Trial.

PURPOSE: This study aimed to investigate the effects of a peer-led oral health intervention based on the Health Belief Model and the Social Cognitive Theory on improving oral health among Hong Kong adolescents. METHODS: The study adopted a cluster-randomized controlled trial design, and 1184 students in 12 schools were randomized to intervention or control groups. After baseline assessment, the intervention group received a peer-led theory-based oral health intervention, while the control group received booklets for oral health promotion. Self-reported brushing and flossing, Health Belief Model/Social Cognitive Theory constructs, and oral health-related quality of life (OHRQoL) were measured at baseline, 6 months, and 12 months, and dental plaque accumulation and caries status were measured at baseline and 12 months. The trial was registered at https://www.clinicaltrials.gov (NCT03694496). RESULTS: Brushing, flossing, and OHRQoL improved more in the experimental group than in the control group at the 6-month follow-up compared with baseline (p < .001). The mean gain score difference was .81 for brushing, .47 for flossing, and -2.51 for OHRQoL. At the 12-month follow-up, the mean gain score of brushing frequency, plaque index, caries status, and OHRQoL were .18, -.28, -.32, and -2.79, respectively, which all sustained the significant difference (p < .001). CONCLUSIONS: Our findings suggested that the Health Belief Model combined with Social Cognitive Theory in a peer-led intervention is effective to increase self-reported brushing frequency and improve oral hygiene status and OHRQoL among adolescents.

The efficacy of peer-led oral health programs based on Social Cognitive Theory and Health Belief Model among Hong Kong adolescents: a cluster-randomized controlled trial.

Oral diseases are preventable through the building of good oral health behaviors. Theory-based behavior change was key to the efficacy of oral health promotion since conventional promotion strategies achieved only short-lived and limited improvements. The objective of the study was to investigate the efficacy of a peer-led oral health intervention based on the health belief model (HBM) and the social cognitive theory (SCT) on oral self-care behaviors among Hong Kong adolescents. One thousand one hundred and eighty-four adolescents in 12 schools participated and were randomly assigned to either intervention or control group, utilizing a cluster-randomized controlled trial design. Brushing/flossing frequency, HBM/SCT constructs, oral health knowledge, and dental anxiety were measured at baseline and 6-month follow-up. Changes in behaviors were assessed using mixed-effects model and the mediators of behavioral change were identified with parallel multiple mediation analysis. At 6 months, the intervention group showed a significant increase in the frequency of brushing and flossing compared with the control group. Self-efficacy was identified as mediator between treatment condition and behavioral changes of brushing and flossing. Combining theories of HBM and SCT is a promising avenue for efficacy in oral health behaviors. The effects were mediated through cognitive variables, which provided guidance for both theory and health intervention development.

Impact of COVID-19 on ongoing & ensuing dental research.

The current global COVID-19 pandemic has almost marked its one year of existence and influenced everyone either at an individual or community level. There are plenty of clinical recommendations and guidelines for the practitioners, and beyond doubt, the treating clinicians and other healthcare providers who have been in the frontline of this battle might have been significantly affected as a direct consequence of this pandemic. However, most of the clinical recommendations and guidelines are pivoted on intense research, and thus it is entirely reasonable to foretell that if dental research is impacted, the care-providers and consequently the patients will inevitably be affected. The present paper attempts to narratively summarize the potential disruptions on dental research due to the pandemic and endeavours to forewarn the dental researchers and scientific communities about the impact of COVID-19 on ongoing and ensuing dental research in the coming years. The ongoing COVID-19 pandemic has significantly affected laboratory and clinical research globally and will probably change the course of individuals and organizations engaged in dental research for some time. Tailor-made contingency plans by the individuals and organizations and sustaining the momentum of dental research by maintaining the flexibility in administration and utilization of research grants, extensions of grants and funding deadlines, adaption of study designs and procedures, pause or delay enrolment of participants, innovation in research collaborations and scholarly communications across different fields are some of the suggested measures that can be utilized to minimize the disruption during this pandemic.

The application of theory-guided oral health interventions in adolescents: a systematic review and meta-analysis of randomized controlled trials.

OBJECTIVE: To explore theory-guided randomized controlled trials aimed at improving adolescents' oral health and evaluate their effectiveness. DESIGN: Multiple library databases with search criteria for articles between 1990 and 2019. MAIN OUTCOME MEASURES: Searched references were coded and screened for theory-guided interventions for adolescent oral health. Characteristics of each study (study sample, adopted theory, outcome measures, length of follow-up and main findings) were extracted and the quality of the eligible trials assessed. Effect sizes for theory-guided interventions for different follow-up periods were analysed and compared with traditional oral health education. RESULTS: About 2135 results were uncovered, 64 were extracted for further screening, and 10 studies were eligible for inclusion. For plaque presence outcomes, no statistical difference was observed between theory-guided interventions and traditional interventions at 3 months (MD: -5.94, 95% CI: -16.39 to 4.51). When the duration of observation was extended to over one year, a significant reduction was found (SMD: -0.25, 95% CI: -0.46 to -0.04). CONCLUSION: Theory-guided interventions for improving oral hygiene status appear to be more effective than traditional interventions for adolescents in the long term. However, more comprehensive studies are required for validation to support the implementation and adoption of these programs in the clinical setting.

Modelling health belief predictors of oral health and dental anxiety among adolescents based on the Health Belief Model: a cross-sectional study.

BACKGROUND: A vicious cycle exists between dental anxiety, oral health behaviors and oral health status. Based on previous research, psychological factors of the Health Belief Model (HBM) are associated with oral health behaviors and oral health, and are likely involved in this cycle. However, little is known about the relationship between HBM factors and dental anxiety of adolescents. The purpose of this cross-sectional study was to investigate the relationship between health belief factors, oral health and dental anxiety based on the constructs of the HBM. METHODS: 1207 Grade 2 students from 12 secondary schools in Hong Kong were randomly selected and measured for the decayed, missing and filled permanent teeth (DMFT) index. Data for oral health behaviors, HBM constructs and dental anxiety were collected using questionnaires. The hierarchical entry of explanatory variables into logistic regression models estimating prevalence odds ratios (POR) were analyzed and 95% confidence intervals (95% CI) for DMFT and dental anxiety were generated. Path analysis was used to evaluate the appropriateness of the HBM as predictors for oral health behaviors, DMFT and dental anxiety. RESULTS: Based on the full model analysis, individuals with higher perceived susceptibility of oral diseases (POR: 1.33, 95% CI: 1.14-1.56) or girls or whose mother received higher education level were likelier to have a DMFT≥1, while those with higher perceived severity (POR: 1.31, 95%CI: 1.09-1.57), flossing weekly, DMFT≥1 or higher general anxiety level statistically increases the possibility of dental anxiety. The results from path analysis indicated that stronger perceived susceptibility, greater severity of oral diseases, less performing of oral health behaviors and a higher score of DMFT were directly related to increased dental anxiety level. Other HBM variables, such as perceived susceptibility, self-efficacy beliefs, cues to action and perceived barriers, might influence dental anxiety through oral health behaviors and caries status. CONCLUSIONS: Clarifying the propositional structures of the HBM may help the future design of theory-based interventions in reducing dental anxiety and preventing dental caries.

Dental anxiety and caries experience from late childhood through adolescence to early adulthood.

OBJECTIVE: To assess the association between dental anxiety and caries experience from late childhood through adolescence and into early adulthood (12, 15 and 18 years old, respectively). METHODS: A prospective cohort study was conducted among a population-representative sample of Chinese in Hong Kong. A baseline survey was conducted at age 12 and follow-up assessments were completed at ages 15 and 18. Caries experience was assessed as the number of decayed, missing and filled teeth (DMFT). Dental anxiety was assessed using the Modified Dental Anxiety Scale (MDAS). Participants' socio-economic status and oral health-related behaviours were ascertained using a self-complete questionnaire. Negative binomial regression was used to explore the association between dental anxiety and subsequent caries status, controlling for other factors. RESULTS: At baseline, 668 children participated; 279 (41.8%, comprising 57.0% females) completed all three phases of data collection. MDAS scores at age 18 were lower than at age 12. Caries experience increased as participants aged. At age 15 and 18, females had higher MDAS and DMFT scores than males. Reported frequency of snacking between meals was associated with MDAS scores at age 18. In regression analyses, dental anxiety at age 12 was not significantly associated with dental caries experience at age 15, controlling for socio-demographic and oral-health behaviour factors at age 12. Likewise, dental anxiety at age 15 was not significantly associated with dental caries experience at age 18, controlling for the same factors at age 15. CONCLUSION: Dental anxiety assessed by MDAS in late childhood and adolescence appears not to predict dental caries experience later in life in this population.

Development and validation of the Oral health behavior questionnaire for adolescents based on the health belief model (OHBQAHBM).

BACKGROUND: Oral health belief is a prerequisite of changing oral health behaviors especially during adolescence. However, there is a paucity of well-established questionnaire for use among adolescents. This study aimed to develop and validate an instrument to evaluate adolescents' beliefs about oral health behaviors using health belief model. METHODS: A preliminary 43-item questionnaire was developed by an expert panel. Then the questionnaire was finalized by decreasing the number of items to 35 by analyzing the results from face validity and factor analysis from 421 Hong Kong secondary school students. The content validity were evaluated by a panel of 2 behavioral scientists, 2 dentists, 2 schoolteachers and 10 adolescents. The construct validity of the questionnaire was assessed by performing exploratory factor analysis (EFA) and confirmatory factor analysis (CFA). The Cronbach's alpha coefficient, item-total correlation and intraclass coefficient were used to test its reliability. In addition, to confirm its applicability, multiple regression analysis and path analysis were used to evaluate the possibility of HBM as predictors for oral health behaviors and oral hygiene status. RESULTS: The initial analysis extracted six factors that jointly accounted for 62.47% of the variance observed. Based on CFA, the final version of the questionnaire consisted of 35 items and the data of the final version fitted the model well. The Cronbach's alpha coefficient for the subscale (> 0.7), item-total correlations (0.47-0.91) and the intraclass coefficient (0.82-0.91) were all above acceptable thresholds. The results of multiple regression analysis and path analysis confirmed its ability to predict oral health behaviors and status. CONCLUSIONS: The present findings indicate satisfactory validity, reliability and applicability of the proposed Oral Health Behavior Questionnaire for Adolescents based on the Health Belief Model (OHBQAHBM) for measuring oral health beliefs of adolescents. This questionnaire can be used as an instrument to measure oral health beliefs and predict oral health behavior and oral hygiene status of adolescents.

Dental fear association between mothers and adolescents-a longitudinal study.

AIM: To assess the longitudinal association between adolescents' and their mothers' dental fear. STUDY DESIGN: A longitudinal questionnaire survey study. METHODS: A randomized sample of 12-year-old adolescents were selected from local Hong Kong schools. Adolescents and their mothers self-completed the Modified Dental Anxiety Scale (MDAS). The sociodemographic background of the mothers and the oral health habits of the adolescents were also collected and these measurements were repeated at 15- and 18-years-old. Non-parametric tests (Mann-Whitney U test/Kruskall Wallis test) were used to test associations between MDAS dental fear items and independent variables. Logistic regression (adjusted for family's sociodemographic background and adolescent's oral health habits) was performed to evaluate the longitudinal association between adolescents' and mothers' dental fear. RESULTS: A total of 212 mother-child pairs were recruited at baseline (12-year-old adolescents). In the first and second follow-ups (15- and 18-years-old), 195 and 182 mother-child pairs completed the survey. Significant associations between mother's and child's scores in "feeling about having their teeth scraped and polished", "having teeth drilled", and 'having an injection in the gum' were found when adolescents were 12- years-old (P < 0.01) and 18-years-old (P < 0.05), but not at 15-years-old. CONCLUSION: Adolescents' and mothers' dental fear is associated at 12-years-old and 18-years-old, but not at 15-years-old, which is likely specific to the Hong Kong context but may be extrapolated to other industrialized countries with caution.

The association of socio-economic status, dental anxiety, and behavioral and clinical variables with adolescents' oral health-related quality of life.

PURPOSE: It is not clear which factors hold more weight in predicting oral health-related quality of life (OHRQoL). Therefore, this study explored which component of factors (e.g., socio-economic status, clinical status or oral health behaviors, dental anxiety, oral health knowledge) has a better predictive value in different aspects (e.g., oral symptoms, functional limitations, social and emotional conditions) of adolescents' OHRQoL. METHODS: Participants were randomly selected from Grade Two (S2) students within 12 secondary schools in Hong Kong. The independent variables include the following : socio-economic (monthly family income, parents' educational background), oral health behaviors (the frequency of brushing and having snacks like chocolate or biscuits), and oral health-related factors (oral health knowledge, dental anxiety, dental caries and bleeding index). Adolescents' OHRQoL was evaluated using the 16-item Child Perception Questionnaire (CPQ11-14-ISF:16). Frequencies and means were used for data description. Different variables were analyzed as predictors of OHRQoL by multi-level linear regression analysis. RESULTS: 1207 adolescents (46.6% females) participated in this study. The mean total CPQ11-14-ISF:16 was 14.2 (9.8). Mean scores of oral symptoms, functional limitations, and emotional and social well-being were 4.4 (2.8), 4.2 (2.8), 3.2 (3.1), and 2.4 (2.7), respectively. In the final model, adolescents with poorer oral health knowledge, higher dental anxiety levels, brushed their teeth less than once a day and consumed chocolates or biscuits more regularly as reported by a statistically worse OHRQoL (p < 0.05). In addition, gingival bleeding was a predictor of the oral symptom domain (ß = 0.7, p = 0.027); the emotional well-being of adolescents whose father went to college had a better OHRQoL (ß = - 0.9, p = 0.014) and adolescents from the higher-income family had a statistically better social well-being (p = 0.015). CONCLUSION: Our study indicates that adolescents with poorer oral health knowledge, higher dental anxiety levels, brushing their teeth less than once a day, or having a daily consumption of chocolate or biscuits had statistically worse OHRQoL. These findings can provide guidance for future oral health promotion in improving OHRQoL among adolescents.

A cohort study of factors that influence oral health-related quality of life from age 12 to 18 in Hong Kong.

BACKGROUND: There is a lack of cohort studies on the influence factors of oral health-related quality of life (OHRQoL). This study aimed to follow subjects from age 12 to 18 to analyse the sociodemographic and clinical factors that may influence OHRQoL. METHODS: This cohort study selected a representative sample from Hong Kong. Periodontal status and caries were examined according to WHO criteria. Four orthodontic indices were used to assess malocclusion. Child Perceptions Questionnaires (CPQ11-14) with 8 items (CPQ11-14-ISF: 8) and 37 items were used to assess OHRQoL at age 12 and age 15, respectively; Oral Health Impact Profile (OHIP-14) was used to assess OHRQoL at age 18. Wilcoxon signed ranks test and Friedman's test were used to analyse the age-related change of OHRQoL and malocclusion from age 12 to 18. Generalized estimating equations were used to analyse the influence factors of OHRQoL and to calculate adjusted risk ratio (RR). RESULTS: Subjects recruited in this study were 589 (305 females, 284 males), 364 (186 females, 178 males) and 300 (165 females, 135 males) at age 12, 15 and 18, respectively. Among them, 331 subjects (172 females, 159 males) were followed from age 12 to 15, and 118 subjects (106 females, 82 males) were followed from age 12 to 18. Subjects had less severe malocclusion at age 12 than at ages 15 and 18 (p = 0.000, measured by Dental Aesthetic Index). Age, periodontal status, and malocclusion had an effect on OHRQoL. When compared with OHRQoL at age 12, worse OHRQoL was observed at age 15 (adjusted RR = 1.06, 95%CI = 1.01-1.12, p = 0.032), but not at age 18 (adjusted RR = 1.01, 95%CI = 0.95-1.08, p = 0.759). Unhealthy periodontal conditions had a negative effect on OHRQoL (adjusted RR = 1.14, 95%CI = 1.04-1.25, p = 0.007). Only severe malocclusions had a negative effect on OHRQoL; a more severe malocclusion was associated with a higher effect on OHRQoL (adjusted RR = 1.09, 95%CI = 1.01-1.18, p = 0.032 for severe malocclusion, and adjusted RR = 1.17, 95%CI = 1.07-1.28, p = 0.001 for very severe malocclusion measured by Dental Aesthetic Index). CONCLUSION: Age, periodontal status, and malocclusion had an influence on OHRQoL from age 12 to 18. When clinicians attempt to improve subjects' OHRQoL, it is necessary to consider these factors.

Reliability of lateral cephalometric radiographs in the assessment of the upper airway in children: A retrospective study.

OBJECTIVES: To test the reliability of Lateral cephalometric radiographs (LCRs) for use in the assessment of the upper airway, hyoid bone, soft palate, and tongue. MATERIALS AND METHODS: The records of 57 healthy Chinese children from a nonhospital population (mean age = 12.6 years, SD = 0.5, 28 males and 29 females) who received two consecutive LCRs in the natural head posture were retrospectively analyzed. Fifteen linear, angular, and area measurements were used to describe the airway, hyoid bone, soft palate, and tongue. The reliability between the two LCRs was assessed with the intraclass correlation coefficient (ICC) and F-test. Errors were estimated with the Dahlberg and Bland-Altman method, and intra- and inter-assessor agreements were determined. RESULTS: Measurements of upper airway and hyoid bone had excellent method reliability, intra-assessor reliability, and inter-assessor reliability (ICC > 0.8). However, the method reliability and the inter-assessor reliability for soft palate and tongue was less favorable (ICC from 0.60 to 0.96). Soft palate area and thickness were the most critical parameters. Intra-assessor reliability was greater than both method reliability and inter-assessor reliability (which were similar). CONCLUSIONS: The measurement of upper airway morphology, defined as the intramural space, and of the hyoid bone position were highly reliable on LCRs of children. However, the limited reliability in the assessment of tongue and soft palate area may compromise the diagnostic application of LCRs to these structures.

Oral Health of Children With Attention Deficit Hyperactivity Disorder: Systematic Review and Meta-Analysis.

Objective: This systematic review investigated the oral health of children with ADHD. Method: A structured search strategy was performed on five electronic databases: SCOPUS, Web of Science, COCHRANE, PubMed, and PsychInfo. Studies were included in the review if they reported clinical oral health outcomes on a population diagnosed with ADHD under the age of 18 years old. Qualitative and quantitative analysis was performed on pooled prevalence and mean/median values for caries, trauma, periodontal problems, and tooth wear. Results: Twenty-seven effective articles were reviewed by two calibrated assessors. Meta-analysis of the results found higher mean number of decayed surfaces, plaque index, and trauma prevalence among children with ADHD. Conclusion: Children with ADHD show increased risk for caries and traumatic dental injuries, and may have poorer oral hygiene compared with children without ADHD. More awareness among clinicians would promote better caries- and trauma-preventive advice and management.

The effectiveness of behavioral interventions to improve oral health in adolescents at different periods of follow-up: A systematic review and meta-analysis.

BACKGROUND: The aim of this review was to examine the effectiveness of behavioral interventions at different follow-up periods to improve adolescents' oral health. METHODS: CENTRAL, MEDLINE, EMBASE and other databases were systematically searched. Inclusion criteria were as follows: participants aged 10-19 years old, randomized controlled trials using behavioral interventions, outcome measurements including oral health knowledge, attitudes, practices, and oral health status. For each included study, behavior change techniques (BCT) were identified and the quality and risk of bias assessments obtained. PROSPERO reference: CRD42018090341. RESULTS: After searching and screening, 17 clinical trials were included in the systematic review. The most commonly used BCTs were behavior health link, information on consequences, and social comparisons. A significant reduction of plaque index was detected (SMD:-0.46; 95 % CI:-0.82∼-0.10) for 3 months and (SMD:-0.71; 95 % CI:-1.08∼-0.33) for 6 months. The reduction of gingival index after 6 months was also significant (SMD:-0.90; 95 % CI:-1.33∼-0.47). Oral health knowledge and oral health-related behavior were also improved after behavioral interventions. CONCLUSION: There is moderate evidence that behavioral interventions are effective in promoting oral health in adolescents. To establish more evidence-based conclusions, further research should focus on: quality control of interventions, full descriptions regarding the BCT, long-term follow-ups, and behavior change reinforcements. PRACTICAL VALUE: Given the need of early prevention of oral diseases, well-designed oral health promotion programme are needed to improve behavior and outcome of adolescents' oral health.

Validation for Brazilian Portuguese language of the Hong Kong Oral Health Literacy Assessment Task for Paediatric Dentistry (BOHLAT-P).

BACKGROUND: Oral health literacy (OHL) is associated with oral health outcomes. AIM: To validate the Brazilian Portuguese version of the Hong Kong OHL Assessment Task for Paediatric Dentistry (HKOHLAT-P). DESIGN: We performed cross-cultural adaptation of the HKOHLAT-P. A sample of 200 pre-schoolers and caregivers from Campina Grande, Brazil completed the Brazilian HKOHLAT-P (BOHLAT-P), sociodemographic questionnaire, the Brazilian Early Childhood Oral Health Impact Scale (B-ECOHIS), and the Brazilian Rapid Estimate of Adult Literacy in Dentistry (BREALD-30). Child dental caries was assessed. Instrument reliability was measured by internal consistency (Cronbach's alpha) and test-retest (ICC). Exploratory factor analysis (EFA) and confirmatory factor analysis (CFA) evaluated dimensionality. Regression models tested associations between BOHLAT-P and exploratory variables (P < .05). RESULTS: BOHLAT-P demonstrated excellent reliability (Cronbach's alpha = 0.92; ICC = 0.95). BOHLAT-P and BREALD-30 scores (r = .71), number of schooling years (r = .60), and reading hours (r = .34) were positively correlated. BOHLAT-P and B-ECOHIS scores (r = -.22), and BOHLAT-P scores and number of cavitated teeth (r = -.15) were negatively correlated. After controlling for confounding variables, BOHLAT-P scores were not associated with caries or number of teeth with cavitated caries. CONCLUSION: BOHLAT-P is a valid and reliable instrument to assess the OHL of Brazilian parents.