Qat Chewing and Periodontal Pathogens in Health and Disease: Further Evidence for a Prebiotic-Like Effect.

AIM: Qat chewing has been reported to induce subgingival microbial shifts suggestive of prebiotic-like properties. The objective here was to assess the effect of qat chewing on a panel of classical and new putative periopathogens in health and periodontitis. MATERIALS AND METHODS: 40 qat chewers and 40 nonchewers, equally stratified by periodontal health status, were recruited. Taqman, real-time PCR was used to quantify total bacteria, Porphyromonas gingivalis, Tannerella forsythia, Treponema denticola, Parvimonas micra, Filifactor alocis, Synergistetes, and TM7s in pooled subgingival biofilm samples. Differences in microbial parameters between the study groups were analysed using ordinal regression. RESULTS: In health, the qat chewers harboured significantly lower relative counts of P. gingivalis, T. forsythia, Synergistetes, and TM7s after adjustment for multiple comparisons (P ≤ 0.007). At nominal significance level, they also carried lower counts of TM7s and P. micra (P ≤ 0.05). In periodontitis, the chewers had lower counts of all taxa; however, only T. denticola withstood correction for multiple comparisons (P ≤ 0.0063). CONCLUSIONS: Qat chewing is associated with lower proportions of periopathogens, particularly in subjects with healthy periodontium, which supports previous reports of its prebiotic-like properties. This potentially beneficial biological effect can be exploited by attempting to isolate the active fraction.

Is the burden of oral diseases higher in urban disadvantaged community compared to the national prevalence?

BACKGROUND: The urban low income has often been assumed to have the greatest dental treatment needs compared to the general population. However, no studies have been carried out to verify these assumptions. This study was conducted to assess whether there was any difference between the treatment needs of an urban poor population as compared to the general population in order to design an intervention programme for this community. METHODS: A random sampling of living quarters (households) in the selected areas was done. 586 adults over 19 years old living in these households were clinically examined using World Health Organization (WHO) Oral Health Survey criteria 4th edition (1997). RESULTS: The overall prevalence of dental caries, periodontal disease, denture wearers and temporomandibular joint problems were 70.5%, 97.1%, 16.7% and 26%, respectively. The majority (80.5%) needed some form of dental treatment. The highest treatment needs were found in the oldest age group while the lowest were in the youngest group (19-29 years) (p = 0.000). The most prevalent periodontal problem was calculus; regardless of gender, ethnicity and age. Significantly more females (20.5%) wore prosthesis than males (11.1%) (p = 0.003). Prosthetic status and need significantly increased with age (p = 0.000). About one in four adults had Temporo-Mandibular Joint (TMJ) problems. Overall, it was surprising to note that the oral disease burden related to caries, prosthetic status and treatment need were lower in this population as compared to the national average (NOHSA, 2010). However, their periodontal disease status and treatment needs were higher compared to the national average indicating a poor oral hygiene standard. CONCLUSIONS: The evidence does not show that the overall oral disease burden and treatment needs in this urban disadvantaged adult population as higher than the national average, except for periodontal disease. The older age groups and elderly were identified as the most in need for oral health intervention and promotion. An integrated health intervention programme through a multisectoral common risk factor approach in collaboration with the Faculties of Medicine, Dentistry and other agencies is needed for the identified target group.

A review of the global literature on dental therapists.

OBJECTIVE: Access to adequate oral health care is deficient in many parts of the world. Many countries are now using dental therapists to increase access, particularly for children. To inform the discussion on dental therapists in the workforce, particularly in the United States, the W.K. Kellogg Foundation funded a review of the global literature to identify as many documents as possible related to the practice of dental therapists since the establishment of the School Dental Service in New Zealand in 1921. METHODS: Consultants in each of the countries considered to have a substantive literature on dental therapists were asked to participate in the research; seventeen in total. In addition to identifying and reviewing published articles, a focus of the research was on identifying 'gray' documents. Standard databases were searched for key words associated with dental therapists. In addition, searches were conducted of the governmental and dental association websites of all countries known to have dental therapists in their oral health workforce. RESULTS: Fifty-four countries, both developing and developed, were identified where dental therapists are members of the workforce. Eleven hundred documents were identified from 26 of these countries, with over 2/3 of them cited in the published monograph. Reliable evidence from the related literature and verbal communication confirmed the utilization of dental therapists in an additional 28 countries. Thirty-three of the countries were members of the Commonwealth of Nations, suggesting a mechanism of spread from New Zealand. Variable lengths of training/education existed for dental therapists with the tradition being 2 years postsecondary. In a few countries, the training of therapists and hygienists is now being combined in a three academic year program. Historically, dental therapists have been employed by government agencies caring for children, typically in school-based programs. Initiatives in some countries allow limited care for adults by dental therapists with additional training. CONCLUSIONS: The evidence indicates that dental therapists provide effective, quality, and safe care for children in an economical manner and are generally accepted both by the public and where their use is established, by the dental profession.

Caries increment among army personnel: a 5-year longitudinal study.

To assess the progression of dental caries among Malaysian infantry soldiers after 5 years in military service. A retrospective cohort study with a self-administered questionnaire and a clinical oral examination. Data were available for 173 (67.3%) soldiers. Mean decayed, missing, or filled teeth had increased significantly by 20.6% (P = .001) over 5 years. The highest increase was in the missing teeth component (+120%), followed by filled teeth (+23%). This was accompanied by a decrease in decayed teeth (-23.5%; P < .05). In terms of surfaces, mean decayed, missing, or filled surfaces, missing surfaces, and filled surfaces had increased significantly (P < .05). Caries experience was significantly associated with smoking status and rank (P < .05). Dental caries experience was worse after 5 years in military service compared with during recruitment, and there were more tooth extractions than restorations. Health promotion interventions are needed to prevent further tooth loss among soldiers.

Health promoting schools and children's oral health related quality of life.

BACKGROUND: The study objective was to compare children's oral health related quality of life (OHRQoL) in schools with 6 years of implementation of a health promoting school model in Malaysia, i.e. the Doktor Muda Programme (DMP) and in schools without the DMP. METHODS: This report was part of a larger study to evaluate the DMP impact on schoolchildren's oral health knowledge, attitudes, behaviour, caries progression and OHRQoL. It was conducted in Negri Sembilan state. The sample comprised 3455, Year 6 (11-12 year old) children; 1282 from DMP (intervention) and 2173 from non-DMP (control) schools. The Malay Child-OIDP index was used to evaluate children's levels of oral impacts on 8 daily performances after 6 years of DMP implementation (2006-2011). Prevalence, score, impact intensity, causes and extent of impacts were compared. Chi-square and Mann-Whitney tests were used in the data analysis. RESULTS: Overall response rate was 95.1%. Prevalence of overall impacts was 57.8% and 60.8% (mean total impact score was 7.10 and 7.77) in the intervention and control group, respectively. The three most frequently affected performances in both groups were eating, cleaning teeth and emotional stability. Significantly less DMP children had oral impact on cleaning teeth (p = 0.034). The majority of children with impacts in both groups reported 'very little' to 'moderate' levels of impact intensity. Significantly more DMP children reported having 'very little' and 'little' levels of impact intensity on cleaning teeth (p = 0.037) and emotional stability (p = 0.020), respectively. Significantly less DMP children reported having 'very severe' level of impact intensity on speaking (p = 0.038). The most prevalent cause of impacts in both groups was toothache. Significantly less DMP children reported bleeding gums (p = 0.016) and presence of plaque/calculus as causes of impacts (p = 0.032). About 75% of children with impacts in both groups reported having up to four daily performances affected. CONCLUSION: This study showed that the health promoting school model, i.e. the Doktor Muda Programme for primary schools in Malaysia had some positive impacts on 11-12 year old children's oral health related quality of life.

Assessment of dental caries predictors in 6-year-old school children - results from 5-year retrospective cohort study.

BACKGROUND: This was a retrospective cohort study undertaken to assess the rate and pattern of dental caries development in 6-year-old school children followed-up for a period of 5 years, and to identify baseline risk factors that were associated with 5 years caries experience in Malaysian children. METHODS: This 5-years retrospective cohort study comprised primary school children initially aged 6 years in 2004. Caries experience of each child was recorded annually using World Health Organization criteria. The rates of dental caries were recorded in prevalence and incidence density of carious lesions from baseline to final examination. Risk assessment was done to assess relative risk for caries after 5 years in children with baseline caries status. Simple and multiple logistic regression analysis were performed to identify significant independent risk factors for caries. RESULTS: The sample consisted of 1830 school children. All components of DMFT showed significant differences between baseline and final examination. Filled teeth (FT) component of the DMFT showed the greatest increases. Results revealed the initial baseline caries level in permanent dentition was a strong predictor for future caries after 5 years (RR=3.78, 95% CI=3.48-4.10, P<0.001). Logistic regression analysis showed significant association between caries occurrence and residence (urban/rural) (OR=1.80, P<0.001). However, it was not significantly associated with gender and ethnicity. The incidence density of caries, affected persons (IDp) observed from baseline and after 5 years was 5.80 persons/100 person-year of observation. The rate of new caries-affected tooth (IDt) in the period from baseline and after 5-years was 0.76 teeth/100 teeth-year of observation. CONCLUSION: The majority of 12-year-old school children (70%) were caries-free and most of the caries were concentrated in only a small proportion (30%) of them. We found that the presence of caries in permanent teeth at the age of 6 years was a strong predictor of future caries development in this population. The strong evidence of early permanent teeth caries at six years old to predict future caries incidence at 12-year-olds, which could be obtained at almost no cost, questions the need for and cost-effectiveness of expensive technology-based commercial caries predictions kits.

A Malay version of the Child Oral Impacts on Daily Performances (Child-OIDP) index: assessing validity and reliability.

BACKGROUND: The study aimed to develop and test a Malay version of the Child-OIDP index, evaluate its psychometric properties and report on the prevalence of oral impacts on eight daily performances in a sample of 11-12 year old Malaysian schoolchildren. METHODS: The Child-OIDP index was translated from English into Malay. The Malay version was tested for reliability and validity on a non-random sample of 132, 11-12 year old schoolchildren from two urban schools in Kuala Lumpur. Psychometric analysis of the Malay Child-OIDP involved face, content, criterion and construct validity tests as well as internal and test-retest reliability. Non-parametric statistical methods were used to assess relationships between Child-OIDP scores and other subjective outcome measures. RESULTS: The standardised Cronbach's alpha was 0.80 and the weighted Kappa was 0.84 (intraclass correlation = 0.79). The index showed significant associations with different subjective measures viz. perceived satisfaction with mouth, perceived needs for dental treatment, perceived oral health status and toothache experience in the previous 3 months (p < 0.05). Two-thirds (66.7%) of the sample had oral impacts affecting one or more performances in the past 3 months. The three most frequently affected performances were cleaning teeth (36.4%), eating foods (34.8%) and maintaining emotional stability (26.5%). In terms of severity of impact, the ability to relax was most severely affected by their oral conditions, followed by ability to socialise and doing schoolwork. Almost three-quarters (74.2%) of schoolchildren with oral impacts had up to three performances affected by their oral conditions. CONCLUSION: This study indicated that the Malay Child-OIDP index is a valid and reliable instrument to measure the oral impacts of daily performances in 11-12 year old urban schoolchildren in Malaysia.

Dental health status and treatment needs in the infantry regiment of the Malaysian Territorial Army.

The aim of this study was to determine the dental health status and treatment needs of personnel in the Infantry Regiment of the Malaysian Territorial Army (TA).This cross-sectional study involved stratified and systematic random sampling with a total sample size of 300. Dental health status and treatment needs were assessed using the standard WHO oral assessment criteria (1997). The prevalence of caries experience was 96% (mean ± SD DMFT [decayed, missing, filled teeth] = 8.0 ± 5.5). Active decay prevalence was high (85%; mean ± SD = 3.6 ± 3.1) indicating high unmet treatment need. Missing teeth prevalence was high (69%; mean ± SD = 2.8 ± 3.7). Filled teeth prevalence was low (56%, mean ± SD = 1.5 ± 2.0). In all, 90% of participants required some form of dental treatment, of whom 85% required restorative treatment, 5% advanced restorative treatment, 36.7% extractions, and 45.3% prosthetic treatment. These findings suggest that there was a high need for dental treatment in the Infantry Battalions of Malaysian TA Regiments and the service must be made available to cater to the needs.

Malaysian dental graduates' competence in holistic care: what do graduates and employers think?

The purpose of this study was to explore the University of Malaya (UM) dental graduates' competence in holistic care in real settings from the employers' and graduates' perspectives. A self-administered questionnaire consisting of ten domains was sent to thirty senior dental officers of the Ministry of Health (MOH) and 164 UM graduates. In this article, nineteen major competencies that best represent the graduates' competence in the provision of holistic care are discussed. Each competency was rated on a scale of 1 (very poor) to 4 (very good) and was categorized as "poor and of major concern" (if less than 60 percent of respondents scored good or very good), "satisfactory and of minor concern" (60-69 percent), or "excellent" (70 percent and above). One hundred and six out of 164 graduates (64.6 percent) and twenty-nine out of thirty employers (96.7 percent) responded. Overall, the employers rated the graduates lower than what the graduates rated themselves on all items. While the graduates felt they were excellent and satisfactory in sixteen out of nineteen items (84.2 percent), the employers felt they were poor in fourteen out of nineteen (73.7 percent). Both groups agreed that the graduates were excellent in communication, but poor in life-saving skills, obtaining patient's family and psychosocial histories, and recognizing signs and symptoms (not intraoral) indicating the presence of a systemic disease. In conclusion, although the graduates felt competent in the majority of the holistic care competencies, the employers had some reservations over such claims. Outcomes of the study led to recommendations to incorporate longer community-based learning hours, an improved behavioral science component, a module for special care patients, and multidepartmental collaborative teachings in the new integrated program aimed for implementation in 2011.

HIV/AIDS-related knowledge among Malaysian young adults: findings from a nationwide survey.

PURPOSE: HIV/AIDS poses a serious threat to young people, both in Malaysia and throughout the world. A nationwide cross-sectional survey was conducted to assess the knowledge, attitudes, and beliefs about HIV/AIDS among the Malaysian public. This article reports the findings of knowledge about HIV/AIDS among young adults. METHODS: A total of 1075 young adult respondents aged 15-24 years participated in this survey. The response rate was 82.2%. RESULTS: The data indicated that HIV/AIDS knowledge among the respondents was moderate, with a mean knowledge score of 20.1 out of 32 points. The great majority had adequate knowledge of the major routes of HIV transmission, but fewer were aware of other modes of transmission, such as tattooing and piercing, sharing personal items, and breast-feeding from an infected mother. The great majority knew that HIV is not transmitted by mosquito bites, sharing meals, casual contact, and using public swimming pools and toilets. CONCLUSIONS: Misconceptions about HIV/AIDS exist although generally knowledge on HIV/AIDS transmission and prevention was accurate. Education and intervention programs are needed to increase the level of knowledge and awareness of HIV/AIDS. The findings have important implications for the development of primary HIV/AIDS prevention programs for young adults in Malaysia.

Assessing the competency of University of Malaya dental graduates: employers' and graduates' perceptions.

A survey was conducted to assess competencies of dental graduates of the Faculty of Dentistry, University of Malaya, as perceived by the graduates and their employers, based on the five-year undergraduate curriculum introduced in 1995. All senior dental officers in the Ministry of Health (MOH), representing employers, and all 164 dental graduates of the years 2000, 2001, and 2002 were sent a self-administered questionnaire covering eight areas of competency. The respondents had to rate these areas on a scale of 1 (very poor) to 4 (very good). The responses for each area were then dichotomized into poor (1 and 2) and good (3 and 4). If less than 60 percent of the respondents rated an area as good, then it was categorized as needing attention; 60-69 percent as satisfactory; and 70 percent and above as excellent. One hundred and six graduates (64.6 percent) and twenty-nine employers (96.7 percent) responded; of the graduates, 73.6 percent were working in the MOH and 22.6 percent in private practice. About 57.1 percent of employers reported that at least five graduates have worked under them. Graduates (85.7 percent) and employers (83.3 percent) agreed that graduates have excellent skills in communication. Although all graduates perceived their competency to be excellent in the four areas (treatment planning; community-based skills; management, administrative skills, and personal management; and professional development skills), employers felt that these are the areas that are of concern and needed attention. In conclusion, whilst generally the graduates' level of competency in almost all areas is acceptable or good, there are areas of concern that need to be addressed to further improve the five-year curriculum at the University of Malaya.

HIV/AIDS-Related Knowledge Among Malaysian Young Adults: Findings From a Nationwide Survey.

PURPOSE: HIV/AIDS poses a serious threat to young people, both in Malaysia and throughout the world. A nationwide cross-sectional survey was conducted to assess the knowledge, attitudes, and beliefs about HIV/AIDS among the Malaysian public. This article reports the findings of knowledge about HIV/AIDS among young adults. METHODS: A total of 1075 young adult respondents aged 15-24 years participated in this survey. The response rate was 82.2%. RESULTS: The data indicated that HIV/AIDS knowledge among the respondents was moderate, with a mean knowledge score of 20.1 out of 32 points. The great majority had adequate knowledge of the major routes of HIV transmission, but fewer were aware of other modes of transmission, such as tattooing and piercing, sharing personal items, and breast-feeding from an infected mother. The great majority knew that HIV is not transmitted by mosquito bites, sharing meals, casual contact, and using public swimming pools and toilets. CONCLUSION: Misconceptions about HIV/AIDS exist although generally knowledge on HIV/AIDS transmission and prevention was accurate. Education and intervention programs are needed to increase the level of knowledge and awareness of HIV/AIDS. The findings have important implications for the development of primary HIV/AIDS prevention programs for young adults in Malaysia.

Validation of the Geriatric Oral Health Assessment Index (GOHAI) in the Malay language.

OBJECTIVE: To translate and validate the Geriatric Oral Health Assessment Index (GOHAI into the Malay language for use in Malaysia. METHODOLOGY: The 6-Likert scale GOHAI was translated into the Malay language and self-administered on 189 subjects aged 60+. All subjects underwent oral status assessment. The measure was assessed for construct and discriminant validity, for test-retest reliability and principal component factor. FINDINGS: Mean GOHAI score was 46.2 (SD 9.7, range 17-60). The Cronbach's alpha was 0.79. Mean GOHAI scores increased with more positive self-rated oral health and general health. The elderly with no perceived dental treatment need had higher mean GOHAI scores than those with perceived needs. There were slightly stronger inverse correlations between GOHAI scores and caries experience, number of teeth present, and number of pathologically mobile teeth. The measure demonstrated strong test-retest reliability. Eight of the 12 items had Spearman's r3 0.7. Only one principal factor was found at eigenvalue > 1. Using ANCOVA, self-rated perception of oral health and perceived need for dental treatment had the most significant impact on the GOHAI score. CONCLUSION AND RECOMMENDATIONS: The Malay language version of the GOHAI demonstrated acceptable validity and reliability and will be an important instrument to measure oral health-related quality of life among Malay-speaking Malaysians. Use of the Malay language version GOHAI should also be pursued among diverse adult age groups.