Sociodemographic and Clinical Factors That Influence Oral Health-Related Quality of Life in Adolescents: a Cohort Study.

OBJECTIVE: To determine the sociodemographic and clinical factors that may influence oral health-related quality of life (OHRQoL) at ages 12 to 15. BASIC RESEARCH DESIGN: Cohort study. PARTICIPANTS: Cluster-randomized sample of Hong Kong 12-year-olds. MAIN OUTCOME MEASURES: The Child Perceptions Questionnaire (CPQ11-14) was used to measure OHRQoL as the response variable. Periodontal status and caries were examined according to WHO criteria. Malocclusion was assessed using Dental Aesthetic Index. Potential predictors of OHRQoL (age, gender, father's education, mother's education, household income, periodontal status, caries, and malocclusion) were analyzed by structural equation modelling. RESULTS: At age 12, 589 participants (305 females, 284 males) were included. At age 15, 331 (172 females and 159 males) were followed up. For direct effects, age 15 was associated with higher oral symptoms (OS) scores (ß=0.124, 95%CI=0.049 to 0.2) but lower emotional well-being (EWB) scores (ß=-0.105, 95%CI=-0.184 to -0.03). Males had higher OS scores than females (ß=0.126, 95%CI=0.059 to 0.208). Mother's education had positive effects on children's EWB (ß=-0.096, 95%CI=-0.159 to -0.018). Malocclusion had negative effects on functional limitations (FL) (ß=0.083, 95%CI=0.013 to 0.186). For indirect effect, mother's education showed a link via EWB to OHRQoL (ß=-0.077, 95%CI=-0.123 to -0.018). Malocclusion showed a link via FL to OHRQoL (ß=0.037, 95%CI=0.006 to 0.087). CONCLUSIONS: Age, gender, mother's education and malocclusion predicted OHRQoL at ages 12 and 15.

Global Burden and Inequality of Dental Caries, 1990 to 2019.

Previous studies on the global burden of caries primarily focused on simple descriptive statistics. We aimed to characterize the burden, trends, and inequalities of untreated caries of permanent and deciduous teeth from 1990 to 2019 at the global, regional, and national levels through an array of analytic approaches. Estimates of caries burden were extracted from the Global Burden of Disease Study 2019. Decomposition analysis was performed to examine the contribution of demographic and epidemiologic factors to the evolving number of prevalent caries cases. In portfolio analysis, the caries epidemiologic profile of each country was categorized by terciles of age-standardized prevalence in 2019 and average annual percentage change from 1990 to 2019. Sociodemographic attribution analysis was performed to reveal the scale of inequality in burden of caries. Age-standardized prevalence of caries in permanent and deciduous teeth decreased 3.6% (95% uncertainty interval, 2.6% to 4.5%) and 3.0% (1.3% to 4.9%), respectively. Population growth was the key driver of the changes in the number of caries cases, especially in sub-Saharan Africa (percentage contribution: 126.6%, permanent teeth; 103.0%, deciduous teeth). Caries prevalence in the permanent dentition was lower in more developed countries, whereas a reverse trend was noted in the deciduous dentition, except for the highest sociodemographic quintile where caries prevalence was the lowest. Globally, 64.6 million (95% CI, 64.4 to 64.9 million) and 62.9 million (62.8 to 63.1 million) prevalent cases of caries in permanent and deciduous teeth were attributable to sociodemographic inequality in 2019. This amounted to 3.2% (3.2% to 3.2%) and 12.1% (12.1% to 12.1%) of the global number of prevalent cases of caries in permanent and deciduous teeth. Burden of dental caries remains a global public health challenge. A systemwide reform of the global oral health care system is needed to tackle the causes of the burden and inequality of dental caries.

Enlightenment of re-entry airflow: The path of the airflow and the airborne pollutants transmission in buildings.

Viable aerosols in the airflow may increase the risk of occupants contracting diseases. Natural ventilation is common in buildings and is accompanied by re-entry airflow during the ventilation process. If the re-entry airflow contains toxic or infectious species, it may cause potential harm to residents. One of the Covid-19 outbreaks occurred in a public residential building at Luk Chuen House (LC-House) in Hong Kong. It is highly suspected that the outbreak of the disease is related to the re-entry airflow. The study attempts to explain and discuss possible causes of the outbreak. In order to understand the impact of airflow on the outbreak, a public residential building similar to LC-House was used in the study. Two measurements M - I and M - II with the same settings were conducted for a sampling unit in the corridor under low and strong wind conditions respectively. The sampling unit and the tracer gas carbon dioxide (CO2) were used to simulate the index unit and infectious contaminated airflow respectively. The CO2 concentrations of the unit and corridor were measured simultaneously. Two models of Traditional Single-zone model (TSZ-model) and New Dual-zone model (NDZ-model) were used in the analysis. By comparing the ACH values obtained from the two models, it is indicated that the re-entry airflow of the unit is related to the corridor wind speeds and this provides a reasonable explanation for the outbreak in LC-House, and believes that the results can help understand the recent frequent cluster outbreaks in other residential buildings.

Oral Health Birth Cohort Studies: Achievements, Challenges, and Potential.

Birth cohorts are those among observational studies that provide understanding of the natural history and causality of diseases since early in life. Discussions during an International Association for Dental Research symposium in London, United Kingdom, in 2018, followed by a workshop in Bangkok, Thailand, in 2019, concluded that there are few birth cohort studies that consider oral health and that a broader discussion on similarities and differences among those studies would be valuable. This article aims to 1) bring together available long-term data of oral health birth cohort studies from the low, middle, and high-income countries worldwide and 2) describe similarities and differences among these studies. This work comprises 15 studies from all 5 continents. The most studied dental conditions and exposures are identified; findings are summarized; and methodological differences and similarities among studies are presented. Methodological strengths and weaknesses are also highlighted. Findings are summarized in 1) the negative impact of detrimental socioeconomic status on oral health changes over time, 2) the role of unfavorable patterns of dental visiting on oral health, 3) associations between general and oral health, 4) nutritional and dietary effects on oral health, and 5) intergenerational influences on oral health. Dental caries and dental visiting patterns have been recorded in all studies. Sources of fluoride exposure have been documented in most of the more recent studies. Despite some methodological differences in the way that the exposures and outcomes were measured, some findings are consistent. Predictive models have been used with caries risk tools, periodontitis occurrence, and permanent dentition orthodontic treatment need. The next steps of the group's work are as follows: 1) establishing a consortium of oral health birth cohort studies, 2) conducting a scoping review, 3) exploring opportunities for pooled data analyses to answer pressing research questions, and 4) promoting and enabling the development of the next generation of oral health researchers.

Efficacy of caries and gingivitis prevention strategies among children and adolescents with intellectual disabilities: a systematic review and meta-analysis.

BACKGROUND: Dental caries and periodontal diseases are the most common oral diseases among human beings. Individuals with intellectual disabilities (IDs) have poor oral health and limited access to dental care. The aim of this study was to investigate the efficacy of strategies in caries and gingivitis prevention among children and adolescents with ID. METHODS: Four electronic databases (PubMed, Cochrane Library, Web of Science and Scopus) were searched from their commencement date to 17 April 2017. Randomised or non-randomised controlled trials evaluating the efficacy of interventions in caries and gingivitis prevention were included if the participants were children and adolescents with ID. Gingival index and caries experiences were reported in the format of mean difference and standard error. Meta-analysis was conducted if data could be pooled from two or more studies using similar outcome measurements and intervention. RESULTS: A total of 1455 articles published in English were identified. Fourteen studies formed the basis of qualitative analysis; six studies were feasible to perform quantitative analysis. Meta-analysis favoured fluoride to placebo in caries prevention [Z = 2.02, P < 0.05, 95% CI: -0.71 (-1.40, -0.02)], while the effectiveness of chlorhexidine remained elusive. CONCLUSIONS: Both mechanical and chemical approaches had been applied to caries and gingivitis prevention among children and adolescents with ID. Insufficient evidence supported the efficacy of chlorhexidine nor powered toothbrush, while fluoride was suggested to be an effective caries preventive strategy in fluoride-deficient areas. More well-designed randomised controlled trials using integration strategies are encouraged in further studies.

Interpreter-mediated dentistry.

The global movements of healthcare professionals and patient populations have increased the complexities of medical interactions at the point of service. This study examines interpreter mediated talk in cross-cultural general dentistry in Hong Kong where assisting para-professionals, in this case bilingual or multilingual Dental Surgery Assistants (DSAs), perform the dual capabilities of clinical assistant and interpreter. An initial language use survey was conducted with Polyclinic DSAs (n = 41) using a logbook approach to provide self-report data on language use in clinics. Frequencies of mean scores using a 10-point visual analogue scale (VAS) indicated that the majority of DSAs spoke mainly Cantonese in clinics and interpreted for postgraduates and professors. Conversation Analysis (CA) examined recipient design across a corpus (n = 23) of video-recorded review consultations between non-Cantonese speaking expatriate dentists and their Cantonese L1 patients. Three patterns of mediated interpreting indicated were: dentist designated expansions; dentist initiated interpretations; and assistant initiated interpretations to both the dentist and patient. The third, rather than being perceived as negative, was found to be framed either in response to patient difficulties or within the specific task routines of general dentistry. The findings illustrate trends in dentistry towards personalized care and patient empowerment as a reaction to product delivery approaches to patient management. Implications are indicated for both treatment adherence and the education of dental professionals.

The relationship between oral hygiene status and obesity among preschool children in Hong Kong.

OBJECTIVES: To explore the association between oral hygiene status and obesity among preschool children in Hong Kong. METHODS: Three hundred and twenty-four 5-year-old children in Hong Kong were recruited. Their oral hygiene status was recorded using visible plaque index (VPI). Body height, body weight, waist circumference (WC), hip circumference and triceps skinfold thickness (TRSKF) were measured to assess general adiposity (weight/height ratio, W/H; body mass index, BMI), central adiposity (WC; waist/hip ratio, WHR) and peripheral adiposity (TRSKF). The relationships between VPI and W/H, BMI, WC, WHR and TRSKF were examined in bivariate and regression analyses. RESULTS: Fifty-six per cent of the children were considered to have high VPI (VPI ≥ 65.0%). Logistic regression analyses identified that W/H z-score (OR = 1.28, 95% CI = 1.01-1.61) and WC z-score (OR = 1.25, 95% CI = 1.00-1.58) were associated with high VPI. No association was found after adjusted for socio-demographic status (P > 0.05). CONCLUSION: Oral hygiene status was not associated with obesity among 5-year-old children in Hong Kong after controlling for socio-demographic factors.

Association between dental caries and adiposity status (general, central, and peripheral adiposity) in 12-year-old children.

BACKGROUND/AIMS: To investigate the cross-sectional relationship between dental caries experience and adiposity status (general, central, and peripheral adiposity) in 12-year-old children in Hong Kong. METHODS: A random sample of 668 12-year-old students was recruited. Clinical assessment for dental caries (DMFT) was conducted using WHO criteria. Anthropometric measurements for body height, body weight, waist circumference (WC), hip circumference and triceps skinfold thickness (TRSKF) were performed to assess general adiposity (weight-height ratio, body mass index); central adiposity (WC; waist-hip ratio, WHR), and peripheral adiposity (TRSKF). Associations between adiposity indices and dental caries experience [prevalence DMFT > 0, 'high' experience (DMFT ≥ SiC Index value) and 'very high' experience (DMFT ≥ SiC10 Index value)] were examined in bivariate and multivariate regression analyses. RESULTS: The response rate was 76.9% (n = 514/668). Regression analyses (adjusted for oral hygiene practice, snacking habits, and socio-demographic factors) identified that WHR z score was associated with 'high' dental caries experience (OR 1.33, 95% CI 1.05, 1.70, p = 0.02), and that WHR z score was associated with 'very high' dental caries experience (OR 1.52, 95% CI 1.10, 2.11, p = 0.01). TRSKF z score was associated with 'very high' dental caries experience (OR 1.47, 95% CI 1.10, 1.96, p = 0.01). CONCLUSIONS: In a population-based sample of 12-year-old children in Hong Kong, dental caries experience was associated with adiposity. Central and peripheral, but not general adiposity was associated with dental caries experience.

Borderline personality disorder subscale (Chinese version) of the structured clinical interview for DSM-IV axis II personality disorders: a validation study in Cantonese-speaking Hong Kong Chinese.

OBJECTIVE: Borderline personality disorder is an important but under-recognised clinical entity, for which there are only a few available diagnostic instruments in the Chinese language. None has been tested for its psychometric properties in the Cantonese-speaking population in Hong Kong. The present study aimed to assess the validity of the Chinese version of the Borderline Personality Disorder subscale of the Structured Clinical Interview for the Diagnostic and Statistical Manual of Mental Disorders Axis II Personality Disorders (SCID-II) in Cantonese-speaking Hong Kong Chinese. METHODS: A convenience sampling method was used. The subjects were seen by a multidisciplinary clinical team, who arrived at a best-estimate diagnosis and then by application of the SCID-II rater using the Chinese version of the Borderline Personality Disorder subscale. The study was carried out at the psychiatric clinic of the Prince of Wales Hospital in Hong Kong. A total of 87 patients of Chinese ethnicity aged 18 to 64 years who attended the clinic in April 2007 were recruited. The aforementioned patient parameters were used to examine the internal consistency, best-estimate clinical diagnosis-SCID diagnosis agreement, sensitivity, and specificity of the Chinese version of the subscale. RESULTS: The Borderline Personality Disorder subscale (Chinese version) of SCID-II had an internal consistency of 0.82 (Cronbach's alpha coefficient), best-estimate clinical diagnosis-SCID diagnosis agreement of 0.82 (kappa), sensitivity of 0.92, and specificity of 0.94. CONCLUSION: The Borderline Personality Disorder subscale (Chinese version) of the SCID-II rater had reasonable validity when applied to Cantonese-speaking Chinese subjects in Hong Kong.

Oral health-related quality of life in Hong Kong preschool children.

OBJECTIVES: To assess the impact of early childhood caries (ECC) on the quality of life in a population of preschool children and their families in Hong Kong. METHODS: A random sample of 1,296 Chinese preschool children participated in the survey and were subjected to an oral examination for their ECC status by 2 trained examiners. The parents were asked to respond to the Early Childhood Oral Health Impact Scale (ECOHIS) and an extra set of questions concerning their sociodemographic background. RESULTS: The final data analysis included 1,261 children with a mean (±SD) age of 3.9 ± 0.66 years. The prevalence figures for ECC and severe ECC were 19.9 and 15.2%, respectively. Decayed teeth were found in 34.3% of the children while only 5.2% had filled teeth. The mean (±SD) dmft in this group of children was 1.5 ± 2.98. Higher ECOHIS scores were found in parents with lower education or income level, or with children who were born in mainland China (p < 0.05), or with children who had decayed, missing, or filled teeth (p < 0.001). In multiple regression analyses, decayed teeth and filled teeth in primary dentition were the better predictors (p < 0.001) of the ECOHIS score among the various parent and child characteristics collected in this survey. CONCLUSIONS: The findings of this study showed that parents of young children with dental caries experience perceived that both the children and other family members had poorer quality of life.

Ovitrap surveillance of the dengue vectors, Aedes (Stegomyia) aegypti (L.) and Aedes (Stegomyia) albopictus Skuse in selected areas in Bentong, Pahang, Malaysia.

Ovitrap surveillance was conducted in methodically selected areas in Bentong, Pahang, Malaysia from June 2008 till December 2009 in order to identify insular sites with stable Aedes aegypti population. Eleven sites were surveyed in Bentong district, Pahang, and one of these locations (N3º33' E101º54') was found to have an ovitrap index of Ae. aegypti and Aedes albopictus ranging from 8%-47% and 37%-78% respectively, indicating that this site could be a high-risk area for dengue outbreak. Ae. aegypti larvae were found in both indoor and outdoor ovitraps (p>0.05) while significant difference between the populations of Ae. albopictus larvae from indoors and outdoors was observed (p<0.01). Data collected in this study could provide important entomological information for designing an effective integrated vector control programme to combat Aedes mosquitoes in this area.

Dental age assessment: are Demirjian's standards appropriate for southern Chinese children?

Estimation of age is an important requisite in forensic, judicial and criminal proceedings. Dental age can be estimated from a dataset that has been prepared from a similar or a different population group. Demirjian and his co-workers proposed dental maturity scores from a French-Canadian population and this has served as a reference dataset for evaluation of age for various population groups. Considering the high number of illegal immigrants who have entered Hong Kong from neighboring countries, age estimation studies on southern Chinese is warranted. This study aimed to validate the applicability of Demirjian's dataset on a southern Chinese population. A total of 182 dental panoramic tomographs comprising an equal number of boys and girls with an age range from 3 to 16 years were scored. Dental maturity scores were obtained from the Demirjian's dataset and dental age was calculated. The difference in chronological and estimated dental ages was calculated using the paired t-test. There was a mean overestimation of dental age of 0.62 years for boys (p < 0.01) and 0.36 years for girls (p < 0.01). Demirjian's dataset is not suitable for estimating the age of 3-16 years old southern Chinese children.

Dengue vector surveillance in insular settlements of Pulau Ketam, Selangor, Malaysia.

A year-long ovitrap surveillance was conducted between November 2007 and October 2008 in two insular settlements (Kampung Pulau Ketam and Kampung Sungai Lima) within the Malaysian island of Pulau Ketam. Eighty standard ovitraps were placed indoors and outdoors of randomly selected houses/locations. Results demonstrated an endemic baseline Aedes population throughout the year without weekly large fluctuations. Kampung Pulau Ketam has high Aedes aegypti and Aedes albopictus population, but only Ae. aegypti was found in Kampung Sungai Lima. Aedes aegypti showed no preference for ovitraps placed indoor versus outdoor. However, as expected, significantly more outdoor ovitraps were positive for Ae. albopictus (p<0.05). Trends in Ae. albopictus and Ae. aegypti populations mirrored each other suggesting that common factors influenced these two populations.

A catalogue of anomalies and traits of the primary dentition of southern Chinese.

Variation in size, form and morphology of the teeth result in anomalies such as macrodontia, microdontia, hyperdontia, hypodontia, double tooth, taurodontism and dens in dente. While traits that may occur more commonly in certain ethnic groups may be considered to be specific to that population. The characteristics of these anomalies and traits are presented along with the prevalence figures for their occurrence in primary dentition of southern Chinese.

Association between developmental defects of enamel and different concentrations of fluoride in the public water supply.

OBJECTIVES: To compare the prevalence and severity of developmental defects of enamel (DDE) among subjects whose maxillary incisors developed during periods with different concentrations of fluoride in the public water supply. METHODS: Standardized intra-oral photographs of random samples of 12-year-old children were collected in 1983, 1991 and 2001 (n = 1,990) in Hong Kong and assessed for DDE by a trained masked examiner. The fluoride concentrations in the public water supply at the times when the enamel on their maxillary incisors developed were 1.0, 0.7 and 0.5 ppm, respectively. RESULTS: The mouth prevalence of DDE for these children (based on the maxillary incisors) were 92.1, 55.8 and 35.2% in the years 1983, 1991 and 2001, respectively (p < 0.001). Most of these children were affected by diffuse opacities (89.3% in 1983, 48.5% in 1991 and 32.4% in 2001, p < 0.001). Marked differences in the mean number of teeth affected by DDE (p < 0.001) and in the maximum extent of DDE (p

Declines in tobacco brand recognition and ever-smoking rates among young children following restrictions on tobacco advertisements in Hong Kong.

BACKGROUND: We compared the recognition of tobacco brands and ever-smoking rates in young children before (1991) and after (2001) the implementation of cigarette advertising restrictions in Hong Kong and identified continuing sources of tobacco promotion exposure. METHODS: A cross-sectional survey of 824 primary school children aged from 8 to 11 (Primary classes 3-4) living in two Hong Kong districts was carried out using self-completed questionnaires examining smoking behaviour and recognition of names and logos from 18 tobacco, food, drink and other brands common in Hong Kong. RESULTS: Ever-smoking prevalence in 2001 was 3.8 per cent (1991, 7.8 per cent). Tobacco brand recognition rates ranged from 5.3 per cent (Viceroy name) to 72.8 per cent (Viceroy logo). Compared with 1991, in 2001 never-smoker children recognized fewer tobacco brand names and logos: Marlboro logo recognition rate fell by 55.3 per cent. Similar declines were also seen in ever-smoker children, with recognition of the Marlboro logo decreasing 48 per cent. Recognition rates declined amongst both boys and girls. Children from non-smoking families constituted 51 per cent (426) of the sample, whereas 34.5 per cent (284), 8.5 per cent (70), 1.7 per cent (14) and 4.4 per cent (36) of the children had one, two, three or more than three smoking family members at home, respectively. Tobacco brand recognition rates and ever-smoking prevalence were significantly higher among children with smoking family members compared with those without. Among 12 possible sources of exposure to cigarette brand names and logos, retail stalls (75.5 per cent; 622), indirect advertisements (71.5 per cent; 589) and magazines (65.3 per cent; 538) were ranked the most common. CONCLUSION: Advertising restrictions in Hong Kong have effectively decreased primary-age children's recognition of tobacco branding. However, these children remain vulnerable to branding, mostly through exposure from family smokers, point-of-sale tobacco advertisement and occasional promotions. Action to curb these is now required.