Exploring Malaysian schoolchildren's perception of the advantages and disadvantages of the ToothPoly board game: a qualitative study

The effectiveness of children's oral health education (OHE) is determined by the appropriateness of the educational materials used, which can influence their attitude towards oral health. However, there is a lack of studies exploring the benefits of OHE materials from the perspective of schoolchildren. This study aimed to explore schoolchildren's opinions on the newly developed ToothPoly board game as an OHE tool. A qualitative approach using focus group discussions (FGDs) was conducted among 44 schoolchildren aged 12 years old from a public school in Malaysia. Convenience sampling was employed to recruit the schoolchildren. The ToothPoly board game was playtested and FGDs were conducted after the playtesting session ended. Data collection and analyses were performed concurrently until data saturation was reached. The data were transcribed and coded using Atlas.Ti software version 9.1.3 followed by the framework method analysis. Mixed opinions were observed among the schoolchildren with a majority expressing favourable opinions on the advantages of the ToothPoly board game as an OHE tool. Five themes emerged from the advantages aspect, i.e., fun and enjoyable, promote focus, attention and oral health-related learning, attractive board game features, and enhance peer interaction. Meanwhile, two themes emerged that were related to the disadvantages of the board game, i.e., "competition with online games and media" and "not practical for a large group activity". The findings showed that the ToothPoly board game was perceived as a useful, interactive, and enjoyable tool to learn about oral health in small groups. The findings of the study highlight the importance of tailoring OHE activities to fulfil the needs of specific target groups to ensure its acceptance and future success.

Clustering of Health and Oral Health-Compromising Behaviours in Army Personnel in Central Peninsular Malaysia

Health- and oral health-compromising behaviours (HOHCBs) impact the health readiness of military personnel, resulting in decreased fitness performance, thus affecting combat readiness. This study aimed to identify the clustering patterns and number of HOHCBs in army personnel in Central Peninsular Malaysia. Thus, a cross-sectional study using a multistage sampling technique and a validated 42-item online questionnaire was conducted to assess ten health (medical screening, physical activity, sedentary lifestyle, smoking status, alcohol consumption, substance abuse, aggressive behaviours, sleep, and road safety habits) and five oral health behaviour domains (tooth brushing, fluoridated toothpaste use, flossing, dental visits, and bruxism). Each HOHCB was dichotomised into healthy and health-compromising behaviour and analysed using hierarchical agglomerative cluster analysis (HACA). With the majority being males (92.5%), of other ranks (96.8%), and healthy (83.9%), 2435 army members of a mean age of 30.3 years (SD = 5.9) participated, with a response rate of 100%. HACA identified two clustering patterns: (i) 'high-risk behaviours' (30 HOHCBs) and (ii) 'most common risk behaviours' (12 HOHCBs) with a mean clustering number of 14.1 (SD = 4.1). In conclusion, army personnel in Central Peninsular Malaysia displayed 2 broad HOHCB clustering patterns, 'high-risk' and 'most common risk', with an average of 14 HOHCB clusters per person.

Translation and Validation of the Malay Version of Oral Health Impact Profile for Temporomandibular Disorders

Most prior oral health-related quality of life (OHRQoL) research concerning temporomandibular disorders (TMDs) had utilised generic OHRQoL measures. This study aimed to translate and validate the Malay version of Oral Health Impact Profile for TMDs (OHIP-TMDs), a TMDs-specific OHRQoL tool, for use in Malay literate populations. The translation and cross-cultural adaptation of the OHIP-TMDs into the Malay language were implemented according to the international guidelines. A convenience sample of 243 subjects completed the Malay OHIP-TMDs (OHIP-TMDs-M) as well as the Malay Short Oral Health Impact Profile (S-OHIP-M), Global Oral Health ratings (GOH-M) and Fonseca Anamnestic Index (FAI-M). The OHIP-TMDs-M was re-administered to a subset of 40 subjects after two weeks for test-retest reliability. Concurrent, convergent and discriminative validity were assessed using Spearman’s rank correlation, Kruskal Wallis and Mann-Whitney U tests with significance level set at p < 0.05. The OHIP-TMDs-M was found to have excellent internal consistency (Cronbach’s alpha = 0.98) and test-retest reliability (intraclass correlation coefficient = 0.99, p < 0.001). A strong and positive correlation with S-OHIP-M (rs = 0.74) was observed, and OHIP-TMDs-M scores differed significantly between subjects with disparate GOH-M ratings (p < 0.001). Furthermore, the OHIPTMDs-M was able to discriminate between subjects with and without TMDs. The OHIP-TMDs-M was found to have excellent reliability and good validity. It is a promising tool for assessing TMDs-specific OHRQoL in Malay literate populations.

A randomized controlled trial of 6-month dental home visits on 24-month caries incidence in preschool children

OBJECTIVES

This paper reports on the effect of 6-month dental home visits compared to no dental home visits on 24-month caries incidence in 5- to 6-year-olds.

METHODS

5- to 6-year-olds attending kindergartens were randomized to receive either 6-month dental home visits and education leaflets (Intervention group) or education leaflets alone (Control group) over 24 months. To detect a 15% difference in caries incidence with a significance level of 5% and power of 80%, 88 children were calculated to be needed in the Intervention group and 88 in the Control. Baseline clinical data included oral examinations at the kindergartens. Follow-up visits were made on the 6th, 12th and 18th month. At the end of the 24 months, both the Intervention and Control groups were visited for oral examinations. The primary outcome was caries incidence, measured by the number and proportion of children who developed new caries in the primary molars after 24 months. The secondary outcome was the number of primary molars that developed new caries (d-pms). Frequency distributions of participants by baseline socio-demographic characteristics and caries experience were calculated. The chi-square test was used to test differences between the caries experience in the Intervention and Control groups. The t test was used to compare the mean number of primary molars developing new caries between the Intervention Group and the Control Group. The number of children needed to treat (NNT) was also calculated.

RESULTS

At the 24-month follow-up, 19 (14.4%) developed new caries in the Intervention Group, compared to 60 (60.0%) in the Control Group (p = .001). On average, 0.2 (95% CI = 0.1-0.3) tooth per child in the Intervention Group was observed to have developed new caries compared to 1.1 (95% CI = 0.8-1.3) tooth per child in the Control Group (p = .001). The number of children needed to treat (NNT) to prevent one child from developing new caries was 2.2.

CONCLUSIONS

The present study has demonstrated that 6-month home visits to families of 5- to 6-year-olds are effective in caries prevention in 5- to 6-year-olds of low-income families in a middle-income country where access to health services, including oral health promotion services, is limited.

Validation of the Simplified Malaysian Psychosocial Impact of Dental Aesthetics Questionnaire for the Sociodental Approach to Estimate the Orthodontic Treatment Need

(1) This study aimed to generate a simplified form of the Malaysian psychosocial impact of dental aesthetics questionnaire (PIDAQ[M]) and validate its use in the sociodental approach for estimating orthodontic treatment need. (2) Two eight-item forms were derived: an impact simplified PIDAQ[M] (ISP8), comprising the most impactful items as rated by 35 participants, and a regression simplified PIDAQ[M] (RSP8), derived from regression analysis of 590 participants’ data from the PIDAQ[M] validation study. Their psychometric performances were assessed for internal consistency, validity (criterion and construct), reproducibility (reliability and agreement), and responsiveness to change. The sociodental estimates were based on 204 orthodontic patients’ data who were assessed for normative need, impact-related need, and propensity-related need. McNemar analysis compared the sociodental estimates when both simplified PIDAQ[M] forms and the original PIDAQ[M] were used to measure impact-related need. (3) Both simplified PIDAQ[M] forms were valid, reproducible, and responsive. The sociodental estimates when using the ISP8 (38.2%) were similar to when the PIDAQ[M] (35.8%) was used (p > 0.05) but overestimated by 3.4% (p < 0.05) when the RSP8 (39.2%) was used as the assessment tool. (4) The simplified PIDAQ[M] can replace the original PIDAQ[M] in the sociodental approach to estimate the orthodontic treatment needs of the Malaysian population.

Psychometric properties of the Malay Fonseca Anamnestic Index for temporomandibular disorders

OBJECTIVE

This study translated/cross-culturally adapted the Fonseca Anamnestic Index (FAI) for temporomandibular disorders (TMDs) into Malay and psychometrically tested the Malay-FAI (FAI-M).

METHODS

The FAI-M was created according to international guidelines. Internal consistency/test-retest reliability were assessed with Cronbach's alpha/intra-class correlation (ICC) coefficients. Construct and convergent validity were appraised by relating the FAI-M to the Global Oral Health (GOH) questionnaire and Short-form Oral Health Impact Profile (S-OHIP) using Kruskal-Wallis and Spearman's rho correlation (α = 0.05).

RESULTS

Of the 243 participants enrolled, 54.7% (n = 133) had no TMDs, while TMDs were present in 45.3% (n = 110). The FAI-M presented very good internal consistency (α = 0.90) and test-retest reliability (ICC = 0.99). Theoretically predicted FAI-M score patterns matched the GOH categories, and strong correlations were discerned between FAI-M and S-OHIP (rs = 0.71).

CONCLUSION

The FAI-M exhibited good psychometric properties and can be applied in Malay-speaking populations.

Reliability and Validity of the Malaysian English Version of the Diagnostic Criteria for Temporomandibular Disorder (M-English DC/TMD)

This study aimed to assess the reliability and validity of Graded Chronic Pain Scale 2.0 (GCPS 2.0) and Jaw Functional Limitation Scale-20 (JFLS-20) of the Malaysian English version of Diagnostic Criteria for Temporomandibular Disorders (M-English DC/TMD). GCPS 2.0 and JFLS-20 underwent psychometric analysis involving content, face, criterion, and construct (exploratory factor analysis (EFA), convergent, discriminant, known group) validity including internal and test-retest reliability on 208 samples. The construct validity was assessed against 14 hypotheses and non-parametric statistics were used to assess the data. The GCPS 2.0 and JFLS-20 had high internal consistencies (α = 0.85 and 0.96) with an intraclass correlation coefficient value of 0.95 and 0.97, respectively. The content validity index for GCPS 2.0 and JFLS-20 were 0.87 and 0.95, respectively. The EFA of GCPS 2.0 identified one factor whereas three factors were identified for JFLS-20. Both instruments had moderate to strong positive correlation with other instruments when assessing for concurrent (r = 0.75–0.80, p < 0.01) and convergent (r = 0.58–0.70, p < 0.01) validity, while moderate to high negative correlation (r = −0.86–−0.68, p < 0.01) against the global self-rating oral health items. Based on the study, GCPS 2.0 and JFLS-20 of the M-English DC/TMD proven to be reliable and valid for use in the Malaysian population with TMD.

Adolescents’ opinions on the use of a smartphone application as an oral health education tool: A qualitative study

Developing health-related smartphone applications for oral health education should consider the end-user's perspectives to ensure they will be usable. This study aimed to explore the opinions of secondary school students in Selangor, Malaysia regarding the use of a smartphone application for oral health education and to identify the features for an oral health education smartphone application from the perspectives of adolescents. Focus group discussions were conducted among Form Two (14-year-old) and Form Four (16-year-old) students from selected government secondary schools in Selangor utilising a semi-structured topic guide until data saturation was achieved. Data were analysed using framework analysis. Ten focus group discussions were conducted involving 77 participants. Mixed opinions were recorded on the use of health-related smartphone applications for oral health education. The preferred features in a health-related smartphone application are disease detection, have games and rewards, educational and fun, access to a dentist, reminders, and user-friendliness. Adolescents are aware of the positive aspect of using health-related smartphone applications for oral health education; however, they are wary of the need to install one. Nevertheless, identifying adolescents’ preferred features of an oral health education app is the first step in developing an application tailored to their needs. Smartphone application could be a timely strategy to improve oral health education delivery and behaviour improvement for this age group.

WhatsApp and Health Communication

Little is known about the use of WhatsApp in promoting oral health among parents or caregivers. Therefore, the survey examined the impact of social media in disseminating health infographic messages in supporting children's oral health from the parent's perspective. The group of respondents read or saw posts or messages related to health education through Facebook (n=85, 31.9%), WhatsApp (n=68, 25.2%), and YouTube (n=61, 22.6%). There was a significant difference before and after the infographics were sent to the respondent, and it was found to be statistically significant (P-value &lt;0.001). As a social media platform for oral health education purposes, WhatsApp appeared to improve parents' knowledge and behaviors towards their children's oral health. Most respondents perceived WhatsApp to be beneficial. Knowing how people use social media now could help health communication efforts be more effective and equitable.

Motivators and barriers to oral hygiene self-care among adolescents in Malaysia: A qualitative study

OBJECTIVE

Having good oral hygiene self-care, especially a regular toothbrushing habit will promote lifelong oral health. Therefore, understanding the factors that influence an adolescent's oral hygiene behaviour is important in developing effective oral health programmes for this age group. This study aimed to explore the motivators and barriers to adolescents' oral hygiene self-care by exploring the perspectives of secondary school students from three government schools in the state of Selangor, Malaysia.

METHODS

Focus group discussions (FGD) were conducted with Form 2 (14-years-old) and Form 4 (16-years-old) students from selected secondary schools in Selangor using a semi-structured topic guide until data saturation was reached. Data were transcribed verbatim and analysed using framework method analysis.

RESULTS

A total of 10 FGDs were conducted involving 77 adolescents. The motivators for good oral hygiene self-care were appearance, fear of oral disease, consequences of oral disease and past toothache experience. The barriers for oral hygiene self-care were poor attitude towards oral care, lack of confidence in toothbrushing skills, snacking habit and the taste of toothpaste.

CONCLUSION

Understanding the motivators and barriers to adolescents' oral hygiene self-care is the first step in designing effective oral health education messages. The findings from this study can be used as a guide for oral health education programmes and development of materials that fulfil the needs of the adolescent population.

Exploring the opinions of secondary school students on the strengths and weaknesses of the school dental service in Selangor, Malaysia: a qualitative study

Background

The Malaysian School Dental Service (SDS) was introduced to provide systematic and comprehensive dental care to school students. The service encompasses promotive, preventive, and, curative dental care. This study aimed to undertake a process evaluation of the SDS based on the perspectives of government secondary school students in Selangor, Malaysia.

Methods

The study adopted a qualitative approach to explore the opinions of secondary school students on the SDS implementation in their schools. Data from focus group discussions involving Form Two (14-year-olds) and Form Four (16-year-olds) students from the selected schools were transcribed verbatim and coded using the NVivo software before framework method analysis was conducted.

Results

Among the strengths of the SDS were the convenience for students to undergo annual oral examination and dental treatment without having to visit dental clinics outside the school. The SDS also reduced possible financial burdens resulting from dental treatment costs, especially among students from low-income families. Furthermore, SDS helped to improve oral health awareness. However, the oral health education provided by the SDS personnel was deemed infrequent while the content and method of delivery were perceived to be less interesting. The poor attitude of the SDS personnel was also reported by the students.

Conclusion

The SDS provides effective and affordable dental care to secondary school students. However, the oral health promotion and education activities need to be improved to keep up with the evolving needs of the target audience.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12903-021-01741-7.

Use of the sociodental approach in estimating orthodontic treatment needs in adolescent patients

PURPOSE

The sociodental model integrates clinical assessment, perceived impacts of malocclusion on quality of life, and behavioural propensity when prioritising orthodontic treatment. This study compares the effect of using different instruments to measure impact-related need on the assessment of orthodontic treatment need based on the sociodental framework.

MATERIALS AND METHODS

In this cross-sectional study, 206 Malaysian adolescents (age: 11-18 years) were screened in orthodontic clinics to identify those with normative need, oral impacts due to malocclusion, and having high and medium-to-high behavioural propensities. The Index of Orthodontic Treatment Need classified normative need. The Psychosocial Impact of Dental Aesthetics (PIDA) questionnaire and the Condition-Specific Child-Oral Impacts on Daily Performances (CS-OIDP) index measured oral impacts. Subjects' behavioural propensities for successful treatment outcome were based on the Basic Periodontal Examination and International Caries Detection and Assessment System. Data were analysed using the McNemar test.

RESULTS

The response rate was 99.0%. Estimates of normative need (89.7%) were significantly reduced under the sociodental model by 65.7% (p < 0.0001) when impact-related need was measured using PIDA, and by 41.7% (p < 0.0001) when measured using CS-OIDP. The difference between the results of the two instruments in proportions of identified need for orthodontic treatment was 24.0% (p < 0.0001).

CONCLUSION

For Malaysian adolescents, estimates of need for orthodontic treatment when assessed with the sociodental approach were substantially lower than normative clinical assessment and depended highly on the tools selected to assess the patient's impact-related need. Health policy makers should understand the implication of adopting one instrument or the other when estimating orthodontic treatment need.

Impacts of Self Perceived Malocclusion on the Oral Health Related Quality of Life of Young Adults

Self-awareness of poorly arranged teeth can influence the quality of life. This study aimed to report the impacts of self-perceived malocclusion in young adults and the association between demographic characteristics and oral health related quality of life (OHRQoL). In this cross-sectional study, six-hundred-forty-three subjects from Selangor, Malaysia selected using a multistage sampling technique answered the Psychosocial Impact of Dental Aesthetics (PIDA) questionnaire and self-rated their dental appearance using the Aesthetic Component of the Index of Orthodontic Treatment Need. Data were analyzed using multifactorial ANOVA to identify the association between demographic characteristics and total PIDA score. Five-hundred-twenty-four subjects (81.5%) completed the questionnaires. Overall, 87.8% had impacts on their OHRQoL. Psychological impact was the most impacted domain (75.8%), followed by dental self-confidence (59.4%), social impact (48.9%) and aesthetic concern (22.1%). 16.8% reported significant impacts on all domains. Their mean PIDA score was 36.3 (SD 17.1). Prevalence, extent and severity of impacts were higher amongst those with self-perceived malocclusion. Gender, ethnicity, and self-perceived malocclusion status were associated with PIDA score (p < 0.05). Sub-urban and rural females had significantly higher PIDA scores than sub-urban and rural males. In conclusion, majority of Malaysian young adults especially those with self-perceived malocclusion were impacted by their dental aesthetics.

The effect of the SIMS Programme versus existing preschool oral healthcare programme on oral hygiene level of preschool children: study protocol for a cluster randomised controlled trial

Background

Despite the implementation of the preschool oral healthcare programme (POHP) for 5–6-year-old children over the past 3 decades in Malaysia, dental plaque and caries levels in this age group remain high. Among the child-level attributable factors are unhealthy self-care behaviours (poor oral hygiene and high sugary diet). In order to improve the children’s oral health, an improved programme called the ‘Senyuman Indah Milik Semua’ Programme (SIMSP) or ‘Beautiful Smile for All’ programme is introduced. In this programme, a triad of dental hygienist-teacher-parent works together to improve children’s oral hygiene levels compared with the existing POHP that involves dental hygienists only. The aim of this study is to compare the effect of the SIMSP versus the existing POHP on oral hygiene levels of 5–6-year-old children in the Kampar district, Perak state, Malaysia.

Methods

This study is a pragmatic, cluster-randomised, parallel-group, matched pair, controlled trial with blinded outcome assessment. Randomisation is performed using a computer-generated table with a 1:1 allocation comparing the SIMSP and the POHP involving 28 preschools in the Kampar district, Perak, Malaysia. The intervention consists of preschool visits by a group of dental therapists, in-class oral health lessons and daily toothbrushing conducted by class teacher, child home toothbrushing supervised by parents, and infographic oral health messages to parents. The control consists of the existing POHP that involves preschool visits by a group of dental therapists only. The trial lasts for 6 months. Primary outcome variable is the mean plaque score change after 6 months. To determine the feasibility of the SIMSP, a process evaluation will be conducted using the perspectives of dental therapists, teachers, and parents on the appropriateness, effectiveness, facilitators, and barriers to the SIMSP implementation as well as an audit trail to assess the trial intervention.

Discussion

Cluster randomisation may lead to a random effect and cluster selection bias. These factors will be accounted for when analysing the data and interpreting the outcomes. The effectiveness of the SIMSP will be evaluated by comparing the results with those of the POHP.

Trial registration

ClinicalTrials.gov NCT04339647. Registered on 5 April 2020 – Retrospectively registered.

Nicotine Dependence among Adolescents Single and Dual Cigarette Users

The prevalence of concurrent use of combustible and electronic cigarettes (dual-use) is on the rise among Malaysian adolescents. This study compares nicotine dependence among exclusive cigarette users, e-cigarette users, and dual adolescent users. A total of 227 adolescent smokers completed a self-administrated questionnaire with items based on Hooked on Nicotine Checklist (HONC) incorporated. Endorsement of at least one HONC item indicates nicotine dependence. Exhaled carbon monoxide readings and salivary cotinine data were also collected. Over half (52.9%) of the participants were exclusive e-cigarette users (EC). The prevalence of exclusive conventional cigarette smokers (CC) and dual users was 11.9% and 35.2%, respectively. Adolescents who have mothers with secondary school education were more likely to become addicted to nicotine (Adjusted Odd Ratio (aOR) = 2.72; 95% CI = 1.17–6.32). Adolescents’ “mother’s education” level predicted nicotine dependence. This highlighted the need to target families within the identified demography with a more supportive anti-tobacco program.

Translation and Adaptation of the Diagnostic Criteria for Temporomandibular Disorders into the Malay Language: Psychometric Evaluation of Contents

AIMS

To develop the Malay DC/TMD through a formal cross-cultural adaptation (CCA) process for use in non-English speaking populations and to determine the reliability and validity of the Malay Graded Chronic Pain Scale (M-GCPS) and Malay Jaw Functional Limitation Scale (M-JFLS).

METHODS

The English DC/TMD was translated into the Malay language using the forward-backward translation procedures specified in the INfORM guideline. The initial Malay instrument was pre-tested, and any discrepancies were identified and reconciled before producing the final Malay DC/TMD. Psychometric properties of the M-GCPS and M-JFLS were evaluated using a convenience sample of 252 subjects and were assessed using internal consistency and test-retest reliability, as well as face, content, concurrent, and construct validity testing. Internal consistency was assessed using Cronbach's alpha, while test-retest reliability was examined using intraclass correlation coefficient (ICC). Concurrent and construct validity of both domains were performed using Spearman ρ correlation test. In addition, construct and discriminant validity were appraised using Kruskal-Wallis and Mann-Whitney U tests, respectively.

RESULTS

Cronbach's alpha values for the M-GCPS and M-JFLS were 0.95 and 0.97, respectively. The ICC was 0.98 for the M-GCPS and 0.99 for M-JFLS. The majority of the tested associations for both domains were found to be statistically significant, with good positive correlations.

CONCLUSION

The M-GCPS and M-JFLS were found to be reproducible and valid. The Malay DC/TMD shows potential for use among Malay-speaking adults.

Facilitators and Barriers to the Implementation of Preschool Oral Healthcare Programme in Malaysia from the Perspective of Dental Therapists: A Qualitative Study

The Preschool Oral Healthcare Programme (POHP) was introduced in Malaysia by the Ministry of Health in 1984 to provide oral healthcare for 5–6-year-old children. Most of its evaluations were directed towards assessing children’s oral health status. Little emphasis has been placed on assessing the programme feasibility from the perspectives of the oral health personnel. The objective of the study was to explore the facilitators and barriers to the implementation of the POHP using the perspectives of dental therapists (DT) in Selangor state, Malaysia. This study took a qualitative approach using focus group discussion (FGD) as the data collection method. The data were transcribed verbatim followed by thematic analysis using NVivo 12 Pro version software. A total of 13 FGDs had been conducted involving 114 DT. The main facilitators were good dental teamwork, assistance from schools and teachers, sufficient training of DT, adequate support from dental administration, and good cooperation from the children. The main barriers were lack of financial support, manpower, time, inadequate support from preschools and children, language barrier, and accessibility to sugary food and drinks at schools. The study provided important insights regarding the POHP that would be useful for programme improvement through policy changes, workforce training, and enhanced school participation.

Impact of maternal and child dental anxiety on oral health-related quality of life of 5-6-year-old preschool children

BACKGROUND

There is a lack of evidence with regards to the association between both maternal and child dental anxiety and the mother's perception of her child's oral health-related quality of life (COHRQoL). The aim of this study was to investigate the association of maternal and child dental anxiety with COHRQoL and the effect of demographic factors as moderators in this relationship. In addition, the association between child's dental caries experience and the COHRQoL was also assessed.

METHODS

A cross-sectional study was conducted involving 1150, 5-6 year-old preschool children in Selangor, Malaysia. Mothers answered a questionnaire on socio-economic status, the Malay-Modified Dental Anxiety Scale to assess maternal dental anxiety, and the Malay-Early Childhood Oral Health Impact Scale to assess COHRQoL. Child's dental anxiety was assessed using the Malay-Modified Child Dental Anxiety Scale via a face-to-face interview prior to oral examination to assess dental caries. Data were analysed using structural equation modelling to assess the relationship between maternal and child dental anxiety and COHRQoL.

RESULTS

Overall, complete data on 842 mother-child dyads were analysed. The mean scores of total ECOHIS, the child impacts section (CIS), and the family impacts section (FIS) were 17.7 (SD = 4.9), 12.6 (SD = 3.7), and 5.1 (SD = 1.9), respectively. The mean dental anxiety scores for mothers and children were 11.8 (SD = 4.5) and 16.9 (SD = 4.3), respectively. Maternal dental anxiety was associated with the CIS (b = 0.08, p < 0.001), the FIS (b = 0.01, p = 0.001), and the total ECOHIS (b = 0.14, p < 0.001). Maternal education level, income, urban/rural location, and kindergarten type were moderators to the relationship. In addition, there was also a significant relationship between child's dental caries experience and COHRQoL (p < 0.001).

CONCLUSIONS

Maternal dental anxiety and child's dental caries experience have significantly impacted the COHRQoL, the CIS, and the FIS domains. Demographic factors such as maternal education, income, urban/rural location, and kindergarten type acted as moderators that can strengthen or weaken the relationship between maternal dental anxiety and COHRQoL of 5-6-year-old preschool children.

Caregivers' perceptions towards oral healthcare services for elders living in Malaysian nursing homes-A qualitative study

OBJECTIVE

To assess the perceptions of caregivers towards oral healthcare services received by elders in Malaysian nursing homes and to identify challenges and suggestions for improvement.

BACKGROUND

Caregivers play an important role in the oral health care of elders in nursing homes.

METHODS

This study employed a qualitative approach using the nominal group technique (NGT) to obtain caregivers' feedback in nursing homes in Malaysia. Data were manually transcribed, summarised into keywords/key phrases, and ranked using weighted scores.

RESULTS

In total, 36 caregivers (21 from government and 15 from private nursing homes) participated in the NGT sessions. Overall, caregivers were satisfied with the low treatment cost, the quality of treatment, and the availability of dental visits to nursing homes. Caregivers were dissatisfied with the frequency of dental visits, long waiting times at government dental clinics, and inadequate denture hygiene education for elders in nursing homes. The challenges faced by caregivers were elders' poor oral health knowledge and attitude and lack of elders' trust of caregivers to look after their oral health. Suggestions for improvement were to increase the frequency of dental visits to nursing homes, provide oral health education to elders and caregivers, and give treatment priority to elders at dental clinics.

CONCLUSION

Despite being satisfied with the basic oral healthcare services received by elders in Malaysian nursing homes, caregivers raised some issues that required further attention. Suggestions for improvement include policy changes in nursing home dental visits and treatment priority for elders at government dental clinics.

Responsiveness to change of the Malay-ECOHIS following treatment of early childhood caries under general anaesthesia

OBJECTIVES

To evaluate the sensitivity and responsiveness of the Malay version of Early Childhood Oral Health Impact Scale (Malay-ECOHIS) to dental treatment of early childhood caries (ECC) under general anaesthesia (GA) and determine the minimally important difference (MID) for the Malay-ECOHIS.

METHODS

A sample of 158 preschool children with ECC awaiting dental treatment under GA was recruited over an 8-month period. Parents self-completed the Malay-ECOHIS before and 4 weeks after their child's dental treatment. At 4 weeks follow-up, parents also responded to a global health transition judgement item. Data were analysed using independent and paired samples t tests, ANOVA and Pearson correlation coefficients.

RESULTS

The response rate was 87.3%. The final sample comprised 76 male (55.1%) and 62 female (44.9%) preschool children with mean age of 4.5 (SD = 1.0) years. Following treatment, there were significant reductions in mean scores for total Malay-ECOHIS, child impact section (CIS), family impact section (FIS) and all domains, respectively (P < 0.001). The effect size (ES) for the Malay-ECOHIS was +1.0; across the domains, it ranged from +0.4 to +1.9. There was a weak, positive correlation for Malay-ECOHIS change scores (r = 0.165) and CIS change scores (r = 0.175) with the number of decayed teeth (dt), respectively. Similar correlation was also observed between Malay-ECOHIS change scores and the number of extracted teeth (r = 0.129). Based on the global health transition judgement, 62.3% of parents reported their child's oral condition to be "a little improved" while 37.7% reported it to be "much improved" following treatment, with Malay-ECOHIS mean change scores of 6.7 (ES = +1.1) and 9.6 (ES = +1.2), respectively. There was an observed gradient in the Malay-ECOHIS change scores and ES in relation to parents' perception of their child's oral health improvement after treatment, supporting the responsiveness of the measure. The Malay-ECOHIS MID was found to be 7 scale points.

CONCLUSION

The Malay-ECOHIS is empirically shown to be sensitive and responsiveness to dental treatment of ECC under GA.

Knowledge, perceptions and clinical application of the shortened dental arch concept among Malaysian government dentists

AIM

To assess the knowledge and perceptions of Malaysian government dentists regarding the shortened dental arch (SDA) concept and its application in clinical practice.

BACKGROUND

The SDA concept refers to a specific type of dentition with intact anterior teeth and a reduction in posterior occlusal pairs. Dentists' knowledge and perceptions of the SDA concept can influence its application in clinical practice.

METHODS

A self-administered questionnaire on the SDA concept was distributed to 326 government dentists in the states of Selangor and Kuala Lumpur, Malaysia. The data were analysed using SPSS version 22 software.

RESULTS

The response rate was 84.0%. The majority of respondents had good knowledge on five of six knowledge items and good attitudes towards 10 of 17 perception items. However, only one-fifth (20.4%) reported having applied the SDA concept in the clinic. A larger number of participants who graduated locally than who graduated abroad perceived that patients <60 years of age, without molar support, can attain acceptable chewing function and that SDA treatment does not lead to loss of occlusal vertical dimension (P < 0.05). A larger number of participants with ≤5 years of work experience than with >5 years of work experience perceived that the SDA concept enables simpler treatment planning (P < 0.05). Finally, a larger number of participants who graduated abroad than who graduated locally observed that patients without molar support had temporomandibular joint problems (P < 0.05).

CONCLUSION

Although Malaysian government dentists have good knowledge and perceptions of the SDA concept, it is not widely applied in the clinic. Concerted efforts in SDA training of dentists are needed to help to shorten denture waiting lists and reduce costs.

Validation and reliability of the Malaysian English version of the psychosocial impact of dental aesthetics questionnaire for adolescents

Background

The Malay version of the Psychosocial Impact of Dental Aesthetics Questionnaire has been validated for use by Malaysian adolescents. Although Malay is their national language, English is widely used as the lingua franca among Malaysians of different ethnicities. This study aimed to validate an English version of the PIDAQ adapted for use by Malaysian adolescents to optimize data capture from adolescents who prefer English as the medium for communication.

Methods

The published English version of PIDAQ was pilot tested on 12- to 17-year-old adolescents, resulting in a few modifications to suit the Malaysian variety of English. Psychometric properties were tested on 393 adolescents who attended orthodontic practices and selected schools. Malocclusion was assessed using the Malocclusion Index, an aggregation of Perception of Occlusion Scale and the Aesthetic Component of the Index of Orthodontic Treatment Need, by the subjects (MI-S) and investigators (MI-D). Data were analysed for internal consistency and age-associated invariance, discriminant, construct and criterion validities, reproducibility and floor and ceiling effects using AMOS v.20 and SPSS v.20.

Results

The item Don’t like own teeth on video of the Aesthetic Concern (AC) subscale was not relevant to a large proportion of participants (11.7%). Therefore, it was removed and the Malaysian English PIDAQ was analysed based on 22 items instead of 23 items. Confirmatory factor analysis showed good fit statistics (comparative fit index: 0.902, root-mean-square error of approximation: 0.066). Internal consistency was good for the Dental Self-Confidence, Social Impact and Psychological Impact subscales (Cronbach’s alpha: 0.70-0.95) but lower (0.52–0.62) though acceptable for the AC subscale as it consisted of only 2 items. The reproducibility test was acceptable (intra-class correlations: 0.53–0.78). For all PIDAQ subscales, the MI-S and MI-D scores of those with severe malocclusion differed significantly from those with no or slight malocclusion. There were significant associations between the PIDAQ subscales with ranking of perceived dental appearance, need for braces and impact of malocclusion on daily activities. There were no floor or ceiling effects.

Conclusion

The adapted Malaysian English PIDAQ demonstrated adequate psychometric properties that are valid and reliable for assessment of psychological impacts of dental aesthetics among Malaysian adolescents.

Validation and reliability of the translated Malay version of the psychosocial impact of dental aesthetics questionnaire for adolescents

BACKGROUND

This paper describes the cross-cultural adaptation of the Psychosocial Impact of Dental Aesthetics Questionnaire (PIDAQ) into Malay version (Malay PIDAQ), an oral health-related quality of life (OHRQoL) instrument specific for orthodontics for Malaysian adolescents between 12 and 17 years old.

METHODS

The PIDAQ was cross-culturally adapted into Malay version by forward- and backward-translation processes, followed by psychometric validations. After initial investigation of the conceptual suitability of the measure for the Malaysian population, the PIDAQ was translated into Malay, pilot tested and back translated into English. Psychometric properties were examined across two age groups (319 subjects aged 12-14 and 217 subjects aged 15-17 years old) for factor structure, internal consistency, reproducibility, discriminant and construct validity, criterion validity, and assessment of floor and ceiling effects.

RESULTS

Fit indices by confirmatory factor analysis showed good fit statistics (comparative fit index = 0.936, root-mean-square error of approximation = 0.064) and invariance across age groups. Internal consistency and reproducibility tests were satisfactory (Cronbach's α = 0.71-0.91; intra-class correlations = 0.72-0.89). Significant differences in Malay PIDAQ mean scores were observed between subjects with severe malocclusion and those with slight malocclusion based on a self-rated and an investigator-rated malocclusion index, for all subscales and all age groups (p < 0.05). Construct validity of the Malay PIDAQ subscales with those who rated themselves with excellent to poor dental appearance and those who felt they needed or did not need braces, showed significant associations for all age groups (p < 0.05). Criterion validity also showed significant association between the Malay PIDAQ scores with those with and without impact on daily activities attributed to malocclusion. There were no ceiling effects detected but floor effects were detected for the Aesthetic Concern subscale.

CONCLUSION

The study has provided initial evidence for the validity and reliability of the Malay PIDAQ to assess the impact of malocclusion on the OHRQoL of 12-17 year old Malaysian adolescents.

Psychometric properties of the faces version of the Malay-modified child dental anxiety scale

BACKGROUND

To evaluate the psychometric properties of the faces version of the Modified Child Dental Anxiety Scale (MCDASf) Malay version in 5-6 and 9-12 year-old children.

METHODS

The MCDASf was cross culturally adapted from English into Malay. The Malay version was tested for reliability and validity in 3 studies. In the Study 1, to determine test-retest reliability of MCDASf scale, 166 preschool children aged 5-6 years were asked to rank orders five cartoons faces depicting emotions from 'very happy' to 'very sad' faces on two separate occasions 3 weeks apart. A total of 87 other 5-6 year-old children completed the Malay-MCDASf on two separate occasions 3 weeks apart to determine test-retest reliability for Study 2. In study 3, 239 schoolchildren aged 9-12 years completed the Malay-MCDASf and the Malay-Dental Subscale of the Children Fear Survey Schedule (CFSS-DS) at the same sitting to determine the criterion and construct validity.

RESULTS

In study 1, Kendall W test showed a high degree of concordance in ranking the cartoon faces picture cards on each of the 2 occasions (time 1, W = 0.955 and time 2, W = 0.954). The Malay-MCDASf demonstrated moderate test-retest reliability (Intraclass correlation coefficient = 0.63, p <0.001) and acceptable internal consistency for all the 6 items (Cronbach's alpha = 0.77) and 8 items (Cronbach's alpha = 0.73). The highest MCDASf scores were observed for the items 'injection in the gum' and 'tooth taken out' for both age groups. The MCDASf significantly correlated with the CFSS-DS (Pearson r = 0.67, p < 0.001).

CONCLUSIONS

These psychometric findings support for the inclusion of a cartoon faces rating scale to assess child dental anxiety and the Malay-MCDASf is a reliable and valid measure of dental anxiety in 5-12 year-old children.

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.

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.