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Introduction: The bi-directional relationship between periodontitis (PD) and diabetes mellitus (DM) has been confirmed. Medical practitioners (MPs) serve an important role in relaying this information to patients. This study aimed to investigate the awareness, knowledge, attitudes and practices (KAP) in the management of DM patients with PD in primary care clinics under the Ministry of Health (MOH) of Malaysia. Methods: A self-administered questionnaire on KAP in the management of DM patients with PD was posted to 725 medical officers (MOs) and family medicine specialists (FMSs) in MOH clinics in Kedah, Terengganu, Johor and Negeri Sembilan. Collected data were tabulated and analysed using descriptive and regression analyses (simple and multiple). Statistical significance was defined as p < 0.05. Results: A total of 549 MPs responded. The majority of MPs were MOs (92.6%) and female (75.8%). FMSs had a greater awareness of PD when compared to MOs (p = 0.002). All MPs had good knowledge, except for the incorrect notion that excessive sugar causes PD (94.3%). Overall, FMSs had better knowledge when compared to MOs (p=0.026). The majority of MPs agreed that ‘they should update their knowledge on the association between systemic disease and PD’ (89.6%) and claimed that ‘it was not their responsibility to examine DM patients for PD’ (83.1%). Most MPs did not enquire or examine for PD in their DM patients. More FMSs (67.5%) referred patients to dentists compared to MOs (31.6%). Conclusion: Most MPs have sufficient knowledge on PD, but a negative attitude in the management of PD in DM patients. The reasons for not referring included workload and patients refusing referral.

This review aimed to evaluate the effectiveness of systemic antibiotics as adjunctive treatment to subgingival debridement in patients with periodontitis. Randomized controlled trials were included that assessed the effectiveness of systemic antibiotics in improving periodontal status, indicated by clinical attachment gain level, probable pocket depth reduction, and bleeding on probing reduction of patients with any form of periodontitis at any follow-up time. Network meta-analyses with a frequentist model using random effects was employed to synthesize the data. The relative effects were reported as mean difference with a 95% confidence interval. Subsequently, all treatments were ranked based on their P-scores. A total of 30 randomized controlled trials were included in this network meta-analyses. Minimally important clinical differences were observed following the adjunctive use of satranidazole, metronidazole, and clindamycin for clinical attachment gain level and probable pocket depth reduction. For bleeding on probing reduction, minimally important clinical differences were observed following the adjunctive use of metronidazole and a combination of amoxycillin and metronidazole. However, the network estimates were supported by evidence with certainty ranging from very low to high. Therefore, the findings of this network meta-analyses should be interpreted with caution. Moreover, the use of these antibiotics adjunct to subgingival debridement should be weighed against possible harm to avoid overuse and inappropriate use of these antibiotics in patients with periodontitis.

Purpose To determine the measurement equivalence of computer touch screen assessment (CTSA) and paper based assessment (PBA) of the oral health impact profile (OHIP-14). Patients and Methods A randomized crossover trial was conducted. Sixty participants were randomized to either i) Arm A: completed CTSA then PBA of OHIP-14, or ii) Arm B: PBA and then CTSA of OHIP-14 within the same day. User preference and time taken to complete the assessments were recorded. Agreement between CTSA and PBA was determined using directional difference (DD), absolute difference (AD), and intraclass correlation coefficient (ICC). Results There was no significant difference in CTSA and PBA OHIP-14 scores (P>0.05). The magnitude of the DD in scores between assessment methods was small for overall scores and all domains (

This research aims to evaluate the effectiveness of pre-procedural rinsing using essential oils-mouthwash (Listerine®) in reducing bioaerosol contamination in a dental clinic. Thirty (30) subjects who consisted of those receiving treatment for periodontitis problems were randomly assigned to rinse with either 20 mL of Listerine® or 20 mL of placebo as control rinse. Every subject was instructed to gargle using the rinse for 1 min. Microbial samples of environmental air and saliva were collected before and after the rinse. All samples were further analyzed for total plate counts to measure the microbial level. Rinsing using Listerine® showed significant reduction in the level of microbial load in saliva compared to the control mouthrinses. Analysis done at three defined distance intervals from the operating site showed the level of bioaerosol contamination was highest at distance nearest to the treatment point of 1 ft. Based on counts of cfu, there was higher presence of microbial contaminant in bioaerosols of the control-rinsed group compared to the test-rinsed group using Listerine®. Therefore, it can be concluded that rinsing using Listerine® was effective towards reducing the microorganisms in saliva and oral cavity in general.

To evaluate patient’s subjective preferences to scaling with narrow probe-shaped EMS Perio Slim PS tipscompared to conventional tip based on pain perception using the Visual Analogue Scale (VAS). Ten patientswere treated using a piezoelectric ultrasonic device (EMS) and two different scaler tips representing aconventional scaler tip and a Perio Slim PS scaler tip in a split-mouth design. Pain was evaluated after 2minutes scaling using Visual Analogue Scale (VAS). Data obtained was analysed by SPSS version 19.0 usingWilcoxon test. Pain assessment after treatment confirmed by the Visual Analogue Scale (VAS) showed thatthe Perio Slim PS scaler tip (maximum pain score: 4, minimum: 2) caused less pain than the conventionalscaler tip (maximum: 8, minimum: 3) (p-value = 0.007). Using Perio Slim PS scaler tip caused less pain anddiscomfort during scaling treatment when compared with conventional scaler tip.

Background This study aimed to assess the impact of periodontitis (PD) on the health related quality of life (HRQoL) and oral health related QoL (OHRQoL) of subjects with rheumatoid arthritis (RA) and PD. Methods Subjects from dental and RA clinics were screened. Complete periodontal examinations were performed. Subjects were divided into 4 groups: RA-PD, RA, PD and healthy controls (HC). Questionnaires on characteristics and Malaysian versions of Oral Health Impact Profile (OHIP-14(M)) and Health Assessment Questionnaire (HAQ-DI)) were answered. Results A total of 187 subjects were included (29 RA-PD, 58 RA, 43 PD and 57 HC). OHIP-14(M) severity score was highest in the PD group (17.23 ± 10.36) but only significantly higher than the HC group (p p p Conclusion PD and RA subjects both suffer impacts on their OHRQoL and HRQoL respectively. The interaction effect of both diseases significantly conferred impacts on their OHRQoL and HRQoL as measured by the OHIP-14(M) and HAQ-DI.

Summary Objectives The aim of this study was to compare vacuum-formed thermoplastic retainers (VFRs) constructed on stone models (VFR-CV) and those constructed on three-dimensional (3D) printed models (VFR-3D) based on patients’ perspective and post-treatment stability. Study design The research was designed as a crossover, randomized control trial. Materials and methods Subjects comprised patients receiving fixed appliances at a teaching institution and indicated for VFRs. Post-treatment stone models were scanned with a structured-light scanner. A fused deposition modelling machine was used to construct acrylonitrile-butadiene-styrene (ABS)-based replicas from the 3D scanned images. VFRs were fabricated on the original stone and printed models. Analysis comprised independent t-tests and repeated measures analysis of variance. Randomization Subjects were allocated to two groups using Latin squares methods and simple randomization. A week after debond, subjects received either VFR-CV first (group A) or VFR-3D first (group B) for 3 months, then the interventions were crossed over for another 3 months. Blinding In this single-blinded study, subjects were assigned a blinding code for data entry; data were analysed by a third party. Outcome measures The primary outcome measured was oral health-related quality of life (OHRQoL) based on Oral Health Impact Profile-14 (OHIP-14). Secondary outcome was post-treatment stability measured using Little’s Irregularity Index (LII). Results A total of 30 subjects (15 in each group) were recruited but 3 dropped out. Analysis included 13 subjects from group A and 14 subjects from group B. Group A showed an increase in LII (P < 0.05) after wearing VFR-CV and VFR-3D, whereas group B had no significant increase in LII after wearing both VFRs. Both groups reported significant improvement in OHRQoL after the first intervention but no significant differences after the second intervention. LII changes and OHIP-14 scores at T2 and T3 between groups, and overall between the retainers were not significantly different. No harm was reported during the study. Conclusion VFRs made on ABS-based 3D printed models showed no differences in terms of patients’ OHRQoL and stability compared with conventionally made retainers. Registration NCT02866617 (ClinicalTrials.gov).

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.

The objective of this study was to assess the effectiveness of the 5A’s smoking cessation intervention (5A’s) to that of brief advice (BA) conducted by dentists. A single-blinded randomized controlled trial was designed to compare the effectiveness of the interventions. Six Dental Public Health specialists were recruited, randomized and trained to participate in this trial. Two hundred and fifty patients were required on both arms. The main outcome measures were biochemically validated self-reported abstinence and behaviour change at 6-months follow-up. The odd of quitters in 5A’s intervention was 3.81 (95% CI: 1.87-7.76; p= 0.00) times higher compared to BA. After controlling other factors, the odds ratio for the 5A’s was 1.90 (95% CI: 0.652-5.547; p=0.24) higher compared to BA. The 5A’s was found to be more effective in initiating positive behaviour change compared to BA. However, after controlling other factors, there was no difference in the effectiveness although the odds ratio was slightly higher in 5A’s.

Despite the overwhelming interest in medical tourism research, knowledge in dental tourism, which is its subspecialty, remains limited. This study is the first to measure tourist profiles, travel motivation and satisfaction among inbound dental tourists in Malaysia. We purposely sampled twelve selected private dental clinics in Kuala Lumpur, Selangor, Melaka and Penang; and distributed the questionnaires to their inbound dental tourists. A total of 196 inbound tourists responded to the questionnaire, mainly from Southeast Asia, Australia, New Zealand and Europe. In order of importance, the main motivation factors were dental care quality, dental care information access, and cost-savings. Tourists were extremely satisfied with dental care services received in the country. While dental care quality, dental care information access and supporting services positively influenced tourist satisfaction; cost-savings and cultural similarities had negative influences. Based on the research findings, we propose some managerial and marketing recommendations.

Background Dentine hypersensitivity is a common problem attributed by patent dentinal tubules. Ingredients incorporated in toothpastes aim to occlude patent dentinal tubules to minimize the dentine hypersensitivity. However, frequent consumption of acidic soft drinks may reverse the dentinal tubules' occlusion. In this in vitro study, the efficacy of dentinal tubules occluded by commercially available toothpastes to withstand different durations of an acidic soft drink challenge was investigated. Methods One hundred and twenty dentine discs were divided into three groups. The discs from each group were brushed with toothpaste containing bioactive glass, arginine and control toothpaste. Each group was then divided into four subgroups and exposed to acidic soft drink over four different time durations. Results The scoring and the percentage of occluded dentinal tubules by Novamin-containing toothpaste was significantly better compared with arginine or the control toothpaste. Acidic soft drink challenge reduced the extent of dentinal tubules occlusion along with time. Dentinal tubules occluded by Novamin-containing toothpaste withstand the acidic challenge comparatively for a longer period. Conclusions The findings demonstrated that occlusion of dentinal tubules is more efficient by the bioactive glass-containing toothpaste and thus may contribute to its better resistance to acidic soft drink challenge.

To explore the phenomenon of tongue piercing in Klang Valley. Semi-structured in-depth interviews were conducted with piercers and those who had their tongue pierced (“piercees”) in Klang Valley. Five piercers and eight piercees were interviewed. Piercees had their tongue pierced at age 16-25 years. Three mainreasons for tongue piercing were to enhance appearance, express their individuality, and out of curiosity. They reported that they experienced various immediate and late complications. However, most were aware of and expected the complications. The majority of piercers reported adequate infection control procedures and enquired about the client’s health prior to piercing. Although some clients reported problems, such reports were rare. Tongue piercing is an invasive procedure with some risks, but precautions such as proper infection control procedures minimize the likelihood of encountering serious problems. The reasons for tongue piercing varied between individuals. Although the majority of the interviewed piercers reported cross-infection control, their knowledge of the medical risks associated with tongue piercing varied widely.

Aims: To evaluate the self-perceived preparedness of final-year dental undergraduate students in dental public universities in Malaysia. Methods: Final-year dental undergraduate students from six dental public universities in Malaysia were invited to participate in an online study using a validated Dental Undergraduates Preparedness Assessment Scale DU-PAS. Results: In total, about 245 students responded to the online questionnaire yielding a response rate of 83.05%. The age range of the respondents was 23-29 years with a mean age of 24.36 (SD 0.797). The total score obtained by the respondents was ranged from 48 to 100 with a mean score of 79.56 (SD 13.495). Weaknesses were reported in several clinical skills, cognitive and behavioural attributes. Conclusions: The preparedness of undergraduate students at six dental institutions in Malaysia was comparable to students from developed countries. The dental undergraduate preparedness assessment scale is a useful tool, and dental institutions may be used for self-assessment as well as to obtain feedback from the supervisors.

To assess the impact of extent and severity of chronic periodontitis (CP) on oral health-related quality of life (OHRQoL).A cross-sectional comparative study was performed on subjects from multiple dental centres in Malaysia using a questionnaire covering sociodemographics, OHRQoL using the Malaysian Oral Health Impact Profile questionnaire, OHIP-14(M) and self-reported symptoms. Participants with severe CP were age-and gender-matched with periodontally healthy/mild periodontitis (HMP) participants based on inclusion and exclusion criteria. Full mouth periodontal examination was performed on participants. Outcome measures were OHIP-14(M) prevalence of impact and severity of impact scores.One hundred and thirty (130) participants comprising 65 severe CP and 65 HMP participants were included in the study. Prevalence of impact on OHRQoL was significantly higher in the severe CP than HMP group, with an odds ratio of 3. Mean OHIP-14(M) score was significantly higher in the severe CP (18.26 ± 10.22) compared to HMP (11.28± 8.09) group. The dimensions of psychological discomfort and functional limitation, and factors such as 'discomfort due to food stuck' and 'felt shy' were impacted more in severe CP compared to HMP group (p0.05). When compared with the HMP group, generalised severe CP participants showed higher prevalence of impact on OHRQoL [OR=5] (p0.05) compared to localised severe CP [OR=2] (p = 0.05). Participants who had experienced self-reported symptoms had statistically significant impacts on OHRQoL.Severe CP had a greater impact on OHRQoL compared to HMP. Impacts were mainly for functional limitation and psychological discomfort dimensions. When considering extent of disease, the impact on OHRQoL was mostly in generalised severe CP subgroup.

This study aimed to investigate the association between oral disease burden and oral health related quality of life (OHRQoL) among overweight/obese (OW/OB) and normal weight (NW) Malaysian adolescents. A total of 397 adolescents were involved in the two-year prospective observational cohort study. OHRQOL was measured through a self-administered questionnaire containing the short version of the Malaysian Oral Health Impact Profile (OHIP[M]). Body mass index (BMI) was used for anthropometric measurement. Whilst, decayed, missing, and filled teeth (DMFT) index, Significant Caries Index (SiC), simplified basic periodontal examination (S-BPE), and gingival bleeding index (GBI) were used for clinical assessment tools. Higher dental caries prevalence was observed in the NW group while higher SiC was reported in the OW/OB group. Regardless of the obesity status, the prevalence of gingivitis (BPE code 1 and 2) was high in this study. A reduction of GBI prevalence was observed in the two-year follow-up results with an increased prevalence of OHRQoL impact in the OW/OB group compared to the NW group (p &gt, 0.05). The findings from this study suggested that obesity status did not have influence over the burden of oral diseases and OHRQoL. It offers insights referring to the changes in adolescents’ oral diseases burden and OHRQoL.

The fixation process in histology is an important process that will eventually determine the quality of the histology slides. Fixation of the dental pulp involves the entry of the fixative agent into the dental pulp through the root canals that are found at the apical part of the root. The objective of this study was to evaluate the effectiveness of four methods of tooth preparation (teeth cut longitudinally or cervically, removal of apical third of root and whole uncut teeth) on the fixation process of the dental pulp for producing high quality histology slides. Among the four methods of tooth preparation, removal of the apical one-third of the root produced high quality histology slides as fixation of the dental pulp was improved and hence, preservation of the pulp’s architecture and contents were achieved. It is concluded that removal of the apical one-third of the root improves the fixation process of the dental pulp in teeth.

Dentists can offer their patients who smoke tobacco assistance with smoking cessation. We conducted this study to assess dental patient knowledge about the effects of smoking and perceptions and attitudes regarding the role of dentists in smoking cessation counselling. We conducted this study to inform tobacco cessation programs that could potentially include dentists. We conducted a cross-sectional study using a self-administered questionnaire among 375 patients. The mean age of subjects was 33.4 years; females comprised 51.5%. Participants were divided into 3 groups: those who never smoked (n = 263, 70.7%), smokers (n = 92, 24.7%), and ex-smokers (n = 17, 4.5%). Significantly more participants (p = 0.046) who never smoked (92.9%) knew smoking can cause bad breath than smokers (86.9%). Significantly more participants (p = 0.002) who never smoked (74.8%) knew smoking can cause periodontal disease than smokers (57.6%). Significantly more participants (p0.001) who never smoked (84.5%) knew smoking can cause oral cancer than smokers (66.7%). Significantly more participants (p0.001) who never smoked (86.7%) knew smoking can cause lung cancer than smokers (69.7%). Significantly more participants who never smoked (85.5%) felt dentists should be interested in the smoking status of their patients (p = 0.004) than smokers (72.6%). Significantly more participants (p = 0.08) who never smoked (69.6%) stated dentists should give smoking cessation advice than smokers/ex-smokers (59.0%). Smoker/ ex-smokers had less knowledge about the effects of smoking on oral and general health than non-smokers. Both smokers/ex-smokers and non-smokers felt dentists should provide smoking cessation advice.

Introduction: This study assesses dental students’ and patients’ perceptions on the role of dental students as smoking cessation counsellors as well as the patient’s quit rate at the University of XX. Materials and methods: Self-administered questionnaires were distributed to all senior dental students (n=154) in XX University and telephone call interviews were conducted on their patients (n=169) who received smoking cessation counselling from September 2010 to June 2013. Results: Response rates for dental students and patients were 68.2% and 67.3% respectively. Most of the dental students in this study were females (72.3%) whereas the majority of patients were males (97.6%). An average of six months follow up indicated that 22.5% of patients had quit smoking, 65.3% reduced the number of cigarettes smoked and 6.5% had relapsed. About a third of patients surveyed (33.1%) believed that smoking cessation counselling was extremely helpful compared to what students perceived (5.7%, p

Objective To assess the oral health-related quality of life (OHRQoL) of patients provided with mandibular implant fixed partial prostheses (IFPP) for rehabilitation of two adjacent missing posterior teeth and complete denture patients provided with mandibular implant-supported overdenture (ISOD). The response to change in OHRQoL with implant prostheses was additionally compared. Material and methods In this prospective study, 20 IFPP (mean age 47.0; SD 12.9 years) and 28 ISOD (mean age 61.5; SD 9.1 years) patients received 2 mandibular implants. Metal ceramic nonsplinted fixed prostheses were provided in IFPP group, while in ISOD group, the mandibular overdentures were retained by nonsplinted attachments. Patients rated their oral health-related quality of life using OHIP-14 Malaysian version at baseline (T0), 2–3 months (T1) and 1 year (T2) postimplant treatment. Mean OHIP-14 for total and domain scores between groups and intervals was analysed using repeated-measures ANOVA and t-test. Mann–Whitney and Wilcoxon signed–rank tests were used for the comparison of mean score change and effect size, while the association between pre- and post-treatment scores was determined using multivariate linear regression modelling. Results The total OHIP and domain scores before implant treatment were significantly higher (lower OHRQoL) in IFPP than in ISOD groups, except for physical pain where this domain showed similar impact in both groups. Postimplant scores between groups at T1 and T2 showed no significant difference. The mean score changes at T0–T1 and T0–T2 for total OHIP-14 and domains were significantly greater in IFPP except in the domains of physical pain and disability which showed no difference. Large effect size (ES) was observed for total OHIP-14 in IFPP while moderate in ISOD. Improved OHRQoL was dependent on the treatment group and pretreatment score. Conclusion Improvement in OHRQoL occurred following both mandibular implant-supported overdentures and implant fixed partial prostheses.

Introduction: Clinical resolution of periodontitis (CRP) of type-2 diabetic patients with chronic periodontitis (T2DM-PD) after receiving non-surgical periodontal treatment (NSPT) has been reported in the previous studies. This study aimed to evaluate CRP of T2DM-PD under medicaldental coordinated care (M-DCC). Materials and Methods: A 6-months follow-up quasi-experimental study was conducted among 20 subjects who received M-DCC in 2016. M-DCC included standard diabetic care provided by medical professional from 3 health clinics and NSPT provided by periodontal specialists from two periodontal specialist clinics. Target glycemic control achievement (TGCA) HbA1c 6.5% was assessed at baseline and 6 months after NSPT. Clinical resolution of PD was measured in terms of BPE, BOP %, CAL(mm), PPD(mm), PPD 4mm, PPD =4 mm and PPD 6mm at baseline, 3 and 6 months. Paired simple t test and ANOVA F test were applied to infer clinical resolution of periodontitis and its relation to TGCA. Results: Mean (SD) of average BPE at baseline, 3- and 6-months were 3.52(0.34), 3.12(0.33) and 3(0.45) with (p

Objectives: This paper describes the development of a short version of the Malaysian Oral Health Impact Profile. Methods: The 45-item OHIP(M) was shortened using a method known as the 'item frequency method'. Here, the two most frequently reported items from each of the seven OHIP(M) subscales were chosen to form the short version, designated as the S-OHIP(M). Field testing was conducted to assess the effect of different modes of administration (mail versus interview) of the short form and to test its measurement properties (reliability and validity). A total of 206 respondents completed the questionnaire. In order to carry out test-retest analysis, a second administration was carried out 15 days after the first administration on a selected subsample. Results: The mail questionnaire had a lower response rate and a higher percentage of missing data than the interview administered questionnaire. However, the mail mode of administration resulted in higher scores than interview. Cronbach's alpha was 0.89 and the ICC was also 0.89. All hypotheses developed to assess validity were confirmed. Conclusion: The S-OHIP(M) was found to be valid and reliable and appropriate for use in the cross-sectional studies in Malaysian adult populations. This record was migrated from the OpenDepot repository service in June, 2017 before shutting down.

This study investigated changes in periodontal outcomes after nonsurgical periodontal treatment (NSPT) and evaluated associations of change in salivary resistin level with periodontal outcomes in obese Malaysians with chronic periodontitis. Sixty-two obese adults with chronic periodontitis were randomly divided into a test group (n = 31), which received NSPT, and a control group (n = 31), which received no treatment. Plaque score (PS), gingival bleeding index (GBI), probing pocket depth (PPD), and clinical attachment loss (CAL) were measured at baseline and at 6 and 12 weeks after NSPT. Salivary resistin levels were evaluated by using an enzyme-linked immunosorbent assay. PS was significantly lower in patients who received NSPT than in the control group at 6 and 12 weeks (P < 0.05). In the NSPT group the percentages of sites with shallow and moderate pockets decreased significantly, but there was no significant change in deep pockets. Resistin levels significantly decreased after NSPT (P < 0.05). Change in salivary resistin level was not significantly associated with periodontal outcomes. In obese Malaysians, NSPT significantly improved PS and GBI, and improved PPD and CAL for shallow and moderately deep pockets but not for deep pockets. Salivary resistin level was not associated with improvement in either periodontal variable.

Objective: To determine the prevalence of malocclusion and need for orthodontic treatment among persons with Down Syndrome (DS). Materials and Methods: Study participants were 113 persons with DS from the selected community-based rehabilitation center who fulfilled the inclusion and exclusion criteria. Ten occlusal characteristics of the Dental Aesthetic Index (DAI) were measured on study models to determine the degree of malocclusion. A single score represented the dentofacial anomalies, determined the level of severity, and determined the need for orthodontic treatment. Results: Crowding in the anterior maxillary and mandibular arch was the main malocclusion problems among the subjects with DS. Comparison between age group and genders revealed no significant differences in four categories of orthodontic treatment need (P > .05). Conclusion: Most of the subjects with DS (94; 83.2%) had severe and very severe malocclusion, which indicated a desirable and mandatory need for orthodontic treatment.

Aim: To assess the oral health related quality of life (OHQoL) of a selected population of Malaysian adults and to compare the OHQoL by periodontal status. Material & Methods: This cross-sectional study comprises a convenient sampling of fifty subjects from the Primary Care Unit, Faculty of Dentistry, University of Malaya. OHQoL was assessed using the Malaysian version of Oral Health Impact Profile-14 (OHIP-14). Basic periodontal examination (BPE) was performed on all subjects to determine their periodontal status. Descriptive statistics and bivariate analysis were performed. Results: Psychological discomfort, physical pain and psychological disability domains were the most affected dimensions in this population. Subjects with income levels >RM2,500 had higher impacts on their OHQoL as compared to those from other income levels (p 0.05). Conclusion: Subjects with high income levels had high impacts on their OHQoL. Those with periodontitis experienced higher impacts on their OHQoL as compared to those who had a healthy periodontium or gingivitis and affected a wide range of domains of quality of life.

Objective: To explore the association between social support and stress levels in preclinical and clinical dental students in Malaysia. Method: A cross sectional survey of dental undergraduate students was conducted at the Faculty of Dentistry, University of Malaya, Universiti Kebangsaan Malaysia and Universiti Sains Malaysia. Stress was measured using the Dental Environment Stress (DES) questionnaire. A DES-32 item was used to measure stress for the clinical students and DES-16 item for the preclinical students. Four questions were used to measure social support. The total stress scores were standardized for comparison purposes. Results: A total of 357 (79.7%) preclinical and 417 (71.8%) clinical undergraduate dental students responded to the questionnaires. The clinical students experienced higher stress [mean standardized DES score = 72.63, SD = 10.64] than preclinical students [mean standardized DES score = 70.19, SD=12.01]. The two most stressful items reported by preclinical students were ?fear of failing? and ?examination and grades?. Among clinical students, the two most stressful items related to academic were ?completing course requirement? and ?fear of failing course? and items related to clinical session were ?fear of being barred due to the clinical schedule? and ?patients late or absent?. Multiple regression analyses revealed that low stress levels among preclinical students were significantly associated to a lot of contact with students of the same course. Conclusion: To some extent, social support does play a role in explaining differences in perceived stress, in particular among preclinical students.

Introduction: Evidences on the bilateral relationship between diabetes mellitus (DM) and periodontal diseases (PD) have been growing. Oral hygiene practice (OHP) is one of major determinants for PD. Thus, the aim of this study was to assess periodontal disease status and oral hygiene practices of DM-patients from public medical primary care clinics (PMPCCs). Methods: A medical-dental research team conducted an active PD-screening among 193 DMpatients using both self-reported questions (SRQs) and basic periodontal examination (BPE) by professionals at 3-PMPCCs in Kuantan in 2015. OHP was categorized into two groups; acceptable OHP (two/three-time tooth-brushing/day using with/without mouthwash/flossing) and need to improve OHP (one-time tooth brushing/day using with/without mouth-wash/flossing). HbA1C ≤ 6.5% was used as cut-off for glycaemic control achievement. A cross- analysis was done to infer the influences of demographic-background and OHP on PD- status and relationship between PD- status and glycaemic control achievement. Results: Out of 193 DM-patients, 72.5% (140/193) were PD-screening positive in self-reporting while 54.9% (106/193) had PD in professional screening. OHP of majority (86%) were acceptable. Only 14% (27/193) achieved glycaemic-control status. Influence of demographic and OHP on PD-status ( by BPE) and relationship between PD and glycaemic control achievement did not found out. There were no age and race difference in OHP; however, acceptable OHP was significantly higher (p

Objective The aim of this study was to investigate correlations between dental pulp cell count of odontoblasts, subodontoblasts and fibroblasts and age, within different age groups. Formulation of regression equations using the dental pulp cell count for predicting age was attempted. Design Eighty-one extracted teeth were grouped into two age groups (6–25 years, 26–80 years). The teeth were demineralized and histological sections were prepared for cell count. Regression equations were generated from regression analysis of cell count and tested for age estimation. Results The number of dental pulp cells were found to increase until around the third decade of life and following this, the odontoblasts and subodontoblasts cell numbers began to decline while the fibroblasts seemed to remain almost stationary. The Pearson correlation test revealed a significant positive correlation between the cell number for all type of cells and age in the 6–25 years group (r = +0.791 for odontoblasts, r = +0.600 for subodontoblasts and r = +0.680 for fibroblasts). In the 26–80 years age group, a significant negative correlation of the odontoblasts (r = −0.777) and subodontoblasts (r = −0.715) with age was observed but for fibroblasts, the correlation value was negligible (r = −0.165). Regression equations generated using odontoblasts and subodontoblasts cell number were applicable for age estimation. The standard error of estimates (SEEs) were around ± 5 years for 6–25 years and ± 8 years for 26–80 years age groups. The mean values of the estimated and chronological ages were not significantly different. Conclusions A significant correlation between the cell count of odontoblasts and subodontoblasts with age was demonstrated. Regression equations using odontoblasts and subodontoblasts cell number can be used to predict age with some limitations.

Objective To assess Malaysian government dentists' experience, willingness and barriers in providing domiciliary care for elderly people. Material and methods A descriptive cross-sectional study was conducted using a self-administered postal questionnaire targeting government dentists working in the Ministry of Health in Peninsular Malaysia. Results Seven hundred and eleven out of 962 dentists responded with a response rate of 74.0%. Only 36.1% of the dentists had experience in providing domiciliary care for elderly people in the past 2 years with mean number of visit per year of 1. Younger dentists below the age of 30 and those with confidence in providing the service were the most willing to undertake domiciliary care for elderly patients (OR = 13.5, p

Demand and use for oral health-related quality of life (OHRQoL) instruments have increased in recent years in both research and clinical settings. These instruments can be used to measure patient's health status or detect changes in a patient's health status in response to an intervention or changes in disease trajectory. Ensuring universal acceptance of these measures requires easy interpretation of its scores for clinicians, researchers, and patients. The most important way of describing and interpreting this significance of changes in OHRQoL is through the establishment of minimal important difference (MID). The minimally important difference represents the smallest improvement considered worthwhile by a patient. A comprehensive search of published literature identified only 12 published articles on establishment of MID for OHRQoL measures. This scarcity of published studies on MID encourages the need of appropriate interpretation and describing patient satisfaction in reference to that treatment using MID. Anchor- and distribution-based methods are the two general approaches that have been proposed and recommended to interpret differences or changes in OHRQoL. Both of these methods of determining the MID have specific shortcomings; therefore, it is proposed to adopt triangulation approaches in which the methods are combined. The objective of this review is to summarize the need for, importance of, and recommendations for methods of establishing MID for OHRQoL measures.

The aim of the present study is to determine the ?community indicator? for dental caries among secondary school children within the Federal Territory of Kuala Lumpur (FTKL). School factors were investigated for their ability to be used as community indicators. The components encompassing school factors include: type of school, school?s examination performances at the Peperiksaan Menengah Rendah (PMR) level, in the subjects of Mathematics, Bahasa Melayu (Malay Language), Science and English, school?s socioeconomic circumstances and school?s material deprivation. The study design is ecological in nature where schools were the unit of analysis. It used aggregated data for caries experiences acquired from the Oral Health Management Information System and the school factors which were extracted from the schools? database. The subjects involved in this study were all the (75) day type secondary schools in FTKL. However, only 55 schools had complete information both for the dental caries factor and the school factors which were available for analysis. The use of bivariate analysis suggested that the school mean DMFT was significantly associated with the schools? performance in English (p= 0.02) and the schools? socioeconomic code (p= 0.005). The schools? performance in English and socioeconomic code were able to explain about 10 percent and 14 percent of the variation in the school mean DMFT respectively. The final model that included both variables together explained about 17 percent of the variation in school mean DMFT. As a conclusion, this study suggests that the schools? performance in English at the PMR level and the schools? socioeconomic code could be used as community indicator to identify secondary schools with higher caries level in FTKL. Nevertheless, further improvement of the model is needed in order to create a more reliable indicator.

The objectives of this study were to assess the practice of molar root canal treatment (RCT) among general dental practitioners (GDPs), confidence level of GDPsin performing molar RCT and to identify factors that influence their confidence in managing molar RCI. One hundred questionnaires were distributed to GDPsin Kuala Lumpur and Selangor. Fifty questionnaires were delivered by mail and the remaining fifty were hand-delivered. All data was coded and verified. FiftysixOOPs responded to the questionnaires. Only fortyfive questionnaires were accepted (n=45) as eleven OOPs had never performed molar RCI. Most of the OOPs followed the standard quality guidelines while performing molar RCT except for vitality testing (36.4%) and rubber dam usage (27.3%). In this study, 100% of the GDPs were confident in making diagnosis of perinidicular diseases and 95.4% were confident in performing molar RCT from history taking until obturation. Patients' tolerance and availability of instruments and materials (97.7%) were two factors that most influence the GDPs' confidence level. The. least influencing factor was undergraduate training (78.1 %). Attending seminars and lectures on endodontic, large number of molar teeth treated for ReT, patLents' affordability to pay for RCT and postgraduate training also influence GDPs' confidence to a certain degree. From this study, it can be concluded that majority of OOPs complied standard quality guidelines except for vitality testing and rubber dam usage. Most of them were confident in performing molar RCT and were greatly influenced by the availability or"instruments and materials in their clinic and patients' tolerance in receiving molar RCI.

The aims of this study were to determine the prevalence and factors that influenced smoking behaviours among male adolescents in Kuantan, Pahang. A cross-sectional study was conducted among the form four male students in Kuantan District. Three hundred and twenty three students were randomly selected from eight secondary schools. A self-administered questionnaire was distributed to all the respondents. Almost half of the sample was smokers (45.8%) and half of them were Malays (53.1%). Students whose parents had lower level of occupation were more likely to smoke (58.8%). Among smokers, 34.5% of them smoked since primary school and a majority (91.7%) smoked 10 or less cigarettes per day. Half of them (53.4%) reported that they bought loose cigarettes and most of them used their school pocket money to purchase the cigarettes (81.7%). From the multivariate analysis, it was found that Non-Science Stream classes (OR=3.92, 95% CI= 2.10, 7.32), peers' smoking (OR=6.07, 95% CI= 2.32, 15.92), and attitude towards smoking (OR= 21.93, 95% CI= 9.71,49.51) were significantly associated with smoking habit. The prevalence of smoking among male adolescents was considerably high'in this population. It is recommended that antismoking activities in school be carried out regularly and should involve an active participation from the adolescents themselves since peers have great influence on smoking habits.

The purpose of this study was to gather information on the oral hygiene behaviour among the visually impaired adolescents. Interview and observation methods were used to collect data. A total of 114 visually impaired adolescents were interviewed and 10 of the interviewees were selected for observation on the actual oral hygiene practices. The mean age of the sample was 16 years old. The sample comprised of 53.5% female, majority were Malays (86.8%) and most of them were from the lower income group. Fifty four percent of the sample had low vision and 45.6% were blind. All of the participants reported that they brushed their teeth daily and most of them brushed twice a day or more. Flossing (6.1%) was not common practice among this group. It was observed that they encountered some difficulties, especially when putting the toothpaste on the toothbrush and also the way that they brushed their teeth could cause detrimental effect to the oral cavity. Thus, they need to be taught on proper oral hygiene care so that they can practice safe oral hygiene care and maintain their own oral health.

Background Chronic periodontitis (CP) is a global public health issue. Studies have suggested CP could be linked to obesity due to their similar pathophysiological pathway. The aim of this study is to determine the prevalence of CP and to assess the predictors for CP among the obese Malaysian population. Methods This is a cross-sectional study on obese participants. Obesity is defined as an individual who has Body Mass Index (BMI) ≥27.5 kg/m2. A convenience sampling method was used. A total of 165 paricipants were recruited. This study involved answering questionnaires, obtaining biometric and clinical measurements of Visible plaque index (VPI), Gingival bleeding index (GBI), Probing pocket depth (PPD) and Clinical attachment loss (CAL). Data analysis was carried out using SPSS statistical software (SPSS Inc., version 20, US). Results A total of 165 participants; 67 (40.6 %) males and 98 (59.4 %) females participated in the study. Mean age of the participants was 43.9 (±8.9). The prevalence of CP among the obese population was found to be 73.9 %. Out of this, 43 and 55 % were categorised as moderate and severe CP respectively. Around 64 % of participants had sites with CAL ≥4 mm and participants with sites with PPD ≥4 mm were reported to be 25 %. Around 83 % of the participants had sites with GBI ≥30 and 92 % of participants had sites with VPI ≥20 %. GBI and VPI were found to have significantly higher odds for CP. Conclusion Prevalence of CP was high among obese Malaysians. GBI and VPI were potential predictors for CP in this obese population.

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.

Purpose: The purpose of this study was to evaluate and compare Oral Health-Related Quality of Life (OHRQoL), denture satisfaction, and masticatory performance in edentulous patients provided with mandibular implantsupported overdentures (ISODs) retained with telescopic attachments and those of conventional complete dentures (CCDs). Peri-implant soft tissue changes were also evaluated at various intervals during a 1-year observation period. Materials and Methods: Participating patients received new CCDs and later received two mandibular interforaminal implants and had their mandibular CCDs converted into ISODs with telescopic attachments. Questionnaires were used to assess OHRQoL (Shortened Oral Health Impact Profile-14, Malaysian version) and denture satisfaction at different stages of treatment with CCDs and ISODs. Objective masticatory performance with the CCDs and ISODs was recorded with a mixing ability test. Evaluations were carried out at 3 months with the new CCDs, 3 months after mandibular ISOD provision, and 1 year after receiving the ISOD. Peri-implant parameters were additionally assessed at specific intervals during the treatment period. The data obtained were statistically analyzed and compared. Results: In the 17 patients who completed the protocol, significant improvements were observed in OHRQoL and patient satisfaction when CCDs were modified to ISODs, after 3 months, and at 1 year. Significantly better mixing ability with the ISOD was noted, with the highest values observed at 1 year. Statistically insignificant differences were observed for all the peri-implant parameters, except for gingival recession, for which significant changes were observed 6 months after ISOD delivery (values had stabilized by 1 year). Conclusion: Telescopic crown attachment-retained mandibular ISODs improved OHRQoL, dental prosthesis satisfaction, and masticatory performance compared to CCDs. Peri-implant soft tissue response and implant stability were found to be favorable after 1 year.

The purpose of this cross-sectional study was to assess the legal representatives' perceptions on dental care access of individuals with Down syndrome (DS) compared to their non-DS siblings in Peninsular Malaysia.This cross-sectional study was conducted throughout community-based rehabilitation centers (CBRC) and the Down Syndrome Organization. Legal representatives of individuals with DS within the criteria were given a structured and validated questionaire.This study demonstrated that individuals with DS (76.9%) significantly utilized more health services than non-DS siblings (23.1%). The service most regularly used was speech therapy followed by opthalmology and dental services. Twenty-five per cent of respondents reported difficulty in finding dental care services for their DS child and 46.9% admitted that healthcare for their DS child took more time. The majority of DS individuals received less complex dental treatment and none received any orthodontic treatment, despite their severe occlusal problems.A high proportion of parents appear to be able to access dental and medical care for their DS child. However, some parents perceived difficulty in finding oral healthcare.

Objectives: The objective of this study was to assess changes in the oral health-related quality of life (OHRQoL) among patients wearing fixed orthodontic appliances 24 h after insertion. Materials and Methods: Sixty patients aged between 14 and 24 years (29 males and 31 females; mean age, 17.8 years; SD 3.1 years) were recruited from the Postgraduate Clinic, Department of Children's Dentistry and Orthodontics, Faculty of Dentistry, University of Malaya. The oral health-related quality of life (OHRQoL) was measured before treatment and 24 h after insertion of the orthodontic appliance. The instrument used to measure OHRQoL was a modified self-administered short version of Malaysian Oral Health Impact Profile (OHIP-16[M]) questionnaire. The higher the score, the poorer is the OHRQoL. Results: Overall score of OHRQoL increased significantly 24 h after insertion (mean 43.5±10.9) as compared to before insertion (mean 34.1±9.2) (P

Periodontal bio-repositories, which allow banking of clinically validated human data and biological samples, provide an opportunity to derive biomarkers for periodontal diagnosis, prognosis and therapeutic activities which are expected to improve patient management. This article presents the establishing of the Malaysian Periodontal Database and Biobank System (MPDBS) which was initiated in 2011 with the aim to facilitate periodontal research. Partnerships were established with collaborating centres. Policies on specimen access, authorship and acknowledgement policies were agreed upon by all participating centres before the initiation of the periodontal biobank. Ethical approval for the collection of samples and data were obtained from institutional ethics review boards. A broad-based approach for informed consent was used, which covered areas related to quality of life impacts, genetics and molecular aspects of periodontal disease. Sample collection and processing was performed using a standardized protocol. Biobanking resources such as equipment and freezers were shared with the Malaysian Oral Cancer Database and Tissue Bank System (MOCDTBS). In the development of the MPDBS, challenges that were previously faced by the MOCDTBS were considered. Future challenges in terms of ethical and legal issues will be faced when international collaborations necessitate the transportation of specimens across borders.

Background Oral-Health-Related Quality of Life (OHRQoL) instruments are useful outcome measures in dental health services research; however, there are no reports of the use OHRQoL measures in evaluating the outcome of basic dental care in children anywhere. Aim The aims of this study are to evaluate the responsiveness of the Khmer version of the Child Perceptions Questionnaire11–14 (CPQ11–14) and to describe changes in OHRQoL associated with the provision of basic dental care. Design A pre-test/post-test design, with a clinical convenience sample of children aged from 8 to 14 years of age who received basic dental care from a local nongovernmental organisation (NGO). Results Of the 140 children in the baseline sample, 116 (82.9%) were followed up. The mean change in CPQ11–14 overall score for those with caries was 1.7, representing a small improvement in OHRQoL. There was a moderate (one in three) statistically significant reduction in the prevalence of impacts across the whole sample (P

The habit of chewing betel quid has been practised since ancient times. Although the world has gone through modernization, a significant proportion of people still practices this habit. Substantial evidence has shown that betel quid chewing is associated with the occurrence of oral cancer and precancerous lesions, which has a tremendous psychosocial impact on an individual's life. Thus it becomes significantly important to dentistry to look into this matter. Since betel quid chewing is oneof the causes of oral cancer, effort in cha~ging this habit is essential. This article addresses this issue.

A cross-sectional study was conducted to ascertain the relationship between parental oral health perception on the importance of the deciduous dentition and the dental caries status of their preschool children. Clinical oral examination of the preschool children was performed and self-administered questionnaires were given to the parents to be completed. Four hundred and eight preschool children were examined and 390 of their parents responded to the self-administered questionnaire. Those parents who brought their children for regular dental check-up at least once a year; favoured restorative treatment and practised tooth brushing habit before bedtime were more likely to have children with significantly lower mean 'dft' as well as higher proportions of caries free mouth (> 50 %). Those children who started early in practising tooth brushing also had better dental caries status but the differences were not significant. However, there were no significant and appreciable differences in their mean 'dft' with respect to the frequencies of tooth brushing per day. It was concluded that parents with better oral health perception as reflected by those parents who (a) practiced regular dental check-up for their children; (b) favoured restorative treatment for their children's decayed deciduous teeth; (c) ensured their children brushed their teeth before bedtime are associated with better dental caries status of their preschool children.

This study was undertaken to investigate the number and types (fluoride or non-fluoride) of toothpaste products available in the Malaysian market based on the label. Thirty-five brands of toothpaste were identified, of which ten (29%) were specifically recommended for children. Two of the children's toothpaste recommended that children below seven years old use a pea size amount of toothpaste. One (3%) was recommended for both children and adult. The remaining 24 (69%) did not state if they were recommended for either children or adults. To improve the flavour of the toothpastes, a variety of flavours had been added especially in children's toothpaste. Almost half of the toothpastes were for prevention of tooth decay and gum disease. Other indications were for tooth sensitivity, tooth whitening and stain removal. Twentyseven (77%) of the toothpastes were imported, while eight (23%) were made in Malaysia. Twenty-six (74%) of the toothpaste contained fluoride and the most common type of fluoride used was sodium monofluorophosphate (NaMFP). The fluoride concentration was not labeled in more than half (63%) of the fluoridated toothpaste. Of those that were fluoridated, different units of measurement were used. As there is no uniformity in the labelling of these products, it is recommended that the responsible authorities should take more action in enforcing proper labelling of the fluoride concentration in the toothpaste using standardized units.

A pilot study was conducted on 135 sixteen-year-old students from three rural schools in Kelantan to establish the prevalence of oro-facial pain and discomfort. About 44% reported to have experienced some oro-facial pain in the precedingfour weeks. About 27% of those with pain, still experienced the pain at the time of clinical examination but only 8% have consulted professional help. Most of the pain encountered were only mild or moderate in nature. Only 7% and 10% respectively, reported that the pain affected their sleep and concentration to study. The main cause was toothache and sensitivity. The prevalence of discomfort was 22%, the most common causes being recurrent oral ulcers and bleeding gums. The impacts of oro-facial pain was mainly manifested at the personal level, and very few affecting social functioning. However, untreated decay and missing teeth were very low (mean DT 0.47, mean MT 0.27), while filled teeth (mean Ff 2.9) was the main component of the DMFf (mean 3.66, sd ± 2.6). Severe periodontal disease and the prevalence of traumatised teeth was not a major public health problem. The high prevalence of pain merit further research. Therefore a larger study involving other age-groups in other states isplanned.

This study aimed to determine the impact of dental caries in terms of Oral Health–Related Quality of Life (OHRQoL) for Cambodian children. The Child Perceptions Questionnaires (CPQ) were cross-culturally adapted and validated for the Cambodian population using a sample of 430 Cambodian children. The participants had a high caries burden, with a mean number of decayed-missing-and-filled deciduous tooth surfaces (dmfs) of 8.8 (SD = 11.1) and a mean DMFS of 3.7 (SD = 5.5) for the permanent dentition. Two in 5 children had at least one pulpally involved tooth. There was a significant difference in mean CPQ8-10 and CPQ11-14 scores by caries experience and by global item response for the respective age-groups, with those in the more severe caries categories scoring higher. Similar gradients were apparent with the CPQ11-14 in the 8- to 10-year age-group. The differences in OHRQoL scores by caries experience demonstrate the construct validity of the CPQ11-14 for the 8- to 14-year age-group.

Objective: The aim of this randomized controlled clinical trial was to compare oral health-related quality of life (OHRQoL) of patients treated with conventional, active self-ligating (ASL), and passive self-ligating (PSL) brackets in different therapeutic phases. Methods: Sixty patients (mean age 18.3 years; 29 males and 31 females) requiring orthodontic treatment were randomly and equally assigned to receive conventional (Victory Series), ASL (In-Ovation R), or PSL (Damon 3MX) brackets. OHRQoL was measured with a self-administered modified 16-item Malaysian version of the Oral Health Impact Profile for immediate (soon after the visit) and late (just before the subsequent visit) assessments of the bonding and activation phases. Data were analyzed with the Kruskal-Wallis and chi-square tests. Results: The PSL and ASL groups showed more immediate and late impacts in the bonding phase, respectively; the conventional group was affected in both the assessments. The first activation phase had similar impacts in the groups. After the second activation, the conventional group showed more immediate impacts, whereas the PSL and ASL groups had more late impacts. The commonly affected domains were “physical disability,” “functional limitation,” “physical pain,” and “psychological discomfort.” No significant differences in the prevalence and severity of immediate and late impacts on OHRQoL of the patients were noted in any therapeutic phase. Conclusions: No bracket system seems to ensure superior OHRQoL. This information could be useful for explaining the therapeutic phases, especially the initial one, and selecting the optimal bracket system based on the patient’s preference.

Demand and use for oral health-related quality of life (OHRQoL) instruments have increased in recent years in both research and clinical settings. These instruments can be used to measure patient's health status or detect changes in a patient's health status in response to an intervention or changes in disease trajectory. Ensuring universal acceptance of these measures requires easy interpretation of its scores for clinicians, researchers, and patients. The most important way of describing and interpreting this significance of changes in OHRQoL is through the establishment of minimal important difference (MID). The minimally important difference represents the smallest improvement considered worthwhile by a patient. A comprehensive search of published literature identified only 12 published articles on establishment of MID for OHRQoL measures. This scarcity of published studies on MID encourages the need of appropriate interpretation and describing patient satisfaction in reference to that treatment using MID. Anchor- and distribution-based methods are the two general approaches that have been proposed and recommended to interpret differences or changes in OHRQoL. Both of these methods of determining the MID have specific shortcomings; therefore, it is proposed to adopt triangulation approaches in which the methods are combined. The objective of this review is to summarize the need for, importance of, and recommendations for methods of establishing MID for OHRQoL measures.