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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.

Background The influence of scaler tip design on root surface roughness, tooth substance loss and patients’ pain perception is investigated. Methods This article was divided into the following parts: Part 1 Surface roughness and substance loss: an in vitro study, which involves intact extracted teeth sectioned and treated using a piezoelectric ultrasonic device (PM200 EMS Piezon, Switzerland) with a conventional scaler tip (FS-407) and a Perio Slim (PS) scaler tip (Perio Slim DS-016A). All sectioned samples for tooth surface roughness (n = 20) and tooth substance loss (n = 46) analyses were measured and compared using a 3D surface texture analyser and scanning electron microscope (SEM) respectively, at baseline and following scaling. Part 2 Pain Perception: a clinical study, which was a split mouth study design including 30 participants with gingivitis and/or mild chronic periodontitis; treated with supra-gingival scaling from teeth #13 to #23. Subjects were randomised to group A or group B. Group A was treated first with PS scaler tips, whereas group B was treated first with conventional scaler tips. Pain perception was recorded using the visual analogue scale (VAS). Results In vitro study: both scaler tips caused significant reduction in root substance roughness after scaling (p p > 0.05) was observed. The PS scaler tip caused statistically significantly less root substance loss (p p Conclusions In the in vitro study, using a slim scaler tip design causes less tooth substance loss compared to a wider scaler tip design. In the clinical study, less pain was observed compared than a wide (conventional) scaler tip design.

Aim: This study aimed to investigate the relationships between acculturative stress, perceived stress, social support, and subjective oral health outcomes among international graduate students in Malaysian public universities. Materials and Methods: A total of 312 international graduate students completed a web-based questionnaire, including measures of acculturative stress (ASSIS-36), perceived stress scale (PSS-4), social support (MSPSS-12), oral health perceptions (global rating item), and oral health-related quality of life (OHRQoL, OIDP-8). The hypotheses of the conceptual model were tested using structural equation modeling-partial least squares (SEM-PLS) with the support of SmartPLS. Results: Twenty-seven percent (27.1%) of the variance in OHRQoL was explained by acculturative stress, perceived stress, social support, and oral health perceptions. The path coefficient between oral health perception and OHRQoL was the strongest (β = –0.385, P < 0.001). Acculturative stress directly influenced OHRQoL (β = 0.20, P = 0.009) and indirectly through perceived stress (β = 0.05, P = 0.019). Social support mediated the relationship between perceived stress and OHRQoL (β = 0.046, P = 0.02). The overall predictive power of the model was 23%. Conclusion: Results indicated that acculturative stress, perceived stress, and social support are among the predictors of OHRQoL. Oral health perceptions and acculturative stress were the most significant predictors that contributed the largest amount to the model. The findings emphasize the potential role of psychosocial factors in relation to oral health. The empirical evidence of this study could facilitate the planning of targeted strategies that address stress reduction and social support. Such strategies might be a new promising way to enhance OHRQoL as these elements can be modified and response to interventions.

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 (

Background Non-surgical periodontal therapy (NSPT) known as gold standard treatment in managing periodontitis. The aim of this study was to investigate the response of NSPT in periodontitis subjects who were obese. Clinical parameters of periodontitis, changes in serum resistin and periodontal pathogens in subgingival plaque were compared before and after NSPT in periodontitis subjects who were obese and with normal weight. Methods A total of 48 periodontitis subjects (obese, n = 18; normal weight, n = 30) were recruited (hereafter will be referred as participants) to participate into a prospective, before and after clinical trial. Obesity status is defined by body mass index (BMI) criteria (obese: ≥30 kg/ m2; normal weight 2). Visible Plaque Index (VPI), Gingival Bleeding Index (GBI), Probing Pocket Depth (PPD) and Clinical Attachment Loss (CAL) were recorded; and serum and plaque were collected at baseline and following 12 weeks post-NSPT. Serum resistin level was analyzed using enzyme-linked immune-sorbant assay (ELISA), while detection of periodontal pathogens in dental plaque were carried out using real time PCR (qPCR). Results Following NSPT, means VPI and GBI showed significant improvement between obese and normal weight groups (p P. gingivalis, T. forsythia, and P. intermedia between obese and normal weight groups following NSPT. Conclusions Regardless of obesity status, NSPT has a significant impact on VPI and GBI in periodontitis subjects. However, the impact of NSPT towards serum resistin and periodontal pathogens was non-significant in those with periodontitis. Trial registration This study followed the Consolidation Standards of Reporting Trials Statement and retrospectively registered on 26/11/2015 at clinicaltrials.gov (No. NCT02618486).

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.

The WHO recommended pictorial health warnings (PHWs) on cigarette packs in 2003 to educate and warn the public of smoking effects. Malaysia too has implemented this policy since 2009. This study explored the public’s understanding of the gazetted PHWs depicted on cigarette packs available in Malaysia. A qualitative study using four focus group discussions (FGDs) was conducted among smokers and non-smokers aged 18–40 in Malacca, Peninsular Malaysia. Thematic analyses were performed using the Atlas Ti version 8.0 software. Six themes have emerged reflecting the public’s understanding of the existing PHWs in Malaysia, namely, (i) awareness and exposures, (ii) recall and attention, (iii) perceived goals, (iv) perceived target groups, (v) attitude in understanding, and (vi) knowledge and meaning of PHWs. All participants were aware of the PHWs depicted on legal cigarettes but not seen on most illicit cigarettes. PHWs were perceived to give awareness and warning about the smoking effects targeting smokers and non-smokers. Participants understood the lung and oral health-related images easily than other body parts such as gangrene foot, miscarriages, etc. Besides enforcement on illicit cigarettes without PHWs, policymakers or relevant authorities should emphasize creating relevant and clear pictorial messages in educating the public to avoid confusion affecting the public’s understanding of the PHWs.

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.

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.

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.

Backgrounds: People in Yemen and in East African countries chew khat more than five hours daily. Objectives: The aim of this study was to assess the relationship between khat and occlusal caries progression. Methods: A cohort study was carried out among 98 Yemeni khat chewers and 101 non-chewers aged 18-35 years old with early occlusal caries lesions. All participants answered questions on socio-demographic, khat , oral hygiene , sugar intake, and oral health knowledge at baseline. All posterior teeth with an early enamel lesion on occlusal surfaces detected by visual inspection at baseline were also subjected to DIAGNOdent assessment to confirm early lesion (DIAGNOdent reading 13-24). Participants were re-examined after 12 weeks. Caries progression was considered to occur when the DIAGNOdent reading was >25. Data were analyzed using Relative risk, Mann–Whitney U test, a Wilcoxon Signed-Rank test and logistic regression analysis. Results: Occlusal caries progression incidence between khat chewers and non-chewers, with the relative risk was 1.68. There was no significant difference in occlusal caries progression on chewing side and non-chewing side among khat chewers. Khat chewing was a statistical predictor for those with low income. Conclusion: Khat is a risk factor for occlusion caries progression among low income group. Keywords: Khat, caries progression, DIAGNOdent pen.

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.