Clinical evidence for silver diamine fluoride to reduce dentine hypersensitivity: A systematic review.

OBJECTIVE: To assess the clinical evidence for silver diamine fluoride (SDF) to reduce dentine hypersensitivity in adults. METHODS: Two independent researchers searched the English literature in five databases (Scopus, PubMed, Web of Science, EMBASE and the Cochrane Library) up to 15th July 2023 for clinical trials investigating the desensitising effect of professionally applied SDF to manage dentine hypersensitivity in adults aged 18 or above at any follow-up period. The primary outcome was the change in dentine hypersensitivity between baseline and follow-up visits after SDF application regarding any validated pain outcome measures. The Cochrane guidelines were used for the risk of bias assessment. RESULTS: Three hundred and thirty-one studies were identified, and four of them were finally included. Three of the included studies were rated as having a 'low risk' of bias. The SDF solution reduced dentine hypersensitivity in adults. The percentage reduction in dentine hypersensitivity ranged from 23 % to 56 % after a single application of SDF solution. Moreover, the SDF solution was more effective than potassium nitrate, potassium oxalate and glutaraldehyde plus hydroxyethyl methacrylate in reducing dentine hypersensitivity. Meta-analysis indicated a more significant reduction in visual analogue scales (1-10) by 1.35 (95 % CI:0.9-1.8; p<0.00001) after receiving the SDF application than controls. CONCLUSION: The included clinical trials showed that SDF solution reduced dentine hypersensitivity in adults. However, clinical trials are few, and their protocol varied from one another. Further well-designed clinical trials should be conducted to provide more evidence on its use to manage dentine hypersensitivity. CLINICAL SIGNIFICANCE: SDF is cleared as desensitizing agents by the US Food and Drug Administration to manage dentine hypersensitivity, which induces pain, limits food choice, and impacts the quality of life. Evidence from this systematic review informs clinicians and provides researchers insight for future research on SDF use for dentine hypersensitivity. THE INTERNATIONAL PROSPECTIVE REGISTER OF SYSTEMATIC REVIEWS (PROSPERO) REGISTRATION NUMBER: CRD42023462613.

Improving oral health of older adults for healthy ageing.

The objective of this article is to discuss the importance of oral health in achieving healthy ageing and the role of all stakeholders in improving oral health for older adults. The World Health Organization defined healthy ageing as the process of developing and maintaining the functional ability that enables well-being in older age. It recognized healthy ageing as an important goal and the key to turn population ageing from a challenge to an opportunity. Healthy ageing has positive impacts on individual older adults, their families and societies. It enhances quality of life of older adults, strengthen family bonding of families and reduce resource demand of the societies. Maintaining oral health and function is essential in healthy ageing. Oral health affects systemic health, cognitive health and psychological health. Oral functions such as eating ensure nutritional health in older adults. Most oral diseases are preventable and oral function decline can be recovered by intervention. Unfortunately, oral diseases remain prevalent and oral function decline is being neglected in older adults. Policy makers, national dental associations, academics and healthcare professionals should collaborate to provide a patient-centred, comprehensive and integrated care to older adults. Health policy reforms are needed to reduce the global oral health inequalities in older adults. Population-wide prevention should be accessible, affordable and available to older adults. Universal oral health coverage is crucial for integration of oral health into general health care.

Tooth Wear in Older Adults: A Review of Clinical Studies.

INTRODUCTION: Tooth wear is a prevalent dental condition among older adults, leading to pain and adversely affecting aesthetics, functionality, and their overall quality of life. This review aims to update the information on tooth wear in older adults from the past five years and to provide guidance on the clinical management of tooth wear in older adults. METHODS: A literature search was conducted in three electronic databases, Scopus, Pubmed, and Embase, for English publications from January 2019 to December 2023 on clinical studies with participants aged 65 or above on tooth wear. A total of 307 articles were retrieved and 14 articles were finally included as references for this study. RESULTS: This review highlights the common causes of tooth wear and various risk factors, such as medical conditions, hyposalivation, dietary habits, oral hygiene practices, parafunctional habits, and occlusal factors, associated with tooth wear. It is crucial for oral health care professionals to diagnose and manage tooth wear at an early stage through a risk assessment and a clinical examination to avoid complex restorative procedures. Tooth wear management should prioritize prevention, aiming to control etiological and risk factors while employing non-restorative treatments. Restorative intervention, if indicated, should be simple, minimally invasive, and cost-effective. Tooth wear progression should be monitored regularly to determine if a further intervention is needed. CONCLUSION: Since the clinical studies on tooth wear in older adults over the past five years are limited and mainly cross-sectional, more interventional clinical studies are warranted to provide more clinical guidance on tooth wear management in older adults.

Erosive tooth wear among non-institutionalised older adults in Hong Kong: a cross-sectional study.

BACKGROUND: Non-institutionalised older adults is the majority of older adults in Hong Kong. The study aimed to examine erosive tooth wear (ETW) and its association with dental conditions and oral hygiene habits among non-institutionalised older adults in Hong Kong. METHODS: This cross-sectional study recruited dentate adults aged 60 or above from nine elderly daycare centres in the five main districts of Hong Kong. The study consists of a questionnaire survey and a clinical examination. A researcher used a questionnaire to collected the participants' demographic information, oral hygiene habits such as toothbrushing habits and dental visit behaviour. A calibrated examiner performed an oral examination in the daycare elderly centre to assess the ETW using basic erosive wear (BEWE) criteria. Oral hygiene was recorded using visible plaque index. Prosthetic status was recorded using the World Health Organization criteria. Logistic regression was used to examine the correlation between ETW and the dental conditions and oral hygiene habits. RESULTS: This study recruited 433 dentate adults and 333 adults were female (77%). Their age ranged from 60 to 99 years and their mean age was 74 years (SD = 7). They all had ETW (BEWE > 0). Over half of them (57%) had BEWE score of 3, indicating severe ETW. Analysis showed increasing age (OR = 1.030, p = 0.029) and older adults with untreated dental caries had higher odds (OR = 1.822, p = 0.002) of presenting severe ETW. No other associations were found between the ETW and the factors studied. CONCLUSION: Hong Kong non-institutionalised older adults aged 60 or above had ETW and more than half of them had severe ETW. Increasing age and having untreated dental caries were associated with severe ETW.

Transition of care in CHD: a single-centre experience: an enigma remains.

Transition of care refers to the continuity of health care during the movement from one healthcare setting to another as care needs change during a chronic illness. We sought to describe social, demographic, and clinical factors related to successful transition in a tertiary urban care facility in patients with CHD. Patients were identified utilising the electronic medical record. Inclusion criteria were patients with CHDs aged ≥15 years seen in the paediatric cardiology clinic between 2013 and 2014. Deceased patients were excluded. Clinical and demographic variables were collected. Patient charts were reviewed in 2015-2021 to determine if included patients were a) still in paediatric cardiology care, b) transitioned to adult cardiology/adult CHD, or were c) lost to follow-up. A total of 322 patients, 53% male (N:172), 46% female (N:149) were included. Majority had moderately complex lesions (N:132, 41%). Most patients had public insurance (N:172, 53%), followed by private insurance (N:67, 21%), while 15% of patients (N:47) were uninsured. Only 49% (N = 159) had successful transition, while 22% (N = 70) continued in care with paediatric cardiology, and 29% (N = 93) were lost to follow-up. Severity of CHD (p = 0.0002), having healthcare insurance (p < .0001), presence of a defibrillator (p = 0.0028), and frequency of paediatric cardiology visits (p = 0.0005) were significantly associated with successful transition. Most patients lost to follow-up (N:42,62%) were either uninsured or had public insurance. Lack of successful transition is multifactorial, and further efforts are needed to improve the process in patients with CHD.

JAK inhibitor treatment for inborn errors of JAK/STAT signaling: An ESID/EBMT-IEWP retrospective study.

BACKGROUND: Inborn errors of immunity (IEI) with dysregulated JAK/STAT signaling present with variable manifestations of immune dysregulation and infections. Hematopoietic stem cell transplantation (HSCT) is potentially curative, but initially reported outcomes were poor. JAK inhibitors (JAKi) offer a targeted treatment option that may be an alternative or bridge to HSCT. However, data on their current use, treatment efficacy and adverse events are limited. OBJECTIVE: We evaluated the current off-label JAKi treatment experience for JAK/STAT inborn errors of immunity (IEI) among European Society for Immunodeficiencies (ESID)/European Society for Blood and Marrow Transplantation (EBMT) Inborn Errors Working Party (IEWP) centers. METHODS: We conducted a multicenter retrospective study on patients with a genetic disorder of hyperactive JAK/STAT signaling who received JAKi treatment for at least 3 months. RESULTS: Sixty-nine patients (72% children) were evaluated (45 STAT1 gain of function [GOF], 21 STAT3-GOF, 1 STAT5B-GOF, 1 suppressor of cytokine signaling 1 [aka SOCS1] loss of function, 1 JAK1-GOF). Ruxolitinib was the predominantly prescribed JAKi (80%). Overall, treatment resulted in improvement (partial or complete remission) of clinical symptoms in 87% of STAT1-GOF and in 90% of STAT3-GOF patients. We documented highly heterogeneous dosing and monitoring regimens. The response rate and time to response varied across different diseases and manifestations. Adverse events including infection and weight gain were frequent (38% of patients) but were mild (grade I-II) and transient in most patients. At last follow-up, 52 (74%) of 69 patients were still receiving JAKi treatment, and 11 patients eventually underwent HSCT after receipt of previous JAKi bridging therapy, with 91% overall survival. CONCLUSIONS: Our study suggests that JAKi may be highly effective to treat symptomatic JAK/STAT IEI patients. Prospective studies to define optimal JAKi dosing for the variable clinical presentations and age ranges should be pursued.

Physical activity as a modifiable risk factor for periodontal disease.

Non-communicable diseases (NCDs), which contribute significantly to global morbidity, are largely preventable through behavioral changes. As with other NCDs, periodontitis is associated with modifiable risk factors such as smoking and stress and is linked to multiple adverse health outcomes through a shared pathway of chronic systemic inflammation. While the health benefits of physical activity have been widely promoted in public health and extensively studied for other systemic conditions, its impact on periodontal health has only recently started to gain attention. This article critically evaluates the current literature on the relationship between physical activity and periodontitis. While cross-sectional studies have shown an inverse association between physical activity levels and periodontitis risk in the general population, clinical oral health surveys of elite athletes with high levels of physical activity have nonetheless revealed poor periodontal conditions. Although causality has not been determined, physical activity could positively impact periodontitis directly, by reducing inflammatory biomarkers, and indirectly, through its modulatory effects on insulin sensitivity, obesity, bone density, stress, and other health promoting behaviors. Given the importance of risk factor control during initial periodontal therapy, understanding the role of physical activity as a potential behavioral risk modifier is paramount. The findings of this review provide an evidence-based overview of how physical activity could influence periodontitis. There is a need for longitudinal cohort studies to verify the temporality of the reported associations and exclude confounders, while interventions are needed to assess the efficacy of physical activity on periodontal treatment outcomes.

Smoking cessation in dental setting: a narrative review on dental professionals' attitude, preparedness, practices and barriers.

Integration of smoking cessation program into routine oral health care has been advocated by World Health Organization since it brings extensive benefits to oral health. By tobacco cessation, patients are less prone to progression of periodontal disease, have less future tooth loss, have reduced risks of oral mucosal lesions and head and neck cancers. Evidence indicates that dentists are in a favorable position to deliver effective smoking cessation advice to improve patients' oral health. This article aims to present the current situation of smoking cessation in dental setting, including dental management of smoking patients, perceptions of dentists and dental students towards smoking cessation, challenges dental professionals face when carrying out cessation interventions. Patients' perspectives are also evaluated to provide a clearer picture of smoking cessation practice in the dental field. Review of past surveys show most patients welcome smoking cessation advice from dental practitioners. Meanwhile dentists may have wrong assumption that patients would disapprove them if they advise patient to quit smoking. On top of that, main obstacles identified are lack of training, inadequate treatment time and insufficient knowledge towards smoking cessation guidelines and referral routes. With regard to the potential barriers, evidence demonstrates that more trainings on smoking cessation strategies are needed. Future research in this aspect is also indicated to further foster the practice of smoking cessation counselling in dental setting.

Diet, Nutrition, and Oral Health in Older Adults: A Review of the Literature.

Diet, nutrition, and oral health are closely linked. Malnutrition is a challenging health concern in older adults that is associated with physical decline affecting their daily activities and quality of life. The aim of this review is to provide an evidence-based summary of the relationship between diet and nutrition and oral health in older adults and its implications. The World Health Organization has declared healthy ageing a priority of its work on ageing. The American Dental Association confirmed the bidirectional relationship between diet and nutrition and oral health. The literature shows that diet and nutrition are related to oral diseases, including dental caries, periodontal diseases, tooth wear, and even oral cancer. Insufficient nutritional intake and poor dietary habits increase the risk of oral diseases, such as dental caries, in older adults. On the other hand, in older adults, poor oral conditions such as periodontal disease may induce pain, infection, and tooth loss, affecting nutritional intake. Surveys have shown that older adults, in particular, those in disadvantaged communities, suffered from nutritional deficiencies or imbalances affecting their oral health. In addition, the current literature shows that malnutrition is associated with frailty, hospitalization, mortality, and morbidity. Good oral health and functional dentition are essential to maintain sufficient nutritional intake among older adults and reduce the risk of malnutrition. Therefore, integrating oral health into general health care service in older adults is imperative to improve their nutritional and oral health status to achieve healthy ageing.

Effects of Auditory Training in Older Adults.

PURPOSE: This study examines the effects of an auditory training program on the auditory and cognitive abilities of older adults. Auditory rehabilitation programs are generally designed for hearing aid users, and studies have demonstrated benefits for them. In this study, we seek to understand whether such a training program can also benefit older adults who do not wear hearing aids. We also examined if cognitive benefits can indeed be observed as a result of the training. METHOD: Sixty-four older adults were recruited and assigned into three groups: the experimental group (n = 20), the active control group (n = 21), and the no-training control group (n = 23). The experimental group underwent an auditory training program (Listening and Communication Enhancement [LACE]) during the training phase. Meanwhile, the active control group listened to short audio clips and the no-training control group did not participate in any program. An auditory test (Quick Speech-in-Noise [QuickSIN]) and a battery of cognitive tests were conducted before and after the training to examine the participants' performance on auditory ability, short-term memory, and attention. RESULTS: The results showed improvements in auditory and cognitive abilities during the training period. When assessing the training effects by comparing the pre- and the posttraining performances, a significant improvement on the QuickSIN task was found in the training group but not in the other two groups. However, other cognitive tests did not show any significant improvement. That is, the LACE training did not benefit short-term memory and attention. The improved performance on short-term memory during the training was not maintained in the posttraining session. CONCLUSION: Overall, the study has extended the auditory benefit from the LACE training to the typical aging population in terms of improved communication ability, but the effect of training on auditory abilities did not transfer to gains in cognitive abilities.

Honest, Open, Proud (HOP) for people with mental illness in Hong Kong: a randomized controlled trial.

BACKGROUND: Self-stigma among people with mental illness is negatively associated with personal and clinical recovery. Due to the concealable nature of mental illness, people with mental illness experience constant struggles between concealment and disclosure. Disclosure of mental health challenges can potentially minimize negative impacts of self-stigma and enhance self-esteem and sense of empowerment. Honest, Open, Proud (HOP) is a peer-led intervention that promotes autonomous and dignified decisions about disclosure. PURPOSE: This study examined the effectiveness of HOP on concealment motivation, empowerment, self-stigma, stigma stress, and recovery among people with lived experience of mental illness in Hong Kong. METHODOLOGY: A total of 162 participants with a mean age of 45.38 were recruited and randomized into intervention group and waitlist control group. Participants in the intervention group were invited to attend a 6-session HOP group intervention. RESULTS: Significant improvement in optimism score from the empowerment scale was found in the intervention group compared to the waitlist control group and the effect was sustained at 1-month follow-up. However, significant changes were not found in other outcome variables. CONCLUSION: Only improvement in optimism was observed in the current study. Future study needs to examine the effects of HOP with further modification to maximize the benefit for people with lived experience of mental illness in the local context.

Can High-Fidelity Patient Simulation Be Used for Skill Development in Junior Undergraduate Students: A Quasi-Experimental Study.

High-fidelity patient simulation (HFPS) is widely used in professional training to enhance students' competence in clinical management. A guideline for HFPS provides a systematic approach to direct students to learning during the simulation process. Problem-solving (PS) and clinical reasoning (CR) skills are essential to developing students' professional competence in safe and effective care. These two skills should be initiated in the early training. A structured guideline was developed for HFPS. This study aimed to investigate the effects of the structured HFPS guideline on the development of PS and CR skills in junior nursing students. The students were required to go through four sessions, pre-briefing, simulation design, facilitation, and debriefing, for the HFPS; the study utilized the Problem-Solving Inventory (PSI) and the Nurses' Clinical Reasoning Scale (NCRS) to measure PS and CR abilities before and after HFPS. Bivariate analysis, a one-sample t-test, and an independent t-test were performed to evaluate the performance of the PS and CR skills during the two study periods. A total of 189 students were recruited, with 92 in the intervention group and 97 in the control group. The research assistant was responsible for student recruitment through email invitations and allocating the students into the control group or the intervention group. A Wilcoxon analysis was performed and revealed significant differences in PS and CR between the two groups (p < 0.001). The analytic results showed that the PSI, particularly in domains of Problem-Solving Confidence (PSC) (p < 0.001) and overall PS (p < 0.001), and the CR (p < 0.001) had significant improvement after HFPS, particularly in the intervention group. The study concluded that the structured HFPS guideline significantly improved the students' problem-solving and clinical reasoning abilities. Nurse educators play an important role in providing explicit learning instructions in a simulation guideline that directs and guides students to learn at each stage of HFPS. The students can be directed to be engaged in their learning through HFPS to enhance their competence in knowledge and skill development (PS and CR) for their personal and professional development.

PRDM16 Deletion Is Associated With Sex-dependent Cardiomyopathy and Cardiac Mortality: A Translational, Multi-Institutional Cohort Study.

BACKGROUND: 1p36 deletion syndrome can predispose to pediatric-onset cardiomyopathy. Deletion breakpoints are variable and may delete the transcription factor PRDM16. Early studies suggest that deletion of PRDM16 may underlie cardiomyopathy in patients with 1p36 deletion; however, the prognostic impact of PRDM16 loss is unknown. METHODS: This retrospective cohort included subjects with 1p36 deletion syndrome from 4 hospitals. Prevalence of cardiomyopathy and freedom from death, cardiac transplantation, or ventricular assist device were analyzed. A systematic review cohort was derived for further analysis. A cardiac-specific Prdm16 knockout mouse (Prdm16 conditional knockout) was generated. Echocardiography was performed at 4 and 6 to 7 months. Histology staining and qPCR were performed at 7 months to assess fibrosis. RESULTS: The retrospective cohort included 71 patients. Among individuals with PRDM16 deleted, 34.5% developed cardiomyopathy versus 7.7% of individuals with PRDM16 not deleted (P=0.1). In the combined retrospective and systematic review cohort (n=134), PRDM16 deletion-associated cardiomyopathy risk was recapitulated and significant (29.1% versus 10.8%, P=0.03). PRDM16 deletion was associated with increased risk of death, cardiac transplant, or ventricular assist device (P=0.04). Among those PRDM16 deleted, 34.5% of females developed cardiomyopathy versus 16.7% of their male counterparts (P=0.2). We find sex-specific differences in the incidence and the severity of contractile dysfunction and fibrosis in female Prdm16 conditional knockout mice. Further, female Prdm16 conditional knockout mice demonstrate significantly elevated risk of mortality (P=0.0003). CONCLUSIONS: PRDM16 deletion is associated with a significantly increased risk of cardiomyopathy and cardiac mortality. Prdm16 conditional knockout mice develop cardiomyopathy in a sex-biased way. Patients with PRDM16 deletion should be assessed for cardiac disease.

The form and function processing of lexical tone and intonation in tone-language-speaking children with autism spectrum disorder.

Studies on how the form versus function aspect of tone and intonation is processed by autistic individuals have mainly focused on speakers of non-tonal languages (e.g., English) with equivocal results. While the samples' heterogeneous cognitive abilities may be contributing factors, the phenotype of tone and intonation processing in autism may also vary with one's language background. Thirty-eight cognitively able autistic and 32 non-autistic Mandarin-speaking children completed tone and intonation perception tasks, each containing a function and form condition. Results suggested that the abilities to discriminate tone and intonation were not impaired at either the form or function level in these autistic children, and that these abilities were positively associated with one another in both autistic and non-autistic groups. The more severe the autism symptoms, the worse the form- and function-level of tone and intonation processing. While enhanced tone and intonation processing has been found in a subgroup of autistic children, it may not be a general characteristic of the autistic population with long-term tone language experience. These findings reveal typical tone and intonation processing at both the form and function levels in cognitively able Mandarin-speaking autistic children and provide evidence for associated tone and intonation processing abilities across levels.

Treating hypersensitivity in older adults with silver diamine fluoride: A randomised clinical trial.

OBJECTIVE: This study aimed to evaluate the desensitizing effect of topically applied 38% silver diamine fluoride (SDF) solution on the exposed root surface of hypersensitive teeth in older adults. METHOD: This double-blind randomised clinical trial recruited healthy older adults with dentine hypersensitivity. A trained examiner tested the most hypersensitive tooth root surface with a blast of compressed cold air from a three-in-one syringe. The participants gave a sensitivity score (SS) in visual analogue scale from 0 (no pain) to 10 (agonizing) at the baseline visit. Then, they received 38% SDF or 5% potassium nitrate solution (control) as intervention on the root surface. After the intervention, they received a compressed cold air test and reported the SS again. The compressed cold air test followed by intervention was repeated at 4- and 8-week follow ups. The primary outcome was the reduction in SS at 8-week follow-up with reference to the SS at baseline before intervention. Shapiro-Wilk and Mann-Whitney U tests were performed for data analysis following a normality test of SS. RESULTS: This trial recruited 148 participants, and 139 (94%) participants completed the trial. The median percentage reductions in SS in the SDF and potassium nitrate groups were 60% and 50%, respectively (p < 0.001). CONCLUSION: According to the results, 38% SDF solution reduced hypersensitivity on the exposed root surface of older adults. In addition, 38% SDF was more effective than 5% potassium nitrate solution to reduce hypersensitivity on the exposed root surface of older adults. CLINICAL SIGNIFICANCE: Dentin hypersensitivity is common amongst older adults and negatively affects their quality of life. To date, there is no gold standard professionally applied desensitizing therapy in treating hypersensitivity. Evidence from this clinical trial could aid clinical practice and improve oral health in older adults. TRIAL REGISTRATION: This study was registered at ClinicalTrials.gov (NCT05392868).

Challenges in Accurate Diagnosis of HCC in FALD: A Case Series.

Patients with single ventricle cardiac disease palliated with Fontan procedures inevitably develop Fontan-Associated Liver Disease (FALD), which poses a significant risk for hepatocellular carcinoma (HCC). Standard imaging criteria for the diagnosis of cirrhosis are not reliable due to parenchymal heterogeneity of FALD. We present 6 cases to demonstrate our center's experience and the challenges in diagnosing HCC within this patient population.

Theory-based behavioral change interventions to improve periodontal health.

Periodontal disease is a significant global health burden affecting half of the world's population. Given that plaque and inflammation control are essential to the attainment of periodontal health, recent trends in preventive dentistry have focused on the use of behavioral models to understand patient psychology and promote self-care and treatment compliance. In addition to their uses in classifying, explaining and predicting oral hygiene practices, behavioral models have been adopted in the design of oral hygiene interventions from individual to population levels. Despite the growing focus on behavioral modification in dentistry, the currently available evidence in the field of periodontology is scarce, and interventions have primarily measured changes in patient beliefs or performance in oral hygiene behaviors. Few studies have measured their impact on clinical outcomes, such as plaque levels, gingival bleeding and periodontal pocket reduction, which serve as indicators of the patient's disease status and quality of oral self-care. The present narrative review aims to summarize selected literature on the use of behavioral models to improve periodontal outcomes. A search was performed on existing behavioral models used to guide dental interventions to identify their use in interventions measuring periodontal parameters. The main models were identified and subsequently grouped by their underlying theoretical area of focus: patient beliefs (health belief model and cognitive behavioral principles); stages of readiness to change (precaution adoption process model and transtheoretical model); planning behavioral change (health action process approach model, theory of planned behavior and client self-care commitment model); and self-monitoring (self-regulation theory). Key constructs of each model and the findings of associated interventions were described. The COM-B model, a newer behavioral change system that has been increasingly used to guide interventions and policy changes, is discussed with reference to its use in oral health settings. Within the limitations of the available evidence, interventions addressing patient beliefs, motivation, intention and self-regulation could lead to improved outcomes in periodontal health. Direct comparisons between interventions could not be made due to differences in protocol design, research populations and follow-up periods. The conclusions of this review assist clinicians with implementing psychological interventions for oral hygiene promotion and highlight the need for additional studies on the clinical effects of behavioral model-based interventions.

Complex Repair of Anomalous Left Coronary Artery From the Pulmonary Artery in a 55-Year-Old Patient.

Anomalous left coronary artery from the pulmonary artery (ALCAPA) is a congenital malformation that classically presents within the first year of life. Few patients survive into adulthood, and initial presentation after the fourth decade of life is rare. We describe a 55-year-old woman who presented after cardiac arrest. She initially refused surgery and underwent automated implantable cardioverter defibrillator placement, followed later by surgical repair involving reimplantation of the left coronary artery to the aorta and pulmonary artery reconstruction using interposition grafts. We report this late presentation of ALCAPA and successful surgical management.

Integration of Oral Health into General Health Services for Older Adults.

The prevalence of oral diseases in the older adult population remains high worldwide and is expected to surge in the coming decade. The World Health Organization (WHO) has listed the oral health of older adults as one of its pivotal concerns. Oral health affects general health, and oral diseases increase mortality and morbidity in older adults. Integrating oral health into the general health service with a patient-centred approach can be an effective way to improve oral and systemic health for older adults simultaneously. This integration tackles the shared risk factors of both oral and noncommunicable diseases, aids in the early detection of systemic disease, strengthens health surveillance, enhances efficient data sharing, and allows for the better allocation of resources and the workforce in the healthcare system. However, the oral healthcare sector operates as an isolated field, with an emphasis on intervention rather than prevention, which presents a key challenge to the success of integration. Therefore, refocusing oral healthcare service on prevention is paramount. In addition, approaches taken in clinical practice implementation, interprofessional education and training, technology and innovation, research and evaluation, advocacy by national professional oral healthcare organizations, and policy making will ensure the efficient, effective, and long-term integration of oral and general health services. Integrating these services would foster the accessibility and affordability of oral healthcare services for older adults to improve their oral health and overall well-being in the coming decade. This review aims to discuss the merits and outline the challenges of integrating oral health into general health services for older adults and to propose the approaches that could be taken.

Native Language Perceptual Sensitivity Predicts Nonnative Speech Perception Differently in Younger and Older Singaporean Bilinguals.

PURPOSE: We investigate in this study how individual variability in native language speech perception (termed Perceptual Sensitivity) influences nonnative speech perception in Singaporean Tamil-English bilinguals. Further, we assess if and how contextual and demographic factors influence Perceptual Sensitivity in the acquired languages and if the influence of Perceptual Sensitivity on nonnative speech perception is different across younger and older bilinguals. METHOD: Perceptual Sensitivity in the native languages was examined by implementing Tamil and English gating tasks in 87 Singaporean Tamil-English bilinguals from two age groups (younger: 19-33 years; older: 55-70 years). Mandarin lexical tone discrimination was implemented as a measure of nonnative speech perception. RESULTS: There was a wide range of variability in Perceptual Sensitivity scores in both languages across both age groups. Perceptual Sensitivity in the first native language (L1 Tamil) was a robust predictor of nonnative speech perception across both age groups, especially for the older bilinguals. However, general intelligence emerged as a stronger predictor than Tamil Perceptual Sensitivity in younger bilinguals. The influence of Tamil Perceptual Sensitivity on lexical tone perception was not tone-specific, supporting a general enhancement of lexical tone perception with better Tamil Perceptual Sensitivity. There was an influence of demographic factors on English Perceptual Sensitivity in older bilinguals, but not for Tamil and not in younger bilinguals. CONCLUSIONS: Our findings corroborate with previous studies in showing that native language Perceptual Sensitivity is positively associated with and predicts nonnative speech perception in younger and older adulthood regardless of language similarity but to varying degrees. Specifically, the influence of Perceptual Sensitivity on nonnative speech perception is stronger in older adulthood, suggesting a possible shift in reliance on crystallized language knowledge with age. Proficiency and use, among other demographic and language variables, do not appear to influence L1 Perceptual Sensitivity in a lesser used language (Tamil) as significantly as previously assumed.