Impact of the special care dentistry education on Malaysian students' attitudes, self-efficacy and intention to treat people with learning disability.

INTRODUCTION: Special Care Dentistry (SCD) education has been introduced in Malaysia, but there are limited number of studies about its impact to students. Thus, this study aimed to explore the level of students' readiness to treat people with learning disability (PWLD) based on their attitudes, self-efficacy and intention to treat. METHODS: A questionnaire was developed based on the Dental Student Attitude to the Handicapped Scale, Scale of Attitudes to the Disabled Persons and Health Action Process Approach. The self-administered, validated questionnaire was tested for reliability (Cronbach's alpha = .71-.81), before being distributed to clinical dental students of both genders from two universities (University A, n = 176 and University B, n = 175). Quantitative data were analysed via t test and ANOVA (p < .05) using the SPSS software. RESULTS: There was no significant difference in mean total attitude score between the universities, although dental students from University A, who mostly reported having received hands-on clinical experience in SCD and exposure to Disability Equality Training (DET), showed significantly higher individual mean attitude score for 5 (out of 24) attitudinal items. The mean total self-efficacy score and individual mean self-efficacy score for 1 (out of 5) self-efficacy items were also significantly higher amongst University A dental students. The intention to treat PWLD was not significantly influenced by university, gender or year of study. CONCLUSION: Incorporation of SCD education in the undergraduate curriculum, with hands-on clinical experience and exposure to DET, is recommended to equip students to be efficient oral healthcare providers for PWLD.

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

BACKGROUND: There is a lack of evidence with regards to the association between both maternal and child dental anxiety and the mother's perception of her child's oral health-related quality of life (COHRQoL). The aim of this study was to investigate the association of maternal and child dental anxiety with COHRQoL and the effect of demographic factors as moderators in this relationship. In addition, the association between child's dental caries experience and the COHRQoL was also assessed. METHODS: A cross-sectional study was conducted involving 1150, 5-6 year-old preschool children in Selangor, Malaysia. Mothers answered a questionnaire on socio-economic status, the Malay-Modified Dental Anxiety Scale to assess maternal dental anxiety, and the Malay-Early Childhood Oral Health Impact Scale to assess COHRQoL. Child's dental anxiety was assessed using the Malay-Modified Child Dental Anxiety Scale via a face-to-face interview prior to oral examination to assess dental caries. Data were analysed using structural equation modelling to assess the relationship between maternal and child dental anxiety and COHRQoL. RESULTS: Overall, complete data on 842 mother-child dyads were analysed. The mean scores of total ECOHIS, the child impacts section (CIS), and the family impacts section (FIS) were 17.7 (SD = 4.9), 12.6 (SD = 3.7), and 5.1 (SD = 1.9), respectively. The mean dental anxiety scores for mothers and children were 11.8 (SD = 4.5) and 16.9 (SD = 4.3), respectively. Maternal dental anxiety was associated with the CIS (b = 0.08, p < 0.001), the FIS (b = 0.01, p = 0.001), and the total ECOHIS (b = 0.14, p < 0.001). Maternal education level, income, urban/rural location, and kindergarten type were moderators to the relationship. In addition, there was also a significant relationship between child's dental caries experience and COHRQoL (p < 0.001). CONCLUSIONS: Maternal dental anxiety and child's dental caries experience have significantly impacted the COHRQoL, the CIS, and the FIS domains. Demographic factors such as maternal education, income, urban/rural location, and kindergarten type acted as moderators that can strengthen or weaken the relationship between maternal dental anxiety and COHRQoL of 5-6-year-old preschool children.

General and erosive tooth wear of 16-year-old adolescents in Kuantan, Malaysia: prevalence and association with dental caries.

BACKGROUND: The objective of this study was to determine the prevalence and severity of general tooth wear (GTW), i.e. tooth wear irrespective of etiology and erosive tooth wear (ETW), i.e. tooth wear predominantly due to erosion; and also to investigate the relationship between ETW and dental caries experience in 16-year-old adolescents in Kuantan, Malaysia. METHODS: A multi-staged cluster sampling method was employed. A total of 598 16-year-old adolescents participated in this study. Participants' demographic profile was assessed through a self-administered questionnaire. Clinical examinations were carried out under standardized conditions by a single examiner. The level of GTW was recorded using the modified Smith and Knight's Tooth Wear Index (TWI) whilst ETW were recorded using the Basic Erosive Wear Examination (BEWE) index. This index was developed to record clinical findings and assist in the decision-making process for the management of erosive tooth wear. Dental caries was recorded using the D3MFT index whereby D3 denotes obvious dental decay into dentine detected visually. RESULTS: The prevalence of GTW, ETW and dental caries, i.e. percentage of individuals found to have at least one lesion, was 99.8%, 45.0% and 27.8% respectively. Two thirds of affected teeth with GTW were observed to have a TWI score of 1 whereas almost all of the affected teeth with ETW had a BEWE score of 2. The mean D3MFT was 0.62 (95% CI 0.50, 0.73) with Decayed (D) teeth being the largest component, mean D3T was 0.36 (95% CI 0.30, 0.43). There was no significant association between socio-demographic factors and prevalence of ETW. Logistic regression analysis also showed no significant relationship between the prevalence of ETW and D3MFT (p > 0.05). CONCLUSIONS: Almost all adolescents examined had GTW but they were mainly early lesions. However, nearly half were found to have ETW of moderate severity (BEWE score 2). No significant relationship between the occurrence of erosive tooth wear and caries was observed in this population.

The Malay version of the Early Childhood Oral Health Impact Scale (Malay-ECOHIS)--assessing validity and reliability.

BACKGROUND: The Early Childhood Oral Health Impact Scale (ECOHIS) is used to assess oral impacts on the quality of life of preschool aged children and their families. The objective of this study was to perform a cross-cultural adaptation of the ECOHIS into Malay and assess its psychometric properties. METHODS: The cross-cultural adaptation of ECOHIS into Malay comprised of translating the ECOHIS into the Malay language (Malay-ECOHIS) by experts followed by face validation of the Malay-ECOHIS by a group of mothers. The Malay-ECOHIS was back translated into English and this was compared with the original ECOHIS. Minor changes were made to the Malay-ECOHIS before it was finalised. The Malay-ECOHIS' psychometric properties were assessed in terms of construct, convergent and discriminant validity as well as internal and test-retest reliability based on two separate studies involving 127 parents of 4-6 year old preschool children followed by oral examinations of 860 preschool children from 25 kindergartens from two districts in Selangor state, Malaysia. Non-parametric statistics were used to assess the relationships between the Malay-ECOHIS and the subjective and clinical outcome measures. RESULTS: The Cronbach's alpha was 0.83 and the weighted Kappa was 0.95 (intraclass correlation = 0.94). The Malay-ECOHIS demonstrated significant associations with different subjective and normative measures, i.e. levels of oral health satisfaction, perceived oral health status, perceived oral health need, toothache experience, pattern of dental attendance, and caries status of preschool children. These significant associations supported its construct, convergent and discriminant validity as well as internal and test-retest reliability. CONCLUSION: This study showed that the Malay-ECOHIS is a valid and reliable instrument to assess the negative impacts of oral disorders/conditions on the quality of life of 4-6 year old preschool children and their families in Malaysia.

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

BACKGROUND: To evaluate the psychometric properties of the faces version of the Modified Child Dental Anxiety Scale (MCDASf) Malay version in 5-6 and 9-12 year-old children. METHODS: The MCDASf was cross culturally adapted from English into Malay. The Malay version was tested for reliability and validity in 3 studies. In the Study 1, to determine test-retest reliability of MCDASf scale, 166 preschool children aged 5-6 years were asked to rank orders five cartoons faces depicting emotions from 'very happy' to 'very sad' faces on two separate occasions 3 weeks apart. A total of 87 other 5-6 year-old children completed the Malay-MCDASf on two separate occasions 3 weeks apart to determine test-retest reliability for Study 2. In study 3, 239 schoolchildren aged 9-12 years completed the Malay-MCDASf and the Malay-Dental Subscale of the Children Fear Survey Schedule (CFSS-DS) at the same sitting to determine the criterion and construct validity. RESULTS: In study 1, Kendall W test showed a high degree of concordance in ranking the cartoon faces picture cards on each of the 2 occasions (time 1, W = 0.955 and time 2, W = 0.954). The Malay-MCDASf demonstrated moderate test-retest reliability (Intraclass correlation coefficient = 0.63, p <0.001) and acceptable internal consistency for all the 6 items (Cronbach's alpha = 0.77) and 8 items (Cronbach's alpha = 0.73). The highest MCDASf scores were observed for the items 'injection in the gum' and 'tooth taken out' for both age groups. The MCDASf significantly correlated with the CFSS-DS (Pearson r = 0.67, p < 0.001). CONCLUSIONS: These psychometric findings support for the inclusion of a cartoon faces rating scale to assess child dental anxiety and the Malay-MCDASf is a reliable and valid measure of dental anxiety in 5-12 year-old children.

Is the burden of oral diseases higher in urban disadvantaged community compared to the national prevalence?

BACKGROUND: The urban low income has often been assumed to have the greatest dental treatment needs compared to the general population. However, no studies have been carried out to verify these assumptions. This study was conducted to assess whether there was any difference between the treatment needs of an urban poor population as compared to the general population in order to design an intervention programme for this community. METHODS: A random sampling of living quarters (households) in the selected areas was done. 586 adults over 19 years old living in these households were clinically examined using World Health Organization (WHO) Oral Health Survey criteria 4th edition (1997). RESULTS: The overall prevalence of dental caries, periodontal disease, denture wearers and temporomandibular joint problems were 70.5%, 97.1%, 16.7% and 26%, respectively. The majority (80.5%) needed some form of dental treatment. The highest treatment needs were found in the oldest age group while the lowest were in the youngest group (19-29 years) (p = 0.000). The most prevalent periodontal problem was calculus; regardless of gender, ethnicity and age. Significantly more females (20.5%) wore prosthesis than males (11.1%) (p = 0.003). Prosthetic status and need significantly increased with age (p = 0.000). About one in four adults had Temporo-Mandibular Joint (TMJ) problems. Overall, it was surprising to note that the oral disease burden related to caries, prosthetic status and treatment need were lower in this population as compared to the national average (NOHSA, 2010). However, their periodontal disease status and treatment needs were higher compared to the national average indicating a poor oral hygiene standard. CONCLUSIONS: The evidence does not show that the overall oral disease burden and treatment needs in this urban disadvantaged adult population as higher than the national average, except for periodontal disease. The older age groups and elderly were identified as the most in need for oral health intervention and promotion. An integrated health intervention programme through a multisectoral common risk factor approach in collaboration with the Faculties of Medicine, Dentistry and other agencies is needed for the identified target group.

The relationship of dental caries and dental fear in Malaysian adolescents: a latent variable approach.

BACKGROUND: To investigate the role of geography (place of residence) as a moderator in the relationship between dental caries disease and treatment experience and dental fear in 16-year-olds living in Malaysia. METHODS: A multi-stage-stratified sampling method was employed. Five hundred and three, 16-year-olds from 6 government secondary schools participated in this study. The questionnaire examined participants' demographic profile and assessed their dental fear using the Dental Fear Survey (DFS). The clinical examination consisted of the DMFT as the outcome measure of dental caries disease and treatment experience by a single examiner (ICC = 0.98). Structural equation modelling inspected the relationship between dental fear and dental caries disease and treatment experience. RESULTS: The mean DMFT was 2.76 (SD 3.25). The DT, MT and FT components were 0.64 (SD 1.25), 0.14 (SD 0.56) and 1.98 (SD 2.43) respectively. Rural compared with urban adolescents had significantly greater mean numbers of decayed and missing teeth. The mean DFS score was 40.8 (SD 12.4). Rural compared with urban adolescents had significantly higher mean scores for physical symptoms of dental fear. The correlation between dental fear (DFS) and dental caries disease and treatment experience (DMFT) was 0.29, p < 0.0001. The structural equation model fitted the raw data well (χ2 = 9.20, df = 8, p = 0.34). All components of DMFT were closely associated in equal strength to the unidimensional hypothetical latent variable of dental caries disease and treatment experience. The strength of the relationship between dental fear and dental caries disease and treatment experience varied in accordance with place of residence. CONCLUSION: In conclusion a relationship between dental fear and dental caries disease and treatment experience was shown to exist in 16-year-old adolescents living in Malaysia. This study showed that the rural-urban dichotomy acted as a moderator upon this relationship.

A school-based fluoride mouth rinsing programme in Sarawak: a 3-year field study.

BACKGROUND: This study was undertaken to assess the impact of fluoride mouth rinsing on caries experience in a cohort of schoolchildren 3 years after implementation. METHODS: 270 children aged 8-9 years from four schools in Sarawak were selected at baseline. Baseline data was collected to ensure that the selected schools did not differ significantly. Children from two schools rinsed with 0.2% sodium fluoride under supervision, while those from the other schools did not. RESULTS: After 3 years, 242 schoolchildren remained in the study. At the end of the study, the mean DMFT for the test group was 2.3 (95% CI, 1.93-2.67) while the mean DMFT for the control group was 4.01 (95% CI, 3.39-4.63). The mean DMFS for the test group was 3.40 (95% CI, 2.68-4.12) while the mean DMFS for the control group was 6.67 (95% CI, 5.47-7.87). After 3 years, 24.2% of those in the test group remained caries free compared to 11.5% in the control group. The risk of developing caries decreased 0.52 times among the children from the 'test' group exposed to the fluoride mouth rinsing programme as compared to the unexposed 'control' group (RR = 0.48, 95% CI, 0.26-0.85). DISCUSSION AND CONCLUSION: The findings show that a school-based weekly 0.2% sodium fluoride mouth rinsing programme is an effective caries preventive measure and should be implemented in fluoride-deficient areas as a means of reducing the prevalence of dental caries in these communities.

The relationship between dental anxiety and dental decay experience in antenatal mothers.

The aim of this study was to investigate the relationship between dental anxiety and dental decay experience among antenatal mothers attending Maternal and Child Health clinics in Malaysia. A cross-sectional study was conducted on a consecutive sample of 407 antenatal mothers in Seremban, Malaysia. The questionnaire consisted of participants' demographic profile and the Dental Fear Survey. The D(3cv)MFS was employed as the outcome measure and was assessed by a single examiner (intraclass correlation = 0.98). A structural equation model was designed to inspect the relationship between dental anxiety and dental decay experience. The mean Dental Fear Survey score for all participants was 35.1 [95% confidence interval (34.0, 36.3)]. The mean D(3cv)MFS score was 10.8 [95% confidence interval (9.5, 12.1)]. Participants from low socio-economic status groups had significantly higher D(3cv)MFS counts than those from high socio-economic status groups. The path model with dental anxiety and socio-economic status as predictors of D(3cv)MFS showed satisfactory fit. The correlation between dental anxiety and dental decay experience was 0.30 (standardized estimate), indicating a positive association. Socio-economic status was also statistically significantly associated with the D(3cv)MFS count (beta = 0.19). This study presented robust evidence for the significant relationship between dental anxiety and dental decay experience in antenatal mothers.

Satisfaction with the oral health services. A qualitative study among Non-Commissioned Officers in the Malaysian Armed Forces.

INTRODUCTION: Patient satisfaction is critical for the growth and prosperity of any oral health service or practice. The success of any oral health service can be assessed by an evaluation of the degree of satisfaction/dissatisfaction of its patients. OBJECTIVE: The aim of this study is to assess satisfaction/dissatisfaction with the oral health services among Non-Commissioned Officers (NCOs) in the Malaysian Armed Forces (MAF). METHOD: A qualitative study using the Nominal Group Technique was undertaken. Eighty subjects from the Rasah Camp, Seremban were randomly selected from four lists, namely privates, male and female corporals and sergeants and were grouped into 10 discussion groups of eight participants each. Of the 10 groups, four groups comprised male corporals, three groups of privates, two groups of sergeants and one group of female corporals. Two separate discussion sessions were conducted to elicit factors/items causing dissatisfaction and satisfaction expressed by the participants. Every participant then scored all the factors perceived as important by members of the group. The score ranged from 0-9 i.e., the least to the most important. Scores were weighted, and the weighted score of every participant for each item was added. The ratings of the factors were determined by comparing the sum of the weighted scores. RESULTS: The six most important factors/items rated in the satisfaction discussion were modem equipment (9.07), friendly dentist (8.27), pleasant surgery (8.23), good quality treatment (7.93), friendly staff (7.18) and pain alleviation (6.07). These factors were further regrouped into three broad categories i.e. (1) Clinic set-up, (2) Patient-personnel interaction (PPI) and (3) Technical competency (TC). In the dissatisfaction discussion six factors/items were rated i.e. long waiting time (10.39), sequence of treatment not followed (7.18), non-availability of dentist (7.16), unfriendly staff (7.05), poor quality treatment (6.80) and restricted time for treatment (5.98). The three most important categories in the dissatisfaction discussion were (1) Administrative efficiency, (2) PPI and (3) TC. CONCLUSION: A conceptual model was developed to explain the factors affecting patients' satisfaction/dissatisfaction with the oral health services. It is recommended that a questionnaire survey be undertaken to validate and reflect the entire population of the MAF. Remedial measures highlighted in the areas of dissatisfaction should be addressed accordingly based on the quantitative study.