Association of temperament with oral health behaviour and caries status in Thai preschool children.

BACKGROUND: Temperament associated with oral health behaviour and early childhood caries (ECC) in preschoolers remains inconclusive. AIM: This cross-sectional study investigated the association of temperament with oral health behaviour and ECC status. DESIGN: A total of 421 Thai preschoolers were recruited from elementary schools in Chonburi Province, Thailand. Their caregivers assessed three temperament dimensions (surgency, negative affectivity and effortful control) using the Thai version of the Children's Behaviour Questionnaire Very Short Form and reported oral health behaviours (brushing cooperation and cariogenic snack frequency). Three calibrated dentists assessed ECC status using the modified WHO dmft/dmfs (decayed, missing and filled teeth/surface) index that included noncavitated and cavitated carious lesions. RESULTS: Multiple regression analysis, after adjusting for child's and caregiver's characteristics, revealed that children with high negative affectivity or low effortful control were more likely to have uncooperative brushing behaviour. The temperament scores of children who consumed cariogenic snacks daily and those who did not were comparable. Children with low surgency, high negative affectivity or low effortful control were more likely to have high dmfs scores. CONCLUSION: Negative affectivity and effortful control were associated with brushing behaviour. Temperament was not associated with the frequency of cariogenic snack consumption. All temperamental dimensions, however, were associated with ECC.

Influence of past advanced behavior guidance experience on parental acceptance for autistic individuals in the dental setting.

BACKGROUND: Autism is a lifelong neurodevelopmental disorder that poses challenges during dental treatment. Advanced behavior guidance techniques (BGTs) have been used to provide dental care for autistic people who have specific characteristics and complex dental treatment. This study was conducted to evaluate parental acceptance and analyze parents' opinions of advanced BGTs during dental treatment in autistic people. METHODS: This cross-sectional study was conducted on 141 parents of autistic people from the Mahidol Dental Hospital and the Autism online community. Informed consent was obtained before enrolling participants in the study. All parents were asked to rate their acceptance after watching VDO clips: passive restraint by device (PRBD), oral sedation (OS), and general anesthesia (GA) to evaluate parental acceptance of advanced BGTs through an online questionnaire survey. The online questionnaire included a visual analog scale (VAS) and open-ended questions to collect their opinions on each advanced BGT. Participants were categorized into two subgroups as follows: 81 in the "Experience group" and 60 in the "No experience group" according to their autistic people' advanced BGT experience. Friedman's two-way analysis of variance and the Mann-Whitney U test were used for statistical analyses. Open-ended questions were analyzed using quantitative content analysis. RESULTS: PRBD was ranked the highest, followed by GA and OS. Parents in the "Experience group" rated significantly higher acceptance of their BGT experience than parents in the "No experience group" in all the three advanced BGTs. CONCLUSIONS: All advanced BGTs were particularly accepted in this study. Previous experience of advanced BGTs had an influence on parental acceptance. Parents commented on their opinions toward each advanced BGT with a variety of perspectives. TRIAL REGISTRATION: The protocol was approved by the ethical committee of the Faculty of Dentistry/Faculty of Pharmacy, Mahidol University (COA.No.MU-DT/PY-IRB 2021/022.1702) and was registered with Thai Clinical Trials Registry (TCTR20220521001).

Association of sensory sensitivities and toothbrushing cooperation in autism spectrum disorder.

BACKGROUND: Sensory over-responsivity (SOR) is common in autistic spectrum disorder (ASD), and it leads to a more intense response to sensory stimuli. AIM: To compare toothbrushing cooperation at home and in a dental office between SOR and sensory not over-responsivity (SNOR) children with ASD. DESIGN: This cross-sectional observational study was conducted with 51 children with ASD aged 4-17 years. Caregivers assessed each subject's sensory response by completing a back-translation questionnaire listing eight sensitivities. Subjects who had three or more of the sensitivities were considered SOR subjects. Toothbrushing cooperation in the dental office was recorded on videos. Statistical analysis used the Spearman correlation coefficient, chi-square test, Fisher's exact test, and Mann-Whitney U test. RESULTS: SNOR subjects (n = 10) had significantly higher scores in toothbrushing cooperation at home and in the dental office than did SOR subjects (n = 41) (P < .05). Oral sensitivity was significantly associated with toothbrushing cooperation at home, whereas oral, light, sound, and touch (face) sensitivities were significantly correlated with toothbrushing cooperation in the dental office (P < .05). CONCLUSIONS: SOR subjects showed less toothbrushing cooperation than SNOR subjects both at home and in the dental office.

A retrospective comparison of dental treatment under general anesthesia versus non-pharmacological approach in patient with special health care needs.

Background/purpose: The unmet dental needs are still at the highest rate in patients with special health care needs (SHCN) owing to their physical conditions, lack of cooperation, anxiety and dental fear. This study was aimed to investigate the differences in characteristics and outcomes of dental treatment between general anesthesia (GA) and non-pharmacological approach (NP) in patients with SHCN. Materials and methods: This study reviewed the dental chart records of SHCN patients from 2005 to 2019. The dental chart records were divided into two subgroups: GA and NP groups. The demographic data, recall behavior and treatment outcomes were analyzed and compared between groups. The comparisons between groups were analyzed by Pearson's chi-squared test, Fisher's exact test and Mann-Whitney U test at a significant level of 0.05. Results: Two hundred and sixty-one patients aged 2.2-43.1 years with mean age 14.22 ± 8.64 years old were included. The proportion of cases treated under GA (62%) and NP (38%) was 1.6:1. General anesthesia group had significantly higher in mean ages, caries experience, definitely negative behavior and treatment needs than NP group (P < 0.001). Moreover, recall rates in GA group were significantly lower than NP group (P < 0.001) without a significant difference in regularity. New caries occurrence (P = 0.015) with faster rate (P = 0.035), and behavior changes was significantly found in GA group (P = 0.007) after 24 months of recall. Conclusion: Patients with SHCN who were at older age and had high caries experience with definitely negative behavior and numerous treatment needs were more justifiably for GA. A significant new caries occurrence with faster rate tended towards SHCN patients who underwent GA.

A 6-month comparison of toothbrushing efficacy between the horizontal Scrub and modified Bass methods in visually impaired students.

OBJECTIVE: The aim of this study was to compare the efficacy of the horizontal Scrub and modified Bass methods of toothbrushing in visually impaired students for 6 months. METHODS: Sixty visually impaired students, aged 10-12 years, were recruited to a randomized controlled clinical trial. At baseline, plaque index (PI) and gingival index (GI) were assessed, and then subjects were randomly divided into the horizontal Scrub and modified Bass groups. Subjects received verbal and tactile toothbrushing instruction and used their assigned methods twice daily. They were recalled at 1 and 6 months for clinical measurement and reinforce of instruction. Significance of PI and GI over time was compared using the paired t-test and between brushing group at each time point using the t-test. RESULTS: Over the 6-month period, there were significant reduction from baseline for the mean PI and GI in both groups (P < 0.001). There were no significant differences between two methods at each time point (P > 0.05), however. CONCLUSIONS: Both the horizontal Scrub and modified Bass methods can be effectively reduced plaque index and gingival index in visually impaired students. The efficacy of both methods was not different, however.

Visual pedagogy-guided toothbrushing training to enhance fine motor skills in individuals with intellectual disabilities and impaired fine motor skills.

AIMS: To evaluate the effect of visual pedagogy-guided toothbrushing training on oral hygiene, toothbrushing ability, and fine motor skills in individuals with intellectual disability (ID) and impaired fine motor skills. METHODS: This quasi-experimental study comprised 37 subjects aged 6-24 years. The plaque index (PI), gingival index (GI), toothbrushing ability, and fine motor skills were evaluated before and after 3 and 6 months of individual visual pedagogy-guided toothbrushing training. Friedman's post hoc test and Spearman's correlation coefficient were used for statistical analyses. RESULTS: The PI, GI, toothbrushing ability, and fine motor skills of the 23 subjects who remained in the study at the 6-month follow-up period significantly improved from those measured at baseline (p < 0.05). A significant association was observed between the improvements in both toothbrushing ability and fine motor skills (p < 0.05). CONCLUSIONS: Visual pedagogy-guided toothbrushing training could improve the oral hygiene and toothbrushing ability of individuals with ID and impaired fine motor skills. Moreover, improvements in the toothbrushing ability could enhance the fine motor skills of these individuals.

Effects of fluoride dentifrice on remineralization of demineralized primary enamel.

This study was performed to compare the remineralizing effects of various concentrations of fluoride containing dentifrices against artificial demineralization of primary enamel. One hundred twenty primary incisors were partly covered with a nail varnish, leaving a 1 x 1 mm window, then placed in demineralizing solution for 96 hours to produce artificial carious lesions 60-100 microm in depth. They were assigned to 8 groups (A to H; n = 15). Groups A-D were exposed to a half pea-sized portion of dentifrice (0.16 g) and groups E-H were exposed to a pea-sized portion of dentifrice (0.32 g), both groups with fluoride concentrations of 0, 250, 500 and 1,000 ppm. The pH-cycling method was carried out for 7 days, then the teeth were cut through the lesions and examined under a polarized light microscope; photographs were taken and analyzed. Lesion depth was measured using a computerized method using the Image-Pro Plus Program. The results were analyzed using the One way ANOVA and LSD tests. The mean lesion depth in the 2 non-fluoridated control groups (A and E) were significantly deeper than in the fluoridated groups. There were no differences found between the half pea-sized and pea-sized dentifrice.

Parental acceptance of behavior management techniques for preschool children in dental practice: Revisited.

BACKGROUND: Parental acceptance of behavior management techniques (BMTs) in dental practice is important and subjected to change with the dynamics of the society. AIMS: The aim of this study was to evaluate the parental acceptance of eight selected BMTs: tell-show-do (TSD), voice control (VC), passive restraint (PR), active restraint (AR), parental presence/absence (PP/PA), oral sedation (OS), inhalation sedation nitrous oxide/oxygen (N2O/O2), and general anesthesia (GA) and its associated factors in a group of Thai parents. DESIGN: The cross-sectional study was conducted among 200 parents of preschool children in Bangkok metropolitan. MATERIALS AND METHODS: Parents were asked to rate the BMTs demonstrated in video with a Visual Analog Scale (VAS). Possible relevant factors were collected via questionnaires. Descriptive statistics were used to describe the samples. BMTs were ranked by mean VAS using the general linear model repeated measure. The association between the mean VASs and parental and child's factors was analyzed using the one-way ANOVA and independent t-test. Significant factors were further analyzed by multiple linear regression. The level of confidence was set at 95%. RESULTS: All BMTs were acceptable. TSD was rated the highest, followed by PR, VC, AR, N2O/O2, OS, GA, and PP/PA, respectively. Parental dental anxiety was associated with less acceptance of PP/PA. Child's experience of VC, AR, OS, and PP/PA was related to better acceptance of the techniques. CONCLUSIONS: The BMTs were better accepted with similar pattern compared to past studies. PP/PA was the least accepted related to high parental anxiety. Child's experience with BMTs increased the acceptance.

The Effectiveness of Visual Pedagogy for Toothbrushing in Children with Autism Spectrum Disorder.

OBJECTIVES: The aim of this study was to evaluate toothbrushing effectiveness in children with mild and moderate levels of severity of autism spectrum disorder (ASD) after using visual pedagogy. MATERIALS AND METHODS: This quasi-experimental study was carried out with 30 children with ASD aged 5-17 years; 21 had mild ASD and 9 had moderate ASD. Informed consent and the subject's demographic information were obtained from caregivers. All subjects were then asked to show their toothbrushing practices, which were recorded by video. The toothbrushing ability, toothbrushing cooperation, and plaque index were evaluated before the study and at 2 weeks, 4 weeks, 3 months, and 6 months after visual pedagogy had been used. Results were analyzed by the Friedman test, Pearson's chi-square test, Fisher's exact test, and Mann‒Whitney U test. RESULTS: Toothbrushing ability was significantly improved at all periods of follow-up. Toothbrushing cooperation and the dental plaque index were significantly better than before the study at 4 weeks, 3 months, and 6 months of follow-up. The toothbrushing ability of subjects with mild ASD was significantly better than that of subjects with moderate ASD at 4 weeks and 6 months of follow-up. The toothbrushing cooperation of the mild group was significantly better than that of the moderate group at 2 weeks, 4 weeks, and 3 months. There was no statistically significant reduction in the plaque index between the two groups. CONCLUSION: Visual pedagogy is useful for improving toothbrushing effectiveness in children with mild or moderate severity ASD. However, children with moderate severity ASD take longer to improve.