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).

Psychometric evaluation of the Thai version of the Early Childhood Oral Health Impact Scale (Th-ECOHIS): a cross sectional validation study.

BACKGROUND: Early childhood caries (ECC) is prevalent in Thailand, but no appropriate tool has been available to measure its impact on children's quality of life. This study translated the Early Childhood Oral Health Impact Scale (ECOHIS), a widely used proxy-reported questionnaire developed in the United States for measuring the oral health-related quality of life of preschool children and their families, into Thai (Th-ECOHIS). The scale's psychometric properties were investigated in Thai caregivers and their children. METHODS: Cultural adaptation for the scale development within the Thai context was processed using forward-backward translation by experts. A face and content validation was conducted among 20 Thai caregivers to attain the final Th-ECOHIS. Psychometric testing was done on 3-year-old child-caregiver pairs in Bangkok using the interviewer-administered mode. Children's oral health was determined by caries experience (decayed, missing and filled primary teeth, dmft) and treatment need. The caregivers answered the Th-ECOHIS and global questions regarding their perception of the children's oral health. Across-items reliability was assessed by internal consistency using the Cronbach's alpha coefficient. Test-retest reliability was managed at a 2-week interval in 10% of the sample using the intraclass correlation coefficient calculated by two-way analysis of variance. The discriminant validity was tested by the relationship between the severity of dental caries, treatment need and Th-ECOHIS scores, using the Kruskal-Wallis test. RESULTS: A total of 214 child-caregiver pairs participated. Twenty-two percent had ECC (dmft 1-3) and 17.3% had severe ECC (dmft 4 or higher) with mean (SD) dmft 1.63 (2.92). All items in the original ECOHIS were retained in the Thai version. The test-retest reliability of Th-ECOHIS was 0.87; internal consistency was 0.85; the total Th-ECOHIS scores were significantly correlated with the global rating of oral health question (r = 0.604). Th-ECOHIS scores in both child and family impact sections and the total were significantly associated with the severity of caries (p <  0.001) and treatment need (p <  0.001). CONCLUSIONS: Th-ECOHIS demonstrated good reliability and validity. It could be used on caregivers to assess the impacts of ECC on quality of life of Thai pre-school children and compared to other countries.

Simplify pulpectomy in primary molars with a single-file reciprocating system: a randomized controlled clinical trial.

OBJECTIVES: To compare the clinical use of a single-file NiTi reciprocal system (sNiTi) to that of stainless steel hand file (SSH) instrumentation in primary tooth pulpectomy. MATERIALS AND METHODS: A prospective randomized clinical trial was conducted in 34 healthy children aged 3-7 years. Thirty-seven mandibular primary molars were randomly assigned to two groups: sNiTi and SSH. Instrumentation time, obturation time, quality of obturation, and 6- and 12-month clinical and radiographic outcomes were compared between the two groups. RESULTS: The median instrumentation time using sNiTi (3.23 min) was significantly shorter than that for SSH (7.38 min). Obturation times were not different. The quality of obturation was significantly different only in the mesial root canals; overfilling was seen more in the sNiTi group, while underfilling occurred more in the SSH group. At 6 and 12 months, both groups showed comparable clinical and radiographic success regardless of the type of instrumentation. CONCLUSIONS: sNiTi shortens instrumentation time with comparable obturation time, overall quality of obturation, and clinical and radiographic outcomes with SSH. CLINICAL RELEVANCE: Pulpectomy is indicated to prevent premature loss of primary teeth with irreversible inflamed or infected pulp. However, it is complicated and time-consuming. sNiTi reciprocating system is an alternative to hand filing technique, avoiding multiple steps and simplifying pulpectomy procedures.

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.

Global Oral Health Policies and Guidelines: Using Silver Diamine Fluoride for Caries Control.

Silver diamine fluoride (SDF) was developed in Japan in the 1960s. It is a clear solution containing silver and fluoride ions. Because of its anti-bacterial and remineralizing effect, silver diamine fluoride has been used in managing dental caries for decades worldwide. This paper aims to summarize and discuss the global policies, guidelines, and relevant information on utilizing SDF for caries management. SDF can be used for treating dental caries in most countries. However, it is not permitted to be used in mainland China. Several manufacturers, mainly in Australia, Brazil, India, Japan, and the United States, produce SDF at different concentrations that are commercially available around the world. The prices differ between contents and brands. Different government organizations and dental associations have developed guidelines for clinical use of SDF. Dental professionals can refer to the specific guidelines in their own countries or territories. Training for using SDF is part of undergraduate and/or postgraduate curriculums in almost all countries. However, real utilization of SDF of dentists, especially in the private sector, remains unclear in most places because little research has been conducted. There are at least two ongoing regional-wide large-scale oral health programs, using SDF as one of the components to manage dental caries in young children (one in Hong Kong and one in Mongolia). Because SDF treatment does not require caries removal, and it is simple, non-invasive, and inexpensive, SDF is a valuable strategy for caries management in young children, elderly people, and patients with special needs. In addition, to reduce the risk of bacteria or virus transmission in dental settings, using SDF as a non-aerosol producing procedure should be emphasized under the COVID-19 outbreak.

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.

Cariogenic properties of Streptococcus mutans clinical isolates with sortase defects.

OBJECTIVE: In Streptococcus mutans, a Gram-positive pathogen of dental caries, several surface proteins are anchored by the activity of sortase enzyme. Although various reports have shown that constructed S. mutans mutants deficient of sortase as well as laboratory reference strains with a sortase gene mutation have low cariogenic potential, no known studies have investigated clinical isolates with sortase defects. Here, we examined the cariogenic properties of S. mutans clinical isolates with sortase defects as well as caries status in humans harboring such defective isolates. DESIGN: Sortase-defective clinical isolates were evaluated for biofilm formation, sucrose-dependent adhesion, stress-induced dextran-dependent aggregation, acid production, and acid tolerance. Additionally, caries indices of subjects possessing such defective isolates were determined. RESULTS: Our in vitro results indicated that biofilm with a lower quantity was formed by sortase-defective as compared to non-defective isolates. Moreover, impairments of sucrose-dependent adhesion and stress-induced dextran-dependent aggregation were found among the isolates with defects, whereas no alterations were seen in regard to acid production or tolerance. Furthermore, glucan-binding protein C, a surface protein anchored by sortase activity, was predominantly detected in culture supernatants of all sortase-defective S. mutans isolates. Although the sortase-defective isolates showed lower cariogenic potential because of a reduction in some cariogenic properties, deft/DMFT indices revealed that all subjects harboring those isolates had caries experience. CONCLUSIONS: Our findings suggest the impairment of cariogenic properties in S. mutans clinical isolates with sortase defects, though the detection of these defective isolates seemed not to imply low caries risk in the subjects harboring them.

Multilocus sequence typing analysis of Streptococcus mutans strains with the cnm gene encoding collagen-binding adhesin.

Streptococcus mutans is one of the oral pathogens associated with infective endocarditis (IE). With respect to bacterial binding ability to the extracellular matrix, the Cnm protein, a cell surface collagen-binding adhesin of S. mutans, is known as one of the possible virulence factors with regard to IE. In this study, we aimed to determine the distribution of the cnm gene, which encodes Cnm, in a large number of clinical isolates of S. mutans from Thai subjects. Then, the cnm-positive strains were classified using a multilocus sequence typing (MLST) scheme, which we constructed previously. In addition, the data were analysed together with our previous MLST data of cnm-positive strains from Japan and Finland in order to evaluate the clonal relationship among S. mutans strains harbouring the cnm gene. The cnm gene was detected in 12.4 % of all 750 Thai isolates, and serotype f showed the highest rate of detection (54.5 %). According to the MLST data, two clonal complex groups were revealed as the important clones related to cnm-positive S. mutans from various origins of isolation. Moreover, the collagen-binding properties of S. mutans strains with the cnm gene were significantly greater than those of strains without the gene, although four cnm-negative strains classified into two sequence types (STs), ST110 and ST136, showed extremely high collagen-binding rates suggesting the presence of additional genes involved with collagen binding in these STs. Taken together, these results provided information on both epidemiological as well as evolutional aspects of S. mutans possessing the cnm gene.

Periodontal status and orthodontic treatment need of autistic children.

AIM: To evaluate the periodontal status and orthodontic treatment need of autistic children and compare these findings to nonaffected, same-age individuals. METHOD: The periodontal status and orthodontic treatment need were evaluated in 32 autistic and 48 nonautistic boys and girls age 8 years to 12 years (mean 9.7 ± 1.2 years and 9.9 ± 1.1 years, respectively). The periodontal status of all subjects was recorded using the Community Periodontal Index of Treatment Need (CPITN) with a slight modification. The orthodontic treatment need was determined using the Dental Aesthetic Index (DAI). Chi-square test and odds ratio were used for statistical analysis. RESULTS: No significant sex differences were found in the autistic or nonautistic groups. The autistic children presented with a significantly poorer periodontal status than the nonautistic children (P<.05). No significant differences in terms of the various malocclusion categories were found between both groups (P>.05); however, children with autism showed missing teeth, spacing, diastemas, reverse overjets, open bites, and Class II molar relationship tendencies in a higher percentage than nonautistic individuals. In all, autistic children and nonautistic children frequently needed orthodontic treatment. CONCLUSION: This study suggests that children with autism require special dental management to improve their oral hygiene as well as their dental esthetics. More care from parents, general dentists, and pedodontists/orthodontists should be provided routinely to autistic children.