The Efficacy of a Multi-Theory-Based Peer-Led Intervention on Oral Health Among Hong Kong Adolescents: A Cluster-Randomized Controlled Trial.

PURPOSE: This study aimed to investigate the effects of a peer-led oral health intervention based on the Health Belief Model and the Social Cognitive Theory on improving oral health among Hong Kong adolescents. METHODS: The study adopted a cluster-randomized controlled trial design, and 1184 students in 12 schools were randomized to intervention or control groups. After baseline assessment, the intervention group received a peer-led theory-based oral health intervention, while the control group received booklets for oral health promotion. Self-reported brushing and flossing, Health Belief Model/Social Cognitive Theory constructs, and oral health-related quality of life (OHRQoL) were measured at baseline, 6 months, and 12 months, and dental plaque accumulation and caries status were measured at baseline and 12 months. The trial was registered at https://www.clinicaltrials.gov (NCT03694496). RESULTS: Brushing, flossing, and OHRQoL improved more in the experimental group than in the control group at the 6-month follow-up compared with baseline (p < .001). The mean gain score difference was .81 for brushing, .47 for flossing, and -2.51 for OHRQoL. At the 12-month follow-up, the mean gain score of brushing frequency, plaque index, caries status, and OHRQoL were .18, -.28, -.32, and -2.79, respectively, which all sustained the significant difference (p < .001). CONCLUSIONS: Our findings suggested that the Health Belief Model combined with Social Cognitive Theory in a peer-led intervention is effective to increase self-reported brushing frequency and improve oral hygiene status and OHRQoL among adolescents.

The efficacy of peer-led oral health programs based on Social Cognitive Theory and Health Belief Model among Hong Kong adolescents: a cluster-randomized controlled trial.

Oral diseases are preventable through the building of good oral health behaviors. Theory-based behavior change was key to the efficacy of oral health promotion since conventional promotion strategies achieved only short-lived and limited improvements. The objective of the study was to investigate the efficacy of a peer-led oral health intervention based on the health belief model (HBM) and the social cognitive theory (SCT) on oral self-care behaviors among Hong Kong adolescents. One thousand one hundred and eighty-four adolescents in 12 schools participated and were randomly assigned to either intervention or control group, utilizing a cluster-randomized controlled trial design. Brushing/flossing frequency, HBM/SCT constructs, oral health knowledge, and dental anxiety were measured at baseline and 6-month follow-up. Changes in behaviors were assessed using mixed-effects model and the mediators of behavioral change were identified with parallel multiple mediation analysis. At 6 months, the intervention group showed a significant increase in the frequency of brushing and flossing compared with the control group. Self-efficacy was identified as mediator between treatment condition and behavioral changes of brushing and flossing. Combining theories of HBM and SCT is a promising avenue for efficacy in oral health behaviors. The effects were mediated through cognitive variables, which provided guidance for both theory and health intervention development.

The application of theory-guided oral health interventions in adolescents: a systematic review and meta-analysis of randomized controlled trials.

OBJECTIVE: To explore theory-guided randomized controlled trials aimed at improving adolescents' oral health and evaluate their effectiveness. DESIGN: Multiple library databases with search criteria for articles between 1990 and 2019. MAIN OUTCOME MEASURES: Searched references were coded and screened for theory-guided interventions for adolescent oral health. Characteristics of each study (study sample, adopted theory, outcome measures, length of follow-up and main findings) were extracted and the quality of the eligible trials assessed. Effect sizes for theory-guided interventions for different follow-up periods were analysed and compared with traditional oral health education. RESULTS: About 2135 results were uncovered, 64 were extracted for further screening, and 10 studies were eligible for inclusion. For plaque presence outcomes, no statistical difference was observed between theory-guided interventions and traditional interventions at 3 months (MD: -5.94, 95% CI: -16.39 to 4.51). When the duration of observation was extended to over one year, a significant reduction was found (SMD: -0.25, 95% CI: -0.46 to -0.04). CONCLUSION: Theory-guided interventions for improving oral hygiene status appear to be more effective than traditional interventions for adolescents in the long term. However, more comprehensive studies are required for validation to support the implementation and adoption of these programs in the clinical setting.

Modelling health belief predictors of oral health and dental anxiety among adolescents based on the Health Belief Model: a cross-sectional study.

BACKGROUND: A vicious cycle exists between dental anxiety, oral health behaviors and oral health status. Based on previous research, psychological factors of the Health Belief Model (HBM) are associated with oral health behaviors and oral health, and are likely involved in this cycle. However, little is known about the relationship between HBM factors and dental anxiety of adolescents. The purpose of this cross-sectional study was to investigate the relationship between health belief factors, oral health and dental anxiety based on the constructs of the HBM. METHODS: 1207 Grade 2 students from 12 secondary schools in Hong Kong were randomly selected and measured for the decayed, missing and filled permanent teeth (DMFT) index. Data for oral health behaviors, HBM constructs and dental anxiety were collected using questionnaires. The hierarchical entry of explanatory variables into logistic regression models estimating prevalence odds ratios (POR) were analyzed and 95% confidence intervals (95% CI) for DMFT and dental anxiety were generated. Path analysis was used to evaluate the appropriateness of the HBM as predictors for oral health behaviors, DMFT and dental anxiety. RESULTS: Based on the full model analysis, individuals with higher perceived susceptibility of oral diseases (POR: 1.33, 95% CI: 1.14-1.56) or girls or whose mother received higher education level were likelier to have a DMFT≥1, while those with higher perceived severity (POR: 1.31, 95%CI: 1.09-1.57), flossing weekly, DMFT≥1 or higher general anxiety level statistically increases the possibility of dental anxiety. The results from path analysis indicated that stronger perceived susceptibility, greater severity of oral diseases, less performing of oral health behaviors and a higher score of DMFT were directly related to increased dental anxiety level. Other HBM variables, such as perceived susceptibility, self-efficacy beliefs, cues to action and perceived barriers, might influence dental anxiety through oral health behaviors and caries status. CONCLUSIONS: Clarifying the propositional structures of the HBM may help the future design of theory-based interventions in reducing dental anxiety and preventing dental caries.

Dental anxiety and caries experience from late childhood through adolescence to early adulthood.

OBJECTIVE: To assess the association between dental anxiety and caries experience from late childhood through adolescence and into early adulthood (12, 15 and 18 years old, respectively). METHODS: A prospective cohort study was conducted among a population-representative sample of Chinese in Hong Kong. A baseline survey was conducted at age 12 and follow-up assessments were completed at ages 15 and 18. Caries experience was assessed as the number of decayed, missing and filled teeth (DMFT). Dental anxiety was assessed using the Modified Dental Anxiety Scale (MDAS). Participants' socio-economic status and oral health-related behaviours were ascertained using a self-complete questionnaire. Negative binomial regression was used to explore the association between dental anxiety and subsequent caries status, controlling for other factors. RESULTS: At baseline, 668 children participated; 279 (41.8%, comprising 57.0% females) completed all three phases of data collection. MDAS scores at age 18 were lower than at age 12. Caries experience increased as participants aged. At age 15 and 18, females had higher MDAS and DMFT scores than males. Reported frequency of snacking between meals was associated with MDAS scores at age 18. In regression analyses, dental anxiety at age 12 was not significantly associated with dental caries experience at age 15, controlling for socio-demographic and oral-health behaviour factors at age 12. Likewise, dental anxiety at age 15 was not significantly associated with dental caries experience at age 18, controlling for the same factors at age 15. CONCLUSION: Dental anxiety assessed by MDAS in late childhood and adolescence appears not to predict dental caries experience later in life in this population.

Development and validation of the Oral health behavior questionnaire for adolescents based on the health belief model (OHBQAHBM).

BACKGROUND: Oral health belief is a prerequisite of changing oral health behaviors especially during adolescence. However, there is a paucity of well-established questionnaire for use among adolescents. This study aimed to develop and validate an instrument to evaluate adolescents' beliefs about oral health behaviors using health belief model. METHODS: A preliminary 43-item questionnaire was developed by an expert panel. Then the questionnaire was finalized by decreasing the number of items to 35 by analyzing the results from face validity and factor analysis from 421 Hong Kong secondary school students. The content validity were evaluated by a panel of 2 behavioral scientists, 2 dentists, 2 schoolteachers and 10 adolescents. The construct validity of the questionnaire was assessed by performing exploratory factor analysis (EFA) and confirmatory factor analysis (CFA). The Cronbach's alpha coefficient, item-total correlation and intraclass coefficient were used to test its reliability. In addition, to confirm its applicability, multiple regression analysis and path analysis were used to evaluate the possibility of HBM as predictors for oral health behaviors and oral hygiene status. RESULTS: The initial analysis extracted six factors that jointly accounted for 62.47% of the variance observed. Based on CFA, the final version of the questionnaire consisted of 35 items and the data of the final version fitted the model well. The Cronbach's alpha coefficient for the subscale (> 0.7), item-total correlations (0.47-0.91) and the intraclass coefficient (0.82-0.91) were all above acceptable thresholds. The results of multiple regression analysis and path analysis confirmed its ability to predict oral health behaviors and status. CONCLUSIONS: The present findings indicate satisfactory validity, reliability and applicability of the proposed Oral Health Behavior Questionnaire for Adolescents based on the Health Belief Model (OHBQAHBM) for measuring oral health beliefs of adolescents. This questionnaire can be used as an instrument to measure oral health beliefs and predict oral health behavior and oral hygiene status of adolescents.

Dental fear association between mothers and adolescents-a longitudinal study.

AIM: To assess the longitudinal association between adolescents' and their mothers' dental fear. STUDY DESIGN: A longitudinal questionnaire survey study. METHODS: A randomized sample of 12-year-old adolescents were selected from local Hong Kong schools. Adolescents and their mothers self-completed the Modified Dental Anxiety Scale (MDAS). The sociodemographic background of the mothers and the oral health habits of the adolescents were also collected and these measurements were repeated at 15- and 18-years-old. Non-parametric tests (Mann-Whitney U test/Kruskall Wallis test) were used to test associations between MDAS dental fear items and independent variables. Logistic regression (adjusted for family's sociodemographic background and adolescent's oral health habits) was performed to evaluate the longitudinal association between adolescents' and mothers' dental fear. RESULTS: A total of 212 mother-child pairs were recruited at baseline (12-year-old adolescents). In the first and second follow-ups (15- and 18-years-old), 195 and 182 mother-child pairs completed the survey. Significant associations between mother's and child's scores in "feeling about having their teeth scraped and polished", "having teeth drilled", and 'having an injection in the gum' were found when adolescents were 12- years-old (P < 0.01) and 18-years-old (P < 0.05), but not at 15-years-old. CONCLUSION: Adolescents' and mothers' dental fear is associated at 12-years-old and 18-years-old, but not at 15-years-old, which is likely specific to the Hong Kong context but may be extrapolated to other industrialized countries with caution.

The association of socio-economic status, dental anxiety, and behavioral and clinical variables with adolescents' oral health-related quality of life.

PURPOSE: It is not clear which factors hold more weight in predicting oral health-related quality of life (OHRQoL). Therefore, this study explored which component of factors (e.g., socio-economic status, clinical status or oral health behaviors, dental anxiety, oral health knowledge) has a better predictive value in different aspects (e.g., oral symptoms, functional limitations, social and emotional conditions) of adolescents' OHRQoL. METHODS: Participants were randomly selected from Grade Two (S2) students within 12 secondary schools in Hong Kong. The independent variables include the following : socio-economic (monthly family income, parents' educational background), oral health behaviors (the frequency of brushing and having snacks like chocolate or biscuits), and oral health-related factors (oral health knowledge, dental anxiety, dental caries and bleeding index). Adolescents' OHRQoL was evaluated using the 16-item Child Perception Questionnaire (CPQ11-14-ISF:16). Frequencies and means were used for data description. Different variables were analyzed as predictors of OHRQoL by multi-level linear regression analysis. RESULTS: 1207 adolescents (46.6% females) participated in this study. The mean total CPQ11-14-ISF:16 was 14.2 (9.8). Mean scores of oral symptoms, functional limitations, and emotional and social well-being were 4.4 (2.8), 4.2 (2.8), 3.2 (3.1), and 2.4 (2.7), respectively. In the final model, adolescents with poorer oral health knowledge, higher dental anxiety levels, brushed their teeth less than once a day and consumed chocolates or biscuits more regularly as reported by a statistically worse OHRQoL (p < 0.05). In addition, gingival bleeding was a predictor of the oral symptom domain (ß = 0.7, p = 0.027); the emotional well-being of adolescents whose father went to college had a better OHRQoL (ß = - 0.9, p = 0.014) and adolescents from the higher-income family had a statistically better social well-being (p = 0.015). CONCLUSION: Our study indicates that adolescents with poorer oral health knowledge, higher dental anxiety levels, brushing their teeth less than once a day, or having a daily consumption of chocolate or biscuits had statistically worse OHRQoL. These findings can provide guidance for future oral health promotion in improving OHRQoL among adolescents.

A cohort study of factors that influence oral health-related quality of life from age 12 to 18 in Hong Kong.

BACKGROUND: There is a lack of cohort studies on the influence factors of oral health-related quality of life (OHRQoL). This study aimed to follow subjects from age 12 to 18 to analyse the sociodemographic and clinical factors that may influence OHRQoL. METHODS: This cohort study selected a representative sample from Hong Kong. Periodontal status and caries were examined according to WHO criteria. Four orthodontic indices were used to assess malocclusion. Child Perceptions Questionnaires (CPQ11-14) with 8 items (CPQ11-14-ISF: 8) and 37 items were used to assess OHRQoL at age 12 and age 15, respectively; Oral Health Impact Profile (OHIP-14) was used to assess OHRQoL at age 18. Wilcoxon signed ranks test and Friedman's test were used to analyse the age-related change of OHRQoL and malocclusion from age 12 to 18. Generalized estimating equations were used to analyse the influence factors of OHRQoL and to calculate adjusted risk ratio (RR). RESULTS: Subjects recruited in this study were 589 (305 females, 284 males), 364 (186 females, 178 males) and 300 (165 females, 135 males) at age 12, 15 and 18, respectively. Among them, 331 subjects (172 females, 159 males) were followed from age 12 to 15, and 118 subjects (106 females, 82 males) were followed from age 12 to 18. Subjects had less severe malocclusion at age 12 than at ages 15 and 18 (p = 0.000, measured by Dental Aesthetic Index). Age, periodontal status, and malocclusion had an effect on OHRQoL. When compared with OHRQoL at age 12, worse OHRQoL was observed at age 15 (adjusted RR = 1.06, 95%CI = 1.01-1.12, p = 0.032), but not at age 18 (adjusted RR = 1.01, 95%CI = 0.95-1.08, p = 0.759). Unhealthy periodontal conditions had a negative effect on OHRQoL (adjusted RR = 1.14, 95%CI = 1.04-1.25, p = 0.007). Only severe malocclusions had a negative effect on OHRQoL; a more severe malocclusion was associated with a higher effect on OHRQoL (adjusted RR = 1.09, 95%CI = 1.01-1.18, p = 0.032 for severe malocclusion, and adjusted RR = 1.17, 95%CI = 1.07-1.28, p = 0.001 for very severe malocclusion measured by Dental Aesthetic Index). CONCLUSION: Age, periodontal status, and malocclusion had an influence on OHRQoL from age 12 to 18. When clinicians attempt to improve subjects' OHRQoL, it is necessary to consider these factors.

Oral Health of Children With Attention Deficit Hyperactivity Disorder: Systematic Review and Meta-Analysis.

Objective: This systematic review investigated the oral health of children with ADHD. Method: A structured search strategy was performed on five electronic databases: SCOPUS, Web of Science, COCHRANE, PubMed, and PsychInfo. Studies were included in the review if they reported clinical oral health outcomes on a population diagnosed with ADHD under the age of 18 years old. Qualitative and quantitative analysis was performed on pooled prevalence and mean/median values for caries, trauma, periodontal problems, and tooth wear. Results: Twenty-seven effective articles were reviewed by two calibrated assessors. Meta-analysis of the results found higher mean number of decayed surfaces, plaque index, and trauma prevalence among children with ADHD. Conclusion: Children with ADHD show increased risk for caries and traumatic dental injuries, and may have poorer oral hygiene compared with children without ADHD. More awareness among clinicians would promote better caries- and trauma-preventive advice and management.

The effectiveness of behavioral interventions to improve oral health in adolescents at different periods of follow-up: A systematic review and meta-analysis.

BACKGROUND: The aim of this review was to examine the effectiveness of behavioral interventions at different follow-up periods to improve adolescents' oral health. METHODS: CENTRAL, MEDLINE, EMBASE and other databases were systematically searched. Inclusion criteria were as follows: participants aged 10-19 years old, randomized controlled trials using behavioral interventions, outcome measurements including oral health knowledge, attitudes, practices, and oral health status. For each included study, behavior change techniques (BCT) were identified and the quality and risk of bias assessments obtained. PROSPERO reference: CRD42018090341. RESULTS: After searching and screening, 17 clinical trials were included in the systematic review. The most commonly used BCTs were behavior health link, information on consequences, and social comparisons. A significant reduction of plaque index was detected (SMD:-0.46; 95 % CI:-0.82∼-0.10) for 3 months and (SMD:-0.71; 95 % CI:-1.08∼-0.33) for 6 months. The reduction of gingival index after 6 months was also significant (SMD:-0.90; 95 % CI:-1.33∼-0.47). Oral health knowledge and oral health-related behavior were also improved after behavioral interventions. CONCLUSION: There is moderate evidence that behavioral interventions are effective in promoting oral health in adolescents. To establish more evidence-based conclusions, further research should focus on: quality control of interventions, full descriptions regarding the BCT, long-term follow-ups, and behavior change reinforcements. PRACTICAL VALUE: Given the need of early prevention of oral diseases, well-designed oral health promotion programme are needed to improve behavior and outcome of adolescents' oral health.

Upper Airway Changes following Functional Treatment with the Headgear Herbst or Headgear Twin Block Appliance Assessed on Lateral Cephalograms and Magnetic Resonance Imaging.

OBJECTIVE: The present study compared the changes in the upper airway dimensions and sleep-related breathing disorder (SRBD) condition between functional treatment with the headgear Herbst (HG-Herbst) and headgear Twin Block (HG-TB) appliance. Soft tissues were assessed on lateral cephalometric X-ray and magnetic resonance imaging (MRI). MATERIALS AND METHODS: Consecutive patients who sought orthodontic treatment at the Faculty of Dentistry of The University of Hong Kong were screened. Adolescents (12-17 year sold for boys and 10-15 years old for girls), with class II molar relationship and overjet >5 mm, with no severe transverse maxillary deficiency, were recruited. Patients were assigned either to the HG-Herbst or to the HG-TB treatment by stratified block randomisation, with sex as the stratification factor. Lateral cephalograms, magnetic resonance imaging (MRI), and the Paediatric Sleep Questionnaire (PSQ) were obtained at baseline and after treatment. RESULTS: 28 patients were enrolled, and 26 patients (13 in each group) completed the treatment. Following 1 year of functional appliance treatment, a significantly lower increase of the lower anterior facial height was observed in the HG-Herbst group compared to the HG-TB group (p = 0.024). However, no significant differences were observed in the upper airway structures or SRBD between the two groups. CONCLUSION: The changes in upper airway dimensions and SRBD condition were not significantly different between the HG-Herbst and the HG-TB appliance treatment. Additional studies with larger sample size are warranted.

Factors influencing the oral health-related quality of life among children with severe early childhood caries in Hong Kong.

OBJECTIVE: To assess the oral health-related quality of life among Hong Kong preschool children with severe early childhood caries. METHODS: A total of 315 Hong Kong preschool children diagnosed with severe early childhood caries (S-ECC) were recruited. Their caries and plaque status were evaluated. Their parents were asked to complete the Early Childhood Oral Health Impact Scale (ECHOIS) and a sociodemographic background questionnaire. RESULTS: There was a 98.7% response rate. The mean age was 4.7 ± 0.8 years. The mean decayed, missing and filled teeth (dmft) score was 10.2 ± 4.5. Almost all the children (98.7%) had decayed teeth. More than half of the children (61.4%) had a visible plaque index (VPI) score of above 90%. About one quarter (28.9%) were experiencing symptoms of pain. The dmft score of the child was significantly associated with the ECOHIS child impact, child function, family impact and family distress domains (P < .001). The presence of pain was significantly associated with increased ECOHIS child and family impact scores (P < .001). In the multiple regression analyses, the dmft score and presence of pain showed a significant association with the ECOHIS scores (P < .001). CONCLUSION: The OHRQoL of children with S-ECC was worsened with the presence of pain and severity of the disease. More measures need to be placed to decrease the prevalence of children with S-ECC.

Association of infant growth with emergence of permanent dentition among 12 year-aged southern Chinese school children.

BACKGROUND: There is a need to comprehensively investigate the relationship between tooth eruption and infant growth to explain the theory of tooth emergence. This study aimed to investigate the association between infant growth during the first year of life and the emergence of the permanent teeth. METHODS: A random sample of 668, 12-year-old students was recruited from a birth cohort. Erupted permanent tooth number was recorded. The association of infant growth (growth trajectories and growth rates) and permanent tooth emergence was examined through logistic regression analyses. The regression model was adjusted by potential confounders including gender, gestational age, mode of delivery, type of feeding, parental education, and health status. RESULTS: The response rate was 76.9% (n = 514). Two hundred and forty-five (47.7%) children had all 28 permanent teeth erupted. Infants who had higher birth weight z-scores and those who had grown slowly during the first three months of life were more likely to have complete permanent teeth emergence at their 12-year-old in both unadjusted (p <  0.01) and adjusted model (adjusted for gender, gestational age, mode of delivery, type of feeding, parental education, and health status, p <  0.01). However, no significant association was found between the growth trajectories and permanent tooth emergence in either unadjusted or adjusted models (p > 0.05). CONCLUSION: Birth weight and infant growth during the first three months of life might be associated with permanent tooth emergence at their 12 years of age. This association may be applied in the assessment of risk for dental caries or malocclusion.

Repair of dentine-related lesions without a drill or injection.

For covering the shortages of traditional treatments, a novel and non-invasive system was developed with the simple adaption of nature's own repair process, while an extrinsic electric field was introduced to improve its remineralization kinetics. In an in vivo study, acid-etched rabbit dentine was used to evaluate the remineralization efficacy and safety of the system. The exposed dentine tubules were fully occluded after 5 hours/1.0 mA and 8 hours/0.5 mA of remineralization. After 5 hours of remineralization (1.0 mA), the micro-hardness of the demineralized dentine was fully recovered, equal to native rabbit dentine. Haematoxylin-eosin staining demonstrated no obvious inflammatory reaction. This study provides a feasible solution to realize rapid repair of dentine.

The factors that influence oral health-related quality of life in young adults.

BACKGROUND: Young adulthood is a time when subjects transform their role from a dependent child to an independent social identity. This cross-sectional study aimed to analyze the sociodemographic and clinical factors that may influence the OHRQoL of 18-year-old young adults. METHODS: A representative sample was selected from Hong Kong. Periodontal status and caries were examined according to WHO criteria. Four orthodontic indices were used to assess malocclusion. The oral health impact profile (OHIP-14) was used to measure OHRQoL. Adjusted OR was calculated by ordinal logistic regression. RESULTS: A total of 300 eligible subjects (165 females, 135 males) were recruited. Females had more severe caries than males; however, gender was not a significant factor of OHRQoL. Household income affected OHRQoL more than parents' education did: household income had effects on physical pain, psychological discomfort, psychological disability, and the total OHIP; while parents' education had some effects on functional limitation, physical pain and psychological discomfort. As for clinical factors, unhealthy periodontal conditions were more prevalent than caries (94.67% vs. 59.00%); however, both of them showed no effect on OHRQoL. Malocclusion had a negative effect on OHRQoL; the most affected subscales were psychological discomfort and psychological disability. CONCLUSION: In this study, family ecosocial factors and malocclusion had an effect on OHRQoL. Among the family ecosocial factors, it was household income that had the most effect on OHRQoL. Malocclusion mainly affected the subscales of psychological discomfort and psychological disability. Gender, periodontal status and caries had no effect on young adults' OHRQoL.

Association Between the Severity of Malocclusion, Assessed by Occlusal Indices, and Oral Health Related Quality of Life: A Systematic Review and Meta-Analysis.

PURPOSE: To assess whether different levels of malocclusion have different effects on the oral health-related quality of life (OHRQoL) and which domains of OHRQoL could be affected. MATERIALS AND METHODS: Nine electronic databases were searched. To make studies comparable, studies using the Child Perceptions Questionnaire (CPQ) to measure OHRQoL, and the Dental Aesthetic Index, Index of Orthodontic Treatment Need, and Index of Complexity, Outcome and Need to measure malocclusion were selected for systematic review. Meta-analysis was performed to calculate the weighted mean scores of CPQ. The two independent samples t-test was used to detect whether different severity groups of malocclusion have different CPQ scores. RESULTS: A total of 22 studies were included in this review and 6 were included in the meta-analysis. Most studies used a cross-sectional design and convenience sampling. Meta-analysis showed that the weighted mean scores of CPQ increased with malocclusion severity. The t-test showed nearly all levels of malocclusion affected the domains of functional limitation and social well-being; only very severe malocclusion affected the domains of oral symptoms, emotional well-being and the overall OHRQoL (p < 0.05). CONCLUSION: When OHRQoL was assessed by CPQ11-14 and malocclusion was assessed by orthodontic indices, children with malocclusion could have oral functional limitations and worse social lives; children with very severe malocclusion could further develop oral symptoms and had worse emotional experiences. Future longitudinal population-based studies would be helpful to confirm these results.

In vitro and in vivo evaluation of electrophoresis-aided casein phosphopeptide-amorphous calcium phosphate remineralisation system on pH-cycling and acid-etching demineralised enamel.

Casein phosphate-amorphous calcium phosphate (CPP-ACP), as a remineralisation agent, is extensively used in managing demineralised enamel; however, its remineralisation kinetics is low. This study aimed to improve remineralisation kinetics of CPP-ACP by introducing a rapid remineralisation method with electrophoresis. In vitro, a pH-cycling enamel model was used to test remineralisation potentials of electrophoresis-aided CPP-ACP. For verifying remineralisation potentials of electrophoresis-aided CPP-ACP in vivo in a rabbit model, acid-etched enamel surface on rabbit maxillary incisors was remineralised by electrophoresis-aided CPP-ACP with 1.0 mA (group A) or 0.5 mA (group B). Both in vitro and in vivo, it was observed that electrophoresis was benefit to improve remineralisation kinetics of CPP-ACP, and the demineralised enamel was completely remineralised after 5 h. The Ca/P ratio in remineralised enamel consisted with that of hydroxyapatite, the microstructure in native enamel. Meanwhile, in vivo the micro-hardness of acid-etched enamel in group A (322.55 ± 31.90) and group B (322.55 ± 31.90) recovered up to the value of native enamel after 5 h remineralisation (p > 0.05). The Hematoxylin-eosin stain demonstrated that the electric field used in this study was safe on rabbit dental pulp. Therefore, this efficient and safe method has the potential to be applied in treating enamel deminerlisation.

The factors that influence oral health-related quality of life in 15-year-old children.

BACKGROUND: Several hypotheses on factors that influence oral health-related quality of life (OHRQoL) have been proposed but a consensus has not been reached. This cross-sectional study aimed to analyse the sociodemographic and clinical factors that may influence the OHRQoL of 15-year-old children. METHODS: A representative sample was selected from Hong Kong. Periodontal status and caries were examined according to WHO criteria. Four orthodontic indices were used to assess malocclusion. Child Perception Questionnaire (CPQ11-14, 37 items) including four domains, namely oral symptoms (OS), functional limitations (FL), emotional well-being (EWB), and social well-being (SWB), was used to measure OHRQoL. Adjusted OR was calculated by ordinal logistic regression. RESULTS: A total of 364 eligible subjects (186 girls, 178 boys) were recruited. The prevalence of caries was higher in girls than in boys (P = 0.013). Compared with girls, boys tended to have a better experience in the domains of EWB, SWB and the total CPQ (adjusted OR = 0.46, 0.59 and 0.61, respectively). Unhealthy periodontal conditions were more prevalent than caries (92.6% vs. 52.7%); moreover, periodontal conditions with CPI scores of 2 had a negative effect on the domain of SWB and the total CPQ (adjusted OR = 1.76 and 1.71, respectively). Only the most severe malocclusion showed an effect on the domain of FL and the total CPQ (adjusted OR = 1.55 and 2.10, respectively). Little effect of family ecosocial factors and caries was found on CPQ scores. CONCLUSION: In this study, gender, periodontal status, and malocclusion showed an effect on OHRQoL after adjusting for potential confounders. Boys had less caries and better OHRQoL than girls did. Unhealthy periodontal conditions led to worse social welfares and OHRQoL. The most severe level of malocclusion caused oral functional limitations, hence worse OHRQoL.

The factors that influence the oral health-related quality of life in 12-year-old children: baseline study of a longitudinal research.

BACKGROUND: Oral health-related quality of life (OHRQoL) could be affected not only by oral health but also by demographic and ecosocial factors. This research aimed to analyze the sociodemographic and clinical factors that may influence the OHRQoL of 12-year-old children. METHODS: A representative sample was selected from Hong Kong. Periodontal status and caries were examined according to WHO criteria. Four orthodontic indices were used to assess malocclusion. Child Perception Questionnaires (CPQ11-14-ISF:8 and CPQ11-14-RSF:8) including four domains, namely oral symptoms (OS), functional limitations (FL), emotional well-being (EWB), and social well-being (SWB), were used to measure OHRQoL. Adjusted OR was calculated by ordinal logistic regression. RESULTS: Totally 589 eligible subjects (305 females, 284 males) were recruited. Males tended to rank higher in OS domain but lower in EWB domain (adjusted OR = 1.89 and 0.67). Mother's education was linked more closely with children's CPQ scores. Higher education levels were associated with better quality of life (adjusted OR = 0.45 and 0.37). Household income showed no effect on CPQ scores. Unhealthy periodontal conditions had a negative effect on EWB and total CPQ (adjusted OR = 1.61 and 1.63). High caries experience only had a negative effect on SWB (adjusted OR = 1.60). Malocclusion affected FL, EWB, SWB and total CPQ: all malocclusion severities affected SWB; only severe malocclusions affected FL, EWB and total CPQ. CONCLUSION: Males were more tolerant of oral symptoms than females were. Higher levels of mother's education led to better OHRQoL of their children. Unhealthy periodontal conditions affected emotional well-being, while high caries experience affected social well-being. All malocclusion severities had an effect on social well-being; severe malocclusion further caused functional limitations, worse emotional well-being, and hence worse OHRQoL.