The implication of instructional design for deciduous tooth identification in a dental morphology course for undergraduate dental students.

Background/purpose: The pediatric dentistry courses are lacking in our six-year undergraduate dental education. The purpose of this study was to evaluate the implication of instructional design for deciduous tooth identification in a dental morphology course for undergraduate dental students through students' perspectives. Materials and methods: A total of 34 s-year dental students who took this dental morphology course were invited to fill out the questionnaire for survey of instructional design for deciduous tooth identification after the class. Results: Of the 34 dental students, 32 of them participated in the survey with a valid response rate of 94.1%. The results showed that most students found the learning activity of instructional design for deciduous tooth identification to be helpful for improving their knowledge about deciduous dentition. Most of them also had positive attitude towards this instructional design. Conclusion: Since the proportion of pediatric dentistry courses in the undergraduate dental education is very low and children's oral problems are indeed faced by all dentists, it is important to add learning units of pediatric dentistry-related knowledge in different undergraduate dental professional courses or to propose strategies to promote students' awareness of self-directed learning about pediatric dentistry. This study may serve as a model for other undergraduate dental courses in Taiwan.

Mirror, mirror? An evaluation of identical twin mirroring in tooth crown morphology.

It has been estimated that 25% of monozygotic ("identical") twin pairs exhibit reverse asymmetry (RA) or "mirroring" of minor anatomical features as a result of delayed zygote division. Here, we examine whether identical twin mirroring accounts for patterns of dental asymmetry in a sample of monozygotic and dizygotic ("fraternal") twins. We focus on crown morphology to approach the following question: is there an association between dental RA frequency and twin type suggestive of the presence of mirror image twins in our sample? Data were collected from 208 deciduous and 196 permanent dentitions of participants of the University of Adelaide Twin Study using Arizona State University Dental Anthropology System standards. RA frequencies were compared across morphological complexes (deciduous, permanent), twin types (monozygotic, dizygotic), and traits. Fisher's exact tests were performed to formally evaluate the association between twin type and dental RA. Across the entire dataset, RA rates failed to exceed 8% for any twin type. In monozygotic twins, deciduous mirroring totaled 5.3% of observed cases, while permanent mirroring totaled 7.8% of observed cases. We found no statistically significant association between RA and twin type for any morphological character (p-value range: 0.07-1.00). Our results suggest the timing of monozygotic twin division does not explain the structure of asymmetry for our morphology dataset and that published estimates of identical twin mirroring rates may be inflated or contingent upon phenotype. Instead, rates reported for this sample more closely align with the proposed etiology of this condition.

ASH2L, Core Subunit of H3K4 Methylation Complex, Regulates Amelogenesis.

Histone methylation assumes a crucial role in the intricate process of enamel development. Our study has illuminated the substantial prevalence of H3K4me3 distribution, spanning from the cap stage to the late bell stage of dental germs. In order to delve into the role of H3K4me3 modification in amelogenesis and unravel the underlying mechanisms, we performed a conditional knockout of Ash2l, a core subunit essential for the establishment of H3K4me3 within the dental epithelium of mice. The absence of Ash2l resulted in reduced H3K4me3 modification, subsequently leading to abnormal morphology of dental germ at the late bell stage. Notably, knockout of Ash2l resulted in a loss of polarity in ameloblasts and odontoblasts. The proliferation and apoptosis of the inner enamel epithelium cells underwent dysregulation. Moreover, there was a notable reduction in the expression of matrix-related genes, Amelx and Dspp, accompanied with impaired enamel and dentin formation. Cut&Tag-seq (cleavage under targets and tagmentation sequencing) analysis substantiated a reduction of H3K4me3 modification on Shh, Trp63, Sp6, and others in the dental epithelium of Ash2l knockout mice. Validation through real-time polymerase chain reaction, immunohistochemistry, and immunofluorescence consistently affirmed the observed downregulation of Shh and Sp6 in the dental epithelium following Ash2l knockout. Intriguingly, the expression of Trp63 isomers, DNp63 and TAp63, was perturbed in Ash2l defect dental epithelium. Furthermore, the downstream target of TAp63, P21, exhibited aberrant expression within the cervical loop of mandibular first molars and incisors. Collectively, our findings suggest that ASH2L orchestrates the regulation of crucial amelogenesis-associated genes, such as Shh, Trp63, and others, by modulating H3K4me3 modification. Loss of ASH2L and H3K4me3 can lead to aberrant differentiation, proliferation, and apoptosis of the dental epithelium by affecting the expression of Shh, Trp63, and others genes, thereby contributing to the defects of amelogenesis.

Blended Learning with Video Demonstrations Enhances Dental Students' Achievements in Tooth Carving.

Background: Learning fine motor skill is central to preclinical dental education. Dental students are introduced to anatomical tooth carving to facilitate the development of their fine motor skill and manual dexterity. Various carving technique exists, such as wax build-up, and geometric (block carving technique). Since substantial laboratory Time and instructors' effort are required to teach students the desired techniques, blended learning approach via pre-recorded demonstration may improve the teaching and learning efficiency of anatomical tooth carving. For years, we used the Geometric method to teach preclinical dental students to carve down tooth sculptures after performing live demonstrations for them. Multiple practical laboratory demonstrations are necessary to deepen the student's comprehensive understanding of dental anatomical features and teach them correct instrumentation; this is time-consuming and challenging due to limited laboratory hours and limited view field. Accordingly, in 2016 the teaching staff created videos for tooth drawing, carving, and identification, and uploaded them to the students' university platform. Years later, we decided to perform this retrospective study. Objective: To assess the enhancement in students' tooth carving skills after implementing blended learning with video demonstrations. Methods: The student's total grades were used for comparative purposes. The students' total grades between 2010 and 2019 were collected and categorized into two groups: Group 1 (n=858), which learned tooth carving by the Geometric method after live demonstrations, and Group 2 (972), which benefited from blended learning with video demonstrations in learning. The two groups' mean, median, mode, Percentile 75, and Percentile 90 were compared. Results: Group 2 showed higher grades than group 1, and the differences between the two groups' mean and median were statistically significant p<0.001. Moreover, the mode, P75 and P90 favored group 2. Conclusion: Results show that blended learning with video demonstrations enhanced the achievements of dental students in tooth carving.

Peopling of the Americas: A new approach to assessing dental morphological variation in Asian and Native American populations.

OBJECTIVES: Through biodistance analyses, anthropologists have used dental morphology to elucidate how people moved into and throughout the Americas. Here, we apply a method that focuses on individuals rather than sample frequencies through the application rASUDAS2, based on a naïve Bayes' algorithm. MATERIALS AND METHODS: Using the database of C.G. Turner II, we calculated the probability that an individual could be assigned to one of seven biogeographic groups (American Arctic, North & South America, East Asia, Southeast Asia & Polynesia, Australo-Melanesia, Western Eurasia, & Sub-Saharan Africa) through rASUDAS2. The frequency of classifications for each biogeographic group was determined for 1418 individuals from six regions across Asia and the Americas. RESULTS: Southeast Asians show mixed assignments but rarely to American Arctic or "American Indian." East Asians are assigned to East Asia half the time while 30% are assigned as Native American. People from the American Arctic and North & South America are assigned to Arctic America or non-Arctic America 75%-80% of the time, with 10%-15% classified as East Asian. DISCUSSION: All Native American groups have a similar degree of morphological affinity to East Asia, as 10%-15% are classified as East Asian. East Asians are classified as Native American in 30% of cases. Individuals in the Western Hemisphere are decreasingly classified as Arctic the farther south they are located. Equivalent levels of classification as East Asian across all Native American groups suggests one divergence between East Asians and the population ancestral to all Native Americans. Non-arctic Native American groups are derived from the Arctic population, which represents the Native American founder group.

Machine learning model to predict the width of maxillary central incisor from anthropological measurements.

PURPOSE: To improve smile esthetics, clinicians should comprehensively analyze the face and ensure that the sizes selected for the maxillary anterior teeth are compatible with the available anthropological measurements. The inter commissural (ICW), interalar (IAW), intermedial-canthus (MCW), interlateral-canthus (LCW), and interpupillary (IPW) widths are used to determine the width of maxillary central incisors (CW). The aim of this study was to develop an automated approach using machine learning (ML) algorithms to predict central incisor width in a young Turkish population using anthropological measurements. This automation can contribute to digital dentistry and clinical decision-making. METHODS: In the initial phase of this cross-sectional study, several ML regression models-including multiple linear regression (MLR), multi-layer-perceptron (MLP), decision-tree (DT), and random forest (RF) models-were validated to confirm the central width prediction accuracy. Datasets containing only male and female measurements, as well as combined were considered for ML model implementation, and the performance of each model was evaluated for an unbiased population dataset. RESULTS: Compared with the other algorithms, the RF algorithm showed improved performance for all cases, with an accuracy of 96%, which represents the percentage of correct predictions. The plot reveals the applicability of the RF model in predicting the CW from anthropological measurements irrespective of the candidate's sex. CONCLUSIONS: These results demonstrated the possibility of predicting central incisor widths based on anthropometric measurements using ML models. The accurate central incisor width prediction from these trials also indicates the applicability of the proposed model to be deployed for enhanced clinical decision-making.

Measuring Dental Enamel Thickness: Morphological and Functional Relevance of Topographic Mapping.

The interest in the development of dental enamel thickness measurement techniques is connected to the importance of metric data in taxonomic assessments and evolutionary research as well as in other directions of dental studies. At the same time, advances in non-destructive imaging techniques and the application of scanning methods, such as micro-focus-computed X-ray tomography, has enabled researchers to study the internal morpho-histological layers of teeth with a greater degree of accuracy and detail. These tendencies have contributed to changes in established views in different areas of dental research, ranging from the interpretation of morphology to metric assessments. In fact, a significant amount of data have been obtained using traditional metric techniques, which now should be critically reassessed using current technologies and methodologies. Hence, we propose new approaches for measuring dental enamel thickness using palaeontological material from the territories of northern Vietnam by means of automated and manually operated techniques. We also discuss method improvements, taking into account their relevance for dental morphology and occlusion. As we have shown, our approaches demonstrate the potential to form closer links between the metric data and dental morphology and provide the possibility for objective and replicable studies on dental enamel thickness through the application of automated techniques. These features are likely to be effective in more profound taxonomic research and for the development of metric and analytical systems. Our technique provides scope for its targeted application in clinical methods, which could help to reveal functional changes in the masticatory system. However, this will likely require improvements in clinically applicable imaging techniques.

Armed to the teeth: The underestimated diversity in tooth shape in snakes and its relation to feeding behavior and diet.

The structure, composition, and shape of teeth have been related to dietary specialization in many vertebrate species, but comparative studies on snakes' teeth are lacking. Yet, snakes have diverse dietary habits that may impact the shape of their teeth. We hypothesize that prey properties, such as hardness and shape, as well as feeding behavior, such as aquatic or arboreal predation, or holding vigorous prey, impose constraints on the evolution of tooth shape in snakes. We compared the morphology of the dentary teeth of 63 species that cover the phylogenetic and dietary diversity of snakes, using 3D geometric morphometrics and linear measurements. Our results show that prey hardness, foraging substrate, and the main feeding mechanical challenge are important drivers of tooth shape, size, and curvature. Overall, long, slender, curved teeth with a thin layer of hard tissue are observed in species that need to maintain a grip on their prey. Short, stout, less curved teeth are associated with species that undergo high or repeated loads. Our study demonstrates the diversity of tooth morphology in snakes and the need to investigate its underlying functional implications to better understand the evolution of teeth in vertebrates.

Notch Signaling Pathway in Tooth Shape Variations throughout Evolution.

Evolutionary changes in vertebrates are linked to genetic alterations that often affect tooth crown shape, which is a criterion of speciation events. The Notch pathway is highly conserved between species and controls morphogenetic processes in most developing organs, including teeth. Epithelial loss of the Notch-ligand Jagged1 in developing mouse molars affects the location, size and interconnections of their cusps that lead to minor tooth crown shape modifications convergent to those observed along Muridae evolution. RNA sequencing analysis revealed that these alterations are due to the modulation of more than 2000 genes and that Notch signaling is a hub for significant morphogenetic networks, such as Wnts and Fibroblast Growth Factors. The modeling of these tooth crown changes in mutant mice, via a three-dimensional metamorphosis approach, allowed prediction of how Jagged1-associated mutations in humans could affect the morphology of their teeth. These results shed new light on Notch/Jagged1-mediated signaling as one of the crucial components for dental variations in evolution.

The dentition of the Early Upper Paleolithic hominins from Ksâr 'Akil, Lebanon.

There are scant human remains associated with Early Upper Paleolithic (EUP) industries. The rock shelter at Ksâr 'Akil, Lebanon, is one of the few circum-Mediterranean archaeological sites with EUP artifacts and associated fossils attributed to Homo sapiens. The skull and post-crania of the juvenile 'Egbert' (Ksâr 'Akil 1) from the EUP levels (conservatively dated from ∼43 to 39 ka) have been lost; the partial edentulous maxilla of 'Ethelruda' (Ksâr 'Akil 2) from the Initial Upper Paleolithic levels has only recently been rediscovered, leaving an isolated deciduous molar (Ksâr 'Akil 3) from Levantine Aurignacian strata. A fourth individual was found adjacent to Ksâr 'Akil 1 in 1938, but never described, and is apparently also lost. New archival research at the Peabody Museum of Archaeology and Ethnography uncovered photographs and radiographs of Ksâr 'Akil 1 and photographs of the fourth individual (which we designate Ksâr 'Akil 4). These new photographs and radiographs allow a comparative dental analysis of both individuals. Radiographs confirm an age of 7-8 years for Ksâr 'Akil 1 and photographs of Ksâr 'Akil 4 suggest a similar, if not slightly younger, age. Compared to other fossil H. sapiens, the teeth of Ksâr 'Akil 1 and Ksâr 'Akil 4 are remarkably modern. The upper deciduous third premolars lack a hypocone and metacone; the upper deciduous fourth premolars of Ksâr 'Akil 1 have reduced hypocones and both individuals have upper fourth premolars and first molars with square (as opposed to skewed) occlusal outlines, resulting from a hypocone that is smaller than, or equal in size to, the metacone. The lower first permanent molars of Ksâr 'Akil 1, and possibly Ksâr 'Akil 4, are four-cusped, which is a rare trait among Paleolithic and recent H. sapiens.

An Anthropological Investigation of the Sociocultural and Economic Forces Shaping Dental Crowding Prevalence.

OBJECTIVE: The aim of the current study is to explore country of origin and social race category differences in dental crowding prevalence through an anthropological approach. DESIGN: Data were collected from individuals within five countries (Australia, China, Japan, South Africa, United States; n = 1008) and seven social race groups in two countries (American Black, American White, Latinx, and Indigenous in the United States, South African Black, South African White, and South African Coloured; n = 654). Statistical significance between groups was assessed with a Kruskal-Wallis test, while a Dunn's post-hoc test identified which groups significantly differed. RESULTS: Results indicate South Africa is characterized by the lowest frequencies of dental crowding, with Coloured South Africans yielding the highest and Black South Africans displaying the lowest frequencies. Individuals in the United States exhibited relatively high levels of minor dental crowding. American Blacks had lower crowding levels, while the Indigenous group had high levels of severe crowding. Individuals within China and Japan exhibited higher relative prevalence of severe crowding. CONCLUSIONS: Overall, significant differences exist in dental crowding prevalence across countries and social race categories using an anthropological grading system to assess crowding. These differences are likely impacted by sociocultural (aesthetic preferences) and economic (access to dental care) factors.

Craniofacial Bones and Teeth in Spacefarers: Systematic Review and Meta-analysis.

INTRODUCTION: Estimating the risk of dental problems in long-duration space missions to the Moon and Mars is critical for avoiding dental emergencies in an environment that does not support proper treatment. Previous risk estimates were constructed based on the experience in short-duration space missions and isolated environments on Earth. However, previous estimates did not account for potential changes in dental structures due to space travel, even though bone loss is a known problem for long-duration spaceflights. The objective of this study was to systematically analyze the changes in hard tissues of the craniofacial complex during spaceflights. METHODS: Comprehensive search of Medline, Embase, Scopus, the NASA Technical Report Server, and other sources identified 1,585 potentially relevant studies. After screening, 32 articles that presented quantitative data for skull in humans (6/32) and for calvariae, mandible, and lower incisors in rats (20/32) and mice (6/32) were selected. RESULTS: Skull bone mineral density showed a significant increase in spacefaring humans. In spacefaring rodents, calvariae bone volume to tissue volume (BV/TV) demonstrated a trend toward increasing that did not reach statistical significance, while in mandibles, there was a significant decrease in BV/TV. Dentin thickness and incisor volume of rodent incisors were not significantly different between spaceflight and ground controls. DISCUSSION: Our study demonstrates significant knowledge gaps regarding many structures of the craniofacial complex such as the maxilla, molar, premolar, and canine teeth, as well as small sample sizes for the studies of mandible and incisors. Understanding the effects of microgravity on craniofacial structures is important for estimating risks during long-duration spaceflight and for formulating proper protocols to prevent dental emergencies. KNOWLEDGE TRANSFER STATEMENT: Avoiding dental emergencies in long-duration spaceflights is critical since this environment does not support proper treatment. Prior risk estimates did not account for changes in dental structures due to space travel. We reviewed and synthesized the literature for changes in craniofacial complex associated with spaceflight. The results of our study will help clinicians and scientists to better prepare to mitigate potential oral health issues in space travelers on long-duration missions.

Under the lens: a report on global dental morphology modules / Bajo la lupa: un reporte sobre los módulos de morfología dental a nivel global

SUMMARY: Dental morphology (DM) is the first introduction of dental graduates towards the identification of tooth; hence it is an important component of the dental curriculum. Traditionally, it is taught by manual carving of wax blocks, but the limitations of this method have been highlighted. There is a need to adopt innovative teaching methodologies to invigorate the concepts of dental anatomy (DA) and reduce the stress in teaching and learning with a proposal in standardization of training methodologies worldwide. Methods: A three-phased project was designed with an aim to collect global data related to teaching dental morphology within the dental curriculum. One dental professional actively involved in university teaching of DM subject was invited from 11 countries. The present study involved compilation of data from phase 1 questionnaire responses, followed by its discussion and analysis, and generation of preliminary report. Results: It is universally acknowledged that acquiring dental morphology knowledge by dentists is a prerequisite before they commence clinical practice. Our data points that no uniformity in DA course modules exists throughout the world and globally the subject requires curriculum redesigning. Conclusions: Consensus should be achieved amongst academicians in DM teaching and learning context. Innovative and standardized DM modules with component of computer-based and remote learning techniques should also be introduced.

La morfología dental (MD) es el primer contacto de los estudiantes de odontología con la identificación del diente; por lo tanto, es un componente importante del plan de estudios de la carrera. Tradicionalmente, se enseña mediante el tallado manual de bloques de cera, pero se han destacado las limitaciones de este método. Existe la necesidad de adoptar metodologías de enseñanza innovadoras para dinamizar los conceptos de anatomía dental (AD) y reducir el estrés en la enseñanza y el aprendizaje con una propuesta de estandarización de metodologías de formación, a nivel mundial. Métodos: Se diseñó un proyecto de tres fases con el objetivo de recopilar datos globales relacionados con la enseñanza de la morfología dental dentro del plan de estudios dental. Se invitó a un profesional de la odontología de cada uno de 11 países que participa activamente en la enseñanza universitaria de la MD. Esto incluyó la recopilación de datos de las respuestas a un cuestionario en la fase 1, seguida de su discusión y análisis, y la generación de un informe preliminar. Resultados: Se reconoce universalmente que la adquisición de conocimientos de morfología dental por parte de los odontólogos es un requisito previo antes de comenzar la práctica clínica. Nuestros datos indican que no existe uniformidad en los módulos del curso de AD en todo el mundo, por lo que el tema requiere un rediseño del plan de estudios. Conclusiones: Debe lograrse consenso entre los académicos en el contexto de enseñanza y aprendizaje de MD. También se deben introducir módulos innovadores y estandarizados de MD con componentes de aprendizaje remoto y de base digital.

Dental health of pediatric patients with X-linked hypophosphatemia (XLH) after three years of burosumab therapy.

An inactivating PHEX gene mutation with the resultant accumulation of several mineralization-inhibiting proteins (e.g., FGF23) causes skeletal and dental morbidity in X-linked hypophosphatemia (XLH). This prospective case-control study explored the effect of burosumab, an anti-FGF23 antibody, on dental health of children with XLH. Ten children (age 4.3-15 years) with XLH underwent burosumab treatment per protocol. Assessment of their dental status at treatment initiation and after 1 and 3 years of treatment included clinical, laboratory and radiographic evaluation of rickets and dentition. Orthopantomographic examinations of ten healthy sex- and age-matched controls were selected for comparison. Coronal and pulp dimensions of a selected permanent mandibular molar were measured with Planmeca Romexis® software. One year of treatment led to improvement of height z-score (p=0.019) and healing of the rickets (p<0.001) in the XLH patients, and those achievements were maintained after three years of treatment. Dental morphology of XLH patients, distinguished by increased pulp-coronal ratios compared to controls (p=0.002), remained larger after the first year of treatment (p<0.001) and did not attain the decrease expected with age after three years of treatment. Five patients had a history of recurrent dental abscesses, with three having undergone at least one episode during the year before burosumab initiation. One patient sustained recurrent abscesses throughout three years of treatment. The persistence of the unique dental morphology of XLH patients undergoing burosumab therapy, as evidenced by excessively larger pulp dimensions, supports the role of other PHEX gene-related local mineralization inhibitors, such as osteopontin, in the pathogenesis of dental morbidity.

Portable x-ray fluorescence spectroscopy geochemical sourcing of Miocene primate fossils from Kenya.

Understanding the biogeography and evolution of Miocene catarrhines relies on accurate specimen provenience. It has long been speculated that some catarrhine specimens among the early collections from Miocene sites in Kenya have incorrect provenience data. The provenience of one of these, the holotype of Equatorius africanus (NHM M16649), was previously revised based on x-ray fluorescence spectroscopy. Here we use nondestructive portable x-ray fluorescence spectroscopy to test the provenience of additional catarrhine specimens that, based on morphology and/or incomplete provenience information, were identified as possibly having been collected at a different site from that recorded at museum accession. We test the hypotheses that two specimens purportedly from the Early Miocene site of Rusinga (KNM-RU 1681 and KNM-RU 1999) are instead from Maboko, three specimens purportedly from the Middle Miocene site of Fort Ternan (KNM-FT 8, KNM-FT 41, and KNM-FT 3318) are instead from Songhor, and one specimen accessioned as being from Songhor (KNM-SO 5352) is from that site. Elemental data reveal that two of the specimens (KNM-FT 3318 and KNM-RU 1681) are likely to have been collected at sites other than their museum-accessioned provenience, while two others (KNM-RU 1999, and KNM-FT 41) were confirmed to have correct provenience. Results for both KNM-FT 8 and KNM-SO 5352, while somewhat equivocal, are best interpreted as supporting their accessioned provenience. Our results have implications for the distribution of certain catarrhine species during the Miocene in Kenya. Confirmation of the provenience of the specimens also facilitates taxonomic attribution, and resulted in additions to the morphological characterizations of some species. The protocol presented here has potential for wider application to assessing questions of provenience for fossils from other locations and periods.

Early Pleistocene hominin teeth from Gongwangling of Lantian, Central China.

The fossil hominin individual from Gongwangling of Lantian, Central China, represents one of the earliest members attributed to Homo erectus in East Asia. Recent paleomagnetic analyses have yielded an age of 1.63 Ma for the Gongwangling hominin. The fossils from this site are critical to characterize the morphological features of early hominins in East Asia and to understand their relationships with other earlier and later members of the genus Homo. However, most morphological details of the Gongwangling cranium were obliterated due to postmortem erosion and deformation. Here we used high-resolution microcomputed tomography and three-dimensional virtual imaging techniques to extract the teeth and reconstruct the worn/damaged areas, describe the external morphology, measure crown diameters, record nonmetric traits of the crown and root, and investigate the shape of the enamel-dentine junction using geometric morphometrics. We compared the data obtained from the six teeth of the Gongwangling hominin with African early Homo, African and Georgian Homo erectus s.l., Asian Homo erectus, Homo antecessor, pre-Neanderthals, Neanderthals, and modern humans. Our results show that the Gongwangling specimens display affinities with other specimens attributed to H. erectus s.l. The highly divergent and noncoalesced three-root system in the Gongwangling specimens is comparable to that in the Early Pleistocene members of H. erectus s.l., and differs from Middle Pleistocene representatives of the species. The enamel-dentine junction shape of the Gongwangling molars prefigures the Asian H. erectus pattern later found in East Asian Middle Pleistocene H. erectus. The morphological comparisons between East Asian Early Pleistocene (e.g., Gongwangling, Meipu, and Quyuan River Mouth) and Middle Pleistocene H. erectus (e.g., Zhoukoudian, Hexian, and Yiyuan) suggest a potential temporal trend within this species in East Asia.