Relationship between Aspiration Pneumonia and Feeding Care among Home Care Patients with an In-Dwelling Nasogastric Tube in Taiwan: A Preliminary Study.

Home care patients have swallowing dysfunction and rely on an in-dwelling nasogastric tube (NGT) to complement oral food intake, supplement their diet, and maintain adequate nutritional status. This study explored the relationship between aspiration pneumonia (AP) and feeding care among home care patients with an in-dwelling NGT. This preliminary study employed a cross-sectional design. There were 35 patients who relied on an in-dwelling NGT to complement their oral intake of food (NGT-oral feeding) and their primary caregivers participated in this study. All of them developed AP in the past year. Factors involving food intake performance during mealtime of the home care patients and feeding care provided by the caregivers were simultaneously observed and recorded. Among the six risk factors univariately correlated with the incidence of AP, feeding in a noisy environment, using a large spoon to feed the participants, more than 5 mL of food per mouthful, food intake duration lasting > 30 min, swallowing twice for each mouthful of food, and coughing at least once every day remained significant in the logistic regression model (all p < 0.05). Four risk factors for AP were correlated with feeding care; the adjusted risk ratio ranged from 6.17 to 14.96 (all p < 0.05). In addition to each individual's food intake ability, improper feeding assistance was related to the risk factors for AP among home care patients with NGT-oral feeding. Thus, home caregivers should receive safe oral feeding education and training.

Skeletal Stability after Mandibular Setback via Sagittal Split Ramus Osteotomy Verse Intraoral Vertical Ramus Osteotomy: A Systematic Review.

PURPOSE: The purpose of present study was to review the literature regarding the postoperative skeletal stability in the treatment of mandibular prognathism after isolated sagittal split ramus osteotomy (SSRO) or intraoral vertical ramus osteotomy (IVRO). MATERIALS AND METHODS: The articles were selected from 1980 to 2020 in the English published databases (PubMed, Web of Science and Cochrane Library). The articles meeting the searching strategy were evaluated based on the eligibility criteria, especially at least 30 patients. RESULTS: Based on the eligibility criteria, 9 articles (5 in SSRO and 4 in IVRO) were examined. The amounts of mandibular setback (B point, Pog, and Me) were ranged from 5.53-9.07 mm in SSRO and 6.7-12.4 mm in IVRO, respectively. In 1-year follow-up, SSRO showed the relapse (anterior displacement: 0.2 to 2.26 mm) By contrast, IVRO revealed the posterior drift (posterior displacement: 0.1 to 1.2 mm). In 2-year follow-up, both of SSRO and IVRO presented the relapse with a range from 0.9 to 1.63 mm and 1 to 1.3 mm respectively. CONCLUSION: In 1-year follow-up, SSRO presented the relapse (anterior displacement) and IVRO posterior drift (posterior displacement). In 2-year follow-up, both of SSRO and IVRO showed the similar relapse distances.

Investigation of the Effectiveness of Surgical Treatment on Maxillary Medication-Related Osteonecrosis of the Jaw: A Literature Review.

AIM: Medication-related osteonecrosis of the jaw (MRONJ) occurs after exposure to medication (antiresorptive or antiangiogenic agents) for bone-related complications. It is more common in the mandible than in the maxilla. The present study investigated maxillary MRONJ in elderly patients through a meta-analysis. METHODS: Keywords, including "MRONJ", "maxilla", and "surgery", were entered into databases, including Embase, PubMed/MEDLINE, Cochrane Library, and ProQuest, which were searched systematically. RESULTS: Investigating 77 studies, we found that 18 (2 case reports and 16 case series) papers conformed to the standards. The results revealed a 2.6:1 female-to-male ratio of disease occurrence. The average age of patients was 70.6 ± 5.5 years, and most patients were in the third stage (43.6%). The average time of medication usage was 50.0 ± 20.1 months. The pooled proportion of clinical efficacy of surgery was 86%. CONCLUSION: To prevent and manage MRONJ, all elderly patients should maintain proper oral hygiene and receive dental examinations regularly. Risk assessment and safety management of MRONJ should be performed by medical teams.

Effect of Microimplant Neck Design with and without Microthread on Pullout Strength and Destruction Volume.

The microthread neck concept has been applied to dental implants. This study investigated the pullout strength and destruction volume of orthodontic microimplants with and without the microthread neck design. Fifteen microimplants (diameter: 1.5 × 10 mm) of three types (Types A and B: without microimplant neck; Type C: with microimplant neck) were tested. The insertion torque (IT), Periotest value (PTV), horizontal pullout strength (HPS), and horizontal destruction volume (HDV) of each type were measured. Kruskal-Wallis H test and Dunn's post-hoc comparison test were performed to compare the measured values of the three types of microimplants. The correlations of the measured values were used to perform the Spearman's correlation coefficient analysis. The ITs of Types B (8.8 Ncm) and C (8.9 Ncm) were significantly higher than those of Type A (5.2 Ncm). Type B yielded the lowest PTV (4.1), and no statistical differences in PTV were observed among the three types. Type A had a significantly lower HPS (158.8 Ncm) than Types B (226.9 Ncm) and C (212.8 Ncm). The three types did not exhibit any significant differences in the HDV. The results of the Spearman's correlation coefficient test revealed that HDV (ρ = 0.710) and IT (ρ = 0.813) were strongly correlated with HPS, whereas for PTV and HPS, it was not. HPS was strongly and significantly correlated with HDV. The orthodontic microimplant with a microimplant neck design did not perform better than that without a microthread in the mechanical strength test.

Postoperative Changes in Tongue Area and Pharyngeal Airway Space following Mandibular Setback Surgery through Intraoral Vertical Ramus Osteotomy.

PURPOSE: The aim of this study was to determine changes in the tongue area and pharyngeal airway space (PAS) after intraoral vertical ramus osteotomy (IVRO). MATERIALS AND METHODS: Serial lateral cephalograms of 40 patients with mandibular prognathism who underwent IVRO were evaluated before (T1), immediately after (T2), and more than 1 year after (T3) surgery. Paired t-tests and Pearson's correlation analysis were used to evaluate the postoperative changes in the mandible, nasopharyngeal airway (NOP), retropalatal pharyngeal airway (RPP), retroglossal pharyngeal airway (RGP), hypopharyngeal airway (HOP), PAS, and tongue area (TA). The null hypothesis states that there are no significant correlations among the extent of mandibular setback and the changes in the TA and PAS after IVRO. RESULTS: Immediately after the operation (T12), the mandible was set back by 12.6 mm. The NOP, HOP, and PAS were significantly reduced by 35.7 mm2, 116 mm2, and 185 mm2, respectively. The TA was increased by 69.6 mm2. The changes in PAS and TA revealed no significant difference between female and male patients at T12, T23, and T13. Moreover, no significant correlations were found among the extent of mandibular setback, TA changes, and PAS changes after IVRO. Thus, the null hypothesis was accepted. CONCLUSIONS: At the final follow-up (T13), no significant change was found in the PAS (including NOP, RPP, RGP, and HOP) and TA. The changes in PAS and TA revealed no significant difference between female and male patients at T12, T23, and T13.

Decreased Tongue Pressure Associated with Aging, Chewing and Swallowing Difficulties of Community-Dwelling Older Adults in Taiwan.

Personalized tongue pressure (TP) training focuses on improving swallowing. This study aims to establish the TP values of different age levels and compare changes between different swallowing status among community-dwelling elders. In this cross-sectional study, 1000 participants, aged 60 years old and above, were recruited from community care centers. All participants were classified into non chewing and/or swallowing difficulties (NCSD) and with chewing and/or swallowing difficulties (CSD) groups and their diseases and dieting status were recorded using a structured questionnaire. A disposable oral probe was used to measure TP by asking participants to compress it against the hard palate with maximum voluntary effort. Among 1000 elders, 63.10% had CSD and their TP (from 31.76 to 18.20 kPa) was lower than the NCSD group (from 33.56 to 24.51 kPa). Both groups showed the same tendency for TP decline with increasing age. Decline of TP makes CSD elderly have a poor appetite, eat a soft or liquid diet, and take longer to eat a meal (all p < 0.050). The secondary risk factor dominating TP decline for NCSD and CSD elders is having an education level less than primary school and an abnormal eating assessment, respectively. Our results demonstrated that TP decline has a significant relationship with age changes. Education level and an abnormal eating assessment score are closely associated with TP decline. A series of TP values can be used as a reference indicator of personalized medicine during the aging process among community-dwelling older adults.

Analysis of Facial Skeletal Morphology: Nasal Bone, Maxilla, and Mandible.

The growth and development of facial bones are closely related to each other. The present study investigated the differences in the nasomaxillary and mandibular morphology among different skeletal patterns. Cephalograms of 240 participants were divided into 3 groups based on the skeletal pattern (Class I, Class II, and Class III). The dimensions of nasomaxilla (nasal bone length, nasal ridge length, nasal depth, palatal length, and maxillary height) and mandible (condylar length, ramus length, body length, symphysis length, and entire mandibular length) were measured. One-way analysis of variance and Pearson's correlation test were used for statistical analysis. No significant differences were observed among the skeletal patterns in terms of nasal bone length, palatal length, maxillary height, or condylar length. Class II had a significantly shorter ramus, mandibular body, and entire mandibular length compared with those of Class I and Class III. Nasal ridge length exhibited a significant moderate correlated with nasal bone length (correlation coefficient: 0.433) and maxillary height (correlation coefficient: 0.535). The entire mandibular length exhibited a significant moderate correlated with ramus length (correlation coefficient: 0.485) and body length (correlation coefficient: 0.536). In conclusion, nasal and maxillary dimensions exhibited no significant difference among the 3 skeletal patterns. Mandibular body and entire mandibular lengths were significantly positively correlations with Class III skeletal patterns.

The investigation of pharyngeal airway space by cephalogram landmarks in primary school children in Taiwan.

BACKGROUND/PURPOSE: Proper breathing is essential to healthy growth and development of children. The present study aimed to investigate changes in the pharyngeal airway space in primary-school children. MATERIALS AND METHODS: Cephalometric radiographs were obtained from 93 primary-school children, who were divided into three age groups (Group I, aged 7-8 years; Group II, aged 9-10 years; and Group III, aged 11-12 years). Landmarks identified on each cephalogram included the tip of the uvula (U), hyoid bone (H), and epiglottis (E). Linear and angular measurements comprised nasopharyngeal airway (NP); PS (shortest distance from the soft palate to the pharyngeal wall); UP (distance from the tip of the uvula to the pharyngeal wall); TS (shortest distance from the posterior tongue to the pharyngeal wall); EP (distance, parallel to the X-axis, from the epiglottis to the pharyngeal wall). Statistical analysis was performed using one-way analysis of variance and Pearson correlation tests. RESULTS: Group III had the highest values for all the variables. The three groups exhibited significant differences for all pharyngeal airway variables, except for EP. The three groups had significantly different vertical U, H, and E. There were positive correlations between age and NP, PS, UP, and TS; however, no significant correlation was observed between age and EP. Age significantly correlated with the vertical U, E, and H. Correlations between age and the horizontal U, E, and H were nonsignificant. CONCLUSION: Among primary-school children from various grades, age significantly correlated with all pharyngeal airway variables, except with EP.

Dental Treatment Needs and Related Risk Factors among School Children with Special Needs in Taiwan.

The purpose of this study was to assess dental treatment needs (TNs) and related risk factors of children with disabilities (CD). This cross-sectional study recruited 484 CD, 6 to 12 years of age, from 10 special education schools in Taiwan. Dental status and TNs were examined and evaluated by well-trained dentists and based on the criteria set by the World Health Organization (1997). The results indicated that 61.78% required restorative dental treatment due to their dental caries. On average, each participant had 2.72 teeth that required treatment, and 6.38 surfaces required restoration. One-quarter of the participants (24.79%) required 1- or 2-surface restoration, and one out of three (36.98%) had more complex TNs (including 3 or more surfaces to be filled, pulp care, extraction, and more specialized care). The significant risk factors associated with restorative TNs among CD were those whose parents had lower socioeconomic status, frequent sweets intake, insufficient tooth-brushing ability, and poor oral health. Most of the CD had extensive unmet TNs for their caries and required complex treatment to recover the function of their teeth. Encouraging parents/caregivers to take their children for dental treatment, promoting awareness of the importance of dental hygiene, giving assistance to brushing their teeth after eating, and controlling and/or modifying sweet diet habits are necessary to reduce CD's dental caries, especially those with lower socioeconomic status parents/caregivers.

Association between the dental occlusion and perceived ability to eat foods of Taiwanese older adults.

Tooth loss is a common problem among older adults that affects masticatory function (MF) and food selection. Financial burden is a reason that some older adults in Taiwan with this condition forgo dental restoration. To identify the number of posterior occlusal support areas (POSAs) associated with MF. Large-scale cross-sectional study included 1100 community-dwelling participants of Taiwan aged ≥65 years. Participants completed dental examination and questionnaires through personal interviews. Masticatory performance was evaluated using a colour-changeable chewing gum. Masticatory ability was evaluated on the basis of how many of 14 common foods the participants were able to eat. Participants were grouped into 10 categories (A1-A3, B1-B4 and C1-C3) according to the Eichner index (EI) of posterior occlusal contacts. Multivariable regression models were used to analyse the association between the EI groups and MF. More than 80% of the participants with two or more POSAs (those in groups A1-B2) could easily eat various foods. Compared with those in groups A1-B2, those in groups in B3, B4, C1, C2 and C3 exhibited a significantly different masticatory performance (all P < .001) and significantly higher difficulty in eating fruits and vegetables. A dose-response effect between POSAs and perceived masticatory ability to eat fruits and vegetables was observed (P < .05 for both trends). Preservation of at least two POSAs is essential for MF. Older adults with tooth loss can undergo the restoration of two POSAs to improve MF and increase food intake.

Relationship between hyoid bone and pharyngeal airway in different skeletal patterns.

BACKGROUND/PURPOSE: The hyoid bone and its attached muscles play an important role in the maintenance of the pharyngeal airway space. The aim of the present study was to investigate the correlations between hyoid bone and pharyngeal airway spaces among three skeletal patterns. MATERIALS AND METHODS: Cephalograms of 90 male and 90 female were divided into skeletal patterns: Class I, Class II, and Class III. The following pharyngeal airway spaces were measured: SP, soft palate related pharyngeal airway; BP, B point related pharyngeal airway; C2P, second cervical vertebra related pharyngeal airway; and LP, laryngopharyngeal airway. The paired t-test, one-way analysis of variance, and Pearson correlation analysis were used in the statistical analyses. RESULTS: SP was significantly longer in Class III (12.4 mm) than in Class I (10.7 mm) and Class II (9.5 mm), and BP was significantly greater in Class III (16.3 mm) than in Class II (12.4 mm). The hyoid bone had a significantly anterior location in Class III compared to Class II, whereas vertical positions of the hyoid bone showed no significant differences among the three skeletal patterns. Among female with a Class III skeletal pattern, the horizontal position of the hyoid bone had a positive moderate, significant correlation with the C2P, whereas among male, this was not observed. CONCLUSION: The location of the maxilla (SNA) was not significantly correlated with the pharyngeal airway space. However, the more protruding the mandible (SNB) is, the more anterior the hyoid bone and the longer the pharyngeal airway will be.

Nasomaxillary and mandibular bone growth in primary school girls aged 7 to 12 years.

BACKGROUND/PURPOSE: Facial bone growth manifests in primary school-aged children, especially girls. This study investigated the changes in nasomaxillary and mandibular morphology of primary school girls. MATERIALS AND METHODS: Cephalograms of 60 primary school girls were divided into 3 groups (group I, aged 7-8 years; group II, aged 9-10 years; and group III, aged 11-12 years). The dimensions of the nasomaxilla (nasal bone length, nasal ridge length, nasal depth, palatal length, and maxillary height) and mandible (condylar length, condylar width, coronoid length, coronoid width, ramus length, body length, symphysis length, and entire mandibular length) were measured. One-way ANOVA and Pearson's correlation coefficient were used for statistical analysis. RESULTS: Nasal ridge length, nasal depth, and maxillary height were significantly greater in group III than in group I and group II. Condylar width and body length were significantly greater in group III than in group I and group II. Pearson's correlation revealed significant positive correlations between age and nasal ridge length, nasal depth, or maxillary height. There were also significant positive correlations between age and ramus length, body length, or entire length of the mandible. CONCLUSION: We found that nasal ridge length, nasal depth, maxillary height, condylar width and body length were significantly greater in group III than in group I or in group II. Moreover, there were significant correlations between age and the nasal ridge length, nasal depth, maxillary height, ramus length, body length, or entire length of the mandible.

Dimension and Location of the Mandibular Lingula: Comparisons of Gender and Skeletal Patterns Using Cone-Beam Computed Tomography.

OBJECTIVE: The study aimed to investigate and measure the anatomical relationship between the mandibular lingula (Li) and skeletal patterns using cone-beam computed tomography (CBCT). Materials and Methods. In total, 72 participants (23 men and 49 women) were categorized into three groups according to their skeletal patterns (specifically, the A point-nasion-B point (ANB]) angle) as follows: Class I (0° < ANB < 4°), Class II (ANB ≥ 4°), and Class III (ANB ≤ 0°). The CBCT images of 144 rami were collected, and the distance from the Li to the external oblique ridge (Li-EOR), internal oblique ridge (Li-IOR), posterior border of the ramus (Li-PBR), inferior border of the ramus (Li-IBR), sigmoid notch (Li-Sm), and mandibular foramen (Li-MF) was examined. The Li-hMF (horizontal distance from the Li to the MF) and Li-vMF (vertical distance from the Li to the MF) were measured. The comparisons of gender, side (right and left), and skeletal patterns were then evaluated by statistical analysis. RESULTS: The values of the Li-EOR and Li-PBR (19.99 mm and 15.93 mm, respectively) were significantly higher in men than in women (18.85 mm and 14.89 mm, respectively). Moreover, the Li-IBR was higher in men (32.91 mm) than in women (30.40 mm). Both sides (right and left) and skeletal patterns demonstrated that the Li-EOR, Li-IOR, and Li-PBR were not significantly different. Pearson's correlation test reported a strong correlation between the Li-EOR and Li-IOR (r=0.610). CONCLUSION: The distances from mandibula lingula to the external oblique ridge, posterior border of ramus, and inferior border of ramus were significantly longer in men than in women. Similarly, both horizontal and vertical distances from the lingula to the mandibular foramen were significantly longer in men than in women. Therefore, the results demonstrated that the Li was longer and more protruding in men than in women. With respect to the horizontal distance from the mandibular lingula to the mandibular foramen, of the three types of the skeletal system (Class I, Class II, and Class III), Class III was the significantly largest.

Postoperative Skeletal Stability and Pharyngeal Airway: Counterclockwise versus Clockwise Rotation during Mandibular Setback Surgery.

PURPOSE: To compare the effects of counterclockwise rotation (CCR) and clockwise rotation (CR) of the mandible on the pharyngeal airway during mandibular setback surgery. Materials and Methods. Serial cephalograms of 40 patients with mandibular prognathism, including 20 who underwent CCR and 20 who underwent CR, were taken at the following time intervals: preoperatively (T1), immediately postoperatively (T2), >1 year after surgery (T3), final surgical changes (T31), postoperative stability (T32), and immediate surgical change (T21). Changes in menton (Me) and hyoid (H) positions, soft palate width, soft palate length, soft palate angle and craniovertebral angle (C2C4-SN), and pharyngeal airway spaces (nasal pharyngeal airway (NOP), uvula pharyngeal airway (UOP), tongue pharyngeal airway (TOP), and epiglottis pharyngeal airway (EOP)) were evaluated. RESULTS: The mean Me (T31) setback for CCR and CR was 12.56 and 13.06 mm, respectively, with 2.41 mm upward and 3.29 mm downward, respectively. The vertical Me position of CR exhibited significant downward movement compared with that of CCR. The mean H setback results for CCR and CR were 4.42 and 5.75 mm, respectively, with 1.47 mm downward and 2.97 mm downward, respectively. The C4C2-SN angles for CCR and CR increased by 2.68° and 3.65°, respectively, whereas their palatal angles increased by 2.35° and 5.25°, respectively. Pearson's correlation analysis (T31) revealed that for CCR, no pharyngeal airway spaces were significantly correlated with any measured variables. In CR, NOP was significantly correlated (r = 0.58) with the vertical Me position. Significant relapse (T32) was observed after CR in the horizontal (r = 0.58) with the vertical Me position. Significant relapse (T32) was observed after CR in the horizontal (r = 0.58) with the vertical Me position. Significant relapse (T32) was observed after CR in the horizontal (. CONCLUSION: Pharyngeal airway space narrowed postoperatively, and its patency was appropriately maintained through natural physiological regulation of the craniovertebral angle (C2C4-SN). Significant postoperative relapse was correlated with CR.

The correlation among gripping volume, insertion torque, and pullout strength of micro-implant.

BACKGROUND/PURPOSE: The fixation stability is the key factor for orthodontic micro-implant to succeed. This study evaluated the mechanical properties of three types of micro-implants by analyzing their structural configurations. MATERIALS AND METHODS: Thirty micro-implants of three types (diameter 1.5 mm, Types A, B, C) were assessed. All micro-implants were manually driven into artificial bones at an 8-mm depth. The insertion torque (IT), pullout strength (PS), and gripping volume (GV) of each type were measured. The indexes of mechanical properties denoted as the PS/IT, GV/IT and PS/GV ratios. Intergroup comparisons and intragroup correlation were examined using statistical analysis. RESULTS: Type B had the greatest inner-outer diameter ratio (0.67), and Type A had the smallest (0.53). The IT of Type A (5.26 Ncm) was significantly (p = 0.038) lower than that of Type C (8.8 Ncm). There was no significant difference in the pullout strength. The GV of Type A (9.7 mm3) was significantly greater than Type C (8.4 mm3). Type C was significantly greater than Type B (7.2 mm3). The ratios of mechanical properties (PS/IT, PS/GV, and GV/IT) were found significant in intergroup comparison. The PS/GV ratio was in order: Type B (26.5) > Type A (23.0) > Type C (20.2). Spearman's rho rank correlation test showed that PS of Type B was correlated significantly with GV. CONCLUSION: The design of thread and gripping volume were the important factors that contributes to the mechanical strengths of micro-implant.

Translation and validation of Taiwanese version of the Early Childhood Oral Health Impact Scale (ECOHIS).

BACKGROUND/PURPOSE: Treating and preventing dental caries in children have been major health concerns in Taiwan. However, little discussion on oral health-related quality of life in Taiwanese preschooler exists. This study aimed to construct and validate a Taiwanese version of the Early Childhood Oral Health Impact Scale (ECOHIS) for preschool children in Taiwan. MATERIALS AND METHODS: A Taiwanese version of the ECOHIS was developed using the forward-backward translation method. Our study population (n = 251) comprised children aged 3-6 years old. Parents of the children signed informed consent and self-completed ECOHIS. Data were analyzed for internal reliability using Cronbach's alpha coefficient, and item-to-total correlation was determined. Criterion validity was tested for the relationship between ECOHIS scores and caries experience (dmft). A multiple linear regression model was used to assess the independent variables of the ECOHIS. RESULTS: Cronbach's alpha for the total score of the Taiwanese version of ECOHIS was 0.76. The validity of the ECOHIS was tested, and scores of both the total scale and family impact section were found to be statistically significantly related to dmft (P < 0.005). Multiple linear regression analysis revealed that with an increase in dmft, the total score of the ECOHIS significantly increased (95% CI = 0.22-0.63, P < 0.001). CONCLUSION: The Taiwanese version of the ECOHIS is a valid and reliable tool to assess the oral health-related effect on 3- to 6-year-old children in Taiwan.

Caregivers' oral health knowledge, attitude and behavior toward their children with disabilities.

BACKGROUND/PURPOSE: This study was undertaken to document the knowledge, attitude and behavior among family caregivers, and to identify the related factors influencing their behavior in promoting their and children's oral health. MATERIALS AND METHODS: A cross-sectional study was conducted to collect self-administered questionnaires from 503 family caregivers, who cared for 6-12 year-old children with disabilities in 10 special schools. Multiple regression models were used to analyze the association between caregiver's oral health behaviors and related factors. RESULTS: Most caregivers were female (74.8%). The top three sources of oral health knowledge among caregivers were dentists (66.60%), books (34.59%) and television (31.21%). Comparison of oral health knowledge and attitude scores among different education levels of caregivers yielded statistically significant differences (p < 0.05). Eighty-four percent of caregivers cleaned their teeth twice a day and 46.12% used dental floss. More than half of caregivers (60.44%) assisted their children to brush teeth. Only 12.65% took their children to receive fluoride varnish services. Caregivers' favorable oral health behavior was found to be significantly associated with a higher education level, better knowledge and positive attitude. The determining factor of caregivers' preventive behavior was attitude. Education level influenced the caregiver's knowledge. Knowledge is positively associated with attitude. CONCLUSION: Inadequate knowledge is the major factor preventing caregivers from favorable oral health behavior. Oral health related educational programs aimed at promoting caregivers' behavior must take into consideration the caregivers' knowledge level first. Education programs should be recommended to caregivers with a lower education level.

Toothbrushing habits and risk indicators of severe early childhood caries among aboriginal Taiwanese.

The purpose of this study was to investigate the toothbrushing habits and risk indicators among aboriginal children with severe early childhood caries (S-ECC). This was a cross-sectional purposive sampling study that included 281 aboriginal children aged 2 to 5 years living in remote regions in southern Taiwan. Participant received dental examinations and questionnaires that were completed by caretakers. From among the 281 participants, 238 children (84%) presented with S-ECC. A low-frequency toothbrushing habit among the children with S-ECC was associated with caretakers with low-frequency toothbrushing (P = .001). The odds ratio of a child using improper toothbrushing methods having a caretaker with a low brushing frequency was 3.45 (P = .0157). Low-frequency toothbrushing and improper toothbrushing methods were associated with S-ECC. The caretakers' brushing frequency was a risk indicator associated with the children's poor oral hygiene.

Impact of 24-month fluoride tablet program on children with disabilities in a non-fluoridated country.

The aim of this study was to evaluate the caries preventive effects of a school-based fluoride tablet program in children with disabilities. Two hundred and seventeen children with disabilities were divided into two groups: the intervention group (IG) ingested 1.0mg fluoride tablet daily while the control group (CG) ingested a placebo. The initial oral examinations were conducted prior to fluoride intake and 24-month follow-up examinations were conducted to evaluate the effectiveness of fluoride tablet ingestion. The results from this study demonstrated significant reductions in the DMFT index (the sum of decayed, missing, and filled permanent teeth), 0.63, as well as the DMFS index (the sum of decayed, missing, and filled surfaces of the permanent dentition), 1.25, when compared with the CG. A statistically significant reduction in the DMFT index and DMFS index (30.42% and 36.84%, respectively) suggested an anti-cariogenic benefit to fluoride tablet administration. Greater caries reduction occurred on mesio-distal and bucco-lingual surfaces (53.27% and 52.57%, respectively). Fluoride tablets should be considered as a caries preventive strategy in school-based caries prevention programs for children with disabilities in fluoride deficient areas.

Urinary fluoride concentration in children with disabilities following long-term fluoride tablet ingestion.

Urine is the most commonly utilized biomarker for fluoride excretion in public health and epidemiological studies. Approximately 30-50% of fluoride is excreted from urine in children. Urinary fluoride excretion reflects the total fluoride intake from multiple sources. After administering fluoride tablets to children with disabilities, urinary fluctuation patterns should be investigated. The purpose of this study was to monitor the short and long term fluctuating patterns of urinary fluoride concentration after fluoride tablets were ingested by children with disabilities. Children with disabilities aged 6-12 years old were selected randomly and were divided into three groups: Group A, 1.0mg fluoride tablet, Group B, 0.5mg fluoride tablet, and Group C, control group. The urine samples were collected in the morning (MU) and 2h after fluoride tablets were ingested (AU). Urine was collected on the day prior to fluoride intake (baseline), the first, the third, the fifth and the eighth day of fluoride ingestion for a short term, and once every 6 months for a total of 18 months for long-term observation. The AU sample showed statistically significantly higher concentrations of urine fluoride than those of the MU samples, and no statistically significant difference was noticed in the MU samples among the three groups. Group A showed the highest urinary fluoride concentration (UFC) among the three groups. UFC increased as ingested fluoride tablet dosage increased, and it returned to the baseline level on the following day and persisted throughout the study period.