MASCC/ISOO Clinical Practice Statement: Management of oral complications of targeted therapy.

PURPOSE: A MASCC/ISOO Clinical Practice Statement (CPS) is aimed at generating a concise tool for clinicians that concentrates practical information needed for the management of oral complications of cancer patients. This CPS is focused on the management of oral complications of targeted therapy. METHODS: This CPS was developed based on critical evaluation of the literature followed by a structured discussion of a group of leading experts, members of the Oral Care Study Group of MASCC/ISOO. Targeted agents were identified using the National Cancer Institute's list of Food and Drug Administration approved targeted therapy drugs. The information is presented in the form of succinct bullets and tables to generate a short manual about the best standard of care. RESULTS: Oral toxicities secondary to targeted therapy include various mucosal conditions, gingival conditions, jawbone disease, dysesthesia, taste change, and dry mouth. For the purpose of this CPS, we focused on oral mucosal conditions, gingival conditions, taste change, and dysesthesia. The treatment of oral toxicities depends on the symptom severity. Topical steroids and immunomodulators are often used as first-line therapy for oral mucosal toxicities. Treatment approaches for oral dysesthesia and taste change primarily revolve around symptoms management. Typically, therapy protocols align with the therapeutic algorithms employed for other neuropathic pain conditions, incorporating topical pharmacological interventions to achieve relief. Other oral toxicity requires a more specific approach. CONCLUSION: Management of oral toxicities from targeted molecular therapies is designed to alleviate patient discomfort and optimize treatment outcomes. Collaboration between medical and oral health professionals is necessary for best management practices.

MASCC/ISOO Clinical Practice Statement: Clinical assessment of salivary gland hypofunction and xerostomia in cancer patients.

PURPOSE: A MASCC/ISOO Clinical Practice Statement (CPS) is aimed at generating a concise tool for clinicians that concentrates practical information needed for the management of oral complications of cancer patients. This CPS is focused on the clinical assessment of salivary gland hypofunction and xerostomia in cancer patients. METHODS: This CPS was developed based on a critical evaluation of the literature followed by a structured discussion of a group of leading experts, members of the Oral Care Study Group of MASCC/ISOO. The information is presented in the form of succinct bullets and tables to generate a short manual about the best standard of care. RESULTS: The objective assessment of saliva secretion involves an extra- and intra-oral clinical examination while the subjective assessment involves eliciting information on the patient's complaint of xerostomia and its impact on daily functioning. This CPS summarizes the common investigator- and patient-reported instruments used in clinical practice for assessing salivary gland hypofunction and xerostomia in cancer patients. CONCLUSION: There is a range of tools to assess salivary gland function in patients undergoing cancer therapy, patients recovering from cancer therapy, or cancer survivors. Clinicians should ideally conduct both objective and subjective measurements to ensure a clear understanding about the status of the patients in order to provide the most appropriate treatment.

MASCC/ISOO Clinical Practice Statement: Management of salivary gland hypofunction and xerostomia in cancer patients.

PURPOSE: A MASCC/ISOO Clinical Practice Statement (CPS) is aimed at generating a concise tool for clinicians that concentrates practical information needed for the management of oral complications of cancer patients. This CPS is focused on the management of salivary gland hypofunction and xerostomia in cancer patients. METHODS: This CPS was developed based on critical evaluation of the literature followed by a structured discussion of a group of leading experts, members of the Oral Care Study Group of MASCC/ISOO. The information is presented in the form of succinct bullets and tables to generate a short manual about the best standard of care. RESULTS: Salivary gland hypofunction and xerostomia in cancer patients are managed by (i) stimulating saliva production of salivary glands with residual secretory capacity or (ii) artificial wetting of the oral and lip surfaces which can be achieved by pharmacological or non-pharmacological interventions. Pharmacological interventions encompass the use of sialagogues and sialolytics, while non-pharmacological interventions involve the use of moistening agents, mechanical, gustatory, or electrostimulation of the salivary glands. Additional treatment modalities may be incorporated in practice based on local availability and the clinician's experience. CONCLUSION: The information presented in this CPS offers clinicians convenient access to the dosages and regimens of different interventions for managing salivary gland hypofunction or xerostomia to facilitate clinical efficiency and conserve valuable time for clinicians.

Munchausen syndrome by proxy: A narrative review and update for the dentist and other healthcare professionals.

Munchausen syndrome by proxy (MSbP) is a form of abuse in which a caregiver with Factitious Disorder Imposed on Another (FDIA) fabricates or induces signs or symptoms in a person under their care to satisfy a self-serving psychological need. Unnecessary clinical evaluations, procedures, and treatments that are initiated based on falsification by the abuser inadvertently add to the trauma experienced by the victim. It is a form of abuse and the impact on victims can be severe, sometimes fatal, and far-reaching such as prolonged neglect and extension to affected siblings. The long-term exposure to MSbP may predispose the victim to eventually developing factitious disorder imposed on self (FDIS). While MSbP often involves child victims, elderly, adults, and pets have also been reported as victims. MSbP can be a diagnostic challenge, and the important keys to timely identification of MSbP include the ability to detect deception by caregivers through awareness, clinical suspicion, and careful review of available health records; it also involves collecting collaborative information from other relevant healthcare providers including dentists, schoolteachers, and social workers. To date, there are limited published cases of MSbP with oral findings. This paper provides a narrative review of the current understanding of MSbP with a section on cases with oral findings. This paper aims to increase awareness about the clinical presentations and management considerations for MSbP among dentists and other healthcare professionals.

Perception of nurses applying silver diamine fluoride to children's teeth: A mixed methods study.

BACKGROUND: No studies have evaluated the unique potential of nurse-led silver diamine fluoride (SDF) application for children to bridge the gap in interprofessional collaboration. AIM: To investigate the attitudes, beliefs and perceptions of nurses regarding nurse-led SDF application at the well-child visit and identify possible barriers and make recommendations. DESIGN: Mixed methods design involving a questionnaire and semi-structured individual interviews were conducted. RESULTS: All eligible nurses (n = 110) completed the questionnaire, and 16 were interviewed. Questionnaire responses highlighted that nurses were not confident in providing oral health services (score: <3 of 5) beyond oral hygiene advice (score: ≥3.9 of 5) but believed that they should be providing these services for individuals with difficulty accessing care. Interviews reflected that most nurses viewed oral health care as an important part of paediatric health but were limited by knowledge, time and manpower. Most were willing to expand their job scope to include SDF application with formal education and training, competency assessments and approaches to counter time limitations. CONCLUSION: Where nurses are already providing basic oral healthcare, nurse-led SDF application could be the next step. Findings suggest that systemic changes should include strategies to empower and motivate nurses to apply SDF at the well-child visit.

Temperament and past behaviour can predict behaviour success for nitrous oxide sedation.

BACKGROUND: There is currently insufficient evidence on potential predictors of a child's behaviour with nitrous oxide (N2O) sedation. AIM: To examine the association between a child's temperament and behavioural outcomes during dental treatment with N2O sedation, and the child's perception to N2O sedation. DESIGN: At the first visit (dental treatment visit), temperament was assessed using the Child Behaviour Questionnaire-Short Form and behaviour was assessed by an independent rater using the Venham Behaviour Rating Scale. At the second visit, the child's experience with N2O sedation was elicited. RESULTS: Seventy-two healthy children aged between 36 and 95 months were recruited. Planned dental treatment was completed in 84.7% of the subjects. Venham behaviour success <3 and Venham behaviour success <1 were achieved in 73.6% and 33.3%, respectively. The temperament domain of effortful control was associated with Venham behaviour score (ρ = -0.266, p = .024) and Venham behaviour success <1 (OR = 3.506, 95% CI = 1.328-9.259, p = .011). Baseline Frankl behaviour score was significantly associated with all behavioural outcomes. Venham behaviour success <3 was significantly associated with a child reporting to have enjoyed the dental treatment visit (p = .026). CONCLUSION: Effortful control and baseline behaviour were associated with behavioural outcomes of N2O sedation and can be used to predict a child's behaviour.

Incidence, severity, and temporal development of oral complications in pediatric allogeneic hematopoietic stem cell transplant patients - a multicenter study.

PURPOSE: Oral mucositis is a common complication for patients undergoing allogeneic hematopoietic stem cell transplantation (HSCT) and causes pain and difficulties in functions like eating and swallowing, resulting in lower quality of life and greater need of treatment with opioids and parenteral nutrition. This prospective multicenter study focused on pediatric recipients of HSCT in the neutropenic phase concerning oral complications, timing, severity, and patient experience. METHODS: The cohort comprised 68 patients, median age 11.1 years (IQR 6.3) receiving allogeneic HSCT at three clinical sites. Medical records were retrieved for therapy regimens, concomitant medications, oral and dental history, and subjective oral complaints. Calibrated dentists conducted an oral and dental investigation before HSCT. After HSCT graft infusion, study personnel made bedside assessments and patients filled out a questionnaire once or twice a week until neutrophil engraftment. RESULTS: We followed 63 patients through the neutropenic phase until engraftment. 50% developed oral mucositis of grades 2-4. Peak severity occurred at 8-11 days after stem cell infusion. Altogether, 87% had subjective oral complaints. The temporal distribution of adverse events is similar to the development of oral mucositis. The most bothersome symptoms were blisters and oral ulcerations, including mucositis; 40% reported severe pain and major impact on activities of daily living despite continuous use of opioids. CONCLUSION: This study highlights the burden of oral complications and their negative effect on the health and quality of life of HSCT recipients.

Accuracy of the American Association of Endodontists diagnostic criteria for assessing pulp health in primary teeth.

OBJECTIVES: There is a lack of studies evaluating the accuracy of the 2009 American Association of Endodontists (AAE) diagnostic criteria for diagnosing pulpal health in primary teeth. This study aimed to estimate and correlate the diagnostic accuracy of clinical diagnosis of reversible and irreversible pulpitis using the 2009 AAE criteria with histological findings in primary teeth. METHODS: Eighty primary teeth that were clinically diagnosed with normal pulp (n = 10), reversible pulpitis (n = 30), irreversible pulpitis (n = 30) and pulp necrosis (n = 10) were collected. The teeth were histo-processed, and pulp tissues were diagnosed histologically as uninflamed pulp, reversible or irreversibly inflamed and necrosis based on previously proposed criteria. RESULTS: The clinical diagnosis of pulp necrosis (sensitivity 70%, specificity 96%) and normal pulp (sensitivity 91%, specificity 100%) matched the histological diagnosis of necrosis and uninflamed pulp in 70% and 100%, respectively. The clinical diagnosis of irreversible pulpitis (sensitivity 64%, specificity 72%) matched the histological diagnosis of irreversible pulp inflammation for 47% of teeth evaluated. For the clinical diagnosis of reversible pulpitis (sensitivity: 65%, specificity: 86%), 80% matched the histological diagnosis of reversible pulp inflammation. Teeth with histologically diagnosed irreversible pulp inflammation were more likely to have lingering (OR 5.08; 95% CI 1.48-17.46, P = 0.010) and nocturnal tooth pain (OR 15.86; 95% CI 1.57-160.47, P = 0.019) when compared to teeth with reversible pulp inflammation. Using the classification and regression tree model, the presence of widened periodontal ligament space and nocturnal tooth pain were useful predictors of irreversible pulp inflammation with an accuracy of 78%. CONCLUSION: The 2009 AAE criteria was acceptable for primary teeth with pulp necrosis and normal pulp but poor for reversible pulpitis and irreversible pulpitis.

Masticatory function after comprehensive dental treatment in children with severe early childhood caries.

BACKGROUND: Parents are frequently concerned that their child's mastication may be compromised after comprehensive dental treatment. AIM: To evaluate changes in masticatory function and food preferences after dental treatment in children with early childhood caries. DESIGN: This prospective study assessed masticatory function with the (1) mixing ability test using duo-coloured chewing gum and (2) the number of chews/g and time taken to eat six food items before and 3 months after dental treatment. A dental examination and a food preference questionnaire were also completed. RESULTS: Twenty-five children (age: 4.9 ± 0.5 years, baseline dmft/child: 11.4 ± 4.9) completed the study. The mean number of restorations/child, total extractions/child, and posterior extractions/child was 5.1 ± 2.9, 6.4 ± 5.2, and 3.6 ± 2.3, respectively. The number of chews/g of cereal (p = .014) and popcorn (p = .003) significantly increased after dental treatment. The number of chews/g and duration taken for cereal (chews/g: r = 0.795, p = .000, duration: r = 0.794, p = .000) and peanuts (chews/g: r = 0.459, p = .032) were significantly associated with more extractions. There was no change in mastication function for the other foods, mixing ability score, and child's food preferences after dental treatment. CONCLUSIONS: An increased number of chews/g is needed for certain hard foods after dental treatment, which was associated with an increased number of total and posterior extractions.

At what age do children have the motor development to adequately brush their teeth?

BACKGROUND: There is no consensus regarding when children are ready to brush independently. AIM: To examine the effects of chronological age and motor development on toothbrushing effectiveness in 5- to 7-year-old children. DESIGN: In this cross-sectional study, the change in Oral Hygiene Index (OHI) score and the improvement in OHI category (eg, poor to fair) were used to measure toothbrushing effectiveness. Motor development was assessed using the Beery-Buktenica Developmental Test of Visual Motor Integration, and a parental questionnaire was used to determine the child's ability to perform certain daily tasks. RESULTS: Children aged ≥6 years were significantly more likely to show improvement in OHI category (OR = 2.4, p = .032) than 5-year-old children. Parental report of their child's ability to write/print addresses (OR = 3.7, p = .009), tie shoelaces (OR = 2.9, p = .008), and cut/file nails (OR = 3.2, p = .036) was significantly more likely to show improvement in OHI category. A model using chronological age, visual motor age, ability to write/print addresses, tie shoelaces, cut/file nails, and toothbrushing duration achieved 61.8% sensitivity and 80.4% specificity in predicting a child's ability to achieve improvement in OHI category. CONCLUSIONS: Children entering elementary school (≥6 years old) brushed their teeth more effectively than preschool children. A multifactorial model provided an acceptable predictor of the child's ability to brush effectively.

MASCC/ISOO clinical practice guidelines for the management of mucositis: sub-analysis of current interventions for the management of oral mucositis in pediatric cancer patients.

OBJECTIVE: The aim of this sub-analysis was to highlight the MASCC/ISOO clinical practice guidelines for the management of oral mucositis (OM) in pediatric patients and to present unique considerations in this patient population. METHODS: This sub-analysis of the pediatric patient population is based on the systematic review conducted by the Multinational Association of Supportive Care in Cancer/International Society of Oral Oncology (MASCC/ISSO) published in 2019/2020. Studies were scored and assigned a level of evidence based on previously published criteria. Data regarding adverse effects and compliance was collected from the original publications. RESULTS: A total of 45 papers were included and assessed in this sub-analysis, including 21 randomized controlled trials (RCTs). Chewing gum was demonstrated to be not effective in preventing OM in pediatric cancer patients in 2 RCTs. The efficacy of all other interventions could not be determined based on the available literature. CONCLUSION: There is limited or conflicting evidence about interventions for the management of OM in pediatric cancer patients, except for chewing gum which was ineffective for prevention. Therefore, currently, data from adult studies may need to be extrapolated for the management of pediatric patients. Honey and photobiomodulation therapy in this patient population had encouraging potential. Implementation of a basic oral care protocol is advised amid lack of high level of evidence studies.

MASCC/ISOO clinical practice guidelines for the management of mucositis secondary to cancer therapy.

BACKGROUND: Mucositis is a significant toxicity of cancer therapy with numerous systemic sequelae. The goal of this systematic review was to update the Multinational Association of Supportive Care in Cancer and International Society of Oral Oncology (MASCC/ISOO) Clinical Practice Guidelines for the management of mucositis. METHODS: The literature was reviewed systematically to identify interventions for mucositis. Studies were rated according to the presence of major and minor flaws according to previously published criteria. The body of evidence for each intervention and in each treatment setting was assigned a level of evidence based on previously published criteria. Guidelines were developed based on the level of evidence, with 3 possible guideline determinations: recommendation, suggestion, or no guideline possible. RESULTS: The guideline covers evidence from 1197 publications related to oral or gastrointestinal mucositis. Thirteen new guidelines were developed for or against the use of various interventions in specific treatment settings, and 11 previous guidelines were confirmed after aa review of new evidence. Thirteen previously established guidelines were carried over because there was no new evidence for these interventions. CONCLUSIONS: The updated MASCC/ISOO Clinical Practice Guidelines for mucositis provide professional health caregivers with a clinical setting-specific, evidence-based tool to help with the management of mucositis in patients who have cancer.

Systematic review of basic oral care for the management of oral mucositis in cancer patients and clinical practice guidelines.

PURPOSE: The aim of this study was to update the clinical practice guidelines for the use of basic oral care (BOC) interventions for the prevention and/or treatment of oral mucositis (OM). METHODS: A systematic review was conducted by the Mucositis Study Group of the Multinational Association of Supportive Care in Cancer/International Society for Oral Oncology (MASCC/ISOO). The body of evidence for each intervention in each cancer treatment setting was assigned an evidence level. The findings were added to the database used to develop the 2013 MASCC/ISOO clinical practice guidelines. Based on the evidence level, one of the following three guideline determinations was possible: Recommendation, Suggestion, No guideline possible. RESULTS: A total of 17 new papers across six interventions were examined and merged with a previous database. Based on the literature, the following guidelines were possible. The panel suggests that the implementation of multi-agent combination oral care protocols is beneficial for the prevention of OM during chemotherapy, head and neck (H&N) radiation therapy (RT), and hematopoietic stem cell transplantation (Level of Evidence III). The panel suggests that chlorhexidine not be used to prevent OM in patients undergoing H&N RT (Level of Evidence III). No guideline was possible for professional oral care, patient education, saline, and sodium bicarbonate, and expert opinion complemented these guidelines. CONCLUSIONS: The evidence supports the use of multi-agent combination oral care protocols in the specific populations listed above. Additional well-designed research is needed on the other BOC interventions prior to guideline formulation.

World Workshop on Oral Medicine VII: Relative frequency of oral mucosal lesions in children, a scoping review.

OBJECTIVE: To detail a scoping review on the global and regional relative frequencies of oral mucosal disorders in the children based on both clinical studies and those reported from biopsy records. MATERIALS AND METHODS: A literature search was completed from 1 January 1990 to 31 December 2018 using PubMed and EMBASE. RESULTS: Twenty clinical studies (sample size: 85,976) and 34 studies from biopsy services (40,522 biopsies) were included. Clinically, the most frequent conditions were aphthous ulcerations (1.82%), trauma-associated lesions (1.33%) and herpes simplex virus (HSV)-associated lesions (1.33%). Overall, the most commonly biopsied lesions were mucoceles (17.12%), fibrous lesions (9.06%) and pyogenic granuloma (4.87%). By WHO geographic region, the pooled relative frequencies of the most common oral lesions were similar between regions in both clinical and biopsy studies. Across regions, geographic tongue (migratory glossitis), HSV lesions, fissured tongue and trauma-associated ulcers were the most commonly reported paediatric oral mucosal lesions in clinical studies, while mucoceles, fibrous lesions and pyogenic granuloma were the most commonly biopsied lesions. CONCLUSIONS: The scoping review suggests data from the clinical studies and biopsy records shared similarities in the most commonly observed mucosal lesions in children across regions. In addition, the majority of lesions were benign in nature.

A systematic review of dental disease management in cancer patients.

INTRODUCTION: This systematic review aims to update on the prevalence of odontogenic-related infections and the efficacy of dental strategies in preventing dental-related complications in cancer patients since the 2010 systematic review. REVIEW METHOD: A literature search was conducted in the databases MEDLINE/PubMed and EMBASE for articles published between 1 January 2009 and 30 June 2016. Each study was assessed by 2 reviewers and the body of evidence for each intervention was assigned an evidence level. RESULTS: After examination of the abstracts and full-text articles, 59 articles satisfied the inclusion criteria. The weighted prevalence of dental infections and pericoronitis during cancer therapy was 5.4 and 5.3%, respectively. The frequency of dental-related infections during intensive chemotherapy after complete, partial, and minimal pre-cancer dental evaluation/treatment protocols ranged from 0 to 4%. Protocols involving third molars extractions had the highest complications (40%). CONCLUSIONS: In view of the low prevalence of infections and the potential for complications after third molar extractions, it is suggested that partial dental evaluation/treatment protocols prior to intensive chemotherapy; whereby minor caries (within dentin), asymptomatic third molars or asymptomatic teeth without excessive probing depth (<8 mm), mobility (mobility I or II) or with periapical lesions of <5 mm were observed; is a viable option when there is insufficient time for complete dental evaluation/treatment protocols. The use of chlorhexidine, fluoride mouth rinses as well as composite resin, resin-modified glass ionomer cement (GIC), and amalgam restorations over conventional GIC in post head and neck radiation patients who are compliant fluoride users is recommended.

Interim therapeutic restoration approach versus treatment under general anaesthesia approach.

BACKGROUND: Although dental treatment under general anaesthesia (GA) remains the long-established approach for treating anxious children, treatment under GA presents with increased risks, costs and parental acceptability issues. Interim therapeutic restoration (ITR) has been proposed as an alternative approach. AIM: To compare the incidence and types of failures between children managed with the ITR approach and those managed under GA within 12 months of treatment completion. DESIGN: A retrospective cohort study of children who received dental treatment utilizing the ITR approach was compared to children treated under GA. Age, gender and dental disease matching was done. Statistical analyses were carried out with Independent t-test and chi-square analyses. RESULTS: A total of 132 children (GA = 66, ITR = 66) were included, and the groups did not differ in terms of initial age, sex, dmft and initial behaviour score. ITR group had a significantly higher rate (P < 0.001; 95% CI: [0.21 to 0.97]) of restorative failure and visits required when compared to the GA group. There were no difference for incidence of pain (P = 0.55; 95% CI: [-0.074 to 0.10]) and behaviour scores (P = 0.46) between the two groups at the 12-month visit. CONCLUSIONS: ITR approach may be a viable alternative to the GA approach when treating paediatric dental patients.

Nanoparticles strengthen intracellular tension and retard cellular migration.

Nanoparticles can have profound effects on cell biology. Here, we show that after TiO2, SiO2, and hydroxyapatite nanoparticles treatment, TR146 epithelial cell sheet displayed slower migration. Cells after exposure to the nanoparticles showed increased cell contractility with significantly impaired wound healing capability however without any apparent cytotoxicity. We showed the mechanism is through nanoparticle-mediated massive disruption of the intracellular microtubule assembly, thereby triggering a positive feedback that promoted stronger substrate adhesions thus leading to limited cell motility.

Prevalence of molar incisor hypomineralization (MIH) in Singaporean children.

BACKGROUND: There is a lack of data on molar incisor hypomineralization (MIH) in Asia, but this is not an indication that MIH is rare in the Asian population. Early identification of MIH is important as affected teeth frequently display post-eruptive enamel loss which would result in rapid caries progression. AIM: This objective of this study was to assess the prevalence of MIH in Singaporean children. DESIGN: Patients were recruited from 30 schools across Singapore. All children were examined by a single dentist, and the judgement criteria used were based on the 2003 European Academy of Paediatric Dentistry criteria. RESULTS: A total of 1083 children; average age of 7.7 ± 0.3 years were examined. One hundred and thirty-five children (12.5%) had MIH. A significantly higher proportion of children of the Malay ethnicity had MIH, compared to Chinese children (P = 0.02). Post-eruptive enamel breakdown and the presence of atypical restorations were correlated with increasing number of MIH teeth/child (Rho= 0.599, P < 0.001) and the cumulative enamel opacity colour score (Rho = 0.601, P < 0.001). CONCLUSIONS: Our findings suggest the role of ethnicity in MIH occurrence and that MIH severity may be influenced by the number of MIH teeth/child and the cumulative enamel opacity colour score.

Antibiotic prophylaxis prescribing practices of dentists in Singapore.

BACKGROUND: Infective endocarditis is a serious complication that results in significant morbidity and mortality in susceptible patients. The guidelines for antibiotic prophylaxis have been updated by the American Heart Association and National Institute for Health and Clinical Excellence. The antibiotic prophylaxis prescribing practices among dentists in Singapore are unknown. AIM: To determine the specific infective endocarditis antibiotic prophylaxis prescribing practices of dentists in Singapore. METHODS: A questionnaire survey was sent through an email link and by postal mail. Statistical analysis was carried out using SPSS 19.0. RESULTS: Responses were received from 458 dentists (34.3% response rate), of which 278 (65.9%) were general practitioners. The majority of respondents (39.8%) followed the American Heart Association 2007 guidelines and 30.2% followed cardiologists' recommendations. The accuracy of prescriptions for 13 cardiac conditions and 12 dental procedures were evaluated. The median number of accurate answers for cardiac conditions was eight for the American Heart Association 1999 guidelines, and four for the American Heart Association 2007 and National Institute for Health and Clinical Excellence guidelines, respectively. The median number of accurate answers for dental procedures was generally high, both for dentists who followed the American Heart Association 1999 guidelines (median = 10) and American Heart Association 2007 (median = 9) guidelines. Majority of respondents (82.8%) felt that developing a local guideline would be beneficial to the local dental community. CONCLUSION: Dentists were accurate in their prescriptions of antibiotic prophylaxis for dental procedures, but not for cardiac conditions. It may be helpful to attain a consensus among local cardiologists and dentists to unify the antibiotic prophylaxis prescription practices in Singapore.

High caries prevalence and risk factors among young preschool children in an urban community with water fluoridation.

BACKGROUND: Singapore is unique in that it is a 100% urban community with majority of the population living in a homogeneous physical environment. She, however, has diverse ethnicities and cultures as such; there may be caries risk factors that are unique to this population. AIM: The aims were to assess the oral health of preschool children and to identify the associated caries risk factors. DESIGN: An oral examination and a questionnaire were completed for each consenting child-parent pair. RESULTS: One hundred and ninety children (mean age: 36.3 ± 6.9 months) were recruited from six community medical clinics. Ninety-two children (48.4%) were caries active. The mean d123 t and d123 s scores were 2.2 ± 3.3 and 3.0 ± 5.6, respectively. Higher plaque scores were significantly (P < 0.0005) associated with all measures of decay (presence of decay, dt, ds). The risk factors for severity of decay (i.e., dt and ds) include child's age, breastfeeding duration, and parents' ability to withhold cariogenic snacks from their child. CONCLUSIONS: The high caries rate suggests that current preventive methods to reduce caries in Singapore may have reached their maximum effectiveness, and other risk factors such as child's race, and dietary and breastfeeding habits need to be addressed.