Rahul Nair

Quantitative analysis of the maxilla and the mandible in hyper- and hypodivergent skeletal Class II pattern.

OBJECTIVES To examine the volumetric (size) difference in the maxilla and the mandible of hyper- and hypodivergent skeletal patterns in Angle class II malocclusion. DESIGN Descriptive retrospective study. The hypothesis is that a hypodivergent mandible has a larger size than a hyperdivergent mandible. SETTING AND SAMPLE POPULATION Using cone-beam computed tomography, 20 subjects with Angle class II malocclusion were classified into two groups; 10 of 20 subjects formed a hyperdivergent group while the rest formed a hypodivergent group. MATERIAL AND METHODS Cone-beam computed tomography images were obtained and processed and 3D volume data was measured by one clinician. Dahlbergs technique was used to assess the measurement error and significant difference was set at p < 0.05. RESULTS No significant differences were found between the volumes of the maxilla and mandible in both groups. Differences were observed in the ratio of mandibular/maxillary volumes. The hypodivergent group had a significantly larger (p = 0.014) ratio than the hyperdivergent group. CONCLUSIONS Maxillary and mandibular volumes differ between hyper- and hypodivergent skeletal patterns.

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.

Oral health status and complete denture status of independent-living Singaporean elderly residing in a community home

AIM Past studies have examined the oral health status of elderly Singaporean adults residing in long term care facilities and living in residential housing but no oral health research has been conducted on elderly Singaporeans residing in community homes. The aim of this paper is to report on the oral health status and complete denture status of a group of free living (community dwelling) elderly in Singapore from the AWWA Community Home for Senior Citizens, and investigate the relation between the clinical findings and demographic data. MATERIALS AND METHODS This research used a cross-sectional design and was conducted in the month of December 2011. Consenting residents of the AWWA home who were over the age of 60 participated in this study. Sampling strategy was census. Two calibrated interviewers collected demographic information from the participants and four calibrated dentists conducted extra-oral and intra-oral soft tissue examinations along with assessment of dentition, periodontal and denture status. STATISTICAL ANALYSIS All data were input into Microsoft Excel 2010(™) and analysed in SPSS 21.0(™). Descriptive analysis and bivariate analysis were performed on the demographic factors and other variables of interest. The Spearman׳s test, Mann-Whitney U and Chi-Square test were used to examine the correlation between the clinical findings and age, gender and education level respectively. RESULTS Among the 70 participants, two subjects (2.9%) had complete dentition, 34 (48.6%) were partially dentate, and 34 (48.6%) had no teeth. The mean number of teeth among the partially dentate participants was 11.28 while the mean number of anterior, posterior and total occlusal contacts were 1.61, 2.17 and 3.78 respectively. The mean number of decayed teeth (DT) and filled teeth (FT) were 2.81 and 0.25, giving a mean DFT score of 3.06. The mean Root Caries Index was 0.13. Periodontal examination revealed that only 5 (13.9%) individuals had healthy periodontal tissues, while 2 (5.6%) had the highest score of 1, 9 (25.0%) had the highest score of 2, 11 (30.6%) had the highest score of 3 and 7 (19.4%) had the highest score of 4. Amongst the partially dentate, 14 had dentures and 20 had none. There were 34 edentulous participants and 23 had at least one denture while 11 did not have any complete dentures. The most frequent unsatisfactory finding for complete dentures was inadequate retention of the mandibular dentures. When the dentures were grouped into those that were satisfactory and those that had at least one unsatisfactory factor, 11 of the 26 maxillary dentures and 17 of the 23 mandibular dentures fell to the latter category. Analysis revealed that there was a correlation between age and the number of teeth with a correlation coefficient of -0.43 (p=0.01) and age with the mean DFT, -0.33 (p=0.05). CONCLUSION The findings of this study revealed a high treatment need for this group of elderly.

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.

Adult perceptions of dental fluorosis and select dental conditions-an Asian perspective.

OBJECTIVE To compare lay peoples perceptions with regard to various levels of dental fluorosis and select dental defects versus normal dentition. METHODS Adults rated digitally created photographs made showing lips (without retraction) and teeth depicting the following conditions: no apparent aesthetic defects (normal, Thylstrup- Fejerskov score 0 - TF0), 6 levels of fluorosis (TF1-6), carious lesions (two cavitated and one noncavitated), malocclusions (Class II, Class III, anterior open bite and greater spacing), extrinsic staining and an incisal chip. The photographs were displayed on colour-calibrated iPads(™) . Participants used a self-administered questionnaire to rate their perceptions on (Item 1) how normal teeth were, (Item 2) how attractive the teeth were, (Item 3) need to seek correction of teeth, (Item 4) how well the person took care of their teeth and (Item 5) whether the person was born like this. Data from Item 5 were excluded due to low reliability. RESULTS Ratings for Item 1 showed that TF1-4 was similar or significantly better than TF0. For Item 2, TF1 and TF4 were significantly better than TF0, with TF2 and TF3 being similar. For Item 3, there was significantly lower need to seek correction with TF2 and TF4 versus TF0, whereas TF1 and TF3 were similar to TF0. TF5 and TF6 were rated significantly lower than TF0 for Item 1 and Item 2, and significantly higher rating for Item 3 (need to seek correction). Ratings for Item 4 were similar, with TF1, TF2 and TF4 being rated significantly higher than TF0, and TF5 and TF6 being rated lower. Cavitated caries and staining were generally perceived as being significantly less favourable than TF6, with higher need to seek correction as well. Noncavitated carious lesion and incisal chip were rated similar to TF0. Cavitated carious lesions were rated aesthetically similar or significantly worse than TF0 and TF6. CONCLUSIONS Severe fluorosis (TF5 and 6) was perceived to be less aesthetically pleasing and received higher ratings for need to seek correction than normal teeth. Mild-to-moderate fluorosis (TF1-4) showed similar or better aesthetic perceptions and similar or lower need to seek correction, when compared to normal teeth (TF0). Easily visible cavitated dental caries was rated worse than teeth with severe fluorosis (TF6) and normal teeth (TF0).

Critical review of willingness to pay for clinical oral health interventions

OBJECTIVES This critical review aimed to identify, consolidate and evaluate the quality of Willingness to Pay (WTP) studies applied to clinical contexts in the field of dentistry. METHODS PubMed and Web of Science databases were systematically searched for relevant publications. Screening and data extraction was then performed. Primary literature in English-language were included to assess the WTP for oral health interventions, when the valuations were applied to a clinical measure. Twenty-six publications met the inclusion criteria. RESULTS WTP was elicited mainly via face-to-face interviews (13 publications) and questionnaires (12 publications). The majority (24) of publications selected an out-of-pocket payment vehicle. Eleven publications adopted a bidding method, nine publications adopted an open-ended format, and the remaining six studies adopted a payment card or choice method. Pre-testing was reported in only nine publications, and few studies accounted for starting point bias. Eight of 11 publications found that higher incomes were associated with higher WTP values. The female gender, a younger age and higher education levels were associated with a higher WTP in select studies. CONCLUSIONS Only a small minority of the studies used strategies to avoid well documented biases related to WTP elicitation. Cost versus benefit of many clinical scenarios remain uninvestigated. CLINICAL SIGNIFICANCE WTP studies in dentistry may benefit from pre-testing and the inclusion of a script to minimise hypothetical bias. They may also be better conducted face-to-face and via a shuffled payment card method. Income levels, and potentially education levels, gender and age, should be assessed for their influence on WTP values.

Reliability and Validity of Skills and Needs Inventories in Functional Behavior Assessments and Interventions for School Personnel

The Skills and Needs Inventories in Functional Behavior Assessments and Intervention (SNI-FBAI) was developed and administered to 338 special educators and 28 teaching support staff across seven special education schools in Singapore. The SNI-FBAI was evaluated in terms of its content, face, and construct validity. Internal consistency was also established. Results of the study indicate that the SNI-FBAI is a reliable and valid measure. With the psychometric properties of the SNI-FBAI established, schools are encouraged to use this scale to assist with meeting professional development needs of their special educators and teaching support staff in functional behavior assessments and interventions.

Perceived Skills and Training Needs Among Singaporean School Personnel in Using Functional Behavior Assessments and Behavioral Interventions

The aim of this exploratory study was to investigate the level of skills and training needs reported by special educators and teaching associates in functional behavioral assessment (FBA) and behavioral interventions within special education (SPED) schools in Singapore. The Skills and Needs Inventories in Functional Behavior Assessments and Interventions (SNI-FBAI), a self-report inventory, was administered to 378 special educators and 38 teaching support staff across seven SPED schools in Singapore. Perceived ratings across both groups were obtained across 13 items for skills and six items for training needs in FBA and behavioral interventions. The results suggested that special educators and teaching associates indicated relatively lower ratings on their perceived skill in more items related to conducting an FBA when compared with items related to behavioral interventions. In terms of training needs, both groups rated developing skills in FBA and behavioral interventions for managing severe challenging behaviors as a priority area for training.

Critical review of the validity of patient satisfaction questionnaires pertaining to oral health care

OBJECTIVES Review the validation process reported for oral healthcare satisfaction scales that intended to measure general oral health care that is not restricted to specific subspecialties or interventions. METHODS After preliminary searches, PUBMED and EMBASE were searched using a broad search strategy, followed by a snowball strategy using the references of the publications included from database searches. Title and abstract were screened for assessing inclusion, followed by a full-text screening of these publications. English language publications on multi-item questionnaires that report on a scale measuring patient satisfaction for oral health care were included. Publications were excluded when they did not report on any psychometric validation, or the scales were addressing specific treatments or subspecialities in oral health care. RESULTS Fourteen instruments were identified from as many publications that report on their initial validation, while five more publications reported on further testing of the validity of these instruments. Number of items (range: 8-42) and dimension reported (range: 2-13) were often dissimilar between the assessed measurement instruments. There was also a lack of methodologies to incorporate patients subjective perspective. Along with a limited reporting of psychometric properties of instruments, cross-cultural adaptations were limited to translation processes. CONCLUSIONS The extent of validity and reliability of the included instruments was largely unassessed, and appropriate instruments for populations outside of those belonging to general adult populations were not present.

Differences in willingness to pay for an extraction, a filling, and cleaning teeth at various levels of oral health-related quality of life, as measured by oral impacts on daily performance, among older adults in Singapore

OBJECTIVE To examine the differences in Willingness to pay (WTP) for an extraction, a filling, and cleaning of teeth among older adults with varying levels of Oral Health-related Quality of Life (OHQoL). BACKGROUND OHQoL has been used extensively to measure utilities as reported by individuals of interest. Currently there are no reports that examine the WTP of individuals at various levels of OHQoL. METHODS A convenience sample of adults 60 years or older were recruited. Besides other domains, questionnaires were used to assess WTP (extraction, filling, and cleaning of teeth), OHQoL (using Oral Impacts on Daily Performance-OIDP), McArthur scale, and access to care. RESULTS Tamil ethnicity was related to higher WTP for an extraction (mean ratio, 1.63-3.98; 95% Confidence Interval [CI]), increase of age in years was related to lower WTP for extraction (mean ratio, 0.96-1.00 [95%CI]) and increasing OIDP score was related to lower WTP for extractions (mean ratio, 0.80-0.99 [95%CI]). Tamil ethnicity was associated with higher WTP for fillings (mean ratio, 2.69-6.44 [95%CI]); higher age in years was associated with lower WTP for fillings (mean ratio, 0.94-0.99 [95%CI]), and higher OIDP scores was trending to be associated to lower WTP for filling (mean ratio, 0.80-1.00 [95%CI]). Tamil Ethnicity was also associated with higher WTP for cleaning (mean ratio, 2.14-7.19 [95%CI]), higher age in years was also associated with cleaning (mean ratio, 0.94-0.99 [95%CI]). CONCLUSION Individuals with higher OIDP scores tended to have lower WTP for extraction, filling and cleaning; with significant differences reported for extraction.