exposure during enamel formation. Increased and decreased in fluorosis prevalence may also reflect to the different ways of measuring the disease. The choice of measuring fluorosis is depends on the objective of the assessment such as assessing public health significant of fluorosis in the population or assessing the detailed of biological effects of fluoride. These differences in requirement have led to the adoption of many indices and assessment methods of enamel fluorosis, which subsequently led to evaluation of examiner agreement between them. Several indices were developed to measure dental fluorosis in the 20th century. These include fluorosis specific indices such as Dean’s Index; the Thylstrup and Fejerskov Index; the Total Tooth Surface Index; and the Fluorosis Risk Index. Non-specific descriptive indices such as the Developmental Defects of Enamel index have also been used to record fluorosis. Fluorosis has most commonly been recorded using clinical examinations and photographs. Recent developments have seen the use of a Visual Analog Scale and automated grading systems such as Quantitative Light Fluorescence emerge as possible enhancements to fluorosis scoring. This article aims to review existing indices and new methods in measuring dental fluorosis, together with examiner reliability across different methods and indices.
Fluorosis, Dental ; Fluorides

Tobacco usage among dental students and the amount of training they received may have an impact on tobacco cessation activities undertaken for their patients. This study aims to assess Malaysian dental students’ tobacco use, exposure to second-hand smoke and their attitude towards tobacco control activities and curriculum. This was a cross-sectional study using a self-administered questionnaire adapted from the Global Health Professions Students Survey (GHPSS). The questionnaire was distributed to all Malaysian fourth and fifth year dental students in four public dental schools (n=372), namely University of Malaya (UM), Universiti Teknologi Mara (UiTM), Universiti Kebangsaan Malaysia (UKM) and Universiti Sains Islam Malaysia (USIM). The data were analysed using descriptive and chi square tests. In total, (n=349) respondents completed the questionnaire, yielding a 93.8% response rate. Although the prevalence of Malaysian dental students who ‘ever smoked’ was 21.2%, the prevalence of current smokers was low (2.3%). About 62% and 39% of students reported having been exposed to second-hand smoke in public and at home, respectively. USIM students were significantly less likely to recall having received training about approaches to smoking cessation (52.9%, p<0.001). Significantly fewer smokers than non-smokers agreed on tobacco banning policy. Regardless of their smoking status, the majority of dental students showed positive attitudes towards dentists’ role in tobacco cessation. Tobacco user among Malaysian dental students was low. There were statistically significant differences between ever smokers and non-smokers’ attitudes towards tobacco banning policy. The majority of dental students showed positive attitudes towards dentists’ role in tobacco cessation.

nformation regarding water fluoridation (WF) in Malaysia has been substantially documented, but is scattered in various government publications and may be lost to the stakeholders. This paper is a review of water fluoridation in Malaysia and its effect on oral health: a history of WF in Malaysia, the current policy, the evidence of its effectiveness, the challenges and the future directions. A search for relevant physical and electronic documents of WF in Malaysia resulted in the identification of 70 documents for review. WF was gazetted as national policy with an optimal fluoride level of 0.7 parts-per-million (ppm) in 1972, with a reduction of the level to 0.5 ppm in 2005. Evidence showed that WF effectively reduced population dental caries while fluorosis was not a prevalent public health concern. Strong collaboration between stakeholders and the extensive network of piped water supplies resulted in 80% of the population receiving WF in 2013. However, the coverage was reduced to 74.1% in 2018, largely due to the cessation of WF in Pahang. The key challenges in WF included a lack of funding, weak legislation, use of reverse osmosis water filtration system, difficulty to maintaining an optimal level of fluoride in the water, and lack of local data on the impact of WF cessation on oral health, and its cost-effectiveness. This review will provide dental health professionals with scientific evidence on WF and oral health in Malaysia and assist them in answering relevant questions about WF raised by the public.
Dental Caries ; Fluorosis, Dental ; Malaysia ; Review [Publication Type] ; Fluoridation

Objective: This study aimed to assess self-perceived aesthetics and orthodontic need, information-seeking behaviours and knowledge on orthodontic treatment among young adults in Malaysia. Methods: A cross-sectional study was conducted among 933 polytechnic students in Malaysia using a selfadministered questionnaire. The Aesthetic Component (AC) of the Index of Orthodontic Treatment Need (IOTN) was used to assess self-perceived orthodontic need. Respondents were also asked about their intention to seek orthodontic treatment. Those showing intention were further asked about their reason(s) for seeking treatment, their information-seeking behaviours, and knowledge on orthodontic treatment. Data was analysed using SPSS. Results: The overall response rate was 93.2% with the mean age of 20.43 (SD±1.07). Although most of the respondents rated themselves under the no treatment need category of the AC-IOTN scale, 61.9% reported intention to seek orthodontic treatment. The main reason for seeking treatment was to improve dental function (45.3%) and aesthetics (40.1%). Most claimed to look for information prior to orthodontic treatment, either using online or offline platforms. Many relied on friends (83.3%) as a source of information and more than half used online sources including social media and websites. A minority demonstrated lack of knowledge in terms of appropriate places to receive treatment (2.2%) and qualification of orthodontic practitioners (37.7%). Conclusions The majority of young Malaysian adults have high intention to seek orthodontic treatment regardless of their perceived need. A minority had lack of knowledge about qualified orthodontic providers and places to receive treatment. Majority reported positive attitudes towards information-seeking behaviour prior to seeking orthodontic treatment.
Information Seeking Behavior ; Young Adult

Dental quackery has been a problem for decades and is becoming a major concern in many countries, including Malaysia. Recent development of a new service offered by quacks in Malaysia is “fake braces”, which alarmed dental professionals. The fake braces appear similar to the professionally fitted orthodontic appliances comprising of archwires that are secured on brackets by coloured ligatures except they are fitted by unqualified individuals who have no formal clinical training. In addition, the orthodontic materials and dental equipment used for this illegal service were substandard and unregulated. Therefore, such fitted appliances are harmful to the teeth and oral health. Efforts to record the extent of fake braces practice and its oral health consequences have been challenging as they are marketed through the social media, and the victims were either reluctant to come forward or did not know the appropriate channel to file a complaint to the health authority. This is an expert opinion paper with the aims to highlight typical presentation of fake braces, modus operandi of fake braces providers, the harmful effects of fake braces on the patient’s oral health, the role of social media advertising in promoting fake braces, and the impacts to the illegal providers.

Introduction: Water fluoridation (WF) was ceased in the state of Pahang, Malaysia, in July 2012. Any changes in fluoride exposure during childhood can influence the development of fluorosis. Thus, this study aimed to compare the prevalence of fluorosis between WF-ceased and WF-continued areas in Malaysia, and its associated factors among 7 and 12-year-old children. Methods: A cross-sectional study was conducted among children in WF-ceased and WF areas (n=1211). The 12-year-olds in WF-ceased areas were exposed to WF between 4.5 to 6.5 years before cessation, and it was hypothesised they would have similar fluorosis prevalence as their counterparts who lived in WF areas. The 7-year olds were born during the cessation period. Examination of fluorosis was performed by a calibrated dentist using Dean’s criteria and a parental questionnaire was utilised to collect information about demographics and exposure to fluoride. Results: Fluorosis prevalence (Dean’s≥2) was significantly lower among children in WF-ceased areas than WF areas (p< 0.001). Intra-area comparison indicated that the 12-year olds have higher prevalence of fluorosis than the 7-year-olds, except for anterior fluorosis scores among those in WF areas. The majority of fluorosis cases were very mild in both areas. Simple logistic regression indicated that duration of exposure to WF, age, mother’s income and education, age started toothbrushing with toothpaste, and frequency of toothbrushing were associated with fluorosis. Conclusions: Fluorosis prevalence decreased following water fluoridation cessation. The null hypothesis that 12-year-olds in both areas would have similar prevalence of fluorosis was rejected. Several factors were associated with fluorosis.

ABSTRACT This study aimed to determine the fluoride and pH levels of beverages likely to be consumed by children in Malaysia and to estimate daily fluoride intake from consumption of these beverages. A convenience sampling of 120 ready-to-drink beverages were purchased and categorised into 11 groups (UHT recombined milk, fresh milk [pasteurised], cultured milk [probiotic], yogurt beverages, fresh fruit juices, fruit flavoured beverages, soy-based beverages, malt-based beverages, tea, carbonated beverages and bottled waters). Fluoride concentration was measured using a fluoride ion-selective electrode while the pH level was measured using a pH meter. The fluoride concentration in the beverages ranged from 0.02±0.00 mg/L to 2.77±0.06 mg/L. Tea was found to have the highest fluoride concentration. The intake of fluoride from consumption of other types of beverages is below the lowest-observed-adverse-effect level (except tea). The pH of the beverages included in the study ranged from 2.20±0.01 to 7.76±0.00. Carbonated beverages (mean pH: 2.98±0.50) were found to be extremely acidic followed by fresh fruit juices (mean pH: 3.38±0.34) and fruit flavoured beverages (mean pH: 3.90±0.92). The correlation between fluoride and pH levels was weak, τ = 0.058 and not statistically significant (p < 0.35). The majority of the beverages had a low fluoride level and their consumption is unlikely to cause fluorosis except for tea. Almost half of the beverages had a low pH level with carbonated beverages being the most acidic.
Fluoridation ; Carbonated Beverages ; Dental Care for Children ; Acid-Base Imbalance

Introduction: Despite the increased number of homeless people in Malaysia, there is limited information on their oral health status and oral health-related quality of life (OHRQoL). This study aims to investigate the impact of caries experience, dental anxiety, oral health (OH) knowledge, and OH behaviours on the OHRQoL of homeless adults in Malaysia, as well as to determine the mediation role of caries experience towards OHRQoL. Methods: A cross-sectional study involving homeless persons was conducted in five states in Malaysia. Dental caries was examined using Decayed, Missing and Filled Teeth (DMFT) index. Face-to-face interview was conducted to collect information about OH knowledge and behaviours, dental anxiety, and OHRQoL using validated questionnaires. Meanwhile, descriptive and bivariate analyses were conducted using SPSS. Partial least squares structural equation modelling (PLS-SEM) was performed to test the hypotheses of the conceptual model with the support of SmartPLS. Results: A total of 192 homeless people completed the questionnaire and oral examination. The majority were male (84.9%), with a mean age of 43.72 (SD = 11.6). The severity of OHRQoL impact (mean OHIP score) was 18.61(SD = 11.3). There were significant independent relationships between dental anxiety (β = 0.306, p < 0.001) and caries experience (β = 0.280, p < 0.001) on the homeless OHRQoL. It was found that the relationship between OH knowledge and OHRQoL was significantly mediated by caries experience. Conclusion: According to the structural model, caries experience, dental anxiety, and OH knowledge have significantly impacted the OHRQoL of the Malaysian homeless. These studied factors should be considered in the adoption of a holistic approach to improve the OHRQoL among homeless people in Malaysia.