A self-administered questionnaire survey was conducted to investigate the level of dental knowledge among senior medical, pharmacy and nursing students of Universiti Kebangsaan Malaysia, and to determine self-reported practices of oral care. Students were invited to complete a set of questionnaires on knowledge related to causes, prevention, signs and treatment of dental caries and periodontal disease; and practices related to oral hygiene and dental visits. A total of 206 questionnaire forms were distributed. 204 forms were returned complete (response rate = 99%). Dental knowledge scores ranged from 0 (no correct answer given) to 16 (gave all correct answers). The mean knowledge scores between the groups were statistically different (p < 0.05): pharmacy students scored highest (mean = 12.29, 95% CI 11.44, 13.14) followed by the medical students (mean = 12.02, 95% CI 11.33, 12.71) and nursing students (mean = 10.83, 95% CI 10.40, 11.26). Areas that had lowest knowledge scores were signs and treatment of gum disease. With regard to oral care practices, majority cited that they brushed teeth at least twice a day (94.6%) and used toothbrush and toothpaste (97.5%). Not many (21.8%) used dental floss and about half (54.2%) reported visiting the dentist more than twelve months ago. Reasons for dental visits included getting check-ups (64.6%), restorations (45.6%) and emergency care such as extractions (24.0%). In general students had at least a moderate level of dental knowledge but demonstrated poor knowledge in some areas. While most reported good oral hygiene habits, behaviour related to dental visits need to be improved. Findings suggest a need for inclusion of oral health education in the medical, pharmacy and nursing curriculum.

The paucity of published literature on periodontal treatment needs and services in developing countries has undermined the significance of periodontal disease burden on healthcare systems. This study analyses periodontal status and population treatment needs of Malaysians, and patterns of periodontal services provided at public sector dental clinics. A retrospective approach to secondary data analysis was employed. Data for population treatment needs were extracted from three decennial national oral health surveys for adults (1990, 2000 and 2010). Annual reports from the dental subsystem of the government Health Information Management System (HIMS) provided information on oral health care delivery for years 2006-2010. They were based on summaries of aggregated data; analyses were limited to reporting absolute numbers and frequency distributions. Periodontal disease prevalence declined between 1990 (92.8%) to 2000 (87.2%) but a sharp rise was observed in the 2010 survey (94.0%). The proportion of participants demonstrating periodontal pockets of 6 mm and more increased in 2010 survey after showing improvements in 2000. Individuals not requiring periodontal treatment (TN0) increased in proportion from 1990 to 2000, only to drop in 2010. An increase in utilisation was observed alongside a growing uptake of periodontal procedures (62.2% in 2006 to 73.6% in 2010). Only about 10% of treatment was surgeries. While the clinical burden of periodontal disease is observed to be substantial, the types of treatment provided did not reflect the increasing needs for complex periodontal treatment. Emphasis on downstream and multi-collaborative efforts of oral health care is deemed fit to contain the burden of periodontal disease.

The vast range of treatment protocols available for non-surgical management of chronic periodontitis can affect the consistency of clinical decision-making for dentists. This is further compounded by the different case definitions for periodontitis used in various clinical studies. The aim of this paper is to describe the steps taken leading to an expert consensus of periodontitis case definition followed by the development of a clinical pathway for managing chronic periodontitis. To assist reaching a consensus on a standard case definition of periodontitis for clinical research, a roundtable discussion was held involving 13 dental specialists and researchers from universities and the Ministry of Health. Participants discussed clinical experiences in identifying periodontitis and related issues based on scientific evidence. A further expert panel discussion consisting of 8 periodontists was conducted at another session to review current management practices and evidence-based practices available from the literature and generated a clinical pathway for non-surgical management of periodontitis. The case definition derived from the roundtable discussion recognises differentiation of selected clinical parameters and their thresholds as well as the extent and severity of the periodontitis. As for the newly developed clinical pathway, experts collectively defined the appropriate goals to satisfy the multidimensional needs of the patients which are translated into detailed elements of care, including the sequence of events of patients at each dental visit over time. The agreed case definition will facilitate selection and recruitment of cases for clinical studies while the clinical pathway can be used to reduce variations between clinicians.
Case definitions ; clinical pathway ; periodontitis

The coronavirus disease 2019 (COVID-19) has sparked concerns among dental patients due to its high infectivity. The implementation of the Movement Control Order in 2020 by the Malaysian government (MMCO-2020) has added constraints to access to dental clinics and may affect the patients’ status of oral disease. This study aims to investigate the impact of MMCO-2020 on the periodontal health and oral health-related quality of life (OHRQoL) of periodontitis patients with/out non-communicable diseases (NCDs). A cross-sectional study involving 139 patients with periodontitis was conducted to assess patients’ OHRQoL, oral health problems, and their perceived barriers to access dental treatment during MMCO-2020 using the Oral Health Impact Profile (OHIP-14) and questionnaire on oral health-related problems. The overall mean OHIP-14 score was relatively low (10.08 ± 8.861), suggesting that the OHRQoL is generally good during MMCO-2020. However, 44 (31.7%) periodontitis patients score ADD ≥14, indicating poorer oral health status and greater dental treatment needed. There was statistically significant association between periodontitis patients with comorbidities (i.e., presence of NCDs) with poorer OHIP-14 scores and mean plaque score changes at pre- and postMMCO, suggesting that special care is required by this group, even during the national lockdown. Of the 45 (32.4%) patients who reported having problems, most (30, 36.1%) decided to “visit the dentist for treatment’. Meanwhile, the most frequent barriers were “could not get an appointment” (14, 34%), “problem is not serious” (13, 39.4%) and “fear of COVID” (9, 27.3%). The MMCO-2020 restrictions on the population had a minimal negative impact on the OHRQoL of patients with periodontal disease, but provisions can be arranged to address the basic and urgent needs of selected periodontitis patients, especially those presented with medical comorbidities.

The vast range of treatment protocols available for non-surgical management of chronic periodontitis can affect the consistency of clinical decision-making for dentists. This is further compounded by the different case definitions for periodontitis used in various clinical studies. The aim of this paper is to describe the steps taken leading to an expert consensus of periodontitis case definition followed by the development of a clinical pathway for managing chronic periodontitis. To assist reaching a consensus on a standard case definition of periodontitis for clinical research, a roundtable discussion was held involving 13 dental specialists and researchers from universities and the Ministry of Health. Participants discussed clinical experiences in identifying periodontitis and related issues based on scientific evidence. A further expert panel discussion consisting of 8 periodontists was conducted at another session to review current management practices and evidence-based practices available from the literature and generated a clinical pathway for non-surgical management of periodontitis. The case definition derived from the roundtable discussion recognises differentiation of selected clinical parameters and their thresholds as well as the extent and severity of the periodontitis. As for the newly developed clinical pathway, experts collectively defined the appropriate goals to satisfy the multidimensional needs of the patients which are translated into detailed elements of care, including the sequence of events of patients at each dental visit over time. The agreed case definition will facilitate selection and recruitment of cases for clinical studies while the clinical pathway can be used to reduce variations between clinicians.

The important role of non-dental healthcare professionals (HCPs) in promoting oral health is well-accepted and has received increased attention in recent years. However, greater efforts are needed to train them in ensuring better competency in delivering this role. The aim of the present study is to assess oral health and care knowledge among HCPs by further exploring possible challenges faced by them in managing oral health problems, particularly in regard to patients in a public primary healthcare clinic. In the case of the current research, a focus group discussion was carried out with ten HCPs who are directly involved with patients from different units within the health clinics. In particular, the questions developed for the focus group discussion were divided into two parts: (1) knowledge on oral health and its link to general health, and (2) issues and challenges faced by HCPs in handling patients with oral health problems in their daily routine. The session was recorded on a digital audio tape, the responses were then transcribed, followed by the grouping of the scripts which were then qualitatively analysed. The results revealed that majority of the participants appeared to have good knowledge of general and basic oral health; however, only very few of them were aware of the relationship between oral health problems with systemic conditions. Meanwhile, one of the main challenges faced by HCPs in handling patients with oral health problems is their limited knowledge of oral health problems. Specifically, the main challenges refer to the management of medically compromised patient requiring dental treatment as well as the difficulty in changing the mindset of patients regarding oral health issues, especially in terms of seeking dental treatment. In conclusion, it has been clearly observed that HCPs involved in the present study have good knowledge of general health and oral health but limited knowledge related to oral health to systemic health. Furthermore, they tend to face numerous challenges when dealing with patients, especially due to their limited knowledge of oral health facts and drug prescription for oral problems. Therefore, there is an urgent need of additional training for both HCPs and dental teams for the purpose of enabling both parties to provide coordinated and comprehensive service to patients with oral health problems at the primary healthcare clinics.