CARIES INCREMENT AMONG SCHOOLCHILDREN EXPOSED TO DIFFERENT FLUORIDE CONCENTRATIONS IN WATER: A FIVE-YEAR RETROSPECTIVE COHORT STUDY Previous studies have indicated that the cessation of community water fluoridation (CWF) leads to an increase in caries prevalence among schoolchildren. However, little is known about the rate of caries progression among schoolchildren exposed to different concentrations of fluoride in water. Hence, this study aimed to compare the mean caries increment in permanent dentition among Malaysian schoolchildren with partial exposure (in Pahang) and full exposure (in Perak) to CWF and determine its associated factors. This was a five-year retrospective cohort study using an analysis of secondary data of school dental records among schoolchildren exposed to different fluoride concentrations in the water supply. Children in Perak were exposed to CWF throughout life while children in Pahang were exposed to CWF for the first five to six years of their lives before it was discontinued. The children were followed retrospectively from 2015 (initially aged eight years old) to 2019 (12 years old). Relevant data such as demographic characteristics, caries experience and exposure to other clinical preventive dental treatments were extracted and analysed using SPSS 21.0. Descriptive, independent t-test and negative binomial regression were used to examine the data. The sample consisted of 462 school dental records in both states. The prevalence of schoolchildren with DMFT scores of 2 and ≥ 3 increased by 10.4% and 13.9%, respectively, in Pahang from 2015 to 2019, compared to 4.8% and 0.9% in Perak. The mean (M) and standard deviation (SD) of caries increment at tooth and surface levels in permanent dentition among schoolchildren in Pahang (M = 0.83, SD = ±1.50 and M = 1.00, SD = ±2.10) was significantly greater (p < 0.001) compared to Perak (M = 0.18, SD = ±0.53 and M = 0.22, SD = ±0.66) over the same period. After controlling for confounders, partial exposure to CWF remained a strong predictor for mean caries increment over a five-year study period. This study showed greater mean caries increment in permanent dentition among schoolchildren in Pahang after CWF ceased. Hence, the findings from this study could be used to assist policy makers to support reimplementation and continuation of CWF in Malaysia.

GOOGLE TRENDS ANALYSIS OF TOOTHACHE-RELATED INFORMATION-SEEKING BEHAVIOURS DURING COVID-19 PANDEMIC IN MALAYSIA Google Trends (GT) is a primary tool for studying online behaviours and exploring web search trends related to specific topics over time. During the COVID-19 outbreak in Malaysia, several Movement Control Orders (MCO) were implemented, resulting in restricted access to dental care. The public may have searched for online information to manage their dental problems and needs. This study aimed to investigate toothache-related information-seeking keywords via GT and their correlation with different phases of the MCO implementation. A retrospective study was conducted using GT to collect Relative Search Volume (RSV) of toothache-related keywords from 2020 to 2021 in Malaysia. RSV was compared between the various MCO phases which were the First MCO (March-May 2020), Conditional MCO (May-June 2020), Recovery MCO (June 2020-March 2021), MCO by states (March-May 2021), MCO3.0 (May-June 2021) and the National Recovery Plan (NRP) from June 2021 onwards. Data were analysed descriptively using Microsoft Excel and SPSS software. The mean RSV was 74.43 (SD ± 8.46), with a peak of 100 on the week of 25th July 2021. The highest recorded RSV period between May to September 2021 corresponded with MCO3.0 and the early phase of NRP. The most searched toothache-related keyword in Malaysia was “ubat sakit gigi”, with an RSV of 100. All top related search keywords were in the Malay language. States with the highest RSV of toothache-related keywords were Kelantan, Sabah, and Terengganu. There was a positive correlation between RSV of toothache-related keywords and the different phases of MCO, r = 0.206 and p = 0.036 (p < 0.05). MCO implementations and seasonal interest during the COVID-19 pandemic seemed to influence the trend of Google users in Malaysia seeking information about toothaches. These findings may be used as supplementary data to support planning for oral health services and information delivery.

COST ANALYSIS OF COMMUNITY WATER FLUORIDATION IN KERIAN, PERAK There is limited information available regarding the cost of community water fluoridation (CWF) in Malaysia. Issues related to the cessation of CWF since 2012 in one of the states in Malaysia, were due to the cost of fluoride chemical and the privatisation of water treatment facilities (WTF). Hence, this study aims to estimate the total and per capita cost of the CWF programme in Kerian, Perak, from 2015 to 2019. This was a retrospective record review, analysing CWF expenditure data in two WTF and two dental clinics in Kerian, Perak, from 2015 to 2019, using a healthcare provider perspective. The data on the population coverage of CWF in Kerian was obtained from the Perak Dental Division. Activity-based costing followed CWF guidelines for implementation, operation and maintenance, monitoring, and evaluation activities. All cost items (capital, manpower, safety, maintenance, chemical, and transportation) were presented in MYR 2015 with a 3.0% discount rate. Over the five-year period, the cost of the CWF programme was estimated as follows: MYR 242,644.33 (20.4%) for programme implementation, MYR 796,627.93 (66.9%) for programme operation and maintenance, MYR 147,542.05 (12.4%) for programme monitoring, and the remaining MYR 3,508.20 (0.3%) for programme evaluation. The highest contributor to the CWF programme cost was the fluoride chemical; sodium fluorosilicate, at MYR 450,364.53 (37.8%). The population that received fluoridated water was 189,015. From 2015 to 2019, the CWF programme in Kerian, Perak, incurred an estimated total cost of MYR 1,190,322.51, with a cost per capita of MYR 6.30. This cost analysis enables oral health policymakers and WTF authorities to make informed decisions about investing in the CWF programme.

PUBLIC PERCEPTION ON THE USE OF ECO-FRIENDLY BAMBOO TOOTHBRUSH Plastic toothbrushes which are mainly made of polypropylene are one of the sources of plastic pollution. With the increased awareness of this alarming global issue, eco-friendly bamboo toothbrushes have been introduced and are becoming widely available in the market. The study aimed to explore the public’s experience with bamboo toothbrushes and identify their feature preferences. An observational study using a qualitative approach was conducted among 10 participants aged from 18 to 40 years old without any experience using bamboo toothbrushes (based on the inclusion and exclusion criteria). A selected standard bamboo toothbrush was given to the participants and they were asked to use the bamboo toothbrush for two weeks based on the instructions provided. At the end of two weeks of usage, a one-to-one, semi-structured in-depth interview was conducted either face-to-face or online. These interviews were recorded, transcribed and analysed using thematic analysis. Most participants expressed mixed views regarding their experience using the bamboo toothbrush in comparison to their previous conventional plastic toothbrush. The most preferred features of the bamboo toothbrush cited by the participants were related to a non-slippery handle, small-sized toothbrush and eco-friendly material. The majority of the participants have the intention to continue using the bamboo toothbrush provided some modifications to the design are made. Identifying the ideal features of a bamboo toothbrush could be a timely strategy to reduce the impact of plastic in oral health care.

“Fake braces” is a term used to describe fixed orthodontic appliances that are fitted by unlicensed providers. This trend has raised public health concerns in certain countries with marketing typically undertaken on social media. We aimed to investigate the frequency and nature of Instagram posts by fake braces providers in Malaysia. Initial screening of Instagram accounts was performed using relevant hashtags (#fakebraces, #cheapbraces). Public Instagram accounts that fulfilled the inclusion criteria were assigned a code with posts evaluated over a one-month period. Data were coded and analysed using thematic analysis. Frequency distribution was calculated using Microsoft Excel. Thirty-eight Instagram accounts were analysed. 2831 images/videos were posted, receiving 7165 likes with videos being viewed 21, 918 times. The majority of posts were related to fake braces services (36.7%), followed by non-relevant posts (29.4%) and other services (14.5%). Services were provided mainly at home (44.7%) or offered both home and door-to-door services (23.7%). Although the posts on promotions were less frequent (5.4%), the displayed prices were low (RM150 to RM500), offering additional packages and discounts. Unlicensed providers have a variety of content to engage with social media audiences. Efforts should be made to increase public awareness, directing them towards reliable information about orthodontic services.
Orthodontics

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.

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: 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.

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.

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