[Show abstract][Hide abstract] ABSTRACT: Four-factor structure of the two 8-item short forms of Child Perceptions Questionnaire CPQ11-14 (RSF:8 and ISF:8) has been confirmed. However, the sum scores are typically reported in practice as a proxy of Oral health-related Quality of Life (OHRQoL), which implied a unidimensional structure. This study first assessed the unidimensionality of 8-item short forms of CPQ11-14. Item response theory (IRT) was employed to offer an alternative and complementary approach of validation and to overcome the limitations of classical test theory assumptions.
A random sample of 649 12-year-old school children in Hong Kong was analyzed. Unidimensionality of the scale was tested by confirmatory factor analysis (CFA), principle component analysis (PCA) and local dependency (LD) statistic. Graded response model was fitted to the data. Contribution of each item to the scale was assessed by item information function (IIF). Reliability of the scale was assessed by test information function (TIF). Differential item functioning (DIF) across gender was identified by Wald test and expected score functions.
Both CPQ11-14 RSF:8 and ISF:8 did not deviate much from the unidimensionality assumption. Results from CFA indicated acceptable fit of the one-factor model. PCA indicated that the first principle component explained >30 % of the total variation with high factor loadings for both RSF:8 and ISF:8. Almost all LD statistic <10 indicated the absence of local dependency. Flat and low IIFs were observed in the oral symptoms items suggesting little contribution of information to the scale and item removal caused little practical impact. Comparing the TIFs, RSF:8 showed slightly better information than ISF:8. In addition to oral symptoms items, the item "Concerned with what other people think" demonstrated a uniform DIF (p < 0.001). The expected score functions were not much different between boys and girls.
Items related to oral symptoms were not informative to OHRQoL and deletion of these items is suggested. The impact of DIF across gender on the overall score was minimal. CPQ11-14 RSF:8 performed slightly better than ISF:8 in measurement precision. The 6-item short forms suggested by IRT validation should be further investigated to ensure their robustness, responsiveness and discriminative performance.
BMC Public Health 12/2015; 15(1):792. DOI:10.1186/s12889-015-2133-3 · 2.26 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Background/aims:
To investigate the association between birth weight and infant growth during the first year of life and the occurrence of developmental defects of enamel (DDE) in permanent dentition.
A random sample of 668 12-year-old students was recruited from a birth cohort. Permanent incisors and first molars were clinically examined for DDE using the modified FDI (DDE) index. Multivariable negative binomial regression was used to examine the association of growth trajectory (five categories) from birth to 12 months with the occurrence of DDE (any defects, demarcated opacities, diffuse opacities, and hypoplasia) in the permanent dentition.
The response rate was 76.9% (n = 514). Four hundred and eighty-five children had complete records of growth- and health-related data. In the unadjusted model, infants who had birth weights closer to the WHO average and rapid growth were more likely to have 'demarcated opacities' (p < 0.05), and the first 3 months of life was the 'critical period' to develop 'demarcated opacities' in permanent dentition. However, after adjusting for the confounders (gender, gestational age, mode of delivery, type of feeding, parental education, and health status), significant association with the occurrence of 'demarcated opacities' (p < 0.05) remained only for the children of trajectory V (heavier birth weights and rapid growth); no 'critical period' was found to be significantly associated with DDE.
Infants with heavy birth weight and rapid growth during the first year of life were more vulnerable to the occurrence of DDE in terms of demarcated opacities in their permanent dentition.
Caries Research 09/2015; 49(6):575-582. DOI:10.1159/000381425 · 2.28 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Background:
Motivational interviewing (MI) has great potential in changing health-related behaviors. In addition to delivery in face-to-face individual counseling, MI can be delivered through online groups, a method that is particularly appealing to adolescents and may offer several benefits. This randomized controlled trial compares the effectiveness of prevailing health education (HE), face-to-face individual MI and online group MI in improving adolescents' oral health behaviors (diet and toothbrushing) and in preventing dental caries and periodontal diseases.
In each of Hong Kong's main districts (Hong Kong Island, Kowloon and the New Territories), three secondary schools will be recruited and randomly assigned to three groups (HE, face-to-face individual MI, and online group MI). A total of 495 adolescents (aged 12 to 13 years) with unfavorable oral health behaviors ("snacking twice or more a day" and/or "brushing teeth less than twice a day") will be recruited: 165 in each group. Two dental hygienists will be trained to deliver the interventions. HE will be provided through an oral health talk. Participants in the "face-to-face individual MI" group will join a one-on-one counseling session. For "online group MI," participants will form groups of 6 to 8 and join a synchronous text-based online counseling session. At baseline and after 6, 12 and 24 months, clinical outcomes (caries increment and gingival health) and oral health self-efficacy and behaviors (toothbrushing and snacking) will be recorded through an oral examination and a questionnaire, respectively. Effectiveness of the interventions will be evaluated and compared. The primary outcomes will be the "number of new carious surfaces" and "gingival bleeding score" (% of surfaces with gingival bleeding). The secondary outcomes will be changes in oral health self-efficacy and behaviors (toothbrushing and snacking frequencies). A preliminary economic evaluation and a process evaluation will be included to analyze the cost of the interventions and the interactions in MI sessions.
Since online group MI is expected to be more convenient, accessible, and time efficient, it might address the practicality issues and pave the way for the application of MI in dental practice. The findings will assist public health workers and dental practitioners to choose effective and viable approaches in delivering behavioral interventions. Since unhealthy diet and poor personal hygiene are common risk factors accountable for many systemic diseases, the intervention scheme identified in this study can also contribute to advancing general health.
The HKU Clinical Trial Register #HKCTR-1852 (registered on 13 November 2014).
[Show abstract][Hide abstract] ABSTRACT: Objectives
To assess changes in the oral health-related quality of life (OHRQoL), after comprehensive oral rehabilitation under general anaesthesia (CORGA), among children (i) <6 years using the Early Childhood Oral Health Impact Scale (ECOHIS) and (ii) aged 6–14 years using the child oral health-related quality of life (COHRQoL) instrument.MethodsA total of 136 healthy children who had CORGA were recruited over a period of 12 months. The parent or caregiver of the study participants completed the age-appropriate questionnaire prior to the dental treatment and at the subsequent follow-up appointments (2 weeks and 3 months). Data were analysed using repeated-measures anova and Bonferroni tests.ResultsThe overall ECOHIS scores decreased significantly (P < 0.001) demonstrating large effect sizes. The greatest decreases were for the domains of child oral symptoms (57.5%) and psychology (38.7%) in the child impact section (CIS) and for the domain of parental distress (38.9%) and family function (40%) in the family impact section (FIS). For COHRQoL, the overall P-CPQ and FIS scores decreased significantly for all items (P < 0.001), demonstrating large effect sizes. The greatest decreases were for the domains of oral symptoms (77.7%), functional limitations (74.3%), and the FIS (80.1%).Conclusions
The OHRQoL of children in both age groups (<6 and 6–14 years) was significantly improved after CORGA.
International Journal of Paediatric Dentistry 09/2015; DOI:10.1111/ipd.12200 · 1.34 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Numerous facial photogrammetric studies have been published around the world. We aimed to critically review these studies so as to establish population norms for various angular and linear facial measurements; and to determine inter-ethnic/racial facial variations.
A comprehensive and systematic search of PubMed, ISI Web of Science, Embase, and Scopus was conducted to identify facial photogrammetric studies published before December, 2014. Subjects of eligible studies were either Africans, Asians or Caucasians. A Bayesian hierarchical random effects model was developed to estimate posterior means and 95% credible intervals (CrI) for each measurement by ethnicity/race. Linear contrasts were constructed to explore inter-ethnic/racial facial variations. We identified 38 eligible studies reporting 11 angular and 18 linear facial measurements. Risk of bias of the studies ranged from 0.06 to 0.66. At the significance level of 0.05, African males were found to have smaller nasofrontal angle (posterior mean difference: 8.1°, 95% CrI: 2.2°-13.5°) compared to Caucasian males and larger nasofacial angle (7.4°, 0.1°-13.2°) compared to Asian males. Nasolabial angle was more obtuse in Caucasian females than in African (17.4°, 0.2°-35.3°) and Asian (9.1°, 0.4°-17.3°) females. Additional inter-ethnic/racial variations were revealed when the level of statistical significance was set at 0.10.
A comprehensive database for angular and linear facial measurements was established from existing studies using the statistical model and inter-ethnic/racial variations of facial features were observed. The results have implications for clinical practice and highlight the need and value for high quality photogrammetric studies.
PLoS ONE 08/2015; 10(8):e0134525. DOI:10.1371/journal.pone.0134525 · 3.23 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Background:
Even though oral cavity cancer (OCC; ICD 10 codes C01, C02, C03, C04, C05, and C06) ranks eleventh among the world's most common cancers, accounting for approximately 2 % of all cancers, a trend analysis of OCC in Hong Kong is lacking. Hong Kong has experienced rapid economic growth with socio-cultural and environmental change after the Second World War. This together with the collected data in the cancer registry provides interesting ground for an epidemiological study on the influence of socio-cultural and environmental factors on OCC etiology.
A multidirectional statistical analysis of the OCC trends over the past 25 years was performed using the databases of the Hong Kong Cancer Registry. The age, period, and cohort (APC) modeling was applied to determine age, period, and cohort effects on OCC development. Joinpoint regression analysis was used to find secular trend changes of both age-standardized and age-specific incidence rates.
The APC model detected that OCC development in men was mainly dominated by the age effect, whereas in women an increasing linear period effect together with an age effect became evident. The joinpoint regression analysis showed a general downward trend of age-standardized incidence rates of OCC for men during the entire investigated period, whereas women demonstrated a significant upward trend from 2001 onwards.
The results suggest that OCC incidence in Hong Kong appears to be associated with cumulative risk behaviors of the population, despite considerable socio-cultural and environmental changes after the Second World War.
BMC Oral Health 07/2015; 15(1):83. DOI:10.1186/s12903-015-0074-y · 1.13 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Human faces are under a constant state of change throughout the entirety of one's lifetime. Photogrammetry has been advocated for use in large epidemiological studies investigating facial characteristics. This study aimed to review existing longitudinal photogrammetric studies in terms of the measurements selected and the observed facial changes overtime. A comprehensive literature search was performed in 4 databases, PubMed, ISI Web of Science, EMBASE, and Scopus, which was supplemented by hand search. No limitations were set as to the language, dates, or status of publication. The records were assessed for the eligibility and rated for the risk of bias by 2 independent reviewers. Data regarding study characteristics, measurements selected and the outcomes reported, were extracted for analysis. An initial search identified 5127 studies. After 2 rounds of study screening, 6 eligible studies informed this review. The risk of bias of the studies ranged from 41.7% to 80.8%. Only 1 study performed sample size calculation, and only 17% of the studies had a sample size of over 30 subjects. Confidence interval was reported by none of the studies. The facial features assessed varied among the studies, and some studies focused on only specific regions of the face. Photogrammetry has been used by a limited number of studies in the analysis of longitudinal soft tissue facial changes. Moreover, these studies are heterogeneous with respect to their levels of risk of bias and the facial features assessed. Recommendations are provided to improve the qualities of future photogrammetric studies.
The Journal of craniofacial surgery 07/2015; 26(6). DOI:10.1097/SCS.0000000000001909 · 0.68 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: To determine the associations between autism developmental profiles and cooperation with an oral health screening among preschool children with autism spectrum disorders (ASDs). A random sample of Special Child Care Centres registered with the Government Social Welfare Department in Hong Kong was selected (19 out of 37 Centres). All preschool children with ASDs were invited to participate in the oral health survey and 347 children agreed to participate (among 515 invited). A checklist of autism developmental profiles: (1) level of cognitive functioning, (2) social skills development, (3) communication skills development, (4) reading skills and (5) challenging behaviours was ascertained. Feasibility of conducting oral health screening in preschool children with ASDs was associated with their cognitive functioning (p = 0.001), social skills development (p = 0.002), communication skills development (p < 0.001), reading skills (p < 0.001) and challenging behaviours (p = 0.06). In regression analyses accounting for age (in months) and gender, inability to cooperate with an oral health screening was associated with high level of challenging behaviours (OR 10.50, 95 % CI 2.89-38.08, p < 0.001) and reduced cognitive functioning (OR 5.29, 95 % CI 1.14-24.61, p = 0.034). Age (in months) was positively associated with likelihood of cooperative behaviour with an oral health screening (OR 1.06, 95 % CI 1.03, 1.08, p < 0.001). Feasibility of conducting population-wide oral health screening among preschool children with ASDs is associated with their developmental profiles; and in particular levels of cognitive functioning, and challenging behaviours.
Journal of Autism and Developmental Disorders 05/2015; 45(9). DOI:10.1007/s10803-015-2416-7 · 3.06 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: To assess the effectiveness of diode low-level laser therapy (LLLT) for orthodontic pain control, a systematic and extensive electronic search for randomised controlled trials (RCTs) investigating the effects of diode LLLT on orthodontic pain prior to November 2014 was performed using the Cochrane Library (Issue 9, 2014), PubMed (1997), EMBASE (1947) and Web of Science (1956). The Cochrane tool for risk of bias evaluation was used to assess the bias risk in the chosen data. A meta-analysis was conducted using RevMan 5.3. Of the 186 results, 14 RCTs, with a total of 659 participants from 11 countries, were included. Except for three studies assessed as having a 'moderate risk of bias', the RCTs were rated as having a 'high risk of bias'. The methodological weaknesses were mainly due to 'blinding' and 'allocation concealment'. The meta-analysis showed that diode LLLT significantly reduced orthodontic pain by 39 % in comparison with placebo groups (P = 0.02). Diode LLLT was shown to significantly reduce the maximum pain intensity among parallel-design studies (P = 0.003 versus placebo groups; P = 0.000 versus control groups). However, no significant effects were shown for split-mouth-design studies (P = 0.38 versus placebo groups). It was concluded that the use of diode LLLT for orthodontic pain appears promising. However, due to methodological weaknesses, there was insufficient evidence to support or refute LLLT's effectiveness. RCTs with better designs and appropriate sample power are required to provide stronger evidence for diode LLLT's clinical applications.
Lasers in Medical Science 03/2015; 30(7). DOI:10.1007/s10103-015-1743-4 · 2.49 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: This paper reviews six key communication models and frameworks in healthcare contexts. Comparison suggests key inter-relationships between the different stages of the clinical consultations. Implications are identified for future study in healthcare provider-patient communication. Clinical Relevance: To understand the healthcare provider-patient interaction through communication models.
[Show abstract][Hide abstract] ABSTRACT: Objectives:
To evaluate the effects of two different mandibular advancement devices (MADs) on craniofacial characteristics and upper airway dimensions of Chinese adult patients with obstructive sleep apnea (OSA).
Materials and methods:
Forty-five patients with OSA were recruited as part of a prospective randomized crossover trial for treatment with two different MADs. Lateral cephalograms were taken, and the Epworth Sleepiness Scale and the Sleep Apnea Quality of Life Index were completed at baseline. The Apnea-Hypoxia Index was highly significantly reduced with the monoblock (P < .001) and significantly reduced with the twin block (P < .01). The monoblock demonstrated a superior result than the twin block (P < .05). A significant reduction was found in the distances between the hyoid bone to retrognathia (monoblock, P < .01; twin block, P < .001) as well as the distance between the hyoid bone and mandibular plane angle (P < .001). Furthermore, soft palate length increased significantly (P < .05) with both MADs. However, the changes did not differ in favor of either MAD.
Monoblock was the better MAD to improve OSA severity. No difference could be found in changes of subjective OSA indicators. Significant but similar cephalometric changes were observed, indicating both MADs alter the position of the surrounding musculature and improve upper airway patency. Therefore, the different design features of the MADs suggest an impact on some OSA indicators.
The Angle Orthodontist 01/2015; DOI:10.2319/040314-245.1 · 1.23 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: IntroductionTo quantify average angular measurements that define the soft tissue profiles of 12-year-old southern Chinese and to determine gender differences.Materials and methodsA random population sample of 514 12-year-old children was recruited (about 10% of a Hong Kong Chinese birth cohort). Photographs were taken in natural head posture and 12 soft tissue landmarks were located on the photos to measure 12 angular measurements using ImageJ (V1.45s) for Windows. Approximately 10% of photographs were reanalyzed and method error was calculated. Angular norm values for the 12 parameters were determined and gender differences were assessed using 2 sample T-test with 95% confidence interval.ResultsThe response rate was 54.1% (278/514). Norm values for the 12 angular measurements were generated. The greatest variability was found for the nasolabial (Cm-Sn-Ls) and labiomental (Li-Sm-Pg) angles. Gender differences were found in 4 angular parameters: vertical nasal angle (N-Prn/TV)(p¿<¿0.05), cervicomental angle (G-Pg/C-Me)(p¿<¿0.001), facial convexity angle (G-Sn-Pg)(p¿<¿0.01) and total facial convexity angle (G-Prn-Pg)(p¿<¿0.01).Conclusion
Norm values for 12 angular measurements among 12-year-old southern Chinese children were provided and some variability noted. Gender differences were apparent in several angular measurements. This study has implications in developing norm values for southern Chinese and for comparison with other ethnic groups.
Head & Face Medicine 12/2014; 10(1):1. DOI:10.1186/s13005-014-0056-3 · 0.85 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: To describe and compare the oral health behaviors of preschool children with and without cerebral palsy (CP), and to assess the oral health knowledge and attitudes of their primary caregivers (PCGs). Seventy‐two preschool children with CP were recruited from 23 Special Child Care Centers in Hong Kong. An age‐ (±3 months) and gender‐matched sample of children from mainstream preschools was recruited as a “control group.” Assessment of children's oral health behaviors and the PCGs' oral health knowledge and attitudes was conducted using questionnaires. Preschool children with CP were less likely to have ever attended a dentist (p p > 0.05), but PCGs of children with CP more frequently reported provision of tooth brushing assistance to their children (p p > 0.05). Difference in oral health behaviors existed between preschool children with and without CP. PCGs of children with and without CP had similar oral health knowledge and attitudes.
Special Care in Dentistry 11/2014; 34(6). DOI:10.1111/j.1754-4505.2012.00295.x
[Show abstract][Hide abstract] ABSTRACT: Objective
To examine the current literature on the impact of patients¿ expectations on treatment outcomes or final patient satisfaction and to identify the theoretical frameworks, study designs and measurement instruments which have been employed to assess patients¿ expectations within implant dentistry.MethodsA structured literature search of four databases Pubmed, Cochrane, Web of Science and PsychINFO was conducted following PRISMA guidelines. Any type of literature published in English discussing the topic of `patients expectations¿ in oral health were identified and further screened. Studies reporting on expectations regarding dental implants were selected and a narrative review was conducted.ResultsThe initial search yielded 16707 studies, out of which 1051 `potentially effective studies¿ were further assessed and final 41 `effective studies¿ were included [Kappa¿=¿0.76]. Ten observational studies, published from 1999 to 2013, dealt specifically with expectations of dental implants. There was a large degree of heterogeneity among studies in terms of assessment instruments. Expectations relating to aesthetics and function were primarily considered. Among the 10 studies, 8 were classified as quantitative research and 2 as qualitative research. The STROBE quality of reporting scores of the studies ranged from 13.5 to 18.0. Three of the 8 quantitative studies employed a before/after study design (prospective studies) and used visual analogue scales (VAS) to measure patient expectations.Conclusions
There is a growing interest in patients¿ expectations of dental implants. Most studies are cross sectional in nature and the quality of reporting varies considerably. Expectations with respect to aesthetics and function are key attributes considered. The use of visual analogue scales (VAS) provides quantitative assessments of patients¿ expectations but the lack of standardization of measures prohibits meta- analyses.
Health and Quality of Life Outcomes 10/2014; 12(1):153. DOI:10.1186/s12955-014-0153-9 · 2.12 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Caregivers' oral health literacy (OHL) assessment results have been found to be related to their children's oral health status. A further aspect of this relationship may be the role of caregivers' reading habits.
[Show abstract][Hide abstract] ABSTRACT: Objective
To establish cephalometric norms for the upper airway of 12-year-old Chinese children, and to assess these norms with regard to gender, age, ethnicity and other craniofacial structures.
Lateral cephalograms were obtained from a random sample of 425 12-year-old Chinese children (224 boys and 201 girls) to establish the Chinese norms, and from a matched group of 108 12-year-old Caucasian children (61 boys and 47 girls) as an ethnic comparison. Published data on the upper airway norms of Chinese adults were used to make age comparisons. Nine upper airway and 14 craniofacial variables were measured.
Chinese boys tended to have a thicker soft palate (P = 0.008), and less depth in the retropalatal (P = 0.011), retroglossal (P = 0.034) and hypopharyngeal (P < 0.001) pharynx than Chinese girls, whereas no gender dimorphism was found in Caucasian children. Ethnic differences were found in the depth of the retroglossal oropharynx in both genders and the position of the hyoid bone in boys. Compared with Chinese adults, the overall size of the upper airway in Chinese children was smaller. The mandibular body length and the craniocervical inclination were found to be statistically significantly, albeit weakly correlated with upper airway variables.
Cephalometric norms for the upper airway of Chinese 12-year-old children were established, indicating gender-specific differences, and some ethnic differences were found in comparison with those of 12-year-old Caucasian children. An association between the mandibular body length and the craniocervical inclination with upper airway variables was also noticeable.
Head & Face Medicine 09/2014; 10(1):38. DOI:10.1186/1746-160X-10-38 · 0.85 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Objectives
The objective of this study was to review orofacial functional impairments among patients following stroke, including objective and subjective assessment.MethodsA structured search strategy was applied to three electronic databases (Pubmed, Embase, and Web of Science) to identify effective papers. Relevant data regarding subjects, method, outcomes, and key findings were extracted from the effective papers and the results were summarized.ResultsThe initial search yielded 5227 papers, and 18 effective papers (Kappa: 0.971) were in accordance with the inclusion criteria. The patients with stroke consistently showed a decreased lip force, salivary flow rate, and chewing performance compared to the healthy controls. Due to equivocal results gained from the effective papers, the qualitative assessments regarding whether there was any change in masticatory force on the affected side and oral health-related quality of life were inconclusive.Conclusions
Existing evidence highlights a number of compromised orofacial functions experienced by patients following stroke. These impairments appear to be sustained, with spontaneous recovery unlikely to occur. While rehabilitative approaches may have the potential to improve orofacial function and quality of life following stroke, there is currently a lack of evidence-based interventions available to inform the development of comprehensive rehabilitation protocols.This article is protected by copyright. All rights reserved.