Malaysian government dentists' experience, willingness and barriers in providing domiciliary care for elderly people

ObjectiveTo assess Malaysian government dentists' experience, willingness and barriers in providing domiciliary care for elderly people. Material and methodsA descriptive cross-sectional study was conducted using a self-administered postal questionnaire targeting government dentists working in the Ministry of Health in Peninsular Malaysia. ResultsSeven hundred and eleven out of 962 dentists responded with a response rate of 74.0%. Only 36.1% of the dentists had experience in providing domiciliary care for elderly people in the past 2years with mean number of visit per year of 1. Younger dentists below the age of 30 and those with confidence in providing the service were the most willing to undertake domiciliary care for elderly patients (OR=13.5, p<0.05). The 3 most reported barriers were patient's complex medical history (74.1%), patient's poor attitude towards oral health service (67.5%), and dentist's unfavourable working condition (64.4%). ConclusionThe majority of Malaysian government dentists had not been involved in providing domiciliary care for elderly patients. Apart from overcoming the barriers, other recommendations include improving undergraduate dental education, education for elderly people and carers, improving dentist's working condition, and introducing domiciliary financial incentive for dentist

Validation and reliability of the translated Malay version of the psychosocial impact of dental aesthetics questionnaire for adolescents

Background: This paper describes the cross-cultural adaptation of the Psychosocial Impact of Dental Aesthetics Questionnaire (PIDAQ) into Malay version (Malay PIDAQ), an oral health-related quality of life (OHRQoL) instrument specific for orthodontics for Malaysian adolescents between 12 and 17 years old. Methods: The PIDAQ was cross-culturally adapted into Malay version by forward-and backward-translation processes, followed by psychometric validations. After initial investigation of the conceptual suitability of the measure for the Malaysian population, the PIDAQ was translated into Malay, pilot tested and back translated into English. Psychometric properties were examined across two age groups (319 subjects aged 12-14 and 217 subjects aged 15-17 years old) for factor structure, internal consistency, reproducibility, discriminant and construct validity, criterion validity, and assessment of floor and ceiling effects. Results: Fit indices by confirmatory factor analysis showed good fit statistics (comparative fit index = 0.936, root-meansquare error of approximation = 0.064) and invariance across age groups. Internal consistency and reproducibility tests were satisfactory (Cronbach's alpha = 0.71-0.91; intra-class correlations = 0.72-0.89). Significant differences in Malay PIDAQ mean scores were observed between subjects with severe malocclusion and those with slight malocclusion based on a self-rated and an investigator-rated malocclusion index, for all subscales and all age groups (p < 0.05). Construct validity of the Malay PIDAQ subscales with those who rated themselves with excellent to poor dental appearance and those who felt they needed or did not need braces, showed significant associations for all age groups (p < 0.05). Criterion validity also showed significant association between the Malay PIDAQ scores with those with and without impact on daily activities attributed to malocclusion. There were no ceiling effects detected but floor effects were detected for the Aesthetic Concern subscale. Conclusion: The study has provided initial evidence for the validity and reliability of the Malay PIDAQ to assess the impact of malocclusion on the OHRQoL of 12-17 year old Malaysian adolescents

University of Malaya dental students' attitudes towards communication skills learning: Implications for dental education

The Ministry of Higher Education in Malaysia has called for the implementation of a soft skills module in all public universities in Malaysia. In response to this and as part of curriculum development efforts for a new integrated program for 2011, a study was undertaken to improve the University of Malaya (UM) Faculty of Dentistry's communication skills course. One of the study objectives was to investigate dental students' attitudes towards communication skills learning and the association between their attitudes and demographic and education-related characteristics. A cross-sectional survey-using a self-administered twenty-four-item adapted Communication Skills Attitude Scale (CSAS) that contained both positive (PAS) and negative (NAS) attitude subscales-was carried out targeting all final-year dental students at the UM and the Universiti Kebangsaan Malaysia (UKM). A total of 148 students completed the survey, yielding a response rate of 88.1 percent. Overall, UKM students had significantly more positive attitudes towards communication skills learning (PAS score: mean=48.69, SD=4.48, p<0.001) than UM students (mean=46.03, SD=4.22). There was no statistically significant difference in negative attitudes between the two groups. UKM students with more positive attitudes tended to be female (p<0.05). UM students with more negative attitudes perceived themselves as poor communicators (p<0.05), and UKM students with more negative attitudes tended to have poor English proficiency (p<0.05). This study found that both UM and UKM final-year dental students have positive and negative attitudes towards learning communication skills. These attitudes were significantly associated with certain background and education-related attributes. Outcomes of this study served as a valuable guide in strengthening the communication skills course for the UM's new, integrated dental curriculum

Knowledge, perceptions and clinical application of the shortened dental arch concept among Malaysian government dentists

Background: Dracaena cinnabari (DC) is a perennial tree that located on the Southern coast of Yemen native to the Socotra Island. This tree produces a deep red resin known as the Dragon's blood, the Twobrother's Blood or Damm Alakhwain. The current study performed to evaluate the safety of the DC resin methanol extract after a single or 28 consecutive daily oral administrations. Methods: In assessing the safety of DC resin methanol extract, acute and sub-acute oral toxicity tests performed following OECD guidelines 423 and 407, respectively, with slight modifications. In acute oral toxicity test, DC resin methanol extract administered to female Sprague Dawley rats by oral gavage at a single dose of 300 and 2000 mg/kg body weight. Rats observed for toxic signs for 14 days. In sub-acute oral toxicity test, DC resin methanol extract administered to the rats by oral gavage at 500, 1000, and 1500 mg/kg body weight daily up to 28 days to male and female Spradgue Dawley rats. The control and high dose in satellite groups were also maintained and handled as the previous groups to determine the late onset toxicity of DC resin methanol extract. At the end of each test, hematological and biochemical analysis of the collected blood were performed as well as gross and microscopic pathology. Results: In acute oral toxicity, no treatment-related death or toxic signs were observed. It revealed that the DC resin methanol extract could be well tolerated up to the dose 2000 mg/kg body weight and could be classified as Category 5. The sub-acute test observations indicated that there are no treatment-related changes up to the high dose level compared to the control. Food consumption, body weight, organ weight, hematological parameters, biochemical parameters and histopathological examination (liver, kidney, heart, spleen and lung) revealed no abnormalities. Water intake was significantly higher in the DC resin methanol extract treated groups compared to the control. Conclusion: This study demonstrates tolerability of DC resin methanol extract administered daily for 28 days up to 1500 mg/kg dose

Evidence-based practice among a group of Malaysian dental practitioners.

The objective of this study was to assess dentists' knowledge and use of evidence-based practice (EBP), including their attitudes toward and perceptions of barriers that limit the use of EBP. A cross-sectional survey was used with self-administered questionnaires involving dental practitioners in the state of Selangor, Malaysia. One hundred ninety-three replies were returned, for a response rate of 50.3 percent. More than two-thirds (135/193, 69.9 percent) of the respondents had heard of EBP. Out of the 135 respondents who had heard of EBP, a majority agreed it was a decision-making process based on evidence (127/135, 94.2 percent) and involved a series of steps from formulating the research question, locating and assessing the evidence, to applying it if suitable (129/135, 95.6 percent). Out of the 135 respondents who had heard of EBP, a high percentage agreed that EBP improved their knowledge and skills (132/135, 97.8 percent) and treatment quality (132/135, 97.8 percent). For advice, a majority of the 135 respondents frequently consulted friends and colleagues (123/135, 91.1 percent), made referrals (120/135, 88.9 percent), consulted textbooks (112/135, 83.0 percent), and referred to electronic databases (90/135, 66.7 percent). Out of the 135 respondents, many perceived EBP as very important (59/135, 43.7 percent) and important (58/135, 43.0 percent) and were interested to learn further information about EBP (132/135, 97.8 percent). The main reported barriers were lack of time (87/135, 64.4 percent), financial constraints (54/135, 40.0 percent), and lack of knowledge (38/135, 28.1 percent). A majority of the 135 respondents had knowledge of and positive attitudes towards EBP. However, due to barriers, a majority of them preferred colleagues, textbooks, and referrals for advice instead of seeking evidence from electronic databases

Psychometric properties of the faces version of the Malay-modified child dental anxiety scale

Background: To evaluate the psychometric properties of the faces version of the Modified Child Dental Anxiety Scale (MCDAS(f)) Malay version in 5-6 and 9-12 year-old children. Methods: The MCDASf was cross culturally adapted from English into Malay. The Malay version was tested for reliability and validity in 3 studies. In the Study 1, to determine test-retest reliability of MCDASf scale, 166 preschool children aged 5-6 years were asked to rank orders five cartoons faces depicting emotions from 'very happy' to 'very sad' faces on two separate occasions 3 weeks apart. A total of 87 other 5-6 year-old children completed the Malay-MCDAS(f) on two separate occasions 3 weeks apart to determine test-retest reliability for Study 2. In study 3, 239 schoolchildren aged 9-12 years completed the Malay-MCDASf and the Malay-Dental Subscale of the Children Fear Survey Schedule (CFSS-DS) at the same sitting to determine the criterion and construct validity. Results: In study 1, Kendall W test showed a high degree of concordance in ranking the cartoon faces picture cards on each of the 2 occasions (time 1, W = 0.955 and time 2, W = 0.954). The Malay-MCDASf demonstrated moderate test-retest reliability (Intraclass correlation coefficient = 0.63, p < 0.001) and acceptable internal consistency for all the 6 items (Cronbach's alpha = 0.77) and 8 items (Cronbach's alpha = 0.73). The highest MCDASf scores were observed for the items 'injection in the gum' and 'tooth taken out' for both age groups. The MCDASf significantly correlated with the CFSS-DS (Pearson r = 0.67, p < 0.001). Conclusions: These psychometric findings support for the inclusion of a cartoon faces rating scale to assess child dental anxiety and the Malay-MCDASf is a reliable and valid measure of dental anxiety in 5-12 year-old children

Personality traits and stress levels among senior dental students: Evidence from Malaysia and Singapore

This study aimed to evaluate the association between dental students’ personality traits and stress levels in relation to dental education programs among senior dental students in University Malaya (UM) in Malaysia and National University of Singapore (NUS). A cross-sectional survey using a self-administered questionnaire was conducted on UM and NUS senior dental students. The questionnaire comprised items on demographic background, the Big Five Inventory Personality Traits (BFIPT) test and a modified Dental Environment Stress (DES) scale. Rasch analysis was used to convert raw data to interval scores. Analyses were done by t-test, Pearson correlation, and Hierarchical regression statistics. The response rate was 100% (UM=132, NUS=76). Personality trait Agreeableness (mean=0.30) was significantly more prevalent among UM than NUS students (mean=0.15, p=0.016). In NUS, Neuroticism (mean=0.36) was significantly more prevalent than in UM (mean=0.14, p=0.002). The DES mean score was higher among NUS (mean=0.23) than UM students (mean=0.07). In UM, Neuroticism was significantly correlated with stress levels (r=0.338, p<0.001). In NUS, these were Neuroticism (r=0.278, p=0.015), Agreeableness (r=0.250, p=0.029) and Conscientiousness (r=-0.242, p=0.035) personality traits. The correlation was strongest for personality trait Neuroticism in both schools. Hierarchical regression analysis showed that gender and Neuroticism were significant predictors for students’ stress levels (p<0.05) with the latter exerting a bigger effect size (R2=0.18) than gender (R2=004). This study showed that gender and Neuroticism personality trait were significant predictors for stress levels among selected groups of dental students in Southeast Asia. Information on students’ personality may be useful in new students’ intake, stress management counseling and future program reviews

Validation and reliability of the Malaysian English version of the psychosocial impact of dental aesthetics questionnaire for adolescents

Background: The Malay version of the Psychosocial Impact of Dental Aesthetics Questionnaire has been validated for use by Malaysian adolescents. Although Malay is their national language, English is widely used as the lingua franca among Malaysians of different ethnicities. This study aimed to validate an English version of the PIDAQ adapted for use by Malaysian adolescents to optimize data capture from adolescents who prefer English as the medium for communication. Methods: The published English version of PIDAQ was pilot tested on 12-to 17-year-old adolescents, resulting in a few modifications to suit the Malaysian variety of English. Psychometric properties were tested on 393 adolescents who attended orthodontic practices and selected schools. Malocclusion was assessed using the Malocclusion Index, an aggregation of Perception of Occlusion Scale and the Aesthetic Component of the Index of Orthodontic Treatment Need, by the subjects (MI-S) and investigators (MI-D). Data were analysed for internal consistency and age-associated invariance, discriminant, construct and criterion validities, reproducibility and floor and ceiling effects using AMOS v. 20 and SPSS v. 20. Results: The item Don't like own teeth on video of the Aesthetic Concern (AC) subscale was not relevant to a large proportion of participants (11.7%). Therefore, it was removed and the Malaysian English PIDAQ was analysed based on 22 items instead of 23 items. Confirmatory factor analysis showed good fit statistics (comparative fit index: 0.902, root-meansquare error of approximation: 0.066). Internal consistency was good for the Dental Self-Confidence, Social Impact and Psychological Impact subscales (Cronbach's alpha: 0.70-0.95) but lower (0.52-0.62) though acceptable for the AC subscale as it consisted of only 2 items. The reproducibility test was acceptable (intra-class correlations: 0.53-0.78). For all PIDAQ subscales, the MI-S and MI-D scores of those with severe malocclusion differed significantly from those with no or slight malocclusion. There were significant associations between the PIDAQ subscales with ranking of perceived dental appearance, need for braces and impact of malocclusion on daily activities. There were no floor or ceiling effects. Conclusion: The adapted Malaysian English PIDAQ demonstrated adequate psychometric properties that are valid and reliable for assessment of psychological impacts of dental aesthetics among Malaysian adolescents

Validation of cone beam CT scan for measurement of palatal depth in study casts

The purpose of this study was to validate the use of digital dental study casts obtained from Cone beam CT Scan (CBCT) against gold standard; that is traditional dental study cast measured with digital caliper. Thirty-four study casts of Malaysian Aborigines were selected from Centre of Malaysian Pribumi Studies Databank. Palatal depth of each study casts were measured using Mitutoyo digital caliper. Subsequently, all the study models were scanned using i-CAT CBCT and the palatal depth were measured using i-CAT software. Data were analysed using SPSS version 12.0 where Intraclass correlation and paired T-test were employed. There was no significant difference in palatal depth between CBCT and Mitutoyo digital caliper (p>0.05). Average measures for Intraclass Correlation is 0.753 indicate that it is consistently good. Within the limitation of this study palatal depth measurement produced by CBCT was as accurate as the digital caliper. However, more samples and parameters should be added to further substantiate the result of this study