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  1. Yusof ZYM, Anwar NH, Mohd Nor NA, Nor MM, Mustafa SE
    Trials, 2021 Feb 22;22(1):156.
    PMID: 33618735 DOI: 10.1186/s13063-021-05111-0
    BACKGROUND: Despite the implementation of the preschool oral healthcare programme (POHP) for 5-6-year-old children over the past 3 decades in Malaysia, dental plaque and caries levels in this age group remain high. Among the child-level attributable factors are unhealthy self-care behaviours (poor oral hygiene and high sugary diet). In order to improve the children's oral health, an improved programme called the 'Senyuman Indah Milik Semua' Programme (SIMSP) or 'Beautiful Smile for All' programme is introduced. In this programme, a triad of dental hygienist-teacher-parent works together to improve children's oral hygiene levels compared with the existing POHP that involves dental hygienists only. The aim of this study is to compare the effect of the SIMSP versus the existing POHP on oral hygiene levels of 5-6-year-old children in the Kampar district, Perak state, Malaysia.

    METHODS: This study is a pragmatic, cluster-randomised, parallel-group, matched pair, controlled trial with blinded outcome assessment. Randomisation is performed using a computer-generated table with a 1:1 allocation comparing the SIMSP and the POHP involving 28 preschools in the Kampar district, Perak, Malaysia. The intervention consists of preschool visits by a group of dental therapists, in-class oral health lessons and daily toothbrushing conducted by class teacher, child home toothbrushing supervised by parents, and infographic oral health messages to parents. The control consists of the existing POHP that involves preschool visits by a group of dental therapists only. The trial lasts for 6 months. Primary outcome variable is the mean plaque score change after 6 months. To determine the feasibility of the SIMSP, a process evaluation will be conducted using the perspectives of dental therapists, teachers, and parents on the appropriateness, effectiveness, facilitators, and barriers to the SIMSP implementation as well as an audit trail to assess the trial intervention.

    DISCUSSION: Cluster randomisation may lead to a random effect and cluster selection bias. These factors will be accounted for when analysing the data and interpreting the outcomes. The effectiveness of the SIMSP will be evaluated by comparing the results with those of the POHP.

    TRIAL REGISTRATION: ClinicalTrials.gov NCT04339647 . Registered on 5 April 2020 - Retrospectively registered.

  2. Yusof ZYM, Hassan WNW, Razak IA, Hashim SMN, Tahir MKAM, Keng SB
    PMID: 29641164
    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.
  3. Yap AU, Apipi M, Ismail SM, Yusof ZYM, Kadir K
    Cranio, 2022 Apr 06.
    PMID: 35384792 DOI: 10.1080/08869634.2022.2059130
    OBJECTIVE: This study translated/cross-culturally adapted the Fonseca Anamnestic Index (FAI) for temporomandibular disorders (TMDs) into Malay and psychometrically tested the Malay-FAI (FAI-M).

    METHODS: The FAI-M was created according to international guidelines. Internal consistency/test-retest reliability were assessed with Cronbach's alpha/intra-class correlation (ICC) coefficients. Construct and convergent validity were appraised by relating the FAI-M to the Global Oral Health (GOH) questionnaire and Short-form Oral Health Impact Profile (S-OHIP) using Kruskal-Wallis and Spearman's rho correlation (α = 0.05).

    RESULTS: Of the 243 participants enrolled, 54.7% (n = 133) had no TMDs, while TMDs were present in 45.3% (n = 110). The FAI-M presented very good internal consistency (α = 0.90) and test-retest reliability (ICC = 0.99). Theoretically predicted FAI-M score patterns matched the GOH categories, and strong correlations were discerned between FAI-M and S-OHIP (rs = 0.71).

    CONCLUSION: The FAI-M exhibited good psychometric properties and can be applied in Malay-speaking populations.

  4. Wan Hassan WN, Makhbul MZM, Yusof ZYM
    J Orofac Orthop, 2021 May 03.
    PMID: 33938957 DOI: 10.1007/s00056-021-00298-y
    PURPOSE: The sociodental model integrates clinical assessment, perceived impacts of malocclusion on quality of life, and behavioural propensity when prioritising orthodontic treatment. This study compares the effect of using different instruments to measure impact-related need on the assessment of orthodontic treatment need based on the sociodental framework.

    MATERIALS AND METHODS: In this cross-sectional study, 206 Malaysian adolescents (age: 11-18 years) were screened in orthodontic clinics to identify those with normative need, oral impacts due to malocclusion, and having high and medium-to-high behavioural propensities. The Index of Orthodontic Treatment Need classified normative need. The Psychosocial Impact of Dental Aesthetics (PIDA) questionnaire and the Condition-Specific Child-Oral Impacts on Daily Performances (CS-OIDP) index measured oral impacts. Subjects' behavioural propensities for successful treatment outcome were based on the Basic Periodontal Examination and International Caries Detection and Assessment System. Data were analysed using the McNemar test.

    RESULTS: The response rate was 99.0%. Estimates of normative need (89.7%) were significantly reduced under the sociodental model by 65.7% (p 

  5. Wan Hassan WN, Makhbul MZM, Othman SA, Yusof ZYM
    Int J Environ Res Public Health, 2022 Jul 16;19(14).
    PMID: 35886519 DOI: 10.3390/ijerph19148665
    (1) This study aimed to generate a simplified form of the Malaysian psychosocial impact of dental aesthetics questionnaire (PIDAQ[M]) and validate its use in the sociodental approach for estimating orthodontic treatment need. (2) Two eight-item forms were derived: an impact simplified PIDAQ[M] (ISP8), comprising the most impactful items as rated by 35 participants, and a regression simplified PIDAQ[M] (RSP8), derived from regression analysis of 590 participants’ data from the PIDAQ[M] validation study. Their psychometric performances were assessed for internal consistency, validity (criterion and construct), reproducibility (reliability and agreement), and responsiveness to change. The sociodental estimates were based on 204 orthodontic patients’ data who were assessed for normative need, impact-related need, and propensity-related need. McNemar analysis compared the sociodental estimates when both simplified PIDAQ[M] forms and the original PIDAQ[M] were used to measure impact-related need. (3) Both simplified PIDAQ[M] forms were valid, reproducible, and responsive. The sociodental estimates when using the ISP8 (38.2%) were similar to when the PIDAQ[M] (35.8%) was used (p > 0.05) but overestimated by 3.4% (p < 0.05) when the RSP8 (39.2%) was used as the assessment tool. (4) The simplified PIDAQ[M] can replace the original PIDAQ[M] in the sociodental approach to estimate the orthodontic treatment needs of the Malaysian population.
  6. Tajudin ZM, Wan Hassan WN, Yusof ZYM, Makhbul MZM
    Healthcare (Basel), 2021 Mar 01;9(3).
    PMID: 33804314 DOI: 10.3390/healthcare9030248
    Self-awareness of poorly arranged teeth can influence the quality of life. This study aimed to report the impacts of self-perceived malocclusion in young adults and the association between demographic characteristics and oral health related quality of life (OHRQoL). In this cross-sectional study, six-hundred-forty-three subjects from Selangor, Malaysia selected using a multistage sampling technique answered the Psychosocial Impact of Dental Aesthetics (PIDA) questionnaire and self-rated their dental appearance using the Aesthetic Component of the Index of Orthodontic Treatment Need. Data were analyzed using multifactorial ANOVA to identify the association between demographic characteristics and total PIDA score. Five-hundred-twenty-four subjects (81.5%) completed the questionnaires. Overall, 87.8% had impacts on their OHRQoL. Psychological impact was the most impacted domain (75.8%), followed by dental self-confidence (59.4%), social impact (48.9%) and aesthetic concern (22.1%). 16.8% reported significant impacts on all domains. Their mean PIDA score was 36.3 (SD 17.1). Prevalence, extent and severity of impacts were higher amongst those with self-perceived malocclusion. Gender, ethnicity, and self-perceived malocclusion status were associated with PIDA score (p < 0.05). Sub-urban and rural females had significantly higher PIDA scores than sub-urban and rural males. In conclusion, majority of Malaysian young adults especially those with self-perceived malocclusion were impacted by their dental aesthetics.
  7. Tahir MKAM, Kadir K, Apipi M, Ismail SM, Yusof ZYM, Yap AU
    J Oral Facial Pain Headache, 2020 12 9;34(4):323-330.
    PMID: 33290438 DOI: 10.11607/ofph.2624
    AIMS: To develop the Malay DC/TMD through a formal cross-cultural adaptation (CCA) process for use in non-English speaking populations and to determine the reliability and validity of the Malay Graded Chronic Pain Scale (M-GCPS) and Malay Jaw Functional Limitation Scale (M-JFLS).

    METHODS: The English DC/TMD was translated into the Malay language using the forward-backward translation procedures specified in the INfORM guideline. The initial Malay instrument was pre-tested, and any discrepancies were identified and reconciled before producing the final Malay DC/TMD. Psychometric properties of the M-GCPS and M-JFLS were evaluated using a convenience sample of 252 subjects and were assessed using internal consistency and test-retest reliability, as well as face, content, concurrent, and construct validity testing. Internal consistency was assessed using Cronbach's alpha, while test-retest reliability was examined using intraclass correlation coefficient (ICC). Concurrent and construct validity of both domains were performed using Spearman ρ correlation test. In addition, construct and discriminant validity were appraised using Kruskal-Wallis and Mann-Whitney U tests, respectively.

    RESULTS: Cronbach's alpha values for the M-GCPS and M-JFLS were 0.95 and 0.97, respectively. The ICC was 0.98 for the M-GCPS and 0.99 for M-JFLS. The majority of the tested associations for both domains were found to be statistically significant, with good positive correlations.

    CONCLUSION: The M-GCPS and M-JFLS were found to be reproducible and valid. The Malay DC/TMD shows potential for use among Malay-speaking adults.

  8. Letchumanan D, Mohamad Norpi N, Yusof ZYM, Razak IA, Abu Kasim NH, Abdullah NA, et al.
    Gerodontology, 2020 Dec;37(4):332-341.
    PMID: 32115787 DOI: 10.1111/ger.12466
    OBJECTIVE: To assess the perceptions of caregivers towards oral healthcare services received by elders in Malaysian nursing homes and to identify challenges and suggestions for improvement.

    BACKGROUND: Caregivers play an important role in the oral health care of elders in nursing homes.

    METHODS: This study employed a qualitative approach using the nominal group technique (NGT) to obtain caregivers' feedback in nursing homes in Malaysia. Data were manually transcribed, summarised into keywords/key phrases, and ranked using weighted scores.

    RESULTS: In total, 36 caregivers (21 from government and 15 from private nursing homes) participated in the NGT sessions. Overall, caregivers were satisfied with the low treatment cost, the quality of treatment, and the availability of dental visits to nursing homes. Caregivers were dissatisfied with the frequency of dental visits, long waiting times at government dental clinics, and inadequate denture hygiene education for elders in nursing homes. The challenges faced by caregivers were elders' poor oral health knowledge and attitude and lack of elders' trust of caregivers to look after their oral health. Suggestions for improvement were to increase the frequency of dental visits to nursing homes, provide oral health education to elders and caregivers, and give treatment priority to elders at dental clinics.

    CONCLUSION: Despite being satisfied with the basic oral healthcare services received by elders in Malaysian nursing homes, caregivers raised some issues that required further attention. Suggestions for improvement include policy changes in nursing home dental visits and treatment priority for elders at government dental clinics.

  9. Kasim SKM, Razak IA, Yusof ZYM
    Int Dent J, 2018 Feb;68(1):31-38.
    PMID: 28782099 DOI: 10.1111/idj.12325
    AIM: To assess the knowledge and perceptions of Malaysian government dentists regarding the shortened dental arch (SDA) concept and its application in clinical practice.

    BACKGROUND: The SDA concept refers to a specific type of dentition with intact anterior teeth and a reduction in posterior occlusal pairs. Dentists' knowledge and perceptions of the SDA concept can influence its application in clinical practice.

    METHODS: A self-administered questionnaire on the SDA concept was distributed to 326 government dentists in the states of Selangor and Kuala Lumpur, Malaysia. The data were analysed using SPSS version 22 software.

    RESULTS: The response rate was 84.0%. The majority of respondents had good knowledge on five of six knowledge items and good attitudes towards 10 of 17 perception items. However, only one-fifth (20.4%) reported having applied the SDA concept in the clinic. A larger number of participants who graduated locally than who graduated abroad perceived that patients <60 years of age, without molar support, can attain acceptable chewing function and that SDA treatment does not lead to loss of occlusal vertical dimension (P < 0.05). A larger number of participants with ≤5 years of work experience than with >5 years of work experience perceived that the SDA concept enables simpler treatment planning (P < 0.05). Finally, a larger number of participants who graduated abroad than who graduated locally observed that patients without molar support had temporomandibular joint problems (P < 0.05).

    CONCLUSION: Although Malaysian government dentists have good knowledge and perceptions of the SDA concept, it is not widely applied in the clinic. Concerted efforts in SDA training of dentists are needed to help to shorten denture waiting lists and reduce costs.

  10. Hashim NA, Yusof ZYM, Saub R
    Community Dent Oral Epidemiol, 2019 02;47(1):24-31.
    PMID: 30187941 DOI: 10.1111/cdoe.12417
    OBJECTIVES: To evaluate the sensitivity and responsiveness of the Malay version of Early Childhood Oral Health Impact Scale (Malay-ECOHIS) to dental treatment of early childhood caries (ECC) under general anaesthesia (GA) and determine the minimally important difference (MID) for the Malay-ECOHIS.

    METHODS: A sample of 158 preschool children with ECC awaiting dental treatment under GA was recruited over an 8-month period. Parents self-completed the Malay-ECOHIS before and 4 weeks after their child's dental treatment. At 4 weeks follow-up, parents also responded to a global health transition judgement item. Data were analysed using independent and paired samples t tests, ANOVA and Pearson correlation coefficients.

    RESULTS: The response rate was 87.3%. The final sample comprised 76 male (55.1%) and 62 female (44.9%) preschool children with mean age of 4.5 (SD = 1.0) years. Following treatment, there were significant reductions in mean scores for total Malay-ECOHIS, child impact section (CIS), family impact section (FIS) and all domains, respectively (P 

  11. Esa R, Jamaludin M, Yusof ZYM
    Health Qual Life Outcomes, 2020 Sep 29;18(1):319.
    PMID: 32993663 DOI: 10.1186/s12955-020-01565-z
    BACKGROUND: There is a lack of evidence with regards to the association between both maternal and child dental anxiety and the mother's perception of her child's oral health-related quality of life (COHRQoL). The aim of this study was to investigate the association of maternal and child dental anxiety with COHRQoL and the effect of demographic factors as moderators in this relationship. In addition, the association between child's dental caries experience and the COHRQoL was also assessed.

    METHODS: A cross-sectional study was conducted involving 1150, 5-6 year-old preschool children in Selangor, Malaysia. Mothers answered a questionnaire on socio-economic status, the Malay-Modified Dental Anxiety Scale to assess maternal dental anxiety, and the Malay-Early Childhood Oral Health Impact Scale to assess COHRQoL. Child's dental anxiety was assessed using the Malay-Modified Child Dental Anxiety Scale via a face-to-face interview prior to oral examination to assess dental caries. Data were analysed using structural equation modelling to assess the relationship between maternal and child dental anxiety and COHRQoL.

    RESULTS: Overall, complete data on 842 mother-child dyads were analysed. The mean scores of total ECOHIS, the child impacts section (CIS), and the family impacts section (FIS) were 17.7 (SD = 4.9), 12.6 (SD = 3.7), and 5.1 (SD = 1.9), respectively. The mean dental anxiety scores for mothers and children were 11.8 (SD = 4.5) and 16.9 (SD = 4.3), respectively. Maternal dental anxiety was associated with the CIS (b = 0.08, p 

  12. Babar MG, Andiesta NS, Bilal S, Yusof ZYM, Doss JG, Pau A
    Community Dent Oral Epidemiol, 2022 Dec;50(6):559-569.
    PMID: 35138648 DOI: 10.1111/cdoe.12710
    OBJECTIVES: This paper reports on the effect of 6-month dental home visits compared to no dental home visits on 24-month caries incidence in 5- to 6-year-olds.

    METHODS: 5- to 6-year-olds attending kindergartens were randomized to receive either 6-month dental home visits and education leaflets (Intervention group) or education leaflets alone (Control group) over 24 months. To detect a 15% difference in caries incidence with a significance level of 5% and power of 80%, 88 children were calculated to be needed in the Intervention group and 88 in the Control. Baseline clinical data included oral examinations at the kindergartens. Follow-up visits were made on the 6th, 12th and 18th month. At the end of the 24 months, both the Intervention and Control groups were visited for oral examinations. The primary outcome was caries incidence, measured by the number and proportion of children who developed new caries in the primary molars after 24 months. The secondary outcome was the number of primary molars that developed new caries (d-pms). Frequency distributions of participants by baseline socio-demographic characteristics and caries experience were calculated. The chi-square test was used to test differences between the caries experience in the Intervention and Control groups. The t test was used to compare the mean number of primary molars developing new caries between the Intervention Group and the Control Group. The number of children needed to treat (NNT) was also calculated.

    RESULTS: At the 24-month follow-up, 19 (14.4%) developed new caries in the Intervention Group, compared to 60 (60.0%) in the Control Group (p = .001). On average, 0.2 (95% CI = 0.1-0.3) tooth per child in the Intervention Group was observed to have developed new caries compared to 1.1 (95% CI = 0.8-1.3) tooth per child in the Control Group (p = .001). The number of children needed to treat (NNT) to prevent one child from developing new caries was 2.2.

    CONCLUSIONS: The present study has demonstrated that 6-month home visits to families of 5- to 6-year-olds are effective in caries prevention in 5- to 6-year-olds of low-income families in a middle-income country where access to health services, including oral health promotion services, is limited.

  13. Alsanabani AAM, Yusof ZYM, Wan Hassan WN, Aldhorae K, Alyamani HA
    Children (Basel), 2021 May 25;8(6).
    PMID: 34070552 DOI: 10.3390/children8060448
    (1) Objectives: This paper aimed to cross-culturally adapt the Psychosocial Impact of Dental Aesthetics Questionnaire (PIDAQ) into an Arabic language version (PIDAQ(A)) for measuring the oral health related quality of life related to dental aesthetics among 12-17-year-old Yemeni adolescents. (2) Material and methods: The study comprised three parts, which were linguistic validation and qualitative interview, comprehensibility assessment, and psychometric validations. Psychometric properties were examined for validity (exploratory factor analysis (EFA), partial confirmatory factor analysis (PCFA), construct, criterion, and discriminant validity) and reliability (internal consistency and reproducibility). (3) Results: The PIDAQ(A) contained a new item. EFA extracted three factors (item factor loading 0.375 to 0.918) comprising dental self-confidence, aesthetic concern, and psychosocial impact subscales. PCFA showed good fit statistics (comparative fit index (CFI) = 0.928, root-mean-square error of approximation (RMSEA) = 0.071). In addition, invariance across age groups was tested. Cronbach's α values ranged from 0.90 to 0.93 (intraclass correlations = 0.89-0.96). A criterion validity test showed that the PIDAQ(A) had a significant association with oral impacts on daily performance scores. A construct validity test showed significant associations between PIDAQ(A) subscales and self-perceived dental appearance and self-perceived need for orthodontic braces (p < 0.05). Discriminant validity presented significant differences in the mean PIDAQ(A) scores between subjects having severe malocclusion and those with slight malocclusion. No floor or ceiling effects were detected.
  14. Abdul Razakek NFS, Yusof ZYM, Yusop FD, Obaidellah UH, Kamsin A, Nor NAM
    J Clin Pediatr Dent, 2024 Jan;48(1):101-110.
    PMID: 38239162 DOI: 10.22514/jocpd.2023.096
    The effectiveness of children's oral health education (OHE) is determined by the appropriateness of the educational materials used, which can influence their attitude towards oral health. However, there is a lack of studies exploring the benefits of OHE materials from the perspective of schoolchildren. This study aimed to explore schoolchildren's opinions on the newly developed ToothPoly board game as an OHE tool. A qualitative approach using focus group discussions (FGDs) was conducted among 44 schoolchildren aged 12 years old from a public school in Malaysia. Convenience sampling was employed to recruit the schoolchildren. The ToothPoly board game was playtested and FGDs were conducted after the playtesting session ended. Data collection and analyses were performed concurrently until data saturation was reached. The data were transcribed and coded using Atlas.Ti software version 9.1.3 followed by the framework method analysis. Mixed opinions were observed among the schoolchildren with a majority expressing favourable opinions on the advantages of the ToothPoly board game as an OHE tool. Five themes emerged from the advantages aspect, i.e., fun and enjoyable, promote focus, attention and oral health-related learning, attractive board game features, and enhance peer interaction. Meanwhile, two themes emerged that were related to the disadvantages of the board game, i.e., "competition with online games and media" and "not practical for a large group activity". The findings showed that the ToothPoly board game was perceived as a useful, interactive, and enjoyable tool to learn about oral health in small groups. The findings of the study highlight the importance of tailoring OHE activities to fulfil the needs of specific target groups to ensure its acceptance and future success.
  15. Ab Mumin N, Yusof ZYM, Marhazlinda J, Obaidellah U
    BMC Oral Health, 2021 08 11;21(1):394.
    PMID: 34380484 DOI: 10.1186/s12903-021-01741-7
    BACKGROUND: The Malaysian School Dental Service (SDS) was introduced to provide systematic and comprehensive dental care to school students. The service encompasses promotive, preventive, and, curative dental care. This study aimed to undertake a process evaluation of the SDS based on the perspectives of government secondary school students in Selangor, Malaysia.

    METHODS: The study adopted a qualitative approach to explore the opinions of secondary school students on the SDS implementation in their schools. Data from focus group discussions involving Form Two (14-year-olds) and Form Four (16-year-olds) students from the selected schools were transcribed verbatim and coded using the NVivo software before framework method analysis was conducted.

    RESULTS: Among the strengths of the SDS were the convenience for students to undergo annual oral examination and dental treatment without having to visit dental clinics outside the school. The SDS also reduced possible financial burdens resulting from dental treatment costs, especially among students from low-income families. Furthermore, SDS helped to improve oral health awareness. However, the oral health education provided by the SDS personnel was deemed infrequent while the content and method of delivery were perceived to be less interesting. The poor attitude of the SDS personnel was also reported by the students.

    CONCLUSION: The SDS provides effective and affordable dental care to secondary school students. However, the oral health promotion and education activities need to be improved to keep up with the evolving needs of the target audience.

  16. Ab Mumin N, Yusof ZYM, Marhazlinda J, Obaidellah U
    Int J Dent Hyg, 2021 Oct 10.
    PMID: 34628709 DOI: 10.1111/idh.12556
    OBJECTIVE: Having good oral hygiene self-care, especially a regular toothbrushing habit will promote lifelong oral health. Therefore, understanding the factors that influence an adolescent's oral hygiene behaviour is important in developing effective oral health programmes for this age group. This study aimed to explore the motivators and barriers to adolescents' oral hygiene self-care by exploring the perspectives of secondary school students from three government schools in the state of Selangor, Malaysia.

    METHODS: Focus group discussions (FGD) were conducted with Form 2 (14-years-old) and Form 4 (16-years-old) students from selected secondary schools in Selangor using a semi-structured topic guide until data saturation was reached. Data were transcribed verbatim and analysed using framework method analysis.

    RESULTS: A total of 10 FGDs were conducted involving 77 adolescents. The motivators for good oral hygiene self-care were appearance, fear of oral disease, consequences of oral disease and past toothache experience. The barriers for oral hygiene self-care were poor attitude towards oral care, lack of confidence in toothbrushing skills, snacking habit and the taste of toothpaste.

    CONCLUSION: Understanding the motivators and barriers to adolescents' oral hygiene self-care is the first step in designing effective oral health education messages. The findings from this study can be used as a guide for oral health education programmes and development of materials that fulfil the needs of the adolescent population.

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