Displaying publications 21 - 36 of 36 in total

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  1. Othman WMN, Ithnin M, Wan Abdul Aziz WNA, Wan Ali WNS, Ramli H
    J Int Soc Prev Community Dent, 2021 01 30;11(1):33-40.
    PMID: 33688471 DOI: 10.4103/jispcd.JISPCD_336_20
    Aims: This study aimed at exploring the self-perception of Orang Asli (OA) from the Temuan tribe in Jelebu by using the Global Self-rated Oral Health (GSROH) and General Oral Health Assessment Index (GOHAI).

    Materials and Methods: It was a cross-sectional study involving a two-stage sampling to select the district and villages. A total of 325 participants were selected based on convenience sampling.

    Results: Almost half of the participants rated their oral health as poor or average. The mean GOHAI score was 52.96 (±7.749), ranging from 29 to 60. The GOHAI score was statistically significantly lower for female gender (P = 0.025), lower education level (P = 0.001), and elderly (P = 0.001). The GSROH score was also statistically significant with GOHAI score (P = 0.001).

    Conclusions: A limited number of studies were conducted in this area, particularly in the vulnerable population of OA. Our study found that half of the OA living in the fringe had a poor GOHAI score. It is, therefore, suggested that potential study and intervention programs concentrate on the low GOHAI score group; the male, lower educational context, and the elderly.

  2. Nekkanti S, Kaur K, Balagopal S, Agarwal P
    J Int Soc Prev Community Dent, 2020 11 24;10(6):759-765.
    PMID: 33437710 DOI: 10.4103/jispcd.JISPCD_339_20
    Aim and Objectives: Toothbrushing is one of the most important factors in controlling plaque accumulation and dental caries. There are vast varieties of toothbrushes available in the market. This study was designed to evaluate the effectiveness of novel chewable toothbrushes as compared to manual toothbrushes in plaque removal among 10-12-year-old children.

    Materials and Methods: This randomized controlled trial was conducted on 40 healthy children aged between 10 and 12 years of age who were randomly assigned to either of the groups: Group I--Chewable Toothbrushes and Group II--Manual Toothbrushes. Following oral prophylaxis, baseline records of oral hygiene indices (Simplified oral hygiene index (OHI-S) in indexed teeth and Turesky modification of Quigley Hein plaque index (TMQHI) were taken. Baseline Saliva samples were collected and sent for Streptococcus mutans counts. Children were then instructed to use their respective toothbrush twice daily for a week. Oral hygiene indices and S. mutans counts were repeated after 1 week.

    Results: Differences in pre-brushing and post-brushing plaque scores and salivary S. mutans counts were statistically significant when compared using paired-sample t test and independent-sample t test. There was a significant reduction in salivary S. mutans counts after using both chewable and manual toothbrushes. However, there was no statistically significant difference between the two groups (P = 0.08).

    Conclusion: Chewable toothbrushes are equally effective in plaque control when compared to manual toothbrushes. These can be a reliable alternative for children who lack manual dexterity.

  3. Venkiteswaran A, Tandon S
    J Int Soc Prev Community Dent, 2021 04 15;11(2):115-124.
    PMID: 34036071 DOI: 10.4103/jispcd.JISPCD_320_20
    Aim: This narrative aims to outline the use of hypnosis in managing dental anxiety in during dental treatment. The PICO used to answer the objectives are (P) dental patients, (I) hypnosis, (C) conventional behaviour management techniques & (O) reduced pain/anxiety.

    Materials and Methods: An electronic search of three databases; PubMed, Scopus and EBSCOhost was conducted using the keywords "hypnosis or hypnotherapy" AND "dentistry or dental" between the year 2000 and 2020. A total of 19 studies were selected based on eligibility. Data extracted were study subject, design of study, parameters used to assess, type of hypnosis script used and the study outcome.

    Results: The studies show that hypnosis is effective in pain management and dental anxiety. It can also be used for improving compliance in patients who are wearing orthodontic appliances (Trakyali et al, 2008) and reducing salivary flow during dental treatment (Satlz et al, 2014).

    Conclusion: Hypnosis has the potential to be a useful tool in the management of children and adults.

  4. Brejawi MS, Venkiteswaran A, Ergieg SMO, Sabri BM
    J Int Soc Prev Community Dent, 2022;12(5):547-553.
    PMID: 36532319 DOI: 10.4103/jispcd.JISPCD_105_22
    AIM: This study aims to assess the relationship between stress, family functioning, and molar-incisor hypomineralization (MIH).

    MATERIALS AND METHODS: A total of 162 children between the ages of 7 and 9 years were included in this retrospective study, as were their respective parents; the children were examined for MIH while questionnaires centering on stress and family functioning were given to the parents. Statistical analysis was performed using the Mann-Whitney U test and independent samples T-test.

    RESULTS: A significant correlation between stress as a contributing factor and MIH was concluded; children with higher stress scores had higher occurrences of MIH. On the contrary, family functioning quality was not found to have a direct correlation with MIH.

    CONCLUSIONS: Stress is correlated to MIH and is potentially one of the main causal factors that contribute to the development of the defect.

  5. Kuppusamy E, Ratnasingam MD, Yazid F, Rosli TI, Ali AM, Sockalingam SNMP, et al.
    J Int Soc Prev Community Dent, 2023;13(2):133-140.
    PMID: 37223451 DOI: 10.4103/jispcd.JISPCD_213_22
    OBJECTIVES: This study aims to explore the information-seeking behavior patterns of parents with children receiving treatment for early childhood caries (ECC).

    MATERIALS AND METHODS: Semistructured in-depth interviews were conducted with 20 parents of children with ECC. A topic guide was developed, focusing on questions relating to (i) the timing of their seeking information on ECC, (ii) the types of EEC information they seek, and (iii) the resources used to seek information. The interviews were audio-recorded and transcribed verbatim. Thematic analysis was performed, whereby the data were coded and categorized into themes and subthemes.

    RESULTS: Four main themes were identified: the immediacy of seeking information, perceived information need, use of resources, and barriers to seeking information. Parents either sought information immediately after detecting changes to the appearance of their child's teeth, with some being aware of the changes after signs and symptoms developed. The types of information parents usually sought covered the disease, its prevention, and management. Common sources of information were friends, family, the internet, and healthcare professionals. Barriers to seeking information discussed by parents were lack of time as well as insufficiency and inaccuracy of the information they received.

    CONCLUSION: This study highlighted the need for comprehensive, tailored early education on ECC for parents using reliable information sources. There is also a need to empower other nondental healthcare professionals to provide oral healthcare education for parents.

  6. Omar AF, Mokhtar IW, Ahmad MS
    J Int Soc Prev Community Dent, 2023;13(2):148-156.
    PMID: 37223444 DOI: 10.4103/jispcd.JISPCD_234_22
    AIMS AND OBJECTIVES: A "caregiver" is responsible for managing the basic needs of others, including individuals with special needs (IWSNs). Caregivers play an important role in the well-being of IWSNs, though caring can lead to a decline in health and quality of life. This qualitative study aimed to investigate the perceived healthcare challenges faced by caregivers of IWSNs in Malaysia.

    MATERIALS AND METHODS: Thirty-two primary caregivers were interviewed via audio-recorded semistructured focus group discussions to investigate their perceived barriers and challenges in caring for IWSNs. The qualitative data were then analyzed via thematic analysis.

    RESULTS: Thirty-two participants took part in a total of nine discussion sessions, where the majority were females (n = 29; 90.63%) and from the Malay race (n = 30; 93.75%). Most of the IWSNs under their care had autism (n = 11; 34.38%) and were between 6 and 10 years of age (n = 13; 40.63%). The main themes identified were related to healthcare services, support systems, caregivers' personal factors, and IWSN issues. Within the healthcare services domain, themes regarding the accessibility and appropriateness of healthcare facilities and the attitudes of staff were uncovered, whereas in the support system domain, themes pertaining to community and peer, family, and governmental support were discussed. In the domain of caregivers' personal factors, themes regarding stress with the burden of care and feelings of guilt were noted, and in the area of IWSN factors, the theme of behavioral difficulties exhibited by IWSNs was discussed.

    CONCLUSION: Primary caregivers in Malaysia face challenges with healthcare facilities and staff, gaining support from the community, family, and government, burning out, and feeling guilty as well as behavior issues of their IWSN. Thus, understanding these challenges is vital in providing healthcare services that cater to not only IWSNs but also their caregivers to ensure the success and well-being of all involved.

  7. Ibrahim DFA, Venkiteswaran A, Hasmun NN
    J Int Soc Prev Community Dent, 2023;13(4):273-286.
    PMID: 37876578 DOI: 10.4103/jispcd.JISPCD_29_23
    AIMS AND OBJECTIVES: The aim of this study was to systematically review the ability of resin infiltration to conceal demineralized enamel lesions to normal enamel translucency and to maintain color stability.

    MATERIALS AND METHODS: A literature search of PubMed, MEDLINE, Web of Science, and Scopus databases and a manual search of articles from 2009 to 2021 for randomized controlled trials (RCTs) and clinical efficacy trials (nonrandomized) were performed. Methodological quality and risk of bias (RoB) of included papers was assessed using Cochrane Collaboration Risk of Bias Tool 2.0 for RCTs and ROBINS-I (Risk Of Bias In Non-randomized Studies of Interventions) tool for nonrandomized studies.

    RESULTS: A total of 352 titles and abstracts were reviewed. Eight RCTs and three clinical efficiency studies were included in this review. The masking effects of the demineralized enamel lesion were reported immediately after resin infiltration, and the color stability of this material was up to 24 months, with no adverse effects noted. For RCTs, four studies were classified as "some concerns" and four were as "low RoB." For nonrandomized studies, all of the studies presented an overall moderate RoB.

    CONCLUSION: Resin infiltration achieves the best esthetic outcomes compared with microabrasion and remineralization therapy. Color stability was achieved with this material for up to 24 months and no adverse effects were noted. Factors contributing to the esthetic outcomes of the resin include the elimination of the hypermineralized surface layer, the homogeneity of the resin itself, and polishing after resin infiltration. Longitudinal follow-up and improved control of confounding variables should characterize future high-quality systematic reviews.

  8. Ibrahim DFA, Venkiteswaran A, Hasmun NN
    J Int Soc Prev Community Dent, 2023;13(3):194-207.
    PMID: 37564169 DOI: 10.4103/jispcd.JISPCD_36_23
    AIMS AND OBJECTIVES: Studies on resin infiltration and its penetration capability are becoming the focus of emerging dentistry. The depth of resin penetration could be a key determining factor in creating a diffusion barrier and in the success of infiltration. The aim of this review article was to evaluate the penetration depth of commercially available resin infiltration in early caries lesions and to identify factors that influence the penetration capability of resin infiltration.

    MATERIALS AND METHODS: A literature search was performed in four databases (PubMed, Science Direct, Scopus, and Web of Science) and manual searching from 2009 to December 2022. Eligibility criteria included in vitro studies pertaining to factors affecting the penetration depth of resin infiltration into the enamel. The risk of bias assessment was done by using checklist for reporting in vitro studies (CRIS).

    RESULTS: The initial search resulted in a total of 297 studies. Twenty-nine were assessed for eligibility, and 23 were selected in the qualitative synthesis. According to the CRIS guidelines, all of the studies were classified as moderate risk of bias. The penetration of resin infiltration is influenced by the enamel surface treatment with hydrochloric acid, formulations containing triethylene glycol dimethacrylate (TEGDMA), the addition of ethanol, penetration time, duration of penetration time, saliva contamination, caries activity, and type of tooth. The hypermineralized surface layer needs to be removed for better resin perfusion.

    CONCLUSION: The key to optimal resin infiltration depends on the enamel surface treatment with hydrochloric acid and application technique, infiltration duration, formulation of TEGDMA and ethanol in the resin composition, as well as the type and caries activity of involved teeth. Resin infiltration has superior penetrability compared to fissure sealant, casein phosphopeptide-amorphous calcium phosphate nanocomplexes, flowable composite, adhesive and fluoride varnish. Resin penetration depth may be a critical factor in forming a diffusion barrier and the effectiveness of infiltration in halting the progression of caries.

  9. Affandi TYIMS, Wan Mokhtar I, Mohd Yusof MYP, Ahmad MS
    J Int Soc Prev Community Dent, 2023;13(3):256-263.
    PMID: 37564173 DOI: 10.4103/jispcd.JISPCD_228_22
    AIMS AND OBJECTIVES: Special care dentistry (SCD) provides oral health care to disabled individuals in an environmental, cultural or social setting that supports their oral health. This study aimed to analyze the profiles of patients managed at an SCD clinic in a teaching hospital based on their sociodemographic background, medical condition or disability, dental diagnosis and treatment provided.

    MATERIALS AND METHODS: This retrospective audit study included patients seen from the clinic's inception in January 2017 until June 2022, retrieved from the faculty's record management system. The pattern of patients seen was arranged on an Excel sheet and analyzed using SPSS. Quantitative data were analyzed via descriptive analysis (frequency) and chi-square test (P < 0.05).

    RESULTS: A 220% surge in the number of patients treated between January 2017 and June 2022, from two to 91 years old, with more male patients seen. Most patients had an intellectual disability (49.7%), followed by medical compromised (16.4%) and genetic conditions or syndromes (12.0%). 43% of had caries, which is more prevalent in women, and 31.6% had periodontal disease, with the majority being between the ages of 21 and 40. Periodontal treatment accounted for most of the dental treatment (76.1%). Even though only a small percentage of endodontic therapy was performed (2.4%), a significant association was found between the treatment, gender and age group of patients seen in the clinic.

    CONCLUSION: Considering their health profile, oral diagnosis and therapy, this study demonstrated the varied sorts of patients encountered in an SCD specialist clinic. This useful information will be beneficial in the development of a comprehensive care dentistry center for this community.

  10. Abidin ZZ, Halim RA, Noor E, Nor NSM, Nazari NSM, Zaini AA, et al.
    J Int Soc Prev Community Dent, 2023;13(5):416-425.
    PMID: 38124724 DOI: 10.4103/jispcd.JISPCD_123_23
    AIM: The bidirectional relationship between type 1 diabetes mellitus (T1DM) and inflammatory periodontal disease (PD) is globally recognized. However, oral health components are often given lower priority, and studies related to knowledge and the bidirectional association are limited. This study assesses the knowledge and perceptions of PD and its associated risk factors among T1DM patients and/or their parents.

    MATERIALS AND METHODS: Patients under 18 with T1DM at Universiti Teknologi MARA and Universiti Malaya were invited to participate. Structured interviews were conducted to assess participants' knowledge and perceptions of T1DM, and statistical analysis was performed to examine their associations using Pearson's chi-squared test and Fisher's exact test.

    RESULTS: A total of 113 T1DM patients, with a mean age of 11.4 ± 4, completed the interviews. Poor knowledge was observed among parents and T1DM patients (P-value = 0.007) and those who exercised regularly (P-value = 0.047). A significant association with good perception was found among individuals with uncontrolled HbA1c levels (P-value = 0.0018) and those experiencing bleeding symptoms (P-value = 0.021).

    CONCLUSIONS: The study highlights the importance of increasing awareness, a key factor in improving oral health knowledge. Interestingly, despite poor control of clinical parameters, the population displayed good perception, suggesting a potential lack of understanding regarding disease control.

  11. Mohd FN, Said AH, Ahmad MS, Ridzwan AN, Muhammad AI, Mat Naji AS
    J Int Soc Prev Community Dent, 2023;13(6):477-484.
    PMID: 38304533 DOI: 10.4103/jispcd.JISPCD_89_23
    BACKGROUNDS: People with intellectual disabilities (PWID) are often characterized by challenges in learning and difficulties in performing daily activities. These difficulties can have an impact not only on the individuals themselves but also on the people around them, especially their parents, caregivers, and healthcare workers. Therefore, establishing a positive relationship between parents or caregivers and individuals with disabilities is crucial as a key factor in promoting positive healthcare experiences and outcomes.

    AIM: This study aims to explore the barriers and perceptions toward healthcare services among parents or caretakers of people with intellectual disability, including the challenges and their expectations toward healthcare services.

    MATERIALS AND METHODS: This was a qualitative study using purposive sampling. Thirty participants were contacted at the initial stage and invited to participate in the study. Semi-structured in-depth interviews were done among parents and caretakers of PWID who attended Special Care Dentistry and Paediatric Dentistry clinics in Sultan Ahmad Shah Medical Centre, Kuantan, Pahang. Topic guides were generated from literature review and expert opinions, followed by pilot interviews to refine them. However, after the interviews were done for the first 13 participants, we have reached data saturation, and no new themes emerged. The interviews were recorded, verbatim transcribed, and analyzed using Braun and Clarke's guidelines for thematic analysis.

    RESULTS: The satisfaction of parents or caretakers toward healthcare services for PWID and positive experiences in receiving healthcare services were noted. However, the results revealed several barrier themes in seeking healthcare services: lack of availability of parking, longer waiting time, appointment time, crowded environment, limited information on the availability of the services, and longer travel duration. Furthermore, expectation themes emerged from this study: continuous follow-up, accessibility to healthcare services, and staff attitude.

  12. Ismail N, Isa KAM, Hamzah SH, Mokhtar IW
    J Int Soc Prev Community Dent, 2023;13(6):500-508.
    PMID: 38304538 DOI: 10.4103/jispcd.JISPCD_52_23
    AIM: To compare caregivers' acceptance, consent, and concern toward utilization of a combination of basic behavior guidance technique (CBBGT) and Papoose Board (PB) for their special needs children and to evaluate the impact of PB usage on the caregiver's attitude and the association between their education level, monthly household income, and previous dental experience.

    MATERIALS AND METHODS: This cross-over study incorporated 90 special needs children who were recruited to receive dental treatment with two ways of behavior guidance exposures consecutively in the order of A-B/B-A design. Exposure A is CBBGT (distraction, tell-show-do, and positive reinforcement), while Exposure B is PB. The dental procedures were either dental prophylaxis or restoration with a handpiece. Caregivers need to answer a paper-based questionnaire before and after exposure. The Wilcoxon sign rank test and logistic regression were utilized in order to establish the comparability, impacts, and association.

    RESULT: About 88 caregivers of special needs children aged between 2 and 15 years completed the sequence. Overall, 98.9% of the children presented with neurodevelopmental disorders. Twenty-seven caregivers were significantly concerned when the combination of basic BGT was applied to their children, and 14 caregivers felt the same for PB. However, the Wilcoxon sign rank test revealed insignificant caregiver scores on acceptance and consent for both methods but significantly improved attitudes towards the use of PB after observing the placement of their children.

    CONCLUSION: The studied caregiver demonstrated equivalent acceptance, consent, and concern toward the use of PB and a combination of basic BGT with improved attitudes after comprehensive explanation and real-time observation of PB usage during their children's dental treatment.

  13. Haque M
    J Int Soc Prev Community Dent, 2017;7(4):147-160.
    PMID: 28852629 DOI: 10.4103/jispcd.JISPCD_224_17
    Medicine improves the quality of life and increases mean age of human beings as it fights against diseases. Accessibility to medicines is the fundamental right of every person. The principle of the essential medicines (EMs) is that a limited number of availability of medicine will promote to a better supply chain and rational prescribing to the rural and remote health centers for any developing countries. Furthermore, it was also expected that this concept will also ensure better procurement policy at lower costs, more in amount, with easier storage. Thereby, EMs will safeguard and improve distribution and dispensing of medicine. Correspondingly, motivational and dedicated training program regarding drug information and adverse drug reactions will boost up access to medicine and health-care. In addition, the selection of medicine from EM is the first step in the direction of the rational use of medicine and progress and ensuring the quality of health care. Thereafter, selection needs to be followed by appropriate use. Everyone should receive the right medicine, in an adequate dose for an adequate duration, with appropriate information and follow-up treatment, and at an affordable cost. The acceptance and implementation of World Health Organization-promoted EM policies in deferent countries have improved quality use of medicine in terms of accessibility and affordability, predominantly in developing countries. The corporations and teamwork among various participants of health care are instantly obligatory to progress equitable access to medicines in low- and middle-income countries.
  14. Voruganti S, Haricharan PB, Mudrakola DP, Turagam N
    J Int Soc Prev Community Dent, 2020;10(4):410-414.
    PMID: 33042881 DOI: 10.4103/jispcd.JISPCD_217_19
    BACKGROUND: Accurate diagnosis, reporting of caries and its consequences, is absolute mandate for planning an efficient, effective community health-care program. Literature reports indicate shortcomings of existing caries assessment tools. Caries assessment spectrum and treatment (CAST) is novice caries quantification tool, which quantifies the entire spectrum of carious lesions. This tool records give an insight into the status of restorations along with various progressive developmental stages of dental caries. This instrument has been validated for face, content, and construct by an expert group, and currently, its usage is on the rise.

    AIM: The aim of this study was to report the reliability of this assessment tool with regard to the primary and permanent dentition of school children and adults belonging to a south Indian district.

    MATERIALS AND METHODS: A cross-sectional study was carried out by two trained and calibrated examiners by examining 192 school children in the age-group between 4 and 6 years and 262 adults between 19 and 69 years. The study sample was reexamined by the same examiners after a gap of 4 weeks. The κ coefficient values and percent of agreement were calculated for the data recorded from the study subjects.

    RESULTS: The analyzed data showed moderate intra-examiner and inter-examiner reproducibility for either of the dentition as revealed by κ coefficient values (0.80-0.89). Inter- or intra-examiner agreement was found to be substantial to almost perfect (percent agreement above 90%) with respect to both the age-groups.

    CONCLUSION: The CAST tool seems quite promising to be the future for quantifying caries spectrum for a community or an individual.

  15. BenGhasheer HF, Saub R
    J Int Soc Prev Community Dent, 2020;10(4):520-531.
    PMID: 33042896 DOI: 10.4103/jispcd.JISPCD_192_20
    AIM: This study aimed to investigate the relationships between acculturative stress, perceived stress, social support, and subjective oral health outcomes among international graduate students in Malaysian public universities.

    MATERIALS AND METHODS: A total of 312 international graduate students completed a web-based questionnaire, including measures of acculturative stress (ASSIS-36), perceived stress scale (PSS-4), social support (MSPSS-12), oral health perceptions (global rating item), and oral health-related quality of life (OHRQoL, OIDP-8). The hypotheses of the conceptual model were tested using structural equation modeling-partial least squares (SEM-PLS) with the support of SmartPLS.

    RESULTS: Twenty-seven percent (27.1%) of the variance in OHRQoL was explained by acculturative stress, perceived stress, social support, and oral health perceptions. The path coefficient between oral health perception and OHRQoL was the strongest (β = -0.385, P < 0.001). Acculturative stress directly influenced OHRQoL (β = 0.20, P = 0.009) and indirectly through perceived stress (β = 0.05, P = 0.019). Social support mediated the relationship between perceived stress and OHRQoL (β = 0.046, P = 0.02). The overall predictive power of the model was 23%.

    CONCLUSION: Results indicated that acculturative stress, perceived stress, and social support are among the predictors of OHRQoL. Oral health perceptions and acculturative stress were the most significant predictors that contributed the largest amount to the model. The findings emphasize the potential role of psychosocial factors in relation to oral health. The empirical evidence of this study could facilitate the planning of targeted strategies that address stress reduction and social support. Such strategies might be a new promising way to enhance OHRQoL as these elements can be modified and response to interventions.

  16. Ealla KKR, Kumar AN, Turagam N, Sooraparaju SG, Yerrapothu RMR, Bhaskaran MK
    J Int Soc Prev Community Dent, 2018;8(6):508-512.
    PMID: 30596041 DOI: 10.4103/jispcd.JISPCD_238_18
    AIM: This study aimed to assess the level of knowledge and attitudes for pit and fissure sealants among undergraduate Indian dental students.

    MATERIALS AND METHODS: A modified questionnaire consisting of 24 items was distributed to 280 undergraduate dental students comprising males and females of different years at MNR Dental College, Sangareddy, India. Descriptive statistics and Chi-square/Fisher's exact tests were used for statistical analysis. The data were computationally tested using Statistical Package for the Social Sciences (SPSS) Version 20, IBM SPSS Statistics software for Windows, Armonk, NY, USA.

    RESULTS: With the response rate at 100%, most of the respondents, i.e., 70.4%, were females and the remaining 29.6% were male. Regarding the level of study, 20.8% were in 3rd year, 43.8% in the 4th year, and 16.8% were in 5th year (internship). The respondents showed a reasonable level of knowledge about sealants, mostly being good with the theoretical concepts of the sealants. On the other hand, respondents showed insufficient knowledge about sealants in the clinical practice.

    CONCLUSION: Although a high proportion of undergraduate dental students showed adequate knowledge about dental sealants, there is a lag in putting that knowledge into work during the clinical practice. These findings suggest an urgent need of dental schools to include and/or update their curriculum regarding fissure sealants to reflect modern dental education that concentrates on evidence-based practice in pediatric dentistry and improve the dental health among the future generations by reducing the incidence of caries.

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