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Fulltext Knowledge, attitudes and practice behaviours of healthcare professionals on association between periodontal disease and preterm and/or low birth weight infants: a malaysian study

Nik Azis NM, Zainol Abidin K

Malaysian Journal of Public Health Medicine, 2016;16(1):45-52.
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Our study aimed to assess the knowledge, attitudes and practice behaviours of primary healthcare professionals in government Maternal and Child Healthcare Clinics (MCHC) on the association between oral health and pregnancy outcomes namely pre-term and/or low birth weight (PT/LBW) infants and to identify the barriers of utilisation of oral healthcare services by pregnant mothers. Questionnaires were distributed to government healthcare professionals working at all seven government MCHC in the Manjung District, Malaysia. 136 out of 158 questionnaires were returned completed yielding a 92% response rate. The questionnaire covers respondents characteristics, attitude and practice behaviours related to oral health and barriers faced when referring pregnant mothers to the dental clinic. 65% of respondents noticed dental/ gum problems in the pregnant mothers that they encountered. The two most frequent response for outcome of delivery linked to gum/ dental problems were premature delivery (49%) responses and low birth weight (27%). Although 95% of the respondents believed that regular dental check-ups is compulsory for pregnant mothers, only 69% regularly refer pregnant mothers for dental check-ups. There was a significance between healthcare professionals that receive continuing dental education and their referrals of antenatal mothers for dental check-ups .
Study site: Maternal and Child Health Clinics (Klinik Kesihatan), Manjung District, Perak, Malaysia.
Impact of the COVID-19 pandemic on the self-reported competencies of dental graduates in a Malaysian setting

Nik-Azis NM, Baharin B, Abdullah D

Eur J Dent Educ, 2021 Dec 23.
PMID: 34942031 DOI: 10.1111/eje.12757

INTRODUCTION: COVID-19 pandemic has disrupted the clinical training of dental programmes worldwide. This study aimed to assess the self-reported competencies of dental graduates directly affected by the COVID-19 pandemic, as compared to the cohort before the year 2020.
MATERIALS AND METHODS: A questionnaire consisting of eight domains with 43 questions was sent to all the Universiti Kebangsaan Malaysia's (UKM) dental graduates of 2019 and 2020 cohorts. The domains were as follows: (A) gathering information at chairside, (B) diagnosis, (C) treatment planning, (D) treatment and prevention, (E) community-based, (F) management and administrative, (G) communication and (H) personal management and professional development. Three additional questions were included to assess satisfaction on clinical teaching and supervision, requirements and assessment and cross-infection control.
RESULTS: A total of 54 (91.5%) and 45 (100%) questionnaires were returned by the 2019 and 2020 cohorts, respectively. The 2019 cohort consistently perceived their competencies to be high across all the eight domains, and these responses were significantly higher than the 2020 cohort for seven out of the eight domains (p
Fulltext Rheumatoid arthritis serotype and synthetic disease-modifying anti-rheumatic drugs in patients with periodontitis: A case-control study

Nik-Azis NM, Mohd N, Mohd Fadzilah F, Mohamed Haflah NH, Mohamed Said MS, Baharin B

PLoS One, 2021;16(6):e0252859.
PMID: 34153036 DOI: 10.1371/journal.pone.0252859

Patients with rheumatoid arthritis (RA) experience a higher prevalence of periodontitis. This study aimed to examine the variation of periodontitis experienced with different serotypes suffered by RA patients and to examine the relationship between the different medications taken for RA that may influence this relationship. Two hundred and sixty RA and control participants underwent standardized periodontal examinations. Medical, serological and radiological (Sharp/van der Heijde) records were assessed. Functional status was assessed using the administered Health Assessment Questionnaire. Moreover, disease parameters, including disease activity (DAS28-ESR) and anti-citrullinated protein antibodies (ACPA) and rheumatoid factor (RF) seropositivity were evaluated. Periodontitis was higher in RA (71.54%) compared with controls (54.62%). The stage of periodontitis experienced by ACPA-positive participants were higher than APCA-negative participants. The probing pocket depth and recession experienced by RF-positive participants were higher than those who were RF-negative. RA participants on methotrexate had lower clinical attachment loss and lower periodontal probing depth compared with participants on a combination methotrexate and other disease-modifying antirheumatic drugs. Participants taking corticosteroids had lower gingival index scores. The association between seropositivity and the type of medications taken with periodontal health parameters in this group of patients suggests that both seropositivity and medications taken are important modifiers in the relationship between periodontitis and RA.
Assessment of gingival thickness in multi-ethnic subjects with different gingival pigmentation levels

Nik-Azis NM, Razali M, Goh V, Ahmad Shuhaimi NN, Mohd Nazrin NAS

J Clin Periodontol, 2023 Jan;50(1):80-89.
PMID: 36089895 DOI: 10.1111/jcpe.13723

AIM: Assessment of the thickness of gingival tissues using the probe visibility test is regarded as the method of choice during routine examinations. However, the probe visibility test has not been validated for patients with gingival pigmentation and its accuracy in populations with physiological gingival pigmentation is yet unknown. This study aims to evaluate different methods for the clinical assessment of gingival thickness in participants with varying levels of gingival pigmentation.
MATERIALS AND METHODS: Buccal mucosa of the maxillary right central incisor teeth of 171 participants was evaluated using four methods, which were direct measurements using calliper, transgingival probing method using an endodontic probe, and probe visibility method using Colorvue biotype probe (CBP) and UNC-15 probe. The pigmentation of the gingiva was assessed using the Dummett-Gupta oral pigmentation lesion index.
RESULTS: The average gingival thickness of the selected population was 1.22 ± 0.38 mm with a distribution of 70% thick and 30% thin gingiva. Transgingival and calliper methods showed good agreement and significant correlation (r = 0.229; p = .003). Visual assessment using CBP and UNC-15 probe showed poor agreement with the direct measurement methods. Gingival pigmentation significantly affected the probe visibility assessment, reducing the visibility of both the CBP (odds ratio [OR] = 4.00; 95% confidence interval [CI], 1.83-8.74) and UNC-15 probe (OR = 1.84; 95% CI, 1.05-3.23) while controlling for thickness of the gingiva.
CONCLUSION: The probe visibility method using either CBP or the UNC-15 probe is affected by the degree of gingival pigmentation. Direct measurements using either a calliper or transgingival probing are recommended as methods to measure the gingival thickness in populations with gingival pigmentation.
Fulltext Functional Disability and Symptomatic Slow-Acting Drugs for Osteoarthritis in Adults with Periodontitis

Nik-Azis NM, Mohd N, Baharin B, Mohd Fadzilah F, Mohamed Haflah NH, Mohamed Said MS

Healthcare (Basel), 2023 Mar 06;11(5).
PMID: 36900775 DOI: 10.3390/healthcare11050770

Osteoarthritis (OA) patients have decreased functional ability and restricted access to healthcare facilities and are on a spectrum of medications. These can impact their oral health. This study aims to investigate the association between periodontal disease and OA disease parameters, specifically the functional disability and the medications taken. This was a cross-sectional study on OA participants recruited from the Hospital Canselor Tuanku Mukhriz. Periodontal health parameters were obtained from an oral examination of the participants. A Health Assessment Questionnaire (HAQ) was administered to ascertain the functional status of the participants. Out of the 130 participants recruited, 71 (54.6%) had periodontitis. There was a correlation between the teeth count with OA severity, where participants with a greater Kellgren-Lawrence score had less teeth (rs = 0.204, p = 0.025). Participants with a greater degree of functional limitation also had less teeth (rs = -0.181, p = 0.039) and a higher clinical attachment loss (rs = 0.239, p = 0.006). There were no associations found between the symptomatic slow-acting drugs in OA and periodontal health parameters. In conclusion, there was a high proportion of periodontitis in patients with OA. Functional disability was associated with measures of periodontal health. It is suggested that clinicians treating OA patients consider the need for a referral for dental care when managing this group of patients.
Comparison between clinical and computerized methods for assessing gingival pigmentation

Nik Azis NM, Abdul Shukor SN, Razali M, Zakaria HY, Zabarulla NZ

Digit Health, 2024;10:20552076241264154.
PMID: 39055786 DOI: 10.1177/20552076241264154

BACKGROUND AND OBJECTIVE: Digital computerized assessment can provide objective values for the measurement of gingival pigmentation. This study aims to compare the Commission Internationale de l'Eclairage Lab color space (CIELAB) values and the computerized intensity values (CIVs) from digital imaging with clinical evaluations using the Dummett-Gupta Oral Pigmentation Index (DOPI) for assessing gingival pigmentation in a multi-ethnic population.
METHODOLOGY: Digital photographs of 188 participants were taken using standardized parameters. The buccal gingival pigmentation was evaluated using three methods (a) a clinical evaluation by two independent assessors using the DOPI, (b) the CIELAB values using the Adobe Photoshop® software (Version 23.1.1) and (c) the CIV calculated using the ImageJ software (Version 1.53k). A hierarchical clustering analysis was used to identify colour groups that clustered together. Agreement between the clinical and digital categorization of the pigmentation was carried out using weighted kappa analysis. Agreements between CIELAB and CIV were compared using intra-class correlation coefficient.
RESULTS: There was a statistically significant difference in the DOPI, the L*, a*, and b* coordinates, and the CIV between the different ethnic groups of the participants. Cluster analysis for the CIELAB and CIV both identified four clusters. The gingival pigmentation categorization using the L*, a*, and b* values moderately agreed with the clinical evaluation using the DOPI index while the categorization with the CIV was in slight agreement with the clinical evaluations.
CONCLUSION: This study identified four clusters of gingival pigmentation in 188 multi-ethnic participants. The clusters, determined by CIELAB values, align with the clinical assessment of gingival pigmentation. Digital measurements derived from clinical photographs can serve as an effective means of pigmentation measurement in dental clinics.
Fulltext Periodontal disease in seropositive rheumatoid arthritis: scoping review of the epidemiological evidence

Nik-Azis NM, Mohd N, Baharin B, Said MSM, Fadzilah FM, Haflah NHM

Germs, 2021 Jun;11(2):266-286.
PMID: 34422698 DOI: 10.18683/germs.2021.1263

The link between periodontal disease (PD) and rheumatoid arthritis (RA) has been hypothesized to lie in the anti-cyclic citrullinated protein antibody (ACPA) molecules present in seropositive RA. This review aimed to discuss how RA and specifically ACPA-positive RA link to PD, and appraise the epidemiological evidence on the relationship between ACPA-positive RA and PD. Articles were searched following the PRISMA guideline across the MEDLINE, Web of Science, Scopus and Cochrane Library databases. A total of 21 articles met the inclusion criteria of reporting the epidemiological data on the different ACPA status of the subjects with RA and PD (or periodontitis) parameters. A discrepancy is noted in the epidemiological evidence on the difference in the prevalence and severity of PD between ACPA-positive and ACPA-negative RA patients. Although the link between RA and PD is mostly discussed in terms of ACPA, reports on the different manifestations of PD between the two RA subsets remains inconclusive.