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Fulltext Oral health literacy among public university undergraduate students and associated factors.

Jaafar A, Al-Kadhim AHA, Ab Malik N

IIUM Medical Journal Malaysia, 2020;19(3):73-79.
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Oral health literacy is an essential element of an individual to make better oral health decision. Low oral health literacy (OHL) is associated with poor oral health decision and outcome. This study aimed to determine factors associated with oral health literacy among undergraduate students in one of the public universities of Malaysia. Materials and methods:This is a cross-sectional study which was undertaken among the undergraduate students of Universiti Sains Islam Malaysia (USIM). Sample selection was done randomly. A validated oral health literacy index of Malay version was used throughout the study. Ethical approval was obtained from the University Research Ethics Committee and respondents had given their consent prior to the data collection. Data analysis was performed using IBM SPSS software version 24.0 and the significant level was set at p< 0.05. Results:The mean oral health literacy of the university undergraduate students was 77.7 (95% CI= 76.75, 78.71). Multiple linear regression indicated that female has higher OHL (β= 4.19; 95% CI= 1.99, 6.39; p< 0.001), social science stream has lower OHL (β= -9.14; 95% CI= -11.20, -7.07; p< 0.001) and higher education level of father had higher OHL (β= 1.97; 95% CI= 0.10, 3.83;p= 0.039) than their counterparts. Conclusion:Oral health literacy is higher among the science streams students compared to the social sciences streams. This suggests that science education might play a significant role in health literacy and improving health outcomes.
Oral health is crucial among people with dementia

Ab Malik N, Walls AWG

Med J Malaysia, 2022 Nov;77(6):771-772.
PMID: 36448399

No abstract available.
Fulltext Periodontal health status of people with dementia - A systematic review of case-control studies

Ab Malik N, Walls AWG

Saudi Dent J, 2023 Sep;35(6):625-640.
PMID: 37817782 DOI: 10.1016/j.sdentj.2023.06.004

BACKGROUND: The number of older people increases globally, so is the risk of cognitive impairment. Periodontal diseases are common among older adults with significant tooth loss and periodontal problems. Thus, this review explored the periodontal disease conditions among individuals with and without dementia.
METHODS: Available databases such as Medline/Pubmed, Web of Science, Scopus, Cochrane Library and Embase/OVID were used in the search. Case-control studies reporting on periodontal disease and dementia parameters were selected based on PICO (Population, Intervention, Comparison and Outcomes) framework. A Newcastle-Ottawa Scale (NOS) was used to assess the quality reporting of the studies and PRISMA guideline was used for screening.
RESULTS: A total of ten studies were identified for analysis. Most studies reported higher plaque index score (PI), bleeding on probing (BoP), pocket depth (PD) and clinical attachment loss (CAL) among individuals diagnosed with dementia or Alzheimer's disease compared with clinically healthy controls or individual diagnosed without dementia. A higher prevalence of subjects with severe periodontal disease was also observed in individuals diagnosed with dementia/Alzheimer's disease. The quality of the studies was found to be moderate with lower comparability and ascertainment criteria scores.
CONCLUSION: This qualitative analysis has shown poor periodontal health and increased inflammatory mediators in case groups compared to the control groups. Thus, more quality studies and novel intervention are warranted to reduce the impact of periodontal health on dementia globally.
Knowledge, Self-Efficacy, and Preventive Behavior of COVID-19 Outbreak Among Community in Malaysia

Ab Malik N, Mohd RH, Abdul Kadir NB

Asia Pac J Public Health, 2021 07;33(5):674-675.
PMID: 33938242 DOI: 10.1177/10105395211012542
Oral Health Care Guidelines, Training, and Resources among Stroke Care Providers

Ab Malik N, M Yatim S, Lam OLT, Jin L, McGrath C

JDR Clin Trans Res, 2017 Jul;2(3):312-319.
PMID: 30938632 DOI: 10.1177/2380084417693784

During a stroke, the mouth tends to become an unhealthy place and may give rise to various life-threatening conditions. To this end, there have been repeated calls to incorporate oral hygiene guidelines and practices for hospitalized stroke patients to prevent aspiration pneumonia and improve patients' oral health. The objective of the study was to determine health care providers' practices of oral health care among patients hospitalized after an occurrence of stroke and to determine health care providers' background and work environment effect on these practices. A cross-sectional study was conducted among stroke care providers in 13 public hospitals in Malaysia. The questionnaires distributed were self-administered, where nursing staff provided details of their oral health care practices for stroke patients. Information on the background of health care providers and work environment was also collected. Overall, a total of 780 responses from the registered nurses were obtained. Almost half of the respondents (48.1%) reported that they recommended toothbrushing twice or more per day to stroke patients. Two-thirds (64.7%) reported that they performed daily mouthwashing on their patient, while less than half (38.8%) reported daily oral hygiene assistance. Result of the analysis revealed that oral hygiene practices were significantly associated with having working wards ( P < 0.05), level of qualification ( P < 0.05), having oral health care guidelines ( P < 0.001), specific resources ( P < 0.05), and attending previous training in oral care ( P < 0.001). Provision of oral hygiene practices for hospitalized stroke patients is important. A lack of oral health care guidelines, support from dental professionals, specific resources, training, and assistance in daily oral care for patients is evident and detrimental to oral hygiene practices. The current findings have significant implications for new initiatives to support health care providers, particularly the registered nurses performing oral health care for hospitalized stroke patients. Knowledge Transfer Statement: This study may provide a basis of information for improving the delivery of oral health care to stroke patients. Enhancement in the training and improvement in the existing guidelines and resources is pivotal for the provision of better oral health care for the potential benefits to these patients, including their improved quality of life and disease prevention.
Oral hygiene practices and knowledge among stroke-care nurses: A multicentre cross-sectional study

Ab Malik N, Mohamad Yatim S, Hussein N, Mohamad H, McGrath C

J Clin Nurs, 2018 May;27(9-10):1913-1919.
PMID: 29266493 DOI: 10.1111/jocn.14241

AIMS AND OBJECTIVES: To investigate oral health knowledge for stroke care and the clinical practices performed for oral hygiene care in Malaysia.
BACKGROUND: Oral hygiene care following stroke is important as the mouth can act as a reservoir for opportunistic infections that can lead to aspirational pneumonia.
DESIGN: A national cross-sectional survey was conducted in Malaysia among public hospitals where specialist stroke rehabilitation care is provided.
METHODS: All (16) hospitals were invited to participate, and site visits were conducted. A standardised questionnaire was employed to determine nurses' oral health knowledge for stroke care and existing clinical practices for oral hygiene care. Variations in oral health knowledge and clinical practices for oral hygiene care were examined.
RESULTS: Questionnaires were completed by 806 nurses across 13 hospitals. Oral health knowledge scores varied among the nurses; their mean score was 3.7 (SD 1.1) out of a possible 5.0. Approximately two-thirds (63.6%, n = 513) reported that some form of "mouth cleaning" was performed for stroke patients routinely. However, only a third (38.3%, n = 309) reported to perform or assist with the clinical practice of oral hygiene care daily. Their oral health knowledge of stroke care was associated with clinical practices for oral hygiene care (p
Fulltext Effectiveness of computer-aided learning in oral health among patients and caregivers: a systematic review

Ab Malik N, Zhang J, Lam OL, Jin L, McGrath C

J Am Med Inform Assoc, 2017 01;24(1):209-217.
PMID: 27274013 DOI: 10.1093/jamia/ocw045

Computer-aided learning (CAL) offers enormous potential in disseminating oral health care information to patients and caregivers. The effectiveness of CAL, however, remains unclear.
OBJECTIVES: The purpose of this study was to systematically review published evidence on the effectiveness of CAL in disseminating oral health care information to patients and caregivers.
MATERIALS AND METHODS: A structured comprehensive search was undertaken among 7 electronic databases (PUBMED, CINAHL Plus, EMBASE, SCOPUS, WEB of SCIENCE, the Cochrane Library, and PsycINFO) to identify relevant studies. Randomized controlled trials (RCTs) and observational studies were included in this review. Papers were screened by 2 independent reviewers, and studies that met the inclusion criteria were selected for further assessment.
RESULTS: A total of 2915 papers were screened, and full texts of 53 potentially relevant papers (κ = 0.885) were retrieved. A total of 5 studies that met the inclusion criteria (1 RCT, 1 quasi-experimental study, and 3 post-intervention studies) were identified. Outcome measures included knowledge, attitude, behavior, and oral health. Significant improvements in clinical oral health parameters (P
Fulltext Effectiveness of a Web-Based Health Education Program to Promote Oral Hygiene Care Among Stroke Survivors: Randomized Controlled Trial

Ab Malik N, Mohamad Yatim S, Lam OL, Jin L, McGrath CP

J Med Internet Res, 2017 03 31;19(3):e87.
PMID: 28363880 DOI: 10.2196/jmir.7024

BACKGROUND: Oral hygiene care is of key importance among stroke patients to prevent complications that may compromise rehabilitation or potentially give rise to life-threatening infections such as aspiration pneumonia.
OBJECTIVE: The aim of this study was to evaluate the effectiveness of a Web-based continuing professional development (CPD) program on "general intention" of the health carers to perform daily mouth cleaning for stroke patients using the theory of planned behavior (TPB).
METHODS: A double-blind cluster randomized controlled trial was conducted among 547 stroke care providers across 10 hospitals in Malaysia. The centers were block randomized to receive either (1) test intervention (a Web-based CPD program on providing oral hygiene care to stroke patients using TPB) or (2) control intervention (a Web-based CPD program not specific to oral hygiene). Domains of TPB: "attitude," "subjective norm" (SN), "perceived behavior control" (PBC), "general intention" (GI), and "knowledge" related to providing oral hygiene care were assessed preintervention and at 1 month and 6 months postintervention.
RESULTS: The overall response rate was 68.2% (373/547). At 1 month, between the test and control groups, there was a significant difference in changes in scores of attitude (P=.004) and subjective norm (P=.01), but not in other TPB domains (GI, P=.11; PBC, P=.51; or knowledge, P=.08). At 6 months, there were significant differences in changes in scores of GI (P=.003), attitude (P=.009), SN (P
Factors influencing the provision of oral hygiene care following stroke: an application of the Theory of Planned Behaviour

Ab Malik N, Mohamad Yatim S, Lam OLT, Jin L, McGrath C

Disabil Rehabil, 2018 04;40(8):889-893.
PMID: 28129510 DOI: 10.1080/09638288.2016.1277397

OBJECTIVES: This study aimed to examine "intention to" and "performance of" oral hygiene care to stroke patients using the Theory of Planned Behavior.
MATERIALS AND METHODS: A large scale survey of 13 centers in Malaysia was conducted involving 806 nurses in relation to oral hygiene care intentions and practices. In addition, information on personal and environmental factors was collected.
RESULTS: The response rate was 95.6% (778/806). The domains of the Theory of Planned Behavior were significantly associated with general intention to perform oral hygiene care: attitudes (β = 0.21, p
A multi-centre randomised clinical trial of oral hygiene interventions following stroke-A 6-month trial

Ab Malik N, Mohamad Yatim S, Abdul Razak F, Lam OLT, Jin L, Li LSW, et al.

J Oral Rehabil, 2018 Feb;45(2):132-139.
PMID: 29090475 DOI: 10.1111/joor.12582

Maintaining good oral hygiene is important following stroke. This study aimed to evaluate the effectiveness of two oral health promotion (OHP) programmes to reduce dental plaque levels following stroke. A multi-centre randomised clinical control trial was conducted among patients hospitalised following stroke in Malaysia. Patients were randomly allocated to two OHP groups: (i) control group who received the conventional method for plaque control-daily manual tooth brushing with a standardised commercial toothpaste, (ii) test group-who received an intense method for plaque control-daily powered tooth brushing with 1% Chlorhexidine gel. Oral health assessments were performed at baseline, at 3 months and 6 months post-intervention. Within- and between-group changes in dental plaque were assessed over time. Regression analyses were conducted on dental plaque levels at 6 months controlling for OHP group, medical, dental and socio-demographic status. The retention rate was 62.7% (54 of 86 subjects). Significant within-group changes of dental plaque levels were evident among the test group (P .05). Regression analyses identified that baseline plaque levels (adjusted ß = 0.79, P
Oral Health Interventions Using Chlorhexidine-Effects on the Prevalence of Oral Opportunistic Pathogens in Stroke Survivors: A Randomized Clinical Trial

Ab Malik N, Abdul Razak F, Mohamad Yatim S, Lam OLT, Jin L, Li LSW, et al.

J Evid Based Dent Pract, 2018 06;18(2):99-109.
PMID: 29747810 DOI: 10.1016/j.jebdp.2017.08.002

OBJECTIVE: To evaluate the presence of oral opportunistic pathogens among stroke survivors, both before and after oral health care interventions.
METHODS: A multicenter randomized clinical trial was conducted on hospitalized stroke survivors. Those in the control group were given standard care of oral hygiene (a manual toothbrush and toothpaste), whereas those in the test group were given intense care of oral hygiene (a powered toothbrush and 1% chlorhexidine oral gel). Oral clinical assessments were carried out, and microbiological samples were collected, using concentrated oral rinse samples at 3 time points: baseline, 3 months, and 6 months.
RESULTS: The prevalence of oral yeast was significantly reduced in the test group at 6 months (P < .05), but no significant difference was observed over time. A significant reduction was observed in the prevalence of Staphylococcus aureus (P < .01) and aerobic and facultative gram-negative bacilli over time (P < .05), but there were no significant differences noted between groups at 6 months. Candida albicans and Klebsiella pneumoniae were the prominent pathogens determined throughout the trial. Kluyvera strains have also been isolated from this cohort.
CONCLUSION: Oral hygiene intervention using a powered tooth brush and 1% chlorhexidine oral gel was effective in reducing the prevalence of oral opportunistic pathogens.
ORAL HEALTH AND VITAMIN D IN ADULT - A SYSTEMATIC REVIEW

Ab Malik N, Mohamad Yatim S, Mokhtar KN, Md Ramli SNR, Dissanayaka WL, Pelekos G, et al.

Br J Nutr, 2022 Apr 13.
PMID: 35416136 DOI: 10.1017/S0007114522000964

This systematic review aimed to provide a synthesis of the evidence relating to how the provision of Vitamin D supplements influences oral health status. An electronic database search was performed across six databases using a standardised search strategy. The PICO framework was used to define the review question. The screening and selection followed PRISMA process. The quality of reporting was assessed using CONSORT guidelines, and the bias was assessed using the revised Cochrane tool RoB2. A total of 1812 studies were retrieved. 1427 studies were excluded due to unmet inclusion criteria. Full texts of 75 potential studies were retrieved and ultimately six studies met the inclusion criteria. There were limitations in the quality of reporting of studies (between 49% and 73%). 70% of the risk of bias items were in the low risks category. Vitamin D interventions varied with respect to dosage and duration. Qualitative syntheses identified significantly better oral health outcomes. Heterogeneity of study design, intervention and outcomes precluded quantitative synthesis. Few clinical trials investigated the effect of Vitamin D supplementation on oral health. There is considerable heterogeneity among studies interventions and oral health outcomes. Quality of reporting of studies have limitations and there is evidence of study biases. Nonetheless, qualitative synthesis of the evidence suggest that Vitamin D supplements improve oral health outcomes, particularly periodontal health. Calcium may also play a significant role. Further high-quality trials are required of comparable Vitamin D supplements with similar oral health outcomes focus to inform quantitative synthesis of the evidence.

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