Catherine Hsu Ling Hong

Purpose: Haematopoietic stem cell transplantation (HSCT) is a curative treatment for haematological malignancies and non-malignant haematological and immunological disorders. The oral cavity, which serves as a reservoir for infection, poses additional risks for patients undergoing HSCT. This study aimed to assess the oral disease burden among children and adolescents undergoing allogeneic HSCT (aHSCT) and to evaluate the oral healthcare they received before transplantation. Methods: This prospective, longitudinal, multicentre cohort study included 91 children and adolescents under 18 years of age who were scheduled for an aHSCT. Results: The mean age of the cohort was 11.2 ± 4.6 years, with acute leukaemia the most common diagnosis (47%), followed by non-malignant haematological disorders (15%). The prevalence of patient-reported oral symptoms was 49%, with sensitivity to hot and cold (10%) and loose teeth (7%) the most common complaints. Dental caries was present in 37%, and 13% had visible dental plaque on more than half of their teeth. Dental extractions were performed in 24% of patients, and 22% received dental restorations. Conclusion: Children and adolescents scheduled for aHSCT face a significant burden of oral disease, with notable dental issues that must be addressed before transplantation. This study underscores the importance of pre-transplant dental evaluations to address remaining dental concerns and minimise post-transplant complications.

Purpose Hematopoietic stem cell transplantation (HSCT) is a curative treatment for various hematologic and non-hematologic disorders. The oral cavity, acting as a reservoir for infections, poses additional risks for patients undergoing HSCT. This study aimed to assess the burden of oral disease in children and adolescents preparing for allogeneic (a)HSCT and to evaluate the oral healthcare received before transplantation. Methods This prospective, longitudinal, multicentre cohort study included 91 children and adolescents under 18 years old scheduled for an aHSCT. Results The mean age of the cohort was 11.2 ± 4.6 years, with the most common diagnosis being acute leukaemia (47%), followed by non-malignant haematological disorders (15%). The prevalence of patient-reported oral symptoms was 49%, with sensitivity to hot and cold temperatures (10%) and loose teeth (7%) being the most common complaints. Dental caries was present in 37%, and 13% had visible dental plaque on more than half of their teeth. Dental extractions were performed in 24% of patients, and 22% received dental restorations. Conclusion Children and adolescents scheduled for aHSCT face a significant burden of oral disease, with notable dental issues that must be addressed before transplantation. This study highlights the importance of pre-transplant dental evaluations in addressing remaining dental concerns and minimizing post-transplant complications.

Background: It is desirable for doctors to conduct caries risk assessment (CRA) and evaluate the child's need for dental referral as medical visits in the first year of life surpass dental visits. Aim: This study aimed to evaluate physicians' proficiencies in performing CRA and risk‐based dental referrals. Design: The study involved a self‐administered questionnaire that elicited participants' demographics and perceptions regarding oral health‐related activities as well as responses to questions pertaining to CRA and referral recommendations via four clinical vignettes (vignettes 1 and 3: low caries risk, vignettes 2 and 4: moderate/high caries risk) of children aged ≤ 2 years. Results: Participants performed better at CRA than for referral recommendation ( p < 0.001). Including a clinical photograph (vignettes 3 and 4) did not improve the accuracy of CRA responses and instead significantly reduced the correct CRA responses for vignette 3 (before: 90.5%, after: 81.7%, p = 0.033). Though for vignette 3, there was an increase in participants making the recommendation to refer for dental evaluation (before: 34%, after: 86%) after being shown the clinical photograph. Conclusion: Doctors were proficient at determining caries risk but less sure when deciding if a dental referral was required.

Background: Grandparental influences on child feeding practices that impact oral health remain under‐investigated. Aim: Explore perspectives and influences of intergenerational caregivers on cariogenic feeding practices in children. Design: This qualitative study is based on phenomenological approach. Data collection involved in‐depth interviews with parent(s) and grandparent(s) from the same family. Results: Thematic saturation was achieved after 26 interviews (13 families) with 13 mothers, 13 grandmothers and one grandfather. Three themes were generated: (1) Intergenerational differences in milk feeding practices —Grandparents had strong preference for formula milk. They advocated formula milk feeding beyond infancy and sometimes encouraged cariogenic comfort feeding habits; (2) Transgenerational influences on snacking practices—Parents' and grandparents' own cariogenic snacking habits encouraged the child's cariogenic snack intake. Grandparents occasionally used sugary treats to reinforce their special identity as grandparents; and (3) Impact of new information sources versus grandparental input —Information sources influencing child feeding practices differed between generations; parents relied on social media (rather than grandparental advice) while grandparents drew from past experiences. However, grandmothers who were actively involved in food preparation had considerable influence on child feeding practices. Conclusion: Practitioners and policymakers should actively engage grandparents to provide them with appropriate information on avoiding cariogenic feeding practices.

Dental caries is one of the most prevalent chronic diseases of childhood. Early childhood caries (ECC), defined as onset of dental caries before 6 years of age, is preventable and reversible in the early stages with proper interventions. The purpose of the study is to assess the clinical effectiveness and cost-effectiveness of technology-enabled anticipatory guidance and peer support in empowering parents to establish good diets, feeding and oral hygiene practices to prevent ECC. Mother-child dyads will be recruited from pre-natal clinics and post-natal wards of a tertiary care hospital in Singapore. The control group will receive conventional oral health education materials while the intervention group will join four rounds of online parent empowerment sessions focusing on anticipatory guidance and peer-support. Mothers will complete a questionnaire and food frequency checklist when their child turns 12, 24 and 36 months; each child will undergo an oral examination at the age of 24 and 36 months. Chi-square tests and two-sample t-tests, or their non-parametric equivalents will be used to compare proportions of children with caries by decayed, missing and filled teeth (dmft) and decayed, missing and filled surfaces (dmfs) scores between groups. Effect sizes and their confidence intervals will be calculated along with number needed to treat. Multivariable analyses will be carried out to assess the effect of the intervention on primary outcomes (caries incidence at 24 and 36 months) and secondary outcomes (including parental efficacy, child’s oral health behaviours and oral hygiene status, quality of life). Cost-effectiveness analyses will also be carried out. The study was approved by Domain Specific Review Board (DSRB 2024/00244). Results will be published in international peer-reviewed journals. The trial was retrospectively registered on ClinicialTrials.gov (NCT06558955) around the time of the commencement of patient recruitment, but prior to the commencement of any intervention.