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This study assessed and compared oral health and oral-health behaviours among children with and without attention deficit hyperactivity disorder (ADHD). The study included 31 children, 12-18 yr of age, with ADHD and 31 age- and gender-matched children without ADHD. Clinical data were recorded by a trained and calibrated examiner for caries, traumatic dental injuries, periodontal health, tooth wear, and salivary function. A questionnaire was also given to parents or caregivers about the oral health habits and behaviours of these children. Data were compared using Mann-Whitney U-tests and chi-square tests. No significant differences were found between children, with or without ADHD, in caries extent or prevalence, dental trauma prevalence, prevalence of periodontal disease or plaque, tooth wear, or unstimulated salivary flow. Children with ADHD had a significantly higher percentage of sites with gingival bleeding, as well as a higher frequency of parent-reported dislike of dentists, bruxism, history of assisted toothbrushing, and toothbrushing duration <1 min. They also had higher attendance at government dental clinics. The findings indicate that children with ADHD have poorer oral hygiene and more adverse oral-health attitudes and behaviours than do children without ADHD., (© 2016 Eur J Oral Sci.)

Objective: To provide a historical and epidemiological overview of the oral health of Hong Kong children., Methods: Literature published before 2014 related to the oral health of Hong Kong children, supplemented with information accessed from government-archived oral health reports, was sourced using electronic databases and hand searches. Dental caries experience, periodontal health, enamel defects, and malocclusion of Hong Kong children were reviewed., Results: A decline in the prevalence and extent of dental caries was observed among Hong Kong schoolchildren and adolescents after the 1960s. Among preschool children, however, dental caries remains common and the extent appears to have increased. The periodontal health of Hong Kong children remains unsatisfactory. Recently, enamel defects/dental fluorosis have considerably reduced. Information about malocclusion in Hong Kong children is limited., Conclusions: Since the 1960s, following public health policies, health promotion activities, and the introduction of a School Dental Care Service, improvements in the oral health of schoolchildren are evident. Nonetheless, the oral health of preschool children remains a concern. Policies and practices to improve the oral health of preschool children in Hong Kong are required.

Aim: To assess and compare the oral health status of preschool children with and without autism spectrum disorders., Methods: A random sample of 347 preschool children with autism spectrum disorder was recruited from 19 Special Child Care Centres in Hong Kong. An age- and gender-matched sample was recruited from mainstream preschools as the control group. Dental caries status, gingival health status, tooth wear, malocclusion, dental trauma and oral mucosal health were assessed and compared between the two groups., Results: It was feasible to conduct a comprehensive oral health screening among 74.1% (257) of the children with autism spectrum disorder. The mean age was 59 ± 10 months (range from 32 to 77 months), of whom 84.4% were males. Children with autism spectrum disorder had better gingival health than children without autism spectrum disorder (mean plaque score and gingival score p < 0.001). Children with autism spectrum disorder had less caries experiences than children without autism spectrum disorder (mean decayed, missing and filled surfaces and decayed surfaces, p < 0.05). Children with and without autism spectrum disorder had similar prevalence of tooth wear, malocclusion, dental trauma experience and oral mucosal lesions (p > 0.05)., Conclusion: Differences in oral health status exist among preschool children with and without autism spectrum disorder. Preschool children with autism spectrum disorder exhibited lower caries experiences and better gingival health than children without autism spectrum disorder., (© The Author(s) 2014.)

Aim: This systematic review investigated the oral health status of children with type 1 diabetes., Methods: A systematic search was conducted using PubMed/Medline, Web of Knowledge, SCOPUS and EMBASE. The search included all studies published from inception of database to January 2014. A total of 1179 abstracts were analyzed for selection in 2 phases. The first phase selection was based on the title and abstracts alone. The selected abstracts were then included for second phase, where full articles were obtained. The selection was carried out by 2 independent reviewers (Kappa value=0.809). Only 37 articles were included for final analysis in this review., Results: There is conflicting evidence in the caries experience between children with type 1 diabetes and healthy children. For periodontal health, most studies reported significantly greater plaque accumulation and higher gingival index in children with type 1 diabetes. Cohort studies reported no significant differences in perioodontal parameters over time., Conclusions: There is conflicting evidence regarding the caries experience of children with type 1 diabetes, but they exhibit poorer periodontal health status with greater plaque accumulation compared to healthy children. Further studies are warranted to assess the oral health status of children with type 1 diabetes., (Copyright © 2015 Elsevier Ireland Ltd. All rights reserved.)

Objective: To describe the relationship between caregivers' oral health literacy (OHL) and the oral health status of their children in an Asian population., Methods: A random sample of 301 child/caregiver dyads was recruited from kindergartens in Hong Kong. Two locally-developed and validated OHL assessment tasks were administered to caregivers with Hong Kong Rapid Estimate of Adult Literacy in Dentistry-30 (HKREALD-30) assessing word recognition and Hong Kong Oral Health Literacy Assessment Task for Paediatric Dentistry (HKOHLAT-P) assessing comprehension. Their children's oral health status was assessed [dental caries experience - decayed, missing, filled teeth index - (dmft) and oral hygiene status - Visible Plaque Index (VPI)]., Results: Caregivers' literacy was associated with children's oral health status. The HKOHLAT-P had a stronger association with children's oral health than HKREALD-30. HKOHLAT-P and HKREALD-30 remained associated with dmft in the adjusted negative binomial regression models (accounting for socio-demographics), Incidence Rate Ratio (IRR) 0.97, p=0.02, and 0.96, p=0.03, respectively. In the adjusted model, HKOHLAT-P was associated with VPI (IRR 0.90, p<0.05), but no association between HKREALD-30 and VPI was evident., Conclusion: The main conclusion of this study was that caregiver oral health literacy was associated with their child's oral health status. A comprehension instrument had a more robust association with children's oral status than a word recognition instrument., Practice Implications: This study has implications for general public health education for designing community-level interventions., (Copyright © 2013 Elsevier Ireland Ltd. All rights reserved.)

Objectives: This paper describes the development of a new literacy assessment instrument, the Hong Kong Oral Health Literacy Assessment Task for Paediatric Dentistry (HKOHLAT-P). Its relationship to literacy theory is analyzed to establish content and face validity. Implications for construct validity are examined by analyzing cognitive demand to determine how "comprehension" is measured., Methods: Key influences from literacy assessment were identified to analyze item development. Cognitive demand was analyzed using an established taxonomy., Results: The HKOHLAT-P focuses on the functional domain of health literacy assessment. Items had strong content and face validity reflecting established principles from modern literacy theory. Inclusion of new text types signified relevant developments in the area of new literacies. Analysis of cognitive demand indicated that this instrument assesses the "comprehension" domain, specifically the areas of factual and procedural knowledge, with some assessment of conceptual knowledge. Metacognitive knowledge was not assessed., Conclusions: Comprehension tasks assessing patient health literacy predominantly examine functional health literacy at the lower levels of comprehension. Item development is influenced by the fields of situated and authentic literacy. Inclusion of content regarding multiliteracies is suggested for further research. Development of functional health literacy assessment instruments requires careful consideration of the clinical context in determining construct validity., (© 2013 American Association of Public Health Dentistry.)

Purpose: To identify and review the psychometric properties of instruments available for measuring oral health literacy., Materials and Methods: A comprehensive computerised search was carried out using six databases. The final papers were rated for level of evidence and scientific quality., Results: A total of 621 potentially relevant articles were retrieved in the primary search. Twenty-nine studies using 13 oral health literacy instruments were included in the final analysis. After applying an international standards framework, all included studies were categorised as evidence level '2c'. Qualities of evidence were rated with STROBE guidelines. Psychometric analysis indicated various levels of validity and reliability across the instruments., Conclusions: As an emerging field, the number and reliability of oral health literacy instruments is rapidly growing, although many are in preliminary stages of testing. The majority of these focus on functional literacy and were developed in English for North American contexts. Further work is indicated to measure oral health literacy as a wider construct across diverse populations.

Background: Oral health literacy is a newly emerging field with considerable research potential., Aim: To validate an original instrument, the Hong Kong Oral Health Literacy Assessment Task (HKOHLAT-P) for paediatric dentistry., Design: A convenient sample of 200 child/parent dyads attending a dental hospital in Hong Kong was selected. Convergent validity was tested by examining the association of HKOHLAT-P scores with those derived from the Test of Functional Health Literacy in Dentistry (TOFHLiD) and Hong Kong Rapid Estimate of Adult Literacy in Dentistry (HKREALD-30). The predictive validity of HKOHLAT-P was determined by testing the association between HKOHLAT-P and children's caries experience (dmft) and the Chinese Early Childhood Oral Health Impact Scale (ECOHIS). The test-retest reliability and internal consistency of HKOHLAT-P were also evaluated., Results: HKOHLAT-P was positively correlated with TOFHLiD and HKREALD-30 (P < 0.01), and was negatively correlated with children's dmft and ECOHIS. In the regression model, HKOHLAT-P was associated with TOFHLiD, HKEALD-30, children's dmft, and ECOHIS (P < 0.05) after controlling for participants' demographic characteristics. The intra-class correlation coefficient of HKOHLAT-P was 0.63 and the Cronbach's α was 0.71., Conclusion: Initial testing of HKOHLAT-P suggested that it is a valid and reliable instrument., (© 2013 John Wiley & Sons Ltd, BSPD and IAPD.)

Aim: To develop and validate an instrument, the Hong Kong Rapid Estimate of Adult Literacy in Dentistry (HKREALD-30)., Methods: The Rapid Estimate of Adult Literacy in Dentistry (REALD-99) was translated into Chinese and modified in the pretest. A total of 200 parents of pediatric dental patients were interviewed using this modified scale and administered additional three sets of self-reported questionnaires. The 99 items of the scale were reduced to 30 (HKREALD-30). Concurrent validity was tested by comparing the HKREALD-30 scores with the participants' educational level, pattern of dental visits and reading habits. Convergent validity was tested by examining the association between HKREALD-30 and the Test of Functional Health Literacy in Dentistry (TOFHLiD). The test-retest reliability and internal consistency of HKREALD-30 were also evaluated., Results: A significant correlation (P < 0.01) was found between HKREALD-30 and participants' reading habits. HKREALD-30 was also highly correlated with TOFHLiD (Spearman's rho = 0.693, P < 0.01). In the regression model, HKREALD-30 was positively associated with TOFHLiD (P < 0.05) after controlling for participants' characteristics. The intra-class correlation coefficient of HKREALD-30 was 0.78 and the Cronbach's alpha was 0.84., Conclusion: Initial testing of HKREALD-30 suggested that it is a valid and reliable instrument for the basic screening of oral health literacy among Chinese people in Hong Kong., (© 2012 Blackwell Publishing Asia Pty Ltd.)

Objectives: To assess the health- and oral health-related quality of life of preschool children with cerebral palsy (CP) and to determine their inter-relationship between the two quality of life measures., Methods: A total of 144 preschool children with and without CP were invited to participate in the case-control study. Health-related quality of life was assessed by the Pediatric Quality of Life Inventory Version 4.0 (PedsQL™ 4.0) and oral health-related quality of life by the Early Childhood Oral Health Impact Scale (ECOHIS). Differences in PedsQL™ 4.0 and ECOHIS scores were determined between the groups, and correlation between PedsQL and ECOHIS were explored., Results: Significant differences in overall scores of PedsQL™ 4.0 (P < 0.001) and in overall scores of ECOHIS (P < 0.05) were apparent between the two groups. In terms of health- and oral health-related quality of life, preschool children with CP fared worse than the age-gender-matched control group. There was a positive albeit weak correlation (r = 0.203, P < 0.05) between PedsQL™ 4.0 and ECOHIS scores., Conclusions: Differences in health- and oral health-related quality of life exist among preschool children with CP. Correlation between health- and oral health-related quality of life could at best be described as weak.

Objectives: The aim of this study was to compare the performance of a generic health-related quality-of-life measure, the Pediatric Quality of Life Inventory Version 4.0 (PedsQL 4.0) and an oral health-specific quality-of-life measure, the Early Childhood Oral Health Impact Scale (ECOHIS) in assessing the impact of severe early childhood caries (S-ECC) on the children's quality of life., Methods: A trained and calibrated examiner conducted a clinical oral assessment of 111 children (mean age: 49 +/- 12 months): 64 of whom were categorized as having S-ECC and 47 as being caries-free. Primary caregivers completed a Chinese version of the PedsQL 4.0 and the ECOHIS. Clinical examinations were conducted blind of the parental assessments., Results: The ECOHIS scores were significantly higher for the S-ECC group than for the caries-free group (P < or = 0.001). No significant difference was found between the PedsQL 4.0 scores in relation to caries status, except for the subscale of physical functioning (P = 0.04). Correlation of caries status with the ECOHIS scores was strong (r = 0.66; P < 0.01). No significant correlation was found between PedsQL 4.0 scores and caries status (r = 0.02; P > 0.05)., Conclusions: The oral health-specific measure, ECOHIS, shows better discriminant property between children with S-ECC and caries-free children than the generic measure, PedsQL 4.0. The ECOHIS appears more sensitive than PedsQL 4.0 in assessing the impact of dental caries on the life quality of preschool children.

Objective: This study aimed to adapt the Early Childhood Oral Health Impact Scale (ECOHIS) for pre-school children in a Chinese speaking community and to investigate its psychometric properties (validity and reliability)., Methods: A Chinese language version of the ECOHIS was derived through a forward-backward translation and tested for face and content validity among a focus group. A convenient sample of pre-school children (n = 111) was recruited (including a sub-sample with early childhood caries and caries-free children). Parents of the children self-completed the derived Chinese-ECOHIS measure. Validity of the measure was assessed by investigating the relationship between dental caries status and Chinese-ECOHIS scores (construct and criterion validity). A sub-sample of the parents repeated the ratings of the measure to enable reliability assessments. Both internal and test-retest reliability were determined., Results: A Chinese version of ECOHIS was derived with minor modification to the original version. Chinese-ECOHIS scores were associated with children's caries experience (dmft) (r = 0.66, P < 0.05) supporting convergent validity. In addition, variations in ECOHIS scores were apparent with respect to caries and caries-free groups (P < 0.001), supporting the ability to distinguish between patient groups. Cronbach's alpha values (internal reliability) for total ECOHIS score were 0.91 and intraclass correlation coefficient value (test-retest reliability) was 0.64., Conclusions: A Chinese version of the ECOHIS was developed and demonstrated acceptable validity and reliability. These findings can enable assessments of pre-school child oral health-related quality of life in Chinese speaking communities.