To investigate the effectiveness of silver diammine fluoride (SDF) solution application in arresting dental root caries and to assess the color of arrested caries lesions. This study was conducted in elderly centers in Hong Kong. A total of 83 elders with 157 root surfaces with active caries lesion were randomly allocated into 3 groups: Gp1 (placebo control)-annual application of soda water; Gp2-annual application of SDF solution; Gp3-annual application of SDF solution immediately followed by potassium iodide (KI) solution. Color of the arrested root caries lesion was assessed with reference to PANTONE color plates and classified into one of the followings: yellow (7401U); light brown (1245U); dark brown (4635U); and black (Black U). Status of root surfaces was assessed every 6 months by the same independent examiner. After 30 months, 100 (64%) of the included root caries lesions were reviewed. The arrest rates of root caries were 45%, 90%, and 93% in Gp1 (control), Gp2 (SDF) and Gp3 (SDF/KI), respectively (χ(2) test, p0.05). The distributions of arrested caries lesions by color were not significantly different between the SDF and SDF/KI groups (χ(2) test, p>0.05). Application of SDF solution, with or without application of KI afterwards, is effective in arresting root caries among elders in a water fluoridated area. In the long term, blackening of arrested root caries is not reduced by immediate application of KI after the application of SDF. In a water fluoridated area, annual application of SDF solution or SDF/KI solution can arrest dental root caries in elders. In the long term, application of KI does not reduce the blackening of arrested caries lesions caused by SDF.

To explore and better understand how patients evaluate satisfaction in dental care and elicit information from them to develop a dental satisfaction instrument. Patients currently receiving dental treatment in a teaching hospital were invited to be part of a qualitative research project which involved focus group discussion. Focus groups were conducted in Cantonese and discussions were recorded (audio and video) and later transcribed. Thirty patients participated and a thematic analysis of data from four focus groups helped generate a questionnaire on dental satisfaction. Six themes were extracted from the contents of the focus group: (i) attitude, (ii) cost, (iii) convenience, (iv) pain management, (v) quality, and (vi) patients’ perceived need for prevention of oral disease. Compared to the existing Dental Satisfaction Questionnaire (DSQ), majority of the dental satisfaction aspects mentioned in focus group discussions were similar to items in DSQ supporting its content validity. Focus groups covered more aspects including attitude of dental supporting staff, convenience of emergency services, admission of patients and treatment duration. Consideration of the clinical skills of the operator, hospital infection control, and knowledge on prevention of oral disease were also expressed. The focus group discussions elicited the views of patients not covered by DSQ items thereby suggesting areas for development of a new satisfaction questionnaire.

Background: Silver diamine fluoride (SDF) solution gains increasing popularity in arresting dentine caries in clinical practice. The aim of this systematic review was to summarize the findings from laboratory studies on the influence of SDF application on the bond strength of dentine to various adhesives and to glass ionomer cements (GICs). Methods: Two independent reviewers conducted a literature search in the databases Medline, Ovid, PubMed and Web of Science until 15th August 2019 using the search keywords [‘bond strength’] AND [‘silver diamine fluoride’ OR ‘silver diammine fluoride’ OR ‘SDF’ OR ‘silver fluoride’ OR ‘diamine silver fluoride’]. Articles investigating the effect of SDF application on the bond strength of dentine to various adhesives and to GICs were included in this review. Information on how SDF application influenced the bond strength was extracted from the included articles. Besides, related information, e.g. test method of bond strength, concentration and brand of SDF, type of adhesive system and GIC, testing dental substrate, protocol of specimen preparation, and failure mode was also reviewed. Results: A total of 13 articles were included in this review, with 8 and 6 studies investigating the effect of SDF application on the bond strength of dentine to various adhesives and to GICs, respectively. Sound dentine as well as demineralized dentine created by chemical methods, e.g. immersing in a demineralizing solution, was commonly adopted as the testing dental substrate. The microtensile bond strength (mTBS) test was the predominant method employed. However, the bond strength values had large variations among studies, ranging from <10 to 162 Mpa. Regarding the bond strength to different adhesives, 4 studies indicated that SDF application followed by rinsing with water had no significant influence. However, another 4 studies reported reduced bond strength after SDF application. Regarding the bond strength to GICs, 4 studies concluded that SDF application had no adverse impact on the bond strength. Conclusions: No solid conclusion can be drawn on the effect of SDF application on the bond strength of dentine to adhesives and to GICs due to the high degree of variation of the included studies.

The aim of this randomised non-inferiority clinical trial was to compare the effectiveness of semi-annual (every six months) applications of 25% silver nitrate (AgNO3) solution followed by 5% sodium fluoride (NaF) to semi-annual applications of 38% silver diamine fluoride (SDF) solution in arresting early childhood caries (ECC). Three-year-old children with active cavitated carious lesions were recruited and randomly assigned to two intervention groups. Children in Group A received semi-annual applications of 25% AgNO3 solution followed by 5% NaF varnish on carious lesions. Children in Group B received semi-annual applications of 38% SDF solution followed by a placebo varnish. One trained dentist assessed ECC status at baseline and in all follow-up examinations. An independent operator performed the interventions. The dentist, the children, and their caretakers were blinded to the intervention allocation. Data were analysed using a non-inferiority test. Group A's non-inferiority would be accepted if the lower limit of the 95% confidence interval (CI) for the difference in the mean number of arrested decayed surfaces (ds) was greater than -0.5. At baseline, 1,070 children were recruited, and 535 children were assigned to each group. After 30 months, the mean arrested ds in Groups A (n = 447) and B (n = 433) were 3.7 ± 3.6 and 3.6 ± 3.7, respectively (p = 0.694). The difference in the mean arrested ds between the two groups was 0.088 (95% CI: -0.351 to 0.526). Semi-annual application of 25% AgNO3 followed by 5% NaF is at least as effective as the semi-annual application of 38% SDF in arresting ECC. Silver and fluoride products are effective in arresting caries. As a simple, non-invasive, and inexpensive strategy, it can be used in young children, elderly adults, and people with special needs.

Professional burnout has been described as a gradual erosion of a person and may be one of the possible consequences of chronic occupational stress. Although occupational stress has been surveyed among dentists in Hong Kong, no study has been published about burnout in the profession. This study aimed to evaluate burnout among Hong Kong dentists and its association with occupational stress. We surveyed a random sample of 1086 registered dentists in Hong Kong, which formed 50% of the local profession. They were mailed an anonymous questionnaire about burnout and occupational stress in 2015. The questionnaire assessed occupational stress, coping strategies, effects of stress, level of burnout, and socio-demographic characteristics of the respondents. Occupational stress assessment concerned 33 stressors in five groups: patient-related, time-related, income-related, job-related, and staff-/technically related. Level of burnout was assessed by the Maslach Burnout Inventory-Human Services Survey (22 items) with three scores: emotional exhaustion, depersonalisation, and personal accomplishment. Completed questionnaires were received from 301 dentists (response rate, 28.3%), of whom 25.4% had a high level of emotional exhaustion, 17.2% had a high level of depersonalisation, and 39.0% had a low level of personal accomplishment. Only 7.0% of respondents, however, had a high level of overall burnout (high emotional exhaustion, high depersonalisation, and low personal accomplishment). A high level of overall burnout was significantly associated with a higher mean score for job-related stressors and lack of postgraduate qualifications (P<0.05). Patient-related stressors are the top occupational stressors experienced by dentists in Hong Kong. In spite of this, a low proportion of dentists have a high level of overall burnout. There was a positive association between occupational stress and level of burnout.

Background: Sense of coherence (SOC) is hypothesized to be an important psychological factor that enables people to cope with stressors and successfully maintain and improve health. Mother’s SOC has been shown to be an important psychological factor associated with oral health and oral health-related behaviors of adolescents and 11- to 12-year-old children. However, little is known about the relationship between the caregiver’s SOC and oral health-related behaviors of the preschool children. The objective of this study was to investigate the relationship between oral health-related behaviors of 5-year-old children in Southern China and SOC of their caregiver. Methods: A cross-sectional study was conducted in a randomized sample of 1332 children aged 5 years and their caregivers in Guangzhou, Southern China. Data were collected through questionnaires completed by the caregivers. The Chinese short version of Antonovsky’s SOC scale (13 items) was employed to assess the caregiver’s SOC. The outcome variables were the child’s oral health-related behaviors, including frequency of sugary snack intake, toothbrushing frequency, utilization of dental service, and pattern of dental visits. Multiple logistic regression was used to analyze the relationship between the variables. Results: No association was found between the children’s sugary snack intake and the mother’s or the father’s SOC. After adjustment for other significant factors related to the child’s oral health-related behaviors, 8.9% of the children whose grandparents (as caregivers) had higher SOC scores had a lower frequency of sugary snack intake, compared with the children whose grandparents had lower SOC scores (OR = 0.61, 95% CI = 0.50–0.73, p = 0.008). The other measures of oral health-related behaviors of the child were not significantly associated with the caregiver’s SOC. Conclusion: Sugary snack intake behavior of the 5-year-old children was not associated with the mother’s or the father’s SOC. It was associated with the SOC of their grandparents, who are a small group of the caregivers in China.