Knowledge and Opinions of Saudi Dentists Regarding Dental Treatment of Patients Undergoing Bisphosphonates.

OBJECTIVES: Bisphosphonates (BPs) are used for treatment of various benign and malignant medical conditions. Medications-related osteonecrosis of the jaws (MRONJ) is a very serious complication of prolonged therapy with BPs. This study aimed to assess the level of knowledge among dental professionals in Saudi Arabia regarding MRONJ. MATERIALS AND METHODS: This was a questionnaire-based, cross-sectional study. A self-administered questionnaire comprising close-ended questions about BPs and MRONJ was sent to a convenience sample of dentists in Saudi Arabia.Statistical Analysis SPSS software was used for data analysis. Chi-square test was used to compare between the groups. The significance level was set at p < 0.05. RESULTS: A total of 607 dentists participated in this survey. Overall, the respondents showed insufficient level of knowledge regarding BPORNJ, with only 70% of the respondents had heard about BPORNJ, and less than 50% recognized the risk factors and clinical features of the disease. Additionally, while two-thirds of the respondents recognized the importance of taking BPs history, the majority did not know the correct treatment approach. Respondents with higher degrees (specialists) showed far better knowledge than general dentists. CONCLUSION: The knowledge regarding BPs therapy and its complications among Saudi dentists is unsatisfactory. Hence, interventions are highly required to improve dentists' knowledge regarding BPs and MRONJ.

The potential association between periodontitis and non-alcoholic fatty liver disease: a systematic review.

OBJECTIVES: Many animal and human studies have shown associations between periodontitis and non-alcoholic fatty liver disease (NAFLD). Hence, the present systematic review sought to investigate such a potential association. METHODS: PubMed/Medline, Scopus, Embase, and Web of Science databases were thoroughly searched to identify all relevant studies. The eligibility criteria were all observational (cross-sectional studies, case-control, cohort studies, and case reports) and interventional studies that assessed the relationship between periodontitis and NAFLD in humans. Due to remarkable heterogeneity and inconsistency among the included studies, no statistical analyses were conducted. RESULTS: A total of 12 studies comprising 53,384 patients were included in the present systematic review. The sample size in the individual studies ranged from 52 to 24,470 patients. All studies except one found significant associations between clinical and/or microbial periodontal parameters and NAFLD. Eight studies found significant associations between clinical periodontal parameters and NAFLD. Four microbial studies found a significant association between periodontal pathogens, especially Porphyromonas gingivalis and NAFLD development and progression. CONCLUSIONS: The available evidence suggests that periodontitis may be a risk factor for development and progression of NAFLD. However, due to limited number of prospective cohort studies included in this review along with the substantial heterogeneity among the included studies, further well-designed prospective cohort studies are highly warranted. CLINICAL RELEVANCE: Given the potential association between periodontitis and NAFLD, it can be assumed that healthy periodontium may be essential for liver health.

The Effect of surface topographical changes of two different surface treatments rotary instrument.

BACKGROUND: One of the major innovations in endodontics has been the introduction of nickel-titanium (NiTi) alloy. This study evaluated the surface topographical changes of two different surface treatments rotary instrument after instrumentation and sterilization. MATERIAL AND METHODS: 240 Extracted teeth were included in this study. 90 new AlphaKite and Revo-S NiTi rotary instruments were selected and divided into two groups (Group A 45 AlphaKite and group B 45 Revo-S). Each group were divided into three subgroups: (A1, B1) n=5 files were used as a control, (A2,B2) n=20 files were used to prepare three root canals using endodontic rotary motor then sterilized by autoclave for one cycle under 121°C at 15 psi for 30 minutes and (A3,B3) n=20 files were used to prepare nine root canals using the same rotary system then sterilized by autoclave for three cycles under 121°C at 15 psi for 30 minutes. Files were examined under scanning electron microscopy. RESULTS: On examining the AlphaKite, A1 revealed gross machining grooves on their surface with no pits, A2 showed disruption of cutting and A3 showed microcracks and deepening of the machining grooves. B1 showed a smoother surface with few machining grooves, B2 showed dulling and blunting of the cutting edges was predominant and B3 files showed plastic deformation in the form of unwinding of the flutes. CONCLUSIONS: The defects were less distributed along the electropolished Revo-S files than the physical vapor deposition AlphaKite. Key words:Endodontic instruments, electropolished, rotary, sterilization.

Knowledge, Attitude and Practice of Hepatitis B Virus Infection among Dental Students and Interns in Saudi Arabia.

BACKGROUND: Hepatitis B virus (HBV) is a worldwide healthcare problem. Dental health care professionals are at a high risk of infection by HBV. The present study investigated the knowledge, attitude and practice of HBV infection among Saudi dental students and Interns in Saudi Arabia. MATERIAL AND METHODS: This was a questionnaire-based cross-sectional study. A self-administered questionnaire consisting of questions on students' knowledge, attitudes, and practices regarding HBV was used. Data of 420 participants were analyzed using SPSS (Statistical Package for Social Studies) version 22.0. RESULTS: The response rate was 84%. Overall, the participants showed fair level of knowledge about HBV, with significant differences between final year students and the interns. Also, the subjects showed negative attitude toward HBV patients. The vast majority reported always wearing gloves (97.9%), gowns (92.1%), face masks (89.2%), disposable caps (87.1%) and protective eye wear (80.9%). The majority of participants (91.4%) had been vaccinated against HBV. However, only 41% completed the recommended 3 doses of the vaccine. CONCLUSIONS: These unsatisfactory findings emphasize the necessity of continued education about HBV in order to improve knowledge, attitudes, and practices of dental students and Interns regarding HBV. Key words:HBV, Knowledge, Practice, Dental students, Interns.

Awareness of basic life support among Saudi dental students and interns.

OBJECTIVE: Fatal medical emergencies may occur at any time in the dental clinic. The present study assessed the level of awareness and attitudes toward basic life support (BLS) among Saudi dental students and interns. MATERIALS AND METHODS: A self-administered questionnaire comprising 23 closed-ended questions was used in this survey. The first part of the questionnaire assessed the demographical profile of the students such as age, gender, and educational level. The second part investigated their knowledge and awareness about BLS. Data from 203 respondents were analyzed using Statistical Package for the Social Studies version 22.0. RESULTS: The response rate was 81.2%. Overall, the respondents showed a low level of knowledge with significant differences between males and females (<0.001). Surprisingly, final-year dental students showed relatively better knowledge than interns though the differences were not statistically significant. CONCLUSION: The present study demonstrates poor knowledge among dental students regarding BLS and showed the urgent need for continuous refreshing courses for this critical topic.

Is Khat (Catha edulis) chewing a risk factor for periodontal diseases? A systematic review.

BACKGROUND: Khat (Catha edulis) chewing is a highly prevalent habit in the Arabian Peninsula and East Africa, and has recently spread to Western countries. The association between khat chewing and oral mucosal lesions is well documented in the literature. However, there is no concrete evidence on the association between khat chewing and periodontal disease. The purpose of this systematic review was to analyze the influence of khat chewing on periodontal health. MATERIAL AND METHODS: A literature search of PubMed, Scopus and Web of Sciences databases was carried out to identify relevant articles published from 1990 to May 2017. The inclusion criteria were all clinical studies that assessed the relationship between khat chewing and periodontal disease. RESULTS: The search yielded 122 articles, of which 10 were included in this systematic review. Most of the studies exhibited a positive correlation between khat chewing and periodontal disease. CONCLUSIONS: Altogether, the analysis of the current evidence reveals that khat chewing is destructive to the periodontium and enhances the risk of periodontal disease progression. However, due to variability of studies, more longitudinal case-controlled studies are highly warranted to establish a causal relation between khat chewing and periodontal disease. Key words:Khat chewing, periodontal health, periodontal disease, risk factor.

The effect of environment (Dry and Natural Saliva) on clasp retention: In vitro study - Part I.

OBJECTIVE: The purpose of this study was to investigate the importance of environments (dry and wet) to dislodge the clasp. MATERIALS AND METHODS: Mandibular test models with natural premolar and molar teeth were used to test four types of clasp (each 12) (Akers, rest plate Akers [RPA], half and half [H-H], and ring clasp) in dry and natural fresh saliva environments. Each clasp was pulled out 10 times with a crosshead speed of 10 mm/min and the force required to withdraw each was measured. STATISTICAL ANALYSIS USED: A paired sample t-test and Wilcoxon test were used. RESULTS: There were significant differences between the dry and wet (natural fresh saliva) environment. However, while the mean of the environment for RPA and ring clasp type was significantly different, the H-H and Akers clasp type was not. CONCLUSION: The environment has an effect on dislodging the clasp but differs according to the type of clasp.

Effect of clasp type and pullout location on clasp retention in different environment: In vitro study.

OBJECTIVE: The purpose of this study was to investigate the importance of pullout location and clasp types in two different environments to dislodge the clasp. MATERIALS AND METHODS: Mandibular test models with natural premolars and molar teeth were used to test four types of clasp (each 12) (Akers, Rest plate Akers, Half and Half, and Ring clasp) with three different pullout location for each type (ring on the rest, loop on the saddle, and wax arising from both rests) in dry and natural fresh saliva environment. Each clasp was pulled out 10 times with a crosshead speed of 10 mm/min, and the force required to withdraw each was measured. STATISTICAL ANALYSIS USED: A one-way ANOVA and Tukey test were used. RESULTS: The ring on the saddle pullout location has the highest retention force while ring on the rest was the lowest. In addition, ring clasp has the highest retention force. CONCLUSION: Clasp type and pullout location had a significant effect on the retentive force.

Efficacy of low-level laser therapy in management of symptomatic oral lichen planus: a systematic review.

Oral lichen planus (OLP) is a chronic inflammatory disease of unknown etiology and indefinite cure. This systematic review assessed the efficacy of low-level laser therapy in the treatment of symptomatic OLP. Electronic databases (PubMed, Scopus, and Web of Science) were searched from date of inception till and including December 2016, using various combinations of the following keywords: oral lichen planus, laser therapy, low-level laser therapy, and phototherapy. Owing to heterogeneity of data, no statistical analyses were conducted. Initially, 227 publications were identified. After selection, only six studies were included in this systematic review. In these studies, the laser wavelengths, power output, and duration of irradiation ranged between 630-980 nm, 20-300 mW, and 10 s-15 min, respectively. All of the included studies found laser to be effective in management of OLP, without any reported adverse effects. The results of the included studies confirm that low-level laser therapy is effective in management of symptomatic OLP and can be used as an alternative to corticosteroids. However, due to variety of methods and substantial variations in laser parameters among these studies, more randomized clinical trials with large sample sizes are highly warranted.

The effect of radiotherapy on survival of dental implants in head and neck cancer patients.

OBJECTIVES: To explore the current literature of the survival of dental implants in irradiated head and neck cancer patients considering the role of implant location, bone augmentation, dose of radiation and timing of implant placement. STUDY DESIGN: Pubmed search was conducted to identify articles published between January 2000 and December 2014 and presenting data of dental implant survival with radiotherapy in head and neck cancer patients. Studies on animal subjects and craniofacial implants were excluded. RESULTS: 18 articles out of 27 were eligible for inclusion in this systematic review. 12 out of 18 studies reported favorable outcome of dental implants and radiotherapy with survival rates between 74.4% and 97%. Seven out of ten studies comparing the survival rates according to site of implant placement reported that implants were found to osseointegrate with greater success in the irradiated mandible than irradiated maxilla. 5 studies which compared implant survival in irradiated native bone versus irradiated grafted bone reported that irradiated grafted bone showed a significantly reduced dental implant survival rate in comparison to irradiated native bone. 6 out of 18studies in which radiation doses exceeded 70 Gy reported lower survival rates of dental implants in comparison to the studies in which radiation doses were ≤70Gy. Higher survival rates were reported in 2 studies in which implants placement was before radiotherapy in comparison to the remaining 16 studies in which implants placement was after radiotherapy. CONCLUSIONS: Dental implants may be affected by radiotherapy especially when they are placed in maxilla, in grafted bone, or after radiation, however, they remain a functional option for rehabilitation of head and cancer patients. More Prospective cohort studies and randomized controlled trails are still needed to draw more evidence based conclusions. KEY WORDS: Dental implants, implant survival, radiotherapy, head and neck cancer.

Development of Nasopalatine Duct Cyst in Relation to Dental Implant Placement.

BACKGROUND: Dental implantation is considered as one of the most widely employed procedures in dental practice. Nasopalatine duct cyst (NPDC) is one of the most common developmental cysts in the oral cavity that develops from the proliferation of embryological epithelial remnants of nasopalatine duct. AIM: The aim of this study was to highlight the development of NPDC after the placement of dental implants. MATERIALS AND METHODS: A literature search was carried out in March 2015 using PubMed, EMBASE, and Cochrane library databases, searching for articles relating the development of NPDC after placement of dental implants. RESULTS: Our search identified only four case reports of NPDC related to dental implants as reported in the literature published in English. CONCLUSION: Placement of dental implants can induce development of NPDCs, indicating that placement of dental implants requires well-trained specialists with perfect skills in dental implantology. Additionally, critical selection of appropriate cases is of great importance in order to avoid the development of such complications.

p53 expression in pleomorphic adenoma of salivary glands: A systematic review and meta-analysis.

OBJECTIVE: There are conflicting data regarding immunohistochemical expression of p53 in pleomorphic adenoma. This systematic review and meta-analysis aimed to examine whether p53 expression has a role in the pathogenesis of pleomorphic adenoma. DESIGN: A comprehensive literature search for relevant studies published from 2000 up to end of 2014 was performed using PubMed, EMBASE and the Cochrane Library Databases. Only articles in which p53 detected by immunohistochemical staining were included. The meta-analysis was done using Comprehensive Meta-Analysis software. RESULTS: Eighteen eligible studies were included in this meta-analysis. Heterogeneity measures showed a statistically significant Cochrane Q value (P-value<0.001). The random effects model showed an effect size of 0.254 with a 95% CI (0.139-0.417). The overall p53 positivity is 25.4%. CONCLUSION: Mutant p53 has to be detected by more precise techniques to emphasize on its role in development of pleomorphic adenoma of salivary gland.

Development of pyogenic granuloma and hemangioma after placement of dental implants: A review of literature.

AIM: The aim of this study is to highlight the development of pyogenic granuloma and hemangioma after the placement of dental implants. MATERIALS AND METHODS: A literature search was performed using MEDLINE, accessed via the National Library of Medicine PubMed Interface, for articles published between 2000 and 2014 in English, relating to the occurrence of pyogenic granuloma or hemangioma in relation to dental implants. RESULTS: Our search identified only four case reports of pyogenic granuloma and hemangioma related to dental implants as reported in the English literature. CONCLUSION: Placement of dental implants can cause development of pyogenic granuloma and hemangioma, indicating that placement of dental implants requires well-trained specialists with perfect skills in dental implantology. Furthermore, the critical selection of the appropriate case is of paramount importance to avoid the occurrence of such complications.

Oral manifestations of Parry-Romberg syndrome: A review of literature.

Parry-Romberg syndrome (PRS) or progressive facial hemiatrophy is a developmental craniofacial disorder of unknown etiology characterized by a slowly progressive unilateral facial atrophy. It is associated with different systemic manifestations particularly, maxillofacial, neurologic and ophthalmologic abnormalities. Dentists must be aware of PRS to identify this invalidating disorder. In this article, we review the etiology, clinical features (especially craniofacial and dental manifestations) and treatment of PRS. We searched in PubMed line using specific words such as PRS from 2008 to 2014 (August). We identify 14 papers have described oral manifestations of this syndrome. We excluded all the article papers that did not indicate to oral manifestations of PRS.

Knowledge and attitude of dental trauma among dental students in Saudi Arabia.

OBJECTIVE: The aim of this study was to assess the level of knowledge and attitude of Saudi dental students in the management of dental trauma in children. MATERIALS AND METHODS: A self-administered questionnaire comprising 17 close-ended questions was used in this survey. The questions were divided into three parts including: Personal and professional profile; knowledge assessment; attitude toward dental trauma. Data of 307 respondents were analyzed using SPSS (Statistical Package for Social Studies) version 22.0 (IBM Corporation, Chicago, IL, USA). RESULTS: The response rate was 76.8%. Around 40.3% of students reported attending additional courses about dental trauma with a significant difference between males (57.2%) and females (19.4%). The vast majority of students (95.7%) stressed the importance of dental trauma education. While 77% could correctly identify the media of transportation of an avulsed tooth, only 26.9% of the students knew the proper method of transportation. Regarding the knowledge of immediate replantation, only 67.5% of students responded correctly. CONCLUSION: The present study demonstrates an insufficient knowledge concerning dental trauma management among dental students in Saudi Arabia. This highlights the need to improve the knowledge of dental students regarding dental trauma and its management using a variety of educational methods such as problem-based learning and powering the curriculum concerning those topics of dental trauma.