Postoperative Morbidity of Dental Paediatric Patients Treated under General Anaesthesia at a University Hospital: An Observational Study.

Aims: To assess prevalence of postoperative morbidity signs and symptoms in children treated under GA, and to investigate the association between pre- and intra-operative factors with postoperative morbidity. Study design and. Methods: Prospective, observational study supported by pre-operative, intra-operative, and postoperative questionnaire conducted on paediatric patients treated for dental reasons under general anaesthesia at a university hospital. Results: Hundred and fifty patients were included with average age 5.5 years. The majority (92%) experienced at least one postoperative morbidity sign and symptom on the day of treatment under GA and the majority of symptoms subside by the third day. Dental pain (81.3%), sleepiness (70%), and poor appetite (46.7%) were the most frequently reported. Logistic regression analysis showed that age, gender, type of treatment provided, use of LA, and duration of procedure were significantly associated with postoperative morbidity. Conclusions: Most patients experienced one or more morbidity sign/s or symptom/s during first postoperative day and the majority subsides by the third day. Dental pain and poor appetite were the most and long lasting reported. Factors that would predict the occurrence of postoperative morbidity were gender, patient's age, and duration of procedure.

Impact of treated and untreated traumatic dental injuries on oral health-related quality of life among 12-year-old schoolchildren in Amman.

BACKGROUND/AIMS: Traumatic dental injuries (TDI) could have negative effects on the physical and psychosocial well-being of children. The aim of this study was to assess the prevalence of TDI and the impact of treated/untreated TDI on the quality of life of children among 12-year-old schoolchildren in Amman. MATERIALS AND METHODS: A cross-sectional study was conducted with 1652 schoolchildren aged 12 years enrolled in schools in Amman. OHRQol was assessed using the Arabic version of the Child Perceptions Questionnaire (CPQ11-14 ). Diagnosis of traumatic dental injury was based on Andreasen's classification. Dental caries and malocclusion were also recorded and analyzed along with social class. Statistical analysis included ANOVA and multiple logistic regression. RESULTS: The prevalence of TDI was 14.6%. There was a statistically significant impact of untreated TDI on all items of CPQ11-14 . When children with treated TDI were compared with those who had not suffered TDI, the only statistically significant impact was difficulty in chewing. Compared to children with treated TDI and those who had not suffered TDI, children with untreated TDI experienced significantly higher impacts related to the overall OHRQol, oral symptoms, the emotional and social well-being domains. Regarding functional limitation domain, children with untreated TDI experienced a significantly higher impact than children who had not suffered TDI, but children with treated TDI still had some limitations. CONCLUSIONS: The prevalence of TDI was 14.6%. Untreated TDI had a negative impact on OHRQol compared to absence of or treated TDI among 12-year-old schoolchildren in Amman.

A longitudinal study of psychological stress among undergraduate dental students at the University of Jordan.

BACKGROUND: The purpose of this study was to identify whether psychological stress increased as undergraduate dental students progressed through their studies from first to fifth year. Another objective was to determine if the perceived sources of stress have changed along the years. METHODS: To achieve these aims, a cohort of students at the University of Jordan were followed from first to fifth year of dental school. Fifth year students completed both the General Health Questionnaire 'GHQ-12' which was used to assess psychological stress and the Dental Environment Stress questionnaire 'DES' which was used to examine the perceived sources of stress. The same cohort of students had completed similar questionnaires during their first year of study. Chi-square analysis and independent t-test analysis were performed to compare GHQ-12 and DES scores between first and fifth year. RESULTS: Results showed that psychological stress increased from first to fifth year of study. Eighty- nine percent of fifth year students scored over the cut-off point of three in the GHQ-12 compared to 58 % in the first year. The difference between the years was statistically significant at p = 0.05. Mean score for DES also increased between first and fifth year of study and the difference was statistically significant at p = 0.05. CONCLUSIONS: Results of this study demonstrated that stress in dental students at the University of Jordan increased along the years. Fifth year students showed a high level of psychological stress and methods to reduce that stress should be further investigated and utilized.

Traumatic dental injuries among 12-year-old schoolchildren in Jordan: prevalence, risk factors and treatment need.

PURPOSE: To assess the prevalence and related factors of traumatic dental injuries (TDI) among 12-year-old Jordanian schoolchildren. MATERIALS AND METHODS: For this cross-sectional study among schoolchildren, a sample of 2560 schoolchildren (1209 boys, 1351 girls) aged 12 years were randomly selected. The epidemiological classification adopted by the World Health Organization (WHO) and modified by Andreasen et al was used to record TDI on incisors. RESULTS: Of the children examined, 5.5% showed TDI. The difference in prevalence between boys and girls was statistically significant (P < 0.01). Maxillary central incisors were the most affected and the most common type of crown injury was enamel/dentin fracture. The relationship between dental injuries and geographic location, area, and socioeconomic indicators was not statistically significant. Most of the TDI occurred at home, followed by school; the most frequent cause was falls. No statistically significant association was found between TDI and dental caries experience (P > 0.05). There was a tendency for boys (P < 0.01), children with an incisal overjet > 3 mm (P < 0.01) and incompetent lip closure (P < 0.001) to have experienced dental injuries. Treatment need due to dental injuries was very high. CONCLUSION: The prevalence of traumatic injuries to permanent incisors in 12-year-old Jordanian schoolchildren was relatively low. TDI was associated with gender, overjet and lip competence, but was not influenced by dental caries experience. There was a great unmet treatment need.

Psychological stress among dental students at the University of Jordan.

The purpose of this study was to investigate the level of psychological stress as well as the perceived sources of stress among undergraduate dental students at the University of Jordan. The top perceived stressors were compared with those of a previous study that examined the perceived sources of stress among undergraduate dental students at the University of Jordan in the year 2000. Psychological stress was assessed using the General Health Questionnaire (GHQ-12). Perceived sources of stress were evaluated using the Dental Environment Stress questionnaire. In the study, 520 students completed the questionnaires, for a response rate of 74 percent. These students showed a high level of psychological stress, with 70 percent at the cutoff point of a score of more than 3 for the GHQ-12. Women had a higher level of stress than men: 73 percent scored more than 3 on the GHQ-12 vs. 63 percent for men, which was statistically significant at p=0.05. The top perceived sources of stress from the year 2000 were mostly unaltered in our study, despite a substantial increase in the number of students as well as changes in the curriculum. Further research is needed into methods to minimize stress on dental students.

The Arabic version of the modified dental anxiety scale. Psychometrics and normative data for 15-16 year olds.

OBJECTIVE: To prepare an Arabic version of the Modified Dental Anxiety Scale (MDAS) and provide normative information including evidence to support the validity of the measure. METHODS: The MDAS was translated into Arabic and back-translated into English. Data collection took place in Amman, Jordan from March 2009 to March 2010. One thousand and six hundred two 10th grade students took part in the study (15-16 years of age) sampled from 32 schools. Questionnaire consisted not only of the MDAS, but also (i) a single global question on dental anxiety to test concurrent validity, (ii) a question on helplessness in the dental surgery to test construct validity and (iii) demographic profile. RESULTS: The level of missing data was minimal for the translated scale. The internal consistency for this sample using the Arabic MDAS was 0.87 (95% confidence interval was 0.86-0.88). The measure was a one-dimensional scale. The proportion of the sample that was highly dentally anxious was 22% (>/= 19 cut-off score). Expected differences between gender and self-reported dental attendance were observed. There were clear significant relationships as predicted between the Arabic MDAS and (i) a single item measure of dental anxiety and (ii) feeling helpless in the dental chair on a previous occasion. CONCLUSION: The Arabic version of the MDAS can be employed for brief assessment of dental anxiety.

Effect of gender on performance of undergraduate dental students at the University of Jordan, Amman.

The purpose of this study was to see if gender-based differences exist in the performance of dental students at the University of Jordan (UJ), Amman. The retrospective analysis included data from two groups of students: 413 fourth-year dental students (178 males and 275 females) from four consecutive years (2005 through 2008) and 357 fifth-year students (128 males and 229 females) who graduated in the years 2005 to 2008. The influence of gender on the results of the fourth-year students in six theoretical and six clinical courses and the cumulative GPAs of the fifth-year students were studied. In both theoretical and clinical fourth-year courses, multivariate analysis of variance (MANOVA) revealed significant main differences in raw scores between the two gender groups. Female students were significantly better in five theoretical courses. In clinical courses, female students outscored male students in pediatric dentistry and prosthodontics, male students outperformed female students in conservative dentistry and orthodontics, and no significant gender differences were seen in oral surgery and fixed prosthodontics. The cumulative GPAs of the female graduated students were significantly higher than those of the male students. The results showed a significant relationship between gender and academic performance of dental students for these classes. The reasons for these findings should be further investigated.

Frequency estimates and risk factors for postoperative morbidity after third molar removal: a prospective cohort study.

PURPOSE: The aim of this study was to estimate the frequency of postoperative complications after mandibular third molar (M3) surgery and identify the risk indicators. PATIENTS AND METHODS: This was a prospective cohort study of a sample of subjects having at least 1 mandibular M3 surgically extracted at a teaching hospital in Jordan. The predictor variables were categorized as patient, anatomic, and operative specific. The outcome variables were postoperative complications recorded as present or absent. Bivariate analyses were computed, then a multivariate logistic regression model was used to identify independent predictors for the common postoperative complications. RESULTS: The study sample was comprised of 149 patients who had 245 extractions. The mean age was 21.6 +/- 3.32 years; 64.9% were females. In the multivariate logistic regression model, age (P = .033, odds ratio [OR] = 1.178), M3 side in relation to the handedness of the operator (P = .048, OR = 4.078), and lingual retraction (P = .001, OR = 11.293) were the variables found as independent predictors for alveolar osteitis. The level of impaction had a significant association with trismus, and operation time acted as an independent predictor for pain (P < .001, OR = 1.085). CONCLUSION: Postoperative morbidity increases with older age, deeper impaction, M3 side differing from the handedness of the operator, and longer procedures.

Subtarsal approach for orbital floor repair: a long-term follow-up of 12 cases in a Jordanian teaching hospital.

PURPOSE: To evaluate the long-term functional and esthetic outcomes of using the subtarsal approach for orbital trauma patients in a group of Jordonian patients. PATIENTS AND METHODS: Twelve patients treated using the subtarsal approach for orbital floor fractures in the Oral and Maxillofacial Surgery unit at the Jordan University Hospital were involved. Aspects evaluated included: the distance between scar and lower lid lash margin, scar length, esthetic appearances of the scar, lid edema, scleral show, ectropion, lagophthalmous, epiphora, subconjunctival injections, and keratoconjunctivitis. RESULTS: Half the cases were the result of road traffic accidents. Follow-up time ranged from 10 to 73 months (mean +/- SD, 37.25 +/- 23.7 months). The postoperative outcome was favorable; 1 scar was noticeable, but was not hypertrophic. One patient suffered from scleral show that was associated with subconjunctival injections. One patient suffered from mild lid edema and 1 had keratoconjunctivitis. No other complications were recorded and patients were satisfied with the outcome. CONCLUSIONS: The subtarsal approach is a safe and simple to perform procedure for treating orbital floor fractures. It results in a good surgical outcome functionally and esthetically.

Dental extraction for patients presenting at oral surgery student clinic.

The aim of this study was to examine the reasons for dental extraction and to determine the pattern of tooth loss in patients seeking care at the oral surgery teaching clinics in the Faculty of Dentistry of the University of Jordan, Amman, Jordan, over a 3-year period. Data pertaining to the dental extractions of 2435 patients were analyzed. The results showed that 63.8% of the teeth included in this study were extracted because of dental caries, 22.9% because of periodontal disease, and 11.0% for prosthetic reasons. Pericoronitis, orthodontic treatment, trauma, and eruption problems accounted for 2.4% of the reported extractions. The upper premolars were the teeth most commonly extracted, and the lower first and second molars were the teeth most commonly extracted because of dental caries. The logistic regression test revealed that extraction because of dental caries occurred mostly in the group aged 21 to 30 years (P < .001). Periodontal disease was not likely the cause of extraction in patients younger than 40 years. Mandibular incisors were the teeth least likely extracted because of dental caries (P < .001), but they were the teeth most commonly extracted because of periodontal disease (P < .001). Extraction for orthodontic reasons mostly involved the premolars (P < .05) and occurred in patients 20 years of age or younger (P < .001). Men were less likely to lose teeth because of caries and periodontal disease (P < .05 and P < .001, respectively) and were more likely to lose teeth for prosthetic reasons and trauma. The information gained from this study is useful to shift oral health planning toward emphasizing the importance of maintaining natural dentition and preventing dental disease.

Use of information and communication technology among dental students at the University of Jordan.

The aim of this study was to investigate the current knowledge, skills, and opinions of undergraduate dental students at the University of Jordan with respect to information communication technology (ICT). Dental students from the second, third, fourth, and fifth years were asked to complete a questionnaire presented in a lecture at the end of the second semester in the 2002-03 academic year. The response rate was 81 percent. Besides free and unlimited access to computers at the school of dentistry, 74 percent of the students had access to computers at home. However, 44 percent did not use a computer regularly. Male students were more regular and longer users of computers than females (p<0.001). A significant number of students (70 percent) judged themselves competent in information technology (IT) skills. More males felt competent in basic IT skills than did females (p<0.05). More than two-thirds acquired their computer skills through sources other than at the university. The main educational use of computers was accessing the Internet, word processing, multimedia, presentations, Medline search, and data management. More clinical students felt competent in word-processing skills (p<0.05) and many more used word processing for their studies (p<0.001) than did preclinical students. More males used word processing for their studies than females (p<0.001). Students used computers for personal activities more frequently than for academic reasons. More males used computers for both academic (p<0.01) and personal activities (p<0.001) than did females. All students had access to the Internet at the university, and 54 percent had access at home. A high percentage of students (94 percent) indicated they were comfortable using the Internet, 75 percent said they were confident in the accuracy, and 80 percent said they were confident in the relevance of information obtained from the Internet. Most students (90 percent) used email. Most students (83 percent) supported the idea of placing lectures on the web, and 61.2 percent indicated that this would not influence lecture attendance. Students used the Internet more for personal reasons than for the study of dentistry. More clinical students used the Internet for dentistry than preclinical students (p<0.001). More males than females used the Internet for dentistry (p<0.01) as well as for pleasure (p<0.01). Time and availability were the main obstacles to Internet use. Dental students at the University of Jordan have access to substantial IT resources and demonstrated attitudes toward the computer and Internet technology and use that were similar to other students in other nations. However, the educational use of ICT among Jordanian students remains low.

Regional odontodysplasia: a review of the literature and report of a case.

We present a rare case of a developmental anomaly called regional odontodysplasia or 'ghost teeth' in an 8.5-year-old Jordanian girl. The anomaly affected both the mandibular primary and permanent incisors, and the canines bilaterally. The maxillary teeth were unaffected. This is the first case of the anomaly to be reported in Jordan. The clinical, radiographic and histological features are reviewed. The management of affected patients is discussed.

Traumatic injuries to permanent anterior teeth among 12-year-old schoolchildren in Jordan.

OBJECTIVES: To assess the prevalence and related factors of incisor trauma among 12-year-old Jordanian schoolchildren. DESIGN: Cross-sectional study among schoolchildren. A sample of 1.878 schoolchildren aged 12 years, 940 boys and 938 girls, were randomly selected from 128 schools in urban and rural areas. Ellis classification was used to record the dental injuries on incisors. RESULTS: Of the children examined 13.8% showed dental trauma. Difference in prevalence between boys (17.1%) and girls (10.6%) was statistically significant (p < 0.05). Maxillary central incisors were the most affected (79.2%) and the most common type of crown injury was enamel-dentin fracture (40.6%). The relationship between dental injuries and socio-economic indicators was not statistically significant. There was a tendency for children with an incisal overjet greater than 5.0 mm to have experienced dental injuries (p < 0.01). Treatment need due to dental injuries was very high but less than untreated damage. CONCLUSION: The prevalence of traumatic injuries to permanent incisors in 12-year-old Jordanian schoolchildren was close to that found in other countries. Being a boy and having overjet greater than 5.0 mm were significant predisposing factors to dental injuries.

Traumatic dental injuries in children presenting for treatment at the Department of Pediatric Dentistry, Faculty of Dentistry, University of Jordan, 1997-2000.

Data pertaining to traumatic dental injuries of children seeking care at the teaching clinics of the Department of Pediatric Dentistry, Faculty of Dentistry, University of Jordan over a period of 4 years were analyzed. The prevalence of traumatic dental injuries was 14.2% from 2751 subjects. The peak incidence of injury was 10-12-year age group. Boys were more affected (18.3%) than girls (10.1%). Most injuries occurred at home (63.2%), and falls were the leading cause of injuries (49.9%). Most injuries involved one tooth (69.3%) and maxillary central incisors were the most affected teeth (90.4%). The commonest injury was uncomplicated crown fracture (62.5%), then complicated crown fracture (28.7%). Only 17.1% of children sought treatment the same day or the day after the injury. At the initial examination, cases seen after a long post-traumatic period required more complicated treatment than those presented within a short time period. Preventive educational program should be instituted in Jordan, directed at parents and school teachers to inform them about the importance of traumatic dental injuries and the benefit of immediate attendance for dental treatment. Furthermore, improving the knowledge of dental practitioners through continuing education would also help in minimizing sequelae of traumatic dental injuries.

Early childhood caries and risk factors in Jordan.

OBJECTIVE: To describe the prevalence of dental caries among Jordanian preschool children and risk factors for caries. DESIGN: Preschool children aged 1 to 5 years from randomly selected nurseries and kindergartens in Amman were surveyed in September 2001. A questionnaire to investigate factors that might have affected dental caries level was completed by parents. Dental caries was diagnosed as recommended by the World Health Organization. RESULTS: The mean dmft scores at 1, 2, 3, 4, and 5 years were 0.19, 1.15, 1.7, 2.13, and 3.22 respectively. Overall, 52% of children were caries-free. Caries level was significantly related to feeding practices, snacking habits, oral health practices and pattern of dental visiting as well as to socio-economic background, parents, education level and awareness. CONCLUSION: The dental caries level was slightly higher than that of children in industrialised countries but lower than that of children in the neighbouring Arab countries. However, the early caries development seen in children from the lower socio-economic classes, because they are at high risk for caries in Jordan, reinforces the need for preventive programmes before eruption of the teeth. Access to dental care must be improved to enable any preventive strategies to be implemented.

Clinical performance and survival of space maintainers: evaluation over a period of 5 years.

The study investigated the clinical performance of 387 space maintainers fitted in 358 patients aged from 3 to 9 years in the Department of Pediatric Dentistry at the Faculty of Dentistry-University of Jordan from 1996 to 2000. Failure occurred in 119 appliances (30.7%), of which 49.6% were due to solder breakage, 32.8% from cement loss, 11% from soft tissue lesions, 4.2% from eruption interference, and 2.5% were completely lost. By using the Kaplan-Meier method, the estimated median survival time for space maintainers was 18 months. Lingual arches had the lowest median survival time of 14 months. Bands and loops, Nance appliances, and removable partial dentures had similar probability of survival. Fixed bilateral mandibular appliances recorded lower survival time than fixed bilateral maxillary appliances. Gender, age, type of dentition, fixed vs. removable, year of placement of the appliance and number of space maintainers fitted simultaneously in the same patient had no significant effect on survival of the appliances.