How good is ChatGPT at answering patients' questions related to early detection of oral (mouth) cancer?

OBJECTIVES: To examine the quality, reliability, readability, and usefulness of ChatGPT in promoting oral cancer early detection. STUDY DESIGN: About 108 patient-oriented questions about oral cancer early detection were compiled from expert panels, professional societies, and web-based tools. Questions were categorized into 4 topic domains and ChatGPT 3.5 was asked each question independently. ChatGPT answers were evaluated regarding quality, readability, actionability, and usefulness using. Two experienced reviewers independently assessed each response. RESULTS: Questions related to clinical appearance constituted 36.1% (n = 39) of the total questions. ChatGPT provided "very useful" responses to the majority of questions (75%; n = 81). The mean Global Quality Score was 4.24 ± 1.3 of 5. The mean reliability score was 23.17 ± 9.87 of 25. The mean understandability score was 76.6% ± 25.9% of 100, while the mean actionability score was 47.3% ± 18.9% of 100. The mean FKS reading ease score was 38.4% ± 29.9%, while the mean SMOG index readability score was 11.65 ± 8.4. No misleading information was identified among ChatGPT responses. CONCLUSION: ChatGPT is an attractive and potentially useful resource for informing patients about early detection of oral cancer. Nevertheless, concerns do exist about readability and actionability of the offered information.

Exam evaluation in prosthodontics across preclinical and clinical years from students' perspective: A cross-sectional study.

INTRODUCTION: The purpose of this study was to explore the students' perceptions and performance in prosthodontics theory exam. METHODS: A cross-sectional descriptive study was conducted on 560 (80.82%) students of different levels (third, fourth and fifth years) to explore their opinions and performance with regard to a number of issues on a prosthodontics theory exam (exam evaluation, exam preparation, exam material, exam timing). Demographic data were also collected. Descriptive statistics were generated and Chi-square test, independent sample t-test, ANOVA test and Pearson's correlation coefficient were used to examine the associations between different variables. The significance level was set at p < .05. RESULTS: Students' responses regarding exam evaluation was influenced by their gender, study level, high-school Grade Point Average (GPA) and undergraduate cumulative GPA. Perceived exam difficulty was significantly affected by gender (p = .03) and study level (p < .001), and negatively correlated to both high-school GPA (p < .001) and university GPA (p = .03). The vast majority (88.2%) depended on lecture hand-outs and lecture notes for study. Exam material and preparation were not significantly affected by any of the demographic variables with most respondents (76.8%) thinking that the lectures blended with prosthodontics laboratories/clinics would improve their understanding of the exam material. The suggested best time to conduct the exam was early afternoon (31.6%). Student performance was significantly affected by the study level (p < .001) and cumulative GPA (p < .001) with significant positive correlation between the high-school GPA and the mark in the exam (r = .29, p < .001) and by the amount of time students spent for exam preparation (p < .001). Those students who reported using textbooks to prepare for the exam got significantly higher marks (66.1 ± 8.7) compared to the students who did not (62.8 ± 9.7) (p = .03). CONCLUSIONS: Course level, GPA and gender were identified as the most influential factors in different aspects of exam evaluation and students' performance. Regular study and use of textbooks were demonstrated to improve academic performance. Additional orientation and guidance relating to the exam (especially for third year students) would be welcomed, as would alternate teaching methods such as small group discussions or study groups.

Management of auto-immune blistering disease in an older patient with severe intellectual disability.

Management of chronic oral mucosal diseases might be challenging in older individuals with intellectual disability because of associated comorbidities, variable clinical presentations, and various barriers imposed by the intellectual disability. This report describes the presentation and management of pemphigus vulgaris in an older female with severe intellectual disability.

Rating communication skills in dental practice: the impact of different sociodemographic factors.

BACKGROUND: Communication abilities are essential for the successful operation of a dental business and significantly influence outcomes, compliance, and patient satisfaction. AIMS AND METHODS: The aim of our study was to evaluate the knowledge and practice of doctor-patient communication among Jordanian dentists. This evaluation was conducted through a survey based on the key components of the Calgary Cambridge Observation Guides. Additionally, the impact of several sociodemographic characteristics on communication abilities was investigated. This cross-sectional study was conducted from January to June 2022. The data collection tool was an online questionnaire developed by the researchers, consisting of three sections: self-reported demographic and professional data, the practice of doctor-patient communication, and knowledge of doctor-patient communication. RESULTS: The study included 305 dentists, comprising 106 males and 199 females, with a mean age of 32.9 ± 9.0 years. The mean score for communication skills knowledge was 41.5, indicating a moderate level of communication skills knowledge. Female dentists demonstrated significantly higher communication scores compared to their male counterparts, and those working in the private sector scored significantly higher than those in the governmental sector or in both sectors (P ≤ 0.05). In general, older and more experienced dentists exhibited better communication skills. Educational level had a positive impact on certain communication skills items. 58.4% believed that communication skills can always be developed and improved through training sessions, while 48.9% reported never having attended such courses. 95.1% believed that training courses on communication skills are always necessary as part of the educational curriculum. The main obstacles that may deter dentists from considering communication skills courses were limited time (62.3%), course availability (37.7%), cost (28.2%), and perceived lack of importance (8.2%). CONCLUSION: Among a sample of Jordanian dentists, there appears to be a discrepancy between knowledge and self-reported practices regarding communication abilities. In certain crucial, evidence-based areas of doctor-patient communication, there are fundamental deficiencies. Considering the significant role dentists play in oral health and prevention, communication skills should be a top educational priority for them.

Dentists' knowledge and preference regarding gingival displacement methods.

INTRODUCTION: An accurate impression is an essential procedure for fabricating indirect fixed restorations. To achieve a precise final impression, the management of gingival tissue is without doubt a crucial. AIM: To evaluate the use of different gingival displacement techniques among dental clinicians and to assess their associated knowledge and technique preferences. METHODS: A self-designed survey was created electronically and sent to a list of dentists. The survey was composed of multiple sections. Participants who stated that they do not use GD methods were asked to answer the survey questions based on their knowledge. Descriptive statistics were generated, andChi-square test was used to examine the association between the different variables. RESULTS: A total of 188 dentists participated in this study. The majority 144 (76.6%) use GD in their practice. When asked which technique yields a more accurate impression with lower incidence of repeating the impression, 93 (64.6%) reported retraction cord technique with a hemostatic agent results in a higher impression accuracy, while only 14 (9.7%) declared the retraction paste technique as being more accurate. CONCLUSION: The cordless GD technique is believed to be easier, faster, and less traumatic to the gingival tissues, nevertheless, the outcome of dental impressions is believed to be more predictable with the use of conventional retraction cords and hemostatic medicaments.

A Cone Beam CT Study on the Correlation between Crestal Bone Loss and Periapical Disease.

The aim of this study was to determine whether the degree of bone loss around teeth can be linked to the loss of vitality of adjacent teeth and periapical disease, which necessitates root canal treatments. Three hundred and twenty-one full maxilla cone-beam computed tomography scans were examined. The parameters investigated included the degree of crestal bone loss in relation to the cementoenamel junction, the presence/absence of apical periodontitis, and the presence/absence of root canal treatments. Out of the 2001 teeth examined, 696 (34.8%) showed evidence of crestal bone loss. The degree of crestal bone loss was classified as mild, moderate, or severe. A significant association (p < 0.001) was found between the presence of crestal bone loss around a tooth and root canal treatment of that tooth. It was found that it is more likely for teeth with crestal bone loss to be root canal treated compared to teeth with existing root canal treatment and healthy crestal bone levels. Furthermore, teeth with buccal or lingual crestal bone loss were significantly associated with a higher rate of periapical disease than teeth without crestal bone loss (p < 0.001). CBCT identified the severity of bone loss on all surfaces of the teeth, and the most common presentation was bone loss to the mid-root level. Teeth with crestal bone loss were significantly more likely to be associated with a higher rate of periapical disease. Teeth with crestal bone loss were more likely to be root treated than teeth with healthy crestal bone levels.

Pattern, frequency and causes of tooth extraction among adult Syrian refugees.

AIMS OR OBJECTIVES: The Syrian crisis has resulted in a significant impact on refugee oral health status, but the scientific literature lacks information characterizing the pattern of tooth extraction in refugees. MATERIALS AND METHODS: The current study analyzed the pattern of tooth extraction and the associated sociodemographic factors among 626 (53.4% females, 46.6% males) Syrian refugees who were treated in dental clinics in the Zaatari camp. All adult Syrian refugees attending the dental unit at Zaatari camp were eligible to participate. Clinical and sociodemographic data were collected from the study sample using a validated semi-structured survey over a period of 4 months. Descriptive statistics were generated and Chi-square test, independent sample t-test, ANOVA test and Bonferroni Post Hoc test were used to examine associations between the different variables. RESULTS: More than one third of the attendees (33.9%) were young adults (18-29 years), and nearly two thirds (69.8%) had no or very basic education. The mean number of teeth that needed extraction was (1.46 ± 0.84) and was significantly higher in males, smokers, older patients, and those with no or basic education. The most common cause for tooth extraction was dental caries (54.8%), followed by tooth fracture/un-restorability (38.5%), and periodontitis (3.4%); while the least common reason was tooth extraction for orthodontic treatment (0.20%). CONCLUSIONS: Dental caries and its sequelae were the leading cause of tooth extraction in this refugee population. Molar teeth were found to be the most frequently extracted and lower anteriors were the least. Older age, smoking, patients with lower educational level, poor oral hygiene and male gender all predispose to a higher incidence of tooth extractions.

Pattern, frequency and causes of dental extraction among children/adolescents Syrian refugees: an observational study.

BACKGROUND: The Syrian conflict has had a massive impact on the dental health of refugees. Dental extraction is a good indicator of socioeconomic position and degree of oral hygiene, however there is a scarcity of evidence in the scientific literature that characterizes the reasons for extraction in refugees. AIMS AND METHODS: The current study looked at the extraction causes and related sociodemographic variables of 322 Syrian refugees (46.3% females, 53.7% males) who were treated in a dental clinic in Zaatari camp (Jordan), from September to December 2019. All child Syrian refugees (aged 4-16) visiting the facility were eligible to participate. A validated semi-structured survey was used to collect clinical and sociodemographic data from the research sample. Chi-square test, Independent sample t-test, and ANOVA test were used to examine associations between the different variables. The significance level was set at P < 0.05. RESULTS: The total number of teeth extracted was 397: 25 (6.3%) permanent teeth, 371 (93.5%) primary teeth, and one mesiodens (0.2%). Overall, lower teeth were most commonly extracted (56.9%). The most common teeth that required extraction were the lower primary molars, with lower left primary second molars being the most commonly extracted (15.9%). As the level of parental education increased, the mean number of extracted teeth decreased (P = 0.035), additionally, as the frequency of toothbrushing increased extractions due to caries decreased significantly (P = 0.027). CONCLUSIONS: Dental caries and pulpal diseases were discovered to be the most prevalent causes for primary and permanent tooth extraction, with no difference between males and females. The lower left primary molar was the most commonly afflicted tooth.

Knowledge about oral manifestations of systemic diseases among medical and dental students from Jordan: An interdisciplinary educational gap.

OBJECTIVE: To assess the ability of medical students to recognize oral manifestation of selected systemic diseases and compare their performance with dental students. MATERIALS AND METHODS: A total of 400 senior medical and dental students were approached to participate. The study protocol involved two parts; a self-administered survey and a direct interview involving clinical photographs for oral signs of systemic diseases. RESULTS: A total of 283 (70.8%) agreed to participate and completed the two- part study. The study population was made of 110 (38.9%) [82 females and 28 males] dental students, and 173(61.1%) [98 females and 75 males] medical students. The knowledge score regarding questions about the normal mouth and oral structures was 15.7 ± 6 out of 22. Dental students had a significantly higher knowledge score about normal mouth and oral structures (20.9 ± 4; range from 17 to 22) compared to medical students (10.6 ± 7; range from 4 to 21) (p = .029). The knowledge score regarding questions about oral manifestations of systemic diseases was 26.8 ± 6 out of 40. Dental students had a significantly higher knowledge score about oral manifestations of systemic diseases (30.8 ± 7; range from 15 to 37) compared to medical students (22.9 ± 4; range from 10 to 36) (p = .031). Only 24.3% (n = 42) medical students reported having adequate training to be able to distinguish between normal mouth and diseases. Nearly all medical students (91.3%; n = 158) felt that it is important to have more formal training in oral examination and disease diagnosis. CONCLUSION: Medical students lack adequate knowledge, diagnostic ability, and confidence with regard to diagnosis of oral signs of systemic diseases. To ensure that medical students have necessary skills in assessing oral diseases, curricula revisions and modifications are required, and specific oral health-related learning outcomes should be introduced and reinforced through clinical training.

Comparison of imaging modalities in the diagnosis of external cervical resorption (ECR): an in-vitro study.

External cervical resorption is a pathological condition affecting the cervical margins of teeth. Due to the increased prevalence and the area it affects, it can be easily misdiagnosed. The ability of clinicians to diagnose ECR and subcategorise the lesions using periapical radiographs and cone beam-CT scans has not been investigated in-depth. This study aims to assess if diagnostic ability to detect ECR lesions with the two modalities was different and if there was a change in the diagnosis when CBCT was used. A human skull, including the mandible was used for this study. The teeth were randomly allocated to the different subcategories, then pre and post-preparation radiographs with CBCT were taken. Statistical analysis was done using IBM SPSS version 16.0 (SPSS Inc., Chicago, IL, USA). The study sample was composed of 60 participants, the overall sensitivity of intraoral radiographs was significantly lower than CBCT. When the participants were told the radiograph and the CBCT were of the same tooth 60% said they would change their diagnosis. The use of intraoral radiographs alone might not be enough to identify and correctly diagnose ECR lesions. CBCT can give a better idea about the nature and the extent of the lesion.

Oral Hygiene Awareness, Practices and Attitudes among Syrian Refugees in Zaatari Camp and Their Impact on Oral Health Status.

PURPOSE: To characterise the oral hygiene habits, attitudes, and oral health practices in relation to sociodemographic factors among refugees in Jordan and to investigate their impact on the oral health status of these refugees. MATERIALS AND METHODS: This cross-sectional study consisted of two parts. First, a face-to-face interview was conducted using a structured questionnaire including demographic and oral health-related questions. Second, clinical oral examination was performed using WHO criteria, DMFT and oral health indices (OHI-S). The participants were adults, aged 18 and older. All patients attending dental clinics and accompanying personnel in the waiting areas at Zaatari camp during the study period were invited to participate, with a sample size of 547 refugees (males = 212, females = 335). RESULTS: 547 adult refugees participated. 75.3% reported toothbrushing less than twice daily, while flossing was uncommon (9.5%). Toothbrushing habits were significantly associated with gender and smoking status. Untreated carious lesions had a high incidence (94.1%); the mean number of decayed teeth was 5.4 and was statistically significantly higher in males and smokers. The mean number of missing teeth was 3.2 and was significantly associated with males, age, smoking, and presence of chronic disease. Participants who reported conditions that had persisted 1 year or more and required ongoing medical attention or limited activities of daily living or both (e.g. diabetes mellitus, hypertension, heart diseases, thyroid disease, chronic renal disease, rheumatoid arthritis, anemia, peptic ulcer, or asthma) were recorded as having chronic disease. The mean number of filled teeth was 3.2 and was statistically significantly associated with age and presence of chronic disease. The mean DMFT was 11.8 and was statistically significantly higher in males, older people, smokers, and those with chronic disease. The OHI-S was 2.2. The most common complaint was pain (92.2%), and only 1.1% visited a dentist for a check-up. CONCLUSION: The prevalence of caries was extremely high, with poor oral hygiene practices among refugees, justifying the urgent need to develop and implement targeted oral health promotion, preventive programs and curative strategies and to enable collaboration of the oral healthcare providers and funding agencies to design the most appropriate interventions for this disadvantaged population. In addition, this information can be used as a basis upon which preventive programs can be assessed for efficacy.

Satisfaction with healthcare services among refugees in Zaatari camp in Jordan.

BACKGROUND: Feedback on satisfaction regarding healthcare services is vital for continuous improvement of the service delivery process and outcome. AIMS AND METHODS: The objective of this study was to assess the satisfaction of refugees with the medical and dental services in Zaatari camp, under 3 domains with 20 key indicators (human and physical health resources, interaction and reactivity, and administration) using a self-administered questionnaire. RESULTS: Of the 500 participants, the satisfaction rate was 72.5%. Young participants and participants with a shorter stay in the camp showed higher overall satisfaction rates (P ≤ 0.01). Within the domains, 'interaction and reactivity' achieved the highest satisfaction score, whereas 'administration efficiency' was ranked the lowest. As for elements within the domains, the most acceptable were the sufficient number of staff and the working hours, availability of radiological services and proper care for children, reasonable waiting time and asking for medical history in every visit. Whereas difficulty to access healthcare services, difficulty to be referred to hospitals, lack of follow up and lack of dental services were the least acceptable. CONCLUSION: In conclusion, whereas refugees were generally satisfied with the provided services, this study indicates that there are areas for further service improvement. This study highlights a significant gaps in healthcare services which if not addressed have the potential to amplify oral/medical health problems.

Impact of COVID-19 pandemic on dental education: online experience and practice expectations among dental students at the University of Jordan.

BACKGROUND: The quarantine associated with the COVID-19 pandemic forced dental schools to suspend their clinical training and to shift to distant learning methods. The aim of this study is to investigate the impact of quarantine on the self-perceived preparedness of dental graduates and to explore the efficacy of online education from students' perspectives. METHODS: The questionnaire distributed to dental students comprised of two main sections. The first part covered the online education experience, and the second part measured the level of self-perceived preparedness for a range of cognitive, communication and professional skills. RESULTS: The survey yielded a response rate of 72%. The majority of students (77%) agreed that they missed educational experiences as a result of the lockdown. More than half of them felt less motivated to follow-up with distant e-learning and believed that online assessment is not a good method for evaluation. A high percentage of the students (66%) thought that online group discussions had a positive value while 67% preferred online lectures compared to theatre lectures. Majority of students particularly 5th year (78.7%) (p < 0.001) stated that the quarantine increased their collaboration with their colleagues. According to 87% of students, the experience most negatively affected was their clinical training. In general, students showed satisfactory self-perceived preparedness related to a range of attributes and professional skills. CONCLUSIONS: The data showed that students partially appreciated the online system, whereas they did not consider it a substitute for face to face clinical practice. The overall self-perceived preparedness level was promising; however students had reservations regarding independent practice following graduation.

Reframing Perceptions in Restorative Dentistry: Evidence-Based Dentistry and Clinical Decision-Making.

OBJECTIVES: The worldwide interest of both dentists and patients in esthetic dentistry has affected decision-making in dental practice. The aim of this study was to investigate contemporary dental practice in restorative dentistry and the relationship between evidence-based dentistry in caries research and decision-making in clinical practice in restorative dentistry. METHODS: The study was conducted through a structured questionnaire distributed randomly at the Jordanian Dental Association registered dentists in Jordan. The questionnaire aimed to clarify the degree of knowledge and practice of evidence-based dentistry in caries research the dentists hold regarding clinical decision-making in restorative dentistry. RESULTS: The majority of the surveyed dentists (77%) treat teeth with irreversible pulpitis with root canal treatment rather than vital pulp therapy. 13.8% routinely insert a post and 23% routinely crown the tooth after root canal treatment regardless of the remaining tooth structure. Badly damaged teeth are treated with full crowns in 72% of the cases. Regarding Hollywood smile or smile makeover, the majority of dentists choose conservative approaches, and implants were the first choice to replace missing teeth for 93.8% of the surveyed dentists. CONCLUSION: A higher degree of implementation of evidence-based dentistry in clinical decision-making was found in Prosthetic Dentistry than in Endodontics. Yet, the gap between evidence-based data and clinical practice needs bridging. More emphasis on communicating these data to educators to integrate them into the dental curriculum is a must.

Satisfaction of optional pairing in clinical dental training.

PURPOSE: The aim of this study was to investigate the perceived satisfaction of optional pairing in undergraduate clinical dental training of fourth- and fifth-year dental students and newly graduated intern dentists in the subject of conservative dentistry and endodontics. METHODS: Data were collected through a paper-based 2-part questionnaire. The first part was made of 3 questions; gender, undergraduate dental year, and grade point average (GPA). The second part involved 9 questions about assistant student-year level preference, satisfaction of optional pairing and main advantages and disadvantages of pairing. Statistical analysis was performed using descriptive statistics and Chi-square test to investigate any statistically significant differences. RESULTS: A total of 92.4% were satisfied with optional clinical pairing. Satisfied respondents reported most prevalent advantages were speeding things up (88.5%) and helping in transferring instruments and materials (85.6%). Unsatisfied respondents reported the most prevalent disadvantages were like to work independently (56.8%) and the assistant was not always cooperative (32.4%). Students with low grade point averages (GPAs) felt incompetent to work in pairs compared with high GPA students (P = 0.001). Only 32.4% of participants thought that the assistant student should be given an evaluation mark. About 75% of respondents reported that clinical pairing improved their diagnostic skills and treatment planning. CONCLUSIONS: Optional pairing in clinical dental training had a high satisfaction percentage. Allowing students to choose their own assistants may reduce pairing disadvantages and enhance its advantages. Students may gain a mentoring benefit from being encouraged to optionally pair with similar or higher study-year students.

Desquamative gingivitis: a challenging diagnosis for clinicians.

Introduction Diagnosis of underlying causes for desquamative gingivitis (DG) is often delayed in clinical settings, but little is known about factors influencing its delayed diagnosis. We investigated the diagnostic patterns and associated factors in a cohort of patients presenting primarily with DG.Materials and methods A total of 41 patients presenting primarily with DG were interviewed to evaluate professional and patient diagnostic delays. Severity of DG was evaluated using the desquamative gingivitis clinical score (DGCS) proposed by Arduino et al. (2017).Results The study sample was composed of 29 females and 12 males. On average, patients waited 10.8 ± 10 months (range 4-20 months) before seeking their first professional consultation (that is, patient delay). Less severe disease and female gender were significantly associated with longer patient delay. Patients consulted an average of 4.1 ± 2 healthcare professionals (range two to six) before a definitive diagnosis was reached, with an average professional delay of 7.3 ± 5 months (range 2-11 months). Professional delay was positively correlated with the number of professional consultations (r = 0.69) and absence of other oral mucosal lesions or extraoral involvement.Conclusions Considerable diagnostic delay is a feature of the natural history of DG. Increased patient knowledge and professional awareness regarding DG symptoms and diagnostic measures is needed to reduce diagnostic delay and improve patients' experience with this disease.

The online attention to oral cancer research: An Altmetric analysis.

OBJECTIVES: Altmetrics, or alternative metrics, have recently emerged as a web-based metrics measuring the impact of research with an emphasis on the public engagement with the research output. In this study, we aimed to identify and analyze research articles about oral cancer that provoked the most online attention. METHODS: Altmetric Explorer was used to identify articles about oral cancer that generated the highest online attention. Descriptive and correlational statistics were performed, and the top 100 articles were identified and analyzed. RESULTS: A total of 7,940 articles were identified. Topics were mostly discussed on Facebook, Twitter, Mendeley, and news outlets. The top 100 articles that generated the highest online attention discussed mainly topics related to treatment outcomes and quality of life. Human papilloma virus (HPV) was the most commonly discussed individual topic in the list of top 100 outputs (n = 20). Most articles originated from the USA (n = 46) and Europe (n = 33; mainly from UK [24 articles]). Articles were published in 47 journals that belong to different specialities; journals with a social media account had significantly higher Altmetric scores for their articles compared to those without an account. CONCLUSION: Topics of general interest to the public such as HPV transmission and vaccination, risk factors, and treatment generated the highest online attention.

Antioxidant capacity and biomarkers of oxidative stress in saliva of khat-chewing patients: a case-control study.

OBJECTIVES: The aim of this study was to investigate the antioxidant levels and biomarkers of oxidative stress in saliva from khat-chewing patients compared with controls. STUDY DESIGN: Saliva samples were collected from 51 chronic khat chewers and 46 age- and sex-matched controls. Concentrations of oxidative stress biomarkers (malonyl-dialdehyde [MDA], protein carbonyl, and 8-hydroxy-2'-deoxyguanosine) and antioxidant defense (total antioxidant capacity [TAC], superoxide dismutase, glutathione peroxidase, and catalase [CAT) were analyzed. RESULTS: Salivary MDA level in the khat users group (45 ± 9.2 nmol/mL) was significantly increased in comparison with controls (13 ± 2.1 nmol/mL; P < .001), but there were no significant differences between the 2 groups regarding the levels of salivary protein carbonyl and oxidized guanine species. Salivary TAC was significantly reduced in khat users (0.25 ± 0.028 mmol/L) in comparison with controls (0.34 ± 0.037 mmol/L). Salivary CAT level was significantly reduced in khat users (6.0 ± 0.47 U/mL) in comparison with controls (7.7 ± 0.43 units/mL; P <.05), but no significant differences were observed between the 2 groups with regard to salivary superoxide dismutase or glutathione peroxidase levels. CONCLUSIONS: Chronic khat chewing is associated with increased levels of salivary MDA and reduced levels of TAC and CAT among a population of adult men in comparison with non-khat-chewing controls. These findings suggest that the pro-oxidative effect of khat chewing may be a contributing mechanism for various oral diseases associated with khat use, including cancer, periodontitis, and caries.

Measuring the social impact of nursing research: An insight into altmetrics.

AIMS: The objectives of this study were to (a) identify nursing journal articles that provoked the most online activity and discussion and (b) assess the association between these articles' altmetric scores and publication characteristics, citation counts; and publishing journals metrics. BACKGROUND: Altmetrics, or alternative metrics, have recently emerged as a complementary way of measuring the societal impact of research by assessing the public engagement with research output. To date, no studies have yet investigated the online attention about scientific papers published in the nursing field. DESIGN: Integration of quantitative and qualitative synthesized evidence. DATA SOURCES AND REVIEW METHODS: InCites Journal Citation Report was used to identify a list of nursing journals indexed in the Web of Science Core Collection. Altmetric Explorer was selected as an altmetrics harvesting tool. The search in Altmetric Explorer yielded 66,608 research outputs from 118 nursing journals. The articles with the top 100 altmetric attention score (AAS) were identified and a new search, limited to only those 100 articles, was run to produce aggregate metrics specific to those articles. The articles were also exported for thematic analysis. RESULTS: The median AAS for the 100 articles was 248, ranging from 138 - 649. The articles were mostly discussed on Twitter, followed by news outlets and Mendeley. Articles indexed in the nursing journals category attracted low online attention compared with articles published in other health journal categories. Twitter remained the dominant source of attention over the years 2012-2018, followed distantly by news outlets. Most online attention came from the USA and the UK. Of the top 100 articles included in the study, the Journal of Advanced Nursing published the highest number of articles (N = 26; Median AAS = 179). The AAS was not significantly different between articles published in Q1 journals and those published in Q2 and Q3 journals. There was a significant relationship between articles' AASs and their citation counts on Scopus and Web of Science. Publication date was significantly related to citation counts on Scopus and Web of Science but not with AASs. CONCLUSION: Altmetrics will likely continue to evolve alongside the rapidly expanding use of social media and online platforms. As nursing continues to strive to have our research and scholarship inform policy, translated into practice and recognized for its scientific merit, we have to remain vigilant about the best ways to disseminate the important work we are doing. Research, such as this study, will allow nursing scholars to benchmark our progress as we adapt to the changing environment for measuring impact and quality in the digital age.

Has the implementation of the Minamata convention had an impact on the practice of operative dentistry in Jordan?

OBJECTIVE: To assess Jordanian dentists' current perception and attitudes towards amalgam and composite restorations four years after the Minamata treaty was endorsed and suggest decision making factors that may influence the type of restoration requested by patients. METHODS: The cross-sectional study was conducted through structured questionnaires distributed to dentists in Amman, Jordan from June 2017 to February 2018. RESULTS: Of the 1686 dentists who were contacted 758 dentists (response rate 45%) responded to the questionnaire either by email or via field visits. Jordanian dentists used more composite restorations than amalgam. Recurrent caries followed by fracture of the restoration were the main reasons for replacement of both fillings by dentists. However, dentists suggested that the main reason patients requested replacement of amalgam was for 'staining'. In addition, a large proportion of the dentists had experienced patients who had asked either for replacement of amalgam (77%) or refused an amalgam filling (99%) for aesthetic reasons. In the opinion of the dentists, only 20% patients requested replacement of amalgam because of the mercury content. CONCLUSION: The findings of this survey suggest that a 'phase-down' of dental amalgam is being implemented in Jordan's dental clinics but it is not associated with commitment to the Minamata Convention, rather to current dental practice trends and patients' aesthetic demands.