Prevalence of sleep-disordered breathing and associations with orofacial symptoms among Saudi primary school children.

BACKGROUND: This study aimed to determine the prevalence of sleep-disordered breathing among primary school children in Riyadh, Saudi Arabia, and to evaluate associations between sleep-disordered breathing and respiratory conditions/orofacial symptoms. METHODS: In this cross-sectional study, 1600 questionnaires were distributed to Saudi boys and girls aged 6-12 years from 16 primary schools in Riyadh. The questionnaire covered relevant demographic and personal characteristics, presence of respiratory conditions and orofacial symptoms, and the Pediatric Sleep Questionnaire. The latter was used to assess the prevalence of symptoms of sleep-disordered breathing and was completed by the participating children's parents. RESULTS: In total, 1350 completed questionnaires were returned (85% response rate). The children' mean age was 9.2 ± 1.8 years; 733 (54.3%) were boys and 617 (45.7%) girls. Overall, 21% of children were at high risk of sleep-disordered breathing. The prevalence of snoring was 14.4% and that of sleep apnea 3.4%. Boys were at higher risk of sleep-disordered breathing than girls (P = 0.040). Children with respiratory conditions or orofacial symptoms were at higher risk of sleep-disordered breathing (P < 0.0001) than children without these conditions/symptoms. CONCLUSIONS: Around 21% of Saudi children are at risk of sleep-disordered breathing. There is a strong association between sleep-disordered breathing symptoms and the presence of respiratory conditions or orofacial symptoms.

Pharyngeal airway dimensional changes after premolar extraction in skeletal class II and class III orthodontic patients.

OBJECTIVE: To assess and compare the changes in pharyngeal airway space dimensions following orthodontic treatment of skeletal class II and class III facial deformities with premolar extraction. MATERIALS AND METHODS: Sixty pre and posttreatment lateral cephalometric radiographs of patients who underwent fixed orthodontic treatment with premolar extraction were collected. The sample was divided into two groups - 32 patients with skeletal class II and 28 patients with skeletal class III malocclusion. Both groups were subdivided into growing patients (<16 years old) and adults (>16 years old). Nasopharyngeal, palatopharyngeal, and glossopharyngeal airway space dimensions were measured in the pretreatment (T0) and posttreatment (T1) cephalometric radiographs using Dolphin Imaging 11.7 software. Two-way, repeated-measures analysis of variance was used to assess the in-treatment changes. RESULTS: Nasopharyngeal airway dimension showed similar significant increase in class II (P = 0.042) and class III (P = 0.049) patients from T0 to T1, whereas palatopharyngeal and glossopharyngeal dimensions were insignificantly decreased in both groups. However, both malocclusions followed the same pattern of changes in relation to airway dimensions. In addition, no significant statistical difference was found in the airway spaces between growing and adult patients. CONCLUSIONS: Extraction of premolars did not affect the pharyngeal dimensions except those of the nasopharynx, which showed a significant increase after extraction in both groups.

Dental and medical health status and oral health knowledge among visually impaired and sighted female schoolchildren in Riyadh: a comparative study.

BACKGROUND: The impact of visual impairment on oral health in the literature is inconclusive, and the available information on the medical and dental health status of visually impaired children is limited. The aim of this study was to evaluate the dental and medical health status, and to assess the oral health knowledge of visually impaired girls aged 6-12 years, and compare them to that of sighted children. METHODS: This analytical cross-sectional study was carried out on 79 visually impaired and 83 age-matched sighted female primary school children. The children's demographic data, medical history, and dental history were obtained through a validated questionnaire. The study population was examined to evaluate their dental caries status using the Decayed Missing Filled Teeth/Surface indices DMFT/DMFS/ and dmft/dmfs for permanent and primary teeth, respectively. Oral hygiene index (OHI), Plaque index (PI) and gingival index (GI) were obtained for periodontal evaluation. Pearson's Chi-square test and t-test were used for the statistical analyses. RESULTS: The general health for both groups was found to be good; however, 21.5% of the visually impaired children had systemic diseases compared with only 4.8% of the sighted children (P = 0.002). Statistically significant differences (P < 0.001) were found between the two groups with regards to OHI. Among the sighted children, 49.4% had good oral hygiene compared with only 22.8% of the visually impaired group. The plaque accumulation was found to be greater among the visually impaired group and gingivitis was also higher. The DMFS score was found to be higher (P = 0.03) among the visually impaired group. CONCLUSIONS: The visually impaired children had more medical conditions and poorer oral health status compared to their sighted peers.

Retention and caries-preventive effect of glass ionomer and resin-based sealants: An 18-month-randomized clinical trial.

The objective of this study was to compare the retention and caries-preventive effect of glass ionomer (Fuji Triage) and resin-based (Clinpro) sealants among 6-9-year-old children. This split-mouth, randomized clinical trial covered 35 children/140 fully erupted permanent first molars. Evaluation was conducted by two independent examiners after 6, 12, and 18 months and the data were compared in relation to the children's caries risk and age groups. The Kaplan-Meier survival method and chi-square test were used for analysis. There were no statistically significant differences in the survival of partial and fully retained sealants or in the survival of caries-free pits and fissures between glass-ionomer and resin-based sealants. In terms of retention, both sealants performed better in the younger age group at the end of the study, and showed better caries prevention in moderate caries risk children. After 18 months, both sealants had comparable retention and caries-preventive effects in 6-9-year old children.

Oral habits, dental trauma, and occlusal characteristics among 4- to 12-year-old institutionalized orphan children in Riyadh, Saudi Arabia.

The aim of this study was to assess the oral habit practices, dental trauma, and occlusal characteristics of 4- to 12-year-old orphans living in governmental orphanages in Riyadh. This cross-sectional study was conducted in three government orphanages and three ordinary schools. All 90 orphans, residing in the orphanage, were included. Ninety schoolchildren were selected to serve as the controls. Demographic data, oral habit history, and dental trauma history were obtained through a questionnaire. All children were examined to confirm the presence of signs of oral habits, dental trauma, and associated occlusal characteristics. Pearson chi-square was used for statistical analysis. Orphans were found to have more digit sucking and oral self-mutilation habits; however, the control children were found to have more nail biting habit. Nearly 21% of the orphans had dental trauma compared to 10% of the control group. About 70% of the dental trauma affected permanent teeth among orphans, whereas, 85% affected primary teeth in the control children. Dental trauma increased as the orphans got older; however, it decreased significantly as the control children got older. Orphans were found to have more cross-bite, increased over-jet, and open-bite. Digit sucking habit was positively associated with class II molar relation, presence of posterior cross-bite, and open-bite. Orphans had increased prevalence of digit sucking habit, self-mutilation, dental trauma, and malocclusion.

Orthodontic treatment need among young Saudis attending public versus private dental practices in Riyadh.

OBJECTIVE: To assess and compare the severity of malocclusion and orthodontic treatment need among young Saudis receiving free treatment at public dental practices versus those paying for treatment at private practices. MATERIALS AND METHODS: This retrospective study evaluated the records of 300 patients (179 females, 121 males; age 13-21 years) treated at orthodontic clinics from 2013 through 2015. The public sample was selected from orthodontic clinics at the College of Dentistry, King Saud University (KSU); the private sample was selected from five private orthodontic clinics in Riyadh, Saudi Arabia. The records were examined for the severity of malocclusion and for orthodontic treatment need using the Dental Health Component of the Index of Orthodontic Treatment Need. The prevalence of each occlusal discrepancy and the Dental Health Component grade were recorded. The severity of malocclusion and orthodontic treatment need were compared between practice types, age groups, and sexes with the chi-square test. RESULTS: Displacement, increased overjet, and Class II and III malocclusion were the most common orthodontic problems in this study. Patients attending public clinics at KSU generally had more severe malocclusion than the patients attending private clinics. Seventy-seven percent of orthodontically treated patients at KSU clinics were in great need of treatment, compared with 58.5% of patients treated at private clinics (P=0.003). Among the patients with great treatment need, approximately 62% of male patients and 70% of patients ≤16 years of age were treated at KSU clinics, compared with 38% and 48%, respectively, treated at private clinics (P<0.0001). CONCLUSION: Young Saudis receiving free orthodontic treatment at public clinics at KSU had more severe malocclusion with greater need of orthodontic treatment than the patients paying for treatment at private clinics.

Saudi dental students' opinions on the qualities and attributes of an effective dental teacher.

OBJECTIVE: To evaluate Saudi dental students' opinions on the qualities and attributes of an effective dental teacher. METHODS: This cross-sectional study was conducted between March and May 2014 at the College of Dentistry, King Saud University. Self-administered questionnaires were distributed to all students enrolled in the 2013/2014 academic year. The questionnaire contained 43 items regarding students' opinions on the qualities and attributes of a good dental teacher. The attributes were grouped into two main categories: performance and personality. Mean and standard deviations were calculated for each item and then for the whole category. Performance and personality were compared between male and female students and between junior and senior students using Mann-Whitney U test. RESULTS: Four hundred and seventy-seven questionnaires were completed, representing a response rate of 79%. Performance attributes were significantly more important than personality attributes to Saudi dental students (P<0.001). Perceptions of performance and personality attributes did not differ between male and female students; however, junior students put more emphasis on personality attributes than senior students. CONCLUSION: Saudi dental students consider performance attributes more important than personality attributes for their successful learning. Teachers' educational skills are valued more than the attributes, which do not connect directly to students' learning process.

Possible association between acetazolamide administration during pregnancy and multiple congenital malformations.

Congenital malformations might occur because of environmental or genetic factors, and sometimes occur because of unknown causes. Acetazolamide is a carbonic anhydrase inhibitor that is used to treat idiopathic intracranial hypertension, glaucoma, and epilepsy. The use of acetazolamide has not been recommended for pregnant women because of reported teratogenic risks. Congenital malformations, such as ectrodactyly, syndactyly, cleft lip/palate, and retarded incisor teeth development, have been reported in experimental animals. However, tooth agenesis due to the use of acetazolamide has not been reported yet. Oligodontia is a severe type of tooth agenesis involving six or more congenitally missing teeth. The causes of oligodontia are attributed to environmental factors, such as irradiation, drugs, trauma, tumors, infection, genetic factors, or a combination. There is no credible evidence of undesirable effects of acetazolamide use in human pregnancy. However, we report a case of a 12-year-old Saudi boy who was exposed to maternal acetazolamide (1,000 mg/day) for treatment of idiopathic intracranial hypertension before pregnancy, during the first trimester, and throughout the pregnancy. This treatment might have resulted in some congenital malformations, such as ectrodactyly, syndactyly, and oligodontia.

Saudi dental students' perceptions of pediatric behavior guidance techniques.

BACKGROUND: Dental students receive theoretical and clinical training in pediatric behavioral guidance techniques at university. Therefore, the content of the educational course and the degree of training in behavioral techniques may have an impact on the students' perceptions and practice of such techniques. The purpose of this study was to evaluate Saudi dental students' perceptions of behavior guidance techniques used in pediatric dentistry, and to assess the changes in their perceptions after 1 academic year of a didactic and clinical educational course. METHODS: This longitudinal study was carried out once at the beginning and once at the end of the 2013/2014 academic year at the College of Dentistry, King Saud University in Riyadh, Saudi Arabia. A questionnaire measuring the perceived acceptability of behavior guidance techniques was completed by 78 fourth-year dental students before and after a pediatric dental course. Acceptability ratings were scored on a 5-point Likert scale and compared and evaluated in relation to demographic data. Paired t-test and one-way analysis of variance were used for the statistical analyses. RESULTS: Before the course, the highest scores were for reinforcement and desensitizing techniques and the lowest were for aversive and communicative techniques. After the course, statistically significant increases were found in the acceptability of aversive techniques (voice control and hand-over-mouth), all pharmacological techniques, and modeling. Most communicative techniques and clinical situations were also rated as significantly more acceptable. Statistically significant decreases in acceptability ratings were found in promising a toy, and immobilization by staff or a parent. Immobilization using a papoose board, modeling, the presence of parents during the child's treatment, and most communicative techniques were rated as significantly more acceptable by male students than female students. CONCLUSIONS: In general, Saudi dental students rated most basic behavior guidance techniques as acceptable. An educational course, including didactic and clinical components, improved their acceptability ratings, and had a considerable influence on their perceptions of behavior guidance in pediatric dentistry.

Evaluating the cariogenic potential of flavored milk: an experimental study using rat model.

OBJECTIVE: The purpose of this study was to evaluate and to compare the cariogenic potential of different commonly consumed favored milk on caries development in rat's molar teeth. MATERIALS AND METHODS: Sixty Sprague-Dawley rats infected with an active growing culture of Streptococcus mutans were offered chocolate favored milk, strawberry favored milk, banana favored milk, plain milk, sweetened plain milk with 5% sucrose, and 10% sucrose ad libitum. RESULTS: Rats consuming favored milk developed significantly lower sulcal and smooth surface caries scores than rats consuming 10% sucrose. However, rats consuming plain milk developed significantly lower sulcal and smooth surface caries scores than animals consuming favored or sweetened plain milk except for chocolate favored milk. CONCLUSION: It was concluded that favored milk containing 5% sucrose showed a moderate cariogenic potential. CLINICAL SIGNIFICANCE: Although the overall results suggest that the cariogenic potential of favored milk is moderate and despite their nutritional value, occasional consumption of favored milk as a beverage might be accepted with caution. Parents, dental practitioners and other healthcare professionals should be aware of the cariogenicity of favored milk. They should keenly encourage the use of plain milk and discourage the use of any cariogenic drink which has a deleterious effect on teeth.

Effect of different preventive agents on bracket shear bond strength: in vitro study.

BACKGROUND: The effects of fluoride and CPP-ACP before bracket bonding on the shear bond strength of orthodontic brackets have been reported with contradicting results. The objective of this in vitro study was to evaluate the effect of different preventive agents namely; casein phosphopeptide-amorphous-calcium-phosphate (CPP-ACP), fluoride-containing-CPP-ACP (CPP-ACPF) and 5% sodium fluoride (5% NaF), on the enamel-bracket shear bond strength (SBS) and to compare their effects when applied before or after acid-etching. METHODS: Human premolar teeth were randomly divided into seven groups (16 teeth per group) as follows: the control group, where no preventive agent was applied on the enamel and 6 experimental groups. Teeth in groups 1a, 2a, and 3a were treated with CPP-ACP paste, CPP-ACPF paste, and 5% NaF, respectively before acid-etching. Teeth in groups 1b, 2b and 3b were treated using the same preventive agents after acid-etching. The brackets were then bonded and the teeth were thermocycled. The brackets' SBS was measured and the adhesive remnant was assessed using adhesive remnant index (ARI). Analysis of variance (ANOVA) and Tukey test were performed to compare the SBS among different groups. Chi-square test was used to evaluate differences in ARI scores between the groups. RESULTS: Enamel surface treatment with CPP-ACPF after acid-etching significantly increased SBS compared to the control and to its application before acid-etching (P < 0.05). Higher ARI index was recorded when the preventive agents were applied after acid-etching. CONCLUSION: Brackets' SBS significantly increased when fluoride-containing-CPP-ACP was applied after acid-etching.

Scanning electron microscope analysis of sealant penetration and adaptation in contaminated fissures.

OBJECTIVE: The objective of this study is to evaluate the penetration and adaptation of two different sealant materials applied under different conditions of contamination using scanning electron microscope (SEM) analysis. MATERIALS AND METHODS: A total of 56 extracted human third molar teeth were randomly assigned into eight equal groups. The treatment groups were defined by the combination of two sealant materials (glass ionomer fissure sealant "Fuji Triage" or resin-based fissure sealant "Clinpro TM") and four surface conditions (dry condition, water contamination, saliva contamination or saliva contamination and air-drying). Penetration depth, sealant adaptation and fissure types were evaluated under SEM after sectioning the teeth. Tukey's test and multiple linear regression analyses were used for statistical analysis. RESULTS: No significant difference in the sealant penetration and adaptation was found between both materials under dry conditions. However, under wet contaminations, resin-based sealant showed less adaptation and penetration with a significant difference when compared to glass ionomer sealant (P < 0.05). The multiple linear regression analyses revealed significant impact of different materials and types of contamination on the sealant penetration and adaptation. CONCLUSION: Glass ionomer sealant has better fissure penetration and more intimate adaptation than resin-based sealant under wet contamination conditions.

Medical and dental health status of orphan children in central Saudi Arabia.

OBJECTIVE: To evaluate the medical and dental health status of orphan children from 4 to 12-years-old, and compare them with children living with their parents. METHODS: This analytical, cross-sectional study took place in 3 government orphanages and 3 ordinary schools in Riyadh, Saudi Arabia from July 2011 to January 2012. All orphans aged 4-12 year were selected (N=90). Ninety children living with their parents were selected randomly to serve as the controls. Demographic data, medical, and dental history were obtained through a questionnaire answered by the orphans' foster mothers and children's parents. The study groups were examined to evaluate their caries status using the Decayed-Missing and-Filled Teeth/Surface indices (DMFT/DMFS) for permanent teeth and (dmft/dmfs) for primary teeth. Oral hygiene status (OHI), plaque deposition (PI), and gingival health (GI) were also assessed. Pearson Chi-square, Mann-Whitney, and Kruskal-Wallis tests were used for statistical analysis. RESULTS: Approximately 36% of the orphans had medical conditions compared to 14.4% of the control children. The control children visited the dentist more than the orphans (p<0.001). Approximately 96% of the orphans had dental caries compared to 90% of the control children (p<0.001). Decayed-missing and-filled teeth/surface index scores were higher among orphans (p=0.004) compared to the control children (p<0.001). Orphans scored higher in PI (p=0.009), GI (p=0.002), and OHI (p<0.001). CONCLUSION: Medical health conditions were more prevalent among orphans living in government orphanages, but they were provided with good and continuous medical care. However, they had more dental caries and worse oral hygiene, as dental care was provided to them only in case of emergency.

Achondroplasia: Craniofacial manifestations and considerations in dental management.

Achondroplasia is the most common form of skeletal dysplasia dwarfism that manifests with stunted stature and disproportionate limb shortening. Achondroplasia is of dental interest because of its characteristic craniofacial features which include relative macrocephaly, depressed nasal bridge and maxillary hypoplasia. Presence of large head, implanted shunt, airway obstruction and difficulty in head control require special precautions during dental management. Craniofacial manifestations and considerations in dental management are presented in 11-year-old female patient with achondroplasia.

An assessment of a new reminder therapy technique for ceasing digit sucking habits in children.

Twenty-one digit-sucker children aged 4-12 old years participated in the assessment of a new reminder therapy technique called "long sleeve sleeping gown ". The result of this study indicated that fifteen children (71.4%) out of 21 were able to stop digit-sucking habits after the application of long sleeve's gown during child's bedtime for 6 weeks. The children who failed to cease this digit-sucking habit (28.6%) were found to not accept to complete the trial period or their mothers thought that they were too young to stop the habit. Among the success group no child was reported to return to digit-sucking 3 months after implementation of long sleeves gown.