Hall technique versus conventional preformed metal crowns: can paediatric dentists tell the difference on radiographs?

PURPOSE: Hall technique (HT) preformed metal crowns (PMCs) are allegedly oversized compared to conventional (C) PMCs. To investigate paediatric dentists' (PDs) perception of HT-PMCs and perception/ability to identify HT or C-PMCs on bitewings radiographs. METHODS: An online cross-sectional questionnaire including ten bitewings (five of each of HT/CPMCs) was sent to PDs across the globe. A PMC type score (from '10') was calculated. T test, Pearson's and Fischer's Chi-square, and Odd Ratios (OR) (p < 0.05). RESULTS: A total of 476 PDs from around the world responded. Most (97%) used PMCs in their practice. Most (98.7%) knew of, and 79% used HT-PMCs. A clear opinion shift, towards supporting HT, over time was noted (OR 11.154 [95% confidence interval (CI) 6.006-20.715]. A majority (67%) thought that HT/C-PMCs were similar radiographically. Only five PMCs were identified correctly [mean score 4.9 (± 1.73)]. A minority who thought that HT/C-PMCs were dissimilar scored higher than those who thought they were similar (5.31 ± 1.22; 4.68 ± 1.9, respectively, p < 0.00001). Nobody identified all ten PMCs. HT-PMCs were 4.63 times more identifiable than C-PMCs [(OR 24.857 CI 15.059-41.028) and (OR 5.361 CI 3.089-9.304)] for HT-PMCs and CP-MCs, respectively (p < 0.0001). CONCLUSIONS: PDs identified the PMC type in half of the bitewings. They perceived no clear radiographic difference between HT-PMCs and C-PMCs, but their chance of recognizing HT-PMCs was five times higher than C-PMCs. HT-PMC support was high.

A 24-month retrospective study of preformed metal crowns: the Hall technique versus the conventional preparation method.

PURPOSE: Conventional and Hall Technique (HT) Preformed Metal Crowns (PMCs) are used for treatment of carious primary molars. The aim was to evaluate the clinical and radiographic success of conventional and HT PMCs in a postgraduate dental setting. METHODS: A retrospective study using patients' electronic case-notes and radiographic images of carious primary molars treated with either conventional or HT PMCs was conducted to assess clinical and radiographic success/failure. A Kaplan-Meier curve was used to assess PMC survival. RESULTS: 187 PMCs (110 HT and 77 conventional) in 65 children (34 females and 31 males) at 6, 12, 18 and 24 months were assessed. At 24 months, the success rates of conventional and HT PMCs were 97.6% and 93.5%, respectively. Two HT (perforated/abscessed) and four conventional (abscessed) PMCs failures occurred. There was no significant difference in success/failure (p = 0.362) at 12 months, but the HT was more successful at 24 months (p = 0.002) with similar survival times for both methods. CONCLUSION: HT and conventionally placed PMCs, when placed in a postgraduate paediatric dentistry setting, were clinically and radiographically very successful at 6, 12, 18 and 24 months post operatively with a slightly higher success of the HT at 24 months.

Children's dental anxiety (self and proxy reported) and its association with dental behaviour in a postgraduate dental hospital.

PURPOSE: Child dental anxiety (CDA) and uncooperative dental behaviour are common. We aimed to assess the prevalence of CDA (self- and proxy- reported) in the United Arab Emirates (UAE) children related to their dental behaviour. METHODS: Data were collected from 312 questionnaires obtained from 156 parent/child (mean age 9.95 ± 2.17 years) pairs attending a postgraduate dental hospital. Demographics, self/proxy- reported CDA scores via a six-question, five-point Likert scale, of the Modified CDA Scale-faces version (MCDAS-f: where ≥ 19 was severe CDA) and Frankl Behaviour Rating Scale (FBRS) scores were compared and analysed. Chi-square test, Pearson's correlation, Kappa- coefficient, one-way ANOVA and independent t test statistical analysis were used (p < 0.05). RESULTS: The prevalence of self and proxy severe CDA was 22.4% (n = 35) and 33.3% (n = 52) respectively, with 9% (n = 14) being dentally- uncooperative. In both groups, extractions caused the highest CDA followed by injections and fillings (p < 0.001). The mean scores for self-reported/proxy-reported CDA were 15.02 (± 4.90)/15.70 (± 6.07) respectively. There was a positive linear correlation between self- and proxy- reported CDA scores and a negative linear correlation between self/proxy- reported CDA scores and the FBRS (p < 0.001). Self/proxy concordance of severe anxiety/none-to-moderate- anxiety was fair (68.6%, kappa = 0.23, p = 0.003). Both self/FBRS and proxy/FBRS concordance of severe anxiety/none-to-moderate- anxiety/behaviour was fair (78.8%, kappa = 0.23, p = 0.001) and (71.8%, kappa = 0.22, p < 0.001) respectively. CONCLUSIONS: Considering the limitations of the present study in a UAE child population sample, the prevalence of CDA from extractions, injections and fillings was 22.4% (self- reported) and 33% (proxy reported). There was fair agreement between child- self and parent- proxy- reported CDA. Increased CDA led to uncooperative dental behaviour.

United Arab Emirates dentists' perceptions about the management of broken down first permanent molars and their enforced extraction in children: a questionnaire survey.

PURPOSE: The broken down first permanent molar (BDFPM) is common in children. Enforced extractions of first permanent molars (EExFPMs) guidelines were published in the United Kingdom (UK) in 2014. We aimed to assess the knowledge and practice of dentists in the United Arab Emirates (UAE) of BDFPMs in children in light of the guidelines. METHODS: A cross-sectional sample of UAE-based dentists treating children completed a self-administered questionnaire covering; knowledge and practice of the principle of EExFPMs; to whom dentists would refer in case of BDFPMs; knowledge of the ideal age for EExFPMs (8-10 years) and finally actual awareness of the EExFPMs guidelines. Chi-square tests (p < 0.05). RESULTS: A total of 199 questionnaires were completed (total return rate was 66.33%). There was no agreement on how to deal with a scenario of BDFPMs. Over 85% majority believed in saving BDFPMs rather than extracting them but 89% would consult/refer to other specialists. Whilst 51% of the participants had never carried out EExFPMs in children, 69% were aware of the EExFPMs concept and 61% knew the ideal timing of a lower FPM extraction. More than 82% were unaware of the actual UK EExFPMs guidelines. Paediatric dentists would consider EExFPMs more than other groups (p = 0.007). CONCLUSION: In the UAE dentist sample surveyed, there was a preference for preserving BDFPMs rather than extracting them in children, despite knowing when the ideal time for extraction was. Training background and specialty were influencing factors. There was a lack of awareness of the actual UK 2014 EExFPMs guidelines.

Public Awareness of Knowledge, Belief, and Attitude Regarding Organ Donation and Organ Transplantation: A National Survey From the United Arab Emirates.

BACKGROUND: Organ donation in the United Arab Emirates (UAE) was restricted until recently to living donation. This survey was conducted to explore the public knowledge, belief, and attitude regarding donation during life and after death. METHODOLOGY: A 31-item survey was distributed among 900 participants (UAE residents) of whom 495 completed the forms and were considered for further analysis. RESULTS: Among the participants, 293 (59.2%) were women and 202 (40.1%) were men. With 8 items as the highest possible score, the mean score of knowledge was 4.42 (SD = 1.54) and 436 (88%) of the participants knew about a brain-dead condition. However, their awareness on organ donation and transplantation legislation in the UAE was not consistent, and less than 198 (40%) had correct knowledge in this regard. Religious belief regarding organ donation was scored at 80 and the mean of the beliefs score obtained was 56.56 (SD = 6.39). Together, 369 (74.6%) of the participants had positive religious sentiments regarding the issue. Participants' attitude toward organ donation and transplantation was scored at 14.7 out of 20 possible score (SD = 2.46) with 396 (80%) acknowledging the fact that organ donation and transplantation prolongs and improves recipient's quality of life. LIMITATIONS: The small number of respondents (n = 495) in the survey was a limitation of the study. CONCLUSIONS: The population of the UAE was moderately well informed and motivated about organ donation and transplantation. Although a knowledge gap about the current legislation prevailed, the majority of the participants were knowledgeable, they nurtured positive beliefs, and had compassionate attitude regarding lawful organ transplantation.

Dentists' knowledge of the guidelines of traumatic dental injuries in the United Arab Emirates.

AIM: This study aimed to assess general dental practitioners' (GDPs) knowledge within the United Arab Emirates (UAE) regarding the management of traumatic dental injuries (TDIs), and to compare their level of knowledge with that of paediatric dentists (PDs). METHODS: Dentists were asked to complete a two-part questionnaire (seven questions covering demographic data and 13 questions about trauma cases scenarios) in electronic and paper format. A total of 296 returned questionnaires were analysed to identify GDPs' knowledge in managing TDIs, and to compare the score of GDPs' knowledge with that of PDs'. RESULTS: Out of a total score of 13, the mean knowledge score (MKnS) for GDPs was 4.87±1.82 (only 37.5% of the 13 questions were answered correctly) while the MKnS of paediatric dentists was 5.56±1.47 (with 42.8% correct answers); both scores indicated poor knowledge and the difference was statistically significant (p=0.005). CONCLUSION: There was poor knowledge of TDIs among the surveyed UAE GDPs as well as the PDs, although PDs scored higher, indicating the need for further training.

A systematic review and meta-analysis of primary teeth caries studies in Gulf Cooperation Council States.

OBJECTIVES: The aim of the study was to evaluate the prevalence and severity of dental caries in pre-school children in the Gulf Cooperation Council (GCC) area. METHODS: A search of literature was conducted to identify articles of dental caries in primary dentitions published during the period from January 1st, 1992 to June 30th, 2016. PubMed, Google Scholar search, and hand searching of journals was conducted to identify relevant articles. The search strategy employed both dental subject headings and free-text terms. RESULTS: Out of a total of 193 studies that fit the initial inclusion criteria, 159 studies were further excluded. Only 34 studies were included in the systematic review and meta-analyses. The overall mean dmft in the primary teeth was 5.14 with prevalence of 80.9% in the GCC area. A high level of heterogeneity in the selected studies was found as demonstrated by Q-value of 2538.501 (df = 21) and I2 value of 99.17%. However, the funnel plots showed symmetrical shape at the bottom in both dmft and prevalence studies indicating absence of publication bias, which was also confirmed by insignificant result of Egger's regression statistical test (Egger's test P = 0.179-0.358). CONCLUSION: Caries in the primary dentition in the GCC States was high both in terms of mean dmft (5.14) and prevalence (80.95%).

Assessment of the knowledge of United Arab Emirates dentists of Child Maltreatment, protection and safeguarding.

AIM: Child safeguarding is society's responsibility. Dentists are uniquely positioned to recognise Child Abuse and Neglect (CAN) in dental practice and the wider society. The United Arab Emirates (UAE) introduced a child protection law in 2016. We aimed to assess the awareness of UAE dentists of child maltreatment, protection and safeguarding. Study Design A cross-sectional survey. MATERIALS AND METHODS: We surveyed 381 UAE dentists about the knowledge and practice of CAN and safeguarding issues using a self-administered anonymous questionnaire. Statistical analysis was carried out using Chi-square, t-test, ANOVA and Pearson's correlation test and statistical significance was set as p <0.05. RESULTS: Over 39 % (n=152) of the responders suspected CAN; male dentists suspected more CAN than females (p=0.015). Orthodontists, paediatric dentists (p<0.001) and female dentists (p=0.001) were more knowledgeable about diagnosing CAN. Paediatric dentists attended more CAN-related postgraduate training (p<0.001) than other specialties. Over 90% (n=346) believed that CAN should be addressed, 58.1% (n=224) and 54.1% (n=206) had CAN undergraduate and postgraduate training respectively but 53.5% (n=204) were unaware of local child protection guidelines. Dentists barriers to child protection reporting were; fear of family violence (59.6%, n=227), lack of knowledge of referral process (60.2%, n=228) and lack of diagnosis certainty (54.9%, n=206). UAE dentists qualified in Western and Asian countries had fewer barriers for child protection reporting (p=0.022) than the Arab and Gulf Cooperation Council qualified dentists. CONCLUSIONS: A large minority of UAE dentists suspected CAN. Factors influencing child protection reporting were identified. Dentists' gender, specialty, and country of qualification affected their knowledge of CAN and practice of safeguarding. Child protection training is recommended.

Oral health challenges facing Dubai children with Autism Spectrum Disorder at home and in accessing oral health care.

AIM: To investigate the challenges faced by Autism Spectrum Disorder (ASD) children and their families in Dubai from three different perspectives of dental care: oral care at home, oral care at the dentist and access to oral care, and to compare the results to their normally developing peers. MATERIALS AND METHODS: A case-control comparative study of 84 ASD and 53 healthy children attending special needs centres and schools in Dubai including siblings of the autistic children. Data collection was by a survey questionnaire completed by parents or guardians. RESULTS: More parents of ASD children compared to parents of healthy children reported difficulties across almost all oral care variables explored. The majority of ASD children's parents (83.3%) reported that their children need assistance in brushing their teeth compared with 15.4% of the healthy controls (p-value < 0.001). The ASD children's uncooperative behaviour increased during dental visits and significantly more parents (37%) rated their child's experience as negative compared with 9.5% among the parents of control children (p-value=0.006). The autistic children had visited a dentist mostly for extractions. CONCLUSION: This study indicates that autistic children in Dubai experience more challenges and barriers to oral care than their typically developing healthy peers.

Early childhood caries and associated risk factors among preschool children in Ras Al-Khaimah, United Arab Emirates.

AIM: To investigate the prevalence and contributing factors of early childhood caries (ECC) in preschool children of Ras Al-Khaimah (RAK), United Arab Emirates (UAE). STUDY DESIGN: Cross-sectional. METHODS: The sample consisted of 540 healthy preschool children between four and six years of age attending 10 nursery schools in RAK, UAE. A structured questionnaire was distributed to the mothers of children who gave consent for their children to be included in the study. The questionnaire was used to collect information regarding child and mother's demographic data, children's feeding and dietary habits, oral hygiene practices and frequency of dental visits. The dental examination of children was conducted by one investigator using a mouth mirror and a torch light source. RESULTS: Five hundred and forty children with a mean age of 5.1 (SD = 0.71) years were included in the study. The prevalence of ECC was 74.1%, the mean dmft was 3.07 ± 0.135. The significant caries index (SiC) was very high (13.3) and the care index was very low (3.8%). A high proportion of caries-free children and those with ECC were either never or only visited dentists when in pain. However, the difference in frequency of dental visits was statistically highly significant (p < 0.001). There was also a statistically significant difference in frequency of tooth brushing between children with and without caries and more than two-thirds of children with ECC spent less than two minutes when brushing their teeth. The difference in sweet consumption was not statistically significant. CONCLUSION: The prevalence of dental decay and the mean dmft were high and the care index was extremely low. There is a great need for prospective studies and community preventive programs to solve the problem of ECC and set plans to treat open cavities in RAK preschool children.

Standard case management of asthma in Sudan: a pilot project.

SETTING: A pilot project for asthma management in selected hospitals in Khartoum and Gezira States, Sudan. OBJECTIVE: To assess standard case management of asthma in 2007-2008. DESIGN: Local adaptation of guidelines, followed by situational analysis, pre-intervention study, training and implementation. Treatment outcome was assessed 1 year after patient enrolment. RESULTS: Situational analysis revealed that inhaled beclometasone was not available in the public sector. During the project, 2068 patients were enrolled: severity of asthma was intermittent in 185 (9.0%), mild persistent in 231 (11.2%), moderate persistent in 640 (31.0%), severe persistent in 812 (39.3%) and unclassified in 200 (9.7%). Of the 1654 patients with persistent asthma who were treated with inhaled corticosteroids, 1157 (70.0%) had treatment cards available for outcome assessment. Of these, 652 (56.4%) did not attend their annual evaluation, among whom 1 (0.1%) died and 651 (56.3%) were lost to follow-up. Of the 505 patients who attended their annual evaluation, 417 (82.6%) improved, 32 (6.3%) were stable and 56 (11.1%) were worse. The frequency of emergency visits and hospitalisation decreased substantially among those who presented for the 1 year follow-up assessment. CONCLUSION: The results of standard case management of asthma were encouraging; however, a high proportion of patients did not return for long-term management.

Incidence and causes of sudden death in a university hospital in eastern Saudi Arabia.

Sudden death is non-violent, unexpected death occurring less than 24 hours from the onset of symptoms. In this retrospective descriptive study we report the frequency and main causes of sudden deaths in relation to total deaths at a large university hospital in the Eastern region of Saudi Arabia over a 6-year period. The medical files of 1273 consecutive deaths were retrospectively investigated and showed 223 (17.5%) cases of sudden death. Males were 56.0% of cases. The incidence of sudden death was highest in the 2 age extremes (32.2% were infants and 31.4% were elderly). There was a seasonal variation, with the highest incidence (29.6%) during spring followed by summer (25.1%). The most important direct causes of sudden death were cardiovascular diseases in 59.2% of cases, respiratory disease in 24.7%, diabetes mellitus in 23.8%, liver disease in 23.3% and infectious disease in 20.2%.

Symptoms in patients attending services for diagnosis of pulmonary tuberculosis in Sudan.

OBJECTIVE: To describe the variation in clinical features of individuals presenting to a health facility with chest symptoms according to their ultimate diagnosis. METHODS: Of 16735 patients (52.6% males and 47.4% females) presenting at respiratory centres in seven states in Sudan, 5338 patients were identified with respiratory tract symptoms: 2917 (54.6%) men and 2421 (45.4%) women, with a mean age of 32 years. Those who had cough for more than 3 weeks that was not responsive to a course of antibiotics were screened by microscopy of two or three sputum specimens and chest radiography. RESULTS: A total of 504 (9.44%) were smear-positive, 259 (4.85%) were smear-negative, and 166 (3.11%) had extra-pulmonary tuberculosis, of whom 59 (1.11%) had pleural involvement; the remaining 4409 suspects (82.6%) were non-tuberculous. CONCLUSION: Tuberculosis patients had a constellation of presenting symptoms, with the principal symptom being cough for more than 3 weeks. The accompanying symptoms with greatest predicted significance were weight loss, tiredness and night sweats.

The effect of decentralisation on tuberculosis services in three states of Sudan.

SETTING: Referral hospitals and primary health care (PHC) facilities in Khartoum, Red Sea and Gadaref States. OBJECTIVES: To measure the effect of the decentralisation of the tuberculosis (TB) services on the clinical profile and treatment outcome of tuberculosis. DESIGN: A cohort study of case detection and treatment outcome using information routinely collected comparing patients attending PHC facilities and referral hospitals in selected locations in Sudan. RESULTS: Two-thirds of all TB patients were diagnosed in referral hospitals and one-third in PHC facilities. In PHC facilities, women represented 46% of notified cases, compared to 37.9% in referral hospitals (OR 1.398, 95%CI 1.343-1.455). Older age groups were more likely to prefer PHC facilities to referral hospitals. In referral hospitals, 38% were cured, 29.3% completed treatment without smear examination and 17.3% defaulted, while in PHC facilities 58% were cured, 17.8% completed treatment without smear examination and 11.6% defaulted. CONCLUSION: PHC facilities provide care for a higher proportion of women and older age groups of tuberculosis patients, suggesting a higher level of accessibility for these groups. A higher cure rate and a lower default rate were noted in PHC facilities, possibly reflecting better conditions for directly observed treatment and follow-up.

Treatment results of DOTS in 1797 Sudanese tuberculosis patients with or without HIV co-infection.

SETTING: Consecutive new tuberculosis (TB) patients, from eight states in Sudan, who had never been previously treated for as much as 1 month between 1998 and 2000. OBJECTIVE: To determine the impact of human immunodeficiency virus (HIV) co-infection on tuberculosis treatment outcome. DESIGN: All patients presenting with symptoms suggestive of tuberculosis underwent sputum microscopy for acid-fast bacilli (AFB). Treatment is free of charge, and directly observed for all smear-positive patients. Treatment outcomes were those defined by the World Health Organization. All patients were tested anonymously for human immunodeficiency virus (HIV) using the Bionor test. RESULTS: Of 10 494 patients suspected of TB and referred for sputum microscopy, 1797 were TB cases; 983 had smear-positive pulmonary tuberculosis, 521 smear-negative pulmonary tuberculosis, and 293 extra-pulmonary tuberculosis. Smear-positive cases showed a cure rate of 77.2% and a failure rate of 1%. Smear-negative and extra-pulmonary patients had a completion rate of 79.4%. Cure rates for the smear-positive cases were 68.3% for HIV-positive and 77.6% for HIV-negative patients (P = 0.164). Case fatality was significantly higher among HIV-positive (12%) than among HIV-negative cases (1.8%) (OR 7.7, 95% CI 3.51-16.8). CONCLUSION: To date, a relatively low proportion of tuberculosis patients in Sudan also have HIV infection. These patients are substantially more likely to die while on treatment for their tuberculosis, a fact that underlines their need for more comprehensive care if their lives are to be prolonged. In addition, every effort is required to diminish the transmission of HIV infection to prevent the tragedy this infection represents to the community.

Environmental influences in hand preference: an African point of view.

In order to examine further the role of cultural and environmental factors in human manual preference, two surveys were undertaken in students from Ivory Coast and Sudan. In the first study (Abidjan, Ivory Coast) 382 secondary students, ages 12 to 22, answered a 20-item manual preference questionnaire. The observed frequency of left-hand preference was 7.9%, with very low left-hand use among the 18-22 age group (1%) and high among the 12-15 age group (14%). In the second study (Khartoum, Sudan) 759 undergraduates, ages 18 to 33, answered a 25-item questionnaire. The observed frequency of left manual preference was 5%. Subjects were also asked to indicate any pressure to change hand for writing, eating, or other manual activities and, in the second study, any upper limb injury which temporarily rendered the subject unable to use his (her) preferred hand. Report of an upper limb injury in the past was related to mixed (or inconsistent) hand preference. In both studies, the target activity against left-hand use was eating. These results show that cultural and environmental factors could change "natural" hand preference in three ways: (i) by changing the hand used for only one activity (e.g., eating), with no change for other familiar unimanual activities; (ii) by reducing the degree of hand preference; (iii) by changing the overall preferred hand, generally reducing the prevalence of left-handedness. The design of handedness studies should allow these possibilities to be distinguished.