Exploring eye care pathways, patient priorities and economics in Pakistan: A scoping review and expert consultation study with thematic analysis.

PURPOSE: As the prevalence of eye diseases increases, demand for effective, accessible and equitable eye care grows worldwide. This is especially true in lower and middle-income countries, which have variable levels of infrastructure and economic resources to meet this increased demand. In the present study we aimed to review the literature on eye care in Pakistan comprehensively, with a particular focus on eye care pathways, patient priorities and economics. METHODS: A systematic scoping review was performed to identify literature relating to eye care in Pakistan. Searches of relevant electronic databases and grey literature were carried out. The results were analysed through a mixed methods approach encompassing descriptive numerical summary and thematic analysis. To consolidate results and define priority areas for future study, expert consultation exercises with key stakeholders were conducted using qualitative semi-structured interviews. RESULTS: One hundred and thirty-two papers (published and unpublished) were included in the final review. The majority (n = 93) of studies utilised a quantitative design. Seven interlinked themes were identified: eye care pathways, burden of eye disease, public views on eye-related issues, workforce, barriers to uptake of eye care services, quality of eye care services and economic impact of blindness. Research priorities included investigating the eye care workforce, the quality and efficiency of current eye care services, eye care services available in rural Pakistan and the costs and benefits related to eye care provision and sustaining eye care programmes. CONCLUSIONS: To the best of our knowledge, this is the first review to synthesise evidence from papers across the field relating to eye care in Pakistan. As such, this work provides new insights into the achievements of the national eye health programme, challenges in eye care in Pakistan and priority areas for future research.

Performance of the pediatric logistic organ dysfunction (PELOD) and (PELOD-2) scores in a pediatric intensive care unit of a developing country.

The study aimed to compare two scores: the pediatric logistic organ dysfunction (PELOD) with its updated version (PELOD-2) in describing the severity of organ dysfunction in pediatric intensive care unit (PICU) and assess the performance of PELOD-2 in the Egyptian population. A prospective cohort study of 200 patients consecutively admitted to PICU between July 2015 and A 2016 was included. The median age was 6 months, and the male to female ratio was 1.04. The median length of PICU stay was 4 days. The overall predicted number of deaths using PELOD was 76 patients whereas, by PELOD-2, it was 50 patients. The observed mortality was 50 patients. The area under the receiving operating characteristic curve was excellent for both PELOD and PELOD-2 (0.93 and 0.91, respectively). The Hosmer and Lemeshow goodness-of-fit test showed good calibration of PELOD-2 (χ 2 = 9.9, p = 0.27), while PELOD showed poor calibration (χ 2 = 42, p = 0.000) in the same studied group. CONCLUSION: Both scores had excellent discrimination. PELOD-2 is reproducible and easier to perform and had better calibration compared to PELOD score. What is Known: • Pediatric logistic organ dysfunction (PELOD) score was developed 1999 and validated in 2003 to describe the organ dysfunction severity in pediatric intensive care units. • A new and easier version of (PELOD-2) was developed 2013 in France and Belgium to replace the old score. It is important to assess the performance of the new score in other population else than the original. What is New: In an Egyptian pediatric intensive care, the performance of the score revealed: • PELOD-2 was an excellent discriminatory score comparable to the original score. • PELOD-2 calibrated well in the Egyptian population while the old score had poor calibration.

Spontaneous space closure after extraction of young first permanent molar. Retrospective cohort study.

Background: Early compromised first-permanent-molar (FPM) extraction can adversely affect occlusion. However, the current literature does not provide sufficient support for definitive early extraction outcome. This cohort study aimed to evaluate the pattern of post-FPM extraction spontaneous space closure and its pre-extraction indicators. Methods: Patients of 7-13 years, with compromised FPM at three-tertiary-centers between 2015 and 2019 were retrospectively screened. Pre-extraction indicators were evaluated (extraction location, direction of the second permanent molar (SPM) long-axis, and SPM Demirjian development stage). Spontaneous space closure pattern was evaluated clinically and radiographically using the American Board of Orthodontics (ABO) grading system. Results: In total, 112 FPMs (73-patients) were identified and five (4.5%) of the extraction sites showed favorable combined-ABO-scores. Distal direction of the SPM long-axis in the maxillary arch significantly decreased the relative risk (RR) of having a SPM rotation/alignment ABO score-1 (P = 0.002; RR = 0.64). For the mandibular arch, Demirjian stage D and E significantly decreased the RR of having ABO score-1 for spacing between the SPMs and second premolars (P = 0.029; RR:0.57, P = 0.004; RR:0.53, respectively) and vertical dimension (P = 0.02; RR = 0.53). Conclusions: The direction of the SPM long-axis and its developmental stage are key indicators of the favorable outcome pattern of spontaneous space closure after FPM early extraction.

Preference for Comprehensive Dental Treatment under General Anesthesia among Parents with Previous Experience: A Cross-Sectional Study.

This study aims to assess whether parents of children who previously received comprehensive dental treatment under general anesthesia (GA) would prefer comprehensive dental treatment under GA over regular dental care if any of their other children required comprehensive dental treatment. In this cross-sectional study, parents of children who met the inclusion criteria were interviewed by a trained pediatric resident about parental-related factors as well as their satisfaction with their previous GA experience. Also, the factors related to the previously treated child were obtained from dental records. Statistical analysis was carried out, and the p value was set to 0.05. A total number of 306 parents were included. Although most parents, 293 (95.8%), showed satisfaction with the previous GA, 170 (58%) of the satisfied parents preferred regular care. Parents of children who were previously treated under GA for medical-related reasons (p = 0.018), fathers working in a governmental sector (p = 0.021), and families with low-average monthly income (p = 0.017) significantly preferred regular care. In conclusion, most parents were satisfied with the previous GA experience. Family income, fathers' occupation, and medical-related factors can influence parental preference for comprehensive dental treatment under general anesthesia if any of their other children require comprehensive dental treatment.

Self-perceived oral health and access to care in diabetic and non-diabetic women: A qualitative study.

BACKGROUND: Access to dental care is of growing importance to individuals with chronic illnesses and policymakers alike. OBJECTIVES: To explore personal views of diabetic and non-diabetic women regarding their oral health and access to dental care. METHODS: A qualitative study was performed involving 6 diabetic and 6 non-diabetic female hospital attendees. A thematic framework approach was used to analyze the interviews. RESULTS: Responses yield three emerging central themes: oral health impact, self-maintained oral health and dental service delivery and costs. Personal views varied particularly in oral health self-perception and visiting the dentist. Certain drawbacks shadowed the quality of care in governmental and private sectors. Response variations were observed among diabetics and non-diabetics. CONCLUSION: Within the study limits, female hospital attendees had variable responses on how they looked upon their oral health. A variation in oral hygiene practices and visiting the dentist was observed. Participants believed that governmental and private clinics offered high quality care, with high treatment costs in private clinics and long waiting times in the public service being the main drawbacks. Practical Significance: Importance of supporting patients, educating practitioners and alarming policymakers about the impact of oral health problems and access to dental care.

Effect of Environmental Tobacco Smoke on Children's Anxiety and Behavior in Dental Clinics, Jeddah, Saudi Arabia: A Cross-Sectional Study.

BACKGROUND: Environmental tobacco smoke (ETS) has been linked to behavioral problems, but no study has assessed its relationship with dental anxiety. Therefore, this study's goal is to assess the relation between ETS and both behavioral problems and dental anxiety among children. METHODS: The study sample was collected from two centres in Jeddah from October 2019 to January 2020. Inclusion criteria included healthy 5-16-year-old children having their first dental visit with no emergency complaint. The questionnaire including general information, ETS exposure, the child's anxiety using the Abeer Children Dental Anxiety Scale (ACDAS) and dental behavior using the Frankl Behavioral Rating Scale. RESULTS: Of 500 children, 337 (67.4% response rate) responded to the questionnaire, among whom 201 (59.6%) had been exposed to passive smoking compared to 136 (40.4%) who had not. Exposed children had a statistically significantly greater tendency to develop anxiety (p = 0.002) and demonstrate uncooperative behavior (p = 0.006). Generalized linear mode and binary regression analyses suggested that ETS has a statistically significant effect on children's dental anxiety and behavior (p < 0.05). CONCLUSIONS: Children exposed to ETS demonstrated statistically significantly higher anxiety levels and uncooperative behavior in the dental clinic compared to those who were not exposed.

Assessment of Dental Decay in a Group of Children in Jeddah, Kingdom of Saudi Arabia.

AIM: The purpose of this research was to determine the prevalence, severity, and pattern of dental decay in 6-7-year-old youngsters in military elementary schools in Jeddah, Kingdom of Saudi Arabia. MATERIALS AND METHODS: The study included 312 youngsters randomly selected from eight elementary schools. Dental decay prevalence was determined by using dmft/dmfs/DMFT/DMFS indices according to the "British Association for the Study of Community Dentistry" diagnostic specifications. RESULTS: There was no statistically notable difference in the prevalence of decay between boys and girls (p = 0.54). There was a notable difference between the mean dmft and dmfs in primary teeth (p = 0.000). There was a notable increase in the prevalence of decay for permanent teeth in males when compared to females (p = 0.011). The mean DMFT in boys was notably higher than that in girls (p = 0.035). No notable difference was found between males and females in mean DMFS (p = 0.54). CONCLUSION: The prevalence of dental decay was high among the study sample. There is a vast need to reduce dental decay by increasing dental awareness for youngsters and their parents. CLINICAL SIGNIFICANCE: Age has an important role in evaluating decay prevalence and dmft/dmfs/DMFT/DMFS indices. On the basis of age, caries is prevalent in 6-7-year-old youngsters and the dmft/dmfs/DMFT/DMFS indices resulted in high values. HOW TO CITE THIS ARTICLE: AL-Malik M, AlKattan H, ALBukhari L, et al. Assessment of Dental Decay in a Group of Children in Jeddah, Kingdom of Saudi Arabia. Int J Clin Pediatr Dent 2019;12(5):423-428.

Gingival hyperplasia in hyaline fibromatosis--a report of two cases.

Hyaline fibromatosis is a rare inherited autosomal recessive disorder affecting connective tissue, characterized by an accumulation of hyaline material in the skin and other organs. This paper reports the oral findings of two cases of hyaline fibromatosis referred to our dental clinic due to extensive overgrowth of gingival tissue in the oral cavity that affected their eating and breathing. One patient was diagnosed with infantile systemic hyalinosis while the other was diagnosed with juvenile hyaline fibromatosis. Both cases showed similar clinical and histopathological findings, but one patient exhibited a more severe form of the disease, therefore it is difficult not to consider them as part of the same disorder. Children with such conditions have special dental needs, thus early dental consultation is important to begin caries prevention measures and dental therapy. No known therapy exists for hyaline fibromatosis. Currently, the only treatment is surgical excision of the lesions to improve esthetics and function.

Pattern of management of oro-facial infection in children: A retrospective.

BACKGROUND: The purpose of this study was to determine the distribution and management of orofacial infection in children treated at one of the major hospitals in Jeddah City, Saudi Arabia over a 12-month period during the year 2014. METHODS: Data from the clinical records of 94 children (33 girls, 61 boys; aged 2-14 years) who presented for treatment of orofacial infection at the emergency dental department of the military hospital in Jeddah during a 12-month period. Patients were treated with antibiotic therapy. A favorable outcome was determined based on length of hospital stay. RESULTS: The results indicated that the most common cause of odontogenic infection in Saudi children was dental caries (88%). The primary posterior teeth (84%) were considered to be a major source of infection. The most commonly affected teeth were the primary first molars (34%), followed by the primary second molars (31%). Six children were hospitalized; four of these stayed less than 4 days, which was considered a short hospital stay. The most common treatment was antibiotics as 93% received a type of antibiotic. CONCLUSIONS: The most common cause of odontogenic infection was dental caries which has been treated with antibiotic prescription and dental procedures.

Prevalence of dental caries, severity, and pattern in age 6 to 7-year-old children in a selected community in Saudi Arabia.

AIMS: The aim of this study was to determine the prevalence, severity, and pattern of dental caries in 6 to 7-year-old children in military primary schools in Jeddah city, Saudi Arabia. METHODS AND MATERIALS: A random sample of 300 children (6 to 7-year-olds) was drawn from six schools of military dependents. Clinical examinations were carried out under standardized conditions by two trained and calibrated examiners (MAM) and (YR). Caries were diagnosed using the British Association for the Study of Community Dentistry (BASCD) criteria. RESULTS: Caries were diagnosed in 288 (96%) of the children, and only 4% were clinically caries free. Mean decayed, missing, and filled teeth (dmft) for the 300 children was 8.06 (+ 4.04) per child and mean decayed, missing, and filled surfaces (dmfs) was 23.18 (+ 15.64). The teeth most affected by caries were mandibular primary second molars (83.35%), and the least affected were mandibular primary central incisors (1.15%). CONCLUSIONS: The level of caries was higher than seen in children of equivalent age in other studies. The level of caries is expected to increase in permanent dentition. The above findings stress the need for an effective program of oral prevention in these children, such as a school dental health education program for children and their parents in order to improve their oral health status.

Comprehensive dental care of pediatric patients treated under general anesthesia in a hospital setting in Saudi Arabia.

The aims of this study were to determine the characteristics of patients and type of dental treatment carried out using dental general anesthesia (DGA) during two years in a following three year period. A total of 182 patients received treatment between 1999 and 2001. The mean age was 4.9 years. The main indication for DGA was behavior management problems. Complete oral rehabilitation including complex restorative treatment and extractions was provided under DGA at a single visit. Failure to return for recalls was common; 83% of patients returned for the post-operative recall but only 26% after a three year period. Most of the patients requiring further treatment accepted it in the dental chair. Only one patient received a second DGA during the three years following treatment.

Oral manifestations of juvenile hyaline fibromatosis: a case report.

Hyaline fibromatosis is a rare autosomal recessive disease of connective tissue, characterised by an accumulation of hyaline in the skin as well as various organs. The clinical features include: multiple cutaneous nodules, joint contractures, osteolytic lesions and gingival hypertrophy. This paper reports the case of an 11-year-old boy, who was referred to our dental clinic complaining of pain in his mouth. On examination, the patient had gross maxillary and mandibular gingival hyperplasia, which caused severe feeding difficulties. He also had severe dental decay, mal-positioned teeth and limited mouth opening. Treatment was done under general anesthesia to remove excess gingival tissue and extract the severely decayed teeth. Histological examination confirmed the diagnosis of juvenile hyaline fibromatosis. It was concluded that patients with this condition have special dental needs. Early diagnosis of the affected children is important in order to start early preventive dental therapy.

Erosion, caries and rampant caries in preschool children in Jeddah, Saudi Arabia.

OBJECTIVES: The objective of this study was to determine the prevalence of dental erosion in preschool children in Jeddah, Saudi Arabia, and to relate this to caries and rampant caries in the same children. METHODS: A sample of 987 children (2-5 years) was drawn from 17 kindergartens. Clinical examinations were carried out under standardised conditions by a trained and calibrated examiner (M.Al-M.). Measurement of erosion was confined to primary maxillary incisors and used a scoring system and criteria based on those used in the UK National Survey of Child Dental Health. Caries was diagnosed using BASCD criteria. Rampant caries was defined as caries affecting the smooth surfaces of two or more maxillary incisors. RESULTS: Of the 987 children, 309 (31%) had evidence of erosion. For 186 children this was confined to enamel but for 123 it involved dentine and/or pulp. Caries were diagnosed in 720 (73%) of the children and rampant caries in 336 (34%). The mean dmft for the 987 children was 4.80 (+/-4.87). Of the 384 children who had caries but not rampant caries, 141 (37%) had erosion, a significantly higher proportion than the 72 (27%) out of 267 who were clinically caries free (SND=2.61, P<0.01). Of the 336 with rampant caries, 96 (29%) also had evidence of erosion. CONCLUSIONS: The level of erosion was similar to that seen in children of an equivalent age in the UK. Caries was a risk factor for erosion in this group of children.

Prevalence and patterns of caries, rampant caries, and oral health in two- to five-year-old children in Saudi Arabia.

PURPOSE: The aim of this study was to determine the prevalence, severity, and pattern of dental caries, as well as the prevalence of rampant caries in preschool children in Jeddah, Saudi Arabia and to relate this to socioeconomic factors, diet, and oral hygiene practices. METHODS: A random sample of 987 children was drawn from 17 nursery schools. RESULTS: Caries were diagnosed in 720 (73%) of the children: 256 (26%) of the children had caries confined to posterior teeth, 54 (6%) had caries only in anterior teeth, and in 382 (39%) both tooth types were affected. Forty-eight children (5%) had caries only in incisors. Rampant caries was diagnosed in 336 (34%). Mean dmft for the 987 children was 4.80 (+/- 4.87) per child and mean dmfs 12.67 (+/- 15.46). Caries and rampant caries were related to social class. CONCLUSIONS: There was little evidence of differing patterns of caries having clearly defined etiology.

Oral injuries in children attending a hospital in Saudi Arabia.

AIMS: To determine the occurrence, causes, types and severity of oral trauma and the time elapsed until seeking dental care in children seen in a hospital in Jeddah, Saudi Arabia. MATERIALS AND METHODS: Data included all cases of oro-facial trauma for children aged 17 years and younger who presented at the emergency and dental departments of the hospital during a 12-month period. RESULTS: A number of 112 patients with traumatic oral injuries visited the hospital during this period. 79 were males and 33 were females. The highest frequency of injury was seen in 9-11 year old children. The most common cause of trauma was due to falls (68%). Most of the dental injuries occurred in the street (57%). The most common types of injury were luxation injuries and complicated crown fractures. Maxillary teeth were more affected than mandibular teeth. Maxillary central incisors were found to be the most affected teeth. 51 patients had soft tissue injuries and 13 patients had facial bone fractures. The largest number of injuries presented on the same day for treatment (70%) or 1 day after (36%). CONCLUSION: From the data this study population showed trends and comman cases of paediatric traumatic oral injuries senn in a major hospital in saudi Arabia.The study helpred us in improving awarness regarding the oral injuries and importance of minimizing its complication through educational programs.