Hygiene practices and antibiotic resistance among dental and medical students: a comparative study.

PURPOSE: Healthcare students' hand and smartphone hygiene is critical due to potential pathogenic and antibiotic-resistant bacteria transmission. This study evaluates hygiene practices in medical and dental students at Kuwait University, exploring antibiotic resistance gene prevalence. METHODS: Swab samples were collected from the hands and smartphones of 32 medical and 30 dental students. These samples were cultured on Columbia Blood Agar and McConkey Agar plates to quantify bacterial colony-forming units (CFUs). The extracted DNA from these colonies underwent RT-PCR to identify antibiotic resistance genes, including tem-1, shv, blaZ, and mecA. Additionally, a questionnaire addressing hygiene practices was distributed post-sample collection. RESULTS: Medical students exhibited more frequent hand hygiene compared to dental students (P ≤ 0.0001). Although significantly fewer bacterial CFUs were found on medical students' smartphones (mean = 35 ± 53) than dental students' (mean = 89 ± 129) (P ≤ 0.05), no significant differences were observed in CFU counts on their hands (medical: mean = 17 ± 37; dental: mean = 96 ± 229). Detection of at least one of the targeted antibiotic resistance genes on medical (89% hands, 52% smartphones) and dental students' (79% hands, 63% smartphones) was not statistically significant. However, the prevalence of two genes, tem-1 and shv, was significantly higher on medical students' hands (78% and 65%, respectively) than on dental students' hands (32% and 28%, respectively). CONCLUSION: Clinically significant prevalence of antibiotic resistance genes were found on medical and dental students' hands and smartphones, emphasizing the importance of ongoing education regarding hand hygiene and smartphone disinfection. This continuous reinforcement in the curriculum is crucial to minimizing the risk of cross-contamination.

Salivary fluoride concentration following toothbrushing with and without rinsing: a randomised controlled trial.

BACKGROUND: Caries prevalence has declined significantly since the introduction of fluoridated toothpaste. There have been several developments regarding specific active fluoride ingredients but not enough evidence to support one over the other. The purpose of this double-blind randomized controlled trial was to compare salivary fluoride concentrations of different fluoride formulations in the form of toothpaste with and without post-brushing water rinsing in adults. METHODS: The study included 120 participants who were randomly assigned to one of 12 groups (10 participants/group). The toothpaste formulas investigated included (1) fluoride-free (0 ppmF); (2) sodium fluoride (1450 ppmF); (3) sodium monofluorophosphate (1450 ppmF); (4) sodium fluoride and monofluorophosphate combined (1450 ppmF); (5) stannous fluoride and sodium fluoride combined (1450 ppmF); and (6) amine fluoride (1400 ppmF). Block randomisation was used to assign each participant to one of the 12 groups. Participants brushed with 1.0 g of one of the six different toothpaste formulations either with or without post-brushing water rinsing. Saliva was collected at six different times (baseline and at 1, 15, 30, 60, and 90 min/s post-brushing). Samples were analysed using a fluoride ion-specific sensitive electrode connected to an ion analyser. RESULTS: The demographic characteristics of the participants were not significantly different among the groups (P > 0.05). Time, toothpaste formulation, and post-brushing rinsing routines had significant effects on saliva fluoride retention (P < 0.05). Amine fluoride-containing toothpaste was the only formula that showed statistically significantly higher concentrations of salivary fluoride at 90 min in both the rinsing and non-rinsing groups. Sodium monofluorophosphate toothpaste did not result in a significant difference compared to the control group at any time point, in both rinsing and non-rinsing groups. CONCLUSIONS: Based on the results from this study, no rinsing after toothbrushing in adults can be recommended when sodium monofluorophosphate containing toothpaste formula is used. It also concludes that amine fluoride resulted in a significantly higher saliva fluoride concentration at 90 min in both the rinsing and non-rinsing groups compared to other fluoride toothpaste formulations. Registry: Protocol Registration and Results System (ClinicalTrials.gov). CLINICAL TRIAL REGISTRATION NUMBER: NCT02740803 (15/04/2016).

Evaluation of a Technique for Reducing Chairside Occlusal Adjustment of Crowns.

PURPOSE: To assess whether the occlusion of metal-ceramic crowns, as received from the laboratory, and the time taken to adjust the occlusion of crowns not deemed acceptable, can be reduced by fabricating the crowns with controlled amounts of infra-occlusion during the laboratory phase. MATERIAL AND METHODS: An opposing set of typodonts, articulated in maximum intercuspal position served as the patient in an in vitro simulation. Seventy-five metal-ceramic crowns were fabricated for the mandibular right second molar with three different occlusal contact specifications: A, control group had occlusal contacts shared evenly by the crown and the neighboring teeth (n = 25); B, first experimental group had the occlusion relieved until 2 shimstock foils were able to be pulled from between the crown and the opposing tooth without tugging (n = 25); C, second experimental group had the occlusion relieved until 4 shimstock foils were able to be pulled from between the crown and the opposing tooth without tugging (n = 25). The occlusion of each crown, as received from the laboratory, was assessed using one of three categories (Excellent, Acceptable, and Poor). Chi-square analysis was used to test the differences in occlusal outcomes between the three study groups. For all of those rated "Acceptable," the time taken to adjust each crown to proper occlusion was recorded. One-way analysis of variance (ANOVA) and Bonferroni tests were carried out to compare the adjustment times across the three study groups. RESULTS: The 2-shim group had the best outcome, with 56% of the crowns rated as "Excellent" (p = 0.001). In addition, there were statistically significant differences in adjustment times between the control group (A) and the 2-shim (B) and the 4-shim (C) groups (p = 0.0001), but not between the 2-shim (B) and 4-shim (C) groups (p = 0.08). CONCLUSIONS: Metal-ceramic crowns fabricated with controlled interocclusal relief of 2- and 4-shims each required less time for chairside occlusal adjustment than crowns fabricated in the laboratory to conventional occlusal contact. However, the overall superior outcome, in terms of the possibility for immediate insertion as received from the laboratory as well as favorable chairside adjustment time, for the 2-shim prespacing suggests that this dimension is the preferred option over 4-shim prespacing to reduce occlusal inaccuracies of indirect restorations.

Prevalence and severity of traumatic dental injuries among young amateur soccer players: A screening investigation.

BACKGROUND/AIMS: Traumatic dental injuries (TDI) are prevalent among soccer players. In Kuwait, no studies of TDI among soccer players have been carried out. The aim of this study was to investigate the prevalence, type and causes of soccer-related traumatic dental injuries among 7-18-year-old amateur soccer players. METHODS: All amateur soccer players who were registered in the 14 sports clubs in the country were invited to participate in this screening study. Players who were present in the club on the assigned examination day were included. The players were examined by two trained and calibrated paediatric dentists for signs of injury to the oral tissues. Injury diagnosis was made according to the Andreasen (2007) epidemiological dental injury classification. The history of any dental injury present at the time of examination was recorded. The timing and nature of any dental advice or treatment sought was also noted. RESULTS: Six hundred sixty-seven (48% inclusion rate) male players were included (mean age of 13.4 ± 2.6 years). In total, 213 injured teeth were observed among 169 (25%) players. The prevalence of soccer-related injuries was 11%, and a greater number of injuries were observed in older players. Maxillary central incisors were the most frequently injured teeth (91%), and enamel-only fractures represented 60% of all injured teeth. Slightly more TDIs were soccer-related (44%) compared to non-soccer-related injuries (39%), and a large number of TDIs (39%) occurred inside the sports clubs. The prevalence of reported soft-tissue injuries was 18%. The majority of the players (75%) did not receive dental care for their injuries. CONCLUSIONS: A significant number of young Kuwaiti amateur soccer players suffered TDIs. In addition, a high percentage of traumatic injuries were not treated, and there was a lack of the use of protective mouthguards.

The impact of ICDAS on occlusal caries treatment recommendations for high caries risk patients: an in vitro study.

BACKGROUND: The diagnostic criteria and tools used in caries lesion detection have been shown to affect the decision-making for caries treatment. Compared to other diagnostic criteria/classifications, ICDAS has been shown to provide a more accurate method for the detection of occlusal caries lesions. The influence of using ICDAS on caries treatment recommendations has received increasing attention in recent years. Therefore, the aim of this study was to assess the impact of ICDAS on dentists' occlusal caries lesions' treatment decisions for patients at high risk for caries. METHODS: Five dentists examined the occlusal surfaces of 270 extracted premolars and permanent molars. For a predetermined clinical scenario, the examiners were asked to indicate their treatment recommendations for each tooth. Four weeks later, all the examiners were trained and calibrated for the use of ICDAS. Then the investigators examined the same 270 teeth independently and indicated their treatment recommendations using the same clinical scenario. Histological validation was used to determine the caries lesions detection performance of the examiners using ICDAS and to assess the relationship between the presence of dentin caries and treatment recommendations for each examiner before and after ICDAS training. Specificity, sensitivity, area under the receiver operating characteristic curve (AUC), and Spearman's correlation coefficients were calculated. The Wilcoxon two-related sample rank test was used to test for differences between treatment recommendations. RESULTS: The strongest correlation for inter-examiner reproducibility was found between the ICDAS D2 cut-off point (ICDAS codes 3-6 as dentin caries) and histologic dentin caries. Treatment recommendations among different examiners before and after ICDAS training demonstrated a statistically significant increase in operative intervention and an increase in the percentage of overtreatment recommendations for two examiners. CONCLUSIONS: The impact of ICDAS on the examiners' caries lesion treatment recommendations varied among the dentists in this study. Treatment decision-making can be influenced by the caries lesion's detection and classification system used.

Optimal outcomes of pulpotomy in young patients: Long-term prospects for permanent molars with signs and symptoms indicative of irreversible pulpitis.

OBJECTIVES: Limited literature addresses the long-term success of complete pulpotomy in permanent molars with signs of irreversible pulpitis in young patients. The aim of this observational study was to prospectively evaluate the long-term outcomes of complete pulpotomy using mineral trioxide aggregate (MTA) over an average period exceeding 11 years. METHODS: Out of 27 molars displaying signs suggestive of irreversible pulpitis which underwent MTA pulpotomy, 24 molars were followed-up for a mean duration of 11.0 ± 2.2 years (range 8.2 to 14.8 years). Clinical and radiographic assessments were periodically conducted, tailored to each patient's specific circumstances. Treatment failure criteria included clinical signs and symptoms and radiographic evidence suggesting a lack of pulpal or periapical healing. RESULTS: 83 % of molars had signs and symptoms of symptomatic irreversible pulpitis, with 83 % displaying apical periodontitis. Clinically and radiographically, all pulpotomies (100 %) were considered successful. A hard tissue barrier was observed in 71 % of teeth, and continued root maturation was evident in all molars with open apices. Complete pulp canal obliteration (PCO) was present in 21 % of the molars. All radiographic apical radiolucencies completely resolved. CONCLUSIONS: This study demonstrates a 100 % success rate over an average 11-year follow-up for complete pulpotomy in managing permanent molars with signs and symptoms of irreversible pulpitis in young patients. It offers evidence for its long-term efficacy in promoting healing of pulp and periapical tissues. CLINICAL SIGNIFICANCE: This study showed high long-term success for complete pulpotomy in young permanent molars with irreversible pulpitis, with clinical and radiographic success over 11 years. Despite initial symptoms of pulpitis and apical periodontitis, the treatment resulted in tissue healing, root maturation, and resolution of periapical radiolucencies, suggesting it as an alternative to root canal therapy.

Evaluating color stability and enamel surface roughness following resin infiltration treatment.

OBJECTIVE: To assess the impact of resin infiltration treatment on enamel color stability and surface roughness after simulating daily exposure to coffee stains and regular toothbrushing with standard toothpaste. MATERIALS AND METHODS: In this in vitro study, we utilized 47 caries-free human enamel specimens, which were divided into two distinct groups. The teeth in the study group underwent artificial demineralization, Icon resin infiltration, and polishing, while the control group received only polishing. Following this, all teeth from both groups were regularly immersed in freshly brewed coffee for 15 min, twice daily, over a span of 30 days. After each staining session, the teeth underwent 10 heavy circular strokes using a soft toothbrush and standard toothpaste. Color changes were measured on Days 1 and 30 using a spectrophotometer. The L*, a*, b* color system defined by the International Commission on Illumination was used to assess the changes. Surface roughness was evaluated at baseline and after 30 days using a 3D surface Metrology Microscope. RESULTS: After 30 days of immersion in coffee, both the study and control groups showed significant changes in color. However, differences were statistically significant between groups for "L" and "a" parameter but not for "b." The overall color change in the study group was higher than the control group. There were no significant differences in surface roughness within or between the groups before and after staining and brushing. CONCLUSIONS: Resin infiltration leads to a significant increase in staining compared to untreated enamel. These staining properties should be taken into account when making clinical decisions regarding the treatment of white spot lesions.

Management Thresholds for Molars With Occlusal Noncavitated Caries Lesions.

AIM: There is sparse research on the effect of factors related to the dentist and patient in the caries management decision-making process. This in vitro study explored the influence of factors related to dentists and patients on the management decision of occlusal noncavitated caries lesions in children. MATERIALS AND METHODS: Five investigators in the specialties of dental public health (DPH), paediatric, prosthetic, and operative dentistry and a general dentist (GDP) participated in this study. Initially, the investigators were asked to independently assess the occlusal surfaces of 175 noncavitated permanent molars and choose a management recommendation using 2 caries risk patients' scenarios. After 1 month, investigators were trained and calibrated to use the International Caries Detection and Assessment System (ICDAS) scoring system. Then, they examined the same teeth, recorded the highest/worst ICDAS score, and chose a management recommendation. Two weeks later, the investigators repeated the teeth examination using magnification loupes and again chose a management recommendation. The teeth were sectioned to study the relationship between the presence of caries and the management recommendations. RESULTS: For the low- and the high-caries risk scenarios, ICDAS training increased the operative intervention by 20% to 27% and 14% to 22%, respectively, for both the GDP and the paediatric dentist (P < .0001). For the low-caries risk scenario, using the magnifying loupes increased the operative recommendations for the DPH, GDP, and the operative dentist by 5% to 23% (P < .05). Compared to the low-caries risk scenario, teeth for patients with high caries risk received more surgical interventions (9%-30%) at all examination conditions for the GDP and the paediatric and operative dentists (P < .0001). CONCLUSIONS: For occlusal noncavitated caries lesions, enhancing dentists' caries detection skills had a significant impact on decisions of surgical intervention. This also influenced the appropriateness of the treatment recommended for the different caries risk groups.

In vitro investigation of the impact of contemporary restorative materials on cariogenic bacteria counts and gene expression.

OBJECTIVES: The aim of this study was to compare the antibacterial effect of different fluoride-containing and bioactive restorative materials, and their effect on the expression of specific biofilm-associated genes and therefore the caries process. MATERIALS AND METHODS: The restorative materials utilized in this study included: 1. Filtek Z250, 2. Fuji II LC, 3. Beautifil II, 4. ACTIVA, and 5. Biodentine. For each material, disc-shaped specimens were prepared. The inhibitory effects against Streptococcus mutans, Lactobacillus acidophilus, and Leptotrichia shahii were tested. After incubation for 24 h and 1 week, colony-forming units (CFUs) were enumerated. From the plates dedicated for biomass quantification and RNA purification, the target glucosyltransferase B (gtfB) and glucan-binding protein B (gbpB) genes were chosen for S. mutans. For L. acidophilus, a gene involved in exopolysaccharide synthesis (epsB) was chosen. RESULTS: Except for Filtek Z250, all four materials showed statistically significant inhibitory effects on the biofilms of all three species. When biofilms were grown in the presence of the same four materials, the expression of S. mutans gtfB and gbpB genes, was significantly reduced. For L. acidophilus, the decrease in the expression of gtfB gene in the presence of ACTIVA was the highest change seen. The epsB gene expression also decreased. Compared to fluoride-releasing materials, bioactive materials had more inhibitory effect against L. acidophilus, both at 24 h and 1 week. CONCLUSIONS: Both fluoride releasing and bioactive materials exhibited a significant inhibitory effect on the biofilm growth. The expression of the targeted biofilm-associated genes was downregulated by both material groups. CLINICAL SIGNIFICANCE: The findings from this study give insight into the antibacterial effect of fluoride-containing and bioactive materials which would help to reduce the chances for secondary caries and therefore increase the lifetime of dental restorations placed for patients.

Association between the caregivers' oral health literacy and the oral health of children and youth with special health care needs.

AIM: Previous studies have shown that children of caregivers with low oral health literacy (OHL) had more untreated caries than children of caregivers with adequate OHL. However, there is a paucity of information on this relationship among children and youth with special health care needs (CYSHCN). Accordingly, this study aims to assess the association between the caregivers' OHL and the oral health status of CYSHCN. METHODS: This cross-sectional study was conducted in four schools dedicated for CYSHCN. A 48-item questionnaire gathered information about the demographic and socioeconomic factors, the child/adolescent's medical condition, dental characteristics, caregiver self-efficacy and the child's dental attitude. The Comprehensive Measure of Oral Health Knowledge (CMOHK) questionnaire was used to assess the caregivers' OHL. The Löe & Silness gingival index (GI) and the Silness & Löe plaque index (PI) were used to assess gingival health and plaque levels, respectively. Directed acyclic graphs (DAGs) were utilized for the selection of the appropriate set of confounding variables for regression analysis. The mean score differences and 95% confidence intervals (CI) were estimated to quantify the associations of the various covariates with oral health outcome variables. RESULTS: This study included 214 child/caregiver dyads. Most participants were physically disabled (56.1%) followed by children with hearing difficulty (9.8%) and congenital anomalies/syndromes (7.9%). The mean PI and GI of the children was 1.26±0.52 and 1.30±0.47, respectively. The median CMOHK score was 12 and the respondents were dichotomized based on the median value. Low caregiver oral health conceptual knowledge was significantly associated with higher PI scores (ß [95% CI] = -0.26 [-0.41, -0.13]; p<0.001. Older participants (12-21-year-olds) had significantly higher plaque scores compared with younger participants (6-12-year-olds) (ß [95% CI] = 0.33 [0.18, 0.51]; p<0.001). Participants who brushed their teeth twice or more daily had significantly lower (ß [95% CI] = -0.15 [-0.43, -0.01]; p = 0.046). Conceptual knowledge score was not significantly associated with GI. CONCLUSION: This study found lower caregiver OHL levels to be associated with higher plaque scores for their child.

Clinical extension of proximal carious lesions compared to bitewing radiographs using photostimulable phosphor plates (PSP).

OBJECTIVES: The aim of this study was to evaluate the use of digital bitewing radiographs using photostimulable phosphor (PSP) plates in the estimation of the true extension of proximal carious lesions. METHODS: The sample size was calculated to be 70 teeth. Adult patients with a minimum of one posterior tooth with primary proximal caries lesions were included. A preoperative bitewing radiograph was taken and the extension of the carious lesion was measured from the most prominent point on the adjacent sound tooth to the deepest axial point of the lesion. An experienced general dentist provided the restorative treatment and made a polyvinyl siloxane impression of the cavity preparation. Clinical caries extension was measured from the most prominent point of the adjacent tooth until the deepest boundary of the axial wall of the preparation on the impression. Postoperative radiographs were taken at the completion of restorative care. The bitewing radiographs were done using PSP plates and caries extension measurements were performed using measuring tools of the digital radiography software. Pairwise comparisons were made between preoperative and postoperative radiographs, and the true clinical depth measurements using paired t-tests. RESULTS: In total, 73 teeth from 44 subjects were included. A significant difference of 0.82 mm was found between preoperative radiographs and clinical measurements (p<0.001). Similarly, comparisons between preoperative and postoperative radiographic measurements showed significant differences of 0.99 mm (p<0.001). CONCLUSIONS: The study found that the true clinical extension of proximal caries after non-selective caries removal was significantly deeper than the preoperative radiographic extension assessment. This was not influenced by the tooth type, the location of the tooth, or the affected tooth surfaces. CLINICAL SIGNIFICANCE: When a non-selective caries removal strategy is adopted, clinicians should be aware that PSP bitewing radiographs underestimate the true clinical extension of proximal caries lesions. This will have an impact on clinicians' practice and restorative treatment decisions.

Dental age estimation: Development and validation of a reference data set for Kuwaiti children, adolescents, and young adults.

OBJECTIVES: This study was designed to establish a Reference Data Set for Dental Age Estimation of young Kuwaiti subjects. DESIGN: Dental Panoramic Tomographs of 1393 Kuwaiti children, adolescents, and young adults aged between 3 and 26 years were re-used to establish a Reference Data Set. The Tooth Development Stages described by Demirjian et al. in 1973 was used to assess all the teeth on the left side of the Maxilla and the Mandible. The Accuracy and Precision of Dental Age Estimation for Kuwaiti children and adolescents was investigated by calculating the age of children using 50 females and 50 males of known age separate from the main study sample. This was the Validation Sample. Summary data for the individual Tooth Development Stages, comprising the number, mean, and standard deviation were used to estimate the age of the subjects in the Validation Sample using the Simple Average Method to calculate the Dental Age. RESULTS: There was no statistically significant difference between the Chronological Age and the Dental Age in males with a mean difference of 0.14 years (1.75 months). The difference in females was significant at -0.33 years (-4.1 months). CONCLUSIONS: These data demonstrate that estimated Dental Age in Kuwaiti females is close, just over 4 months, and is very close, in males within 1.75 months of the Chronologic Age.

Dental plaque microbiota profiles of children with caries-free and caries-active dentition.

OBJECTIVE: Microbiota comparisons between healthy and diseased dental tissues have accentuated the importance of cultivating and identifying bacterial species that play a role in the initiation and progression of dental caries. The objective of this study was to evaluate the bacterial community composition in caries-active and caries-free children. METHODS: Supragingival plaque samples were collected from 64 caries-active and 64 caries-free Middle Eastern children. The hypervariable V3-V4 of the bacterial 16S rRNA gene was sequenced with Human Oral Microbe Identification using Next Generation Sequencing. Microbial community structure and composition analyses were performed by processing operational taxonomic units. Bioinformatic analyses, including analysis of similarity, alpha and beta diversities, and principal coordinate analysis, were carried out. RESULTS: Diversity indices did not find differences between the caries-active and caries-free groups (p > 0.05). Similarity analysis demonstrated that the microbiota composition did not differ between the two groups. Comparative analysis at the species level revealed a significantly higher relative abundance of Leptotrichia shahii, Prevotella melaninogenica, Veillonella dispar, Leptotrichia HOT 498, and Streptococcus mutans in caries-active children (p < 0.05). Corynebacterium matruchotii, Lautropia mirabilis, Neisseria elongata, and Corynebacterium durum were relatively more abundant in the caries-free group (p < 0.05). Species belonging to the Leptotrichia, Prevotella, and Veillonella genera were significantly predominant in the caries-active subjects. CONCLUSION: In view of the lack of a clear association between Corynebacterium spp. and dental caries status in the literature, the predominance of these species in caries-free children warrants further research to understand their possible role in a health-associated microbial community. CLINICAL SIGNIFICANCE: Understanding the relationship between specific bacteria present in dental biofilms and health and disease is essential for preventing and combating dental caries. Using advanced next generation sequencing techniques, the present study demonstrated the complexity of the caries microbiome and identified species/genera whose virulence or protective properties should be further explored.

Prevalence of traumatic dental injuries in preschool children in Kuwait - a screening study.

AIMS: This is the first study in Kuwait to determine the prevalence, etiology, classification of trauma, teeth involved, place of injury and treatment received after dental trauma in preschool children. MATERIAL AND METHODS: A total of 500 preschool children presenting at a dental screening day in all governorates of Kuwait were clinically examined for signs of trauma to their primary teeth. The parents were then interviewed and a prevalidated questionnaire was completed with the demographic data of the participant and history of the dental trauma. RESULTS: A total of 243 (48.6%) males and 257 (51.4%) females were screened. The age range was 2-6 years (mean age of 4.31 +/- 1.03 years). Fifty-six children (68 teeth) suffered trauma to their primary teeth making a prevalence of 11.2%. Majority of dental traumas occurred at home (n = 49, 87.5%) followed by at street (n = 4, 7.1%) and at school (n = 3, 5.4%). The most common reason of oral trauma was falls (n = 53, 94.6%).The most commonly affected tooth was the maxillary right primary central incisor (n = 29, 42.6%) followed by the maxillary left primary central incisor (n = 26, 38.2%). There were 20 teeth with enamel fractures (29.4%), 18 teeth had enamel- dentin fractures (26.5%) and 10 teeth had complicated crown fractures (14.7%). There were 17 luxated teeth (25%) and only three primary teeth (4.4%) were avulsed. The only statistically significant relation found in this study was between the type of trauma and the type of the treatment provided. Of the traumatized teeth, 23 (33.8%) did not receive any type of dental or medical care. CONCLUSION: In spite of the low prevalence of dental trauma in Kuwaiti preschool children, it is highly recommended to plan a community wide trauma prevention campaign targeting parents, children and medical/dental care providers.

Dental age assessment for Kuwaiti children using Demirjian's method.

BACKGROUND: Dental age can be estimated based on the level of tooth mineralization during the developmental process. Various methods of determining chronological and radiographical stages have been used for dental age estimation. AIM: To test the validity of the standards of dental maturation of Demirjian and Goldstein (Ann Hum Biol 3:411-421, 1976) when applied to Kuwaiti children. SUBJECTS AND METHODS: The sample was selected from healthy Kuwaiti children attending the routine and emergency dental clinics of the Faculty of Dentistry, Kuwait University. Good quality rotational pantomographs were obtained for 509 children (263 girls and 246 boys) between 3 and 14 years. Maturation of the seven permanent teeth on the left side of the mandible was determined according to the crown and root development stages described by Demirjian et al. (Hum Biol 45:211-227, 1973). RESULTS: There were statistically significant differences in the mean of dental maturation between Kuwaiti and French-Canadian children (p<0.0001). Kuwaiti children were dentally delayed compared to the Canadian standards (mean dental maturation difference of 0.69 year, SD=1.25 years, CI=0.58-0.80). The mean delay in girls was 0.67 year (SD=1.30 years, CI=0.51-0.83) and in boys it was 0.71 year (SD=1.18 years, CI=0.56-0.86). Using a non-linear regression model, function formulae were developed for Kuwaiti girls and boys. CONCLUSION: The standards of dental maturation described by Demirjian and Goldstein (1976) may not be suitable for Kuwaiti children.

Knowledge, Attitude, and Barriers to Fluoride Application as a Preventive Measure among Oral Health Care Providers.

OBJECTIVE: To investigate the knowledge, attitude, and possible barriers to fluoride application among oral health-care providers in Kuwait. METHODS: A validated self-administered questionnaire was distributed to a random sample of 291 dentists. The questionnaire included four categories: dentists' characteristics, knowledge of and attitude towards fluoride application, factors influencing decision-making on prescription of fluoride, and the clinician's perception of own knowledge. Means, group differences, and logistic regression were calculated. RESULTS: 262 completed the questionnaire (response rate of 90%). Half of the participants (49%) reported that water fluoridation is the best method for caries prevention in children. Majority of the participants (80%) acknowledged that topical fluoride prevents dental caries, but only 40% frequently use it in their practices. Fear of overdose was a concern in 57% of the participants. About 31% believed that caries is a multifactorial disease and cannot be prevented. In addition, 32% of the dentists who thought caries is multifactorial and cannot be prevented stated that restorations take precedence over preventive therapy. CONCLUSION: Despite the participants being in favor of topical fluoride application and believing in its effectiveness, certain barriers were apparent such as knowledge deficiencies, products labelling flaw, and lack of participation in effective continuing educational activities.

Stress Level of Dental and Medical Students: Comparison of Effects of a Subject-Based Curriculum versus a Case-Based Integrated Curriculum.

The aim of this study was to investigate the stress level of medical and dental students at Kuwait University after a case-based integrated curriculum replaced the former subject-based curriculum. A modified version of the Dental Environment Stress questionnaire was used to measure possible stressors for both medical and dental students. The investigators administered the questionnaire for the first time in 2008, when Kuwait University medical and dental schools followed a subject-based curriculum (group A). The same questionnaire was administered for a second time in 2014, when both medical and dental schools had adopted a case-based integrated curriculum (group B). A total of 345 fifth- and sixth-year medical and dental students responded to the questionnaire (group A=187, group B=158), with an overall 83% response rate. The results showed that, for both the dental and medical students, changing to a case-based integrated curriculum raised the stress level for most of the stressors evaluated. "Inconsistency of feedback on work between different instructors," "difficulties in communicating with teaching staff," "amount of assigned class work," and "examinations and grades" were some of the statistically significant stressors for group B students. Female students reported higher levels of stress than male students in both groups. These results suggest that introducing stress management education into the case-based integrated dental and medical curricula could enhance students' psychological well-being.

Infection control knowledge and practices among dentists and dental nurses at a Jordanian University Teaching Center.

BACKGROUND: Information regarding compliance with infection control precautions in the dental settings in the Middle East is scant. OBJECTIVE: To examine the knowledge and practices in infection control among dental staff and dental nurses at a university teaching dental center. METHODS: A self-administered, confidential questionnaire concerning various aspects of infection control knowledge and practices was distributed to 48 dental staff and 28 dental nurses working at the Jordan University of Science and Technology Dental Teaching Center. RESULTS: Responses came from 37 (77%) dental teaching staff members and 23 (82%) dental nurses. Of the dental staff participants, 95% received hepatitis B immunization in comparison with 87% of the dental nurses. Dental nurses were more prone to percutaneous dental injuries (P < .05). In both groups, 100% reported routine wearing of gloves. Although the dental staff reported a statistically higher frequency of washing hands before gloving (46%), dental nurses reported a higher frequency of washing hands after removing the gloves (100%). Dental staff reported statistically higher frequency of routine mask use (43%) than dental nurses (30%). CONCLUSION: Compliance with recommended guidelines for control of cross infection varied among the 2 tested groups. A need exists for proper practice of infection control by both dental staff and dental nurses.

Variables affecting the inter- and intra-examiner reliability of ICDAS for occlusal caries diagnosis in permanent molars.

OBJECTIVES: The aims of this study were to assess the validity and reproducibility of the International Caries Detection and Assessment System (ICDAS) in detecting occlusal caries in permanent molars and to investigate variables that can affect the reproducibility of ICDAS. METHODS: Five experienced, trained, and calibrated investigators examined the occlusal surfaces of 142 extracted permanent molars, ranging from sound to cavitated dentine caries. All visual examinations were conducted under standard conditions. Examinations were repeated after a period of 1 and 3 months from the initial examination. After all examinations were completed, teeth were sectioned and histologic validation was undertaken. Maximum kappa statistics were used to assess bias among examiners and linear weighted kappa was used to assess inter- and intra-examiners' reproducibility. Sensitivity, specificity, accuracy and area under the receiver operating characteristic curve were obtained at D3 threshold. RESULTS: Differences in the marginal homogeneity were observed for the general dentist. Kappa for intra-examiner reproducibility ranged between 0.66 and 0.81 and the inter-examiner reproducibility ranged between 0.42 and 0.75. ICDAS score of ≥3 presented the best Spearman's correlation coefficient (0.69) at Downer's histologic classification D3. Corresponding sensitivity and specificity values at that level were 0.73 and 0.95, respectively. While variables like the interval of time between teeth examinations did not affect the intra-examiner reproducibility, examiners' specialty influenced inter-examiner's reproducibility over time. CONCLUSIONS: ICDAS presented acceptable intra-examiners reproducibility in detecting occlusal caries over time. However, there was a clear effect for examiner's specialty and clinical experience on the inter-examiner's reproducibility of the ICDAS system at different time intervals.

Treatment of TMJ ankylosis in Jordanian children - a comparison of two surgical techniques.

INTRODUCTION: The aim of this study was to report Jordanian experience in surgical treatment of TMJ ankylosis in 22 children. PATIENTS AND METHODS: This retrospective clinical study included children who were diagnosed with TMJ ankylosis and were treated in a dental teaching centre between 1993 and 2001. Patients underwent the release of 24 temporomandibular joint ankyloses and two different surgical techniques were used: either reconstruction of the condyle using costochondral grafts, or using the temporalis muscle as an interpositional material. Patients were followed up for 1-8 years. RESULTS: Twenty-two children (13 males and 9 females) were included in the study. Costochondral grafts were used as a reconstruction material in 16 TMJs (67%), whilst temporalis muscle was used as an interpositional material in 8 joints (33%). The mean preoperative maximum interincisor distance was 6.6 mm+/-1.3, which was increased to a mean of 30.3 mm+/-2.5 postoperatively. Two female patients (9%) suffered recurrence of the ankylosis within 6-12 months postoperatively. In one of these, a costochondral graft was used and temporalis muscle interposition in the other. CONCLUSION: Costochondral graft as a reconstruction material and temporalis muscle as an interpositional material showed comparable success rates when treating TMJ ankylosis in 22 children.