Impact of Protracted War Crisis on Dental Students: A Comparative Multicountry Cross-sectional Study.

BACKGROUND: The impact of conflict and war crisis on dental students is poorly understood. Given the prolonged conflicts and political instability in the Arabic-speaking countries, it is crucial to investigate the effect of these conditions on dental students. This study aimed to assess the impact of protracted war on dental students by comparing the personal, university, and wider context challenges they face across war-affected and unaffected countries. METHODS: A cross-sectional study was conducted including a convenience sample of dental students from 13 universities in 12 Arabic-speaking countries. Respondents were those at entry and exit points of their undergraduate dental training. A self-administered paper questionnaire collected anonymized data on sociodemographics, and personal, university, and wider context challenges that students were facing. Multivariable Poisson regression analyses were carried out. RESULTS: The overall response rate was 64.8%. The mean age was 21.2 (standard deviation = 2.1) years, with 68% of participants being female. After adjusting for age and sex, dental students in Arabic-speaking countries affected by protracted war crisis were significantly more likely to report wider context challenges compared to their counterparts in unaffected countries (n = 2448; beta = 1.12; 95% confidence interval: 1.10-1.13; P < 0.001). DISCUSSION: Dental students in Arabic-speaking countries affected by protracted war crisis were more likely to suffer from wider context challenges such as difficulties in attendance due to the deterioration of security and lack of flexibility of teaching time to accommodate the different circumstances induced by the war crisis. Supporting dental students in areas affected by protracted war crises is needed and may include developing online dental education programs.

The trends in consumption patterns of toothbrushes and toothpastes in Lebanon.

BACKGROUND: The prevalence of dental cavities has been rising especially during the past ten years. Tooth brushing twice a day using a fluoridated toothpaste is a crucial preventive measure. The World Health Organization (WHO) has recommended the yearly use of 6 tubes of toothpaste of 170g each and 4 toothbrushes per individual. AIM: To evaluate the individual yearly consumption of toothpaste tubes and toothbrushes in Lebanon using the amount supplied to the market as a proxy measure after checking if the products meet the standards. METHODS: This study was based on performing secondary quantitative data analysis of the amount of supplied toothpastes and toothbrushes between 2000 and 2016 in Lebanon. The quality of toothpaste brands available in the market was evaluated by reviewing LIBNOR (Lebanese Standards Institution) guidelines that govern the quality and testing standards of oral health products in Lebanon. RESULTS: The yearly supply of toothpaste tubes per individual increased progressively from 1.27 tubes to 1.58 tubes between the year 2000 and 2016 respectively. The yearly supply of toothbrushes per individual fluctuated between 3.1 toothbrushes in 2000 and 3.24 toothbrushes in 2016, where the trend of supply reveals a plateau phase followed by steep increases and decreases between 2012 and 2016. Guidelines governing the quality of toothpastes are regulated by LIBNOR and follow European Standards. CONCLUSION: The yearly consumption of both toothpaste tubes and toothbrushes was below WHO recommendations. This raises the necessity of increasing the promotion of the importance of proper oral hygiene practices as well as the distribution of tubes of toothpastes and toothbrushes to people in need.

Prevalence of Oral Mucosal Lesions Among the Institutionalized Elderly Population in Lebanon.

This study aimed to determine the prevalence of oral mucosal lesions and risk factors among the institutionalized elderly Lebanese population. A representative sample of 526 individuals (49% males and 61% females) aged 65 years and above was examined. A questionnaire and clinical examination were administered. Bivariate and multivariate regressions were carried out. The frequency of oral mucosal lesions was 22.8% and it was associated to the use, integrity (p < .002), and hygiene level (p < .047) of removable mandibular and maxillary prosthesis. Multiple regression analysis also predicted the relationship between the mandibular prosthesis hygiene level and the occurrence of mucosal lesions. The factors controlling the occurrence of oral mucosal lesion were mainly related to the level of oral care given to the individuals. Therefore, a proper oral health care system should be implemented in the Lebanese residential homes to ensure the well-being of the residing population.

Oral health status and care of institutionalized elderly individuals in Lebanon.

BACKGROUND: Oral health of the elderly is a major public health challenge. Data on oral health and dental care of the institutionalized elderly is lacking in Lebanon. AIMS: (1) Assess the oral health of Lebanese people aged 65 years and over living in residential facilities; and (2) identify factors associated with poor oral status. MATERIALS AND METHODS: A.sample of 526 nursing home residents aged 65 years and older was randomly selected from 46 residential facilities. Information collected were sociodemographic characteristics, degree of autonomy regarding toilet use and nutrition, presence of chronic diseases and medications, dry mouth sensation, dental brushing, access to oral health and reasons of dental visits. A structured oral examination was conducted to gather data on DMFT index, oral hygiene indices modified gingival index, and the unmet need for prosthesis. Statistical methods included bivariate and multivariate analyses. RESULTS: 55.9% of the participants were edentates, 41.4% used partial and/or complete dentures, and the minority used dentures with good hygiene. 15% of the dentate sample reported regular tooth brushing, 7% reported to have visited the dental office in the past 12 months, and 57% presented an unmet need for prosthesis. Oral health status was significantly related to age, smoking, daily tooth brushing, and autonomy (P < 0.05). Subjects with chronic diseases and consuming medications were more likely to have xerostomia. CONCLUSION: Oral health status is poor in the elderly institutionalized Lebanese population, which should promote a multidisciplinary team sharing responsibility for daily oral hygiene and access to dental treatment.

Fluoride concentration of bottled water and public water in Lebanon.

BACKGROUND AND AIMS: People in Lebanon turned to bottle water consumption because of its poor public water quality. In general, fluoride is known as dental caries preventive. A study in 1986 and two other national surveys in 1994 and 2004 showed that the concentration of fluoride in public Lebanese water was insignificant for the prevention of dental caries (less than 0.3 mg/L). The aim of the study was to measure the fluoride concentration in the highest selling and known commercial brands for bottled water in Lebanon, as well as to assess their effectiveness regarding prevention of dental caries. RESULT: Fluoride has a notable therapeutic effect but in small doses that fluoride can be found in drinking water. Analysis using an absorptiometry of 625nm and another technique using an Orion electrode of 9609 BN have shown the low content of fluoride in the Lebanese waters (less than 0.3 mg/l). Strategies have recently been evolved based on fluroide supplementation (if the results turn negative) to reduce the index of caries in LEBANON.

Dental caries and fluorosis among children in Lebanon.

PURPOSE: The purpose of this study is to assess caries and enamel fluorosis in a sample of 1433 children aged 6-8, 12, and 15 years from 48 schools in 6 regions of Lebanon, selected by probability proportional to size. METHODS: Children were examined according to the World Health Organization criteria. RESULTS: Our results showed a mean of decayed, missing, and filled teeth (DMFT) of 0.6 (dft of 5.15), 3.42, and 5.44 corresponding respectively to the groups of 6-8-, 12-, and 15-year-old children. In the same groups, the percentage of DMFT = 0 for the 6-8-year-old category was 74%, the 12-year-old category was 20.9%, and for the 15-year-old category was 9.7%; Ten (2.1%) 12 year olds had moderate and one (0.2%) severe scores; these children had been born in other countries. CONCLUSIONS: Survey results confirm the need to implement nationwide dental caries prevention measures. Since water fluoridation is not feasible, salt fluoridation would be the alternative.

Development of an Arabic Version of the Hiroshima University-Dental Behavioral Inventory: Cross-cultural Adaptation, Reliability, and Validity.

The Hiroshima University-Dental Behavioral Inventory (HU-DBI) has not been adequately translated to the Arabic language. The aim of this study is the translation and cultural adaption of the English HU-DBI into standard Arabic. The English HU-DBI was translated into Arabic by three bilingual dental academics. A nonmedical professional performed backward translation into English. The three bilinguals compared both English versions and accordingly modified the Arabic version. English and Arabic versions were answered by 58 bilingual participants. Focus groups and cognitive interviews were conducted to pretest the working version, after which the final Arabic version was tested for test-retest validity on 58 dental students. Bilingual validity and test-retest validity were assessed using the kappa statistic. Responses were similar in the English and Arabic versions for bilingual individuals and on both tests in the test-retest sample. Kappa values ranged from 0.85 to 1.00 for bilingual validity and between 0.82 and 1.00 for test-retest reliability. In conclusion, the Arabic HU-DBI will enable the assessment of knowledge and attitudes toward oral diseases and their prevention in Arab countries and will allow meaningful comparisons between different countries in the region.

[Oral health in school children in Lebanon]. / La santé bucco-dentaire des écoliers au Liban.

This survey is the first epidemiological investigation to be carried out at the national level in Lebanon. It provides a first series of basic data indicative of the present oral health situation in the country. The results of this survey should contribute to the elaboration of a National Oral Health Plan and to the development of a broad strategy for the implementation of preventive measures [8]. Indeed, experience clearly indicates that dental caries cannot be successfully eradicated nation-wide through curative measures only and that preventive measures must also be implemented. The main effort in the field of oral health care should mainly focus on health promotion and education, leading in turn to improved oral hygiene.