The efficacy of manual toothbrushes in patients with fixed orthodontic appliances: a randomized clinical trial.

OBJECTIVE: This study aims to evaluate three types of manual toothbrushes [Cross action (CA), Flat trim (FT), and orthodontic type (OT)] in terms of efficacy in plaque removal in patients undergoing fixed orthodontic treatment. BACKGROUND: Manual toothbrushes are an essential part of oral hygiene for primary prevention. Plaque control, however, can be influenced by a number of individual and material-related factors. Individual factors include the presence of fixed orthodontic appliances on tooth surfaces, such as brackets and bands, which create difficulties with oral hygiene and lead to plaque formation. The evidence for the effectiveness of advanced bristle designs (multilevel, criss-cross) of the manual toothbrush alone in removing plaque in patients undergoing orthodontic therapy is limited. METHODS: The experiment followed the Consolidated Standards of Reporting Trials (CONSORT) guidelines. This was a three treatment, three-period crossover clinical trial with a single brushing exercise. Thirty subjects were randomized to one of the three treatment sequences of different bristle designs: (CA, FT, and OT). The primary outcome measure was the difference in the plaque scores (baseline minus post-brushing) at each study period, as determined by the Turesky-Modified Quigley-Hein Plaque Index. RESULTS: Of the thirty-four subjects enrolled in the study, thirty of the subjects met the inclusion criteria and completed all three periods of the study. The mean age was 19.5 ± 1.52 years, with a range of 18-23 years. The differences between treatments in plaque score reduction after brushing were statistically significant (p-value < .001). The treatment differences were statistically significant (p-value < .001) favoring the FT toothbrush over the OT and CA types of toothbrush designs. On the contrary, the difference between the OT and CA types was not statistically significant. CONCLUSIONS: Plaque was significantly removed by the conventional FT toothbrush after a single brushing compared to the OT and CA types.

Correlation of Dental and Skeletal Malocclusions in Sagittal Plane among Saudi Orthodontic Patients.

AIM: Whether or not the dental relationship correlates with skeletal relationship in the sagittal plane is an area of interest for orthodontic diagnosis and treatment planning. Thus, the aim of this study was to investigate the correlation of the dental malocclusion and the skeletal malocclusion in the sagittal plane among Saudi orthodontic patients. MATERIALS AND METHODS: Orthodontic dental casts and cephalometric radiographs of 124 patients were investigated and analyzed. The dental casts were classified in relation to the molar relationship according to Angle's classification and to the incisal relationship according to the British Standards Institution (BSI) classification. The sagittal relation in the cephalometric radiographs was analyzed according to ANB angle and WITS appraisal. RESULTS: The results show that the incisal relation had a very high significant association with WITS appraisal (p = 0.0045), whereas with ANB, the association was marginally significant (p =0.0528). No significant associations were found with molar relation neither at ANB (p = 0.2075) nor at the WITS (p = 0.4794) appraisal. Significant positive correlations between ANB and WITS appraisal were found at the three incisal classification classes (class I, r = 0.73; class II, r = 0.64; class III, r = 0.75) and no significant correlation was observed in all classes with the Angle's (molar) classification. CONCLUSIONS: The incisal classification had a significant association with WITS appraisal, whereas with ANB the association was marginally significant. No correlation was found between Angle's (molar) classification and ANB or WITS appraisal. CLINICAL SIGNIFICANCE: The incisal relation could be considered as a good indicator of the skeletal malocclusion in the sagittal plane in the orthodontic practice.

Unveiling the Impact of Electronic Cigarettes (EC) on Health: An Evidence-Based Review of EC as an Alternative to Combustible Cigarettes.

Cigarette smoking has been considered a major public health concern due to its serious impact on health. However, smokers intending to quit may find long-term abstinence challenging. When smoking an electronic cigarette (EC), users can experience a sensation and taste similar to that of smoking a combustible cigarette. Therefore, manufacturers promote these products as a viable substitute for combustible cigarettes. However, several researchers report the serious health impacts experienced by EC users. Therefore, this review aims to examine the health impacts of EC use. Based on the findings of the research papers reported in the literature, the role of EC as a smoking cessation tool is unclear. Several researchers have also reported a significant association between EC usage among non-smokers at baseline and the future initiation of combustible cigarette smoking. EC use significantly impacts user health. The nicotine that is present in EC e-liquids can elevate blood pressure, resulting in blood vessel constriction and an increase in heart rate, ultimately leading the body to an ischemic condition, resulting in myocardial infarction (MI), stroke, and increased arterial stiffness. Researchers report a higher likelihood of prediabetes among EC users; its usage was associated with higher OR of having asthma attacks and higher OR of reporting depression and has an impact on birth outcomes among pregnant women. Men using EC are more likely to report erectile dysfunction than non-users. EC also has a significant impact on oral health, which includes periodontal diseases, mucosal lesions, irritation in the mouth and throat, reduced salivary flow, and an increased risk of developing cancer. The physical injury resulting from exploding EC is another health concern. The frequently burned areas included the hands, face, genitalia, and thighs. Marketers promote EC as an alternative to combustible cigarettes and a tool for quitting smoking. However, the Food and Drug Administration has not approved them for smoking cessation. EC can have a serious impact on the health of their users; hence, the findings of this paper have several implications, including the need for regulation of the sales and marketing of these products and educating the users on the impact of these products on their health and safety.

Performance of Artificial Intelligence Models Designed for Automated Estimation of Age Using Dento-Maxillofacial Radiographs-A Systematic Review.

Automatic age estimation has garnered significant interest among researchers because of its potential practical uses. The current systematic review was undertaken to critically appraise developments and performance of AI models designed for automated estimation using dento-maxillofacial radiographic images. In order to ensure consistency in their approach, the researchers followed the diagnostic test accuracy guidelines outlined in PRISMA-DTA for this systematic review. They conducted an electronic search across various databases such as PubMed, Scopus, Embase, Cochrane, Web of Science, Google Scholar, and the Saudi Digital Library to identify relevant articles published between the years 2000 and 2024. A total of 26 articles that satisfied the inclusion criteria were subjected to a risk of bias assessment using QUADAS-2, which revealed a flawless risk of bias in both arms for the patient-selection domain. Additionally, the certainty of evidence was evaluated using the GRADE approach. AI technology has primarily been utilized for automated age estimation through tooth development stages, tooth and bone parameters, bone age measurements, and pulp-tooth ratio. The AI models employed in the studies achieved a remarkably high precision of 99.05% and accuracy of 99.98% in the age estimation for models using tooth development stages and bone age measurements, respectively. The application of AI as an additional diagnostic tool within the realm of age estimation demonstrates significant promise.

Association of Electronic Cigarette Usage with the Subsequent Initiation of Combustible Cigarette Smoking among Dental Students in Riyadh, Saudi Arabia: A Longitudinal Study.

The use of electronic cigarettes, or "e-cigarettes", among youths has sparked worries about the possibility of nicotine dependence as a serious public health issue. Dental practitioners play a critical role in helping their patients quit smoking. Dental schools across the globe have policies encouraging their students to help patients quit smoking. Current research, however, indicates that a significant portion of dental students smoke combustible cigarettes and use e-cigarettes. According to studies, using e-cigarettes has resulted in the subsequent initiation of combustible cigarette smoking among its users. The aim of this study was to determine the association between the use of electronic cigarettes and the subsequent initiation of combustible cigarette smoking among dental students who were not attitudinally susceptible to smoking combustible cigarettes. A longitudinal cohort study was conducted among 121 study participants who were never combustible cigarette users and were attitudinally non-susceptible to smoking at baseline. At baseline, 66 (54.6%) study participants were categorized as e-cigarette users who were attitudinally non-susceptible to combustible cigarette smoking, and 55 (45.4%) study participants were categorized as non-users who were attitudinally non-susceptible to combustible cigarette smoking. The initiation of combustible cigarette smoking was assessed at 6- and 12-month intervals. Binomial regression analysis of the outcome at the end of one-year follow-up, when analyzed with independent variables, revealed a significant influence of e-cigarette use on taking up combustible cigarette smoking [Relative Risk: 9.395; 95% CI: 3.03-29.04]. Chi-squared analysis of independent variables revealed e-cigarette use to be significantly associated with fathers' education level (p = 0.00), parental cigarette smoking status (p = 0.00), cigarette smoking among friends (p = 0.00), and family income (p = 0.00). E-cigarette users are more likely to believe it to be healthier (p = 0.00) than combustible smoking. In the present study, e-cigarette usage demonstrated a significant influence on taking up combustible cigarette smoking among its users. Educational institutions should implement stringent policies and regulations to prevent health professionals from using these products.

A Correlation Analysis between Arch Width and Molar Inclination Using Cone-Beam Computed Tomography Transverse Measurements: A Cross-Sectional Study.

A new era in 3-dimensional analysis has begun with the use of cone-beam computed tomography (CBCT) in orthodontics, which promises to provide a more thorough understanding of the craniofacial skeletal architecture. This study aimed to investigate the correlation between the transverse basal arches discrepancy and dental compensation by utilizing CBCT width analysis. An observational study was conducted to retrospectively review 88 CBCT scans of patients presented to dental clinics from 2014 to 2020 obtained from the Planmeca Romexis x-ray system at three centers. Dental compensation data across normal and narrow maxillae were analyzed and a Pearson correlation was used to find the relationship between molar inclination and width difference. Significant maxillary molar compensation differences were observed between the normal maxilla and narrow maxilla group, where the amount of dental compensation (164.73 ± 10.15) was higher in the narrow maxilla group. A significant negative correlation (r = -0.37) was observed between width difference and maxillary molar inclination. Maxillary molars were tipped buccally to compensate for the reduced maxillary arch width. These findings are important to determine the amount of needed maxillary expansion taking into account the buccal inclination while treating cases.

What Is the Most Effective Frictionless Method for Retracting Anterior Teeth When Using Buccal Fixed-Appliance Therapy? A Systematic Review.

There are various techniques and designs for springs used in orthodontic treatment, including frictionless methods for closing spaces. However, there is limited explicit evidence to support the superiority of one method over another. This review aims to investigate the available evidence and highlight the advantages of these different methods. This review contained six papers, and information such as study design, spring design, applied force systems, variables studied, follow-up period, and records were extracted. All of the studies focused on canine retraction with the Ladanyi spring showing the highest rate of movement (1.8 mm per month) among all springs for upper canine retraction. The Gjessing and T-loop springs outperformed the Reverse Closing Loop and Ricketts spring, respectively, substantially. In terms of tip control, the T-loop spring showed a clear advantage over the modified Marcotte spring with a difference of 1.2° vs. 6.6° per 3 months. Additionally, it was observed that the Reverse Closing Loop caused a significant loss of anchorage during canine retraction with a medial movement of 2.4 mm. When comparing wire types, no significant differences were found between TMA and Nitinol, while stainless steel was found to be less effective in terms of movement rate and tip control. However, the results indicated that there was no clear evidence that one specific technique was definitively preferable to another; therefore, there is an urgent need for more studies with proper study designs to produce more robust conclusions.

Efficacy of Er, Cr: YSGG laser phosphoric acid gel and Riboflavin activated by Photodynamic therapy on enamel reconditioning rebonded to metallic brackets: An Invitro study.

AIM: To evaluate the shear bond strength (SBS) and failure percentage of rebonded metallic brackets after employing various enamel-reconditioning methods (37% phosphoric acid, sandblasting, Er, Cr: YSGG laser, and Riboflavin (RF). MATERIAL AND METHODS: After sample size calculation, a sum of 40 non-carious, non-traumatically extracted and sound human premolar teeth were collected and the enamel surface was prepped by etching, washing, and drying. The enamel surface was primed with a bonding agent and light cured, later brackets were bonded via composite. After bonding, bracket debonding was begun using a Weingart plier and the enamel surface was reconditioned before rebonding. Samples were divided into four (n=10) reconditioning groups at random and subjected to SB with 90-µm alumina particles group 1, Er, Cr: YSGG laser group 2, 37% PA (control) group 3, and RF group 4 respectively. After reconditioning, brackets were rebonded to the enamel surface via an adhesive system and composite. Later, samples were exposed to the universal testing machine for SBS analysis, and bond failure analysis was performed by using an adhesive remnant index (ARI). Statistical analysis was executed by one-way ANOVA and Post Hoc Tukey multiple comparison tests at a statistically significant level of p ˂ 0.05. RESULTS: The SBS analysis showed that the highest SBS of rebounded brackets was exhibited by 37% phosphoric acid (control) and the lowest SBS by sandblasting enamel surface with 90-µm alumina particles for enamel prior rebonding. However, Er, Cr: YSGG laser and RF activated by PDT validated comparable SBS results to control (p>0.05). Contrarily, sandblasting with 90-µm alumina particles showed a statistically significant difference from other analyzed reconditioning groups (p<0.05). Deliberating failure rate analysis by ARI index, the most eminent failures predicted among groups were scored between 0 and 1 except for sandblasting which majorly resulted in a score of 2 showing cohesive type failure. CONCLUSION: Chromium-doped erbium, yttrium-scandium-gallium-garnet (Er, Cr: YSGG) laser, and Riboflavin activated by photodynamic therapy have the potential to be used as an alternative to 37% phosphoric acid for enamel surface reconditioning before the rebonding metallic bracket.

Treatment of Obstructive Sleep Apnea Using Oral Appliances in Saudi Arabia: Are We following the Guidelines?

BACKGROUND: This study aimed to assess sleep medicine physicians' knowledge and attitudes toward the role of oral appliances (OAs) in managing obstructive sleep apnea (OSA) in Saudi Arabia. METHODS: An online questionnaire was administered to the registered physicians practicing sleep medicine (otolaryngology, internal medicine, pulmonology, and family medicine) in Saudi Arabia. The questionnaire included 26 questions under five domains. All the collected data were analyzed using descriptive statistics and Chi-square tests. RESULTS: One hundred sleep physicians (43% Saudi, 75% male) from Saudi Arabia participated in this study. Almost 43% of participants reported inadequate knowledge of the treatment of OSA patients using OAs. Half of the participants were unaware of how OAs work in managing OSA. Most physicians (62%) never referred the patient for treatment of OSA using OAs, whereas 4% referred at least one patient every month. The majority (60%) believed that there are barriers to referring a case for OA treatment, mainly the lack of knowledge of the suitable cases (60%) and the lack of qualified dentists in this area (43%). CONCLUSION: Most sleep physicians reported poor knowledge of OA indications and mechanism of use, with most never referring a case for OA therapy.

Application and Performance of Artificial Intelligence Technology in Detection, Diagnosis and Prediction of Dental Caries (DC)-A Systematic Review.

Evolution in the fields of science and technology has led to the development of newer applications based on Artificial Intelligence (AI) technology that have been widely used in medical sciences. AI-technology has been employed in a wide range of applications related to the diagnosis of oral diseases that have demonstrated phenomenal precision and accuracy in their performance. The aim of this systematic review is to report on the diagnostic accuracy and performance of AI-based models designed for detection, diagnosis, and prediction of dental caries (DC). Eminent electronic databases (PubMed, Google scholar, Scopus, Web of science, Embase, Cochrane, Saudi Digital Library) were searched for relevant articles that were published from January 2000 until February 2022. A total of 34 articles that met the selection criteria were critically analyzed based on QUADAS-2 guidelines. The certainty of the evidence of the included studies was assessed using the GRADE approach. AI has been widely applied for prediction of DC, for detection and diagnosis of DC and for classification of DC. These models have demonstrated excellent performance and can be used in clinical practice for enhancing the diagnostic performance, treatment quality and patient outcome and can also be applied to identify patients with a higher risk of developing DC.

A Morphometric Analysis of Palatal Rugae Patterns in a Saudi Arabian Population.

Background Palatal rugae patterns are useful in the field of forensic dentistry. Ethnicity has a significant effect on the development and final morphological pattern of palatal rugae. This study focused on a morphological analysis of the palatal rugae in a Saudi population to determine if any differences based on age and gender could support identifying an individual. Materials and methods This cross-sectional study conducted at the College of Dentistry, King Saud bin Abdul Aziz University for Health Sciences, was undertaken to evaluate 496 dental casts from the participant database of Saudi nationals from Riyadh. The rugae were delineated using a sharp graphite pencil under adequate light and magnification. The rugae patterns were classified based on the length, shape, and direction of the rugae by two observers as per Thomas and Kotze's criteria. Results The asymptotic chi-square McNemar test indicated bilateral symmetry for all the characteristics of the palatal rugae, except for the backward and forward directions of the rugae. Two-way analysis of variance (ANOVA) revealed a statistically significant interaction between the effects of age group and gender on the primary rugae count (F(3, 488) = 7.466, p <0.05)). In addition, age had a statistically significant effect on the fragmentary rugae (p <0.05), and gender had a statistically significant effect on the circular and backward patterns of the rugae (p<0.05). The females had a higher incidence of backward-directed rugae and the males had more circular rugae. No other significant difference was evident, based on gender. The logistic regression analyses showed a significant association between the circular (OR=1.298; 95% CI= 1.061-1.588) and backward (OR= 0.898; 95% CI= 0.828-0.975) palatal rugae and gender. Also, there was a significant association of the fragmentary palatal rugae (PR) (OR=1.274; 95% CI= 1.084-1.498) with the age group younger than 16 years. Conclusion In a Saudi Arabian ethnic group, the varying type of length of the palatal rugae patterns can be used to identify the age group while the direction and shape can be used to determine gender, although with limited accuracy. Post-mortem identification may benefit from using them along with other reliable forensic tools. There is a need to conduct continued research on diverse populations and ethnic groups in order to evaluate the PR potential in forensic dentistry.

The Posterior Extension of the Palatal Rugae as an Anatomical Constraint for Soft Tissue Grafts in a Saudi Arabian Population.

Background The purpose of this study was to investigate the distal extension of the palatal rugae area as an anatomical constraint on the harvesting of palatal soft tissue grafts in a Saudi Arabian population. Additionally, factors that could affect or predict the extension were considered. Methods Three hundred seventy-four (374) dental casts from Saudi nationals currently residing in Riyadh (170 males and 204 females) were included. Two independent observers used a standardized probe to measure the posterior extent of the rugae on each stone cast bilaterally on a horizontal base. A sharp graphite pencil was used to mark the measurements from the origin of the rugae to their terminal ends on the cast, and a magnification lens was used to identify them. Using this technique, the most posterior extension of the rugae was marked and then analyzed. The normal approximation test for binomial distribution was used to determine the proportion of the subjects with rugael extensions beyond the mesial end of the upper second premolar, and logistic regression was used to see the association of this extension with other factors. Results The asymptotic chi-squared (p = 0.0002) McNemar tests revealed that the posterior distal extension of the rugae was not the same on both sides. A normal approximation test for the left side with 95% confidence intervals (CIs) with the "rugael extension proximal to the mesial end of the upper second premolar" category considered "success" found that the proportion of upper second premolars with rugael extensions proximal to the mesial end was not significantly different to the proportion of rugael extensions beyond the mesial end of the upper second premolars (95% CI: 48.69%-58.79%, p = 0.147). Conversely, the proportion of the upper second premolars with rugael extensions proximal to the mesial end was significantly lower than that beyond the mesial end on the right (95% CI: 35.92%-45.89%, p = 0.00004). Gender, age, and palatal shape did not significantly affect the posterior extension of palatal rugae. Conclusions The palatal rugae on the left side of a sample of the Saudi Arabian population do not considerably extend beyond the upper second premolar mesial aspect, which may provide reliable soft tissue grafts for esthetic mucogingival surgery.

Effects of Lidocaine and Articaine on Neuronal Survival and Recovery.

The local anesthetics lidocaine and articaine are among the most widely used drugs in the dentist's arsenal, relieving pain by blocking voltage-dependent Na+ channels and thus preventing transmission of the pain signal. Given reports of infrequent but prolonged paresthesias with 4% articaine, we compared its neurotoxicity and functional impairment by screening cultured neural SH-SY5Y cells with formulations used in patients (2% lidocaine + 1:100,000 epinephrine or 4% articaine + 1:100,000 epinephrine) and with pure formulations of the drugs. Voltage-dependent sodium channels Na(v)1.2 and Na(v)1.7 were expressed in SH-SY5Y cells. To test the effects on viability, cells were exposed to drugs for 5 minutes, and after washing, cells were treated with the ratiometric Live/Dead assay. Articaine had no effect on the survival of SH-SY5Y cells, while lidocaine produced a significant reduction only when used as pure powder. To determine reversibility of blockage, wells were exposed to drugs for 5 minutes and returned for medium for 30 minutes, and the calcium elevation induced by depolarizing cells with a high-potassium solution was measured using the calcium indicator Fura-2. High potassium raised calcium in control SH-SY5Y cells and those treated with articaine, but lidocaine treatment significantly reduced the response. In conclusion, articaine does not damage neural cells more than lidocaine in this in vitro model. While this does not question the safety of lidocaine used clinically, it does suggest that articaine is no more neurotoxic, at least in the in vitro setting.