PARENTAL EDUCATION, CARIES EXPERIENCE, PLAQUE ACCUMULATION, AND Mutans Streptococci COUNT MAY PREDICT THE INCREMENT OF EARLY CHILDHOOD CARIES IN PRESCHOOL CHILDREN OVER 24 MONTHS.

ARTICLE TITLE AND BIBLIOGRAPHIC INFORMATION: RISK PREDICTORS OF EARLY CHILDHOOD CARIES INCREMENT-A SYSTEMATIC REVIEW AND META-ANALYSIS. Lam PPY, Chua H, Ekambaram M, Lo ECM, Yiu CKY. J Evid Based Dent Pract. 2022 Sep;22(3):101732. SOURCE OF FUNDING: Government TYPE OF STUDY/DESIGN: Systematic review with meta-analysis of data.

WEARING ORTHODONTIC APPLIANCES MAY NOT IMPACT THE ORAL HEALTH-RELATED QUALITY OF LIFE (OHRQOL) OF CHILDREN AND ADOLESCENTS.

ARTICLE TITLE AND BIBLIOGRAPHIC INFORMATION: Impacts of using orthodontic appliances on the quality of life of children and adolescents: systematic review and meta-analysis. Vidigal MTC, Mesquita CM, de Oliveira MN, de Andrade Vieira W, Blumenberg C, Nascimento GG, Pithon MM, Paranhos LR. Eur J Orthod. 2022 Aug 16; 44(4):359-368. SOURCE OF FUNDING: Government. TYPE OF STUDY/DESIGN: Systematic review with meta-analysis of data.

Dietary Determinants of Dental Caries Prevalence and Experience in Saudi Schoolchildren: Frequency versus Quantity.

BACKGROUND: Sugar-added diet has been associated with increased risk of developing dental caries. OBJECTIVE: To investigate the dietary determinants of caries prevalence and experience based on the frequency versus the quantity of consumption among Saudi schoolchildren. METHODS: This is a cross-sectional study that invited 12- to 15-year-old intermediate school students (N = 3000) in four cities in the Eastern Province of Saudi Arabia. Data collection comprised a pretested questionnaire and clinical examination. Caries was diagnosed based on the World Health Organization (WHO) criteria and was recorded as a decayed, missing, filled tooth (DMFT). The questionnaire included questions regarding the consumption of different quantities and frequencies of multiple sugar-containing food items. Multiple logistic and linear regression models were used to assess the influence of sugar-containing food on the dental caries experience (DMFT) and prevalence of decayed teeth. SPSS version 20.0 was used to analyze the data at 5% significance level. RESULTS: Of 3000 invited students, 2262 participated with a participation rate of 75.4%. Our study found that the frequency of soft drink consumption was significantly associated with increased caries prevalence (adjusted OR = 1.33, 95% CI 1.07-1.65) and experience (adjusted B = 0.46, 95% CI 0.16-0.76). The frequency of consumption of fruit juice was statistically significantly associated with increased caries experience (adjusted B = 0.48, 95% CI 0.16-0.79). The interaction terms between the frequency and the quantity of consumption of energy drinks, soft drinks, and sweetened milk were statistically significantly related to caries experience and prevalence. CONCLUSION: Although the frequency of consumption of sugar-containing drinks was more associated with caries experience and prevalence, the interaction between frequency and quantity was highly related to the prevalence and experience of dental caries.

Oral health-related interdisciplinary practices among healthcare professionals in Saudi Arabia: Does integrated care exist?

BACKGROUND: There is a bidirectional relation between oral and general health, therefore collaboration between healthcare providers is needed. This study investigated current interdisciplinary practices (IDP) and the associated factors among healthcare professionals in Saudi Arabia. METHODS: A cross-sectional study was conducted in the Eastern Saudi Arabia recruiting four groups of health professionals (nurses, physicians, pediatricians and Ear-Nose and Throat (ENT) specialists). A validated, self-administered questionnaire was distributed online and shared through social media platforms. The questionnaire explored predisposing factors (demographics) and facilitating factors (knowledge, attitudes, attendance of oral health training and source of knowledge) associated with IDP. RESULTS: A total of 1398 health professionals were recruited. Participants showed fair oral health knowledge (7.1 ± 2.1) and attitudes (22.2 ± 3). Three-fourths (74.6%) reported always providing oral health education (OHE) to their patients, more than half (59.6%) reported always conducting an oral health screening (OHS), two-thirds (66.7%) reported responding to patients' questions about oral health or conditions and 58.7% reported referring patients to dentists. Pediatricians and physicians had greater odds of IDP compared to other health professionals. Source of oral health knowledge (Ministry of Health (MOH) and formal education) was significantly associated with increased odds of IDP. Participants with good oral health knowledge had greater odds of responding to patients' oral health question as well as have more referral practices. CONCLUSION: The results reveal a discrepancy between participants' IDP, knowledge, and attitudes. Incorporating dental component to medical curricula, continuous education and training programs targeting health professionals through Ministry of Health should be considered.

Prevalence and Distribution of Nonsyndromic Dental Anomalies in Children in Eastern Saudi Arabia: A Radiographic Study.

OBJECTIVES: To report the prevalence and distribution of nonsyndromic dental anomalies in children in eastern Saudi Arabia. METHODS: This retrospective records review study involved radiographic examination of 6-18 years old pediatric patients who attended the Dental Hospital of the College of Dentistry, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia. Four calibrated examiners recorded nonsyndromic dental anomalies from patients' digital orthopantomograms (OPG). The anomalies recorded were related to tooth number, shape, and location. Descriptive statistics, chi-square test, and Fisher exact tests were used to report prevalence and differences by gender, nationality, and medical history at the 5% significance level. RESULTS: Of 2226 reviewed patients' records, 1897 met the inclusion criteria and were included in the study. The study sample had equal distribution of males (52.6%) and females (47.4%) and comprised 81.2% Saudi children with a mean age of 8.8 ± 1.84 years. Most study subjects (97.8%) were in mixed dentition and 88.7% were healthy. The prevalence of dental anomalies was as follows: teeth rotations (24.5%), ectopically erupted teeth (6%), congenitally missing permanent teeth (5.4%), peg lateral (1.1%), supernumerary (0.5%), gemination (0.3%), and fusion (0.1%). No statistically significant differences were found in the distribution of dental anomalies by patients' gender, medical history, and nationality (p value ≥0.05). CONCLUSION: This study showed that teeth rotations were the most common dental anomalies followed by ectopic eruptions and congenitally missing teeth. The study findings may guide dental practitioners to better diagnose and manage children with dental anomalies in eastern Saudi Arabia.

Factors affecting dental self-confidence and satisfaction with dental appearance among adolescents in Saudi Arabia: a cross sectional study.

BACKGROUND: Dental appearance affects facial beauty, social interaction and psychological well-being particularly among adolescents. The aim of the current study was to determine factors affecting adolescent dental self-confidence and satisfaction with dental appearance in Saudi Arabia. METHODS: A cross-sectional study was conducted in the Eastern Province of Saudi Arabia among 3500 students attending intermediate and high schools. Data was collected from 2637 students using the translated Arabic version of the psychosocial impact of dental esthetics questionnaire (PIDAQ) in addition to questions about smile esthetics satisfaction and demographic variables including; gender, age, school grade, and parental level of education. Statistical analysis was performed by using logistic regression to assess the effect of demographical variables on PIDAQ and its domains at 5% significance level. RESULTS: About 80% of the participants were satisfied or somewhat satisfied with their smiles. Tooth alignment and tooth color were the most cited reasons for adolescents' dissatisfaction about their smile, 34% and 33% respectively. Females and participants' fathers' university education figured in a statistically significant way regarding higher PIDAQ and aesthetic concerns. Females were 70%, and those with fathers' university education were 22% more likely to have a negative psychological impact. Females expressed aesthetic concerns nearly two times more than males. Participants whose fathers possessed university education had an aesthetic concern 1.25 times more compared to those whose fathers had no school or limited school education. Females and those with mothers who had university education were less likely to have positive dental self-confidence. CONCLUSIONS: Most adolescents exhibited satisfaction with their own smiles. Smile dissatisfaction in the remaining participants was related to teeth alignment, color and shape. Females were more concerned with dental esthetics and smile satisfaction than males. Females and participants whose fathers had a university education exhibited higher psychosocial impact than males and those with or without school education. However, males showed greater self-confidence in their dental aesthetics.

Pattern of dental needs and advice on Twitter during the COVID-19 pandemic in Saudi Arabia.

AIM: To compare and evaluate the influence of the COVID-19 outbreak on tweets related to dental treatment needs and advice of Saudi Twitter users in 2020 by comparing them to the same time-period in 2019. METHODS: Eight independent searches based on dentistry related keywords: "teeth, mouth and gingiva" were carried out within the timeframe between the 23rd of March and the 21st of June for the years 2020 and 2019. Extracted tweets were analyzed by two calibrated examiners as tweets containing expressed dental needs and tweets for dental advice, while spam tweets were excluded. Descriptive analysis was performed to present the overview of the findings using SPSS. Bivariate analysis was performed with Pearson's Chi Square, Fisher's Exact test and Mann-Whitney U test. Statistical significance was set at p ≤ 0.05. RESULTS: A total of 595 tweets from the year 2019 and 714 tweets from the year 2020 were obtained. Overall, combined dental needs and advice tweets, retweets, likes, and replies were higher in 2020 compared to 2019. Dental needs tweets were higher in 2020 compared to 2019, while dental advice tweets were lower in 2020 compared to 2019. Statistically significant differences were found between 2020 and 2019 with regards to dental needs well as with dental advice (p < 0.05). In addition, statistically significant differences were found between 2019 and 2020 with presence of pain, urgency of the dental need and type of advisor (p < 0.05). CONCLUSION: An obvious impact of the pandemic can be seen in the form of increased self-reported dental needs, pain and urgency among the public in Saudi Arabia. This study highlights the importance of social media, specifically Twitter, in expressing the public needs and utilizing it as a platform for education and advice.

Fluoride Varnish Application in Preschoolers Have a Modest Effectiveness in Reducing the Incidence of Dentinal Caries.

ARTICLE TITLE AND BIBLIOGRAPHIC INFORMATION: Fluoride Varnish and Dental Caries in Preschoolers: A Systematic Review and Meta-Analysis. de Sousa FSO, Dos Santos APP, Nadanovsky P, Hujoel P, Cunha-Cruz J, de Oliveira BH. Caries Res. 2019;53(5):502-513. SOURCE OF FUNDING: Government. TYPE OF STUDY/DESIGN: Systematic review with meta-analysis of data.

Mineral Trioxide Aggregate Could Have a Better Success Rate Than Calcium Hydroxide for Partial Pulpotomy of Symptomatic Mature Permanent Molars.

ARTICLE TITLE AND BIBLIOGRAPHIC INFORMATION: Partial Pulpotomy in Mature Permanent Teeth with Clinical Signs Indicative of Irreversible Pulpitis: A Randomized Clinical Trial. Taha NA, Khazali MA. J Endod 2017;43(9):1417-21. SOURCE OF FUNDING: Information not available. TYPE OF STUDY/DESIGN: Randomized clinical trial.

Influences of parents, close friends and classmates on four co-existing oral health practices in Saudi male teenagers.

OBJECTIVE: The objective of this study is to investigate the association between oral health practices and similar practices adopted by parents, close friends and classmates in a group of Saudi male teenagers. MATERIAL AND METHODS: A cross-sectional study was conducted in Dammam, Saudi Arabia, in 2016 including 12-14-year-old intermediate school students (n = 478). A questionnaire assessed socioeconomic background, whether participants, their parents, close friends and classmates brushed twice daily, used tobacco, snacked on sugary foods or sugary drinks and perceiving a supportive classroom environment. Univariate and multivariate logistic regression models assessed the association of parents', close friends', classmates' practices and classroom support with participants' four practices, controlling for socioeconomic factors. RESULTS: The response rate was 93.9%. In multivariate regression, close friends' practices had a strong significant association with teenagers' tooth brushing (OR = 4.45; 95%CI = 1.09, 18.12), tobacco use (OR = 5.63; 95%CI = 3.44, 7.88), snacking on sugary foods (OR = 14.42; 95%CI = 7.89, 21.89) and sugary drinks (OR = 7.05; 95%CI = 5.97, 9.20). The percentages of classmates perceived to brush their teeth and use tobacco were significantly associated with the respective practices in teenagers (OR = 1.03 and 1.02). Fathers' snacking on sugary drinks was significantly associated with that of the teenagers (OR = 4.04; 95%CI= 1.03, 15.85). CONCLUSIONS: In early adolescence, four oral health practices of Saudi males were associated with those perceived to be adopted by their close friends. Fathers' use of sugary drinks was also significantly associated with that of teenagers.

Exploring factors influencing nurses' attitudes towards their role in dental care.

BACKGROUND: The burden of oral disease requires collaboration between health care professionals. Nurses are frequently exposed to patients and can play a vital role in prevention of oral diseases. This study aimed to investigate nurses' attitudes towards their role in dental care and its associated factors. METHODS: This cross-sectional, survey-based study recruited a total of 525 nurses in Eastern Saudi Arabia, using a snow-ball sampling technique. Data was collected using an online, pre-validated 40-item questionnaire with four domains (attitudes, knowledge, practices, and demographic data). RESULTS: Nurses showed satisfactory attitudes (52.8 ± 8.2) and average knowledge (13.4 ±3.9). More than two thirds (70.3%) reported responding to patients' questions about oral health conditions, 47.1% and 19.7% conducted oral health screening and education respectively. Referral practices were reported by 266 (50.7%) of the participants with pain being the main reason for referrals. Attending lectures/ trainings on oral health and having a formal education about oral health were significantly associated with nurses' positive attitudes towards their role in dental care (P<0.001). Conducting oral health screening or education were also significantly associated with positive attitudes (P = 0.001). CONCLUSION: Positive attitudes were observed among those with undergraduate oral health backgrounds, in continuous education, and those who were involved in oral health screenings. There is a need for under and postgraduate inclusion of oral health training in nurses' education.

Application of Er,Cr:YSGG laser versus photopolymerization after silver diamine fluoride in primary teeth.

Examine the effect of dental curing light and laser treatments applied after Silver Diamine Fluoride (SDF) on dentin hardness in carious primary molars. This in-vitro study consisted of 30 extracted primary molars with caries extending into dentin without pulpal involvement. The collected teeth were randomly divided into three groups: group 1: received SDF then Sub-ablative low-energy of Er,Cr:YSGG laser, group 2: received SDF followed by application of curing light for 40 s, group 3: had SDF treatment only. In all groups, 38% Ag (NH3)2F SDF was used. Vickers hardness test was performed on sound dentin below carious lesion. Kruskal-Wallis Test was used to determine the mean difference in dentin hardness of the groups at 5% Significance level using SPSS software. Surface hardness of sound dentin below the carious lesion was statistically significantly higher in the laser + SDF group (891.24 ± 37.33 kgf/mm2) versus the two other groups (Light cure + SDF = 266.65 ± 90.81 kgf/mm2 and SDF only = 117.91 ± 19.19 kgf/mm2) with p-value ≤ 0.001. Although Photopolymerization of SDF increases the surface hardness of sound dentin below the carious lesion, applying laser after SDF has the highest surface hardness due to the laser's sub-ablation of dentin.

Effect of Light Curing on Silver Diamine Fluoride in Primary Incisors: A Microscopic Ex Vivo Study.

Purpose: To determine the effect of a dental curing light on the penetration depth of silver diamine fluoride (SDF), dentin hardness, and silver and fluoride ion precipitation into cavitated carious lesions. Methods: SDF was applied on 16 primary incisors extracted due to caries extending into dentin. Teeth were divided into two groups: (1) control group, was not light-cured; and (2) test group, was light-cured. A scanning electron microscope, and OmniMet software were used to measure penetration depth, dentin hardness, and ion precipitation. Wilcoxon's ranksum test was used for statistical analysis. Results: All samples in both groups showed SDF penetration beyond the carious lesion and into sound dentin. The penetration depth into sound dentin was 70 µm further without the dental curing light it (P<0.001). Silver precipitation in infected dentin with the dental curing light was approximately 2.6 times greater than without it (P=0.02). Dentin hardness of infected dentin was 26 percent more with the dental curing light (P=0.04). Conclusions: Applying a dental curing light during silver diamine fluoride treatment of carious lesions induces more silver ion precipitation in infected dentin, increases its hardness, and, perhaps because more silver stays in the infected dentin, less SDF penetrates into sound dentin.

Infant Oral Healthcare and Anticipatory Guidance Practices among Dentists in a Pediatric Care Shortage Area.

OBJECTIVES: To assess dentists' practices and barriers towards infant oral healthcare (IOH) and anticipatory guidance (AG) in eastern Saudi Arabia. METHODS: A regional, cross-sectional survey was distributed to 340 (323 general dentists (GPs) and 17 pediatric dentists (PDs)) working in a governmental setting in eastern Saudi Arabia. A 23 close-ended, pilot-tested questionnaire was developed. The questionnaire asked about dentists' IOH and AG practices. A five-point Likert scale question assessed barriers interfering with AG practices. Descriptive and multivariate logistic regressions were used. RESULTS: Participation rate was 98.5% (335/340). Only 18% of GPs indicated performing IOH exams, while 100% of PDs do. About 90% of GPs would see children on a first visit when they are ≥3 years old, whereas 60% of PDs reported seeing one-year-old children. Older practitioners and those performing AG were more likely to perform IOH (OR = 1.8, CI = 1.06-3.1, and OR = 3.84, CI = 1.93-7.65, resp.). The majority of respondents (94%) felt their training did not prepare them to practice AG. "Parents bringing their children for the first time for emergency or existing conditions" was cited by 99% of respondents as a barrier to performing AG. CONCLUSION: Increasing the awareness of GPs and parents about the importance of IOH and AG is crucial in improving children's oral health. Collaboration with pediatricians for early referral of children is equally important in increasing the awareness on prevention principles.

Association of Test Anxiety with Temporomandibular Disorder in Health Professions Students: A Cross-Sectional Study.

OBJECTIVE: To assess the prevalence of temporomandibular disorder (TMD) and its association with text anxiety among undergraduate medical, dental, and pharmacy students in Dammam, Saudi Arabia. Material and Methods. This cross-sectional study included health professions students who responded to Fonseca's questionnaire and Test Anxiety Inventory by Spielberger to evaluate TMD and test anxiety, respectively. TMD score was compared in different categories of students, and bivariate and multiple logistic regression analyses evaluated the influence of test anxiety on TMD. RESULTS: The study included 884 participants (44.8% males and 55.2% females) with a mean age of 21.46 ± 1.36 years. Regarding items of Fonseca's questionnaire, most students reported being tense/nervous (65.7%) and had headaches (57.5%). About 45.8% of the participants reported no TMD, and remaining had mild (40.4%), moderate (11.3%), and severe (2.5%) TMD. The mean TMD score was significantly higher in students with high test anxiety (25.6 ± 18.32) than those with low test anxiety (20.25 ± 16.97) (P < 0.001). Mean test anxiety scores significantly differed among TMD categories (P < 0.001) with the lowest score in the no TMD group and the highest in the moderate TMD group. Female gender (adjusted odds ratio 1.4, P 0.039) and high test anxiety (adjusted odds ratio 1.92, P < 0.001) were significantly associated with increased odds of having TMD. CONCLUSIONS: The study revealed a high prevalence of TMD among students. There was a significant association between test anxiety and TMD. The data obtained may guide preventive policies and program on test anxiety and TMD.

First Permanent Molar Caries and Oral Health Practices in Saudi Male Teenagers: Inequalities by Socioeconomic Position.

OBJECTIVES: Caries remains a problem in high-risk groups aggravated by socioeconomic inequalities. The study aimed to investigate (1) oral health practices associated with caries in the 1st permanent molars in Saudi male teenagers and (2) the impact of socioeconomic position (SEP) on caries control using these practices. METHODS: A cross-sectional study targeted 1137 male teenagers in intermediate schools in Khobar and Dammam, Saudi Arabia, in 2016. Caries was examined using the World Health Organization criteria and plaque was assessed using the plaque index of Loe and Silness. A questionnaire assessed SEP (parental education, employment, and home ownership) and oral health practices (using fluoridated toothpaste twice daily, regular dental visits for check-ups, and avoiding daily sugary snacks). Regression models analysed the association of these factors with caries presence and the mean number of decayed 1st permanent molars. Stratification was used to assess differences between SEP levels. RESULTS: The response rate was 81.7%. Caries prevalence and mean (SD) number of decayed 1st permanent molars were 50.4% and 1.08 (1.31). The use of fluoride toothpaste was associated with lower odds of caries and fewer decayed molars (OR = 0.50 and regression coefficient = -0.35). Differences in the relationship between caries and toothpaste were observed by SEP levels with stronger associations in less advantaged groups. CONCLUSIONS: Brushing twice daily using fluoride toothpaste was associated with less caries in Saudi male teenagers with stronger association observed in groups with lower SEP. The use of fluoride toothpaste helps in reducing health inequalities associated with SEP.

School-based fluoride varnish programs: a national survey.

PURPOSE: To identify and describe school-based fluoride varnish (FV) programs in K-12 grades children in the United States. METHODS: This cross-sectional study utilized an online, self-administered survey to identify and describe school-based FV programs in 2016. Several public health directories, mainly The Association of States and Territorial Dental Directors directory, were contacted to identify FV programs. The survey's questionnaire included 23 closed-ended questions regarding program description, assessment, and process. RESULTS: Of 85 identified programs, 52 responded (response rate = 61 percent) with 40 school-based FV programs in operation in 27 states. About 85 percent of responding programs apply FV as part of an existing school-based program. Dental sealants on permanent teeth are the most common procedure provided in addition to FV (92 percent). One-third of programs apply FV once a year versus 28 percent that apply FV twice a year. CONCLUSIONS: Evidence-based guidelines for FV in school-based programs are needed to ensure cost-effectiveness and continuity.

Fluoride Concentration of Water Supply in Eastern Saudi Arabia: A Preliminary Study.

BACKGROUND: Community water fluoridation is known to play a significant role in enhancing oral health by reducing the incidence of dental caries. However, the level of fluoride in the supplied public water in the Eastern Province of Saudi Arabia is unknown. OBJECTIVE: To determine water fluoride levels at the main sources supplying water to households and schools in two major cities (Dammam and Al-Khobar) of the Eastern Province of Saudi Arabia. METHODS: From the Directorate of Water Agency and Directorate of Education, the following were identified as the main sources of public water supply in Dammam and Al-Khobar: the water agency, public water tanks and four contracted companies. Two samples were collected from each of these six identified water sources at two different time points (in January and July 2016; 2 samples/site/time point; N = 24) using 500 mL polythene bottles. Each sample was analyzed using an ion chromatography system at different detection limits (including the lowest detection limit of 0.065 ppm) to determine the fluoride level. RESULTS: There was no fluoride detected in any sample even at the lowest detection limit, indicating that fluoride levels in the studied water samples were <0.065 ppm. CONCLUSION: This study found that in the cities studied, fluoride levels, if any, are considerably below the optimum recommended level for the prevention of dental caries (i.e., 0.7 ppm).

Dentists' perspective about dental amalgam: current use and future direction.

OBJECTIVES: In 2013, the United Nations Environment Programme (UNEP) reached a binding agreement - a.k.a. the Minamata treaty - to decrease dental amalgam use. This study aims to investigate US dentists' current practice and opinions about amalgam use, and to determine factors affecting their amalgam use and opinions. METHODS: A total of 45,557 general dentists and 5,101 pediatric dentists were invited to participate in a pre-tested electronic survey. The survey consisted of 12 close-ended questions using a 5-point Likert Scale. The Qualtrics™ software was used to distribute the survey, followed by three reminders. RESULTS: Response rate was 5.2 percent for general dentists, and 17.6 percent for pediatric dentists. Sixty-two percent of general dentists and 56 percent of pediatric dentists reported using amalgam. Most dentists disagreed with banning amalgam, while agreeing with installing amalgam separators. Environmentally conscious dentists were more likely to agree with banning amalgam and installing amalgam separators. CONCLUSION: Responding dentists favor the continued use of dental amalgam. Their perspectives vary by several factors including dentists' environmental consciousness. Policies toward minimizing amalgam's environmental impact need to be implemented.