The relationship between examination-related academic stress, salivary antioxidant capacity and exercise patterns of final-year Saudi dental students.

OBJECTIVE: To study the impact of examination stress on the total antioxidant capacity (TAC) of senior dental students and compare changes in TAC between students who exercise regularly and those who do not. METHODS: A questionnaire designed to evaluate physical activity levels, body mass index (BMI) and academic performance was distributed to 325 senior dental students. Of the 312 who responded, a total of 70 were enrolled in the study, of whom 60 completed the study. The students were composed of a low-activity group (n = 30), who had a Goddard-Sheppard (GS) exercise score of <25, and a high-exercise group (n = 30), who had a GS score >60. Dental Environment Stress (DES) questionnaires and salivary samples were collected at the first week of the semester and at the week of the examinations. Salivary TAC was measured using a commercially available Radical Absorbance Antioxidant Assay measurement kit (Zen-Bio ORAC™, AMS Biotechnology, Abington UK). A total of 60 students completed the study. RESULTS: A significant increase in DES values and a significant reduction in salivary TAC values were observed in the week of the examination compared to baseline scores. Although no differences were observed in the DES scores between the high-exercise and low-exercise groups, the high-exercise group showed a significantly lower reduction in examination week salivary TAC compared to their counterparts in the low-exercise group. Regression models showed a significant association between the TAC, exercise scores and DES scores in the week of the examinations. CONCLUSION: Regular exercise may help protect students against the oxidative stress associated with academic stress.

Accuracy of electronic apex locators in primary teeth: a meta-analysis.

AIM: To conduct a meta-analysis on the accuracy of electronic apex locators (EALs) in determining working length in human primary teeth. METHODOLOGY: An electronic literature search was conducted using a combination of the terms 'primary teeth', 'root canal length' and 'electronic apex locators'. Additional eligible articles were identified using a manual search. The full texts of identified articles were screened according to inclusion criteria. RESULTS: Overall, 19 studies met the inclusion criteria and were subjected to further data extraction. Meta-analysis of studies that reported mean lengths and difference in mean lengths between EAL and actual root canal length (ARCL) revealed a significant difference (P = 0.015) between the two readings whilst those studies that evaluated intraclass correlation (ICC) suggested a high correlation (P < 0.0001) between the EAL and ARCL readings. A subgroup analysis revealed that the presence of root resorption did not affect the accuracy of EALs (P = 0.567). CONCLUSION: Electronic apex locators offer an acceptable level of accuracy in the measurement of root canal length in primary teeth.

Parental anxiety associated with children undergoing dental treatment.

AIM: Over the past two decades, improvements in both the safety of anaesthetic agents and the techniques of operative dentistry have resulted in the popularity of "day-case anaesthesia". The aim of this study was to evaluate the stress felt by parents of children undergoing dental treatment. The study also aimed to compare the stress felt by parents of children undergoing chairside treatment to the stress felt by parents of children who received their treatment under general anaesthesia. MATERIALS AND METHODS: Study Design: Stress among parents was assessed subjectively using the Modified Dental Anxiety Stress (MDAS) questionnaire and objectively using a pulse oximeter to record the heart rate. The sample comprised of 60 parents of children aged between 4 and 7 years who were divided into three groups. Group A comprised of 20 sets of parents of children who underwent complete dental treatment without any pharmacological behaviour management. Group B comprised of 20 sets of parents of children who were treated at the dental chair with N2O used as pharmacological behaviour management. Group C comprised of 20 sets of parents of children who underwent dental rehabilitation under general anaesthesia. Objective signs were recorded preoperatively, during the procedure and post-operatively. RESULTS: Dental treatment is a stressful experience for a parent. The introduction of a pharmacological method of behaviour management seems to significantly increase the stress felt by the parent. CONCLUSIONS: A significant increase in heart rate was observed among parents whose children were under treatment.

Efficacy of external cold and a vibrating device in reducing discomfort of dental injections in children: A split mouth randomised crossover study.

AIM: To study the discomfort and fear associated with maxillary infiltration injections when using a combination of external cold and a commercially available vibrating device. METHODOLOGY: A total of 60 children aged 7 years old participated in this split mouth randomised crossover study. The control intervention comprised of the administration of 1.8 ml of 2% lidocaine with 1:100,000 adrenaline using a 24 mm 30 gauge needle, while the test intervention used external cold and a commercially available vibrating device in addition to the control protocol. The heart rate of the child at the time of injection was used as an objective measure and the Wong-Baker pain scale was used as a subjective measure of the child's discomfort. The face, limbs, arms, cry and consolability (FLACC) scale was used to record the child's pain as perceived by the dentist. RESULTS: Children reported a significantly lower Wong-Baker score and the operators observed a significantly lower heart rate and FLACC scores in the test visit than the control visit. CONCLUSIONS: Combining external cold with vibrating devices might be effective in reducing discomfort and fear in children undergoing infiltration dental analgesia. CLINICAL TRIALS IDENTIFIER: NCT02675387.

Preliminary images from an adaptive imaging system.

I-ImaS (Intelligent Imaging Sensors) is a European project aiming to produce real-time adaptive X-ray imaging systems using Monolithic Active Pixel Sensors (MAPS) to create images with maximum diagnostic information within given dose constraints. Initial systems concentrate on mammography and cephalography. In our system, the exposure in each image region is optimised and the beam intensity is a function of tissue thickness and attenuation, and also of local physical and statistical parameters in the image. Using a linear array of detectors, the system will perform on-line analysis of the image during the scan, followed by optimisation of the X-ray intensity to obtain the maximum diagnostic information from the region of interest while minimising exposure of diagnostically less important regions. This paper presents preliminary images obtained with a small area CMOS detector developed for this application. Wedge systems were used to modulate the beam intensity during breast and dental imaging using suitable X-ray spectra. The sensitive imaging area of the sensor is 512 x 32 pixels 32 x 32 microm(2) in size. The sensors' X-ray sensitivity was increased by coupling to a structured CsI(Tl) scintillator. In order to develop the I-ImaS prototype, the on-line data analysis and data acquisition control are based on custom-developed electronics using multiple FPGAs. Images of both breast tissues and jaw samples were acquired and different exposure optimisation algorithms applied. Results are very promising since the average dose has been reduced to around 60% of the dose delivered by conventional imaging systems without decrease in the visibility of details.

The role of an occlusal template during the placement of preformed metal crowns in children under general anaesthesia: a randomised control trial.

AIM: This aim was to evaluate preformed metal crowns (PMC) placed under general anaesthesia using an occlusal template in comparison to crowns placed without the use of a template. METHODOLOGY: CONSORT protocols were followed in the design of the study. A total of 60 children between 4-7 years requiring pulpotomy and PMC for all primary molars met the inclusion criteria for this study. The control group comprised patients for whom the PMC were placed without the use of an occlusal template, while in the test group crowns were placed using a polyvinyl siloxane occlusal template. Patients were followed up at 24 h, 7 days, 3 and 6 months. The time taken for the placement of crowns, instances of post-operative discomfort, success or failure of the pulp therapy and loss of any crowns were compared between the groups. RESULTS: The mean time taken for completion of the procedure in the control group was significantly greater than the template group (t = 2.566, p = 0.013). Significantly fewer patients in the template group reported symptoms of discomfort or high points at the 24-h recall; however, these differences were not significant at the 1-week, 3- or 6-month recall. CONCLUSION: The use of an occlusal template for the placement of multiple PMC under general anaesthesia reduces the time taken for their placement and reduces the incidence of immediate post-operative discomfort.

The impact of dental treatment on the salivary cortisol levels of children with severe early childhood caries.

AIM: To compare salivary cortisol levels of caries-free children with those of children with severe early childhood caries (S-ECC) before and 3 months after comprehensive dental treatment. METHODS: Thirty children with S-ECC were matched with 30 caries-free children from middle income families with college-educated working mothers. Early-morning saliva samples were collected from the children using the passive drool method. Post-treatment saliva samples were collected 3 months after completion of treatment in the S-ECC group. Salivary cortisol levels were analysed using electrochemiluminescence immunoassay. RESULTS: Salivary cortisol levels of caries-free children were significantly lower than both the pre-treatment and post-treatment levels of children with S-ECC (F = 26.221, p < 0.0001). The pre-treatment cortisol levels of children with S-ECC were significantly higher than the post-treatment levels (t = 2.588, p = 0.015). No significant differences in cortisol levels were observed between genders or between children treated over multiple visits under local analgesia and in a single visit under general anaesthesia. CONCLUSION: Dental treatment significantly reduced the salivary cortisol levels of children with S-ECC, however, the post-treatment levels remained significantly higher than those of caries-free children.