Prevalence of dental caries in Pakistan: a systematic review and meta-analysis.

BACKGROUND: Optimum oral health is impossible to achieve without managing dental caries. The first step to manage dental caries at a community level is to know its prevalence and trend. Unfortunately, the prevalence of dental caries at the national/regional level is not known in many developing countries. Pakistan is no exception. The present meta-analysis was planned to document the prevalence of dental caries at the national, as well as regional level. This paper will serve as a baseline for making future health policies, and health promotion activities in the country. METHODS: Literature was searched through various databases, such as PubMed, SCOPUS, and Web of science using: "Prevalence", "Dental Caries", "Dental Decay" and "Severity" as keywords. Any study that reported the prevalence of dental caries, and was conducted in the Pakistani population was included. Thirty studies fulfilled the inclusion criteria. Quality assessment of all the included studies was performed using Joanna Briggs Institute (JBI) critical appraisal checklist for prevalence studies. MedCalc software was used to analyze the data. RESULTS: In total 27,878 subjects were included in a meta-analysis from 30 studies. The prevalence estimate of dental caries at the national level was 56.62% (95% CI: 49.54 to 63.57). The I2 value was 99.07% (95% CI: 98.94 to 99.18), (I2 > 75%) indicating heterogeneity, hence pooled proportion was reported using a random-effect model. The prevalence estimate of dental caries in Sindh was 58.946% (95% CI: 43.796 to 73.274), and in Punjab, it was 55.445% (95% CI: 44.174 to 66.44), whilst in Baluchistan and KPK combined was 51.168% (95% CI: 22.930 to 79.004). CONCLUSION: Based on the existing data nearly 60% of the Pakistani population have dental caries. The proportion is almost the same in all provinces. Most of the included studies were found to be of high risk.

Teledentistry awareness, its usefulness, and challenges among dental professionals in Pakistan and Saudi Arabia.

Objectives: This study aims to describe the perception of dental professionals in Pakistan and Saudi Arabia (SA) towards the practice of teledentistry, its usefulness and challenges. Methods: A cross-sectional study was carried out among 190 dentists from January 2021 to April 2021. The participants were included in the study using snowball sampling method. A 26-item adopted questionnaire was distributed using different social media channels. Chi-square test was used for analysis. Results: Out of 190 participants, 46.3% were from Pakistan and 53.7% were from SA. The majority of participants in both countries agreed that teledentistry would enhance guidelines and advice (74.2%), improve peer-to-peer interaction (79.5%) and make patient's referrals more efficient (75.8%). For the usefulness, most participants agree that it is economical for the patients (61.1%), improves communication (74.7%), helps in educating the patients (86.3%), avoid unnecessary travel (76.8%), helps monitoring (71.6%), and benefits patients in remote areas (74.7%); however, more Pakistani participants perceived that time spent with the patient would increase compared to SA participants (p < 0.001) and a higher proportion of SA participants believe that it helps in communication and monitoring of patients (p < 0.001) than Pakistani participants. Regarding the challenges in the use of teledentistry, few participants think that it violates the patient's privacy (22.6%) or is difficult to use (14.7%) or have distrust towards the teledentistry equipment (24.2%). Conclusion: The results indicated a high awareness and a positive attitude towards teledentistry, and its adaptation in their dental practice in both countries. However, limited infrastructure, set-up cost, and information technology (IT) literacy are the main challenges in integrating teledentistry which can be overcome by strategic government initiatives, policies, and programs.

Level of anxiety and depression among undergraduate dental students of University of Hail, Saudi Arabia.

BACKGROUND: Dental students have been identified as having a high level of stress. OBJECTIVE: This study aimed to assess the prevalence of anxiety and depression among undergraduate dental students of university of Hail and to determine the association of anxiety and depression in terms of gender and respective year of study. METHODS: This was an observational cross-sectional study. Nonprobability sampling technique was used to assess the prevalence and association of anxiety and depression among male and female dental students of preclinical and clinical years of College of Dentistry, University of Hail, Saudi Arabia. Students were contacted personally, explained the purpose of the study and asked to participate in the study. Students were asked to complete both Beck's depression inventory and Beck's anxiety inventory to assess the level of their respective status. RESULTS: The results of the survey revealed that a greater number of females suffered from 'moderate' level of anxiety (12.3%) as compared to males (3.2%). Additionally, the percentage for females to experience 'borderline' (11.6%) and 'moderate' (9.7%) level of depression was higher than their male counterparts -'borderline' (7.7%) and 'moderate' (2.6%). The level of anxiety and depression compared with genders was found to be statistically significant. It was noted that final year students (8.4%) experienced 'moderate' level of anxiety and there was a peak rise in level of depression among 4th year (6.5%) and 6th year (5.8%) students as compared with other years. CONCLUSION: The finding of the study emphasizes that the overall percentage of level of depression is comparatively higher than level of anxiety among dental students.

Provision of Endodontic Treatment in Dentistry amid COVID-19: A Systematic Review and Clinical Recommendations.

BACKGROUND: The risk of acquiring COVID-19 during a pandemic is a major concern among health care workers. Dental professionals being in close proximity to the patients had been exposed more than other health care workers. Hence, all the standard operating procedures (SOPs) are strictly advised to be followed. METHODS: A detailed relevant literature search was conducted in international databases such as PubMed, Web of Science, and Science Direct, from January 2020 to November 2020. All the studies that provided recommendations regarding endodontic procedures during the COVID-19 pandemic were included, and those that were not in the English language, case reports, book chapters, and short communications were excluded in this review. In the end, only 6 articles were selected for the systematic review considering that complete information regarding the provision of dental care in the time of COVID-19 with diagnostic accuracy (STARD) was provided. RESULTS: Endodontic treatments were restricted to only emergency dental procedures, and all other patients have advised medications and catered through teledentistry. Endodontic emergencies were advised to be carried out with minimal aerosol production procedures. CONCLUSION: Provision of endodontic care during COVID-19 restricted to only emergency dental procedures by strictly following standard operating procedures. A protocol for COVID-19 prevention was followed by all the dentists and the dental staff in the dental clinics.

Teachers' knowledge about oral health and their interest in oral health education in Hail, Saudi Arabia.

OBJECTIVES: To assess the dental health knowledge and the interest of secondary school teachers in imparting oral health education in Hail, Saudi Arabia. METHODS: It was a questionnaire based cross-sectional survey of secondary school teachers in Hail, Saudi Arabia, carried out from November 2014 to January 2015. A validated self-administered questionnaire was used to determine teachers' oral health knowledge and their interest in participating in oral health education of school children. Data analysis was performed using SPSS version 20 statistical software. RESULTS: Two hundred and twenty three secondary school teachers responded to the survey. Results showed that about 80 to 90 % of teachers had sufficient knowledge of causes and prevention of dental caries and gingivitis. About 94% of teachers agreed that they can play an effective role in oral health promotion while 96% were found to be interested in performing additional duty as oral health promoter. A large majority (91.9 %) had the opinion that oral health education must be included in school curriculum. CONCLUSION: Teachers in Hail region had adequate amount of knowledge regarding oral health, and they were interested to play their role in promoting oral health education. Based on the findings of this study, it is recommended to include dental health education in curriculum at secondary school level and to provide sufficient training to teachers to enable them to participate actively in oral health promotion activities.

School Absenteeism due to Toothache among Secondary School Students Aged 16-18 Years in the Ha'il Region of Saudi Arabia.

Objective. This study assessed the impact of toothache on school attendance among secondary school students in the Ha'il Region, Saudi Arabia. Methods. A cross-sectional, paper based survey was conducted among 16-18-year-old students of public sector secondary schools in the Ha'il Region, Saudi Arabia. Results. Of the 510 students selected from the participating schools, 480 were analyzed (94.1%). Of the sample, 50.4% were boys. Among the participants in the study, 86 students reported school absence due to toothache in the six months prior to the survey. Consequently, the prevalence of absenteeism due to toothache in this study was of 18%. Conclusion. The prevalence of school absenteeism due to toothache among students in the Ha'il Region was low. Yet, still, missed school days due to toothache may have implications for students also in the Ha'il Region, Saudi Arabia, as school absenteeism leads to missed opportunities for learning and academic advancement.

Prevalence of musculoskeletal disorders among dentists in the Hail Region of Saudi Arabia.

BACKGROUND AND OBJECTIVES: Dentists suffer a high prevalence of musculoskeletal disorders (MSDs) but studies are quite limited. The present study was carried out to investigate the prevalence of MSDs among dentists in the Ha'il Region, Saudi Arabia. DESIGN AND SETTINGS: A cross-sectional, questionnaire study was conducted among 80 licensed dentists af.filiated with the Ministry of Health (MoH), Ha'il Region, Saudi Arabia from January 2014-January 2015. PATIENTS AND METHODS: A self-administered questionnaire, based on the Nordic Musculoskeletal Questionnaire (NMQ) was sent to participants after translation to Arabic. The questionnaire was delivered by mail with a prepaid return envelope. RESULTS: Sixty-eight questionnaires (85%) were returned. The prevalence of MSDs among respondents was 77.9% (n=53) with the most commonly affected areas the lower back (73.5%) (39/53) followed by the neck (66%) (35/53) and the shoulders (43.3%) (23/53). Twenty-four (45.2%) of 53 respondents had experienced MSDs in the neck and lower back at the same time throughout the past twelve months. Nearly 85% (45/53) of respondents were found to have MSDs affecting two or more sites. CONCLUSION: Prevalence of MSDs was high among dentists in the Ha'il region. Lower back, neck and shoul.ders were the most commonly affected body sites.

Prevalence of Dental Fluorosis in Saudi Arabia: A Meta-Analysis

Abstract Objective: To identify the prevalence of dental fluorosis in Kingdom of Saudi Arabia. Material and Methods: Literature search for the present study aimed to include all the relevant studies conducted in Saudi Arabia that reported prevalence of dental fluorosis. A literature search was done using keywords (dental, fluorosis, prevalence) using three databases (Scopus, PubMed, and Web of Science). Grey literature was also searched using Google Scholar and research gate. Literature was searched from 1939 till April 2020. The risk of bias was reported using JBI Critical Appraisal Checklist for Studies Reporting Prevalence Data. Twelve studies were included based on inclusive criteria. The only inclusive criteria were studies that were conducted among people living in Saudi Arabia, and studies that reported the prevalence of dental fluorosis. Samples from all age groups that reported prevalence of dental fluorosis were included. MedCalc statistical software was used to perform the analysis. Results: The overall prevalence of dental fluorosis was found to be 46.52%, 95 CI (26.52% to 67.12%). I2 value was reported 99.8%, 95 CI (99.78% to 99.83%), indicating high heterogeneity amongst the finding of studies. Funnel plots indicate the presence of a strong publication bias. Overall, we found some contrasting findings. One study reported prevalence of dental fluorosis as 0% and other with a comparatively large sample size found dental fluorosis to be 90.6%. Conclusion: The present study adds to the literature regarding dental fluorosis in Saudi Arabia by providing an overview of its prevalence. It is concluded that prevalence of dental fluorosis was a bit high. However, findings indicate publication bias. We did not account for severity of dental fluorosis. All the available data was analyzed to measure dental fluorosis prevalence without considering the sample size and sampling technique.

Cytotoxicity, Morphology and Chemical Composition of Two Luting Cements: An in Vitro Study

Abstract Objective: To assess the cytotoxicity, surface morphology, elemental compositions and chemical characterization of two commonly used luting cement. Material and Methods: The two luting types of cement used were Elite Cement® and Hy-Bond Resiglass®. Freshly mixed (n=6) and set form (n=6) of each cement was placed in medium to obtain extracts. The extract from each sample was exposed to L929 mouse fibroblasts (1x104cells/well). Alamar Blue Assay assessed cell viability. Surface morphology and elemental composition were evaluated using scanning electron microscopy and energy dispersive spectroscopy. The chemical characterization was performed by Fourier Transform Infrared Spectroscopy. One-way ANOVA and post-hoc Tukey analysis were conducted to assess results. Results: Hy-Bond Resiglass® was the more cytotoxic of the two types of cement in both freshly mixed (68.10 +5.16; p<0.05) and set state (87.58 +4.86; p<0.05), compared to Elite Cement® both freshly mixed (77.01 +5.45; p<0.05) and set state (89.39 +5.66; p<0.05). Scanning electron microscopy revealed a more irregular and porous structure in Hy-Bond Resiglass® compared to Elite Cement®. Similarly, intense peaks of aluminium, tungsten and fluorine were observed in energy dispersive spectroscopy in Hy-Bond Resiglass. Conclusion: All these three elements (aluminium, tungsten and fluorine) have cytotoxic potential. The Fourier transform infrared spectroscopy revealed the presence of hydroxyethyl methacrylate in Hy-Bond Resiglass®, which has a cytotoxic potential.

Knowledge of Primary School Teachers Regarding Dental Trauma Management in Hail Region, Saudi Arabia

Abstract Objective: To evaluate the knowledge of elementary school teachers about the management of dental trauma. Material and Methods: An observational study, with the cross-sectional design, was conducted among primary school teachers in Hail, Saudi Arabia during January 2017. The questionnaire distributed among 400 primary school teachers from 18 different schools using convenient sampling. Data were gathered and analyzed using SPSS version 20 Results: 378 (94.5%) respondents to the questionnaire. It was found that only 37.8% of the primary school teachers were able to distinguish between the primary and permanent teeth. Only 59.5% reported starting the management of a child with trauma immediately. Merely 38.4% believed that it is important to search for the missing tooth or the broken pieces, whereas 31% would re-implant the permanent tooth into the socket by themselves. Regarding the storage media, only 16.6% respond correctly. According to school teachers, the best way of learning the management of dental trauma at school is through videos (36.2%) and phone application (33.9%) Conclusion: School teachers lack knowledge regarding the management of dental trauma. We strongly recommend planning for dental trauma educational based on the teacher's perception after pilot testing its effectiveness.