Age related impairments in ingestion from a large population based-sample.

OBJECTIVES: Epidemiological data regarding the evolution of problems related to mastication and swallowing with age are lacking. This study aims to (i) describe changes in oral function with age, using data from a large French population, (ii) validate online, self-report uses of an ICF questionnaire in older persons, and (iii) assess whether impairment is related to avoidance of certain foods, xerostomia, body mass index (BMI) and oral health related quality of life (OHRQoL). METHODS: Volunteers aged ≥18 years with internet access completed a series of questionnaires on sociodemographic, anthropometric and oral health characteristics (oral function, Xerostomia Index (XI), OHRQoL, reasons for avoidance of certain food). Oral function was assessed using items derived from the International Classification of Functioning (ICF). Five ICF items related to ingestion function and six items related to activities and participation were used. A validation study was undertaken to identify those with poor chewing ability and low salivary flow amongst older participants reporting impairment. FINDINGS: 39 597 individuals were included. The prevalence of individuals with impairment for ICF items related to ingestion function and oral activity (eating, drinking and speaking), and the percentage of participants with poor OHRQoL increased significantly with age (p < 0.001). Each ICF item was significantly associated with OHRQoL (p < 0.001), XI (p < 0.001), BMI (p < 0.001) and avoidance of certain food due to chewing or swallowing difficulties. CONCLUSION: Overall, 21.5% and 13.5% of the study population had chewing and/or biting impairments respectively, which might affect food selection and consumption. These findings raise individual and population-based issues. Further studies are needed to assess whether impairment in oral function might increase frailty in older individuals, and also to compare data with those from other countries.

Does malocclusion affect ingestion: a systematic review.

OBJECTIVES: The multifactorial aspect of malocclusions and their consequences on ingestion function is rarely described in the literature. The aims of this review are (i) to investigate the relationship between oral ingestion and malocclusion and (ii) to gather malocclusion tools that could help screen subjects at risk of malocclusion-related ingestion disorders. MATERIAL AND METHODS: A systematic review was performed following the Preferred Reporting Items for Systematic Reviews and Meta-Analysis Protocol (PRISMA-P 2015) guidelines. The analysis methods and inclusion criteria have been documented in a protocol published in the Prospective International Register of Systematic Reviews (PROSPERO) under the registration number CRD42023395840. The bibliographic search involved the PubMed®, Cochrane and PROSPERO databases. RESULTS: A total of 29 articles published between 2007 and 2023 were retained by the search criteria for the qualitative synthesis. Twenty of the studies found that the severity of malocclusion has a negative impact on oral ingestion. This review highlights that malocclusion and ingestion impairments are associated but it is not possible to determine causality due to the observational approach of many of the studies. CONCLUSION: Malocclusion has a negative impact on ingestion function. During orthodontic consultations, particular interest should be directed towards chewing, biting, and swallowing disorders, which can affect patients' nutritional status. This review offers arguments for designing further studies assessing the extent to which malocclusions may affect nutritional status. CLINICAL RELEVANCE: Orthodontic treatment should focus on improving patients' ingestion.

Time efficiency and cost analysis between digital and conventional workflows for the fabrication of fixed dental prostheses: A systematic review.

STATEMENT OF PROBLEM: Time and cost are factors that influence a patient's decision on dental prosthetic treatment. Evidence is needed to demonstrate that restoration using digital systems is more rapid and less costly than the conventional process. PURPOSE: The purpose of this systematic review was to analyze and compare the duration and cost of fixed dental prostheses fabricated using digital and conventional methods from scanning or impression making to delivery of the prosthesis. MATERIAL AND METHODS: A systematic review was performed following the Preferred Reporting Items for Systematic Reviews and Meta-Analysis Protocol (PRISMA-P 2015) guidelines. The analysis methods and inclusion criteria were documented in a protocol registered in the Prospective International Register of Systematic Reviews (PROSPERO) (CRD42023458734). The bibliographic search was carried out using PubMed, Cochrane, and PROSPERO databases. The main keywords used were (Prosthodontic OR restorative dentistry OR denture) AND (CAD CAM OR Digital workflow OR Computer Dentistry OR Digital Design) AND (Economic OR cost OR Financial OR time efficiency). Two investigators undertook the different steps of article selection. RESULTS: A total of 8 articles published between 2010 and 2023 were found for the qualitative synthesis by using the search criteria. Two studies showed that conventional impressions took more time than digital scans for the fabrication of a single crown, and 1 study showed the opposite. One study found that a digital scan was faster than conventional impression making for the fabrication of a 3-unit fixed partial denture, and another study showed the opposite. The dental laboratory technician spent more time on the conventional workflow than the digital workflow for the 3-unit framework and veneering process. No difference was found between conventional and digital workflows for clinical evaluation and chairside adjustment for the fabrication of a single crown. No articles have compared the cost of fixed prostheses. CONCLUSIONS: The digital pathway can shorten the laboratory process. However, the duration of the impression or scan may vary depending on the technique used. Studies are needed to analyze the cost-effectiveness of the fabrication of tooth-supported restorations.

Fit and retention of complete denture bases: Part II - conventional impressions versus digital scans: A clinical controlled crossover study.

STATEMENT OF PROBLEM: Although the intraoral scanning of edentulous ridges is feasible, clinical evidence that the resulting denture retention is equivalent to that achieved with conventional impressions is lacking. PURPOSE: The purpose of this clinical study was to determine the retention of complete denture bases fabricated from digital intraoral scans versus conventional impressions by using border molding and posterior palatal seal compression. MATERIAL AND METHODS: Twenty volunteers with an edentulous maxilla were recruited. An intraoral scan of the maxilla and a conventionally border-molded impression with a custom tray were made. The conventional impression was poured; the definitive cast was scanned. Three-dimensionally (3D) printed (PB1) and milled bases (MB1) were fabricated based on the scan of the definitive cast. Based on the intraoral scan, a 3D-printed (PB2) and a milled base (MB2) were fabricated. On each base, a platform with a hook consisting of a central notch orienting the force against the post dam (PD) and 2 lateral notches orienting the forces against the left (LT) and right (RT) tuberosities was set in the center of the outer surface of the base. A traction dynamometer was inserted in the hook and oriented into the corresponding notch by applying force until dislodgement. All bases were subsequently stored in artificial saliva for 2 weeks and scanned. Retention testing was repeated by using the same procedure. To evaluate trueness and to visualize the differences on a color map, the scan of the definitive cast and the intraoral scans were matched and compared in 3 dimensions. The Wilcoxon tests were used to compare the retention of the different bases (95% confidence interval, α=.05). RESULTS: Nineteen participants with a mean ±standard deviation age of 64.1 ±14.7 years completed the 4 study sessions. The retention of printed bases (PD: 16.08 ±15.28 N; LT: 14.98 ±14.72 N; RT: 11.28 ±9.57 N) and milled bases (PD:14.52 ±17.07 N; RT: 11.99 ±12.10 N; LT: 13.55 ±15.53 N) fabricated from conventional impressions presented significantly higher retentive forces than those printed (PD: 6.21 ±4.72 N; RT:5.12 ±2.78 N; LT: 4.45 ±2.77 N) and milled (PD: 6.58 ±4.92 N; RT: 4.65 ±2.63 N; LT: 5.02 ±3.58 N) from the intraoral scans (P<.05). The differences were significant in all directions of dislodgement, as well as after storage in artificial saliva for 2 weeks. Comparison of the 3D distances between the intraoral scan and the definitive cast revealed a mean deviation of 0.45 ±0.11 mm. CONCLUSIONS: Conventional impressions of the edentulous maxilla, including the clinical steps of border molding and posterior palatal seal compression, provide better retention than digital intraoral scans with both milled and 3D-printed denture bases.

Fit and retention of complete denture bases: Part I - Conventional versus CAD-CAM methods: A clinical controlled crossover study.

STATEMENT OF PROBLEM: Clinical evidence is sparse on whether dentures fabricated by computer-aided design and computer-aided manufacturing (CAD-CAM) methods afford superior fit and retention when compared with those fabricated conventionally. PURPOSE: The purpose of this clinical controlled crossover study was to evaluate the peak retention force and fit of CAD-CAM manufactured (3D-printed and milled) maxillary complete denture bases and conventional heat-polymerized bases (control). MATERIAL AND METHODS: Twenty participants with edentulous maxillary arches were recruited. Impressions were made with a border-molded custom tray, and the resulting definitive cast was scanned. The conventional base was manufactured on the definitive cast with a hook and a 45-degree platform with a central notch and 2 lateral notches. The scan of the definitive cast was used for the fabrication of a milled and a printed base. The platform and hook position on the conventional base were transferred digitally to the milled and printed bases. All bases were scanned. A traction dynamometer was orientated into the notches, and retention was evaluated in the post dam and tuberosity areas. Scans were imported into a comparison software program which matched scans to their corresponding reference and performed a 3-dimensional comparison. The Friedman and Wilcoxon tests were used to compare between groups (confidence interval: 95%, α=.05). RESULTS: Nineteen participants with a mean ±standard deviation age of 64.1 ±14.7 years completed all clinical sessions. No significant difference in peak retention was measured between milled (MB1), printed (PB1), and conventional (CB) bases in the post dam (CB: 12.44 ±9.62 N, PB1: 16.08 ±15.28 N, MB1: 14.52 ±17.07 N) and right tuberosity area (CB: 8.99 ±7.82 N, PB1: 11.28 ±9.57 N, MB1: 11.99 ±12.10 N). In the left tuberosity area, peak retention was lower for CB (10.03 ±8.39 N) than PB1 (14.98 ±14.72 N) and MB1 (13.55 ±15.53 N; P=.05). Compared with the definitive cast, the fit of the conventional base (0.18 ±0.01 mm) was closer than the printed (0.21 ±0.03 mm) and milled bases (0.21 ±0.02 mm) (P<.001). CONCLUSIONS: The CD bases manufactured by CAD-CAM techniques provided retention and fit similar to that of conventionally manufactured bases and can therefore be considered suitable techniques.

Assessment of infrazygomatic crest dimensions in different vertical facial growth types for miniscrew insertion: A cone-beam computed tomography study.

INTRODUCTION: This study aimed to assess the depth and height of the infrazygomatic crest (IZC) located in the posterior maxilla at the junction with the zygomatic process in patients with different vertical facial growth types as a potential miniscrew insertion site. METHODS: The sample consisted of cone-beam computed tomography scans of 117 patients (42 males and 75 females), with a mean age of 22.9 ± 2.7. The population was divided into 3 groups according to the measured SN-GoGn angle: Decreased facial proportions (n = 28), average facial proportions (n = 62), and increased facial proportions (n = 27). Bone depth was assessed at 5 levels: apex, 1, 2, 3, and 4 mm vertically from the apex. The measurements were performed on the mesiobuccal and distobuccal roots of the first molar and the mesiobuccal root of the second molar. Repeated-measure analysis of variance followed by univariates analyses and Bonferroni multiple comparisons were performed to compare the mean bone thickness between groups. The IZC height was assessed through a vertical line ranging from the furcation of the maxillary first molar to the sinus floor. Analysis of variance followed by Tukey (honestly significant difference) post-hoc tests was used to compare the mean height between groups. RESULTS: Mean bone depth between the 3 groups were significantly different at the mesiobuccal root region of the first molar at all the measured levels. It was smaller for average, intermediate for decreased, and elevated for increased facial proportions. No statistical difference was shown at the distobuccal root of the first molar except for the apex level and the mesiobuccal root of the second molar except for the apex and 4 mm levels. The mean bone height was significantly different between subjects with increased facial proportions and the 2 other groups. CONCLUSIONS: Subjects with increased facial proportions tend to present a longer and deeper IZC followed by decreased facial proportions, then average facial proportions.

Validation of the French version of COHIP-SF-19 among 12-years children in New Caledonia.

BACKGROUND: Assessment of oral health-related quality of life is now associated to clinical indicators in epidemiological studies. This study aimed at validating the French Short Form of the Child Oral Health Impact Profile (COHIP-SF-19) and assessing the impacts of oral diseases among schoolchildren in New Caledonia (NC). METHODS: A sample of 12-years-old children (n = 971) was selected in 2019 in NC using a random, stratified, and clustered sampling technique. Children filled the French COHIP-SF-19 questionnaire. Information on sociodemographic characteristics, oral hygiene habits, perception of oral health problems were also collected through self-administered questionnaires or from the schools' database. Dental status (dental caries, gingival status, and dental functional units) was clinically recorded at school by four calibrated examiners. Cronbach's alpha and intraclass correlation coefficients (ICC) were calculated. Kruskal-Wallis tests and spearman correlations were used along with multilevel mixed models taking into account the cluster and examiner effects. A confirmatory factor analysis was conducted and sensitivity analyses were performed. RESULTS: Among the 693 children examined, 557 children were included. Oral diseases were frequent in the study population 40% had dental caries and 55% presented gingivitis. The COHIP scores ranged from 7 to 76 (57.9 ± 9.96) with 96.4% of the children having experienced oral health problems, 81.7% reporting functional impacts and 90.5% socio-emotional impacts. Overall, the French COHIP-SF-19 showed satisfactory psychometric characteristics. Internal consistency was high (Cronbach's alpha = 0.80) and reproducibility excellent (ICC = 0.9). Discriminant and concurrent validity were adequate. Indeed, children with less optimal social situation, impaired dental status, declaring severe dental problems or difficulties in accessing oral health care showed lower COHIP-SF-19 scores. Factor analyses suggested a four-component structure with identification of a new domain (self -image) and changes in the repartition of the items within the original domains. Sensitivity analyses showed similar results for children with partial or complete answers in the COHIP questionnaire. CONCLUSIONS: The French COHIP-SF-19 showed satisfactory psychometric characteristics and allowed to identify the high impacts of oral diseases in New Caledonian children, namely for socially deprived children.

Injury patterns among national-level athletes in Lebanon: a retrospective study.

OBJECTIVES: This study aims to assess the annual prevalence, associated factors, and characteristics of musculoskeletal disorders among Lebanese national-level athletes. METHODS: Lebanese athletes aged 18 and over and who competed in a top-level national championship during an entire athletics season were invited to participate in the study. Data were collected through questionnaire assessing self-reported injury during the past year. Injury, dependent variable of the study, was defined as a musculoskeletal condition that made the athlete partially or completely abstains from training or competition for a 1-week minimum injury period. RESULTS: Among the 250 eligible athletes, 210 (84.0%) (25.5±6.7 years) completed the questionnaire. The 1-year retrospective injury prevalence was 51.9% (95% confidence interval, 45.1%-58.7%). Injured athletes reported 150 injuries: 128 (85.3%) affected the lower extremities, and 111 (74.0%) occurred during training. The most common type was muscle cramps/spasm (n=53; 35.3%); and overuse (n=121; 80.7%) was the predominant cause. Athletes who mainly practiced endurance disciplines (-p-value=0.042), who participated in international athletics championships (-p-value=0.047), and who were taking chronic medications (-p-value=0.049) had more injuries in the past year. CONCLUSION: These findings may help inform potential injury prevention programs, which should target injuries affecting the lower extremities, and consider the factors associated with injury risk among Lebanese athletes.

Binge eating among young adults: association with sociodemographic factors, nutritional intake, dietary n-6:n-3 ratio and impulsivity.

Binge eating behaviour (BE) is the major symptom of binge eating disorder (BED). This study aimed to compare the nutritional intake in the presence or absence of BE, with a particular focus on dietary n-6:n-3 ratio, to assess the association between BE and impulsivity and the mediating effect of BMI on this association. A total of 450 university students (age 18-28 years) participated. The self-administered questionnaires were a semi-quantitative FFQ and the UPPS-P Impulsive Behavior Scale and the binge eating scale. The average BE score was 11·6 (se 7·388), and 20 % of the total participants scored above the cut-off of 17, thus presenting BE with 95 % CI of 16·3, 23·7 %. Our study revealed that greater BMI, higher total energy intake, greater negative urgency and positive urgency scores were significantly associated with BE. Participants with high value of dietary n-6:n-3 ratio were 1·335 more at risk to present a BE compared with those with a lower value of this ratio (P = 0·017). The relationship between BE score and UPPS domains score was not mediated by the BMI. This is the first study reporting a link between high dietary n-6:n-3 ratio and BE as well as the fact that BE was linked to both, negative and positive urgencies, and that the association between BE and impulsivity was not mediated by BMI. These findings can help to deal more efficiently with people suffering from BE, a symptom that can precede the development of BED.

Comparison of psychometric properties of GOHAI, OHIP-14, and OHIP-EDENT as measures of oral health in complete edentulous patients aged 60 years and more.

OBJECTIVES: To compare the psychometric properties of three OHRQoL indicators (GOHAI, OHIP-14, and OHIP-EDENT) in a group of complete edentulous subjects and to explore the ability of these instruments to distinguish between individuals with different prosthetic and oral health status. METHODS: This was a cross-sectional study. Edentulous individuals aged 60 years and more were recruited between January 2019 and February 2020 in a medical and dental care centers. The Lebanese versions of GOHAI, OHIP-14, and OHIP-EDENT were used. External and internal consistencies were assessed using intraclass correlation coefficient (ICC) and Cronbach alpha, respectively. The concurrent validity was evaluated by testing the indicators against a proxy measure of a similar concept. To test their discriminative abilities, the ADD (GOHAI and OHIP) and SC (GOHAI and OHIP) scores were dichotomized according to the 25th and 75th percentile, respectively, and multivariate analyses were performed using sociodemographic, clinical, and subjective health parameters as explanatory variables. RESULTS: Two hundred and two edentulous subjects (age: 72.94 ± 7.378 years) were included. The proportion of subjects with no impact was lower for OHIP-EDENT (7.9%) compared to GOHAI (28.2%) and OHIP-14 (38.6%). Reproducibility was satisfactory for all OHRQoL tools since they were able to reproduce the results consistently in time (ICC > 0.80). The Cronbach alpha values were greater than 0.8 indicating acceptable internal consistency. The concurrent validity of the three tools was acceptable since subjects with lower OHRQoL score were less satisfied with their dentures and reported a higher need for self-rated therapy. Concerning the discriminant validity, OHIP-EDENT was more discriminant than OHIP-14 and GOHAI, since it was more able to identify patients with poor prosthetic issues or using instable denture. CONCLUSION: The OHIP-EDENT was more effective in identifying edentulous individuals with oral and prosthetic problems. Our results can help decide which dental instrument to use to assess the perception of oral health in edentulous individuals. More prospective studies are required to compare their evaluative properties.

Assessment of Caries Index and Fluoride Intake in a Pediatric Middle Eastern Population.

AIMS: To assess the fluoride concentration in water sources and its association with caries index in children living in Tripoli, Lebanon. MATERIALS AND METHODS: The concentration of fluoride was measured in tap and bottled water using ion chromatography. For tap water, eight water sources were evaluated before and after domestic distribution during June and November 2016. For bottled water, seven brands available on the market were tested. Caries were recorded in 402 children using DMFT/dmft indices. A questionnaire was distributed to parents to gather information about sociodemographic characteristics, the source of water consumed, the consumption of fluoride supplements, fluoridate salt, tea and sweets, and the frequency of toothbrushing. RESULTS: The fluoride concentration in tap water was not significantly different from the optimal concentration (p value > 0.05). However, the amount of fluoride in bottled water (0.14 ± 0.698 mg/L) was significantly lower than the optimal amount of fluoride recommended by the World Health Organization for decay prevention (0.5-1 mg/L) (p value < 0.001). The prevalence of caries was elevated in children aged 5 years (90.5%) and 12 years (89.6%). The carious indices were lower in children who consume tap water, tea, and fluoridated salt and those who consume less sweet. CONCLUSION: Additional studies covering all Lebanese regions should be performed to develop a national policy concerning fluoride-based scientific evidences. CLINICAL SIGNIFICANCE: Pedodontists should take in consideration the source of water consumed by the patient before prescribing a fluoride supplementation to avoid an overconsumption. They should promote effective oral hygiene methods and nutritional education and encourage regular tea consumption as an affordable source of fluoride to prevent caries.

Assessment of caries on the first permanent molars in a group of seven- to thirteen-year-old schoolchildren: Comparison of DMF and ICDAS systems.

OBJECTIVES: The objective of this study was to compare ICDAS and DMFT/S in the evaluation of caries status of the first permanent molar in 200 children aged 7 to 13 years. METHODS: This was a cross-sectional design study. Participants were selected from two private schools in Lebanon. The examinations were performed by two trained and calibrated examiners using a dental mirror and a WHO probe. The number of decayed (D), missing (M) and filled (F) teeth was recorded in DMFT/S form, and the numbers related to D, M and F were then added to record the DMFT/S value (D1MFT/S, D2MFT/S and D3MFT/S). In the ICDAS, the assessment of caries associated with restorations and sealant was recorded. Student t tests/and Mann-Whitney tests were used to compare the continuous variables. Chi-square tests and Fisher exact tests were used to compare the categorical variables. RESULTS: The average age of the participants was 9.21 ± 1.927 (7-13 years old). No significant difference was found between the mean time to score DMFT, DMFS and ICDAS indices (-p-value > 0.05). The prevalence of caries with D1MFS, D2MFS and D3MFS was 80.5%, 54% and 30.5%, respectively. However, the prevalence of caries with ICDAS II was 77.5%. CONCLUSION: The DMF index is an international user-friendly system that shows the carious history of teeth. However, the ICDAS assesses the different stages of caries and describes the restorative status of the tooth, promoting new preventive approaches and curative needs. More studies should be done to confirm these findings.

Oral health and chemotherapy act as cofactors in malnutrition in the elderly with other cancers than head and neck malignancies.

OBJECTIVES: This study explores whether the chemotherapy regimen has a role in inducing oral health problems and malnutrition in elderly patients with other cancers than head and neck malignancies. MATERIAL AND METHODS: An observational cross-sectional study was designed to compare the relationships between oral health and nutritional status between four groups of elderly differing in cancer or chemotherapy regimen. Data were collected using a questionnaire including the Mini-Nutritional Assessment (MNA), the Geriatric Oral Health Assessment Index (GOHAI) and questions about perception of xerostomia. The oral examinations recorded the number of functional dental units (PFU) and the presence of oral lesions. RESULTS: The sample comprised 46 patients receiving chemotherapy, 48 patients on a non-chemotherapy regimen, 45 persons in complete remission not under treatment and 53 non-cancer patients. Oral health perception was significantly worse in chemotherapy patients. They reported limiting the kinds of food they consumed, the discomfort felt when eating and took medications for oral pain. Oral lesions were frequent in chemotherapy participants. Nutritional status was related to the cancer treatment regimen (OR = 4.17; p value = 0.017), the presence of oral lesions (OR = 4.51; p value = 0.003), perception of xerostomia (OR = 3.54; p value = 0.012), the number of PFU (OR = 2.51; p value = 0.046) and GOHAI score (OR = 1.617; p value = 0.019). CONCLUSION: The presence of oral lesions and the chemotherapeutic regimen were highly associated with nutritional status in older patients with cancer. CLINICAL RELEVANCE: Dental professionals should be asked to intervene preventively and per-therapy to optimise oral health status in elderly patients with other cancers than head and neck malignancies.

Dentinal tubule penetration of AH Plus, BC Sealer and a novel tricalcium silicate sealer: a confocal laser scanning microscopy study.

OBJECTIVES: The aim of this in vitro study was to assess the dentinal tubule penetration of three different sealers, AH Plus, BC Sealer and a novel tricalcium silicate sealer (NTS). MATERIALS AND METHODS: Ninety-six human maxillary central incisors were divided into three experimental groups (n = 32) and were filled with gutta-percha using a single-cone technique in conjunction with one of the three sealers: AH Plus, BC Sealer or NTS. The roots in each group were cross-sectioned at 1 and 5 mm from the root apex, and the surfaces were examined under confocal laser scanning microscopy (CLSM). The sealer penetration depths were measured at their maximum depths and at four circumferential depths (12, 3, 6 and 9 o'clock) and were evaluated using ImageJ software (ImageJ, NIH). RESULTS: The maximum and mean penetration depths were significantly higher at 5 mm compared to 1 mm from the apex in the AH Plus (p < 0.001), BC Sealer (p < 0.001) and NTS groups (p < 0.001). No significant difference was observed between the groups at 1 mm for both parameters. The maximum and mean penetration depths were significantly lower at 5 mm for AH Plus compared with the other two groups (p = 0.012). CONCLUSIONS: Within the study limitations, the BC Sealer and NTS demonstrated better tubule penetration results than the AH Plus sealer. CLINICAL RELEVANCE: Although no study has confirmed a relationship between the penetration depth of root canal sealers and the prevention of apical periodontitis, dentinal tubule sealer penetration may improve obturation quality.

Post-endodontic Flare-ups after a Single-visit Treatment Using the FUI Scoring Method and Associated Factors: A Clinical Prospective Study.

AIM: Flare-ups following a root canal treatment are still a major problem both to the patient and to the clinician. Its definition, etiology, incidence, and risk factors have been the subject of long-standing debate. We conducted this study to investigate the incidence of flare-ups after a single-visit treatment and to identify the factors associated with the flare-up index (FUI). MATERIALS AND METHODS: All patients treated by postgraduate residents in endodontic specialty at Saint Joseph University of Beirut from June 2018 to January 2019 were invited to participate in the study. After a routine root canal treatment, patients were given a questionnaire to fill after 24 hours-48 hours-7 days, covering a postoperative assessment of symptoms using the visual analogue scale (VAS) and FUI. Patients who experienced a severe postoperative pain and/or swelling were identified and categorized as having a flare-up. RESULTS: A total of 423 patients (age: 39.76 ± 12.428 years) were included in the study. The incidence of flare-up was 1.9%. The mean FUI was 5.94 ± 5.646 and was highly correlated with the VAS score (p < 0.001). The factors that significantly influenced the occurrence of flare-ups were: pulpal diagnosis (p < 0.001), preoperative drug intake (p < 0.001), preoperative symptoms (>24 hours) before treatment (p < 0.001), and tooth type (p = 0.013). CONCLUSION: FUI should be used in further studies to confirm our results since it is a valid quantitative method to assess this clinical phenomenon. CLINICAL RELEVANCE: Endodontists should take into consideration the diagnosis and the history of preoperative symptoms since it plays an important role in predicting the occurrence of flare-ups and the success of the treatment.

Social inequalities in oral health in a group of older people in a Middle Eastern country: a cross-sectional survey.

BACKGROUND AND OBJECTIVE: The percentage of Lebanese older people has increased considerably. Given that Lebanese seniors are marginalized in the health policy-making process, we suggest a high social inequality in oral health that has not been studied so far. The purpose of our study was to describe and compare oral health status in a group of Lebanese older people according to their socioeconomic status (SES) MATERIALS AND METHODS: Participants were recruited from three different primary health care clinics in Beirut, Lebanon. Data were collected from an administered questionnaire that included sociodemographic variables, perception of oral health, and regular dental visits. Oral examination included the number of missing and decayed teeth, the prosthetic status, and the number of functional dental units (FUs). The SES of the participants was determined by educational level, previous or actual work, and neighborhood level. RESULTS: 264 participants aged 71.4 ± 6.27 years (64.7% female) were included in the study. Regular dental visit, dental status, FU, and oral health perception were significantly related to the participants' place of residence, educational level, and work. Moreover, the mean number of missing teeth (p = 0.048) and decayed teeth (p = 0.018) was significantly elevated in the low SES. CONCLUSION: There is a clear socioeconomic inequality in oral health among the Lebanese older people. Further researches should explore the potential contribution of psychosocial and behavioral factors in explaining these disparities.

AGE AND REASONS OF THE FIRST DENTAL VISIT OF CHILDREN IN LEBANON.

BACKGROUND: The American Academy of Pediatrics and the American Academy of Pediatric Dentistry have recommended that the child's first dental visit should be during the child's first year of life for dental disease prevention and to decrease the invasive restorative interventions. In Lebanon, no study has been conducted to determine the age and the reasons of the first dental visit of children and who requested the first dental screening. OBJECTIVES: To assess at what age occurred the first dental visit in a group of Lebanese children visiting a private pediatric dental clinic and to explore the reasons for their first dental consultation. MATERIALS AND METHODS: An observational cross-sectional study was conducted. During a five-year period, all children visiting the pediatric clinic were invited to participate in the study. Parents were asked about the general health status of their child, the use of antibiotics before the age of 2 years. Parents were also requested to give the dental reasons for their initial visit to a pedodontist. RESULTS: Two hundred and twenty children (mean age 4.24 ± 1.35 years) visited the pedodontic care office for the first time and were included in the study. All participants had visited a pediatrician before the age of 1 year. Fifty-seven (25.9%) children were referred by a dentist and 163 (74.1%) came with their parents without referral. All participants had at least one reason for the first consultation; the most common were the presence of decayed teeth (50.9%) and a dental pain perception (29.5%). CONCLUSION: All participants had visited a pediatrician at an earlier age but none was referred to a pedodontist by a pediatrician for check-up or prevention. Children came upon the decision of their parents. A dental problem was the major reason which triggered the first visit. Therefore, pediatricians in Lebanon need to keep themselves updated on recommendations regarding children oral health and be encouraged to play an important role in prompting oral health and first dental visits.

Benefits and potential risks of bisphosphonate therapy A narrative review.

Bisphosphonates have been proven to be effective and safe to millions of osteoporotic and cancer patients but were associated with multiple complications. The most prevalent and well established are upper gastrointestinal discomfort for oral bisphosphonates and acute phase reactions for intravenous forms. Although rare, hypocalcaemia and renal injury could be potentially serious. Severe musculoskeletal pain and ocular events may be ignored by physicians, which delay their diagnosis and management. Recently there are growing concerns over two long-term and emerging adverse effects, which are still of unclear pathophysiology and unproven causality. Osteonecrosis of the jaw is more common in cancer sufferers who receive high doses of intravenous bisphosphonates. Atypical femoral fractures are very rare compared with osteoporotic fractures that bisphosphonates prevent. Based on current data, the association of bisphosphonates with esophageal cancer, hepatotoxicity and atrial fibrillation remains doubtful. Overall, the adverse effect profile of these drugs is still unclear. Physicians must be vigilant to bisphosphonate-reported side effects and recognize the level of evidence supporting them, to better communicate the balance between benefits and potential risks to patients.

Validation of the child oral health impact profile (COHIP) french questionnaire among 12 years-old children in New Caledonia.

BACKGROUND: The Child Oral Health Impact Profile (COHIP) is an Oral Health Related Quality of Life (OHRQOL) tool that assesses the impact of oral diseases on quality of life in children. This study aimed to assess the validity of the COHIP French questionnaire (45 items) and to evaluate the OHRQOL of 12-years children in New Caledonia. METHODS: After cultural adaptation of the COHIP questionnaire, data were collected from clinical oral examinations and self-administered questionnaires in a representative sample of children aged 12 years in New Caledonia. Questions related to socio-demographic status or children's perception of their oral and general health were added to the COHIP questionnaire. Studying the association between COHIP scores and health subjective perceptions or dental status indicators assessed concurrent and discriminant validity. The items of the COHIP were subjected to principal components analysis. Finally, reproducibility and reliability were evaluated using Intraclass Correlation Coefficients (ICC) and Cronbach's alpha coefficient. RESULTS: Two hundred and thirty-six children participated in the main study; mean age was 12.6 ± 0.31 years, 55.1 % were girls and diverse ethnic groups were represented. A preliminary reliability analysis has led to calculate COHIP scores with 34 items as in the English version, scores ranged from 35 to 131 (mean ± SD, 101.9 ± 16.84). Lower COHIP scores were significantly associated with the self-perception of poor general or oral health. COHIP was able to discriminate between participants according to gender, ethnic group, oral hygiene, dental attendance, dental fear and the presence of oral diseases. Test-retest reliability and scale reliability were excellent (ICC = 0.904; Cronbach's alpha coefficient = 0.880). Four components were identified from the factor analysis. CONCLUSION: The French 34-items COHIP showed excellent psychometric properties. Further testing will examine the structure and utility of the instrument in both clinical and epidemiological samples.

Bisphosphonate-related osteonecrosis of the jaw: awareness and level of knowledge of Lebanese physicians.

PURPOSE: Bisphosphonate-induced osteonecrosis of the jaw (ONJ) is a potentially destructive complication, particularly encountered in oncology. It is supposed that awareness and good knowledge of this disease by physicians are important factors of its early detection and management. This study aims to evaluate the level of knowledge among a sample of Lebanese physicians with regard to this complication. METHODS: An observational cross-sectional study was conducted at Hôtel-Dieu de France hospital between March and June 2013. Data were collected through a self-administered questionnaire distributed to 190 eligible physicians in the departments involved in prescribing bisphosphonates and managing the ONJ. RESULTS: A total of 136 valid responses were obtained (response rate 71.6 %). Eighty-six (63.2 %) physicians were treating patients with bisphosphonates: the most prescribed form being the weekly oral bisphosphonates for osteoporosis followed by zoledronate several times yearly for bone malignancies. Fifty-one (37.5 %) participants were unaware of bisphosphonate-related ONJ. Furthermore, the level of knowledge was relatively poor: the mean score of all participants was 12.42 ± 10.08, while 77 (56.6 %) had a global score more than 16 over 30. There were statistically significant associations between the level of knowledge and physicians' specialty (p value <0.0001), whether or not they prescribe bisphosphonates (p value = 0.039), the most frequently form prescribed (p value = 0.048), whether or not they attend patients already on bisphosphonate (p value = 0.047), whether or not they have observed (p value = 0.004) and treated (p value = 0.002) exposed necrotic bone of the jaw. CONCLUSIONS: Our study revealed a deficient knowledge regarding bisphosphonate-related ONJ among Lebanese physicians. Appropriate training strategies to increase their awareness are required.