World Workshop on Oral Medicine VIII: Barriers to research in oral medicine: results from a global survey.

OBJECTIVES: To explore factors influencing research interest and productivity and perceived barriers to conducting research in Oral Medicine (OM). METHODS: Invitations to participate in an online survey were e-mailed to a network of international OM practitioners and related professional organizations. Questions captured respondents' demographic/professional variables and gauged research interest, productivity, and perceived barriers to conducting research specifically in OM. Statistical analysis was conducted via descriptive, logistic regression, and multivariate modeling. RESULTS: Five hundred and ninety-three OM practitioners from 55 countries completed the survey, with 54%, 25%, and 21% practicing in high, upper-middle, and lower-middle-income countries, respectively. Eighty-six percent of respondents were interested in conducting research. Age (less interest with an increase in age), working in academia, and practicing in a lower-middle vs high-income country were significant predictors of research interest. Self-reported research productivity was significantly greater among males, those working in academia, and those who graduated from programs that mandated research presentation/publication. Obtaining research funding was a significant barrier among respondents from lower and upper-middle-income countries, whereas finding time for research was a reported barrier by respondents from high-income countries. CONCLUSION: The results of this survey identified perceived barriers to conducting research in OM and highlighted solutions to address such barriers.

Stylohyoid Ligament Calcification and Its Association With Dental Diseases.

OBJECTIVES: This research aimed at investigating the relationship between calcification of the stylohyoid ligaments (SHLs) and odontogenic inflammatory events. METHODS: Cone-beam computed tomography scans of 175 patients were retrospectively assessed for presence of SHL calcifications. Frequencies of 4 types of odontogenic inflammatory events were assessed using the same scans, namely dental extractions, root canal treatments, furcation lesions, and periapical lesions. Patients were telephone-interviewed and asked about histories of tonsillectomy and head and neck trauma. Mann-Whitney U and binary logistic regression tests were used to assess associations between SHL calcification and mean ranks of odontogenic inflammatory events. RESULTS: Calcification of SHLs was detected in 71 (41%) and 58 (33%) patients on the right and left sides, respectively. Tonsillectomy and trauma were reported in 14% and 10% of the sample, respectively. Amongst all inflammatory events, root canal treatments were significantly associated with SHL calcification (U = 2755; Z = -2.1; P = .035). This association was independent from patient age, tonsillectomy, trauma, and other inflammatory events (odds ratio, 1.2; 95% confidence interval, 1.0-1.4; P = .036). CONCLUSIONS: This study presents new evidence that intra-oral inflammatory events, particularly related to root canal treatments, have a stronger association with SHL dystrophic calcification than that associated with traditional predisposing factors (ie, old age, tonsillectomy, and trauma).

Changing Professional Behaviors in the Digital World Using the Medical Education e-Professionalism (MEeP) Framework-A Mixed Methods Multicentre Study.

Background: There is increasing evidence on the exponential use of technology-based social media in medical field that has led to a proliferation of unprofessional behaviors in digital realm. Educating, training, and changing the behaviors of healthcare professionals are essential elements to restrain the rising unprofessional incidents. Therefore, this research was designed to determine the impact of an interventional workshop on the medical and dental students in improving their professional behaviors in the digital world using the newly developed medical Education e-Professionalism (MEeP) framework. Methods: We adopted the Theory of Planned Behavior (TPB) as a benchmark reference which explores constructs intertwined with the mission-based MEeP framework; values (whistleblowing-raising concerns), behaviors (being responsible in the digital world) and identity (reflective practice in the digital world). A multicentre 3-phased mixed-method study was conducted using a pre-workshop survey, an online interventional workshop, and a post-workshop survey. SPSS and NVivo were the tools used for the data analysis. Results: A total of 130 students registered for workshop out of which 120 completed the pre-workshop survey, 62 joined the workshop and 59 completed the workshop and post-workshop survey. From the whistleblowing - raising concern perspective, we found that attitudes and perceived behavioral control had a significant relationship. While for responsible in digital world category, attitude and perceived behavioral control had a significant bearing on the intentions. Third, for reflective practice, attitude and subjective norms significantly enhanced the intention of participants. A multi layered thematic analysis yielded four overarching themes of attitudes, subjective norms, perceived behavioral control and intentions. Most students showed positive attitudes of being reflective, self-directed, and humane. Students realized the subjective norms had made them conscientious, self-aware and conformative. While perceived behavioural control manifested as identity and Intentions were heavily reliant on self-actualization. Conclusion: Our mixed method study found that the interventional workshop using MEeP framework significantly improved attitudes, subjective norms, perceived behavioral control, and intentions. This study provides valuable evidence of MEeP framework evaluation using the theoretical underpinning of TPB by reporting positive changes in professional values, behaviors, and identities of undergraduate medical and dental students.

Willingness of dentists in the United Arab Emirates to perform restorative and surgical treatments for patients infected with hepatitis C.

BACKGROUND: Dentists' refusal to treat patients infected with hepatitis C (HCV) continues to raise ethical concerns, particularly in countries where HCV is prevalent. The aim of this cross-sectional study was to assess dentists' willingness to treat patients infected with HCV and the socio-demographic variables that influence their decision. METHODS: An online questionnaire was disseminated to dentists practicing in the United Arab Emirates (UAE) and enquired about their willingness to perform two dental treatments: restorative and surgical, to patients infected with HCV, while hypothetically being equipped with optimal personal protective equipment. Binary logistic regression test was used to assess socio-demographic factors that predict dentists' unwillingness decision. RESULTS: Two-hundred and forty-five dentists participated in this survey. Among those, 25.6 and 19.3% were unwilling to perform dental extractions and aerosol-generating restorative dental treatments for patients infected with HCV, respectively. Dentists' clinical experience was a significant predictor of their unwillingness decision, with those of shorter clinical experience expressing greater reluctance than their counterparts (OR:1.61; 95% CI: 1.02-2.54; p = 0.042). CONCLUSION: Patients infected with HCV who need dental care could face rejection by early career dentists, particularly if that treatment is a surgical one. Fresh dental graduates should be made aware of their ethical and legal responsibilities towards patients with infectious diseases, particularly HCV.

The effect of styloid process medial angulation on Eagle's syndrome's self-reported symptoms: A preliminary cross-sectional study.

OBJECTIVE: The aim of this study was to investigate whether the medial angulation of the styloid process (SP), regardless of its length, has an association with self-reported symptoms of Eagle's syndrome. STUDY DESIGN: In this cross-sectional study, we measured the length and medial angulation of the SP, including ossification of the stylohyoid ligaments, in archived cone beam computed tomography scans. Patients with valid contact details were interviewed by telephone and asked about the clinical symptoms related to Eagle's syndrome. RESULTS: Eighty-eight patients participated in this study. Their median age was 39.0 years and ranged from 18 to 75 years. Thirty-one (35.2%) of the participants reported cervicalgia with at least one other symptom related to Eagle's syndrome. The mean length and angulation of the right SP were 37.2 mm and 36.3°, respectively, with both readings showing positive correlation with the left SP (r = 0.746 and r = 0.670, respectively; P < .001). Medial angulation of the SP was a predictor of Eagle's syndrome self-reported symptoms (odds ratio, 1.082; 95% confidence interval, 1.003-1.167; P = .042), adjusted for SP length and the patient's age. CONCLUSIONS: Self-reported clinical symptoms of Eagle's syndrome appear to be more associated with the medial angulation of the SP than with its length. Further research on larger samples is needed to establish the medial angulation cutoff angle and the specific symptoms that are attributed to that angulation.

Oral candidal carriage and its association with dental carious lesions in asymptomatic adults: a cross-sectional study from the UAE.

BACKGROUND: Candida's potential association with dental caries has previously been reported in children. This research aimed at investigating the associations between Candida species in whole saliva and dental and periodontal health indices in a sample of adult patients. METHODS: A cross-sectional study involving 160 patients investigated the associations between Candida species collected by oral rinse technique, and Decayed, Missing, and Filled Surfaces (DMFS), and periodontal health indices. Chi-square and Independent Samples t-test were used to assess the associations between Candida carriage and confounding variables. Binary logistic regression was used to assess association strengths between Candida carriage and DMFS, adjusted for socio-demographic variables, diabetes mellitus and plaque index. RESULTS: Candida colonies were identified in 49 (30.6%) patients with CFUs ranging from 103 to 105 colonies per mL. The quantity of Candida CFUs increased with age (r = 0.200; p < 0.05). Among all dental and periodontal health indices, only DMFS was significantly associated with higher values of Candida carriage (p = 0.034), and this association was independent from sex, age, smoking, diabetes mellitus and plaque index (OR: 1.014; 95% CI 1.0-1.03; p = 0.048). CONCLUSION: The association between Candida species in whole saliva and DMFS reported here supports an etiological role of Candida in dental cariogenesis among adults.

Anxiety among dental professionals and its association with their dependency on social media for health information: insights from the COVID-19 pandemic.

BACKGROUND: Social media can play a detrimental role during a global health emergency. In this study, we aimed at assessing the impact social media has on the anxiety level of dental healthcare workers (DHCWs) whilst living through the COVID-19 pandemic. METHODS: An online questionnaire was disseminated to a cross-sectional sample of DHCWs from 19 countries using social media platforms. The questionnaire enquired about DHCWs' frequency of using social media and their dependency on health-related information posted on those platforms. Anxiety was measured using General Anxiety Disorder scale (GAD-7). RESULTS: Four-hundred and three (403) DHCWs completed the online questionnaire. Sixty-eight percent (68%) frequently use social media for information on COVID-19. The frequency of social media use was higher among younger DHCWs, with shorter clinical experience, and holders of undergraduate qualifications (p = 0.009, p = 0.002, and p = 0.023, respectively). Almost one third of DHCWs had moderate to severe anxiety (31.7%), which was significantly associated with the frequency of social media use (p = 0.016). This association was adjusted for age, years of experience and qualification level (OR 1.75; 95% CI 1.05-2.93; p = 0.032). CONCLUSION: COVID-19 social media infodemic has been adversely impacting the psychological wellbeing of DHCWs. More effective measures are needed to control the quality and spreadability of health information on social media platforms.

Ulcerative Stomatitis as the Sole Manifestation of Progesterone Hypersensitivity.

Oral mucosal involvement of autoimmune progesterone dermatitis is exceedingly rare. This report presents a woman with very painful ulcerative stomatitis that recurred with every menstrual period, in the absence of other clinical manifestations. Ulcers were eventually controlled with oral tamoxifen treatment for three months. Subsequent follow-up visits showed complete resolution of her oral ulcerative lesions. The non-specific nature of her oral ulcers resulted in multiple medical and dental consultations and a delay in reaching the final diagnosis. Clinicians should be aware of the possibility of progesterone hypersensitivity when painful oral ulcerative lesions appear concurrently with each progesterone surge.

Vitamin D and hematinic deficiencies in patients with recurrent aphthous stomatitis.

OBJECTIVES: Recurrent aphthous stomatitis (RAS) represents a dysfunction in focal inflammatory processes. With the emerging anti-inflammatory roles of vitamin D (VD), we wanted to investigate the association between the onset and severity of RAS and serum VD level. METHODS: Fifty-two RAS cases and sex and age-matched controls were screened for serum iron, B12, folic acid, VD and red cell indices. Variables were compared using independent samples t test and chi square. Binary logistic regression was used to assess the association between the severity of RAS and various hematinic deficiencies. RESULTS: VD was deficient in 53% of the study population with no statistically significant difference between the RAS patients and healthy controls (53.6 versus 51.5 nmol/l, respectively). In comparison with controls, RAS patients had lower means of iron (81.0 versus 89.3 µg/dl), vitamin B12 (368.5 versus 412.7 pg ml) and most of the red cell indices; however, these differences were not statistically significant. No correlations were seen between RAS severity assessed by ulcer diameter, number of ulcers and their frequency and hematinic deficiencies. However, logistic regression showed a significant association between the number of ulcers (single or multiple) and VD deficiency (OR 4.978; 95% CI 1.204-20.576; p value = 0.027), adjusted for age, sex and other hematinics. CONCLUSIONS: VD deficiency appears to have a role in aggravating RAS ulcerative episodes, but not their onset. CLINICAL RELEVANCE: Multiple aphthous ulcers might represent a subcategory of RAS lesions in which VD deficiency plays a role in aggravating the oral ulcerative condition.

Pharmacists' clinical competency towards oral mucosal diseases: Results from a mystery shopper study.

OBJECTIVES: To investigate the clinical advices pharmacists would give to patients who present with various oral mucosal lesions. SUBJECTS AND METHODS: One hundred and twenty pharmacists in three major cities in the United Arab Emirates (UAE) were approached by senior dental students acting as mystery shoppers. Pharmacists were shown an image of one of four oral mucosal lesions representing candidosis, aphthous ulcer, erosive lichen planus and squamous cell carcinoma (SCC). Pharmacists' referral pattern and choices of medications were recorded and assessed against demographic variables. RESULTS: Eighty-eight per cent (88%) of pharmacists dispensed a non-prescription medication to treat the oral lesions, including SCC, while only 12% recommended that the lesion shown to them be assessed by a clinician. Among all referral recommendations, 32% were for SCC (p = .006). Geographical proximity of a clinic to the pharmacy was a significant factor in determining pharmacists' referral recommendation (p = .036). CONCLUSION: Most pharmacists dispensed a medication for oral mucosal lesions, including potentially malignant and malignant ones, without referring patients to a medical or dental practitioner. Pharmacists should be aware of the serious nature of some oral mucosal lesions and the necessity to refer those cases to a qualified practitioner for proper clinical assessment.

Prevalence of hepatitis B, C, and HIV among patients attending a teaching dental hospital. A 7-year retrospective study from the United Arab Emirates.

OBJECTIVES: To determine the seroprevalence and case characteristics of hepatitis B, C and human immunodeficiency virus (HIV), and their transmissibility from patients to dental personnel following percutaneous and mucocutaneous injuries. METHODS: All incidents of sharp and splash injuries reported between January 2010 and January 2017 were retrospectively reviewed and analyzed. Descriptive statistics were calculated using the Statistical Package for the Social Science (SPSS). Prevalence was calculated as percentages, and chi-square test was used to assess categorical variables where a p-value of ≤0.05 was considered significant. RESULTS: Among the 436 reported incidents, 372 patients underwent serological screening. Fourteen patients (3.8%) had antibodies against hepatitis C virus, and 8 patients (2.2%) were positive for hepatitis B surface antigens. All positive cases were clinically asymptomatic. There were no positive cases for HIV. Three of the 14 hepatitis C positive patients were actively infectious upon polymerase chain reaction (PCR) analysis, but none of the injured dental personnel seroconverted upon a 6-month follow up. Approximately 88% of dental personnel were vaccinated against hepatitis B. Female personnel showed better vaccination rate by comparison to male personnel (p=0.005). Among the 5 different categories of professional status, cleaners showed a significantly low hepatitis B vaccination rate (p less than 0.000). CONCLUSION: The prevalence of hepatitis B and C is higher than that previously reported from the United Arab Emirates, but transmissibility of viral hepatitis seems to be negligible.

The effect of rubber dam on atmospheric bacterial aerosols during restorative dentistry.

Rotatory dental instruments generate atmospheric aerosols that settle on various surfaces, including the dentist's head. The aim of this study was to quantitatively assess bacterial contamination of the dentist's head and to evaluate whether it is affected by using a rubber dam. Senior dental students (n=52) were asked to wear autoclaved headscarves as collection media while performing restorative dental treatment with and without a rubber dam. Four points from each headscarf were swabbed for bacterial culture after 30min of operative work. Bacterial contamination was quantified by counting the colony-forming units. Regardless of the collection point, using a rubber dam was associated with more bacterial colony-forming units than not using a rubber dam (P=0.009). Despite its clinical value, the rubber dam seems to result in significantly higher aerosol levels on various areas of the dentist's head, requiring that dentists cover their heads with suitable protective wear.

Reporting child abuse cases by dentists working in the United Arab Emirates (UAE).

Reporting of suspicious cases of child abuse is a sensitive issue that is often hindered by uncertainty of diagnosis. This cross sectional study aimed to assess the UAE dentists' experiences in child abuse recognition, the factors that prevent them from reporting suspicious cases to authorities and their perceived training needs. A closed-ended, self-administered questionnaire was distributed to 350 dentists working in the UAE. Chi Square test was used to determine association between training needs on child abuse and its reporting rate. Logistic regression was used to determine the association between perceived training needs and other covariates. One hundred and ninety three respondents satisfied the inclusion criteria. Forty seven (25%) dentists reported encountering a suspicious child abuse case at least once in their career, but only 15 (32%) of those reported their suspicion. Fear of making the wrong diagnosis was the most frequent challenge hindering reporting and dentists who demonstrated a need for specialized training were more likely to express this fear (OR = 5.88, 95% CI: 0.07, 0.45; P = 0.00). The majority of UAE dentists do not report their suspicion to authorities and specialized training should be offered to build dentists' capacity in diagnosing and appropriately reporting suspicious child abuse cases.

Autopsy translates in Arabic to al-tashreeh. Could this term influence its acceptability?

It is not unusual for laypersons to object on the conduct of an autopsy of a loved one for fear of disfigurement or burial delays. In this paper, we discuss a new possible reason for objection among Arabic speaking communities related to the language. The Arabic word for autopsy is "al-tashreeh" which, when examining its other linguistic uses, might result in wrong inferences among laypersons.

Oral cancer in young Jordanians: potential association with frequency of narghile smoking.

OBJECTIVE: The aim of this study was to investigate the relationship between narghile (water-pipe) smoking and the age of patients when diagnosed with oral cancer. STUDY DESIGN: Patients with oral cancer registered in the Jordanian National Cancer Registry were asked about frequency of cigarette, narghile, and alcohol use. Relationship between age at diagnosis and risk factors was assessed using multiple regression analysis. RESULTS: In this sample, 66% of patients were cigarette smokers, and 36% and 17% were narghile smokers and alcohol drinkers, respectively. The multivariate regression analysis adjusted for sex, cigarette smoking, and alcohol drinking found that narghile smokers were significantly younger when diagnosed with oral cancer compared with nonsmokers. CONCLUSIONS: Narghile smoking is an independent risk factor associated with the development of oral cancer at a younger age. Prospective studies of its effect on the earlier development of oral cancer are needed to establish a cause-effect relationship.