Psychological impact of the coronavirus disease 2019 (COVID-19) pandemic on dental students: A nationwide study.

OBJECTIVES: Public mental health concerns have been raised during the coronavirus disease 2019 (COVID-19) pandemic. The aim of this study was to assess the psychological impact of the pandemic on dental students in Saudi Arabia. METHODS: A cross-sectional analytical study was conducted among dental students from different universities in Saudi Arabia selected using 2-stage cluster sampling. The psychological impact was assessed using the validated Arabic version of the Depression, Anxiety and Stress Scale-21 Item questionnaire. The data were analyzed using SPSS software. The Mann-Whitney U and Kruskal-Wallis tests were used as appropriate. A chi-squared test was used to compare the proportions between the sociodemographic data and logistic regression analysis to identify variables associated with the student's responses. RESULTS: The internal consistency of the scale was excellent (0.954). A total of 697 dental students participated voluntarily in the study; their mean age was 21.76 ± 1.859 years, and 54.7% were female. The majority (96.1%) were single, and 69.4% lived in a household of > 5 persons. Significant differences in mental health outcomes were evident for gender, university, and survey time. Elevated levels of depression, anxiety, and stress were recorded among 60.64%, 37.02%, and 34.92%, respectively, of the students. Females, students who lived alone, and junior students were more likely to experience psychological problems during the COVID-19 pandemic. CONCLUSIONS: The presence of elevated levels of depression, anxiety and stress among dental students highlights the need for psychological empowerment strategies involving institutional counseling services.

Microbial evaluation of the effectiveness of different methods for cleansing clear orthodontic retainers: A randomized clinical trial.

OBJECTIVE: To compare effectiveness of brushing an Essix retainer with water only and brushing followed by soaking in one of three commercial cleansing tablets. MATERIALS AND METHODS: A double-blind, parallel, randomized clinical trial with a split-mouth design was completed with 60 volunteers with specific eligibility criteria assigned to three groups to compare the cleansing effectiveness of brushing an Essix retainer with water only, followed by soaking in one of three alkaline peroxide-based commercial cleansing tablets (Retainer Brite®, Kukis®, and Corega®). Each participant wore an upper Essix retainer (with an electronic microsensor) on a full-time basis for 14 days and used one of the three products on one side of the retainer for 15 min/d. The effectiveness of the cleansing tablets was tested by the scanning electron microscopy, bacterial identification, bacterial quantification, and disk diffusion methods. RESULTS: Bacterial quantification tests demonstrated nonsignificant statistical differences between the control and test sides of the three cleansing tablets: Retainer Brite®, Kukis®, and Corega® (Mann-Whitney test P-values were .6, .37, and .5, respectively). A Kruskal-Wallis test also showed nonstatistical difference in the bacterial counts between the three groups (P-value = .5). In vitro tests showed a minimal inhibition zone of Staphylococcus epidermidis only with Corega® tablets. CONCLUSIONS: Using chemical cleansing tablets after mechanical cleansing did not significantly reduce the bacterial count in Essix retainers when compared to use of mechanical cleansing alone. However, the tablets seem to be effective against "cocci" bacterial species.

Do customized orthodontic appliances and vibration devices provide more efficient treatment than conventional methods?

The incorporation of technological advances in the field of clinical orthodontics to increase treatment efficiency has led to the development of customized appliances (Insignia®), archwires (Suresmile®), and the production of devices to enhance tooth movement (Acceledent®). This review presents a comprehensive study of the literature concerning these products, and analyzes the available evidence of their efficiency. To date, one pilot study has evaluated the efficiency of the Insignia® system, three retrospective studies have assessed the efficiency of the Suresmile® system, and a few Acceledent® reports have described its effect on treatment time. Critical appraisal of the reviewed papers revealed that the efficiency of the Insignia® system cannot be confirmed based on the available evidence, while the use of Suresmile® can reduce overall treatment time in simple cases. The acceleration of tooth movement by Acceledent® devices has not yet been confirmed.

Color stability and force decay of clear orthodontic elastomeric chains: An in vitro study.

OBJECTIVE: To compare the percentage force decay of clear and semi-clear elastomeric chain products from eight different manufacturers and to evaluate the amount of discoloration after immersion in colored dietary media of the same elastomeric chain products. MATERIAL AND METHODS: An in vitro study was designed using an electronic force gauge to measure six samples from each of 19 types of elastomeric chains stretched for a period of four weeks. A spectrophotometer was used to measure the color of each specimen (10 of each type) at baseline and after being soaked in a dietary medium (coffee, tea, cola, and wine in 250 ml amounts) for 72 h. RESULTS: There was a significant difference in the percentage of the lost initial force between all the tested E-chains (P<0.001). ANOVA shows a significant difference in the amount of discoloration between the E-chain types (P<0.001). Semi-clear (tooth-color/pearl/obscure) E-chain types (TP-ToothC, OrthO-Pearl, GAC-SiliPearl, 3M-Obscure) present significantly less change in color than clear E-chains of the same brand (TP-Clear, OrthoO-Clear, GAC-SiliClear, 3M-Clear). CONCLUSIONS: Significant differences in the mean percentage force decay between the 19 studied clear elastomeric chain types were present. AO-Memory and Ormco maintained most of their original force at the end of the four-week interval. Significant differences in discoloration also exist between the various types of E-chains. TP Orthodontics (Tooth-Colored, SuperSlick, Clear) and Ortho Organizers (Pearl) showed the least discoloration.

Is arch form influenced by sagittal molar relationship or Bolton tooth-size discrepancy?

BACKGROUND: Orthodontic patients show high prevalence of tooth-size discrepancy. This study investigates the possible association between arch form, clinically significant tooth-size discrepancy, and sagittal molar relationship. METHODS: Pretreatment orthodontic casts of 230 Saudi patients were classified into one of three arch form types (tapered, ovoid, and square) using digitally scanned images of the mandibular arches. Bolton ratio was calculated, sagittal molar relationship was defined according to Angle classification, and correlations were analyzed using ANOVA, chi-square, and t-tests. RESULTS: No single arch form was significantly more common than the others. Furthermore, no association was observed between the presence of significant Bolton discrepancy and the sagittal molar relationship or arch form. Overall Bolton discrepancy is significantly more prevalent in males. CONCLUSIONS: Arch form in a Saudi patient group is independent of gender, sagittal molar relationship, and Bolton discrepancy.

Hard and soft tissue correlations in facial profiles: a canonical correlation study.

BACKGROUND: The purpose of this study was to analyze the relationship between facial hard and soft tissues in normal Saudi individuals by studying the canonical correlation between specific hard tissue landmarks and their corresponding soft tissue landmarks. METHODS: A retrospective, cross-sectional study was designed, with a sample size of 60 Saudi adults (30 males and 30 females) who had a class I skeletal and dental relationship and normal occlusion. Lateral cephalometric radiographs of the study sample were investigated using a series of 29 linear and angular measurements of hard and soft tissue features. The measurements were calculated electronically using Dolphin(®) software, and the data were analyzed using canonical correlation. RESULTS: Eighty-four percent of the variation in the soft tissue was explained by the variation in hard tissue. CONCLUSION: The position of the upper and lower incisors and inclination of the lower incisors influence upper lip length and lower lip position. The inclination of the upper incisors is associated with lower lip length.

Influence of bimaxillary protrusion on the perception of smile esthetics.

OBJECTIVES: To evaluate the impact of bimaxillary protrusion on smile esthetics as perceived by dental professionals and laypersons. METHODS: One hundred and fifty evaluators, equally distributed into their respective panels (orthodontists, general dentists, and laypersons), participated in this cross-sectional study conducted in April to December 2012 in Riyadh, Saudi Arabia. The patient sample consisted of 14 female patients divided equally into 2 groups: bimaxillary protrusion patients, and patients who have had 4-premolar extraction treatment. Two standardized photographs (frontal and three-quarter close-up smile views), and a lateral cephalogram were taken for each patient. The evaluators were asked to rate the attractiveness of each photo according to a 100-mm visual analog scale. These esthetic ratings were correlated with the patients' cephalometric measurements. RESULTS: The bimaxillary protrusion group was rated significantly as less attractive than the treatment group by each evaluator panel. Panel comparison showed that laypeople were less receptive of bimaxillary protrusion than dental professionals. Frontal and three-quarter views of the same smiles were not similarly rated for esthetic perceptions. Correlational analysis revealed that the dentoalveolar measurement with the highest significant negative correlation to the smile esthetics was the upper incisors to palatal plane (U1-PP) angle. CONCLUSION: Patients with bimaxillary protrusion were found to be less attractive than patients who were treated for the condition. This was especially evident among the laypersons. An increase in the upper incisor inclination, as well as a decrease in the interincisal angle compounds the bimaxillary effect. 

Orthodontic treatment and referral patterns: A survey of pediatric dentists, general practitioners, and orthodontists.

OBJECTIVE: This study aims to assess the orthodontic diagnostic skills, referral patterns, and the perceptions of orthodontic benefits of pediatric and general dentists in comparison with orthodontists. MATERIALS AND METHODS: Two online surveys were e-mailed to pediatric dentists, general dentistry practitioners, and orthodontists registered as members of the Saudi Dental Society and the Saudi Orthodontic Society. The surveys included questions about the type of orthodontic treatment provided, referral trends, and timing; presumed benefits associated with successful orthodontic treatment; and diagnosis and treatment plans of seven cases representing different malocclusions. RESULTS: In total, 25 orthodontists, 18 pediatric dentists, and 14 general practitioners completed the survey. Only 38.8% of pediatric dentists and 7.1% of general practitioners reported that they practiced orthodontics clinically. The perceptions of the three groups toward the benefits of orthodontic treatment were comparable in the psychosocial areas. However, the orthodontists perceived significantly lesser effects of orthodontic treatment on the amelioration of temporomandibular disorder (TMD) symptoms. Pediatric dentists tended to rate the need and urgency of treatment higher, while general practitioners tended to rate the need of treatment lower. The selected treatment plans for three early malocclusion cases showed the greatest discrepancies between the orthodontists and the other two groups. CONCLUSIONS: The orthodontists consistently and significantly downplayed the perceived benefit of orthodontic treatment to reduce TMD symptoms. Also, while there was a similarity in the diagnosis, there were notable differences in the proposed treatment approaches, perceived treatment need, and timing of intervention between the three groups of practitioners.

Intensity of pain due to separators in adolescent orthodontic patients.

OBJECTIVE: To investigate the intensity of pain adolescent orthodontic patients experience following the insertion of separators. MATERIALS AND METHODS: Elastomeric separators were placed mesially and distally to the first molars in 62 adolescents (20 male, 42 female, age 12-15 years), and the participants were given self-administrated questionnaires to document perceived pain, pain upon chewing, and the severity of pain's affecting daily life, using a visual analog scale for seven days. RESULTS: The mean perceived pain scores out of 100 on the first 3 days were 54.6 ± 32.7, 51.7 ± 29.9, and 32.3 ± 28.4, respectively; chewing pain scores were: 61.9 ± 35.3, 52.6 ± 30.4, and 39.5 ± 32.1, respectively; the pain's affecting daily life scores were 24.9 ± 35.5, 21.1 ± 30.9, and 11.9 ± 23.7, respectively. A Kruskal-Wallis test showed a statistically significant difference in the reported pain between the three studied parameters. A Mann-Whitney U-test showed an insignificant difference between male and female adolescents. CONCLUSION: Pain perception varies among adolescent patients, but it decreases significantly after the first 2 days, with no gender differences.

Assessment of fluoride concentrations in commercially available mouthrinses in central Saudi Arabia.

OBJECTIVES: To assess the fluoride concentration of different commercially available mouthrinses in central Saudi Arabia, and compare the obtained measurements with label values. METHODS: This cross-sectional study identified 25 brands of mouthrinses in the markets of Riyadh city  between August and September 2013. Nineteen brands of mouthrinses whose labels indicate the percentage of sodium fluoride (NaF) and 6 brands not indicating the fluoride percentage were included in the study. Three bottles of 2 manufacturing batches of each brand were acquired, coded, and analyzed after dilution using specific electrodes for fluoride and an ion analyzer at the College of Science, King Saud University, Riyadh, Saudi Arabia.   RESULTS: The average fluoride concentrations in the tested mouthrinses ranged from 8.4 ppm (Voza) to 448.7 ppm (Sensodyne `Pronamel`). Analysis of variance showed a statistically significant difference (p<0.05) in the fluoride concentration between the studied 25 brands. Almost 60% of the brands' fluoride concentrations were significantly different (mainly lower) from the label value. However, only 5 brands contain fluoride at a concentration not significantly different from the recommended fluoride concentration in daily mouthrinses 0.05% (225 ppm). CONCLUSION: Most of the studied commercially available mouthrinses contain topical fluoride at concentrations below the manufacturers' label value, but above the recommended 0.05%. 

Diagnosing the severity of buccal caries lesions in governmental and private orthodontic patients at debonding, using the ICDAS-II and the DIAGNOdent Pen.

OBJECTIVES: To clinically evaluate the prevalence of buccal caries and white spot lesions (WSLs) at debonding in governmental and private orthodontic patients, using the International Caries Detection and Assessment System (ICDAS-II) and the DIAGNOdent Pen, and to study the correlation between the two methods. MATERIALS AND METHODS: A cross-sectional study was carried out on the nonextracted premolars and anterior teeth of 89 orthodontic patients. They were recruited into two groups based on the treatment center they attended: governmental group (G; n=45) and private group (P; n=44). Immediately after debonding, the examination of buccal caries and WSLs on premolars and anterior teeth was carried out using the ICDAS-II and the DIAGNOdent Pen. Cross-tabulation was applied to study the correlation between the ICDAS-II index and the DIAGNOdent Pen by calculating the Spearman correlation coefficient. RESULTS: The G group showed a significantly higher (P<.0001) prevalence of WSLs and/or buccal caries compared to that of the P group based on evaluation by the two methods. Based on ICDAS-II, 43% of the patients in the P group and 9% in the G group were free from any WSLs. In the G group, 22% of the patients had ≥16 LESIONS, whereas there were none for the P group. The Spearman correlation coefficient between the two methods was .71. CONCLUSIONS: The prevalence of caries and/or WSLs at debonding was significantly higher in the G group compared to the P group. The clinical index (ICDAS-II) showed a good correlation with the DIAGNOdent Pen.

Prevalence of dental anomalies in Saudi orthodontic patients.

AIM: This study aimed to investigate the prevalence of dental anomalies and study the association of these anomalies with different types of malocclusion in a random sample of Saudi orthodontic patients. MATERIALS AND METHODS: Six hundred and two randomly selected pretreatment records including orthopantomographs (OPG), and study models were evaluated. The molar relationship was determined using pretreatment study models, and OPG were examined to investigate the prevalence of dental anomalies among the sample. RESULTS: The most common types of the investigated anomalies were: impaction followed by hypodontia, microdontia, macrodontia, ectopic eruption and supernumerary. No statistical significant correlations were observed between sex and dental anomalies. Dental anomalies were more commonly found in class I followed by asymmetric molar relation, then class II and finally class III molar relation. No malocclusion group had a statistically significant relation with any individual dental anomaly. CONCLUSION: The prevalence of dental anomalies among Saudi orthodontic patients was higher than the general population. CLINICAL SIGNIFICANCE: Although, orthodontic patients have been reported to have high rates of dental anomalies, orthodontists often fail to consider this. If not detected, dental anomalies can complicate dental and orthodontic treatment; therefore, their presence should be carefully investigated during orthodontic diagnosis and considered during treatment planning.

Pattern of skeletal and dental malocclusions in Saudi orthodontic patients.

OBJECTIVE: To determine the distribution of skeletal and dental malocclusions in a sample of Saudi orthodontic patients. METHODS: Six hundred and two randomly selected pretreatment orthodontic records were evaluated in this descriptive, retrospective study conducted between June to September 2009 at the Orthodontic Clinic of the College of Dentistry, King Saud University, Riyadh, Kingdom of Saudi Arabia. Cephalometric analysis using Dolphin software to measure the A point, Nasion, B point (ANB) angle and Wits appraisal was performed to determine the skeletal malocclusion. Angles classification was evaluated to determine the molar relationship using study models. RESULTS: The most common dental malocclusion was Angle Class I followed by the asymmetric molar relationship. The most common skeletal malocclusion using ANB angle was Class I, while the most common skeletal malocclusion using Wits appraisal was Class II. No gender difference was seen in the distribution of the molar relationship and skeletal relationship using both ANB angle and Wits appraisal. CONCLUSION: The pattern of skeletal and dental malocclusions in Saudi orthodontic patients differs, based on the variability of the methods used to assess the anteroposterior jaw-base relationship.

Ethnic differences in dentofacial relationships of Turkish and Saudi young adults with normal occlusions and well-balanced faces.

OBJECTIVES: The aims of the present study were (1) to determine ethnic differences in craniofacial dimensions between Turkish and Saudi populations and (2) to identify possible gender differences between males and females, based on a sample of untreated young adult subjects with normal occlusions and well-balanced faces. METHODS: In total, 163 cephalometric radiographs were traced and evaluated to compare untreated adults of Turkish and Saudi ethnicity. The Turkish group comprised 86 subjects; 45 females and 41 males. The Saudi group comprised 77 subjects; 39 females and 38 males. For statistical evaluation, an independent-samples t-test was performed. RESULTS: The Turkish sample had a more retrognathic maxilla and mandible (p < 0.001 for SNA and SNB) and a more vertical direction of facial development (p < 0.001), with Turkish males having more retrusive lips (p < 0.001). Distinctive ethnic differences were found in craniofacial structures between Turkish and Saudi young adults. CONCLUSIONS: It is appropriate to consider these aesthetic differences when a Turkish or a Saudi patient is being evaluated during routine diagnosis and treatment planning.

Lateral cephalometric norms for Saudi adults: A meta-analysis.

Orthodontic diagnosis and treatment planning require careful evaluation of the patient's cephalometric values and comparison to known population cephalometric means or norms. Despite the availability of several published studies on Saudi cephalometric norms, Caucasian norms are still referred to when Saudi patients are treated. To reach a consensus between these studies and to establish more accurately cephalometric norms for Saudis, a meta-analysis of the relevant literature was performed. Electronic database (PubMed), Saudi Dental Journal and Master theses were searched for studies reporting cephalometric values of normal male and female Saudi adults with numerical data and 8 studies with a total sample size of 485 met the inclusion criteria. A meta-analysis with results from these studies was completed. The combined mean estimates and SD of common cephalometric measurements were calculated. The data included in this comprehensive meta-analysis were compared with Caucasian norms and results indicated that Saudis have distinct cephalometric features. Saudis tend to have slightly more convex profiles and more proclined incisors than the Caucasians. These findings confirm the previously published results and should serve as more accurate reference values that were drawn from a large sample size.

Orthodontic treatment of an anterior openbite with the aid of corticotomy procedure: Case report.

This case report illustrates the orthodontic treatment combined with the corticotomy technique in an adult patient to accelerate tooth movement and shorten the treatment time. The patient was a 22-year-old woman with an anterior open bite and flared and spaced upper and lower incisors. First, fixed orthodontic appliances (bidimensional edgewise brackets) were bonded, and a week later buccal and lingual corticotomy with alveolar augmentation procedure in the maxillary arch from the first molar to the contralateral first molar, and from canine to canine in the mandibular arch was performed. Orthodontic therapy proceeded with frequent activation of the appliances to retract the incisors every 2 weeks. The total treatment time was 5 months and no adverse effects were observed at the end of active treatment. The addition of the decortication procedure to the conventional orthodontic therapy decreased the duration of treatment significantly. Successful closure of the anterior open bite with adequate overbite and interdigitation of the teeth were achieved.

Bonded orthodontic retainers: a comparison of initial bond strength of different wire-and-composite combinations.

OBJECTIVES: The aim of this in-vitro study was to evaluate initial bond strength in Newton (N) of two types of wires (Ortho- Flextech chain and Penta-One Coaxial wire 0.0215") bonded with three lingual retainer composites (FlowTain, Light Cure Retainer and Transbond LR). MATERIALS AND METHODS: One hundred and eighty sound, extracted human premolars were randomly divided into six equal groups. One of the two types of lingual retainer wires was bonded with one of the three types of the composite material in each group. Initial bond strength was measured using an Instron universal testing machine. We also evaluated the failure characteristics after failure at maximum load using an optical microscope. RESULTS: Our findings demonstrated that the Coaxial/Transbond LR group was statistically significantly stronger than the other combinations. Statistically, 0.0215" Coaxial wire provided significantly stronger bond strength than Ortho-Flextech chain, and when the three composite systems were compared, Transbond LR revealed significantly higher bond strength than the others. However, Transbond LR left significantly more resin on the enamel surface after bond failure. CONCLUSION: Significant differences exist between different combinations of wires and lingual retainer composites; however, all the wire-and-composite combinations we tested possess sufficient bond strength for clinical application.

Morphological features of bimaxillary protrusion in Saudis.

OBJECTIVE: To analyze the pre-treatment cephalometric features in Saudi adults with bimaxillary protrusion and to develop cephalometric standards to clarify the overall presentation of this malocclusion for clinicians. METHODS: A descriptive retrospective study was designed in which lateral cephalometric radiographs of 60 individuals with Class I skeletal and dental relationship and decreased interincisal angle were collected between June 2007 and December 2008 at the Orthodontic Clinic, College of Dentistry, King Saud University, Riyadh, Kingdom of Saudi Arabia. Radiographs were studied and compared to those of 60 individuals with similar skeletal and dental relationships, but with normal interincisal angle. The measurements were calculated electronically using Dolphin software. The data were analyzed using the t-test. RESULTS: Saudi individuals with bimaxillary protrusion had a vertical skeletal pattern that is similar to that of the control group, however, they demonstrated increased procumbency of the upper and lower lips. Comparing females to males with bimaxillary protrusion revealed significant increase in male lip thickness. On the other hand, no significant difference was detected in the amount of lip protrusion between males and females. CONCLUSION: Saudi subjects with bimaxillary protrusion demonstrated distinctive soft tissue features when compared to the control group and to other ethnic groups with bimaxillary protrusion.

Fluoride content of bottled drinking waters available in Riyadh, Saudi Arabia.

AIMS: This study aimed to examine the fluoride concentration of commercially available bottled water products in Riyadh, Saudi Arabia, and to assess the accuracy of the labeling of fluoride concentration on the tested brands. METHODS: Fifteen randomly selected commercial brands of bottled water were obtained from supermarkets in Riyadh, Saudi Arabia. Three bottles of each brand were purchased, and fluoride content was measured using a combination fluoride-ion-selective electrode. The average reading for each brand was estimated and also compared with the fluoride content printed on the label. RESULTS: The mean (±SD) fluoride content of the 12 local bottled water samples was 0.79 (±0.09) mg/L with a range from 0.5 to 0.83 mg/L. The mean fluoride concentration of the three imported brands was 0.67 (±0.02) mg/L with a narrow range of fluoride content (0.65-0.69). All tested samples mention the fluoride content on the label except two imported brands. Five samples showed a significant difference between our evaluation and stated content of fluoride that ranged between +0.46 and -0.2 mg/L. CONCLUSIONS: Bottled drinking waters available in Riyadh, Saudi Arabia contain differing concentration of fluoride, but within a safe range for use as a source of systemic fluoride. In addition, the manufactures' labeling of fluoride content may be inaccurate.