Prevalence, distribution, characteristics and associated factors of molar-incisor hypo-mineralisation among Libyan schoolchildren: a cross-sectional survey.

BACKGROUND AND AIM: This study aimed to assess the prevalence and clinical status of molar incisor hypomineralisation (MIH) and other enamel defects and associated factors in Libyan children. METHODS: A cross-sectional survey of a randomly selected sample of 8- to 10-year-old Libyan school children was conducted in the city of Benghazi, Libya in 2019. The children were assessed for the presence of MIH and enamel defects according to EAPD evaluation criteria. The survey was supplemented by a questionnaire, completed by parents, about potential associated factors occurring before, around and after birth. Association with risk indicators was assessed using chi-square and Mann-Whitney U tests. RESULTS: One thousand forty-seven children returned complete questionnaires and attended the clinical examination, with 87% response rate. MIH was the most common form of enamel defects, affecting 162 (15.5%) children. The average number of MIH affected teeth was 3.54 (SD = 1.82). There were no statistically significant associations between the prevalence of MIH and health or demographic characteristics except for the history of early childhood health problems (P = 0.047). CONCLUSIONS: In Libyan children, MIH appeared to be the most prevalent type of enamel defects affecting 15.5% of the participants. Although not statistically significant, MIH appeared to be associated with prenatal, perinatal and post-natal challenges.

Changes in dental caries and sugar intake before and during the conflict in Libya: A natural experiment.

OBJECTIVES: The primary aim of this study was to investigate the impact of reduced sugar consumption on caries experience among 12-year-old Libyan schoolchildren during the Libyan conflict, in comparison to preconflict data collected in the same water-fluoridated setting from a similar age group. A further aim was to investigate the socio-demographic and behavioural factors which may impact caries levels during the conflict. METHODS: A natural experiment in which dental caries data before and during the Libyan conflict, over a 9-year period, was compared. A cross-sectional survey was conducted between December 2016 and February 2017 to collect during-conflict data comparable to preconflict data collected in 2007. A random sample of 1134, 12-year-olds were recruited from public schools in Benghazi. Epidemiological examinations were undertaken by three trained examiners to measure dental caries. Questionnaires addressing socio-demographic and behaviours related to oral health were completed by participants. Data were analysed using SPSS 24, at P ≤ .05. RESULTS: In the during-conflict period, caries prevalence was 42.8% and mean DMFT was 1.09 (SD ± 1.57). These figures were significantly lower than the caries prevalence and severity reported in the preconflict group (P < .001). Logistic regression analysis indicated that male children, those who frequently consumed sugary drinks, who drank bottled water (low fluoride) and whose fathers had relatively lowly occupations were more likely to have dental caries (all P < .05). CONCLUSIONS: This study indicates that decreased levels of sugar intake during the Libyan conflict are associated with a decline in dental caries prevalence and severity. This provides some support for the notion that reducing sugar intake is still an important factor in caries prevention and control even when fluorides are available in public water and toothpaste.

Prevalence and factors associated with traumatic dental injuries among schoolchildren in war-torn Libya.

BACKGROUND/AIMS: No previous epidemiological study has investigated the prevalence and associated factors of traumatic dental injuries (TDIs) among Libyan children. Such information is required for the planning and evaluation of health services. The aim of this study was to assess the prevalence of TDIs and associated factors among 12-year-old schoolchildren in Benghazi, Libya. METHODS: Data for this study were collected as part of a comprehensive, cross-sectional survey investigating oral health status and treatment needs of 12-year-old schoolchildren in Benghazi, Libya, between December 2016 and May 2017. Sociodemographic information was collected through a dental health questionnaire. The children were assessed for oral health status, including TDIs according to modified World Health Organization (WHO) classification criteria, in their classroom by trained and calibrated examiners. Anthropometric measures, lip competence and overjet were all assessed and reported. History of TDIs was sought among those affected. Logistic regression models were applied for TDIs as an outcome variable. The statistical significance for all tests was ≤0.05. RESULTS: Data from 1134 participants were included in this study. TDIs were observed in 10.3% of the sample. Most of these TDIs were enamel fractures only (55.6%) and enamel and dentine fractures (35.9%). "Falling" was the most common cause of TDIs, accounting for 51% of cases. While increased overjet appeared to be associated with higher risk of TDIs (OR: 1.92; 95% CI: 1.29-2.86), being female (OR: 0.34; 95% CI: 0.22-0.53) and overweight (OR: 0.33; 95% CI: 0.13-0.83) were also associated with lower risk of having TDIs. CONCLUSIONS: This survey showed that a considerable proportion (10.3%) of 12-year-old Libyan children had TDIs, with relatively high unmet treatment needs. More efforts are required to develop effective prevention programmes and to enhance the provision of dental treatment of TDIs for Libyan children.

Perceptions of Stress Among Dental Students Living in a War-Affected Zone.

The aims of this study were to assess the perceived levels and sources of stress for Libyan dental students living in a war zone and to compare the results of those students with students living in conflict-free areas in the same country. Eight hundred randomly selected students from three Libyan dental schools in conflict-active and conflict-free regions were invited to participate in a survey in 2016. The survey instrument was the validated Dental Environment Stress (DES) questionnaire translated into Arabic. Responses to the 41 items were on a five-point scale from 0=not stressful at all to 4=very stressful. The response rate was 84.4% (675/800). The results showed that the respondents' overall mean score of stress perception was 2.5 (SD 0.6). There was a statistically significant difference in overall perceived stress between the two groups (p<0.001), with a significantly higher level of stress on five of the six domains for students in the conflict-free zones. For the combined groups, the workload and faculty administration domains had the highest stress scores: mean 3.1 (SD 0.7) and 2.8 (0.7), respectively. Overall, living in conflict-free areas for these students was associated with higher perceived dental school stress than for the students living in a war zone. Stresses of dental school in the conflict-active zone were likely perceived to be relatively less important against the backdrop of stressors imposed by the conflict outside school. Although the overall score of stress perception for these Libyan dental students was comparable to that found in other countries, the perceived stress among students in conflict-active regions was generally lower but varied by domain.

The development and psychometric properties of the Arabic version of the child oral health impact profile-short form (COHIP- SF 19).

BACKGROUND: This study aims to cross-culturally adapt the original English-language COHIP-SF 19 to Arabic culture and to test its psychometric properties in a community sample. METHODS: The Arabic COHIP-SF 19 was developed and its psychometric properties were examined in a population-based sample of 876 schoolchildren who were aged 12 years of age, in Benghazi, Libya. The Arabic COHIP-SF 19 was tested for its internal consistency, reproducibility, construct validity, factorial validity and floor as well as ceiling effects. A Mann-Whitney U test was used to compare the mean scores of COHIP-SF 19 by participants' caries status and self-reported oral health rating, satisfaction and treatment need. RESULTS: The Arabic COHIP-SF 19 was successfully and smoothly developed. It showed an acceptable level of equivalence to the original version. Overall, the internal consistency and reproducibility were acceptable to excellent, with a Cronbach's alpha of 0.84 and an intra-class correlation coefficient (ICC) of 0.76. All hypotheses predefined to test construct validity were confirmed. That is, children who had active dental caries, and who rated their oral health as poor, were not satisfied with their oral health or indicated the need of treatment had lower COHIP-SF 19 scores (P < 0.05). Floor or ceiling effects were not observed. The exploratory Factorial analysis suggested a 4-component solution and deletion of one item. CONCLUSION: The Arabic COHIP-SF 19 was successfully developed. The measure demonstrated satisfactory reliability and validity to estimate OHRQoL in a representative sample of 12-year-old schoolchildren.

Are diet diaries of value in recording dietary intake of sugars? A retrospective analysis of completion rates and information quality.

Objectives Current guidance recommends that dental practitioners should routinely give dietary advice to patients, with diet diaries as a tool to help diet assessment. We explored patients' compliance with diet-diaries usage in a paediatric clinic within a teaching hospital setting, where remuneration is not an issue. Objectives were to investigate associated factors affecting diet diaries return rate and the information obtained from returned diaries.Methods A retrospective study of 200 randomly selected clinical records of children aged 5-11 years who had received diet analysis and advice as part of a preventive dental care programme at a dental teaching hospital between 2010 and 2013. Clinical records, with a preventive care pro forma, were included in the study. Data on social and family history, DMFT-dmft, oral hygiene practices, dental attendance and dietary habits were obtained and compared with information given in completed diet-diaries. A deductive content analysis of returned diet-diaries was undertaken using a pre-developed coding scheme.Results Of 174 complete records included in this study, diet diaries were returned in 60 (34.5%) of them. Diet diaries were more likely to be returned by those children who reported that they regularly brushed their teeth (P <0.05), and those who came from smaller families (P <0.05). Content analysis of diet diaries enabled the identification of harmful types of foods and drinks in 100% of diaries. General dietary issues, frequency and between-meals intake of sugars were also all captured in the majority of diaries (95.0%, N = 56). Information on sugar amount (53.0%, N = 32), prolonged-contact with teeth (57.0%, N = 34) and near bedtime intakes (17.0%, N = 28) was reported in fewer diaries.Conclusions The return rate of diet-diaries in this setting was low, and associated with patients' demographic and oral health characteristics. Returned diet-diaries showed a varied range of missing important dietary information, such as sugar amount, which appears to compromise their validity as a diet assessment tool. Development of a more reliable and acceptable dietary assessment tool for use in the dental setting is needed.

The use of diet diaries in general dental practice in England.

OBJECTIVES: Diet diaries are recommended as a tool to support behaviour change in dental patients at high risk of dental diseases. However, little is known about their use in dental practice. This study aimed to investigate whether and how general dental practitioners (GDPs) use diet diaries and identify factors which influence their use. METHODS: A postal questionnaire was sent to a stratified random sample of general dental practitioners. The questionnaire asked about demographic and professional characteristics of the GDPs and their practices regarding diet advice, collection of dietary information, diet diaries usage (e.g. frequency, considerations and barriers), and interpretation of diet diaries. Descriptive, bivariate and multivariate analyses were conducted. RESULTS: From 972 eligible GDP participants, 250 (26%) responses were received. Whilst almost all of these GDPs reported giving diet advice to patients routinely, and 40% reported also referring to dental care professionals in the practice to deliver dietary advice, only 28% (70) reported that they are involved in using diet diaries. GDPs appeared to target patients for dietary advice: GDPs reported they personally gave diet advice to an estimated 63% of their patients, and referred patients to DCPs for diet advice for 11% of their (GDPs') patients. GDPs used diet diaries more often for child than adult patients. Diet diaries usage was lower among younger dentists and in practices with higher percentages of NHS patients (p⟨0.05). Perceived insufficient remuneration for time involved in using diet diaries was the main reason given for their lack of use. CONCLUSION: Although recommended as best practice, most English GDPs do not frequently use diet diaries to collect diet information in dental practice, mainly due to perceived financial and time constraints. Development of a more efficient tool to assess the dietary habits of dental patients is needed.

Attitudes and practices regarding preventive dentistry among Libyan dentists.

PURPOSE: To assess the attitudes towards and practices related to preventive dentistry among Libyan dentists. METHODS: A cross-sectional, questionnaire-based survey was conducted among dentists working in Benghazi. All dentists registered with the Dental Association of Benghazi and with two or more years of practice were invited to participate. The questionnaire enquired about dentists' demographic (gender and age) and professional characteristics (practice sector and years of service), attitudes towards preventive dentistry using nine semantic differential scales and the frequency with which they performed eight preventive measures to patients. Non-parametric tests were used to compare attitudes towards and practices related to preventive dentistry by participants' demographic and professional characteristics. RESULTS: Of the 175 dentists returning questionnaires (response rate 79%), 166 had complete information on all the variables needed for analysis (75%). Dentists felt preventive dentistry was useful and essential to the community as well as of scientific merit for dentists. As for practices, oral hygiene instruction and recommending fluoridated toothpaste were the most commonly reported preventive measures performed by dentists whereas the application of topical fluoride and fissure sealants were the least reported. Attitudes towards and practices related to preventive dentistry varied by professional but not demographic characteristics. CONCLUSION: Dentists showed a generally positive attitude towards preventive dentistry. However, certain preventive measures, particularly those that incur costs, were less frequently practised.

Dental caries experience and periodontal treatment needs of children with autistic spectrum disorder.

AIM: To assess dental caries experience and periodontal treatment needs among Libyan children diagnosed with autistic spectrum disorder (ASD). MATERIALS AND METHODS: A cross-sectional, comparative case-control study was used, in which dental caries experience of 50 children with ASD was compared with that of 50 controls. The children with ASD were recruited from Benghazi Centre of Children with ASD, Libya. Controls were recruited from school children and matched for age, gender and socioeconomic status. DMFT, dmft for dental caries experience and CPITN for periodontal treatment needs were calculated according to WHO criteria by a calibrated examiner. Scores for DMFT as well as CPITN indices were compared using bivariate analysis. RESULTS: The data analysed for this study comprised observations from a group of children (cases = 50) diagnosed with ASD matched with healthy children (controls = 50). Consequently, each group consisted of 40 males and 10 females aged between 3 and 14 years (mean 7.29 ± 3.11). The ASD children showed significantly lower means for DMFT and dmft teeth as well as higher periodontal treatment needs (p > 0.05). CONCLUSION: Children with ASD were found to be more likely caries-free and have lower DMFT scores and higher unmet periodontal treatment needs than did the unaffected control children.