Medical and Dental Professions' Varying Levels of Awareness Regarding Medication-related Osteonecrosis of the Jaw in Saudi Arabia? A Cross-sectional Study.

AIMS: This study aimed to assess the awareness of the risk of medication-related osteonecrosis of the jaw (MRONJ) among general dental practitioners (GDPs) and primary care physicians (PCPs), focusing on the clinical implications and coordination of treating or identifying high-risk patients. MATERIALS AND METHODS: Two Google Forms electronic questionnaires were distributed to 724 GDPs and 617 PCPs in primary care settings. One for PCPs with eight multiple choice questions and the other for GDPs with 10 multiple choice questions. A clinical case scenario and a section on open-ended comments were included in both questionnaires. The data obtained from each group were statistically analyzed and compared. RESULTS: A total of 239 GDPs and 220 PCPs participated in the study, with a response rate of 34.23%. The mean age of participants was 29.5 years and 54.35% were females (51.2% and 57.5% in the GDPs and PCPs group, respectively). Most participants had graduated from Saudi Arabia. Almost all dentists were aware of osteonecrosis of the jaw (95.1%), 68.3% of them were aware of the guidelines regarding bisphosphonate-related osteonecrosis of the jaw (BRONJ) and MRONJ, 60.5% rated their general knowledge about MRONJ as very poor to poor, and 91.8% did not know any guidelines regarding BRONJ or MRONJ. Among the participants, 75.3% did not know how MRONJ was present in the oral cavity. A total of 69.9% of participants were unaware of other factors associated with an increased risk of MRONJ. CONCLUSION: MRONJ risk awareness varies greatly between dentists who diagnose and manage patients in dental clinics and physicians who write about medicines and therapies. Counseling sessions and greater coordination between dental and medical specialists are strongly suggested while prescribing antiresorptive drugs to prevent the consequent development of MRONJ. CLINICAL SIGNIFICANCE: This study shows a significant lack of knowledge regarding MRONJ among GDPs and PCPs, which may affect the prevention and treatment of patients. Therefore, we urge GDPS and PCPs to take more information from scientific sources on this topic and more cooperation from specialties for the benefit of patients. How to cite this article: Aljohani MH, Aljohani AS, Aljohani RM, et al. Medical and Dental Professions' Varying Levels of Awareness Regarding Medication-related Osteonecrosis of the Jaw in Saudi Arabia? A Cross-sectional Study. J Contemp Dent Pract 2024;25(1):62-67.

Knowledge and Attitude Toward Antibiotic Prescription Among Dental Students and Interns at Multiple Universities in Saudi Arabia.

BACKGROUND: Dental students in Saudi Arabia are authorized to write prescriptions for antibiotics during practical training. Adverse side effects and resistance could result from inappropriate prescription. Accordingly, there is a need to evaluate the knowledge of dental students regarding guidelines and applications of antibiotic prescription. OBJECTIVES: To assess the knowledge and attitude toward guidelines and applications of antibiotic prescription among dental students and interns at multiple universities in Saudi Arabia. METHODS: A cross-sectional study was conducted among dental students in their final clinical years (4th to 6th year) and dental interns. The study data were collected using a valid and reliable structured questionnaire comprising three domains: 1) demographic characteristics, 2) knowledge, and 3) attitude toward antibiotic prescription for dental and systemic conditions. The data were analyzed and presented as frequency percentages, and the chi-square test was used to compare the knowledge and attitude items between the dental students and interns. The statistical significance level was set at p ≤ 0.05. RESULTS: A total of 248 participants (women: 55.6%, men: 44.4%) were included in the study. Approximately 21.8% were 4th year students; 17.7%, 5th year students; 12.9%, 6th year students; and 47.6%, interns. For most items, the knowledge level was relatively high, and the attitude was generally positive among the participants. Approximately, 87.1% had good knowledge about current guidelines for antibiotic prophylaxis, 83.9% about antibiotic prescription, and 95.2% about antibiotic resistance. The interns showed significantly higher knowledge levels and favorable attitude, particularly for guidelines and applications of antibiotic prescription and correct use of antibiotics for oral cases, than did the students. Amoxicillin was the most frequently prescribed antibiotic among the participants. CONCLUSION: The interns and 6th-year students demonstrated a relatively high knowledge level and positive attitude toward appropriate antibiotic prescriptions. However, deficiencies were observed among the students in their early clinical years, particularly for systemic conditions. These findings highlight the importance of implementing educational campaigns and providing guidelines to promote the appropriate use of antibiotics among dental students in their final clinical years.

Conservative management and follow-up of bilateral condylar fractures in pediatric patients: A case report.

Key Clinical Message: Conservative treatment of bilateral condylar fractures, including intermaxillary fixation using arch bars and elastic bands, yields satisfactory results in pediatric patients. Therefore, the conservative approach should be considered the first line of treatment for bilateral condylar mandibular fractures in pediatric patients. Abstract: Road traffic accidents (RTAs) are considered the leading cause of mortality and morbidity of children and adults in Saudi Arabia. Head injuries and fractures are the most common form of injuries resulting from RTAs, with mandibular fractures being the most common head injury; condylar fractures are the most frequent type of mandibular fracture. A review of the literature reveals diverse opinions about the best approach for treating bilateral condylar fractures in pediatric patients. The findings of the literature review are reported in this study. The case presented here shows the result of adopting a conservative approach to treating a bilateral extracapsular displaced condylar fracture. An elastic band was fixed onto intermaxillary fixation (IMF) screws at the midline upper and lower jaws; the patient was followed up for almost 3 years. The conservative approach yielded excellent results, as both condyles were fully repositioned and healed, without causing any deviation or limitation of the mouth opening. The results of this case support considering the conservative approach as the first line of treatment for bilateral condylar mandibular fractures in pediatric patients.

The effects of platelet-rich fibrin on post-surgical complications following removal of impacted wisdom teeth: A pilot study.

OBJECTIVES: Platelet-rich fibrin (PRF) is a fibrin matrix composed of cells, cytokines, and growth factors, which may be liberated from blood at specific times and act as a resorbable membrane. Many studies have demonstrated the benefits of PRF for bone healing in oral and maxillofacial implant surgery. Our study assesses the impact of PRF on postoperative complications following the extraction of impacted wisdom teeth. METHODS: Twenty patients were recruited in this blind controlled randomised clinical trial, i.e. ten patients in the study group and ten patients in the control group. The patients were aged between 18 and 40 years. Surgical removal of impacted teeth #38 and #48 was performed in all the patients. The study group underwent dentoalveolar surgery with the use of PRF, while the control group underwent surgery without PRF. RESULTS: All patients in the study group reported significantly less postoperative pain (p = 0.02) and excellent soft tissue healing during the follow-up period (p = 0.021). In contrast, only 80% of patients in the control group exhibited sufficient soft tissue healing. The difference in postoperative swelling between the two groups was not statistically significant. Additionally, 69% of patients in the study group reported comfortable night sleep during the first 24 h after the operation compared to 31% in the control group. This difference was statistically significant (p = 0.02). CONCLUSION: Based on the outcomes of our study, implanting PRF into surgical extraction sites can be helpful in reducing postoperative pain and improving soft tissue healing. The use of PRF in extraction sockets is simple and biologically safe. The beneficial effects of PRF support its possible application in the field of dental surgery.

Side Effects Reported by Jordanian Healthcare Workers Who Received COVID-19 Vaccines.

Background Distribution of COVID-19 vaccines has been surrounded by suspicions and rumors making it necessary to provide the public with accurate reports from trustworthy experts such as healthcare professionals. Methods We distributed a questionnaire in Jordan among physicians, dentists and nurses who received a COVID-19 vaccine to explore the side effects (SE) they encountered after the first or the second dose of one of three vaccines namely: AstraZeneca Vaxzevria (AZ), Pfizer-BioNTeck (PB), and SinoPharm (SP) vaccines. Results A total of 409 professionals participated. Approximately 18% and 31% of participants reported no SE after the first dose and second dose, respectively. The remainder had mostly local side effects related to injection site (74%). Systemic side effects in the form of fatigue (52%), myalgia (44%), headache (42%), and fever (35%) prevailed mainly after the first dose. These were significantly associated with AZ vaccine, and age ≤ 45 years (p = 0.000 and 0.01, respectively). No serious SE were reported. Conclusions We can conclude that SE of COVID-19 vaccines distributed in Jordan are within the common range known so far for these vaccines. Further studies are needed to include larger sample size and longer follow-up period to monitor possible serious and long-term SE of the vaccines.

The Interplay of Dysregulated pH and Electrolyte Imbalance in Cancer.

Cancer cells and tissues have an aberrant regulation of hydrogen ion dynamics driven by a combination of poor vascular perfusion, regional hypoxia, and increased the flux of carbons through fermentative glycolysis. This leads to extracellular acidosis and intracellular alkalinization. Dysregulated pH dynamics influence cancer cell biology, from cell transformation and tumorigenesis to proliferation, local growth, invasion, and metastasis. Moreover, this dysregulated intracellular pH (pHi) drives a metabolic shift to increased aerobic glycolysis and reduced mitochondrial oxidative phosphorylation, referred to as the Warburg effect, or Warburg metabolism, which is a selective feature of cancer. This metabolic reprogramming confers a thermodynamic advantage on cancer cells and tissues by protecting them against oxidative stress, enhancing their resistance to hypoxia, and allowing a rapid conversion of nutrients into biomass to enable cell proliferation. Indeed, most cancers have increased glucose uptake and lactic acid production. Furthermore, cancer cells have very dysregulated electrolyte balances, and in the interaction of the pH dynamics with electrolyte, dynamics is less well known. In this review, we highlight the interconnected roles of dysregulated pH dynamics and electrolytes imbalance in cancer initiation, progression, adaptation, and in determining the programming and reprogramming of tumor cell metabolism.

Influence of gender on career expectations of oral and maxillofacial surgeons.

OBJECTIVES: This study aimed to explore gender differences on career satisfaction among oral and maxillofacial surgeons (OMFS) and to compare their views on female gender representation in leadership and mentorship positions. METHODS: A questionnaire was distributed among a sample of female and male OMFS surgeons in Egypt, Jordan and Saudi Arabia. Data were statistically analyzed to calculate significant differences between gender groups. RESULTS: A total of 110 (70 males and 40 females) or (18.7%) of a total of 587 (OMFS) surgeons in the three countries participated. Respondents had a mean age of: 39.2 ± 9.0 years (range = 25-60 years). Significantly more males (60) than females (24) indicated satisfaction with their careers (P = 0.008), and significantly more males (66) than females (23) thought that OMFS is the right specialty for them (P < 0.001). Also significantly more males (31) than females (9) indicated OMFS should be solely practiced by males (P = 0.025). On the other hand, significantly more females (20) than males (7) thought that females possess certain qualities that make them more suitable for OMFS (P < 0.001); and more females (27) than males (32) believed that females are under-represented in OMFS (P = 0.031). Significantly more females (25) than males (27) believed that female OMFS surgeons tend to be single or to get divorced (P = 0.018). Males and females were in agreement that females are under-represented in leadership and mentorship positions (P = 0.561). CONCLUSIONS: Females OMFS surgeons are less satisfied with their career than their male peers. It seems that female surgeons are under-represented in the profession especially as leaders and mentors. Socially, more female OMFS surgeons than males tend to be single and this may be correlated with the surgical career.

Loxoprofen Sodium Versus Diclofenac Potassium for Post-Dental Extraction Pain Relief: A Randomized, Triple-Blind, Clinical Trial.

One of the most common post-operative complications of tooth extraction is pain. Oral analgesics, namely loxoprofen sodium and diclofenac potassium, are often prescribed; however, the efficacy of these drugs irrespective of gender and type of extraction has not been tested. Therefore, this study aimed to compare the efficacy of these two drugs in post-dental extraction pain relief among male and female patients in cases of simple and surgical tooth extraction. A single-center, triple-blind, randomized clinical trial was conducted among 100 male and female patients who underwent tooth extraction at Taibah University Dental College and Hospital in Al-Madinah, Saudi Arabia. The patients reported their pain post-operatively after 6 hours and every 12 h for 3 days using the Verbal Descriptor Scale (e.g., "no pain", "mild pain"). Descriptive statistics and chi-square tests were run to analyze the data. An equal number of patients received either the drug loxoprofen sodium or diclofenac potassium and completed the study follow-up. Patients allocated to the diclofenac potassium drug group after 36 h were statistically significantly in their reporting of "no pain" and "mild pain" compared to patients allocated to the loxoprofen sodium group (86% vs. 66%, respectively; p = 0.019), irrespective of gender or type of tooth extraction. However, both groups demonstrated comparable (p > 0.05) post-operative pain relief over the other aforementioned allocated time intervals. In conclusion, the diclofenac potassium group had slightly better control over post-operative pain than the group receiving loxoprofen sodium.

Emergency management of dental trauma: a survey of public knowledge, awareness, and attitudes in Al-Madinah Al-Munawwarah.

BACKGROUND: Dental trauma is one of the most commonly encountered dental emergencies. The prognosis is determined by the appropriate intervention and immediate management of the traumatized teeth. Thus, public awareness is a leading determinant of treatment success. The purpose of this study was to assess the knowledge, attitudes, and awareness of Al-Madinah Al-Munawwarah residents regarding the management of dental trauma. METHODS: This cross-sectional observational study was conducted between December 2016 and January 2018. A two-part self-administered questionnaire comprising 13 closed-ended questions was used. Part one contained questions to elicit demographic data that included information related to the participants' sources of dental trauma. Part two assessed their knowledge and attitudes regarding the most common types of dental trauma. The data were analyzed with IBM SPSS Statistics for Windows, Version 22.0 software. RESULTS: A total of 598 participants were included in this study. The results indicated that 64% of the participants knew where to go to receive treatment for dental trauma, and 74% were aware of the differences in the management of the primary and permanent teeth after trauma. A majority (83%) did not have any information about these issues; however, 83% were interested in learning about the appropriate management of dental trauma. CONCLUSION: The study participants were found to have low levels of knowledge. A majority had never received information about the management of dental trauma or avulsed teeth. Education programs are necessary for promoting positive attitudes by increasing the knowledge about dental trauma management.

Pleomorphic Adenoma in the Lower Lip: A Case Report and a Review.

Pleomorphic adenoma constitutes 50% of salivary gland tumors affecting mostly the parotid gland extraorally, and the palate intraorally. While the upper lip is a common site, it is unusual to encounter this tumor in the lower lip. A 26-year-old man complained of a persistent lump affecting the lower lip. The lesion was excised and was shown on histopathological examination to be a pleomorphic adenoma with squamous metaplasia. At the 18-month review appointment, there was complete healing and no recurrence. Pleomorphic adenoma in the lower lip should be considered among the differential diagnosis of lower labial swellings, especially in young patients. There needs to be reconsideration of the epidemiological and histological characteristics.

Virtual planning of complex head and neck reconstruction results in satisfactory match between real outcomes and virtual models.

OBJECTIVES: The reconstruction of large facial bony defects using microvascular transplants requires extensive surgery to achieve full rehabilitation of form and function. The purpose of this study is to measure the agreement between virtual plans and the actual results of maxillofacial reconstruction. MATERIALS AND METHODS: This retrospective cohort study included 30 subjects receiving maxillofacial reconstruction with a preoperative virtual planning. Parameters including defect size, position, angle and volume of the transplanted segments were compared between the virtual plan and the real outcome using paired t test. RESULTS: A total of 63 bone segments were transplanted. The mean differences between the virtual planning and the postoperative situation were for the defect sizes 1.17 mm (95 % confidence interval (CI) (-.21 to 2.56 mm); p = 0.094), for the resection planes 1.69 mm (95 % CI (1.26-2.11); p = 0.033) and 10.16° (95 % CI (8.36°-11.96°); p < 0.001) and for the planes of the donor segments 10.81° (95 % CI (9.44°-12.17°); p < 0.001) The orientation of the segments differed by 6.68° (95 % CI (5.7°-7.66°); p < 0.001) from the virtual plan; the length of the segments differed by -0.12 mm (95 % CI (0.89-0.65 mm); not significant (n.s.)), respectively, while the volume differed by 73.3 % (95 % CI (69.4-77.6 %); p < 0.001). The distance between the transplanted segments and the remaining bone was 1.49 mm (95 % CI (1.24-1.74); p < 0.001) and between the segments 1.49 mm (95 % CI (1.16-1.81); p < 0.001). CONCLUSIONS: Virtual plans for mandibular and maxillofacial reconstruction can be realised with excellent match. CLINICAL RELEVANCE: These highly satisfactory postoperative results are the basis for an optimal functional and aesthetic reconstruction in a single surgical procedure. The technique should be further investigated in larger study populations and should be further improved.

Outcome of microvascular free flaps in a high-volume training centre.

PURPOSE: Microvascular free tissue transfer allows major ablative defects following oncologic surgical and traumatic reasons to be reliably reconstructed in the head and neck region. A retrospective analysis of the microvascular flap procedures which were performed within one year in a high volume training centre was performed. PATIENTS AND METHODS: The microvascular free flap procedures of the year 2011 were reviewed and followed up until the 31st December 2012. The type and indication of the reconstructive procedure, operation time, operating team, experience and level of training of the surgeons involved, postoperative IMC (intermediate care unit) and/or ICU (intensive care unit) time, inpatient time, flap revisions, further postoperative complications, preoperative and postoperative radiation of the patients, the placement of dental implants were studied. RESULTS: From 1st of January 2011 to 31st of December, 2011, the data of 101 patients with 103 microvascular free flap procedures were analysed of which 72% (84 flaps) were harvested by residents. The patients ranged in age from 14 to 89 years (mean age 59 years, 71 males and 40 females). The mean operation time was 591 min with the longest operation times for scapular flaps (744 min) and the shortest operation times for ALT flaps (455 min). Mean inpatient time was 34.2 days with a minimal time for the fibular flaps of 27.2 days and a maximum of 45.7 days for the latissimus dorsi flaps. 24 flaps (23.3%) in total had to be revised with bleeding being the main cause of immediate revisions (41.7% of all revisions). 5 flaps (4.85% of all flaps) were lost despite a revision procedure meaning a successful revision rate in 79.2% of all revisions. CONCLUSION: Microvascular reconstruction procedures are safe and should be considered as standard procedures for reconstruction of large defects especially in high volume training centres. Intensive flap monitoring and early revisions maximize the flap outcome.