Levels of Depression, Anxiety, and Stress Among Saudi Arabia's Medical and Dental Practitioners: A Cross-Sectional Study Following the Covid-19 Pandemic.

BACKGROUND Healthcare providers, particularly in dentistry and medicine, experience high stress levels, exacerbated by factors like patient anxiety, clinical work, and continuous training. The COVID-19 pandemic has further increased these risks. This study aimed to assess depression, anxiety, and stress (DAS) among dental and medical practitioners in Saudi Arabia, investigating influential factors on their psychological behavior. MATERIAL AND METHODS In this cross-sectional study conducted in July and August 2021, the depression, anxiety, and stress scale (DASS-21) was administered through a Google questionnaire. Data analysis involved stepwise mode modeling and bivariate analysis, with a significant P value <0.05, using the Statistical Package for the Social Sciences. RESULTS The study included 376 dentists and 201 medical practitioners. Most worked more than four days a week, slept under six hours nightly, and were non-smokers. DAS scores indicated depression (51.7-57.4%), anxiety (50.7-58.2%), and stress (54.2-60.1%). Significant differences (P<0.05) were observed among younger, single, female, and lower-income participants. Higher DAS scores correlated with less sleep, extensive social media use, and smoking history. Socio-demographic factors were mostly non-significant for medical practitioners, except social media use. Sleep duration significantly impacted stress levels, while specialty, income, and marital status influenced depression CONCLUSIONS DAS levels were notably higher in dentists compared to medical practitioners, particularly regarding anxiety. The impact of socioeconomic factors varied, being more statistically significant for dentists.

Assessment of the prevalence and configuration of middle distal canals in the mandibular molars in a Saudi subpopulation using Cone-Beam computed tomography.

PURPOSE: The prevalence of the middle distal (MD) canal in the mandibular molar is significantly low among countries including the USA, Spain, Turkey, and Jordan; however, analysis of its prevalence and configuration has not been performed in Saudi Arabia. Therefore, we aimed to assess the prevalence and configuration of the MD canal in Saudi Arabia. METHODS: A retrospective analysis of 132 cone-beam computed tomography (CBCT) images was performed to evaluate the presence of the MD canal in patients visiting the Radiology Department of The College of Dentistry in King Saud University between July 2018 and July 2019. The canal was examined if it was confluent with the distobuccal (DB) or distolingual (DL) canals, fin, or independent. Moreover, the distances from the MD canal to the DL and DB canals and cementoenamel junction (CEJ) were recorded. RESULTS: One MD canal (0.7%) was observed in 145 teeth. It was confluent with the DL canal. No statistical significance was observed among sex and age. The distances from the MD canal to the DL canal, DB canal, and CEJ were 1.4 mm, 1.9 mm, and 3.1 mm, respectively. CONCLUSIONS: The prevalence of the MD canal was significantly low in a Saudi subpopulation (0.7%). Careful evaluation of CBCT images and the pulpal floor is significantly important to detect the MD canal to ensure a good prognosis.

Structural Features of the Mental Foramen in a Saudi Subpopulation: A Retrospective CBCT Study.

INTRODUCTION: Accurate and precise knowledge about the position, size, and shape of the mental foramen (MF) are critical in avoiding procedural complications. The MF's anatomical features vary among different ethnic groups, and various radiographic techniques have been used to determine these variations. AIMS: To evaluate the MF's shape, vertical and horizontal positions, and distance from the border of the mandible. To evaluate the differences among genders as they pertain to the right and left sides of the mandible and research the bilateral symmetry regarding the same variables. MATERIALS AND METHODS: Cone beam computer tomography (CBCT) scans of 155 Saudi patients (69 males and 86 females) who visited the college of dentistry's clinics were obtained from the college database for this retrospective study. All the scans were analyzed by 3 calibrated examiners. The data collected was analyzed statistically, and results were obtained. RESULTS: The MF was located under the mandibular second premolar in 56.9% of cases, whereas in 26.9% of cases, it was located between the first and second mandibular premolar. The most prevalent position was below the level of the apices of the mandibular premolar teeth (87.2%). The round shape was most frequent (44.9%) compared to the H-oval (34.7%) and V-oval (20.4%). The V-oval shape was more frequent in males, while the H-oval shape was more frequent in females. The average distance from the center of the MF to the mandibular border was 14.03 ± 1.58 mm, with males exhibiting a greater distance than females. Overall, there were no significant differences between the bilateral symmetry and the right and left sides for all parameters. CONCLUSION: The most common position of the MF was under the root apex of the mandibular second premolar, with an average distance of about 14 mm from the border of the mandible. The position and shape of the MF were the same bilaterally in the majority of individuals.

Adipogenic Stimulation and Pyrrolidine Dithiocarbamate Induced Osteogenic Inhibition of Dental Pulp Stem Cells Is Countered by Cordycepin.

BACKGROUND: dental pulp-derived stem cells are easy to access and collect and are an excellent source of stem cells for regenerative therapy. These cells can interact with many biomolecules and scaffolds and can pass on the instructive signals to the sites of regeneration where they are used. In this regard cordycepin, a potential biomolecule derived from medicinal mushrooms with a spectrum of bioactive properties such as antioxidant, anti-inflammatory, and anticancer has not yet been tested for its effect on human dental pulp stem cells. OBJECTIVE: the objective of the present study was to assess the in vitro adipogenic and osteogenic differentiation potential of human dental pulp stem cells with or without induction after administration of cordycepin. MATERIALS AND METHODS: human dental pulp stem cells DPSCs were isolated from a healthy permanent tooth extracted for orthodontic purposes after obtaining informed consent. Flow cytometry technique was used to assess the surface markers of these cells such as CD73, CD90, and CD105, CD34, CD45, and HLA-DR. Further, an MTT assay was performed on the cells after subjecting them to various concentrations of cordycepin. Following this, the adipogenic and osteogenic potential of the dental pulp stem cells was assessed with or without induction under the influence/absence of 5 µM of cordycepin. The results obtained were statistically analyzed and documented. RESULTS: it was found that the dental pulp stem cells showed strong positive expression for CD73, CD90, and CD105 and faint expression of CD34, CD45, and HLA-DR. MTT assay revealed that 5 µM was the optimum concentration of cordycepin for all the assays. Concerning adipogenesis experiments, there was a statistically significant lowering of all the 4 adipogenesis-related genes PPARγ, FABP4, LPL, and C/EBPα following cordycepin treatment in the presence of induction compared to the only induction group and untreated control cells (p < 0.05). In connection with osteogenesis, was found that there was a statistically significant increase in the expression of RUNX2, COL1A1, OSX and OCN genes along with the increase in alkaline phosphatase and alizarin red staining in the DPSC treated with cordycepin along with the presence of induction and simultaneous addition of PDTC compared to the control untreated cells and cells treated with induction and simultaneous addition of PDTC (p < 0.05). CONCLUSION: cordycepin can be exploited for its osteopromotive properties and can be used as a bioactive molecule alongside the administration of dental pulp stem cells in the area of regenerative biology and medicine.

"Comparative evaluation of effect of toothbrush-dentifrice abrasion on surface roughness of resin composites with different filler loading:" An in vitro study.

OBJECTIVES: This in vitro study evaluated the effect of toothbrush-dentifrice abrasion on the surface roughness of two restorative posterior resin composites, Filtek Z250 and Z350 after simulated toothbrushing twice daily for a period of 3 months. METHODS: All the specimens were polished and cleaned and surface topography was evaluated by Veeco di CP-II Atomic Force Microscope (AFM) at six different points; similarly, these specimens were again subjected to evaluation after simulated toothbrushing using dentifrice. The surface roughness evaluation was done for AFM images using software made available and the factor measured were average roughness (Ra) and maximum peak to valley distance R(p v). Data were normally distributed as tested using the Shapiro-Wilk W-test (P > 0.05). Therefore, analysis was performed using the parametric tests, i.e., independent "t"-test (for comparing two groups). The level of statistical significance was set at P < 0.05. RESULTS: The mean change in Ra and the mean change in Rp-v for Z350 were less as compared to Z250, and this difference was statistically significant. CONCLUSIONS: Within the limitation of the present study, it can be concluded that toothbrushing increased the roughness in Z250 in comparison to Z350.

Ultrasound Imaging versus Radiographs in Differentiating Periapical Lesions: A Systematic Review.

BACKGROUND: Ultrasonography is a non-invasive method of diagnosing periapical lesions while radiologic methods are more common. Periapical lesions due to endodontic infection are one of the most common causes of periapical radiolucency that need to be distinguished to help determine the course of treatment. This review aimed to examine the accuracy of ultrasound and compare it to radiographs in distinguishing these lesions in vivo. METHODS: This review process followed the PRISMA guidelines. A literature search of databases (PubMed, Scopus, Embase, and Web of Science) was conducted without any restrictions on time. Articles available in English were included. The selection was done according to the inclusion and exclusion criteria. The QUADAS-2 tool was used to assess the quality of the studies. RESULTS: The search provided a total of 87 articles, out of which, five were selected for the final review. In all the studies, ultrasound had higher accuracy in distinguishing periapical lesions. All the studies indicated a risk of bias, especially in patient selection. CONCLUSION: Within limitations, the study indicates that ultrasound is a better diagnostic tool to distinguish periapical lesions compared to radiographs but further studies with well-designed, rigorous protocols and low risk of bias are needed to provide stronger evidence.

Dentistry Amidst the COVID-19 Pandemic: Knowledge, Attitude, and Practices Among the Saudi Arabian Dental Students.

Background: The recent pandemic outbreak has created a huge impact on dentistry. Dental students and dental professionals are at a higher risk because dental practice comprises close communication and widespread exposure to blood, saliva, and other body fluids. It is imperative to evaluate the knowledge and perceptions regarding Coronavirus (COVID-19) among budding dentists. Aim: To assess the knowledge, attitude, and practices of dental students regarding dental practices during COVID-19. Materials and methods: A cross-sectional questionnaire-based study was conducted among undergraduate students in Riyadh, Saudi Arabia. An online questionnaire consisting of demographic, knowledge, and attitude-based questions were circulated among the study population, and the responses for the knowledge and attitude were scored. Their mean scores were then calculated. Chi-square test and nonparametric tests were computed using SPSS version 21 software, and p-values < 0.05 were considered statistically significant. Results: 388 undergraduate dental students have participated in the study from Saudi Arabia. 68% of the respondents believed that they had sufficient knowledge regarding COVID-19. The mean score for knowledge was 5.84 out of 7. Females (6.24) scored statistically significantly higher than males (5.55, p < = 0.001). The mean attitude score was 6.34 out of 9. 93% were using PPE models, while 95% maintained social distancing. Out of all the participating dental students, only 16% were willing to treat patients during the pandemic, and 28% did not want to treat patients, 28% preferred teledentistry. The majority (44%) of dental undergraduates were willing to handle only emergency cases. Conclusion: Accurate knowledge and attitude regarding COVID-19 and diversified opinion on preventive practices during the pandemic period among budding dental professionals evident from Saudi Arabia. Mixed opinions were witnessed among them in seeking help from professional societies. The majority of dental undergraduates were willing to handle only emergency cases.

Location and shape of the apical foramina in posterior teeth: an in-vitro analysis.

PURPOSE: To analyze the morphology of shapes and positions of the apical foramina in permanent maxillary and mandibular posterior teeth. METHODS: Examination of the apical foramina was performed with a stereomicroscope at a magnification of 10×. The anatomic parameters evaluated were the shapes of the peripheral contours of the apical foramina (rounded, oval, asymmetric, and semilunar). The location of the apical foramen was recorded as a center, buccal, lingual, mesial, and distal surface. RESULTS: Results have shown that the frequency of deviation was 68% in all teeth being assessed, while the most frequent location of the apical foramen was in the center, with 32% followed by distal with 18%. The common shape of apical foramina was round shape in all the teeth. CONCLUSIONS: The variation in the location and shapes of apical foramina in teeth. The commonest deviation in location of apical foramina was distal and the frequent shape was of a round shape.

Factors Influencing Pain and Anxiety Before Endodontic Treatment: A Cross-Sectional Study Amongst American Individuals.

OBJECTIVE: The present study aimed to assess preoperative levels of patient anxiety and pain before root canal treatment, and to explore variables that may affect these levels. METHODS: Ninety-five patients presenting for an endodontic visit were recruited for the study. A questionnaire was administered. Visual analog scales were used to record levels of pain and anxiety. Data was tabulated, and analysis was performed using the Pearson Chi-Squire test with continuity correction, and the level of significance was set at 0.05 (P=0.05). RESULTS: Anxiety was detected more frequently in females (60%) than in males (33%) (P=0.016). Sixty-two percent of patients who were waiting for a new treatment were anxious, compared to 39% of those who were returning to continue treatment (P=0.049). Sixty-nine percent of patients in pain reported being anxious (P=0.015). Patients aged 18-30 years reported more pain than those older than 30 years (P=0.023). Forty-three percent of new patients reported being in pain, whereas only 20% of patients returning for a treatment reported pain (P=0.027). CONCLUSION: Anxiety associated with root canal treatment is prevalent, and it was reported primarily by young females who were presenting for a new treatment. Pain and anxiety are highly inter-related, and they are usually reduced after the first endodontic session.

Prevalence and Characteristics of Three-rooted Mandibular Molars in Saudi Population: A Retrospective Radiographic Analysis.

AIMS: To study the prevalence of three-rooted mandibular permanent first molars (PFM) among Saudi population in Al Zulfi. MATERIALS AND METHODS: Subjects were selected from the patients' records, College of Dentistry, Majmaah University, Al Zulfi, Kingdom of Saudi Arabia. Healthy patients with the presence of both mandibular PFM, orthopantomogram (OPG) and/or intraoral periapical (IOPA) radiographs were included in the study. All patients included were evaluated by a single examiner using OPG and IOPA radiographs. The occurrence of three roots, status of the tooth and associated anomalies were considered for analysis. Descriptive statistics performed using IBM SPSS (Version 21.0) at a 95% confidence interval (p < 0.05) while the Chi-square test and Fisher test were used for the incidence, and comparison of occurrence of the third root in PFM in the mandibular arch. RESULTS: A sample of 433 subjects was selected randomly based on our inclusion criteria. Only 24 (5.5%) subjects had evidence of three-rooted mandibular PFM with the mean age of 27.67 years. The frequency of bilateral and unilateral three-rooted mandibular PFM was 2.3% (10) and 3.2% (14), respectively. Overall 41.6% of subjects were witnessed with the bilateral occurrence and unilateral occurrence was 58.4% [(57% (8) were on the right and 42% (6) were left side] (p < 0.05). However, no significant relationship was observed between the left and right occurrence of three-rooted mandibular PFM (p < 0.05). Thirty-four (7.8%) PFM were presented with three roots and among them, 70% (24) received treatment. Dilacerations (12.5%), taurodontism (37%) and hypodontia (4%) were associated with three-rooted PFM in the mandibular arch. Kappa statistics showed excellent intra-examiner reliability (κ = 0.9). CONCLUSION: The prevalence of three-rooted PFM was 5.5% in the present study and unilateral occurrence is very common. Over 70% of these PFM received dental treatment in Saudi Arabia population. Always, IOPA radiographs are required to confirm the evidence of three-rooted mandibular PFM where three-dimensional imaging is not available. CLINICAL SIGNIFICANCE: An Eagle's eye of an endodontist on three-rooted PFM is of utmost importance in the treatment protocol when the tooth is planned for root canal therapy.