Association of oral health awareness and practice of proper oral hygiene measures among Saudi population: a systematic review.

BACKGROUND: Several studies have proven that increasing oral hygiene knowledge correlates with good oral health status compared to those who lack this knowledge. Therefore, the aims of the study to evaluate the overall oral health awareness among the Saudi population based on knowledge and practice of proper oral hygiene measures. METHODS: A systematic review was performed according to the Preferred Reporting Items for Systematic Reviews guidelines. Cross-sectional, cohort, and case-control studies were included in the study and framed into a PICO question. Initially, a search was conducted on PubMed/Medline, Google Scholar, and Cochrane databases. Four independent reviewers screened the identified titles, abstracts, and full texts. Cohen's Kappa score was used to evaluate the level of agreement between the reviewers. RESULTS: Forty cross-sectional studies and one prospective cohort study were included. Several studies showed that most students across all departments of universities knew the protective effects of fluoride on teeth. Two studies assessing the attitude and practice of oral hygiene found that most students knew that poor oral health leads to gum disease, and 59.1% were aware of maintaining oral hygiene using a toothbrush and paste. Most participants knew the importance of oral and dental care before pregnancy and how to reduce dental problems during pregnancy. Pregnant women clean their teeth daily and consider brushing and using toothpaste essential for pregnant women. Studies on oral hygiene practices of patients with diabetes reported that flossing habits were rated less important and most of their respondents never flossed their teeth. CONCLUSION: Strong correlation between oral health knowledge and practices was observed, with the higher the knowledge level, the better the practice. Therefore, new technologies and strategies must be tested for an effective oral health system. TRIAL REGISTRATION: A protocol was specified and registered with the International Prospective Register of Systematic Reviews (PROSPERO) on August 2020 (registration number CRD 42,020,200,373).

A Modified Approach in Lip Repositioning Surgery for Excessive Gingival Display to Minimize Post-Surgical Relapse: A Randomized Controlled Clinical Trial.

Lip repositioning surgeries are performed to treat patients with excessive GD (EGD). This study aimed to explore and compare the long-term clinical results and stability following the modified lip repositioning surgical technique (MLRS) with the addition of periosteal sutures compared to the conventional lip repositioning surgery (LipStaT®) in order to address EGD. A controlled clinical trial with female participants (n = 200) intended to improve their gummy smile were divided into control (n = 100) and test (n = 100) groups. The gingival display (GD), maxillary lip length at rest (MLLR), and maxillary lip length at maximum smile (MLLS) were measured at four time intervals (Baseline; 1 Month; 6 Months, and 1 Year) in millimeters (mm). Data were analyzed by t-tests, Bonferroni-test, and regression analysis using SPSS software. At the one-year follow-up, GD for the control and test groups were 3.77 + 1.76 mm and 2.48 + 0.86 mm, respectively, and their comparisons showed that GD was considerably lower (p = 0.000) in the test group compared to the control group. The MLLS measurements taken at baseline, one-month, six-month, and one-year follow-up showed no significant differences (p > 0.05) between the control and test groups. At baseline, one-month, and six-month follow-up, the mean and standard deviation for the MLLR were almost similar, with no statistically significant difference (p = 0.675). The MLRS is a successful and viable treatment option for the treatment of patients with EGD. The current study showed stable results and no recurrence with MLRS until the one-year follow-up compared to LipStaT®. With the MLRS, a 2 to 3 mm decline in EGD is usually to be expected.

Soft-Tissue Healing Assessment after Extraction and Socket Preservation Using Platelet-Rich Fibrin (PRF) in Smokers: A Single-Blinded, Randomized, Controlled Clinical Trial.

Background: Wound healing is essential in any surgical procedure, and multiple factors, such as smoking, can impair it. The aim of this clinical trial was to evaluate the ability of platelet-rich fibrin to enhance socket wound healing in smokers. Methods: A total of 18 smoker participants with forty non-restorable upper molars indicated for extraction were recruited to the study and were randomly allocated to four different groups for the assessment of four techniques: advanced platelet-rich fibrin (A-PRF), factor-enriched bone graft matrix with advanced platelet-rich fibrin (A/S-PRF), freeze-dried bone allograft and crosslinked collagen membrane (FDBA/CM), and resorbable collagen plug (RCP). One examiner clinically measured soft-tissue closure and the healing pattern using a periodontal probe and a healing index. Each subject was given a questionnaire after each follow-up visit to record several patient-reported experience measures (PREMs). This was conducted at baseline and 10, 21, and 28 days after the extraction procedure. Results: Both A-PRF and A/S-PRF showed significant results in terms of mesio-distally (p = 0.012), and healing pattern parameters (p < 0.0001), while RCP showed the least favorable outcome. Conclusions: Different forms of PRF exhibited enhanced wound closure and healing patterns, as well as reduced post-operative complications among smokers.

The effect of systemic Isotretinoin on salivary tissue inhibitors of metalloproteinases 1 and 2 and salivary flow rate in periodontal disease.

AIMS: To evaluate and compare changes in salivary flow rate and salivary levels of TIMP-1 and TIMP-2 in individuals taking oral Isotretinoin (INN) with those who do not take INN. To assess the variation in TIMP-1 and TIMP-2 as well as salivary flow rate observed at different stages of periodontal disease in comparison to those observed in the case of healthy periodontium. MATERIALS AND METHODS: An examiner-blind case-control study involving 180 human adults divided into six groups based on their periodontal status. Clinical parameters, including pocket depth, clinical attachment level, and bleeding on probing were measured at six sites per tooth. Whole unstimulated saliva samples were collected from all subjects to evaluate salivary flow rate (SFR). Salivary TIMP-1 and TIMP-2 levels were detected using enzyme-linked immunosorbent assay (ELISA). Data were analyzed using IBM SPSS Software. The Kruskal Wallis test and Mann-Whitney U-tests were employed to verify any significant differences between the groups for all parameters. Multi-regression analysis was performed for each parameter tested in each group. All tests were compared at a significance level of 0.05. RESULTS: SFR was statistically significantly lower among all INN groups in comparison to the control groups (P < 0.001). TIMP-1 and TIMP-2 were significantly higher in all INN groups in comparison to the control groups, in both gingivitis cases (P = 0.004, P < 0.0001 respectively) and periodontitis cases (P < 0.0001). CONCLUSION: Although INN reduces salivary flow rate, the findings of the present study revealed that it had an anti-inflammatory effect in periodontal biomarkers. Specifically, it was positively correlated with an elevation of salivary TIMP-1 and TIMP-2. Hence, INN might be a future additive medication to be further evaluated for the treatment of periodontal diseases.

Evaluation of complacency about dental implants with shared decision making and satisfaction scores: A cross-sectional study.

BACKGROUND: The dentist-patient relationship is delicate. Engaging the patient in the dental treatment planning especially for lengthy procedures as dental implants improves the relation as well as treatment outcomes including patient satisfaction. We aimed at evaluating the importance of Shared Decision making (SDM) and level of satisfaction among dental implant patients by employing SDM and satisfaction scores. MATERIALS & METHODS: The present cross-sectional study was pursued between April 2019 to September 2019, among dental implant patients (n = 144) who have completed their prosthetic part of implant treatment with at least 3 months of post-restoration evaluation. Demographic and implant data were collected from electronic filing system (Salud) as well as measurement of SDM score. Data were analyzed using SPSS 24.0 version statistical software. RESULTS: The mean satisfaction score was higher for implant placement with Periodontists (31.9%). However, among surgical specialist the mean satisfaction score was found to be higher for oral surgeons who had 1-5 years of experience (46.5%). Patients reported that their decision making was greatly influenced by the treating dentist. A statistical significance was found where (64.6%) of Implant patients would like to undergo the procedure again (p < 0.0001). CONCLUSION: Shared decision-making and patient satisfaction enables the treatment delivery to be more effective and ethical, in addition to being patient-centered care.

Antimicrobial Effect of Isotretinoin Therapy on Periodontal Pathogens: A Case-Control Study.

Isotretinoin (INN), a drug used to treat severe acne, has anti-inflammatory and antibacterial properties. INN may affect periodontal pathogenic bacteria, so we aimed to study the effect of INN on intraoral microbial profiles of periodontal disease and healthy periodontium. Our case-control study divided 180 subjects into six groups according to periodontal health status and INN usage as follows: healthy periodontium receiving INN (HINN; n = 30); those with generalized plaque-induced gingivitis receiving INN (GINN; n = 30); and those with stage I generalized periodontitis receiving INN (PINN; n = 30). Subjects not taking INN, were categorized in the same manner: those with a healthy periodontium (HC; n = 30); those with generalized plaque-induced gingivitis (GC; n = 30); and those with generalized periodontitis stage I (PC; n = 30). Plaque samples were collected to determine the prevalence of four periodontal pathogens (Porphyromonas gingivalis, Tannerella forsythia, Treponema denticola, and Fusobacterium nucleatum) in each study group using real-time polymerase chain reaction. Data were analyzed using IBM SPSS software, and multiple regression analysis was performed for each parameter tested in each group at a significance level of 0.05. All INN groups showed significantly lower levels of P. gingivalis, T. forsythia, and T. denticola and higher levels of F. nucleatum (p < 0.001). INN had an observable antimicrobial effect on the periodontal pathogen count in patients with plaque-induced gingivitis and chronic periodontitis. INN may have a potential additive antimicrobial value in the treatment of periodontal disease.

Comparison of Polymeric Cyanoacrylate Adhesives with Suturing in Free Gingival Graft Stability: A Split Mouth Trial.

The aim is to compare the use of Cyanoacrylate adhesives (CAA) to the conventional suturing technique in terms of free gingival grafts (FGG) stability and healing in lower anterior and premolar regions. A split mouth design was initiated on 22 participants. Each side (from 2nd premolar to central incisor) was randomized to either the control or test groups. In the control group, sutures were used to stabilize the FGG, while, in the test group, the FGG was stabilized with butyl-cyanoacrylate. Full-periodontal clinical parameters were employed to assess the periodontal health. FGG-related parameters assessed included the keratinized tissue width (KTW), gingival tissue thickness (GTT), FGG shrinkage% and pain using the VAS score. No significant differences in the mean values of the KTW nor FGG shrinkage% across six time points (p < 0.05) were observed, whereas highly significant differences in the mean values of GTT across six time points (F = 3.32; p = 0.008) were observed. The use of CAA in FGG stability and healing is comparable to conventional suturing for soft tissue grafts in terms of success outcomes. With its cost effectiveness, lesser time consumption, post-operative pain and comparable graft stability and dimensions, the use of CAA may be a promising alternative for conventional and microsurgical techniques for the stabilization of FGG in the oral cavity.

The effect of conventional versus electronic cigarette use on treatment outcomes of peri-implant disease.

AIM: To compare changes in clinical periodontal parameters (gingival consistency, colour, BOP, PI, PD) and changes of salivary inflammatory biomarkers (IL-1 ß, IL-6, MMP-8, TNF- α and TIMP-1 between conventional, electronic cigarette smokers and non-smokers after peri-implant treatment. METHODS: Study participants were grouped into three groups (i) Conventional cigarette smokers (ii) Electronic cigarette smokers and (iii) non-smokers respectively. A total of 60 adult patients aged (40-56 years) with 60 implants with active per-impantitis was included.Clinical and Biological parameters were evaluated before surgical treatment at baseline, one, six and twelve month post treatment. Pearson's chi-square test was used to compare the distribution of the categorical while Two-way repeated analysis of variance was used to compare the mean values of quantitative outcome variables among all study groups across the 4 time points. RESULTS: A total of 60 subjects (60 implants) were selected and classified into three groups as per their smoking method 20 participants in each group with one single targeted implant diagnosis with active peri-implantitis. The gingival colour, the change was statistically significant at one year of post treatment.The gingival consistency distribution across the three groups is not statistically significant at baseline, but it is statistically significant at one-month (p = 0.001), six months (p = 0.029) and at the completion of one-year (p = 0.018) post treatment. The plaque index of 100% of non-smokers had changed to '0' and 35% change in cigarettes and 30% change in electronic smokers which is statistically significant (p = 0.016).The prevalence of BOP was observed in the three groups as 72%, 76.5% and 88.9% at baseline. The mean values of PD have shown statistically significant change across the three groups over the four-time intervals of observation (p = 0.024). The comparison of mean values of IL-1 ß, IL-6 and TIMP-1 has shown statistically significant change across the three groups over the four intervals of observation (p < 0.0001). CONCLUSIONS: Electronic cigarette smoking was found to be most prevalent risk indicator for peri-implantitis. Compromised response of peri-implantitis treatment both clinically and biologically was found more among electronic cigarette smokers when compared to conventional cigarette smokers and non-smokers. TRIAL REGISTRATION: This case-control study was conducted at King Saud University's Dental College, Riyadh, Saudi Arabia, in accordance with "Helsinki Declaration of Human Studies" and approved by the Institutional Review Board (Reference no: 87563).

Association between isotretinoin (Roaccutanne) use and changes in periodontal clinical parameters and MMP-8 and MMP-9 salivary levels.

Aims: to evaluate changes in clinical periodontal parameters, salivary levels of MMP-8 and MMP-9, in individuals taking Isotretinoin (INN), and compare with individuals not taking the medication and to compare findings among different stages of periodontal disease and healthy periodontium. Material and methods: A case-control study was conducted with a total of 180 human adults divided into six groups. Clinical parameters, including pocket depth (PD), clinical attachment level (CAL), and bleeding on probing (BOP) were measured at six sites per tooth. Whole unstimulated saliva samples were collected from all subjects to detect salivary level of MMP-8, MMP-9 using Enzyme-linked immunosorbent assay (ELISA). Data were analyzed using IBM SPSS Software. Kruskal Wallis test and Mann-Whitney U-tests were used to test any significant differences in any of the groups on all parameters. Pearson Chi-square test was used to compare the distribution of categorical responses across the study groups. All tests were compared at a significance level of 0.05. Results: In Gingivitis cases, INN group was found to have significantly less BOP (P < 0.0001). In Periodontitis cases, INN group showed significant difference in BOP (P < 0.0001). MMP-8 and MMP-9 were significantly lower among Periodontitis cases taking INN compared to the same group not taking the medication (P < 0.0001). Conclusion: INN assists in reducing clinical and biological signs of inflammation related to periodontal disease progression. INN may be a future additive medication to be further evaluated for treating periodontal disease.

Regenerative Therapy Modality for Treatment of True Combined Endodontic-Periodontal Lesions: A Randomized Controlled Clinical Trial.

The aim of this in-vivo study was to evaluate/compare the clinical periodontal parameters in patients with true combined endo-perio lesions (EPL), treated with gutta-percha (GP) and mineral trioxide (MTA) as an obturation material alone and with addition of bone grafting in such lesions. 120 Saudi patients (mean age = 41yrs) diagnosed with true combined EPL participated in this study. Group I (control group, n = 30) was treated with conventional endodontic treatment using GP for obturation. Group II (n = 30) was treated with conventional endodontic treatment using MTA for obturation. Group III (n = 30) was treated with conventional endodontic treatment using GP for obturation + grafting procedure to fill the bony defect. Group IV (n = 30) was treated with conventional endodontic treatment using MTA for obturation + grafting procedure to fill the bony defect. Clinical parameters (Pocket depth (PD); Clinical attachment loss (CAL); keratinized tissue width (KTW); gingival phenotype (G.Ph.) and Cone Beam Computed Tomography Periapical Index (CBCTPAI)) were recorded and compared at baseline, 3, 6, 12 months' interval. For the groups III and IV, CBCTPAI showed significant difference (p < 0.0001) with the other groups at 6 months and 1-year interval. The group with MTA + bone graft showed 76% and 90% patients with 0 score at 6 months and 1-year follow-up, respectively. Comparison of mean values of PD among study groups at 3 months, 6 months and 1 year showed significant difference at 3 months, whereas the mean PD values of subjects in GP + bone graft showed significantly higher PD values than other 3 groups (p = 0.025). Use of GP and MTA for root canal obturation along with periodontal therapy and bone augmentation helps in resolving complex endo-perio lesions. Bone grafting in addition to obturation with MTA was found to be the best treatment strategy in management of EPL cases and is recommended for clinicians who are treating EPL patients.

Analysis of Prosthetic Factors Affecting Peri-Implant Health: An in vivo Retrospective Study.

OBJECTIVE: To investigate and compare the various restorative and prosthetic parameters affecting peri-implant tissues' health following dental implant placement and functional loading. METHODS: A total of 484 dental implants (length>6mm, non-turned, 2-3 piece, titanium - Straumann) were evaluated for patients (male=271; female=213). Study variables such as patient's age, gender, implant restoration/crown type, crown retention, and implant crown status were assessed against various periodontal parameters (periodontal pocket depth (PPD), plaque index (PI), bleeding on probing (BOP), gingival color, and crestal bone level). All the data were analyzed using the SPSS software. RESULTS: Out of all the investigated dental implants, 201 (42%) of the implants investigated presented with BOP > one-site of the peri-implant mucosa (peri-implant mucositis), 115 (23.76%) presented with peri-implant marginal bone loss. PPD value was significantly lower in good crown status (p<0.0001). Majority of the patients with good crown status had no plaque accumulation based on the PI scores (52.7%). Only 35% of the patients whose crown status was good were having BOP when compared with 65% who did not have any BOP recorded. Gingival color (pale pink and red) showed statistically significant association with crown type (porcelain fused to metal v/s all ceramic) (p=0.005). Most of patients with crown status good had no change in their radiographic findings (94%) compared to only 6% who had implant threads exposed (p<0.0001). CONCLUSION: Optimal design of Implant prosthetic factors are vital for avoiding the development of peri-implant mucositis/peri-implantitis and must be considered during treatment planning while restoring dental implants.

Perception of E-Resources on the Learning Process among Students in the College of Health Sciences in King Saud University, Saudi Arabia, during the (COVID-19) Outbreak.

AIM: to assess the impact of e-learning through different e-resources among health sciences students. METHODOLOGY: A cross-sectional design was conducted among health science students (n = 211; 134 female and 77 male) at King Saud University, Saudi Arabia. The data was collected using a previously used structured questionnaire to assess the impact of e-resources on learning. RESULTS: The four most frequently used e-resources were: Zoom (38%), YouTube (31%), Google applications (29%), and Blackboard (27%). More than one-third of the students (35%) reportedly used e-resources for three or more hours daily. The majority of the students (55.9%) recognized a gender-related and age-related difference among faculty members in terms of e-resources usage. The majority of the students (58.2%) believe that online resources recommended by faculty members were credible. The majority of students believed that their academic performance was primarily influenced by these features of the e-resources: organization/logic of the content (64.5%), the credibility of the video (64.5%), and up to date "look and feel" of the video (60.6%). The study identified the most frequently used e-resources, gender, and age-related differences in faculty members' use of e-resources, students' overwhelming reliance on faculty feedback regarding the credibility of e-resources, and three most important characteristics (organization, credibility, and updated status) of e-resources. CONCLUSION: e-learning resources had a significant impact on participating students' education as they were used very frequently during their health sciences' courses.