Artificial intelligence (AI) in restorative dentistry: Performance of AI models designed for detection of interproximal carious lesions on primary and permanent dentition.

Objective: The objective of this study was to evaluate the effectiveness of deep learning methods in detecting dental caries from radiographic images. Methods: A total of 771 bitewing radiographs were divided into two groups: adult (n = 554) and pediatric (n = 217). Two distinct semantic segmentation models were constructed for each group. They were manually labeled by general dentists for semantic segmentation. The inter-examiner reliability of the two examiners was also measured. Finally, the models were trained using transfer learning methodology along with computer science advanced tools, such as ensemble U-Nets with ResNet50, ResNext101, and Vgg19 as the encoders, which were all pretrained on ImageNet weights using a training dataset. Results: Intersection over union (IoU) score was used to evaluate the outcomes of the deep learning model. For the adult dataset, the IoU averaged 98%, 23%, 19%, and 51% for zero, primary, moderate, and advanced carious lesions, respectively. For pediatric bitewings, the IoU averaged 97%, 8%, 17%, and 25% for zero, primary, moderate, and advanced caries, respectively. Advanced caries was more accurately detected than primary caries on adults and pediatric bitewings P < 0.05. Conclusions: The proposed deep learning models can accurately detect advanced caries in permanent or primary bitewing radiographs. Misclassification mostly occurs between primary and moderate caries. Although the model performed well in correctly classifying the lesions, it can misclassify one as the other or does not accurately capture the depth of the lesion at this early stage.

Knowledge assessment on cleft lip and palate among recently graduated dentists: a cross-sectional study.

BACKGROUND: The complex presentation, associated co-morbidities and multi-disciplinary requirements dictate the requirement for in-depth knowledge in order to effectively manage patients with cleft lip and palate (CLP). We aimed to develop a validated questionnaire for cleft lip and palate knowledge assessment and to evaluate the knowledge of cleft lip and palate among a group of recently-graduated dentists. MATERIALS AND METHODS: A multiple-site, cross-sectional questionnaire-based study was conducted. The study population included recently graduated dentists involved in a dental internship program. A bespoke questionnaire was developed and validated, with internal consistency assessed using Cronbach's alpha and factor analysis performed. A 47-item prototype was distilled into a 15-item questionnaire. This was distributed to the participants with a response rate of 67% obtained. RESULTS: The overall proportion of correct responses among dental interns was moderate (73%). The best results were found in relation to CLP treatment including the effect of unfavorable surgical outcomes on speech (89.5%) and the impact of CLP on the occlusion (87.6%). The lowest rate of correct responses (26.7%) was identified in relation to the association between CLP and smoking. CONCLUSION: A validated CLP questionnaire was developed, permitting evaluation of the knowledge of cleft lip and palate and its management among recently graduated dentists. There is limited appreciation among dental interns of the risk factors for CLP as well as post-surgical complications. Given that general dentists are often the gatekeepers for the management of patients with cleft lip and palate, it is important that the findings of this survey are used to inform the curriculum and teaching of cleft lip and palate.

Regional Odontodysplasia with Actinomycosis Infection: A Rare Case Report.

A rare dental developmental anomaly known as regional odontodysplasia (RO) manifests itself in hypoplastic and hypomineralized teeth with discolored yellow to brown enamel. Radiographically, the affected tooth appears as a shell tooth with a large pulp chamber and a thin layer of teeth structure. The treatment plan is not well-established, and a multidisciplinary approach is often needed. However, a literature review revealed that most of the studies regarding RO are case reports, and more research, including epidemiological, genetic, and experimental studies, is needed to understand this condition better. Additionally, the cause of this anomaly is currently unknown. Removing the affected tooth is a controversial matter, and the treatment options should be chosen on an individual basis, considering the patient's goals for treatment. This report describes an uncommon case of an 8-year-old girl who has RO affecting the front teeth in the upper jaw and a long-standing infection caused by actinomycosis. How to cite this article: Helal N. Regional Odontodysplasia with Actinomycosis Infection: A Rare Case Report. Int J Clin Pediatr Dent 2023;16(1):190-197.

Effectiveness of MI Varnish™ and PreviDent® Varnish in Noncavitated Interproximal Lesions: A Randomized Clinical Trial.

Aim: Evaluating the remineralization efficacy of noncavitated proximal incipient lesions with Colgate® PreviDent® and MI™ varnishes in comparison to the industry standard (1.23%) acidulated phosphate fluoride (APF) gel. Study design: Parallel randomized controlled, multicenter, single-blinded trial. Materials and methods: By flipping a coin, 18 patients with 91 lesions were divided into three groups. The Colgate® PreviDent (n = 33), MI varnish (n = 30), and control (APF gel) groups (n = 28) were identified as the three arms. We conducted an initial assessment and therapy as well as follow-ups at 3 and 6 months to evaluate the course of the caries lesion. Results and statistics: Caries progression was significantly reduced on treated surfaces across both groups. Nine surfaces in the Colgate® PreviDent® group with white spots and dryness did not change, one surface turned into a white patch without dryness, and another surface changed to a sound surface; only two surfaces were discontinued from treatment (restored) due to a misdiagnosis by the operator (n = 2). Nine of the surfaces in the MI™ group maintained their white patches with dryness, whereas one developed a new white patch that was not dry. Only MI varnish™-treated teeth exhibited dramatic radiographic improvement. Caries on the outside enamel were either unchanged or restored to healthy levels. Caries on the inner surface of the enamel also did not change. Conclusion: Remineralizing noncavitated early-stage lesions may be done with both MI™ and Colgate® PreviDent® varnishes. Despite this, radiographic results did not vary significantly across the three groups. In situations of rather advanced incipient caries seen on radiographs, the MI varnish™ might be recommended. How to cite this article: Helal N, Azzahrani GS, Azzouz LZ. Effectiveness of MI VarnishTM and PreviDent® Varnish in Noncavitated Interproximal Lesions: A Randomized Clinical Trial. Int J Clin Pediatr Dent 2023;16(5):751-757.

Factors influencing the desire for orthodontic treatment among patients and parents in Saudi Arabia: A cross-sectional study.

OBJECTIVES: The decision to pursue orthodontic treatment is influenced by a variety of cosmetic, functional, and social reasons. This study compared the factors that influence adults' decisions before orthodontic treatment versus parents' decisions prior to their children's orthodontic treatment in Jeddah city, Saudi Arabia. MATERIALS AND METHODS: A cross-sectional survey was distributed to the patients of orthodontic clinics of King Abdulaziz University in addition to a private orthodontic clinic in Jeddah city, Saudi Arabia. The survey consisted of two versions of a questionnaire: one for adults and one for children's parents. The survey inquired about the participants' demographics, factors that led to the necessity of treatment, and considerations before opting for orthodontic treatment. The factors influencing the decision-making process of adults were compared to that of parents using the Chi-square test. RESULTS: A total of 417 subjects participated, 331 adults and 86 parents. The majority of the respondents in both groups were females. When compared to children, adults were more aware of the necessity for orthodontic treatment (78.5% of adults vs. 41.9% of children). The primary motivation for adults and parents to begin orthodontic treatment was to improve their esthetic appearance (58.6% and 87.2%), whereas functional concerns were less frequently reported (12.1% and 15.1%). Adults relied on less trustworthy sources of information about orthodontic treatment options, whereas parents relied on more dependable sources. CONCLUSIONS: The main reason for opting for orthodontic treatment in Jeddah city, Saudi Arabia was esthetic for both adults and children.

Care Barriers for Patients With Nonsyndromic Orofacial Clefts in Saudi Arabia: A Cross-Sectional Study.

OBJECTIVE: To evaluate the barriers faced by patients with nonsyndromic orofacial clefts (NSOFC) throughout their treatment course in Saudi Arabia. DESIGN: A cross-sectional study. SETTING: Eleven different governmental health care centers across Saudi Arabia. Patients: Records of pediatric patients with NSOFC. INTERVENTIONS: A questionnaire with multiple validation stages was designed to assess the barriers in care of these patients through telephonic interviews with the parents or guardians of patients with NSOFC. MAIN OUTCOME MEASURES: We identified 3 care-barrier-related factors: (1) geographic accessibility, (2) appointment availability and accessibility, and (3) scheduling-related barriers. RESULTS: Overall, 240 participants of both sexes, with orofacial cleft of various types and with various demographic characteristics (residence, family monthly income, and caregiver level of education) were included. The highest mean score of care barriers was reported for scheduling-related barriers. Overall, 186 individuals reported sometimes/often not receiving the required medical care for the following reasons: scheduling difficulties (89%; 37.1%), prolonged waiting room time (40%; 16.7%), and transportation difficulties (36%; 15.0%). A linear regression showed that parents cited late appointments as the main reason for patients with NSOFC not receiving adequate medical care. Care-barrier factors were significantly related to gender (P = .035), patient age (P < .001), place of residency (P < .001), and caregiver's level of education (P = .015). CONCLUSIONS: Gaps in the health care system directly related to common care barriers need to be addressed to ensure adequate care for patients with NSOFC.

Instrument Development and Validation to Assess Care Barriers for Patients in Saudi Arabia with Oral Clefts.

The study objective was to construct and validate a tool to assess, measure, and evaluate the barriers and obstacles that patients with orofacial clefts (OFCs), and their families, face during treatment. The Effective Accessibility and Accommodation subscale, based on the translated Primary Care Assessment Survey and Primary Care Assessment Tool scales, was used as a reference for the questionnaire. A total of 165 parents from three main cleft referral centers in Saudi Arabia were interviewed. Questionnaire content validity was conducted by calculation of a content validity index for each item (I-CVI) as well as for the total scale (S-CVI). Reliability was tested using Cronbach's alpha. Factor analysis and principal components analysis were performed to determine the factor structure of the instrument. The final questionnaire had nine items. Rating results showed both I-CVI and S-CVI scores of 1 and Cronbach's alpha was 0.86. There were three factors (geographic accessibility, appointment availability and accessibility, and scheduling-related barriers) with eigenvalues above 1.00, which collectively accounted for 73% of the variance. In conclusion, this tool is valid and reliable to evaluate accessibility and barriers to care of patients with OFCs in Saudi Arabia.

Effect of Environmental Tobacco Smoke on Children's Anxiety and Behavior in Dental Clinics, Jeddah, Saudi Arabia: A Cross-Sectional Study.

BACKGROUND: Environmental tobacco smoke (ETS) has been linked to behavioral problems, but no study has assessed its relationship with dental anxiety. Therefore, this study's goal is to assess the relation between ETS and both behavioral problems and dental anxiety among children. METHODS: The study sample was collected from two centres in Jeddah from October 2019 to January 2020. Inclusion criteria included healthy 5-16-year-old children having their first dental visit with no emergency complaint. The questionnaire including general information, ETS exposure, the child's anxiety using the Abeer Children Dental Anxiety Scale (ACDAS) and dental behavior using the Frankl Behavioral Rating Scale. RESULTS: Of 500 children, 337 (67.4% response rate) responded to the questionnaire, among whom 201 (59.6%) had been exposed to passive smoking compared to 136 (40.4%) who had not. Exposed children had a statistically significantly greater tendency to develop anxiety (p = 0.002) and demonstrate uncooperative behavior (p = 0.006). Generalized linear mode and binary regression analyses suggested that ETS has a statistically significant effect on children's dental anxiety and behavior (p < 0.05). CONCLUSIONS: Children exposed to ETS demonstrated statistically significantly higher anxiety levels and uncooperative behavior in the dental clinic compared to those who were not exposed.

Reliability and Validity of the Arabic Version of a Questionnaire Assessing Pain, Discomfort and Related Jaw Function Impairment after Extraction of Primary Teeth in Children.

This study aims to translate a previously published English language questionnaire that assessed pain and discomfort after the extraction of primary teeth in children into Arabic, and evaluate its validity and reliability. All participating children (n = 120), aged 9 to 12-years-old, completed the 33-item Arabic version questionnaire after the extraction procedure had taken place. The questionnaire included three parts that were completed at three different times, namely, immediately, the first evening, and one week after the extraction procedure. Internal consistency, content validity, criterion validity, and factor analysis were performed. The results showed a good internal consistency (Cronbach's alpha = 0.83), acceptable criterion validity with a significantly strong correlation with the Visual Analog Scale (VAS), and satisfactory content validity (average content validity index (CVI = 0.90). The final factor model was comprised of four factors with an eigenvalue greater than 1, explaining 70% of the common variance. The identified factors were labeled as follows: Factor 1-analgesic consumption; Factor 2-expression of discomfort from the extraction site; Factor 3-perception of masticatory capability; and Factor 4-pain/discomfort from the dental extraction procedure. Based on the results, a shorter form of the questionnaire had satisfactory psychometric characteristics and can be used with children within the selected age group.

Relationship of Velopharyngeal Insufficiency With Face Mask Therapy in Patients With Cleft Lip and Palate.

OBJECTIVE: To determine whether orthodontic/dentofacial orthopedic maxillary protraction face mask therapy induces changes in velopharyngeal functioning in a cohort of pediatric patients having cleft palate with or without cleft lip. DESIGN: Retrospective chart review. SETTING: A children's hospital in the United States. PARTICIPANTS: Forty-three pediatric patients with cleft palate, with or without cleft lip, syndromic or with isolated clefts, who received face mask therapy from January 2009 to April 2016. INTERVENTION: Clinical data were extracted for review and analysis from medical records obtained from the Cleft Database/Research Registry (CDB-RR). MAIN OUTCOME MEASURES: Pittsburgh Weighted Speech Scores (PWSS) before and after therapy. RESULTS: There was a significant increase in PWSS after face mask therapy for patients with a PWSS score of 0 prior to treatment. Patients with PWSS >0 before treatment remained largely stable after face mask therapy. Maxillary advancement was not significantly associated with change in PWSS or fistula presence/absence. CONCLUSIONS: There is an increased risk of velopharyngeal insufficiency with maxillary protraction face mask treatment in patients with cleft palate. Patient counseling and obtaining consent regarding speech changes during treatment are recommended.

Significance of Cephalometric Radiograph in Orthodontic Treatment Plan Decision.

AIM: The lateral cephalometric radiograph is a standard component of clinical records taken for orthodontic diagnosis and treatment planning. The present study was conducted to assess the utility of cephalometric radiography and analysis in modern orthodontic diagnosis and treatment planning. MATERIALS AND METHODS: A research survey was conducted at Jacksonville University School of Orthodontics. Thirty-one residents and faculty were the participants. The survey sample was collected from the university patients' pool. A survey was given to participants at two time points. At the first time point (T1), the participants were given full records without lateral cephalogram. At the second time point (T2), they were given full records with lateral cephalogram. Two measures were analyzed: (1) a change in orthodontic treatment decision and (2) a change in the orthodontic treatment plan. A traditional McNemar's test was used on paired binary data. We used the conditional logistic regression model with robust variance at a participant level to adjust for a participant-level clustering effect to test the difference in treatment decision before and after. A statistical significance was determined at p = 0.05. RESULTS: It was found that 93.6% of the treatment decisions and 70% of the extraction decisions were consistent after the introduction of lateral cephalograms. There was no statistically significant association observed between two outcome measures and the use of cephalograms (p = 0.80). CONCLUSION: Sufficient evidence does not exist to warrant lateral cephalometric radiographs be taken as a part of standard diagnostic records on every individual seeking orthodontic treatment. CLINICAL SIGNIFICANCE: Evidenced-based selection criteria for prescribing lateral cephalometric radiographs should be developed to reduce the amount of radiation exposure to the general public.

Oxymetazoline Applied Topically to the Nasal Mucosa Decreases Trans-Mucosal Nitrous Oxide Exchange for the Middle Ear.

OBJECTIVE: Determine if the middle ear (ME) trans-mucosal nitrous oxide (N2O) gas exchange rate can be pharmacologically modulated by the nasal application of a vasoconstrictor. METHODS: In a randomized, double-blind, crossover study, 20 adults received a nasal spray challenge containing either oxymetazoline or saline (placebo). At each session, subjects were fitted with a non-rebreathing mask and breathed room air for 20 minutes, 50% N2O:50% O2 for 20 minutes, and 100% O2 for 10 minutes. Throughout, heart rate, blood pressure (BP), and blood O2 saturation were monitored, and bilateral ME pressure was recorded by tympanometry every minute. The primary outcome measure was the slope of the ME pressure-time function for the experimental period, a direct measure of the transMEM N2O exchange constant. The effects of treatment, session, and period on the measured vital signs and of treatment, session, disease history, and ear on the ME pressure-time slopes were evaluated for statistical significance using repeated measures ANOVAs. RESULTS: The analysis documented a significant effect of period on O2 saturation (N2O > room air, P = .03) and of treatment on blood pressure (oxymetazoline > placebo, P < .02) and the ME pressure-time slope (placebo > oxymetazoline, P = .05). CONCLUSION: The exchange rate across the ME mucosa of inert gases can be decreased by topical treatment of the nasal mucosa with oxymetazoline.