Assessment of diagnostic accuracy and reliability of reveal fluorescence dental loupes in detecting molar incisor hypomineralization in children.

BACKGROUND: Molar-Incisor Hypomineralization (MIH) poses challenges to accurate diagnosis, impacting children's oral health. Traditional methods exhibit limitations, necessitating innovative approaches. This study aimed to evaluate the reliability and diagnostic accuracy Reveal Fluorescence Dental Loupes (RFDLs) for the detection of MIH METHODS: This cross-sectional study, adhering to STRAD guidelines, involved 38 healthy children (age 7-9) with MIH. Ethical approval and informed consent were obtained. Microscope images and Reveal loupes were employed for examinations. Validity was assessed against microscope results, and inter- and intra-examiner reliability were measured using ICC and Kappa coefficients. Sensitivity, specificity, and overall accuracy were calculated, with an AUC-ROC analysis for discriminatory ability. RESULTS: Intra-examiner reliability scores were excellent (Examiner 1: ICC 0.92, Examiner 2: ICC 0.94). Inter-examiner reliability (Kappa 0.92) indicated almost perfect agreement. Reveal demonstrated high sensitivity (82.61 %) and specificity (92.59 %), with an overall accuracy of 88.70 %. AUC-ROC analysis supported its robust discriminatory ability (AUC: 0.871). CONCLUSIONS: Reveal Fluorescence Dental Loupes emerged as a promising diagnostic tool for accurate MIH detection, particularly in outreach settings. The study highlights the transformative impact of accessible and reliable diagnostic tools on pediatric oral health outcomes. While acknowledging limitations and the absence of a gold standard, the findings contribute to advancing MIH diagnostic capabilities. Further research in diverse populations is warranted for comprehensive validation.

Impact of Syrian Conflict on the Oral Health of Adolescents: A Cross-Sectional Study.

BACKGROUND: The Syrian conflict has had a negative impact on the psychological and overall health of adolescents. However, little is known about the oral health of those who are internally displaced. AIMS: The purpose of this study was to investigate the relationship between mental health state and self-reported oral health and habits in Syrian adolescents. METHODS: A total of 99 adolescents living in Syria were included in the study. The participants were given four questionnaires: the International Trauma Questionnaire (ITQ), the Depression Anxiety Stress Scale-21 (DASS-21), the Epworth Sleepiness Scale (ESS), and the World Health Organization (WHO) Oral Health Questionnaire for Children (2013). The relationship between self-reported oral and mental health was evaluated. RESULTS: Adolescents with symptoms of mental disturbances or abnormal sleep conditions were statistically more likely to self-report the health of their teeth and gums as below average, less likely to brush their teeth regularly, and reported more frequent smoking (p<0.05). Moreover, symptoms of mental disturbances and abnormal sleep conditions were statistically more likely in adolescents living in rural areas and whose parents' education did not exceed secondary school (p<0.05). CONCLUSION: Syrian adolescents reported mental disturbances, which were reflected in their poor oral health and habits. These findings confirm the need for psychiatric and oral health care programs for Syrians who remain in areas of conflict.

Parental satisfaction and acceptance of silver diamine fluoride treatment for molar incisor hypomineralisation in pediatric dentistry: a cross-sectional study.

The study aimed to investigate parental satisfaction and acceptance of silver diamine fluoride (SDF) treatment for permanent molars affected by molar incisor hypomineralisation (MIH). This study was conducted in the pediatric dental department at Damascus University, Syria. This study was performed at the period from Jan 2023 to April 2023. In this cross-sectional study, a validated questionnaire employing a 5-point Likert scale was used to evaluate esthetics, ease of application, pain perception, and taste acceptability. Participants included 100 parents or guardians of children aged 6-9 years who had received SDF treatment in the past year. The findings of this study revealed high satisfaction levels (77.5%) with the treatment. Parents expressed contentment with the appearance of their child's molars after SDF application (58% agreed or strongly agreed) and found the application process easy and pain-free (100% agreed or strongly agreed). However, taste acceptability posed a challenge, with over half of the parents (53%) finding it unacceptable. Regression analysis underscored the significant impact of esthetics, ease of application, pain perception, and taste on parental satisfaction. Moreover, parents with higher education levels (graduate or postgraduate) exhibited higher acceptance rates compared to those with lower education levels (63.1% vs. 33.6%). Notably, parental gender and age did not significantly influence SDF treatment acceptance. This study provides critical insights into parental satisfaction and acceptance of SDF treatment for MIH-affected permanent molars. Despite concerns about tooth discoloration, the high satisfaction levels suggest that SDF holds promise as an effective treatment option. Parental education significantly influenced acceptance rates. This research highlights the importance of considering parental perspectives and tailoring communication strategies in pediatric dentistry, ultimately contributing to improved care for young patients with MIH.

Analyzing facial action units in children to differentiate genuine and fake pain during inferior alveolar nerve block: a cross-sectional study.

This study aimed to investigate the association between facial action units and pain levels in Syrian children, focusing on both genuine and fake pain expressions. A total of 300 Syrian children aged 6-9 years participated in the study. Pain levels were assessed using the validated Face, Legs, Activity, Cry, Consolability scale, and facial expressions were analyzed using the Facial Action Coding System. The children were asked to mimic their feelings after receiving a dental injection to elicit fake pain expressions. Statistical analysis, including multinomial logistic regression and chi-square tests, was conducted to determine the Action Units (AUs) associated with each pain level and to compare the differences between real and fake pain expressions. The results revealed significant associations between specific AUs and pain levels. For real pain expressions, the most activated AUs across different pain levels with positive coefficient values of correlation (P-value < 0.01) were analyzed. In contrast, for fake pain expressions, AU12 and AU38 were consistently observed to be the most activated. These findings suggest that certain AUs are uniquely associated with fake pain expressions, distinct from those observed in real pain expressions. Furthermore, there were no significant differences between boys and girls in terms of their genuine and fake pain expressions, indicating a similar pattern of AU activation (P-value > 0.05). It was concluded that AUs 4, 6, 41, and 46 were associated with mild pain, and AUs 4, 6, 41, 46, and 11 were associated with moderate pain cases. In severe pain, AUs 4, 6, 7, 9, 11, and 43 were associated. In fake pain feelings, AU43, AU38, and AU12 were the most activated with no difference between boys and girls.

Prevalence and clinical characteristics of molar-incisor hypomineralization in Syrian children: a cross-sectional study.

This study was undertaken to determine the prevalence of molar incisor hypomineralization (MIH) in Syrian children and to provide information about clinical patterns and severity of MIH lesions. A sample of 1138 children aged 8-11 years was recruited for this cross-sectional study. The diagnosis of MIH was made using the criteria of the European Academy of Paediatric Dentistry (EAPD) and the MIH/HPSMs short charting form was used to score the index teeth. The results showed that the prevalence of MIH in Syrian children was 39.9%. Demarcated opacities were the most prevalent pattern of MIH defects on Permanent first molars (PFMs) and permanent incisors (PIs). Spearman rank correlation showed that the mean number of PIs and HPSMs with MIH increased when the number of affected PFMs was increased (P < 0.001). Chi-square test resulted that girls showed a higher number of severe PFMs than boys did with a statistically significant difference (x2 = 133.1, P < 0.05). Moreover, Chi-square test showed that the number of severe PFMs is higher than the number of severe PIs with a statistically significant difference (x2 = 54.9, P < 0.05). In addition, the mean dmft/DMFT index in children with MIH was found to be significantly higher than children without MIH (P < 0.05). The findings emphasize the need for early identification and management of MIH in children to prevent adverse effects on their oral health.

A Novel Scale to Assess Parental Satisfaction of Dental Local Anesthetic Techniques in Children: A Cross-Sectional Study.

Background: Pain control is one of the most important aspects that can affect parental satisfaction of the dental care provided for children. Dental local anesthesia has the highest impact on pain sensation of the children. However, there is no scale in the literature to assess parental satisfaction of dental local anesthetic techniques. Objectives: This study was aimed to assess the parental satisfaction with dental local anesthetic techniques for their children through designing a scale that reflects satisfaction and to study the validity and reliability of this scale. Methods: A cross-sectional observational study was conducted on 150 parents (102 mothers and 48 fathers). Two techniques of local anesthesia were used for each child participated in this study (inferior alveolar nerve block and computerized intraosseous anesthesia). The developed scale consisted of 20 items in a 5-point Likert scale. Half of the items were written in a negative format. Internal consistency, validity, and factor analysis were performed in this study. Independent t-test was used to compare between the two techniques of anesthesia, between boys and girls and among fathers and mothers. Results: Parental satisfaction mean values were higher in the computerized intraosseous anesthesia group in comparison to inferior alveolar nerve block (P value <0.05). The T-test showed that there was no difference between boys and girls regarding parental satisfaction (P value >0.05). Furthermore, fathers show lower satisfaction in the computerized interosseous anesthesia group (P value <0.05). Excellent internal consistency of this scale was resulted as Cronbach's alpha reliability coefficient was 0.985. After factor analysis, seven factor components were retained by using varimax rotation. Conclusions: Findings of this study reported that the designed parental satisfaction of dental local anesthetic techniques scale (PSLAS) is a valid and reliable scale to be used. Moreover, this study showed that parental satisfaction was higher when computerized intraosseous anesthesia was used in comparison to inferior alveolar nerve block.

Remineralization of teeth with casein phosphopeptide-amorphous calcium phosphate: analysis of salivary pH and the rate of salivary flow.

AIM: To investigate the changes of salivary flow rate and salivary pH of Syrian children with mixed dentition following application of Casein Phosphopeptide-Amorphous Calcium Phosphate (CPP-ACP). METHODS: This study is part of a double-blind randomized controlled clinical trial. It included 50 children aged 6-8 who were randomly divided into two treatment groups to receive either CPP-ACP GC Tooth Mousse™ (Group A) or placebo (Group B) with 25 participants per group. After the application of the product in the mouth for 3 min, saliva samples were collected four times (T0, T1, T2, and T3) to measure salivary pH and the rate of salivary flow. RESULTS: There was no significant difference between group A and B in the mean value of salivary flow rate (t = 1.08, P = 0.28, 0.57 ± 0.28 versus 0.56 ± 0.38 respectively) and salivary pH (t = 0.61, P = 0.54, 7.28 ± 0.44 versus 7.25 ± 0.36 respectively). However, there was a significant difference between different time points (T0, T1, T2, and T3) in the mean value of salivary flow rate (0.41 ± 0.30, 0.65 ± 0.36, 0.53 ± 0.28, and 0.56 ± 0.34 respectively) and salivary pH (6.99 ± 0.44, 7.46 ± 0.36, 7.36 ± 0.32, and 7.26 ± 0.32 respectively). CONCLUSION: The application of the GC Tooth Mouse (CPP-ACP) was similar to placebo in increasing the salivary pH and salivary flow rate. TRIAL REGISTRATION: ISRCTN17509082, Registration date 22/11/2022.

Preventive efficacy of 38% silver diamine fluoride and CPP-ACP fluoride varnish on molars affected by molar incisor hypomineralization in children: A randomized controlled trial.

Background: This randomized controlled trial aimed to compare the efficacy of silver diamine fluoride (SDF) and Casein Phosphopeptide-Amorphous Calcium Phosphate fluoride Varnish (CPP-ACPFV) in preventing caries development, enamel breakdown, and sensitivity on molars affected by molar incisor hypomineralization (MIH) in children. Methods: A total of 100 children aged 6 to 9 years were enrolled in the study with two contralateral permanent molars mildly affected by MIH. Affected molars were randomly and equally assigned to receive either SDF or CPP-ACPFV treatment. The interventions were applied at four different time points (baseline, 3, 6, 9 months), and the incidence of caries, caries progression, enamel breakdown, and sensitivity were assessed. Results: The findings of this study revealed significant differences in the incidence of caries between the groups treated with SDF and CPP-ACPFV ( P-value < 0.05). Similarly, there was a significant difference in caries progression between the two groups ( P-value < 0.05). However, no significant differences were observed in enamel breakdown scores between the treatment groups, as the majority of teeth in both groups exhibited a score of 0. Furthermore, there were no significant differences in sensitivity between the treatment groups throughout the study period. Conclusions: In conclusion, the results of this study provide evidence that molars treated with SDF demonstrated a lower incidence of caries and a higher rate of caries arrest compared to those treated with CPP-ACPFV. Both interventions showed promise in preventing enamel breakdown and improving sensitivity. These findings highlight the potential of SDF and CPP-ACPFV as effective treatments for caries prevention and management, emphasizing the importance of early intervention and appropriate dental care strategies in maintaining oral health. Trial registration: ISRCTN54243749 (13/01/2022).

Evaluation of the effect of injectable platelet-rich fibrin (I-PRF) in reducing the resorption of fat graft during facial lipostructure: A randomized clinical trial.

BACKGROUND: Fat graft is considered to be the ideal material for soft tissue augmentation. However, its disadvantage are unpredictable outcomes due to variable resorption. OBJECTIVES: This study is the first clinical trial to evaluate the efficacy of adding injectable platelet-rich fibrin (I-PRF) to fat graft and to compare it with the conventional fat graft in terms of absorption rate. MATERIAL AND METHODS: The study was designed as a double-blind, split-face, randomized, controlled clinical trial. Twenty patients were randomly assigned with regard to the right or left nasolabial folds into 2 groups (n = 10 in each group): group A (fat graft only); and group B (fat graft with I-PRF). Surgical lipostructure was performed in accordance with the protocols described by Coleman. The adipose tissue was extracted from the umbilical region. Then, for the I-PRF preparation, peripheral venous blood was collected into plastic tubes. The follow-up recall visits took place after 1 and 12 months. Five investigators evaluated the preand post-surgical intervention photographs based on the Modified Fitzpatrick Wrinkle Scale (MFWS). RESULTS: The nasolabial fold depth scores were recorded at each of the study phases: before the intervention (1); after 1 month (2); and after 12 months (3). There were statistically significant differences between the scores at various study phases in each group. The Mann-Whitney U test was used to detect differences between the 2 groups. There was no statistically significant difference between the 2 groups regarding nasolabial fold depth 1 month after the intervention (p = 0.360). After 12 months, however, the patients in group A showed higher nasolabial fold depth scores as compared to group B; this difference was statistically significant (p = 0.000). CONCLUSIONS: The study demonstrated the efficacy of I-PRF in reducing the resorption of fat graft, following facial lipostructure.

Assessing the topical application efficiency of two biological agents in managing chemotherapy-induced oral mucositis in children: A randomized clinical trial.

BACKGROUND: oral mucositis is one of the most annoying complications of chemotherapy. This randomized clinical trial aimed to assess the efficiency of Aloe Vera and Olive Oil in managing chemotherapy-induced oral mucositis. METHODS: 36 children between 6 and 9 years and suffering from grade 3 or 4 oral mucositis, according to the World Health Organization (W.H.O.) scale, were enrolled in this clinical trial. Participants were separated into three groups to treat their mucositis using Aloe Vera, Olive Oil, or sodium bicarbonate. Nurses administrated the agents four times daily with sponge sticks. Two blinded investigators examined the oral mucosa after ten days. RESULTS: Both Aloe Vera and Olive Oil significant differences in the management of chemotherapy-induced oral mucositis compared to sodium bicarbonate treatments. CONCLUSIONS: Olive Oil is effective in managing CIOM.

Efficacy of Aloe-Vera Use for Prevention of Chemotherapy-Induced Oral Mucositis in Children with Acute Lymphoblastic Leukemia: A Randomized Controlled Clinical Trial.

Oral mucositis can be caused by chemotherapy and can affect a patient's quality of life. Nowadays, to prevent chemotherapy-induced oral mucositis (CIOM) is a crucial point in palliative care centers. This trial aimed to assess the effectiveness of aloe-vera in that concept. The trial was accomplished at Hematology Department of Hospital of Children of Damascus University, Syria. Acute lymphoblastic leukemia (ALL) children were the population from which 26 children were enrolled in the study. They were aged between 3 and 6 years old and were randomly referred according to the intervention into two groups, Aloe-vera (AV) and sodium bicarbonate 5% (13 each). Spongeous sticks were used to help in applying the material on tongue, labial and buccal mucosa, lips, floor of the mouth, and hard palate. Two blinded external examiners evaluated oral mucosa weekly for up to 2 months using the World Health Organization grading scale. Mann-Whitney U test was used to analyze data. According to the observed findings, CIOM degrees were less severe in the aloe-vera group than in the sodium bicarbonate group. Statistically significant difference of occurrence of different CIOM degrees between groups was recorded in the 2nd, 3rd, 4th, and 7th weeks of follow-up period. Moreover, Mann-Whitney U test indicated that patients in the sodium bicarbonate group began CIOM sooner than those in the aloe-vera group with a statistically significant difference (p = .001). These findings show that topical application of aloe-vera solution is effective in the prevention of CIOM in ALL children.

Knowledge and awareness level of syrian dentists towards novel coronavirus pandemic: cross-sectional study / Nivel de conocimiento y actitud de los dentistas sirios sobre la nueva pandemia de coronavirus: estudio transversal

Objetive: An outbreak of a novel and alarmingly coronavirus disease (COVID-19) was announced in China in December 2019, which later affected about 180 countries worldwide. Thus, this study aims to assess the awareness and attitude of dentists towards COVID-19 in Syria. Materials and Methods: The questionnaire was an online survey; it contained 19 questions formulated based on the information given by WHO and CDC for COVID-19. Study participants were dentists practicing in Syria. The questionnaire was translated into Arabic and published on the internet into multiple platforms. Results:7233 dentists responded to the questionnaire; 64% of the participants were females. The majority of the respondents were general practitioner (78%), nearly half of the respondents had been practicing dentistry for at least 2-4 years (51%). The majority of the respondents has knowledge about COVID-19 and was aware it is contagious. Over half of the Syrian dentists received their information about COVID-19 from social media platforms (55%). Even though the majority of the dentists were aware that the incubation period could last up to 14 days, nearly half of the participants were not aware that symptomless patients can spread the virus (49%). Conclusions: Syrian dental practitioners were aware of COVID-19 definition, incubation period and prevention measures in the dental clinic. However, they had limited attitude regarding COVID-19 symptoms, mode of transmission and management.

Objetivos: En China se anunció en diciembre de 2019 un brote de una nueva y alarmantemente enfermedad por coronavirus (COVID-19), que luego afectó alrededor de 180 países en todo el mundo. Por lo tanto, este estudio tiene como objetivo evaluar el conocimiento y la actitud de los dentistas hacia COVID-19 en Siria. Material y Métodos: El cuestionario se aplicó como una encuesta en línea; contenía 19 preguntas formuladas en base a la información proporcionada por la OMS y los CDC para COVID-19. Los participantes del estudio fueron dentistas que practicaban en Siria. El cuestionario fue traducido al árabe y publicado en Internet en múltiples plataformas. Resultado: 7233 dentistas respondieron al cuestionario; El 64% de los participantes eran mujeres. La mayoría de los encuestados eran dentistas generales (78%), casi la mitad de los encuestados habían estado practicando odontología durante al menos 2-4 años (51%). La mayoría de los encuestados tiene conocimiento sobre COVID-19 y sabía que es contagioso. Más de la mitad de los dentistas sirios recibieron su información sobre COVID-19 de redes sociales (55%). Aunque la mayoría de los dentistas sabían que el período de incubación podría durar hasta 14 días, casi la mitad de los participantes no sabían que los pacientes sin síntomas pueden transmitir el virus (49%). Conclusion:Los odontólogos sirios conocían la definición de COVID-19, el período de incubación y las medidas de prevención en la clínica dental. Sin embargo, tenían una actitud limitada con respecto a los síntomas de COVID-19, el modo de transmisión y el manejo.

Comparing the efficacies of two chemo-mechanical caries removal agents (2.25% sodium hypochlorite gel and brix 3000), in caries removal and patient cooperation: A randomized controlled clinical trial.

INTRODUCTION: This study compared and evaluated the effectiveness of Brix 3000 and 2.25 % sodium hypochlorite (NaOCl) gel with conventional rotary instrumentation method in caries excavation of primary molars. The null hypothesis: no difference between the two tested chemo-mechanical caries removal (CMCR) agents used in this trial. MATERIALS AND METHODS: a randomized controlled clinical trial conducted with 32 children suffering from proximal caries of primary maxillary molars, age ranging between 6 and 9 years old. Subjects were randomly assigned into three groups: Brix 3000, NaOCl gel, and conventional with 10, 12, and 10 teeth in each group, respectively. After isolation of selected teeth, either CMCR agent were applied for two minutes. The application was repeated as needed until a caries-free surface was obtained. The conventional group used low-speed burs to excavate all carious lesions. The time required to obtain a caries-free result for each testing method was recorded. Wong-Baker FACES pain rating scale was used to assess the acceptance of the technique used by the child. RESULTS: Conventional treatment required significantly less time for caries removal compared to Brix 3000 (P = .002) and NaOCl gel (P = .000). No significant difference observed between Brix 3000 and NaOCl gel (P = .679). Statistically higher pain scores were observed with conventional treatment compared to both Brix 3000 (P = .000) and NaOCl gel (P = .005). Pain scores were lower with Brix 3000, and NaOCl gel with no significant difference observed between the CMCR agents (p = .690). CONCLUSIONS: CMCR agents that are effective in removing the carious dentine of primary teeth without negatively affecting the cooperation of children. CLINICAL SIGNIFICANCE: The use of a 2.25 % sodium hypochlorite gel can be an effective and well-tolerated method of removing decay from primary teeth and reduce the trauma associated with conventional rotary caries removal.