Burden of oral disease in the Middle East: Opportunities for dental public health.

A significant increase in the burden of oral-health related diseases in the Middle East has been observed recently. This increase has been largely the result of poor awareness concerning the importance of oral health and best practices towards achieving good oral hygiene. Contributing factors to this burden include but are not limited to: increased sugar consumption, inadequate oral hygiene practices and a high prevalence of smoking. All these factors are known to have considerable influence on the development of the most common oral diseases, such as dental caries, periodontal diseases, oral precancerous lesions and cancer. Although oral diseases represent a significant burden on the quality of life and healthcare economics of Middle Eastern countries, restorative and preventive dental care have not been given nearly enough attention. The prevention of dental diseases is critical to preserving not only oral health but also to maintaining general well being. This Supplement will address the need for oral disease preventative approaches with the use of epidemiological data, and will focus on the management and prevention of dental caries and periodontal disease, providing practical advice on for the management of plaque biofilm. There is a significant need for increased public awareness and regular surveillance of oral hygiene practices in the Middle East, as well as the complications associated with poor oral hygiene. In addition, development of guidelines, public health awareness programmess and dental community educational programmes are urgently needed.

Improving oral health in the Middle East - recommendations from the first Middle East Oral Hygiene Advisory Board meeting.

Chronic periodontitis may be a sequela of chronic gingivitis, usually because of accumulation of plaque and calculus. Consistent good dental hygiene can help prevent gingivitis and periodontitis. Mechanical removal of plaque through frequent and efficacious brushing and flossing is the principal means of preventing periodontal diseases and diminishing the risk of caries. According to the American Dental Association (ADA), antimicrobial mouth-washes may provide additional oral health benefits, in addition to brushing and flossing, for preventing and reducing gingivitis and plaque. There is a multitude of mouthwashes available for these purposes. The consensus panel of the Middle East Oral Hygiene Advisory Board has recommended that an antiseptic mouthwash should be used as a daily adjunct to mechanical cleaning for prevention of oral disease. Recommending particular mouthwashes should take into consideration the patient's ability to perform good oral hygiene practices (tooth brushing and dental flossing), the condition of the patient's teeth, gingivae and oral mucosa, and the proven efficacy of the mouthwash along with its potential adverse effects. Of the many mouth rinses available, only a few contain chemical agents that have some ability to penetrate biofilm and to kill plaque biofilm bacteria. Currently, only chlorhexidine mouthrinse and Listerine (an essential oil-containing mouth rinse) products, with the claim of plaque and gingivitis reduction, have been accepted for that purpose by the ADA and have a proven record of safety and efficacy. Essential oil-containing mouthrinses have been clinically proven as effective in reducing plaque and gingivitis. Dental care professionals should spend time discussing biofilm control with their patients, and be an information source for the best oral care products. Therefore, it is essential that dental care professionals should continue to monitor published research and work with their colleagues to make evidence-based decisions. In this way, patients will be directed to dental hygiene aids, including antiseptic mouthwashes that can be most effective for improving their oral health.

The efficacy of alpha-tocopherol in functional recovery of spinal cord injured rats: an experimental study.

OBJECTIVE: The objective of this study is to examine the effects of the alpha-tocopherol on rats with spinal cord injury (SCI). SETTING: Research Center, Sultan Bin Abdulaziz Humanitarian City, Riyadh, Kingdom of Saudi Arabia. METHOD: Female Sprague-Dawley rats weighing 180-220 g were anesthetized with chloral hydrate (450 mg kg(-1) body weight) by intraperitoneal injection and laminectomy was performed at the T 7-8 level leaving the dura intact. A compression plate (2.2 x 5.0 mm) was loaded with a weight of 35 g placed on the exposed cord for 5 min to create SCI. The subjects were divided into three groups of eight rats each. Group 1 served as control (SCI+saline); whereas groups 2 and 3 served as test groups, alpha-tocopherol was given orally in doses of 1000 mg kg(-1) body weight for group 2 and 2000 mg kg(-1) body weight for group 3, respectively. Daily activities were recorded in the activity cage for 14 days post-operatively. RESULTS: At day 1 (baseline, 24 h after the surgery), there was no significant difference between mean motor scores of all groups. After day 1, the three groups showed continuous improvement in motor score; such improvement was maintained throughout the duration of the study with different levels for each group. By the end of the study (day 14), groups 2 and 3 showed statistically significant improvement in the mean motor score compared with group 1 (P<0.05). However, no significant difference was observed between test groups 2 and 3 by the end of the study. CONCLUSION: The results suggest that the administration of alpha-tocopherol may have reparative effects for SCI because of its antioxidant effect.

Evaluation of dental extractions, suturing and INR on postoperative bleeding of patients maintained on oral anticoagulant therapy.

OBJECTIVES: To examine the consequences of temporary withdrawal of warfarin and/or suturing on bleeding and healing pattern following dental extractions. METHODS: Two hundred and fourteen patients on long-term oral anticoagulation (warfarin) therapy scheduled for dental extraction were randomly divided into four groups: no suturing and discontinued (group 1) or continued warfarin (group 2), and suturing and discontinued (group 3) or continued warfarin (group 4). International normalised ratio (INR) was determined at different time points (baseline, days 1, 3 and 7). RESULTS: Discontinuing warfarin reduced INR level significantly at day 1, which subsequently reached <1.5 in 96 out of 104 patients (group 1 and 3). Statistical comparisons among the different treatment groups did not reveal any significant difference regarding bleeding status or healing pattern. Interestingly, patients who received sutures showed higher but insignificant incidence of bleeding postoperatively compared to their respective controls. CONCLUSION: Dental extractions may be safely performed for patients on anticoagulation therapy provided the INR level is kept <3.0 and effective measures of local haemostasis are administered. The decision to suture should be made on case-by-case basis, as the trauma associated with soft tissue handling might outweigh its advantages in certain situations like simple extractions.

Clinical evaluation of subgingival application of metronidazole 25%, and adjunctive therapy.

The effect of topical application of a metronidazole gel (ELYZOL DENTAL GEL), and adjunctive therapy in the treatment of adult periodontitis was assessed clinically. A single, masked examiner performed clinical assessments. Fourteen patients were involved, each one received four different treatments including control, and the four treatments were randomly applied to at least one tooth in each quadrant for each patient in a comparative split-mouth design. Clinical examinations were carried out before treatment and 90 days after treatment. All patients had at least one tooth in each quadrant with probing pocket depth of > or = 5mm. The four treatment groups were: (I) One session of one hour of scaling and root planning, (II) metronidazole 25% dental gel (ELYZOL DENTAL GEL) applied on day 0 and day 7, (III) scaling adjunctive to metronidazole 25%, and (IV) No treatment. Instruction in oral hygiene was given to all subjects at base line examination. At the end of the study (day 90), all groups had statistically significant improvement in probing pocket depth (P < 0.02), and in plaque and bleeding indices (P < 0.05) when compared to day 0. However, group III had statistically significantly greater improvement (P < 0.03) in probing pocket depth than groups I, II and IV. Both groups I and II had statistically significantly greater improvement (P < 0.05) in probing pocket depth than control group. On the other hand, both groups were not statistically significantly different from each other in probing pocket depth improvement. It is suggested that topical Elyzol treatment may improve periodontal health as well as subgingival scaling and root planning therapy, and adjunctive treatment could obtain an additional therapeutic effect.

Long-term evaluation of 282 implants in maxillary and mandibular molar positions: a prospective study.

BACKGROUND: Placement of implants into molar positions presents diagnostic, surgical and prosthetic challenges. There are few reported studies for implants placed into molar positions. The purpose of this prospective longitudinal study is to report long-term clinical outcomes for 282 implants placed into molar positions. METHODS: Two-hundred-twelve patients received 282 implants. Implant size, location, jaw shape, and bone quality were recorded for all implants placed into molar positions. Seventy implants were inserted in maxillae and 212 in mandibles. Marginal bone level changes in maxillae and mandibles were measured from non-standardized periapical radiographs taken at abutment connection and an average follow-up of 3.9 years. Mesial-distal implant measurements were made from the top of the implant cylinder to the first point of bone to implant contact. In mandibles, 39 implants were used for single molar replacements, 67 implants were placed into excellent bone quality (type I) and 113 were in good bone quality (type 11); 145 implants were placed into bone with moderate bone resorption (type B); 166 implants were placed in first molar positions and 46 in second molar sites. RESULTS: At 6 years the cumulative success rate (CSR) for mandibular implants is 91.5%, and the success rate from the 2 to 3 year follow-up is 100%. Of the 70 implants placed in maxillae, 16 replaced single molars. Thirty-two implants were placed in jaw shape B with type 2-bone quality. For maxillary implants, the 6-year CSR was 82.9% and the success rate remained steady at 100% after the 2 to 3 year follow-up. For maxillary implants, at abutment connection the average marginal bone level was 1.67 mm, while at follow-up it was 1.98 mm. These differences were statistically significant (P = 0.04), but are not considered to be clinically significant. For mandibular implants, at abutment connection the mean marginal bone level as measured from radiographs was 2.11 mm, and at follow-up was 2.02 mm. This slight gain in bone level was not statistically significant and is not considered to be clinically significant. CONCLUSIONS: Results of this prospective longitudinal study of implants placed into molar positions indicates favorable clinical outcomes. These CSR rates (91.5% mandibles, 82.9% maxillae) are less than what has been reported for implants placed into mandibular and maxillary anterior segments. Differences in outcomes between anterior and posterior locations may be related to bone quality and quantity.

Furcation involvement in posterior teeth.

This article presents two cases in which different treatments were used for mandibular molars with furcation lesions. In the first case, a conventional amputation treatment of the distal root was performed to save the mesial root as a terminal tooth, which was used as a partial denture abutment. The second case describes a relatively new technique in which a root perforation was filled with graft material (synthetic bioglass) and covered with a resorbable membrane to treat an iatrogenic furcation lesion adjacent to the mesial root. Twelve months after surgery, periapical radiographs of both treated cases showed increased bone density. Follow-up in both cases--30 months in the first case and 12 months in the second--showed no pathological recurrence or clinical dysfunction. Root amputation may provide an alternative to extraction in periodontally involved molars. Synthetic bone replacement materials combined with guided tissue regeneration may also help to correct osseous defects incurred by recent furcation perforations with associated bone loss.

Glycaemic index of Pakistani staple foods in mixed meals for diabetics.

Glycaemic index of local staple foods was determined. In first phase, the post prandial blood glucose response of isocaloric portion of wheat chapati and gram flour (baisen) chapati, were compared in 11 type II diabetic patients as a part of mixed meal in fasting state, alternately. The glycaemic index of baisen chapati was 39 as compared with wheat chapati. In second phase of the study, 22 type II diabetic patients were given isocaloric portions of wheat chapati and boiled rice as a part of mixed meal alternately. The glycaemic index of rice was 98 as compared with wheat chapati. This study favours the belief that baisen chapati is better and refutes that rice is bad for diabetics. It also upholds that glycaemic index is useful for planning a diabetic diet.