Parents' Education Level and Children's BMI Explain Caries Distribution Among Kindergarten Students: A Cross-Sectional Study.

Background: Dental caries is a common but preventable, multifactorial disease in children. Among several others, it is influenced by child- and parent-related factors. Aims: To describe knowledge, attitude and practices about oral health among parents of kindergarten children and assess factors influencing caries distribution among the children. Methods: Parents of 290 kindergarten children in AlMadinah, Saudi Arabia, answered questions concerning their oral health knowledge, attitudes and practices. The children underwent an oral clinical examination. Data were collected between February and April 2018. Comparison between groups was done using the Kruskal-Wallis test. Results: All parents agreed on the importance of fluoride to strengthen teeth, while 91.7% thought that sweets have a negative impact on teeth. Almost all children ate sweets and candies (99%), while most of them used toothbrushes and fluoride to clean their teeth (98%). Only 66% of parents took their children to the dentist. The 2-step cluster analysis revealed that clusters of children with high body mass index (BMI) and those whose parents had only primary education had the highest caries prevalence compared to clusters of children with lower BMI and parents with higher education (P < 0.05). Conclusions: Within the study limits, parents demonstrated good oral health knowledge, attitudes and practices. Kindergarten children had high caries, especially those with high BMI and whose parents had low educational levels.

Adjunctive Effect of Green Tea Mouthwash Prepared at Different Steeping Temperatures on Gingivitis: A Triple-Blind Randomized Controlled Clinical Trial.

PURPOSE: To compare the effect of green tea mouthwashes prepared at different steeping temperatures as adjuncts to mechanical plaque control on gingivitis. METHODS: Forty-five women with gingivitis participated in this 4-week randomized controlled clinical trial. They received professional mechanical plaque control and rinsed daily with either warm green tea, hot-cold green tea or placebo. Dental plaque control record (PCR) and gingival bleeding indices (GBI) were recorded at baseline and 7, 14 and 28 days after. RESULTS: Participants' mean age was 20.7 ± 2 years. The mean scores for the PCR and GBI at baseline were 82.4 ± 19 and 85.8 ± 7, respectively. All groups showed significant reduction in PCR and GBI between Days 0 and 28 (p < 0.01). No significant differences in PCR were observed between the groups at any of the examinations (p > 0.01). The warm green tea group demonstrated significantly lower GBI at all examinations compared to the hot-cold group (p < 0.01). CONCLUSIONS: Within study limits, green tea-made mouthwashes significantly reduced plaque and gingivitis when used as adjuncts to mechanical plaque control. The green tea mouthwash prepared in warm water demonstrated significantly higher efficacy in lowering gingivitis compared to that prepared in hot water followed by ice.

Self-perceived oral health and access to care in diabetic and non-diabetic women: A qualitative study.

BACKGROUND: Access to dental care is of growing importance to individuals with chronic illnesses and policymakers alike. OBJECTIVES: To explore personal views of diabetic and non-diabetic women regarding their oral health and access to dental care. METHODS: A qualitative study was performed involving 6 diabetic and 6 non-diabetic female hospital attendees. A thematic framework approach was used to analyze the interviews. RESULTS: Responses yield three emerging central themes: oral health impact, self-maintained oral health and dental service delivery and costs. Personal views varied particularly in oral health self-perception and visiting the dentist. Certain drawbacks shadowed the quality of care in governmental and private sectors. Response variations were observed among diabetics and non-diabetics. CONCLUSION: Within the study limits, female hospital attendees had variable responses on how they looked upon their oral health. A variation in oral hygiene practices and visiting the dentist was observed. Participants believed that governmental and private clinics offered high quality care, with high treatment costs in private clinics and long waiting times in the public service being the main drawbacks. Practical Significance: Importance of supporting patients, educating practitioners and alarming policymakers about the impact of oral health problems and access to dental care.

Comparative Study of Attitudes towards Communication Skills Learning between Medical and Dental Students in Saudi Arabia.

Background: Communication skills (CS) learning is a core skill in medical and dental education. The comparison of attitudes towards CS between dental and medical students based on the taught curriculum (problem-based learning vs. traditional teaching) in Saudi Arabia awaits investigation. Aims: (1) To assess the attitudes of both undergraduate dental and medical students towards communication skills (CS) learning and (2) to compare the attitudes towards CS between Medical and Dental students in relation to sociodemographic and education-related characteristics. Methods and Materials: A cross-sectional study, using an online survey, invited 260 conveniently sampled Taibah university medical and dental undergraduate students. The survey collected data on sociodemographic characteristics, education-related factors, and CS using Communication Skills Attitude Scale (CSAS) that assess positive and negative attitudes (PAS, NAS). Data analysis included descriptive statistics and the Mann-Whitney U test. Results: Of the distributed questionnaire 91% responded (145 dental and 91 medical students). There were, overall, non-significant scores' differences between medical and dental students on PAS (Medicine Median 51 vs. Dentistry Median 50, p = 0.059) and NAS (Medicine Median 32 vs. Dentistry Median 32, p = 0.596). Older medical students, those at clinical levels and those who reported they need to improve their communication skills and student whose parents were not doctors, tended to score statistically significantly (p = 0.032, 0.017, 0.034, and 0.004, respectively) on PAS compared with dental students; on the other hand, medical students with doctor parents scored significantly high in NAS compared to dental students (p = 0.015). Conclusion: Demographic and education-related characteristics underpinned medical student positive attitude towards CS compared to dental students. Although medical and dental students showed no differences in self-rating their attitudes towards (CS). Different factors influence medical and dental students' attitudes towards CS learning.

Oral Health Profiles and Related Quality of Life in Thalassemia Children in Relation to Iron Overload: A Cross-Sectional Study.

The aim was to assess the oral health of children with ß-thalassemia major (BTM) and their oral health-related quality of life (OHRQoL) in relation to the serum ferritin level (SFL). Thirty-nine children with BTM underwent an interview, salivary sampling and an oral clinical examination. The Early Childhood Oral Health Impact Scale (ECOHIS) was used to assess their OHRQoL. The mean age of the participants was 9 ± 3 years, with 62% females. The body mass index and salivary secretion rate were within normal ranges. The mean plaque index, gingival bleeding index and number of decayed, missing and filled tooth surfaces were 70 ± 29, 38 ± 25 and 3.2 ± 4, respectively, with no significant differences between individuals with SFL below or above 2000 ng/mL (p > 0.05). No significant differences were observed between the two groups in any of the ECOHIS questions (p > 0.05). The mean ECOHIS score was 4.2 ± 4. Individuals with SFL ≥2000 ng/mL had a significantly higher mean score in the family domain "Parent Distress" than those with lower SFL (p ≤ 0.05). Within the study limits, children with ß-thalassemia major generally had high dental caries experience and gingival inflammation, yet an acceptable OHRQoL. Those with high SFL had less favorable scores in the domain "Parent Distress".

Undergraduate Dental Students' Acceptance of Treatment by Dental Student Peers: A Cross-Sectional Study.

OBJECTIVE: To enumerate students who accepted/would accept treatment by dental student peers (DSP), describe characteristics of DSP and explore factors associated with determining DSP treatment. METHODS: A 17-item online survey was distributed to students of all levels (383) at Taibah University Dental College and Hospital during the academic year 2019-2020. The survey comprised three sections: section one asked questions about the students' demographics and socioeconomics (family income), section two focused on the acceptance of treatment by DSP, characteristics of DSP, and section three asked about factors influencing acceptance of treatment by DSP. The collected data underwent descriptive, bivariate and logistic regression analyses. RESULTS: Of 383 students, 222 (58%) completed the survey; 72 (32%) were at an intern level and 150 (68%) at other levels. Those who had accepted/would accept treatment by DSP comprised 88% of respondents. Performance (85.4%) and quality of treatment (85.5%) were important characteristics of DSP. The multivariable analysis revealed that increase in score rates of confidence in DSP was significantly associated with acceptance of treatment, odds ratio (OR)=1.89, 95% CI: (1.48-2.43), p<0.001. Similarly, students who had a better understanding of patients' management were more likely to accept treatment by DSP (OR=2.70, 95% CI: 1.05-6.96, p=0.039). CONCLUSION: A high percentage of students had accepted/would accept treatment by DSP. These findings also suggest that students who have confidence in DSP and those who understand patient management would accept oral health care by DSP.

Dental Students' Perceptions before and after Attending a Centre for Children with Special Needs: A Qualitative Study on Situated Learning.

Objectives: To develop an in-depth understanding of the perceptions and experiences of senior dental students before and after fieldwork visits to a centre for children with special needs. Methods: A qualitative study utilised open-ended questions and involved 39 fifth-year dental students. A thematic analysis of the collected responses was undertaken, and a hierarchy of themes and subthemes were developed. Results: Analysis of the pre-visit responses revealed three main themes and a number of subthemes: 'negative expectations', 'positive expectations', and 'pain expectations'. Similarly, four main themes with a number of subthemes emerged from the post-visit responses: 'positive perceptions', 'negative perceptions', 'oral problems observed', and 'recommendations'. Conclusions: Within the study limits, different perspectives were extracted. Prior to the fieldwork visit, students expressed their lack of self-confidence and inadequate preparation. Following the situated learning visit experience, students' perceptions of managing special needs children was positively influenced. Students were happy to be exposed to such an experience, but hoped for better organisation and specialised supervision in the future.

Oral Disease Risk Assessment in Conjunction with Comprehensive Periodontal Care: A Case Report.

AIM: To illustrate the treatment of a complex periodontal disease patient utilizing oral disease risk assessment. BACKGROUND: Periodontal disease is multifactorial in nature and requires addressing multiple factors in order to manage it successfully. Maintenance care is crucial for a favorable outcome, and risk assessment may help formulate the most suitable treatment plan and maintenance program. CASE DESCRIPTION: A 37-year-old man presented at the clinic for comprehensive periodontal treatment prior to replacing his missing teeth. He was healthy but smoked 5-10 cigarettes per day. Based on the clinical and radiographic examinations, the patient had generalized advanced periodontitis with multiple caries lesions, defective fillings, and missing teeth. A comprehensive treatment plan was put for the patient and a detailed assessment of his periodontal disease and caries risk was performed. The patient was assigned as being of high risk for periodontal disease progression and of low-medium caries risk. Three months following execution of the proposed nonsurgical and surgical treatment procedures, the patient demonstrated notable improvement compared to the baseline and was put under a strict maintenance program every 3 months. CONCLUSION: The presented case illustrates how oral disease risk assessment measures may be incorporated within comprehensive management of a periodontitis patient. Recommending this approach remains a personal preference and is yet to be substantiated by evidence. CLINICAL SIGNIFICANCE: Incorporating risk assessment measures in daily clinical practice may prevent the onset and/or progression of future disease, reducing unnecessary effort and expenses, and should be evaluated by concerned policymakers.

Antibiotic Prescribing for Oro-Facial Infections in the Paediatric Outpatient: A Review.

There are many reports on the complications associated with antibiotics abuse during the treatment of paediatric patients, particularly those related to antimicrobial resistance. The dental profession is no exception; there is growing evidence that dental practitioners are misusing antibiotics in the treatment of their paediatric patients. This review is directed to dental practitioners who provide oral healthcare to children. It is also directed to medical practitioners, particularly those working in emergency departments and encountering children with acute orofacial infections. A systematic search of literature was conducted to explore the clinical indications and recommended antibiotic regimens for orofacial infections in paediatric outpatients. The main indications included cellulitis, aggressive periodontitis, necrotizing ulcerative gingivitis, and pericoronitis. Amoxicillin was found to be the most commonly recommended antibiotic for short durations of 3⁻5 days, with metronidazole or azithromycin being the alternative antibiotics in penicillin-sensitive patients.

Can clusters based on caries experience and medical status explain the distribution of overhanging dental restorations and recurrent caries? A cross-sectional study in Madinah - Saudi Arabia.

BACKGROUND: Overhanging dental restorations (ODRs) and secondary caries lesions (SCLs) are of high prevalence and jeopardize the fate of the restoration. OBJECTIVES: To assess the relationship between ODRs, SCLs and certain caries contributory factors. METHODS: A total of 502 radiographic records of dental patients with proximal fillings (mean age 38 ± 13 years, 50% females) were screened for ODRs and SCLs. Descriptive and inferential statistics were used. In addition, two-step cluster analysis was performed in an attempt to explain trends in ODR and SCL distribution. A p value of ≤ 0.05 was considered statistically significant. RESULTS: More than 30% of the individuals had ODRs and SCLs. No differences between genders were observed (p > 0.05). Individuals with medical conditions had more ODRs than those without (49% vs. 34%, p ≤ 0.05), while those with high caries experience had more SCLs (49%, p ≤ 0.05). The cluster analysis grouped the participants in five clusters, with the cluster involving individuals with no medical conditions and low caries experience demonstrating the lowest prevalence of ODRs and SCLs. CONCLUSIONS: Within the study limits, more than one third of the sample of dental patients had ODRs and SCLs. The medical condition was associated with ODRs, while the past caries experience was associated with SCLs.

Antibiotic Self-Medication for Oral Conditions: Characteristics and Associated Factors

Objective: To investigate the prevalence and contributing factors of antibiotic selfmedication for oral conditions in dental patients. Material and Methods: A questionnaire was distributed to 501 patients attending Taibah University Dental College and Hospital, Al Madinah, Saudi Arabia during late 2016. Questions were on socio-demographic characteristics, and pattern of antibiotic self-medication for oral disease. Statistical analysis was performed using IBM SPSS software version 21. Statistical significance level was set at p ≤.05. Results: Age range was 15-64 years (29.08±9.32 years) with 297 females (59.3%) and 204 males (40.7%). 135 patients (27%) self-medicated with antibiotics for oral disease. This practice was statistically significantly associated with the older adults (p=0.001), lack of medical or dental insurance (p=0.014 and 0.007, respectively), and poor dental attendance (p=0.021). A number of 26 (25.7%) perceived analgesics as antibiotics. Amoxicillin-clavulanic acid was the most commonly cited antibiotic by 18 patients (17.8%). Dental pain was the most frequently reported oral condition. Pharmacists were the most common source for antibiotic prescription cited by 58 (57.4%). Conclusion: Antibiotic self-medication for oral disease is associated with the use of broad-spectrum antibiotics for non-indicated clinical oral conditions. The practice was encouraged by lenient behavior of pharmacists, lack of health insurance, and poor dental attendance.

Student perception of the educational environment in regular and bridging nursing programs in Saudi Arabia using the Dundee Ready Educational Environment Measure.

BACKGROUND: Taibah University offers regular nursing (RNP) and nursing bridging (NBP) bachelor programs. We evaluated student perception of the learning environment as one means of quality assurance. OBJECTIVES: To assess nursing student perception of their educational environment, to compare the perceptions of regular and bridging students, and to compare the perceptions of students in the old and new curricula. DESIGN: Cross-sectional survey. SETTING: College of Nursing at Taibah University, Madinah, Saudi Arabia. PATIENTS AND METHODS: The Dundee Ready Educational Environment Measure (DREEM) instrument was distributed to over 714 nursing students to assess perception of the educational environment. Independent samples t test and Pearson's chi square were used to compare the programs and curricula. MAIN OUTCOME MEASURE: The DREEM inventory score. RESULTS: Of 714 students, 271 (38%) were RNP students and 443 (62%) were NBP students. The mean (standard deviation) DREEM score was 111 (25). No significant differences were observed between the programs except for the domain "academic self-perceptions" being higher in RNP students (P < .001). Higher mean DREEM scores were observed among students studying the new curriculum in the RNP (P < .001) and NBP (P > .05). CONCLUSION: Nursing students generally perceived their learning environment as more positive than negative. Regular students were more positive than bridging students. Students who experienced the new curriculum were more positive towards learning. LIMITATIONS: The cross-sectional design and unequal gender and study level distributions may limit generalizability of the results. Longitudinal, large-scale studies with more even distributions of participant characteristics are needed.

Comparing dental students' perceptions of their educational environment in Northwestern Saudi Arabia.

OBJECTIVES: To compare the perceptions of dental students over a 5-year period. METHODS: This cohort study was carried at Taibah University, College of Dentistry, Al-Madinah Al-Munawwarah, Saudi Arabia between 2009 and 2014. Data was obtained using the Dundee Ready Education Environment Measure (DREEM), which consists of 50 items, 4 of these were irrelevant to this cohort and were excluded. All students registered in 2009 were included and followed up in 2014. Their responses were compared using the paired student's t-test. RESULTS: Thirty-four students completed the questionnaire in 2009, and 30 of them participated in 2014 (12% drop out rate). The mean domain and total scores decreased over time. The mean scores for 6 items decreased significantly, while 4 of them had a significant increase. The lowest mean score in 2009 regarding support for stressed students increased (p=0.004) in 2014. However, the highest mean score in 2009 related to having a good social life, reduced (p=0.007) in 2014. This could be an indication of the high workload and its impact on their social lives. CONCLUSION: Student's perceptions were relatively low at the beginning, and remained low throughout the study. There were no significant changes in mean domain, and total scores and although scores of some items improved, most decreased over the study period.

Clinical and biological indicators of dental caries and periodontal disease in adolescents with or without obesity.

OBJECTIVE: This study aims to assess clinical, microbiological and inflammatory parameters as indicators for caries and periodontal disease in adolescents with obesity. MATERIAL AND METHODS: Twenty-seven adolescents with obesity [body mass index (BMI) 37 ± 4 kg/m(2)] and 28 controls (BMI 20 ± 2 kg/m(2)) answered questionnaires and were investigated regarding salivary parameters, plaque pH drop after a 1-min glucose rinse, oral clinical parameters, inflammatory markers in gingival crevicular fluid (GCF) and sub-gingival mirobiota. RESULTS: Compared with controls, adolescents with obesity had a lower stimulated salivary secretion rate (1.55 ± 0.63 vs. 2.05 ± 1.05 mL/min, p < 0.05), higher concentrations of secretory immunoglobulin A (sIgA) (p < 0.001), more decayed tooth surfaces (3.4 ± 6.6 vs. 0.8 ± 1.1, p < 0.05) and more gingivitis (p < 0.01) after controlling for possible confounders. Overall, similar snacking habits, plaque amounts and numbers of deep periodontal pockets were observed. Following the glucose rinse, a slightly more pronounced drop in plaque pH was observed in the obesity group (p > 0.05). No differences in sub-gingival inflammatory or microbial indicators were detected (p > 0.01). CONCLUSIONS: More caries and gingival inflammation were observed in adolescents with obesity. Of the indicators tested, salivary secretion rate was lower and sIgA levels were higher in the obesity group. We are unable to confirm whether differences in caries and gingival inflammation are due to systemic changes that are associated with obesity or due to possible irregular dietary/oral hygiene habits. CLINICAL RELEVANCE: Customised oral health preventive programmes and appropriate collaboration with medical personnel in selecting the best diet, medication and psychological support can help improve the general well-being, including oral health, of children with obesity. This may even reduce the risk of oral diseases.

Profiles of dental caries and periodontal disease in individuals with or without psoriasis.

BACKGROUND: Psoriasis is a chronic inflammatory disease that is manifested on the skin. Studies of oral health in psoriasis patients are limited. The aim of this study is to assess the experience and risk of caries and periodontal disease in individuals with and without psoriasis. METHODS: The material consisted of 89 individuals with mild-to-moderate chronic plaque psoriasis and 54 without psoriasis, recruited at the University Hospital in Gothenburg, Gothenburg, Sweden. Psoriatic arthritis (PsoA) was diagnosed in 25 of the individuals with psoriasis. All participants answered questionnaires and were subjected to saliva sampling and oral radiologic and clinical examinations. Two computer applications were used for illustration of oral disease risk profiles. RESULTS: Individuals with psoriasis had lower salivary pH, fewer remaining teeth, fewer sites with probing depth ≤4 mm, and a lower radiographic alveolar bone level than individuals without psoriasis (P <0.05). Most of the differences remained significant after controlling for confounders. Differences in alveolar bone levels were no longer significant, particularly after introducing the confounder sex into the regression model. Similar numbers of decayed and filled teeth, sites with deep pockets, sites that bled on probing, and risk profiles were observed. Individuals with PsoA exhibited a lower stimulated salivary secretion rate than those without psoriasis (P <0.05). CONCLUSIONS: There were no differences in profiles of caries and periodontal disease experience and risk between individuals with and without psoriasis. Fewer remaining teeth were observed in individuals with psoriasis. However, the exact reason for tooth loss could not be identified. Meanwhile, the reduced salivary pH in individuals with psoriasis and salivary secretion in individuals with PsoA may pose some risk for future caries.

Caries risk and periodontitis in patients with coronary artery disease.

BACKGROUND: There is considerable variation in studies on the oral health of patients with coronary artery disease (CAD). The aims of this investigation are to study the caries risk profile using the Cariogram computer program and the periodontal disease severity in patients with CAD. METHODS: A total of 127 participants (54 test and 73 control) were included. Participants were asked about their general health and daily habits. Clinical examinations, radiographs, and salivary sampling were performed. Cariologic data were entered into the computer program for risk-profile illustration. The onset of CAD conditions was also documented. RESULTS: Compared with controls, participants with CAD consumed less sugar, used fluoride toothpaste less frequently, and had significantly less favorable periodontal parameters (P <0.005). Generally, differences in cariologic parameters between the two groups were not significant. Significantly more participants with CAD exhibited low salivary-secretion rates than controls. The actual chance (percentage) of avoiding new cavities according to the Cariogram was low in the test and control groups (31% and 40%, respectively; P <0.05). Only gingival recession was correlated with the onset of CAD. CONCLUSIONS: Test and control groups had a relatively high caries risk. More severe periodontal disease was observed in participants with CAD.