Prevalence, severity and explanatory factors of tooth wear in Arab populations.

OBJECTIVES: The aim of this study was to assess the prevalence and severity of tooth wear and related risk indicators in six Arab countries. METHODS: This multicenter, multinational cross-sectional study was conducted among 2924 participants between the ages of 18-35 years old from six Arab countries. Calibrated dentists assessed tooth wear using the Basic Erosive Wear Examination Index (BEWE). Participants were also asked to complete a questionnaire that assessed their dietary and oral health habits. Each participant was identified by the sextant with the highest BEWE score in the upper and lower jaws. RESULTS: Odds ratios were estimated for correlates of tooth wear anterior and posterior regions. Oman had the highest prevalence of BEWE score 3 (N = 255 (60.2%)). Overall, the highest BEWE score 3 was observed on the incisal edge of the upper anterior teeth (N = 602 (20.6%)) and in the lower left posterior region (sextant 6) on the occlusal surface (N = 466 (15.9%)). Correlates of severe tooth wear in both regions were eating or drinking more than six times per day, age and education. Drinking soft drinks "once a day" was significantly associated with severe tooth wear in the posterior region (OR: 1.3, 95% CI:1.05, 1.6). Brushing teeth more than twice a day was inversely associated with tooth wear in the anterior region (OR:0.75, 95% CI: 0.57,0.97). CONCLUSION: The prevalence of tooth wear in Arab populations is relatively high, specific preventive and therapeutic measures should be developed to target people at higher risk of this condition. CLINICAL SIGNIFICANCE: Tooth wear is now regarded as a significant oral health problems, dentists should advise their patients about dietary and oral health habits that can lead to severe tooth wear.

The Effect of Combining Radiographs and DIAGNOdent With Visual Examination on Detection and Treatment Decisions of Noncavitated Occluso-dentinal Caries.

The aim of this laboratory study was to evaluate the effectiveness of incorporating radiographic examination and DIAGNOdent with visual examination for the detection and treatment of noncavitated occluso-dentinal caries. Four examiners examined the occlusal surfaces of 160 extracted posterior teeth. Teeth were examined three times with a one-month interval in between. The first examination was visual (V), the second examination was visual with radiograph (VR), and the third examination was visual with radiograph and DIAGNOdent (VRD). Examiners were asked to detect the presence of caries (if any) and identify the extent of caries (if present; ie, enamel or dentin). The examiners were also asked to choose a treatment for each tooth. The examined teeth were later sectioned, and the presence of caries was charted as 0 = no caries, 1 = caries confined to enamel, 2 = caries in the outer dentin, and 3 = caries in the inner dentin. Sensitivity, specificity, area under the curve (Az values), rank correlation coefficient, interexaminer reproducibility, and McNemar χ(2) tests were calculated. VR had statistically higher specificity and lower sensitivity than V and VRD. The means of Az values ranged from 0.58 to 0.63, with no statistical difference between the three examinations (p>0.05). The means of the rank correlation coefficients with histology for detection of dentinal caries were 0.48, 0.23, and 0.44 using V, VR, and VRD, respectively. Interexaminer reproducibility was best for V alone. The percentages of teeth indicated for restorative treatment were 31%, 33%, and 41% using V, VR, and VRD, respectively. The percentages of teeth correctly treated according to histology were 69.4%, 70.0%, and 67.5% using V, VR, and VRD, respectively. There was no difference in the accuracy of treatment decisions between the three examination points (p>0.05). The addition of radiographs and DIAGNOdent to visual examination did not have a significant effect on the improvement of the detection or treatment decisions of examiners of noncavitated occluso-dentinal carious lesions.

Relative contribution of restorative treatment to tooth extraction in a teaching institution.

Teeth can be extracted due to multiple factors. The aim of this retrospective cross-sectional study was to identify the relative contribution of restorative treatments to tooth loss. The study reviewed records of 826 patients (1102 teeth). Patient's gender, age and education were obtained. In addition to the main reason for extraction (caries, periodontal disease, pre-prosthetic extraction, restorative failure and remaining root), the following information was collected about each extracted tooth: type, the status of caries if any (primary or secondary) and pulpal status (normal or reversible pulpitis, irreversible pulpitis, necrotic or root canal treated) and type and size of restoration, if present. Following data collection, descriptive analysis was performed. A log-linear model was used to examine the association between restorative treatment and tooth loss and between reasons for tooth loss and type of tooth. Lower molars followed by upper molars were the most commonly extracted teeth. Teeth with no restorations or with crowns were less likely to be extracted (P < 0·001). Lower and upper molars and lower premolars were more likely to be extracted due to restorative failure, while lower anterior teeth were more likely to be extracted due to periodontal disease (P < 0·05). Twenty two per cent of the extractions was due to restorative failure, and at least 65·9% of these teeth had secondary caries. Gender, age and educational level were factors that affect tooth loss. In conclusion, teeth receiving multiple restorative therapies were more likely to be extracted.

Free flaps for the treatment of avulsion injuries in the feet.

Forty children treated with free-tissue transfer for soft-tissue coverage of the dorsum of the foot were studied during a follow-up period that ranged from 3 months to 5 years after surgery. Avulsion injuries to the foot were commonly caused by being struck by a vehicle. In 37 of the 40 cases, radical debridement of all devitalized tissue, reconstruction of avulsed tendons and ligaments, and bone fixation were followed by free-flap cover as a one-stage procedure, and, in three cases, as a secondary procedure. Various flaps were used, and although no definite conclusions can be drawn as to which flap performed best, the newer, thinner type of fasciocutaneous flaps yielded promising results.