Impact of Protracted War Crisis on Dental Students: A Comparative Multicountry Cross-sectional Study.

BACKGROUND: The impact of conflict and war crisis on dental students is poorly understood. Given the prolonged conflicts and political instability in the Arabic-speaking countries, it is crucial to investigate the effect of these conditions on dental students. This study aimed to assess the impact of protracted war on dental students by comparing the personal, university, and wider context challenges they face across war-affected and unaffected countries. METHODS: A cross-sectional study was conducted including a convenience sample of dental students from 13 universities in 12 Arabic-speaking countries. Respondents were those at entry and exit points of their undergraduate dental training. A self-administered paper questionnaire collected anonymized data on sociodemographics, and personal, university, and wider context challenges that students were facing. Multivariable Poisson regression analyses were carried out. RESULTS: The overall response rate was 64.8%. The mean age was 21.2 (standard deviation = 2.1) years, with 68% of participants being female. After adjusting for age and sex, dental students in Arabic-speaking countries affected by protracted war crisis were significantly more likely to report wider context challenges compared to their counterparts in unaffected countries (n = 2448; beta = 1.12; 95% confidence interval: 1.10-1.13; P < 0.001). DISCUSSION: Dental students in Arabic-speaking countries affected by protracted war crisis were more likely to suffer from wider context challenges such as difficulties in attendance due to the deterioration of security and lack of flexibility of teaching time to accommodate the different circumstances induced by the war crisis. Supporting dental students in areas affected by protracted war crises is needed and may include developing online dental education programs.

Evaluation of desensitizing efficacy of nanohydroxyapatite on the treatment of dentine hypersensitivity following ultrasonic scaling: a randomized controlled trial / Avaliação da eficácia dessensibilizante da nanoidroxiapatita no tratamento da hipersensibilidade dentinária após raspagem ultrassônica: um ensaio clínico randomizado

Objective: This randomized controlled trial aimed to compare nanohydroxyapatite with fluoride on managing post ultrasonic scaling Dentine hypersensitivity (DH). Material and Methods: Thirty patients (aged 20-50 years) with post ultrasonic-scaling DH were included in this study. The sample was randomly divided into three equal groups of 60 teeth each: the first group received nanohydroxyapatite material, the second group received fluoride material and the third group received sterile water as a placebo (controls). The materials were applied once for each patient. All patients were instructed to rate the level of pain before treatment, and after 1 hour, 24 hours, 2 weeks and 1 month on the numerical rating scale (NRS). The Kruskal-Wallis test, Mann-Whitney tests, linear regression analysis were used for the statistical analysis. Significance level was set at 0.05. Results: Both nanohydroxyapatite and fluoride were successful in reducing pain associated with DH when compared with the placebo in subsequent follow-ups (p < 0.05). However, one-hour and one-day post application, nanohydroxyapatite could reduce hypersensitivity pain moreeffectively than fluoride (p < 0.05). Conclusion: Nanohydroxyapatite material was found to besignificantly more effective in reducing the DH that followed ultrasonic scaling one-hour and one-day post application as compared to fluoride and sterile water. Both fluoride and nanohydroxyapatite had similar effect on DH after two-weeks and one-month after application. (AU)

Objetivo: Este ensaio clínico randomizado teve como objetivo comparar a nano-hidroxiapatita com o flúor no manejo da hipersensibilidade dentinária (HD) pós-raspagem ultrassônica. Material e Métodos: Trinta pacientes (com idades entre 20-50 anos) com HD pós-raspagem ultrassônica foram incluídos neste estudo. A amostra foi dividida aleatoriamente em três grupos iguais com 60 dentes cada: o primeiro grupo recebeu material de nano-hidroxiapatita, o segundo grupo recebeu material de flúor e o terceiro grupo recebeu água esterilizada como placebo (controle). Os materiais foram aplicados uma vez para cada paciente. Todos os pacientes foram instruídos a avaliar o nível de dor antes do tratamento, e após 1 hora, 24 horas, 2 semanas e 1 mês na escala de avaliação numérica (NRS). Os testes de Kruskal-Wallis, Mann-Whitney e análise de regressão linear foram usados para a análise estatística. O nível de significância foi estabelecido em 0,05. Resultados: Tanto a nano- hidroxiapatita quanto o flúor foram bem-sucedidos na redução da dor associada à HD quando comparados ao placebo em acompanhamentos subsequentes (p <0,05). No entanto, 1 hora e 1 dia após a aplicação, a nano-hidroxiapatita pode reduzir a dor de hipersensibilidade de forma mais eficaz do que o flúor (p <0,05). Conclusão: O material da nano-hidroxiapatita foi significativamente mais eficaz na redução da HD que se seguiu à raspagem ultrassônica, 1 hora e 1 dia após a aplicação, em comparação com o flúor e a água estéril. Tanto o flúor, quanto a nano-hidroxiapatita apresentou efeito semelhante na HD após 2 semanas e 1 mês após a aplicação (AU)

Cone beam computed tomography findings in the temporomandibular joints of chronic qat chewers: Radiographic bone density and trabecular microstructural analyses.

OBJECTIVES: This cross-sectional comparative study investigated the effects of qat chewing habit on the radiographic bone density (RBD) and trabecular microstructure of temporomandibular joint condyles using cone beam computed tomography (CBCT). STUDY DESIGN: In total, 85 systemically healthy Yemeni males were included and divided into qat chewers (QCs; n = 41); and non-qat chewers (NQCs; n = 44). The participants responded to a structured questionnaire and underwent standardized clinical examination and CBCT scanning of the temporomandibular joint. Measurements of RBD and trabecular microstructure (trabecular thickness, trabecular separation, bone volume fraction, and fractal dimension) were performed. Statistical significance was established at P ≤ .05. RESULTS: No statistically significant differences were found between QCs and NQCs in RBD or trabecular microstructure. The mean standard deviations and maximum values of trabecular separation on the nonchewing side for QCs were significantly lower compared to the corresponding values for NQCs (0.60 and 2.68 for QCs vs 0.72 and 3.05 for NQCs; P = .025 and .05, respectively). A comparison between chewing and nonchewing sides in QCs revealed no significant differences. CONCLUSIONS: Qat chewing habit induces insignificant changes in condylar RBD and trabecular microstructure as detected by CBCT. Further studies using advanced radiographic techniques are warranted.

Cone beam computed tomography findings in temporomandibular joint of chronic qat chewers: Dimensional and osteoarthritic changes.

The social habit of chewing qat (also known as khat) is widely practised in East Africa and the Arabian Peninsula. It has been linked with various oro-facial conditions, including temporomandibular joint disorders (TMD). This cross-sectional, comparative study sought to investigate the effects of qat chewing on temporomandibular joint (TMJ), using cone beam computed tomography (CBCT). A total of 85 Yemeni males were included. The participants were divided into two groups: Qat chewers (QC; n = 41) and non-qat chewers (NQC; n = 44). Relevant data were obtained using a structured questionnaire and standardised clinical examination. Additionally, CBCT images of the TMJs were obtained, and then, osteoarthritic changes and TMJ dimensions were analysed. SPSS 21 was used for statistical analyses, with a significant level was set at 0.05. Compared to NQC, a significantly higher proportion of QC presented with clinical signs of TMDs. The qualitative CBCT findings revealed significantly higher osteoarthritic changes in QC than in NQC: osteophyte (51.2% vs 22.7%; P = .008), subcortical sclerosis (48.8% vs 27.3%; P = .047), articular surface flattening (46.3% vs 6.8%; P = .009) and subcortical cysts (43.9% vs 4.5%; P < .001). However, CBCT quantitative findings (condylar dimensions) did not show significant differences between the two groups. The chewing side of the QC group showed slightly more changes compared to the non-chewing side. The results demonstrate that qat chewing has detrimental effects on TMJ manifested mainly as osteoarthritic changes. Further large-scale studies are recommended.

Effect of bisphosphonate treatment on the jawbone: an exploratory study using periapical and panoramic radiographic evaluation.

OBJECTIVE: This cross-sectional study aimed to explore potential jawbone changes secondary to bisphosphonate (BP) treatment of osteoporosis using digital panoramic and periapical radiography. METHODS: Thirty-nine women, previously examined with dual-energy X-ray absorptiometry, were radiographed by digital panoramic and/or periapical radiography. On periapical radiographs, trabecular bone structure and fractal dimension analyses of the mandibular first molar and edentulous regions were performed. On panoramic radiographs, the mandibular cortical width (MCW) was calculated, and trabecular bone structure and fractal dimension analyses of the trabecular bone in the alveolar and basal bones were performed. The results were compared between patients treated or not treated with BP using linear regression analysis to adjust for potential confounding factors. RESULTS: The analyses of periapical and panoramic radiological images showed no statistical differences in the jawbones between groups after bisphosphonate use for mean intervals of 4.3 and 5 years; respectively. Although the mandibular cortical width on panoramic radiography was correlated with BP use, it was not noted to be statistically significant. CONCLUSIONS: The trabecular parts of the alveolar and basal bones and the MCW were not significantly altered by BP treatment in patients with osteoporosis over 4.3-5 years, as detected by digital periapical and panoramic radiography. The low dosages of bisphosphonates used in the treatment of osteoporosis may explain this lack of change in MCW. Dental radiographs should not be considered as a method to monitor BP-induced jaw bone alterations among osteoporotic patients.

Detecting the effect of bisphosphonates during osteoporosis treatment on jawbones using multidetector computed tomography: The OSTEOSYR project.

AIM: The aim of the present cross-sectional study was to investigate the effects of bisphosphonates (BP), prescribed for osteoporosis, on jawbones using multidetector computed tomography (MDCT). METHODS: Fifty-three women who had dual-energy X-ray absorptiometry examination were scanned by MDCT. Both the cortical and the trabecular parts of the alveolar and the cortical bones were compared between BP users and non-BP users using a number of radiological measurements. Linear regression was used for the statistical analysis. RESULTS: The cortical part of the basal bone of the mandible revealed a significant increase in the BP group (.001 > P-value ≤ .026) after using BP for 5 years. No alternations were observed in the trabecular part of the basal bone or in the cortical or trabecular parts of the alveolar bone over the same duration. CONCLUSIONS: The use of BP as a treatment for osteoporosis for 5 years increased the thickness of the cortex of the basal bone of the mandible, as detected by MDCT. The other parts of the jawbones showed no influence by BP for such a purpose, as detected on MDCT images. Accordingly, models (equations) for predicting the alternations in the inferior cortex of the mandible induced by BP therapy during osteoporosis have been suggested.

Evaluation of different low-dose multidetector CT and cone beam CT protocols in maxillary sinus imaging: part I-an in vitro study.

OBJECTIVES: This in vitro study aimed to assess radiation dose and image quality of different low-dose multidetector CT (MDCT) and CBCT imaging protocols in comparison with the standard MDCT protocol for maxillary sinus imaging. METHODS: Effective dose (E) and image quality of 10 MDCT (changing effective milliampere second starting from 141.3 EmAs to 20 EmAs) and 3 CBCT protocols (changing milliampere second and voxel size) were assessed throughout scanning an anthropomorphic head and neck Alderson Rando phantom. E values were calculated using thermoluminescent dosemeters (TLDs) fixed at 6 sensitive organs (14 sites) on the Rando phantom. Image quality was assessed objectively (by calculating the standard deviation values of the radiographic density of water) and subjectively (by assessing the diagnostic image quality using a four-graded scale: 1 = very good, 2 = good, 3 = acceptable and 4 = unacceptable). RESULTS: Two MDCT protocols (120 kV/32 EmA and 120 kV/25 EmA) had lower radiation doses with statistically significant differences (p < 0.001) compared with that of the standard MDCT protocol (120 kV/141.3 EmA), and they preserved a good diagnostic image quality. One CBCT protocol (120 kV/20 mA) had a reasonable radiation dose and good image quality. There were no statistically significant differences between the above-mentioned lower dose MDCT and CBCT protocols (p > 0.05) with respect to the radiation dose and image quality. CONCLUSIONS: The low-dose MDCT and CBCT protocols are viable methods for maxillary sinus examination as evaluated using the above-mentioned phantom that yield a good diagnostic image quality using E approximately 7 and 11 times lower than that of the standard MDCT, respectively. These findings were evaluated in the in vivo part of this project.

IDIOS: An innovative index for evaluating dental imaging-based osteoporosis screening indices.

PURPOSE: The goal of this study was to develop a new index as an objective reference for evaluating current and newly developed indices used for osteoporosis screening based on dental images. Its name; IDIOS, stands for Index of Dental-imaging Indices of Osteoporosis Screening. MATERIALS AND METHODS: A comprehensive PubMed search was conducted to retrieve studies on dental imaging-based indices for osteoporosis screening. The results of the eligible studies, along with other relevant criteria, were used to develop IDIOS, which has scores ranging from 0 (0%) to 15 (100%). The indices presented in the studies we included were then evaluated using IDIOS. RESULTS: The 104 studies that were included utilized 24, 4, and 9 indices derived from panoramic, periapical, and computed tomographic/cone-beam computed tomographic techniques, respectively. The IDIOS scores for these indices ranged from 0 (0%) to 11.75 (78.32%). CONCLUSION: IDIOS is a valuable reference index that facilitates the evaluation of other dental imaging-based osteoporosis screening indices. Furthermore, IDIOS can be utilized to evaluate the accuracy of newly developed indices.

Assessment of jawbone trabecular bone structure amongst osteoporotic women by cone-beam computed tomography: the OSTEOSYR project.

OBJECTIVE: To assess the trabecular bone structure of jawbones and the dens (the odontoid process of the second cervical vertebra) amongst osteoporotic and nonosteoporotic women using cone-beam computed tomography (CBCT). Analysis of the dens trabecular bone structure aimed to test the validity of CBCT in such analysis. METHODS: Thirty-eight women who went under dual-energy X-ray absorptiometry (DXA) examination were scanned by CBCT. Cuboids from different areas of jawbones and the dens were extracted from each scan. Trabecular thickness (Tb.Th), trabecular separation (Tb.S), bone volume fraction (BV/TV), specific bone surface (BS/TV) and connectivity density were calculated. Student's t-test, Pearson correlation, and logistic regression analysis were used to explore differences in these measures between groups. RESULTS: Jawbone-derived measures showed insignificant differences (P > 0.05) between osteoporotic and non-osteoporotic groups, and weak correlations with femoral neck and lumbar vertebrae T-scores (r ≤ 0.4). Dens-derived measures, however, resulted in the opposite (r = 0.34-0.38 [P value = 0.02-0.036] and r = 0.48-0.61 [P value ≤ 0.003]) and the highest accuracy of osteoporosis prediction: 84.2% and 78.9% respectively. CONCLUSION: Trabecular bone structure of the mandible and maxilla is not affected in osteoporosis as assessed by CBCT. Dens trabecular bone analysis revealed the opposite, so some trabecular bone measures may be assessed by CBCT, which may aid in predicting osteoporosis.

An innovative approach in osteoporosis opportunistic screening by the dental practitioner: the use of cervical vertebrae and cone beam computed tomography with its viewer program.

OBJECTIVES: To investigate the use of cone beam computed tomography (CBCT) for predicting osteoporosis based on the cervical vertebrae CBCT-derived radiographic density (RD) using the CBCT-viewer program. STUDY DESIGN: CBCT scans (WhiteFox, de Gotzen S.r.l device, distributed by Satelec-Acteon Group, Italy) and dual-energy X-ray absorptiometry examinations of 38 women who participated in an earlier investigation were examined. A coronal slice, subjectively determined from the cervical vertebrae, was selected and the RD as gray values for the first and second vertebrae, and the dens was calculated by using CBCT-viewer software (WhiteFox imaging). RESULTS: The CBCT-derived RD values of the dens and the left part of the first cervical vertebra showed the strongest correlation coefficients (r=0.7, 0.6; P<.001) and the highest sensitivity (76.9%, 70%), specificity (92%, 92.9%), and accuracy (90.8%, 86.4%) in predicting osteoporosis in the lumbar vertebrae and the femoral neck, respectively. CONCLUSIONS: CBCT-derived RD of cervical vertebrae can predict osteoporosis status using a CBCT-viewer program. This finding should be confirmed on other CBCT devices.

Radiation-induced thumbs carcinoma due to practicing dental X-ray.

Dealing with diagnostic X-ray radiation may result in serious health problems, unless protection guidelines are followed. This became prevalent immediately a decade following the invention of X-ray radiation, where it had not been known that the accumulative exposure to X-ray radiation may carry huge health hazards. The reoccurrence of various fatal cancer cases compelled the concerned health authorities to develop safety standards to be followed by all X-ray clinics and technicians worldwide. This report documents the clinical case of a dental radiographer, who developed thumbs carcinoma after 15 years of practicing the profession, most likely due to his neglect of the X-ray radiation protection guidelines.

Facebook as a learning environment for teaching medical emergencies in dental practice.

BACKGROUND: Social media can be part of the formal education of health professsionals and in their lifelong learning activities. The effectiveness of Facebook, an online social medium, application for educational purposes was evaluated in this study. It was used to serve as a teaching medium of a course in medical emergencies in dental practice (MEDP). METHODS: Syrian dental students were invited to join a Facebook group "Medical emergencies in dental practice" during the second semester of the academic year 2013-2014. The group privacy settings were changed from an open group to a closed group after the registration period. Administrators of the group published 61 posts during the course period, which extended for one month. Students' progress in learning was evaluated using self-assessment questionnaires administered to the students before and after the course. These questionnaires also queried their opinions regarding the use of Facebook as an educational modality. Qualitative statistics, Wilcoxon signed ranks and Mann-Whitney U-tests were used to analyze the data. RESULTS: Out of 388 students registered in this course, 184 completed it. Two-third of students agreed that Facebook was useful in education. Their impressions of this course were 17.4% as excellent, 52.2% as very good. P values of the self-assessment questions of Wilcoxon signed ranks test were <0.001, indicating self-assessed improvement in MEDP skills. DISCUSSION: Facebook as a social medium provides a unique learning environment. It allows students to discuss topics more openly in a flexible setting with less rigid time and place constraints. In the light of this study it was found that Facebook may be useful in teaching medical emergencies in dental practice in its theoretical aspect.

Osteoporosis prediction from the mandible using cone-beam computed tomography.

PURPOSE: This study aimed to evaluate the use of dental cone-beam computed tomography (CBCT) in the diagnosis of osteoporosis among menopausal and postmenopausal women by using only a CBCT viewer program. MATERIALS AND METHODS: Thirty-eight menopausal and postmenopausal women who underwent dual-energy X-ray absorptiometry (DXA) examination for hip and lumbar vertebrae were scanned using CBCT (field of view: 13 cm×15 cm; voxel size: 0.25 mm). Slices from the body of the mandible as well as the ramus were selected and some CBCT-derived variables, such as radiographic density (RD) as gray values, were calculated as gray values. Pearson's correlation, one-way analysis of variance (ANOVA), and accuracy (sensitivity and specificity) evaluation based on linear and logistic regression were performed to choose the variable that best correlated with the lumbar and femoral neck T-scores. RESULTS: RD of the whole bone area of the mandible was the variable that best correlated with and predicted both the femoral neck and the lumbar vertebrae T-scores; further, Pearson's correlation coefficients were 0.5/0.6 (p value=0.037/0.009). The sensitivity, specificity, and accuracy based on the logistic regression were 50%, 88.9%, and 78.4%, respectively, for the femoral neck, and 46.2%, 91.3%, and 75%, respectively, for the lumbar vertebrae. CONCLUSION: Lumbar vertebrae and femoral neck osteoporosis can be predicted with high accuracy from the RD value of the body of the mandible by using a CBCT viewer program.

Pulpotomy of symptomatic permanent teeth with carious exposure using mineral trioxide aggregate.

INTRODUCTION: To evaluate the clinical and radiographic outcomes of pulpotomy treatment with mineral trioxide aggregate (MTA) in symptomatic mature permanent teeth with carious exposure. MATERIALS AND METHODS: Ten patients aged 27-54 years presented with 11 symptomatic permanent teeth (n=11). Each offending carious tooth was clinically and radiographically determined. We removed caries as conservatively as possible; however pulp exposure was inevitable. ProRoot MTA pulpotomy was performed on these teeth. The patients were followed-up clinically and radiographically for 24-42 months. RESULTS: Immediate relief of patients` symptoms occurred. Moreover, teeth responses to the electric pulp tester were within normal range on follow-up appointment and the radiographs did not reveal any abnormality/lesion in the periapical areas. CONCLUSION: Pulpotomy using MTA could be a good alternative for root canal therapy (RCT) for managing symptomatic mature permanent teeth with carious exposure, however further large-scale multicenter clinical trials are highly encouraged to confirm this hypothesis.