Evaluation of the effects of chronic qat chewing on lateral pterygoid muscle using MRI.

Objective: This study explored the effect of qat chewing (QC) on the lateral pterygoid muscle (LPM), using magnetic resonance imaging (MRI).Methods: Forty qat chewers (QG), divided into three subgroups, according to duration of QC, and 20 non-qat chewers (NQG) were included. MRI sections were obtained to assess hypertrophy and atrophy of the superior belly (SB) and inferior belly (IB) of the LPM on the chewing and contralateral non-chewing side.Results: There was a significantly higher prevalence of atrophy of the IB (p < 0.001) and hypertrophy of the SB and IB (p = 0.002) in the QG. Hypertrophy of SB and IB was marked (p = 0.001) on the chewing side. Conversely, SB atrophy was marked on the non-chewing side (p = 0.003). MRI demonstrated a positive correlation between LPM alterations and the duration of QC in subgroup analysis.Conclusion: Unilateral QC might be a cause of LPM alterations.

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.

WhatsApp-assisted Oral Health Education and Motivation: A Preliminary Randomized Clinical Trial.

AIM: The study aimed to assess the efficacy of using WhatsApp instant messages in enhancing the oral hygiene in patients with gingivitis. MATERIALS AND METHODS: Forty-three systemically healthy male dental patients with gingivitis were recruited consecutively and randomly divided into two groups: WhatsApp group (n = 24) and a control group (n = 19). At baseline visit, the participants were educated and motivated about oral health and given a folio on instructions about the oral hygiene preventive measures. The participants in the study group further received WhatsApp messages about the dental care at weekly intervals throughout the study (3 months). Plaque index (PI) and gingival index (GI) were measured at baseline and after 1 and 3 months. RESULTS: The averages of PI and GI were not significantly different between both groups at any time point of measurement (baseline, after one, and three months; p value >0.05). Intragroup comparisons revealed that the reductions in PI were highly significant after 1 and 3 months (-0.26 ± 0.26 and -0.57 ± 0.35, respectively, for WhatsApp group, and -0.24 ± 0.27 and -0.64 ± 0.4. respectively, for the control group; p value range: 0.001 to <0.001). Similar were the reductions in GI in each individual group (-0.17 ± 0.46 and -0.67 ± 0.05, respectively, for WhatsApp group, and -0.28 ± 0.29 and -0.69 ± 0.41, respectively, for the control group: p value < 0.001). CONCLUSION: Implementing WhatsApp instant messages does not appear to add extrabenefit to the traditional motivation and education on oral hygiene practices in terms of changes in PI and GI over time in patients with gingivitis. CLINICAL SIGNIFICANCE: Although the results were not motivating, this does not preclude the dental professionals from using WhatsApp and the similar technology to deliver oral healthcare advices.

An MRI evaluation of the effects of qat chewing habit on the temporomandibular joint.

OBJECTIVE: The aim of this study was to investigate the effects of the qat chewing habit on the temporomandibular joint by using magnetic resonance imaging. STUDY DESIGN: Sixty patients were included: a study group (40 qat chewers) and a control group (20 nonchewers). On the basis of qat chewing habit duration, the study group was subdivided into 3 further subgroups: subgroup I (5-10 years), subgroup II (11-15 years), and subgroup III (>15 years). Data on qat chewing habit were recorded, and a standardized clinical examination was performed. Bilateral oblique sagittal magnetic resonance imaging sections were obtained to evaluate disk displacement, osteoarthritis, and joint effusion. RESULTS: Clicking and pain were diagnosed in 72.5% and 65% of study group patients, respectively. Significant differences were discovered between the study group and the control group in osteoarthritis and joint effusion (P= .003 and .002, respectively). With regard to qat chewing habit duration, there were differences between study subgroup II and subgroup III versus control group in osteoarthritis (P= .040 and .001, respectively) and the 3 study subgroups versus control group in joint effusion (P= .026, .004, and .001, respectively). Significant correlations were found between osteoarthritis and clicking (P= .006) and muscle pain (P ≤ .044), and between joint effusion and temporomandibular joint pain (P = .006) and muscle pain (P ≤ .014). CONCLUSIONS: Qat chewing habit may be a risk factor for temporomandibular joint disorders with high percentages of osteoarthritis and joint effusion.

Salivary parameters among Arabian snuff (Shammah) users.

OBJECTIVES: To evaluate the salivary flow rate (SFR),  pH, and buffer capacity (BC) among healthy shammah users (SU) in comparison with healthy non-shammah users (NSU). Methods: This case-control study was conducted at the College of Dentistry, Jazan University, Jazan, Kingdom of Saudi Arabia between March 2016 and May 2017. A sample of 27 SU and 30 NSU were recruited. Unstimulated saliva was collected and SFR, pH, and BC were determined. Dental health was assessed using the decay-missing-filled teeth (DMFT) index.  Results: Shammah users were slightly older than NSU (28.9±6.9 versus 24.9±4.3 years). Salivary flow rate  was not significantly different, but pH (6.68±0.46) and BC (5.7±2.07) were significantly lower in SU users than in NSU (7±0.37; p=0.002 versus 8.1±1.47; p less than 0.001). Conversely, the DMFT in SU users was significantly higher (7.96±5.17) compared to that of NSU (4.53±3.46; p=0.007). Salivary pH and BC were significantly and directly correlated (rs= 0.576). The former was significantly and directly correlated with SFR (rs= 0.404), but the latter was not. In contrast, BC inversely correlated with decay (rs= -0.385) and DMFT (rs= -0.399). Conclusions: Shammah use is associated with alterations in saliva quality (pH and BC). It is also associated with poor dental health either through a direct effect or mediation by altered salivary parameters.

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.

Self-Reported Oral Health Attitudes and Behavior of Dental and Medical students, Yemen.

OBJECTIVES: To assess self-reported oral health attitudes and behavior among undergraduate dental and medical students, and to analyze the variations in oral health attitudes based on gender, level of education, study discipline, academic average, and type of university. METHODS: A self-administered questionnaire based on the Hiroshima University-Dental Behavioural Inventory (HU-DBI) was distributed to 1269 undergraduate dental and medical students at two universities (one public and one private) in Sana'a, Yemen. RESULTS: Overall, the mean questionnaire score for the total sample was markedly low (4.91±1.58), with no significant difference between dental and medical students (P>0.05). Females had better oral health attitudes and behavior, especially towards visiting the dentist, tooth-brushing habits and oral hygiene practices (P<0.05). Students attending the public university had better oral health attitudes and behaviors than those attending the private university (P=0.049). On the other hand, no significant associations were observed between students' oral health attitudes/behavior and level of education and academic performance (P>0.05). CONCLUSION: Yemeni dental and medical students have shown markedly poor oral health attitude and behavior. Further studies are required to reveal possible shortcoming in these schools' education process. Dental and medical curricula should emphasize the importance of proper oral hygiene, and further participation of medical and dental students in oral hygiene seminars is highly encouraged.

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.

Oral lesions and dental status among institutionalized orphans in Yemen: A matched case-control study.

OBJECTIVES: The aim of this study was to assess the prevalence of oral mucosal lesions (OMLs) and dental caries and to evaluate oral health practices among institutionalized orphan-children in Sana'a city, Yemen. SUBJECTS AND METHODS: A sample of 202 institutionalized male-orphan-children in the main orphanage in Sana'a city, were matched to 202 non-orphan schoolchildren. Clinical examination included assessment of OMLs based on standard international diagnostic criteria and evaluation of dental status using the Decayed/decayed, Missed/missed and Filled/filled (DMFT/dmft) index according to World Health Organization recommendations. Demographic data and oral hygiene practices were obtained by interviewing each subject using special questionnaire form. RESULTS: Majority of children were in the 12-15 year age group. Nine types of lesions were reported among orphans; the most common lesions were fissured tongue (24.3%), herpes labialis (7.9%) and traumatic ulcers (2.5%). The occurrence of herpes labialis was found to be significantly higher in orphans than in controls (P < 0.01). The prevalence of dental caries was insignificantly lower among the orphans (84.7%) compared with the non-orphans (89.61%; P = 0.136). The mean dmft score was significantly lower in orphans than in controls (2.28 vs. 3.82; P = 0.001). CONCLUSIONS: The institutionalized children in this orphanage had a high prevalence of OMLs but low prevalence of dental caries, though they revealed poor oral hygiene practices. Effective oral health promotion strategies need to be implemented to improve the oral health and oral health practices of children living in orphanages.

Oral lesions and dental status of autistic children in Yemen: A case-control study.

PURPOSE: This study aimed to assess the prevalence of oral lesions among children with autism in Sana'a City, Yemen, and to evaluate their dental status. PATIENTS AND METHODS: This case-control study included 42 children with autism, aged between 5 and 16 years, and 84 age- and gender-matched healthy children as controls. Oral lesions were assessed based on standardized criteria according to the World Health Organization (WHO) recommendations. Dental caries, gingival health, and oral hygiene status were assessed using dmft/DMFT index, Gingival Index (GI), and Plaque Index (PI), respectively. Chi-square test and Mann-Whitney's test were used to compare the groups. RESULTS: Compared to controls, children with autism revealed higher proportion of fistulae (9.5% vs. 2.4%), ulcerative lesions (7.1% vs. 1.2%), gingival hyperplasia (4.8% vs. 0.0%), and cheilitis (4.8% vs. 2.4%); however, the differences were not statistically significant. The mean dmft score was significantly higher in children with autism than in controls (5.23 vs. 4.06; P < 0.001). Moreover, children with autism revealed poorer oral hygiene than controls, and the majority had gingivitis. CONCLUSIONS: Children with autism in Yemen have high prevalence of oral soft tissue lesions, caries, and gingivitis. Therefore, proper oral health education programs should be initiated and directed toward this special section of the society.

Characterization of Yemeni patients treated for oral and pharyngeal cancers in Saudi Arabia.

OBJECTIVE: To determine the relative frequency and rank of oral cancer (OC) and pharyngeal cancer (PC) among Yemeni cancer patients who were treated and registered in the Kingdom of Saudi Arabia (KSA) over 14 years, and to characterize these patients by different grouping factors. METHODS: In this retrospective study, the Saudi Cancer Registry, Riyadh, KSA officially provided the data regarding all Yemeni patients registered between 1994 and 2007. These data were reclassified and analyzed to present the cancer distribution by the main sites adopted by Globocan 2008. The OC and PC patients were statistically described and analyzed according to the demographic data and tumor details. This study was conducted at the Oral Medicine, Medically Compromised and Research Clinic, Department of Dentistry, Riyadh Military Hospital, Saudi Arabia between January and April 2011. RESULTS: There were 5862 Yemenis registered with malignancies. The OC ranked the eighth most common malignancy (215, 3.7%) with 1.65:1 male to female ratio, whereas PC ranked the seventh (245, 4.2%) with 2.06:1 male to female ratio. The most affected oral sub-site was the tongue (91, 42.3%) while the nasopharynx accounted for 79% (194) of PC. The PC patients were significantly younger than those with OC (45.88+/-16.72 versus 55.6+/-15.75). The squamous cell carcinoma was the most frequent morphological type (289, 63.5%) but significantly more frequent in OC. Approximately 56% (255 patients) were diagnosed at advanced stage, however, significantly more frequent in PC (155, 64.6%). CONCLUSION: The relative frequencies of oral and pharyngeal cancers in Yemen are quite high. The demographic and tumor characteristics of these cancers are obviously different.