Dental caries and developmental defects of enamel in cerebral palsy: A meta-analysis

OBJECTIVE

This systematic review and meta-analysis aimed to compare the occurrence of dental caries and developmental defects of enamel (DDE) in individuals with and without cerebral palsy (CP).

MATERIALS AND METHODS

We conducted searches across five databases and the grey literature. Data were organized using EndNote 20. Reporting followed the MOOSE checklist. A random-effects model meta-analyses were conducted using RStudio, presenting results as mean difference (MD), odds ratio (OR), and 95% confidence interval (CI). The risk of bias of studies was analyzed using the Newcastle-Ottawa Scale, and the certainty of evidence was assessed using GRADE.

RESULTS

Among 1336 identified records, 25 studies involving 59,997 participants (mean age: 11.1 years) were included. Data of 12 were pooled into meta-analyses. No significant differences were found between CP and non-CP individuals across indices: DMFT (k = 7) (MD = 0.31; 95% CI [-0.42-1.05]), dmft (k = 4) (MD = 0.31; 95% CI [-0.50-1.14]), DMFS (k = 2) (MD = -0.61; 95% CI [-20.56-19.33]), dmfs (k = 3) (MD = 0.54; 95% CI [-1.09-2.17]), and DDE (k = 3) (OR = 0.80, 95% CI [0.09-7.31]). The certainty of evidence was very low.

CONCLUSION

Individuals with CP do not appear to differ significantly from those without CP in terms of dental caries experience and DDE.

Behaviour support in dentistry: A Delphi study to agree terminology in behaviour management

OBJECTIVES

Dental behaviour support (DBS) describes all specific techniques practiced to support patients in their experience of professional oral healthcare. DBS is roughly synonymous with behaviour management, which is an outdated concept. There is no agreed terminology to specify the techniques used to support patients who receive dental care. This lack of specificity may lead to imprecision in describing, understanding, teaching, evaluating and implementing behaviour support techniques in dentistry. Therefore, this e-Delphi study aimed to develop a list of agreed labels and descriptions of DBS techniques used in dentistry and sort them according to underlying principles of behaviour.

METHODS

Following a registered protocol, a modified e-Delphi study was applied over two rounds with a final consensus meeting. The threshold of consensus was set a priori at 75%. Agreed techniques were then categorized by four coders, according to behavioural learning theory, to sort techniques according to their mechanism of action.

RESULTS

The panel (n = 35) agreed on 42 DBS techniques from a total of 63 candidate labels and descriptions. Complete agreement was achieved regarding all labels and descriptions, while agreement was not achieved regarding distinctiveness for 17 techniques. In exploring underlying principles of learning, it became clear that multiple and differing principles may apply depending on the specific context and procedure in which the technique may be applied.

DISCUSSION

Experts agreed on what each DBS technique is, what label to use, and their description, but were less likely to agree on what distinguishes one technique from another. All techniques were describable but not comprehensively categorizable according to principles of learning. While objective consistency was not attained, greater clarity and consistency now exists. The resulting list of agreed terminology marks a significant foundation for future efforts towards understanding DBS techniques in research, education and clinical care.

Intersection of the iADH undergraduate curriculum in special care dentistry and the association of Canadian faculties of dentistry competencies framework

AIMS

To map the International Association of Disability and Oral Health (iADH) curriculum to the Association of Canadian Faculties of Dentistry (ACFD) competencies framework to develop a strategy for teaching special care dentistry (SCD) using the International Classification of Functioning, Disability, and Health (ICF). To review the literature to identify educational methodologies that support teaching SCD competencies.

METHODS

The 20 subdomains of the ACFD competencies framework were mapped to the 18 subdomains of the iADH competency matrix. A literature review of methods, techniques, or innovations used to teach SCD was conducted using the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) guidelines and the Sample, Phenomenon of Interest, Design, Evaluation, and Research Type (SPIDER) tool.

RESULTS

The iADH curriculum was mapped to the ACFD competencies in the areas of patient care, professionalism, communication and collaboration, practice information management, and health promotion. A total of 176 articles from PubMed and 10 resources from MedEdPortal were identified in the literature search. Eleven articles met the inclusion and exclusion criteria. The overall quantity and quality of studies was low. Experiential learning in either a dental school or hospital-based program seemed to improve knowledge of SCD and to incite greater willingness to treat patients requiring SCD.

CONCLUSIONS

Case-based learning, computer-based modules, standardized patients, and clinical practice are educational strategies for teaching SCD competencies. The integration of SCD into the undergraduate dental curriculum seems feasible, as most required competencies are transferable to all dental disciplines. Furthermore, the ICF provides a functional model that is a patient-centered approach and is applicable to dentistry beyond SCD.

The Impact of COVID-19 on Parental Perception of Oral Health-Related Quality of Life of Children: A Comparison of a Sample from Saudi Arabia and Kuwait

Materials and Methods

OHRQoL was measured using a a validated Arabic version of the Child Oral Health Impact Profile (COHIP). Parents of children aged between 5 and 9 years were administered questionnaire during the COVID-19 pandemic. The responses were compared across the different domains of the questionnaire between the two countries using the Mann-Whitney U test. Differences were also tested between the parents of males and females separately in each city. The correlation of the COHIP scores with the age of the child was done using the Spearman's rho.

Results

No significant differences in overall COHIP scores were found between the parents in Riyadh and Kuwait City (p > 0.05). There were significant gender differences observed across domains in Kuwait (p = 0.030) but not in Riyadh (p = 0.295). There was also a significant negative correlation between the different COHIP domains in Kuwait but not Riyadh.

Conclusion

There is a greater gender difference and age correlation of OHRQoL among the population studied in Kuwait City when compared to those in Riyadh.

The Impact of COVID-19 on Dental Treatment in Kuwait—A Retrospective Analysis from the Nation’s Largest Hospital

Background: The COVID-19 pandemic has changed the way dentistry has been practiced the world over. This study sought to assess the impact of the COVID-19 pandemic on the patterns of attendance for dental treatment in a large hospital in Kuwait through comparisons with data from the year prior to the pandemic. Methods: A total of 176,690 appointment records from 34,250 patients presenting to the AlJahra specialist hospital in Kuwait for dental treatment from April 2019 to March 2021 were analyzed. The types of procedures and the departments in which they presented were analyzed, and the patterns of attendance before and during the pandemic were compared. Results: While there was a significant reduction in the number of orthodontic, endodontic, and periodontal procedures, there were no impacts on oral surgery, restorative procedures, or pediatric dentistry. Conclusions: There has been a return in the number of patients obtaining dental treatment; however, there has been a definite shift in the use of certain dental procedures.

COVID-19-Related School Closures and Caries Risk in Canadian Children

BACKGROUND

Despite increased efforts to improve the health of those with temporomandibular disorder (TMD), the focus remains on medical knowledge rather than patients' opinions and needs regarding quality of treatment and pain management.

OBJECTIVES

We aimed to identify what TMD patients want their dentists to know and do.

METHODS

Open-ended questions were used to understand the perspectives of 6 TMD patients. Two researchers examined the transcripts using interpretive phenomenological analysis.

FINDINGS

TMD participants consistently stressed the need for their dentists to listen and provide them with more advice and information to cope with TMD conditions. They also noted the need for dentists to be skilled in communications, particularly maintaining respectful doctor-patient relations and interpersonal communication.

CONCLUSIONS

Health care providers must acquire practical communication skills and expand their knowledge of TMDs to better support their patients. Improving relations between doctors and their TMD patients could result in positive health outcomes. The implications of this study will be to decrease medical crises and expensive interventions, provide better assistance to patients and refer them to other necessary health care professionals, an approach that will lead to lower care costs, more satisfaction and higher quality of life.

Neighborhood Contexts and Oral Health Outcomes in a Pediatric Population: An Exploratory Study

Aims: This study aimed to explore the impacts of neighborhood-level socioeconomic contexts on the therapeutic and preventative dental quality outcome of children under 16 years. Materials and Methods: Anonymized billing data of 842 patients reporting to a university children’s dental over three years (March 2017–2020) met the inclusion criteria. Their access to care (OEV-CH-A), topical fluoride application (TFL-CH-A) and dental treatment burden (TRT-CH-A) were determined by dental quality alliance (DQA) criteria. The three oral health variables were aggregated at the neighborhood level and analyzed with Canadian census data. Their partial postal code (FSA) was chosen as a neighborhood spatial unit and maps were created to visualize neighborhood-level differences. Results: The individual-level regression models showed significant negative associations between OEV-CH-A (p = 0.027) and TFL-CH-A (p = 0.001) and the cost of dental care. While there was no significant association between neighborhood-level sociodemographic variables and OEV-CH-A, TRT-CH-A showed a significant negative association at the neighborhood level with median household income and significant positive association with percentage of non-official first language (English or French) speakers. Conclusion: Initial analysis suggests differences exist in dental outcomes according to neighborhood-level sociodemographic variables, even when access to dental care is similar.

The efficacy of two different oral hygiene regimens on the incidence and severity of oral mucositis in pediatric patients receiving hematopoietic stem cell transplantation: A prospective interventional study

Aims

This prospective interventional study aimed to assess the efficacy of supersaturated calcium phosphate rinse and the use of an extra‐soft toothbrush twice a day when added to the existing oral hygiene protocol regimen (0.12% chlorhexidine gluconate + 3% sodium bicarbonate + nystatin 5000 U/mL) in reducing the severity of oral mucositis among pediatric patients receiving chemotherapy for the hematopoietic stem cell transplant.

Methods

Forty‐five patients that received chemotherapy for the hematopoietic stem cell transplant were randomly allocated to three groups of 15 patients each. Group A was advised to follow the existing oral hygiene protocol regimen (Control), group B was advised to brush their teeth twice daily using an extra‐soft toothbrush and to follow the control regimen, and lastly group C was advised to use supersaturated calcium phosphate rinse and to follow the control regimen. Oral mucositis was recorded according to World Health Organization criteria from the day of admission (day 1) to the day of discharge (day 28). The incidence of oral mucositis between the three groups was compared using the Kruskall‐Wallis test while the severity of oral mucositis between the three groups was compared using a one‐way ANOVA test.

Results

The results of the study showed no significant difference in the incidence of oral mucositis between the three groups; however, there was a lower severity of oral mucositis in the supersaturated calcium phosphate rinse group when compared to the control group or the group who used an extra‐soft toothbrush with the control regimen.

Conclusion

Although marginally fewer cases and lower severity of oral mucositis was observed in the group using supersaturated calcium phosphate rinse, the lack of statistical significance suggests that the evidence for their use is not conclusive. The results of this study also showed that the introduction of an extra‐soft toothbrush into the oral hygiene regimen did not significantly reduce the incidence of oral mucositis and may actually be responsible for an increase in the severity of oral mucositis.

Parental anxiety associated with children undergoing dental treatment

AIM

Over the past two decades, improvements in both the safety of anaesthetic agents and the techniques of operative dentistry have resulted in the popularity of "day-case anaesthesia". The aim of this study was to evaluate the stress felt by parents of children undergoing dental treatment. The study also aimed to compare the stress felt by parents of children undergoing chairside treatment to the stress felt by parents of children who received their treatment under general anaesthesia.

MATERIALS AND METHODS

Study Design: Stress among parents was assessed subjectively using the Modified Dental Anxiety Stress (MDAS) questionnaire and objectively using a pulse oximeter to record the heart rate. The sample comprised of 60 parents of children aged between 4 and 7 years who were divided into three groups. Group A comprised of 20 sets of parents of children who underwent complete dental treatment without any pharmacological behaviour management. Group B comprised of 20 sets of parents of children who were treated at the dental chair with N2O used as pharmacological behaviour management. Group C comprised of 20 sets of parents of children who underwent dental rehabilitation under general anaesthesia. Objective signs were recorded preoperatively, during the procedure and post-operatively.

RESULTS

Dental treatment is a stressful experience for a parent. The introduction of a pharmacological method of behaviour management seems to significantly increase the stress felt by the parent.

CONCLUSIONS

A significant increase in heart rate was observed among parents whose children were under treatment.

The Relationship between Salivary Total Antioxidant Capacity and Dental Caries in Children: A Meta-Analysis with Assessment of Moderators

Objective:

There has been variation reported in literature examining the relationship between dental caries and total antioxidant capacity (TAC) of saliva in children. This study aimed to systematically review the literature and conduct a meta-analysis of the association between dental caries and TAC in children.

Methodology:

A systematic review of literature was done using the PubMed, Medline, and EBSCO libraries. Of the total of 68 records found, 11 studies were qualitatively assessed in the final analysis. These studies yielded a total of 13 comparisons to be included in the meta-analysis. The type of dentition of the child and the test used to measure TAC were assigned as moderators. A meta-analysis was done of the mean TAC levels, while a meta-regression was formulated using the moderators. All analyses were performed using OpenMetaAnalyst™ meta-analysis software (Brown University, RI, USA).

Results:

The meta-analysis showed significant increase in TAC in children with dental caries when compared to their caries-free counterparts (P < 0.001). The meta-analysis showed high levels of heterogeneity (I²= 99.48). The meta-regression revealed that, while the type of dentition was a significant moderating factor (P = 0.002), the method used to assess the TAC was not (P = 0.053).

Conclusion:

There is a significant increase in TAC in children with dental caries when compared to their caries-free counterparts.

Reliability of mobile phone teledentistry in dental diagnosis and treatment planning in mixed dentition

INTRODUCTION

The aim of the study was to test the reliability of mobile phone teledentistry in the diagnosis and treatment planning of dental caries of children in mixed dentition.

METHODS

A total of 57 cases, aged 6-12 years, among six examiners were used yielding 342 comparisons. The patients were examined by a dentist who was calibrated in the recording of oral findings in children using the World Health Organization (WHO) oral health assessment form for children (version 2013), which served as the gold standard for diagnosis. Six paediatric dentists calibrated using the same WHO form served as the teledentistry group and made their diagnoses using only the images sent to them without the use of radiographs. The pictures obtained were stored on an online cloud platform (Google Drive). The sharing links for these pictures were forwarded to participating dentists using a social media application (WhatsApp Messenger, Facebook Corp., Mountain View, CA).

RESULTS

This study showed greater sensitivity than specificity, and though both sensitivity and specificity were constantly above 80%, it can be stated that the current model has a higher chance of false positive results than false negative results. The reliability of teledentistry in this study is greater in primary teeth than in permanent teeth.

DISCUSSION

Although the use of teledentistry without radiographs is not as accurate as clinical examination, mobile phone teledentistry offers acceptable reliability for the initial diagnosis of caries in children.

Salivary antioxidant capacity of children with severe early childhood caries before and after complete dental rehabilitation

OBJECTIVE

There is a need to determine whether total antioxidant capacity (TAC) in severe early childhood caries (S-ECC) is an indicator of inflammatory response to the lesion or a marker of the disease. This study compared TAC levels in children with ECC before and after dental treatment and compared the results with those of caries-free children.

DESIGN

Prospective study.

SETTING

A teaching hospital.

PATIENT SELECTION

Salivary samples were obtained from 20 children aged 5 years and diagnosed with S-ECC, and 20 age- and sex-matched controls.

INTERVENTION DETAILS

Complete dental rehabilitation under general anesthesia was performed on the children with S-ECC, and follow-up salivary samples were obtained one week and three months postoperatively. TAC was measured using a commercially available Oxygen Radical Absorbance Antioxidant Assay measurement kit (Zen-Bio ORAC™, AMS Biotechnology, Abington, UK).

OUTCOME MEASURES

Differences between children with and without dental caries were tested using the Mann-Whitney U test; differences before and after dental treatment were analyzed using Friedman test followed by Wilcoxon sign-rank test with Bonferroni correction to compensate for multiple comparisons.

RESULTS

Median TAC (1.54 mcg/L, CI 1.15-1.92) of the control group was significantly lower than that of the treated group prior to treatment (p = 0.003). Treatment of the dental lesions significantly reduced TAC of the treated group, and no significant differences were observed between the test and control groups at either one week (p = 0.076) recall or three-month recall (p = 0.096). TAC in children posttreatment was significantly reduced compared to their pretreatment values (p < 0.001).

CONCLUSION

Total antioxidant capacity in the saliva of children with severe early childhood caries undergoes significant reduction following treatment of the carious lesions.

Impact of birth characteristics, breast feeding and vital statistics on the eruption of primary teeth among healthy infants in Saudi Arabia: an observational study

OBJECTIVES

This study aimed to explore the impact of gender, birth weight, maternal age, type of delivery, gestational age and feeding practices on the eruption of teeth in children with no underlying medical conditions or developmental defects in their first year of life.

DESIGN

A cross-sectional observational study design was used.

SETTING

A primary healthcare setting in Riyadh, Saudi Arabia.

PARTICIPANTS

All children in their first year of life attending a vaccination clinic (n=422) were included in the study. Infants with chronic childhood illnesses, those who were below the 5th percentile in height or weight, infants with congenital birth defects and chronic illnesses, infants who were born preterm and low birth weight infants were excluded from the study.

OUTCOME MEASURES

The type of delivery, birth weight, age of mother, height and weight percentile for age (as plotted on the WHO growth chart for infants) and feeding practices were recorded by the examiner, and this was followed by a clinical examination to determine the presence or absence of each tooth. Regression models were developed to determine the effect of the different variables on the presence of primary teeth.

RESULTS

There was a significant association between the weight percentile of the child (adjusted for age) and the number of erupted primary teeth, suggesting that heavier children have an earlier eruption of teeth. No association was observed between birth weight, height percentile for age or maternal age at the time of birth and the number of erupted primary teeth. Children who were exclusively breast fed were significantly more likely to have an erupted first primary tooth earlier than non-breastfed group.

CONCLUSIONS

Breast feeding and the weight of the child may have an influence on the eruption of primary teeth in the first year of life.

An Evaluation of Bite Pattern in Children with Severe-Early Childhood Caries Before and After Complete Dental Rehabilitation

PURPOSE

The purpose of this study was to examine the changes in bite characteristics of children before and after the placement of multiple stainless steel crowns (SSCs) under general anesthesia (GA).

METHODS

Twenty children scheduled for treatment under general anesthesia who needed SSCs in three or more posterior quadrants were included in this study. The bite was digitally analyzed and recorded preoperatively and at one and four weeks postoperatively. The occlusion time, number of force outliers, and distribution of force at each visit was recorded and compared.

RESULTS

The placement of the SSCs in children significantly improved the bite characteristics of the participants. The placement of the SSC did not alter occlusion time, and there were no significant differences in occlusion time. While there was an increase in the number of outliers in the first week after the placement of the crown, there was a reduction in the total number of outliers at the end of one month. All the patients treated with bilateral placement of an SSC showed a posterior balanced occlusion post-operatively, a finding that was retained over the one-month follow-up period.

CONCLUSION

Bilateral placement of SSCs under general anesthesia does not significantly alter the occlusion of the child.

The relationship between examination-related academic stress, salivary antioxidant capacity and exercise patterns of final-year Saudi dental students

OBJECTIVE

To study the impact of examination stress on the total antioxidant capacity (TAC) of senior dental students and compare changes in TAC between students who exercise regularly and those who do not.

METHODS

A questionnaire designed to evaluate physical activity levels, body mass index (BMI) and academic performance was distributed to 325 senior dental students. Of the 312 who responded, a total of 70 were enrolled in the study, of whom 60 completed the study. The students were composed of a low-activity group (n = 30), who had a Goddard-Sheppard (GS) exercise score of <25, and a high-exercise group (n = 30), who had a GS score >60. Dental Environment Stress (DES) questionnaires and salivary samples were collected at the first week of the semester and at the week of the examinations. Salivary TAC was measured using a commercially available Radical Absorbance Antioxidant Assay measurement kit (Zen-Bio ORAC™, AMS Biotechnology, Abington UK). A total of 60 students completed the study.

RESULTS

A significant increase in DES values and a significant reduction in salivary TAC values were observed in the week of the examination compared to baseline scores. Although no differences were observed in the DES scores between the high-exercise and low-exercise groups, the high-exercise group showed a significantly lower reduction in examination week salivary TAC compared to their counterparts in the low-exercise group. Regression models showed a significant association between the TAC, exercise scores and DES scores in the week of the examinations.

CONCLUSION

Regular exercise may help protect students against the oxidative stress associated with academic stress.

Parental Perception of Oral Health-related Quality of Life of Syrian Refugee Children

AIMS AND OBJECTIVES

The conflict in Syria has resulted in the displacement of over 5 million people, many of whom intend to return home at the cessation of hostilities. Oral health plays a critical role in early childhood and this study aimed to qualitatively and quantitatively assess the oral health-related quality of life (OHRQoL) of these children.

MATERIALS AND METHODS

The quantitative assessment of OHRQoL was done using a validated Arabic version of the short-form Parental-Caregiver Perceptions Questionnaire-8 (P-CPQ-8). The P-CPQ-8 was administered to 22 sets of parents of children in a community center catering to urban refugees. A focus group interview and thematic analysis of nine mothers were used to gain a qualitative insight into the problems that could affect the OHRQoL of their children.

RESULTS

The P-CPQ-8 revealed that oral symptoms were the greatest concern of the parents with dental pain being the most commonly reported condition. Although mothers reported higher P-CPQ-8 scores among all domains than fathers, there were no significant differences in the concerns of the fathers and the mothers. The focus group interview raised three major themes - (1) access to dental care, (2) pain felt by the child, and (3) oral hygiene of the child.

CONCLUSION

The parents interviewed in this study were aware of the importance of oral hygiene but reported being unable to look after their children's teeth. Children who are refugees from the Syrian conflict face significant OHRQoL challenges.

Comparison of the Effectiveness of a Mobile Phone-based Education Program in Educating Mothers as Oral Health Providers in Two Regions of Saudi Arabia

Aims and Objectives:

The penetration of mobile phone devices is widespread across the Kingdom of Saudi Arabia. Recently, there has been evidence of the success of phone-based applications in the provision of preventive oral health care to children and their parents. The aim of this study was to compare the effectiveness of a mobile phone-based application in educating mothers of children aged below 6 years of age in preventive dental care.

Materials and Methods:

A mobile phone-based application (iTeethey™) was developed for iPhone and Android and made freely available on Google Play and App Store. The application was then distributed to 3879 mothers of children below 6 years of age (1989 in Riyadh Region and 1890 in Najran region). The mothers were subjected to a standardized knowledge attitude and practice of oral hygiene questionnaire before being asked to download the application. A total of 1055 mothers who downloaded the application completed 3-month recall process.

Results:

Significant improvement in the knowledge of the mothers was reported after the use of the application from both regions. The mothers from Najran showed significantly greater improvement in knowledge when compared to the mothers from Riyadh region. The application was also more effective in mothers with more than one child when compared to first-time mothers.

Conclusion:

Within the limitations of this study, we can state that the mobile phone application used in this study significantly improves the knowledge of mothers toward their child's oral health.

The role of an occlusal template during the placement of preformed metal crowns in children under general anaesthesia: a randomised control trial

AIM

This aim was to evaluate preformed metal crowns (PMC) placed under general anaesthesia using an occlusal template in comparison to crowns placed without the use of a template.

METHODOLOGY

CONSORT protocols were followed in the design of the study. A total of 60 children between 4-7 years requiring pulpotomy and PMC for all primary molars met the inclusion criteria for this study. The control group comprised patients for whom the PMC were placed without the use of an occlusal template, while in the test group crowns were placed using a polyvinyl siloxane occlusal template. Patients were followed up at 24 h, 7 days, 3 and 6 months. The time taken for the placement of crowns, instances of post-operative discomfort, success or failure of the pulp therapy and loss of any crowns were compared between the groups.

RESULTS

The mean time taken for completion of the procedure in the control group was significantly greater than the template group (t = 2.566, p = 0.013). Significantly fewer patients in the template group reported symptoms of discomfort or high points at the 24-h recall; however, these differences were not significant at the 1-week, 3- or 6-month recall.

CONCLUSION

The use of an occlusal template for the placement of multiple PMC under general anaesthesia reduces the time taken for their placement and reduces the incidence of immediate post-operative discomfort.

Extrinsic tooth staining potential of high dose and sustained release iron syrups on primary teeth

Background

Iron in the form of oral supplements is routinely prescribed to children to help fight anemia, however tooth staining is a commonly reported complication. This study tests in vitro, the staining potential of two different forms of iron syrup on primary teeth.

Methods

Forty caries free primary central incisors were divided into four groups of ten teeth each. The control group comprised of ten teeth immersed in artificial saliva, while the test solutions were comprised of different forms of iron mixed with vitamins such that the iron content of each solution was approximately 100 mg (from 100 to 101.1 mg). The test solutions used iron syrup (Ferrose®, SPIMACO, Jeddah, Saudi Arabia) with iron in the form of ferric oxide polymaltose (FOP), slow release formula (Ferroglobin®, Vitabiotics ltd., London, UK) containing ferrous fumarate (FF and a combination of the two (FOP + FF). All the teeth were then immersed for 72 h and subjected to a protocol developed by Lee et al. to test staining. Color changes were measured using a wave dispersion spectro-photometer (Color-Eye 7000A, X-Rite Gmbh, Regensdorf, Switzerland) on the exposed labial surface at 4, 8, 24, 48 and 72 h. Two-way ANOVA with Scheffe’s post hoc test was used to determine significance of difference in shade, while the Kurskull-Wallis test used to determine the significance of difference in clinical staining (∆E > 3).

Results

While all three iron groups showed some amount of staining, the combination of the two forms of iron (FOP+FF) showed significantly lower incidence of clinical staining than the other two groups at the end of 72 h. At the end of 72 h the (FOP) had significantly higher ∆E than ferrrous fumarate (FF ) while the combination (FOP+ FF) had a significantly lower ∆E than either group.

Conclusion

In an in vitro model, combining different forms of iron seems to elicit a lower intensity of staining than equivalent doses of a single form of iron.

Electronic supplementary material

The online version of this article (doi:10.1186/s12903-015-0072-0) contains supplementary material, which is available to authorized users.

Assessment of the impact of stress and anxiety on pain perception in patients undergoing surgery for placement of their first dental implant

AIM

This study aimed to record, both subjectively and objectively the anxiety of patients awaiting placement of their first dental implant and their long term stress levels; and evaluate their relation to the perception of pain by the patient during and after the procedure.

METHODOLOGY

Early morning salivary cortisol samples were collected from 47 patients awaiting the placement of their first dental implant to evaluate long term stress. The patients filled out a dental anxiety stress questionnaire before the procedure. Heart rate and oxygen saturation were recorded at four key intervals; in the waiting room, while seated in the dental chair, during the placement of the implant and five minutes post operatively. The patients were asked to describe their post-operative sensation of pain on a Wong-Baker facial pain scale. The readings were then compared using regression models to assess the best predictor of pain immediately after the operation

RESULTS AND CONCLUSION

The regression models showed that while heart rate in the waiting area was a significant predictor of the reported pain of the patient, long term stress and reported anxiety were not.

The impact of dental treatment on the salivary cortisol levels of children with severe early childhood caries

AIM

To compare salivary cortisol levels of caries-free children with those of children with severe early childhood caries (S-ECC) before and 3 months after comprehensive dental treatment.

METHODS

Thirty children with S-ECC were matched with 30 caries-free children from middle income families with college-educated working mothers. Early-morning saliva samples were collected from the children using the passive drool method. Post-treatment saliva samples were collected 3 months after completion of treatment in the S-ECC group. Salivary cortisol levels were analysed using electrochemiluminescence immunoassay.

RESULTS

Salivary cortisol levels of caries-free children were significantly lower than both the pre-treatment and post-treatment levels of children with S-ECC (F = 26.221, p < 0.0001). The pre-treatment cortisol levels of children with S-ECC were significantly higher than the post-treatment levels (t = 2.588, p = 0.015). No significant differences in cortisol levels were observed between genders or between children treated over multiple visits under local analgesia and in a single visit under general anaesthesia.

CONCLUSION

Dental treatment significantly reduced the salivary cortisol levels of children with S-ECC, however, the post-treatment levels remained significantly higher than those of caries-free children.

Parental perceptions of the oral health-related quality of life of autistic children in Saudi Arabia

The aim of this study was to use parental perception to assess the Oral Health Related Quality of Life (OHRQoL) of children with Autism. A total of 59 families of children with Autism who had an unaffected sibling were cross-matched for age and gender of the affected child with families with no autistic children. The parents were administered the Parental Perception Questionnaire (P-CPQ) and the Family impact scale (FIS) components of and Arabic version of the Child Oral Health Related Quality of Life questionnaire (COHRQL). The P-CPQ scores of Children with Autism were compared with those of their unaffected siblings and those of children from families with no autistic child, while the FIS scores were compared between families with and without an autistic child. Regression models were constructed to show the association of sociodemographic factors on the OHRQoL of autistic children. The results of this study seem to suggest that childhood autism results in a reduced OHRQoL for both the affected child as well as the family. The apparent reduced parental concern with unaffected siblings of autistic children, when compared to parental concern towards children in families with no autistic child is an area that could merit further research.

Factors affecting the willingness to pay for implants: A study of patients in Riyadh, Saudi Arabia

BACKGROUND

One of the factors that dissuade patients needing tooth replacement from choosing dental implants is the prohibitive cost. Willingness to pay (WTP) is a useful tool to determine the ideal cost of an expensive procedure.

AIM

The aim of this study was to study the factors that influence the willingness to pay (WTP) among patients attending a private clinic and compare them to those attending a government setup.

MATERIALS AND METHODS

A total of 100 patients (38 male, 62 female) who had one or more missing teeth were presented with different cost-benefit scenarios and then asked if they were willing to pay the median cost of a single implant in Riyadh city. The mean WTP price was compared using the one way-ANOVA, factors which could possibly influence patients' WTP were grouped together in a Binomial logistic regression model.

RESULTS

Of the 100 individuals surveyed 67% said they would be willing to pay the median price for the placement of an implant. A comparison of socio-demographic factors showed that significant differences were found between gender, income groups and setting of the clinic in the mean WTP price of the patients (P < 0.05). We also found that there was a significant difference in the mean WTP price between groups with regard to the area of the missing tooth, the patients' perception of their oral health and the their desire to want an implant (P < 0.05).

CONCLUSION

The majority of the patients surveyed were willing to pay the median price for an implant. Willingness to pay (WTP) is a multifactorial variable which is significantly influenced by the income of the patient, the setting of the clinic and the gender; the most significant factor being the acceptability of the implant to the patient.

The genetic basis of tooth agenesis: basic concepts and genes involved

Tooth agenesis is the most prevalent craniofacial congenital malformation in humans. While tooth agenesis may be associated with several syndromes, non-syndromic hypodontia refers to the congenital absence of a few teeth in the absence of any other deformity. Recent advances in molecular genetics have made it possible to identify the exact genes responsible for the development of teeth and trace the mutations that cause hypodontia. This paper reviews the literature regarding the genetic basis of non-syndromic tooth agenesis, methods used to study it, and the genes that have been definitively implicated in the agenesis of human dentition.

Evaluation of stress in final-year Saudi dental students using salivary cortisol as a biomarker

The aims of this study were to identify the perceived sources of stress in final-year dental students studying in a private dental school in Riyadh, Saudi Arabia, using a modified dental environmental stress (DES) scale and to correlate these findings, at various times in the semester, with the level of acute stress measured with salivary cortisol as a biomarker. A total of forty final-year students were administered a modified DES questionnaire consisting of twenty-five questions to determine the perceived causes of stress. Salivary cortisol levels during the first week of the semester, the final week of clinical training, and one hour before the final didactic examination were assessed. Baseline cortisol levels were significantly lower than the cortisol levels in the clinic, and both these values were significantly lower than the salivary cortisol levels before the examination (p<0.001). Comparison of cortisol levels to the perceived sources of stress and demographic data collected showed that certain discrepancies may exist between the perceived and actual stress felt by dental students at different times in the academic semester.

Impressions in cleft lip and palate--a novel two stage technique

Though the field of presurgical orthopedics for the management of children with cleft Lip and Palate (CLAP) has made great advances over the past few decades, little is found in literature regarding the imressions required to fabricate these appliances. The purpose of this paper is to describe a novel two stage technique utilizing greenstick compound and addition silicone impression material to provide a safe, economical and accurate method for recording impressions in children with cleft lip and palate.