Perception of Pain With Bitewing, DIAGNOcam, and Teeth Separation Amongst Children

BACKGROUND

This study evaluated the pain and discomfort associated with 3 diagnostic techniques for proximal carious lesions in children aged 5 to 8 years: bitewing (BW) radiographs, DIAGNOcam, and temporary teeth separation.

METHODS

The study included 60 healthy children between the ages of 5 and 8 years who had no prior history of dry mouth or mouth breathing, were definitely positive or positive based on Frankl Behavioral Rating Scale, had at least one pair of matched bilateral primary molars and/or permanent first molars in close contact with the adjacent tooth, and were free of restorations and frank cavitation. Each patient evaluated all 3 techniques. The pain and discomfort ratings were obtained by the Wong-Baker FACES Pain Rating Scale immediately after taking 2 standardised BW radiographs or undergoing use of DIAGNOcam and 2 days after temporary teeth separation with elastic separators by a single trained and experienced paediatric dentist.

RESULTS

The DIAGNOcam procedure resulted in much higher pain and discomfort (3.69 ± 3.10) than the other 2 diagnostic techniques. Within-participant pain and discomfort scored significantly higher with DIAGNOcam compared to BW radiographs (P < .001) and temporary teeth separation (P = .002).

CONCLUSIONS

The DIAGNOcam diagnostic technique caused much more pain and discomfort than BW radiographs and temporary teeth separation using orthodontic elastic separators. The report is part of a randomised clinical trial that was registered at www.

CLINICALTRIALS

gov under the identifier NCT03685058.

Developmental Disturbance in Premolars After Intraligamental Anesthesia Using Computer-Controlled Local Anesthesia Delivery System: An-Eight-Years Follow-Up Study in Children

Aim This study aimed to evaluate the prevalence of developmental disturbances in permanent second premolars in which their tooth buds were exposed to mandibular intraligamental anesthesia (ILA) using a computer-controlled local anesthetic delivery system (CCLAD). Materials and methods This was a longitudinal follow-up study conducted in a previous randomized clinical trial (RCT). In the previous RCT, a total of 91 children were included (61 control and 30 cases). A structured form was created that contained details about the date of birth, age, and sex at which the participants received local anesthesia and the type of local anesthesia administered (ILA using CCLADS, traditional inferior alveolar nerve block [IANB], and IANB using CCLADS). A history of post-treatment abscess, retreatment, and post-treatment extraction was documented in both groups. Descriptive statistics, including frequency and percentage, and additionally, the chi-square test and Fisher's exact test were used to compare ILA and IANB. Results Forty of the 91 children attended follow-up visits. Only two children had developmental defects: one child who received traditional IANB had a demarcated white opacity (this patient had a history of dental abscess), and another who received ILA using CCLADS showed hypoplasia on his permanent premolar. No significant association was found between the type of anesthesia and the presence of developmental defects. Conclusion The slow administration of ILA delivered by CCLADS in the primary teeth does not increase the chances of developmental disturbances or damage to the corresponding permanent tooth bud.

The Effect of Using a Camouflaged Dental Syringe on Children's Anxiety and Behavioral Pain

BACKGROUND

Seeing a dental syringe can be terrifying, especially for young children, and hiding it during local anesthesia (LA) administration can sometimes be challenging for the pediatric dentist.

OBJECTIVE

To assess the effect of a camouflaged dental syringe on children's anxiety and behavioral pain in comparison to the traditional dental syringe during local anesthesia administration in pediatric patients.

MATERIALS AND METHODS

This randomized clinical trial included cooperative and healthy 6- to 10-year-old children scheduled for non-urgent dental treatment that required buccal infiltration anesthesia (BIA) in the maxillary arch. The subjects were randomized into either the test or the control groups. In the test group, subjects received BIA using the camouflaged dental syringe. Subjects in the control group received the BIA using a traditional dental syringe. A single-trained dentist administered all the anesthesia. Heart rate (HR) was monitored at three different time points (before, during, and after) the BIA administration. Subjects' anxiety and behavioral pain were measured using Venham's Anxiety Rating Scale (VARS) and the Face, Leg, Activity, Cry, and Consolability (FLACC) scale, respectively, by two trained and calibrated investigators.

RESULTS

A total of 60 subjects with a mean age of 8.3 ±1.3 years were included. The scores of the VARS in the subjects in the camouflaged group were somewhat lower than the subjects in the traditional group, but the observed difference did not reach statistical significance (P=0.113). However, subjects in the camouflaged group showed significantly lower FLACC scores compared to the traditional group (P=0.034).

CONCLUSION

The utilization of a camouflaged dental syringe is effective in improving children's behavior during local anesthesia administration; therefore, it is recommended as an alternative to using the traditional syringe.

Preference for Comprehensive Dental Treatment under General Anesthesia among Parents with Previous Experience: A Cross-Sectional Study

This study aims to assess whether parents of children who previously received comprehensive dental treatment under general anesthesia (GA) would prefer comprehensive dental treatment under GA over regular dental care if any of their other children required comprehensive dental treatment. In this cross-sectional study, parents of children who met the inclusion criteria were interviewed by a trained pediatric resident about parental-related factors as well as their satisfaction with their previous GA experience. Also, the factors related to the previously treated child were obtained from dental records. Statistical analysis was carried out, and the p value was set to 0.05. A total number of 306 parents were included. Although most parents, 293 (95.8%), showed satisfaction with the previous GA, 170 (58%) of the satisfied parents preferred regular care. Parents of children who were previously treated under GA for medical-related reasons (p = 0.018), fathers working in a governmental sector (p = 0.021), and families with low-average monthly income (p = 0.017) significantly preferred regular care. In conclusion, most parents were satisfied with the previous GA experience. Family income, fathers' occupation, and medical-related factors can influence parental preference for comprehensive dental treatment under general anesthesia if any of their other children require comprehensive dental treatment.

Dental manifestation and management in a patient with combined pituitary hormone deficiency: a two-year case report

Combined pituitary hormone deficiency (CPHD) is a rare disorder caused by a complete absence of the anterior pituitary gland hormones. The Dental manifestation, managmnet and two-year-follow-up of a case of a 12-year-old patient with CPHD is reported in this paper. A 12-year-old male patient with medical history of congenital CPHD and vitamin D deficiency presented for dental treatment. The patient looked tired and younger than his chronological age. Intraoral examination revealed good oral hygiene, generalized edematous gingiva, physiological pigmentation and high maxillary labial frenum attachment. The occlusion examination, showed class I molars, 2 mm overjet and 90% overbite. Single anterior tooth #21 crossbite with 1.5 mm diastema. Also, Miller's class I recession in tooth #31 with a probing depth of 1 mm, and grade I mobility. The treatment plan was formulated in phases, and the primary physician consultation was obtained and a clearance for dental treatment with a recommendation to double the hydrocortisone dose before a stressful dental procedure was recommended. Preventive and restorative programs were planned and provided. Then, the lower lingual holding arch was provided after the extraction of mandibular primary canines with composite turbo, and tooth #21 crossbite was corrected using a nance appliance with Z spring. Finally, the patient was recommended to attend follow-up visits every three months. During which the preventive program was reinforced and the restorative treatments were reevaluated. At the 2-year-follow-up satisfactory and stable aesthetic and functional results were obtained. This report highlights the oral manifestations, the value of establishing a preventive program, and restorative, and orthodontic interventions among patients with CPHD.

Effect of Light-Curable Resin-Modified Glass Ionomer Varnish on Non-Cavitated Proximal Caries Lesions in Primary Molars: A Randomized Controlled Trial

The purpose of this study was to radiographically and clinically assess, after six and twelve months, the additive effect of light-curable resin-modified glass ionomer (LCRMGI) varnish on preventive standard-of-care measures (sodium fluoride varnish, oral hygiene instructions, and dietary counseling) for the treatment of non-cavitated proximal carious lesions in primary molars. This prospective, split-mouth, randomized clinical trial recruited 5-8-year-old children with at least one pair of bilateral non-cavitated proximal carious lesions in the enamel or outer third of the dentin. The lesions were randomized into one of two groups: experimental (which received LCRMGI varnish with the preventive standard-of-care measures) or control (which received the preventive standard-of-care measure). A total of 47 out of 53 participants, with 70 out of 80 pairs, completed the study. Radiographically, lesions in the experimental groups were more likely to regress after six (OR = 3.25) and twelve months (OR = 2.67), but it was not statistically significant (p = 0.052 and p = 0.055, respectively). Clinically, the experimental group showed significantly higher regression rates than the control group after six and twelve months (p = 0.041 and p = 0.003, respectively). The LCRMGI varnish demonstrated promising potential as an adjuvant to preventive standard-of-care measures in promoting regression and inhibiting the progression of non-cavitated proximal carious lesions.

The effect of virtual reality distraction on anxiety level during dental treatment among anxious pediatric patients: a randomized clinical trial

This study evaluated the effect of Virtual Reality Distraction (VRD) on dental anxiety among anxious children undergoing prophylactic dental treatment by utilizing both subjective (Venham Anxiety and Behavioral Rating Scale (VABRS)) and objective (heart rate (HR) and salivary cortisol level (SCL)) measures. This randomized controlled study included 36 (6- to 14-year-old) healthy and anxious children who needed prophylactic dental treatment and had a history of previous dental treatment. The eligible children's anxiety level was evaluated using a modified version of the Abeer Dental Anxiety Scale-Arabic version (M-ACDAS) and those who scored at least 14 or more out of 21 were included. Participants were randomly distributed to either the VRD or control group. In the VRD group, participants wore the VRD eyeglasses during prophylactic dental treatment. In the control group, subjects received their treatment while watching a video cartoon on a regular screen. The participants were videotaped during the treatment, and their HR was recorded at four time points. Also, a sample from each participant's saliva was collected twice, at the baseline and after the procedure. The mean M-ACDAS score at baseline in the VRD and the control groups was not statistically significant (p = 0.424). At the end of the treatment, the SCL was significantly lower in the VRD group (p < 0.001). Neither the VABRS (p = 0.171) nor the HR significantly differed between the VRD and control groups. Virtual reality distraction is a non-invasive method that has the potential to significantly reduce anxiety during prophylactic dental treatment among anxious children.

Clinical Effects of Dental Caries on the Quality of Life of Paediatric Patients Aged 8-10 Years: Utilisation of the PUFA Index

PURPOSE

Saudi children have poor oral health; however, little data are available on the effects of dental caries and its clinical complications on the oral health-related quality of life (OHRQoL) in school-aged children. This study evaluated the impact of caries and its clinical effects on the OHRQoL of a sample of 8- to 10-year-old children attending King Abdulaziz University Hospital.

MATERIALS AND METHODS

The following variables were assessed for each child: sociodemographic data, OHRQoL using an Arabic-validated Child Perception Questionnaire for 8- to 10-year-old children (CPQ8-10), and two global health rating questions. Caries and its clinical effects on oral health were also assessed using the decayed-missing-filled teeth (dmft/DMFT) and pulpal involvement, ulceration, fistula, and abscess (pufa/PUFA) indices. Descriptive statistics of the sociodemographic variables and responses to the CPQ8-10 questions are presented as absolute values and percentages. The CPQ8-10 scores between children with different dmft/DMFT and pufa/PUFA scores were compared.

RESULTS

In total, 169 children participated in this study. The means ± SD of dmft and DMFT were 5.03 ± 2.5 and 2.35 ± 1.7, respectively. However, the pufa and PUFA scores were 1.03 ± 1.6 and 0.05 ± 0.2, respectively. The most common oral health complaint affecting OHRQoL was food stuck to the teeth. Participants with higher dmft and pufa/PUFA scores had statistically significantly higher CPQ8-10 scores than did their counterparts.

CONCLUSION

High dmft and pufa/PUFA scores have a statistically signifcantly negative effect on the OHRQoL among healthy 8- to 10-year-old children. Worse global health ratings correlate with lower OHRQoL.

The Impact of the COVID-19 Lockdown on Sugar-Sweetened Beverage Consumption in Children in Saudi Arabia: A Mixed-Methods Study

(1) Background: In 2020, there seems to have been a global shift in lifestyle and eating habits with the emergence of the coronavirus disease 2019 (COVID-19) and the ensuing lockdowns implemented by national governments. This study assessed the impact of the COVID-19 lockdown on SSBs consumption among healthy 6-11 years old children in Saudi Arabia; (2) Methods: This is a mixed-methods study, incorporating a quantitative component, which was a validated Arabic online questionnaire completed by parents, and a qualitative component, involving structured interviews with 10 selected parents using a criterion sampling method; (3) Results: There was a small decrease in consumption reported during lockdown across all SSBs types (soft drinks, n = 58 (13.9%); juices: n = 115 (27.6%); flavored milk: n = 93 (22.3%)). The results showed that with every increase in the dental pain scale there was a positive odd (AOR:0.64; p = 0.001) of decreased consumption of SSBs. Several themes related to increase and decrease SSBs consumption emerged; (4) Conclusions: There was a small decrease in SSBs consumption during lockdown reported by parents. Several themes emerged that can be used to strategize against problematic eating behavior, enabling such provisions as family dietary interventions, which target both parents and children.

Prevalence and Parental Attitude Toward Nitrous-Oxide and Papoose-Board Use in Two Dental Referral Centers in Saudi Arabia: A Cross-Sectional Study

BACKGROUND

Parental preferences and attitudes strongly influence dentists' choices for managing children's behavior in clinics. This study aimed to assess parental attitudes toward two behavior management technique (BMTs)-nitrous oxide (N2O) sedation and/or protective passive stabilization by papoose board (PB)-before and after their children received dental treatment at two referral centers in Jeddah, Saudi Arabia.

METHODS

Participants were parents of healthy children who required dental treatment under N2O and/or PB over an 18-month period. Before and after dental treatment, parents answered a questionnaire on their attitudes toward BMTs used on their children. Parents were divided into three groups: Group 1 (parents of children who received N2O), Group 2 (parents of children who received PB), and Group 3 (parents of children who received both N2O and PB).

RESULTS

Out of the 132 parents who answered the questionnaire, 106 (80.3%) were in Group 1, 10 (7.6%) in Group 2, and 16 (12.1%) in Group 3. More children of parents with low monthly family incomes were in Group 3 than Group 1 compared to other family-incomes.

CONCLUSION

Parental attitudes toward N2O and/or PB improved after their children experienced BMTs. The future use of PB alone with their child's sibling was parents' least preferred BMT (p = 0.001).

Effect of virtual reality distraction on pain and anxiety during infiltration anesthesia in pediatric patients: a randomized clinical trial

Background

Different distraction techniques have been used in dentistry and have shown great results in managing anxious pediatric patients specially during local anesthesia administration. One of the recently invented techniques is virtual reality. The purpose of the study was to evaluate the effect of virtual reality distraction on anxiety and pain during buccal infiltration anesthesia in pediatric patients.

Methods

Healthy, cooperative 6- to 12-year-old children requiring buccal infiltration anesthesia were randomly assigned to a test or control group. In the test group, local anesthesia was administered while the subjects were watching a cartoon video using virtual reality goggles. Subjects in the control group watched a cartoon video on a screen during the administration of local anesthesia. To assess anxiety in both groups, heart rate was recorded using a pulse oximeter at five time points: (1) once the subject sets on the dental chair as a baseline; (2) when video is on; (3) at topical anesthesia application; (4) during needle insertion; (5) after the administration of local anesthesia. The face, legs, activity, cry, consolability (FLACC) behavioral pain assessment scale and the Wong–Baker FACES pain rating scale were used to assess pain.

Results

A total of 50 subjects were included with a mean age of 8.4 ± 1.46 years. Twenty-nine (58.0%) of the subjects were females. The mean heart rate at all time points except baseline was significantly higher among the test group compared to the control group. Multiple regression analysis showed that younger subjects and females had higher mean FLACC behavioral pain assessment scale scores (P = 0.034 and P = 0.004, respectively) regardless of the distraction technique used. Younger subjects and subjects with higher baseline heart rate reported higher mean Wong–Baker FACES pain rating scale score (P = 0.031 and P = 0.010, respectively), controlling for all other variables.

Conclusion

Female subjects and the younger age group were more likely to report higher pain scores during local anesthesia administration regardless of the type of distraction used.

Trial registration

The study was retrospectively registered in ClinicalTrials.gov with the identifier: NCT04483336 on 23/07/2020.

Clinical and radiographic evaluation of triple antibiotic paste pulp therapy compared to Vitapex pulpectomy in non-vital primary molars

Objectives

This study compared and evaluated the clinical and radiographic efficacy of non‐instrumentation triple antibiotic paste pulp therapy and Vitapex pulpectomy in non‐vital primary molars.

Material and Methods

Healthy, 5–9 years old children with at least one non‐vital primary molar were included in the study. Molars were divided into two groups based on the subject's cooperation level. In the first group, molars received triple antibiotic paste, and a second group received Vitapex pulpectomy followed by a stainless‐steel crown. Triple antibiotic paste was freshly prepared and proportioned in equal parts by volume (metronidazole, minocycline, and ciprofloxacin = 1:1:1) before the scheduled treatment. A clinical and radiographic examination was performed by two trained and calibrated pediatric dentists at the pre‐operative baseline and the 6‐ and 12‐month follow‐up visits.

Results

A total of 28 molars received triple antibiotic paste pulp therapy and 20 received Vitapex pulpectomy. At the 6‐month follow‐up, the success rate among the molars in the triple antibiotic paste group was clinically (92.85%) and radiographically (85.71%) higher compared to the Vitapex group (91.67%, 62.50% respectively) with p = 0.89 and 0.55 respectively. At the 12‐month follow‐up, the molars in the triple antibiotic paste group showed lower clinical (95.45%) but higher radiographic success rate (72.73%) compared to the Vitapex group (100% and 62.50%) with (p = 0.85 and 0.47) respectively. None of the differences were statistically significant.

Conclusions

Both triple antibiotic paste and Vitapex can be clinically and radiographically effective in treating non‐vital primary molars.

Knowledge, perception, and confidence of hospital pharmacists toward pharmacogenetics in Jeddah, Kingdom of Saudi Arabia

Background

Integrating pharmacogenetics (PGx) testing into clinical practice leads to personalized medicine, which improves treatments’ efficacy and safety. Successful implementation of such a service requires sufficient knowledge, perception, and self-confidence among healthcare providers, especially pharmacists.

Objectives

To evaluate governmental hospital pharmacists’ knowledge, perception, and self-confidence toward PGx testing in Jeddah, Kingdom of Saudi Arabia.

Method

This cross-sectional study was conducted using previously validated questionnaire. Pharmacists working in five randomly selected general governmental hospitals in Jeddah between August and October 2019 were interviewed. Comparative and descriptive analyses were used to analyze the data, and the significance level was at P-value < 0.05.

Results

A total of 119 pharmacists with a mean (±SD) age of 31.2 (±5.05) years were included with a response rate of 79.3%. The average total mean (±SD) score for PGx knowledge-based questions was low (2.4 ± 1.09 out of 5). Most of the participants, with a total mean score of (10.1 ± 1.6 out of 12), revealed a positive perception toward PGx testing and its implications. A moderate self-confidence score for utilizing PGx testing (4.3 ± 2.3 out of 8) was observed among the participants. Pharmacists who had completed postgraduate studies had a statistically higher mean knowledge score (P = 0.006) compared with pharmacists with undergraduate degrees.

Conclusion

Governmental hospital pharmacists have limited knowledge and understanding about PGx testing; however, the majority expressed a high level of awareness and agreed that PGx testing is a valuable tool for enhancing drug efficacy and safety. The study also highlighted the importance of improving pharmacists’ knowledge about PGx testing, which will help them in implementing such a valuable service into their clinical practice in Saudi hospitals.

The effect of DentalVibe on pain and discomfort during local anesthesia in children: a randomized clinical trial

Objective: To evaluate the effectiveness of using DentalVibe during injection in comparison with the traditional injection technique, regarding pain and discomfort associated with buccal infiltration anesthesia (BIA) in pediatric patients. Method and materials: This randomized clinical trial included 6- to 12-year-old healthy children currently receiving nonurgent dental treatment on the maxillary arch that required BIA. In the control group, subjects received traditional BIA. In the test group, they received BIA with the aid of DentalVibe. A sample of 30 subjects per group was included. The mean ± SD age of the subjects was 9.18 ± 1.66 years. All the subjects were videotaped, and two trained and calibrated evaluators assessed the children's behaviors during the injection using the face, legs, activity, cry, consolability (FLACC) scale independently. Immediately after anesthesia administration, the subjects were administered the validated Arabic version of the Wong-Baker FACES scale ranging from 0 to 10. Results: Female subjects showed significantly higher mean FLACC and Wong-Baker FACES scale scores (2.20 ± 1.82 and 2.93 ± 3.05) compared with males (1.08 ± 1.37 and 1.12 ± 2.09) (P = .008 and P = .006, respectively). Multiple regression analysis showed that regardless of age and treatment group, females had significantly higher mean scores on the FLACC (β = 1.63, P = .002) and the Wong-Baker FACES scales (OR = 4.44, P = .004) than males. Conclusion: The use of DentalVibe did not significantly affect pain, discomfort, or time during BIA among pediatric patients compared with the traditional technique. Female children were more likely to report higher pain and discomfort scores during BIA administration regardless of age and anesthesia administration technique.

Prevalence of methylenetetrahydrofolate reductase gene polymorphisms (C677T, and A1298C) among Saudi children receiving dental treatment

BACKGROUND

Methylenetetrahydrofolate reductase, the encoded by the MTHFR gene, plays a crucial role in converting the amino acid homocysteine to methionine. Two polymorphisms of the MTHFR gene, C677T and A1298C, reportedly reduce enzyme activity, resulting in hyperhomocysteinemia. Patients with C677T and A1298C polymorphisms may be at higher risk for developing abnormal hyperhomocysteinemia, which has been linked to catastrophic neurological including fatal outcomes.

OBJECTIVE

Determine the prevalence of the MTHFR gene variants C677T and A1298C among pediatric dental patients treated at King Abdulaziz University Hospital.

DESIGN

Cross-sectional.

SETTING

Clinics of pediatric dentistry department.

SUBJECTS AND METHODS

Healthy Saudi children 6-12 years old with no known allergies were screened for eligibility between May and December 2019. A single investigator collected saliva samples. The MTHFR C677T and A1298C polymorphisms were analyzed using polymerase chain reaction and restriction fragment length polymorphism.

MAIN OUTCOME MEASURE

The prevalence of MTHFR gene variants (C677T and A1298C) among the subjects.

SAMPLE SIZE

138.

RESULTS

MTHFR C677T polymorphism was present in 36.2% of the sample and 90.0% of children carrying this allele were heterozygotes. MTHFR A1298C polymorphism was present in 91.3% of the sample and 77.0% of the children carrying this allele were heterozygotes. No linkage disequilibrium between MTHFR C677T and MTHFR A1298C was observed within this sample.

CONCLUSIONS

Our study found a high frequency of the MTHFR A1298C genotype, which was substantially more abundant than expected based on a Hardy-Weinberg distribution. Therefore, caution is advised in using N2O in Saudi children as the increased prevalence of this MTHFR allele may increase the incidence of serious adverse effects among these children.

LIMITATIONS

Further studies are recommended with a larger sample size from randomly selected hospitals from different regions of Saudi Arabia.

CONFLICT OF INTEREST

None.

Relationship of Lower Lingual Arch Appliance Use and Impaction of Second Molars: A Retrospective Study

Purpose: The purpose of this study was to determine the prevalence of permanent mandibular second molar impaction in pediatric patients treated with a lower lingual holding arch (LLHA) to maintain lower arch perimeter. Methods: In this retrospective study, 259 radiographs of nine- to 17-year-old pediatric patients were examined for permanent mandibular second molar impaction. A total of 127 patients with LLHA were compared to a control group of 132 patients who had not received LLHA. Other independent variables (sex and treatment age) were also tested for their value as predictors of impaction difficulty. For statistical analysis, the chi-square test was used. Logistic regression analysis was used to determine the statistical significance of the possible predictors of second molar impaction. Results: The mean age of the subjects was 9.2±1.7 (standard deviation) years old. The prevalence of permanent mandibular second molar impaction was 7.1 percent in patients with LLHA compared to 1.5 percent in the control group. The LLHA group had a likelihood of second molar impaction 6.53 times higher than controls after controlling for age. The relationship was significant with P-value of 0.021. Conclusions: The lower lingual holding arch is associated with an increased risk of second molar impaction in patients nine to 17 years old.

The effect of brushing with Salvadora persica (miswak) sticks on salivary Streptococcus mutans and plaque levels in children: a clinical trial

Background

The aim of the randomized double-blinded clinical trial was to evaluate the effect of tooth brushing with Salvadora persica (miswak) sticks on Streptococcus mutans count and the mean plaque score relative to brushing with fluoridated tooth paste (FTP).

Methods

Our sample included 94 healthy, high caries-risk, 8 to 9-year-old students recruited from a government school, in Jeddah, Saudi Arabia between February and April 2016. Subjects were randomly grouped into test (provided with miswak sticks) and control groups (provided with FTP and soft brushes). Both groups were introduced to a preparatory period (PPP) of 3 weeks. Plaque score and saliva sampling were conducted prior to the PPP and in follow-up visits by a single, calibrated and blinded dentist.

Results

Both groups showed a statistically significant decrease in the mean plaque score across the study (P = 0.007 and P = 0.001, respectively). In addition, subjects in the test group with abundant S. sanguinis increased from zero to six after 3 months.

Conclusions

Salvadora Persica (miswak) and brushing with FTP significantly reduced plaque scores among school children. In addition, Salvadora persica was found to change the proportions of salivary bacteria in favor of species with less risk of inducing caries.

Trial registration

ClinicalTrials.gov ID #: NCT04137393.

Accuracy of the DIAGNOcam and bitewing radiographs in the diagnosis of cavitated proximal carious lesions in primary molars

Aims

To evaluate the diagnostic abilities of near-infrared light transillumination (using the DIAGNOcam) and bitewing radiographs in detecting cavitated proximal carious lesions in primary molars.

Subjects and Methods

The study was a cross-sectional analytical, clinical study. The proximal surfaces of primary molars of healthy 5- to 8-year-old children were radiographically screened for the presence of carious lesions in the enamel or outer third of dentin (D1). Two trained and calibrated examiners evaluated the depth of caries in bitewing radiographs and DIAGNOcam images and then verified the presence of cavitation by direct visual examination using the "International Caries Detection and Assessment System" after temporary tooth separation.

Results

A total of 236 proximal lesions were included in the study. Most of the clinically cavitated lesions (51.9%) were D1 radiographically and in outer dentin lesions (scores 3 and 4) by the DIAGNOcam (37% and 48.1%, respectively). Although DIAGNOcam showed higher sensitivity (0.852) compared to the radiographs (0.519), it showed slightly less specificity (0.569) compared to the radiographs (0.579). However, DIAGNOcam showed higher value of the area under the curve (AUC = 0.722; P < 0.001) compared to the radiographic method (AUC = 0.561; P = 0.308).

Conclusions

The DIAGNOcam showed higher sensitivity and better accuracy than bitewing radiographs in diagnosing cavitated proximal lesions in primary molars and can be generally considered as an alternative to radiographs to detect cavitation without the hazards of ionizing radiation in children.

Parental acceptance of the utilization of silver diamine fluoride on their child's primary and permanent teeth

Purpose: Silver diamine fluoride (SDF) is an effective caries control agent. The aim of our study was to investigate the parental acceptance of the utilization of SDF on their child's primary and permanent teeth and to determine the factors that influence their decision-making. Patients and methods: This descriptive cross-sectional study included parents of healthy children aged 12 years and younger and currently receiving dental treatment. The interview questionnaire was conducted and pre-tested for face and content validity. The trained interviewing dentists showed colored pictures of primary and permanent teeth before and after receiving SDF treatment. The statistical significance was set at P<0.05. Results: A total of 104 parents were included in the study. The mean parental rating of treatment acceptability of the staining associated with SDF was 3.9±1.95. The plurality considered the staining caused by SDF treatment strongly not acceptable 46 (43.4%). Parental acceptance of SDF treatment was significantly affected by the location and type of teeth. Parents showed significantly higher acceptance of SDF treatment on their child's primary compared to permanent teeth and posterior compared to anterior in both dentitions (P<0.001). In addition, parents of children with a history of uncooperative behavior during previous dental treatment were significantly more accepting of SDF treatment regardless of the type and location of the teeth. Conclusion: Parental acceptance of SDF increased for primary compared to permanent teeth, on anterior compared to posterior teeth in both dentitions and for uncooperative children.

Knowledge, Attitude, and Behavior of Restorative, Orthodontic, and Pediatric Departments' Members toward Bisphenol A Dental Exposures

AIM AND OBJECTIVES

The aim of this study is to evaluate the knowledge, attitude, and behavior of Restorative, Orthodontic, and Pediatric Dentistry Departments' members at King Abdulaziz University (KAU), Jeddah, Saudi Arabia, toward bisphenol A (BPA) dental exposure.

MATERIALS AND METHODS

A survey was pretested for face and content validity. It included ten knowledge-, four attitude-, and five behavior-based items. The collected data were analyzed using Windows SPSS software version 22 (IBM Corp., Armonk, NY, USA). Significant levels were set at 0.05.

RESULTS

A total of 109 members participated in this study. Most of them (80 [73.4]) had never attended a lecture or read an article on BPA dental exposure previously. The restorative department members showed the highest (mean ± standard deviation score) in knowledge-based questions (3.32 ± 3.323), and those who reported that they had heard of BPA previously, read an article, or attended a lecture on BPA received significantly higher mean knowledge scores (P < 0.0001). The pediatric dentistry departments' members showed significantly higher agreements to attitude questions. Only ten participants (9.2%) followed the recommended guidelines to reduce patients' exposure to BPA during the application of BPA-containing dental materials.

CONCLUSIONS

Reading an article or attending a lecture on BPA significantly improves the knowledge scores. Therefore, there is a need to increase the awareness on BPA dental exposure among different departments' members in KAU to ensure that BPA exposure to patients is minimized and to ensure the spread of this knowledge to the dental students.

Effectiveness of an oral health education seminar for paediatric and family medicine residents

AIM

To assess the immediate effect of a 60-minute oral health educational seminar for paediatric and family medicine residents in improving their knowledge, attitude, likelihoodtowards incorporating oral health preventive practice in their current practices to well-child visits, and confidence in identifying and referring patients with dental trauma.

MATERIALS AND METHODS

Baseline pre- and post-test design was used to evaluate the immediate effect of a 60-minute PowerPoint oral health educational seminar given to the paediatric and family medicine residents.

STATISTICS

Multiple-choice items were used and the pre- and post-test data were analysed with McNemar and Wilcoxon signed-rank tests. A p-value <0.05 was considered statistically significant.

RESULTS

Sixty-eight residents participated in the oral health educational seminar and completed the questionnaire. The mean age of participants was 29.9 years old (SD ±4.8 yrs.). Immediately following a 60-minute oral health educational seminar, there was an overall significant increase in participants' knowledge, attitudes and likelihood towards incorporating oral health preventive practice in their current practices to well-child visits (p<0.05). More confidence in identifying and referring patients with dental trauma was reported by 100% of participants.

CONCLUSIONS

A 60-minute oral health educational seminar was effective in improving paediatric and family medicine residents' immediate knowledge, attitude, and likelihood towards incorporating oral health preventive practice in their current practices to well-child visits. Significantly more residents felt more confident in identifying and referring patients with dental trauma. Key messages: an oral health educational seminar can be effective in improving paediatric and family medicine residents' immediate knowledge, attitude, and likelihood towards incorporating oral health preventive practice in their current practices to well-child visits.

Radiographic Effectiveness of Resin Infiltration in Arresting Incipient Proximal Enamel Lesions in Primary Molars

PURPOSE

The purpose of this split-mouth, randomized, prospective clinical trial was to evaluate radiographically the effectiveness of resin infiltration, as an adjunct to standard-of-care preventive measures compared to standard-of-care preventive measures alone, in arresting the progression of non-adjacent, incipient, proximal enamel lesions in primary molars 24 months after treatment.

METHODS

The study included a total of 45 healthy five- to eight-year-olds who had been diagnosed radiographically with at least two non-adjacent, incipient, proximal enamel lesions in primary molars (90 lesions). Test group lesions were treated using resin infiltration followed by five percent topical sodium fluoride (NaF) application versus five percent NaF alone in the control group. The alpha level was set at 0.05.

RESULTS

The children were examined after six, 12, 18, and 24 months. Twenty-five subjects were examined at the 24-month follow-up visit, At which time 10 of the 25 test lesions (40 percent) showed caries progression while 18 of the 25 control lesions (72 percent) showed caries progression (P=0.04).

CONCLUSION

Resin infiltration as an adjunct to standard-of-care preventive measures is significantly more effective radiographically in reducing the progression of non-adjacent, incipient, proximal enamel lesions in primary molars compared with standard-of-care preventive measures alone after 24 months.

Treating Mucocele in Pediatric Patients Using a Diode Laser: Three Case Reports

A mucocele is the most common minor salivary gland disease and among the most common biopsied oral lesions in pediatric patients. Clinically, a mucocele appears as a round well-circumscribed painless swelling ranging from deep blue to mucosa alike in color. Mucoceles rarely resolve on their own and surgical removal under local anesthesia is required in most cases. Different treatment options are described in the literature, including cryosurgery, intra-lesion injection of corticosteroid, micro-marsupialization and conventional surgical removal using a scalpel, and laser ablation. Therefore, the goal of this paper was to report three cases of mucocele removal in pediatric patients using a diode laser with a one-month follow-up. Mucoceles were removed by a pediatric dentist using a diode laser with a wavelength of 930 nm in continuous mode and a power setting of 1.8 Watts. In all cases, no bleeding occurred during or after the procedure and there was no need for suturing. On clinical examination during the one-month follow-up, in all three cases there was minimal or no scarring, minimal post-operative discomfort or pain, and no recurrence. Diode lasers provide an effective, rapid, simple, bloodless and well accepted procedure for treating mucocele in pediatric patients. Minimal post-operative discomfort and scarring was reported by all the three patients.