Comparative Evaluation of Various Lens and Ring Flash Combination for Intraoral Photography

BACKGROUND

Extraoral and intraoral dental photographs serve as preoperative records and document the entire treatment. Correctly composed orthodontic photographs are crucial for remote diagnosis and may serve as a bulwark against medicolegal challenges.

MATERIALS AND METHODS

In this prospective study, intraoral frontal photographs of patients with ideal occlusion were taken using two types of lenses (EF-S 18-55 mm f/3.5-5.6 IS STM lens (Canon, Tokyo, JP), SP 90 mm F/2.8 MACRO VC lens (Model F017 Tamron, NY, USA)) and two different ring flash systems (Meike FC-100 Macro Ring LED Light (Meike, China), Macro Ring flash Lite YN-14EX (Yongnuo digital, China)). The combination of lens and flash used was grouped into four groups. Twenty-eight intraoral photographs of patients were taken. An image quality assessment survey was distributed among two groups - 50 orthodontists and 50 other dental specialists.

RESULTS

The participants were asked to assess all the intraoral images and subjectively score them on a scale of one to ten, with one being very poor and ten being excellent, considering the sharpness, color, brightness, contrast, and overall quality of the image. The general dentists rated the images taken with a 90-mm macro lens and ring flash as the best quality photographs. Images obtained using an 18-55 mm lens and ring LED received significantly lesser scores and were graded good by dentists.

CONCLUSION

This combination of lens and flash may prove a valuable investment in the long-term aiding in excellent dental images for diagnosis and treatment monitoring.

Antimicrobial Efficacy of Blended Essential Oil and Chlorhexidine against Periodontal Pathogen (P.gingivalis)-An In Vitro Study

Background

Essential oils (EOs) have a considerable amount of therapeutic and preventive effect in treating dental diseases due to their wider potential as antibacterial and anti-inflammatory agents. EOs like virgin coconut oil, eucalyptus oil, peppermint oil thyme oil, and clove oil, when used in combination, may further have enhanced antimicrobial effects. However, limited information exists on the synergistic effect of these oils when used in combination, especially on the primary periodontal pathogen Porphyromonas gingivalis.

Aim

The current study aims to compare the antimicrobial efficacy of commercially available EO on the periodontal pathogen, P. gingivalis, in comparison to chlorhexidine (CHX).

Materials and Methods

Antimicrobial efficacy of EO and CHX was assessed at various concentrations against the periodontal pathogen P. gingivalis, by evaluating the minimum inhibitory concentration (MIC) and minimum bactericidal concentration (MBC).

Results

P. gingivalis was seen to be sensitive at a MIC of 100 μg/ml and 50 μg/ml concentration of the EO, which is regarded as the MIC of EO against P. gingivalis and CHX effectively inhibited microbial growth at 0.4 μg/ml.

Conclusion

A combination of EOs possesses a potent antibacterial activity against P. gingivalis, and the antibacterial efficacy increases with increasing concentration of EOs.

Treatment of Gingival Recession Defects with Pouch and Tunnel Technique Using Connective Tissue Graft and Lyophilized Chorion Membrane in Smokers

BACKGROUND The chorion membrane has been used for several decades as an allograft in tissue repair and various periodontal regenerative procedures. The present study, conducted at a single center in India, aimed to evaluate and compare the clinical outcomes of 26 gingival recession sites in chronic smokers treated using a pouch and tunnel technique with connective tissue graft (CTG) and lyophilized chorion membrane (LCM). MATERIAL AND METHODS The study included 22 smokers with 26 sites of recession defect, with Miller's class I and class II gingival recession, which were allotted into control and test groups. The control group (13 sites) was treated with CTG, and the test group (13 sites) was treated with LCM. Clinical parameters like recession depth, recession width, relative clinical attachment level (RCAL), relative gingival position, width of attached gingiva, and width of keratinized gingiva were recorded at baseline and 6 months postoperatively. Visual analogue scores for pain and wound-healing index scores were assessed in the first week after surgery. RESULTS All clinical parameters showed significant improvements from baseline to 6 months postoperatively in the control and test groups. Recession width, RCAL, width of attached gingiva, and width of keratinized gingiva demonstrated significant differences, whereas mean root coverage percentage and recession depth did not show any significant differences between the study groups at 6 months postoperatively. CONCLUSIONS This study supports the role of LCM allograft as a scaffold to promote soft tissue regeneration and has demonstrated a favorable role for its use in root coverage procedures in patients who smoke.

Suppression of Tumorigenicity 2 Pro-Inflammatory Biomarker Linking Diabetes Mellitus and Periodontitis: A Pilot Study

BACKGROUND Suppression of tumorigenicity 2 (ST2) is a member of the interleukin (IL)-1 family and has 2 isoforms: ST2L, a transmembrane form, and ST2, a soluble form. IL-33 can act as an immune system alarm signal when released by damaged cells, which in turn activates other cells expressing the ST2 receptor. This can cause inflammatory cytokines to be released and produced, as well as trigger osteoclastogenesis. This study aimed to investigate the levels of soluble ST2 in gingival samples. MATERIAL AND METHODS The study population consisted of 30 individuals. The participants were divided into 3 groups: healthy participants, patients with periodontitis, and patients with periodontitis and diabetes mellitus. Periodontitis was determined using probing depth, clinical attachment loss, and gingival index. Patients with stage 2 to 4 periodontitis met the inclusion criteria. Gingival crevicular fluid (GCF) was collected for quantification of samples for ST2 levels by using an enzyme immunoassay. RESULTS The mean±standard deviation of ST2 GCF concentrations was relatively high (558.87±68.99) in the group with periodontitis and diabetes mellitus, compared with that of the periodontitis group (452.06±54.18) and healthy group (252.82±87.9). CONCLUSIONS GCF ST2 values were found to be a marker of inflammatory activities. Thus, GCF ST2 could be a potential biomarker for the diagnosis of periodontitis as well as systemic diseases, such as diabetes mellitus. This pilot study was limited by a small number of participants. To confirm the associations, more large-scale investigations should be conducted.

Interdental Papillary Reconstruction by Microtunnelling Technique Using Autologous Biomatrices-A Randomised Controlled Clinical Trial

Background and objectives: The study aimed to evaluate and compare the amount of papillary gain and black triangle height reduction after intervention with a microtunnelling technique with either Connective tissue graft (CTG) or Platelet-rich fibrin (PRF) as a biomatrix at 6 months using a microsurgical approach. Materials and Methods: Twenty-six patients with interdental papillary loss were included in the study. The patients were selected randomly for the study groups with thirteen patients in each group: a control group where CTG was utilised as a matrix, and a test group where PRF was utilised as a matrix, for interdental papillary reconstruction. A microtunnelling technique was performed for both the study groups under a surgical microscope. The primary parameters assessed were interdental Papillary height (PH) and Black triangle height (BTH) at baseline, with secondary parameters Visual analogue score by dentist (VAS-D) and patient (VAS-P) assessed at 6 months. Results: Both the control and test groups showed a significant reduction in BTH within their respective group at six months (p < 0.05). The gain in papillary height significantly improved only in the CTG group at 6 months. However, significant differences could not be demonstrated for any of the variables such as BTH (p value = 0.582) and PH (p-value = 0.892) between the study groups at 6 months. Conclusions: IDP reconstruction utilising a microtunnelling approach with CTG or PRF was successful without any significant differences between the groups for the parameters assessed at 6 months.

The Efficacy of Low-Level Laser Therapy Combined with Single Flap Periodontal Surgery in the Management of Intrabony Periodontal Defects: A Randomized Controlled Trial

This study aimed at assessing the clinical outcomes of the Single Flap Approach (SFA) with the additional use of Low-level laser therapy (LLLT). The defects were treated as per the principles of SFA, whereby 20 defects received only SFA (control group) and 20 defects received additional LLLT for bio stimulation/bio modulation (test group). Stable primary closure of the flaps was obtained with vertical internal mattress sutures. Plaque indices (FMPS), clinical attachment levels (CAL), probing pocket depth (PPD), and gingival bleeding scores (FMBS) were calculated at baseline, and at the 3rd and 6th months in both groups. An EHI score of 1 was observed at all sites except for two, where a score of 2 in the control group at week 2 was observed. In the test group, the PPD reduction at 6 months was 3.60 ± 0.95 and in the control group it was 3.75 ± 0.91 mm. CAL gain at 6 months was 2.70 ± 1.36 mm and 3.45 ± 1.2 mm in the test group and showed no statistical significance. These data suggested the positive effect of LLLT over CAL gain; thus, LLLT may be combined with SFA to potentially enhance the early wound healing and higher clinical outcomes in terms of increase in CAL and decrease in PPD.

Periodontal Treatment for Chronic Periodontitis With Rheumatoid Arthritis

BACKGROUND

History of rheumatoid arthritis (RA) increases risk of periodontal diseases. A pro-inflammatory condition noted in periodontitis is considered a trigger for RA. Thus, periodontal treatment aimed at attenuating the pro-inflammatory state could aid in potentially reducing the risk of RA.

AIMS

The objective of this research was to assess the effect of periodontal therapy on rheumatoid factor, Disease Activity Score-28, anti-citrullinated protein antibody, and C-reactive protein levels in patients with chronic periodontitis (CP) and RA.

MATERIALS AND METHODS

The sample consisted of 28 patients with CP and RA. The study was designed to be a double-blind, randomised controlled clinical study. The samples were randomly categorised to either the treatment group (n = 13) or the control group (n = 15). CP status (plaque index, bleeding on probing, probing pocket depth, clinical attachment loss), clinical rheumatologic status (Disease Activity Score), and biochemical status (C-reactive protein, anti-citrullinated protein antibody, and rheumatoid factor) were assessed at baseline and at follow-up at 8 to 12 weeks.

RESULTS

The treatment group showed a highly statistically significant reduction in bleeding on probing (P < .005), probing pocket depth (P < .001), plaque index (P < .001), and C-reactive protein (P < .001); a gain in the clinical attachment loss (P < .001) and an improvement in Disease Activity Score-28 (P = .001) were observed at reassessment following nonsurgical periodontal treatment as compared to the control group. However, blood serum anti-citrullinated protein antibody (P = .002) and rheumatoid factor levels (P = .351) were found to increase from baseline to 8 to 12 weeks following subgingival scaling and root planing.

CONCLUSIONS

Reduction of inflammation in the periodontium by nonsurgical periodontal therapy did not reduce anti-citrullinated protein antibody and rheumatoid factor levels. However, it has shown improvement in periodontal conditions, and remarkable changes were observed in the clinical Disease Activity Score and C-reactive protein levels of individuals with RA.

Role of Toothbrushes as Gene Expression Profiling Tool for Oral Cancer Screening in Tobacco and Alcohol Users

AIM

The use of toothbrushes was investigated as a potential RNA source and gene expression profiling tool for oral cancer screening in tobacco and alcohol users.

METHODOLOGY

A total of 20 subjects were selected on the basis of inclusion and exclusion criteria. They were divided into two groups: group I-healthy controls (n = 6); group II-individuals who consume tobacco and alcohol (n = 14). After the volunteers brushed their teeth using a soft-bristle toothbrush with ~0.5 gm of toothpaste, the toothbrushes were collected, and the gene expression of BAX, BCL2, CDK4, CKDN2A, GNB3, and TCF7L2 was assessed.

RESULTS

The gene expression of BAX decreased significantly in alcoholics and smokers (0.13867 ± 0.12014), while the gene expression of BCL2 increased in alcoholics and smokers (1.91001 ± 0.90425) in comparison with healthy controls (p = 0.0054 and p = 0.0055). Although there was increased expression of CDK4, CKDN2A, and TCF7L2 and decreased expression of GNB3 in smokers and alcoholics, the results were not significant.

CONCLUSIONS

A toothbrush is a good source of RNA, and gene expression analysis can be performed using the genetic material retrieved from toothbrushes, which can aid in the early diagnosis of oral squamous cell carcinoma among tobacco and alcohol users. Further studies with a larger sample size and different durations of toothbrush use should be conducted to explore the role of toothbrushes as a noninvasive tool for disease diagnosis.

Evaluating the Effect of Tideglusib-Loaded Bioactive Glass Nanoparticles as a Potential Dentine Regenerative Material

Dental pulp treatment is the least intrusive procedure currently available for preserving the vitality of the pulp. Several studies are underway to improve the bioactivity of pulp capping materials. Tideglusib isa potent anti-inflammatory, antioxidant, and a regenerative drug developed against Alzheimer’s disease and has been shown to be effective in the treatment of dental cavities. However, its bioactive properties encapsulated within the nanoparticles as a component of pulp capping material are largely unknown. In this study, tideglusib-loaded bioactive glass nanoparticles were synthesized (tideglusib-BgNPs) and mixed at various concentrations into the calcium silicate cement to testits physiomechanical and bioactivitiescompared with biodentine (control). The calcium silicate cement with 10wgt% tideglusib-BgNPs showed comparable physiomechanical properties to that of biodentine. Additionally, the assessment of cytotoxicity and bioactivity (cell proliferation, wound healing, and cell migration assays) showed increased bioactivity in terms of better wound healing, increased proliferation, and better migration of human dental pulp stem cells than biodentine. These findings suggest new opportunities to use tideglusib-BgNPs in pulp therapy.

The Effect of Self-Reported Diabetes on Alveolar Bone Loss and Number of Missing Teeth

Background:

Diabetes mellitus, a major public health problem worldwide, is a known risk factor for periodontitis.

Objective:

This study aimed to investigate the effect of diabetes on periodontal health in a Saudi population by assessing alveolar bone level, and the number of missing teeth.

Methods:

In this retrospective study, the dental records of 203 patients (30–70 years old) patients (diabetic group = 102; control = 101) who visited King Abdulaziz University, Faculty of Dentistry, were examined through panoramic radiography. Bone loss measurements were carried out using the Ramfjord teeth index, and the number of missing teeth was counted for both groups. Independent t-test was used for comparing the total average represented by two group means, while Chi-square test was utilized to establish relationships between categorical variables.

Results:

The diabetic group had a significant 1.35-fold higher mean total bone loss (3.59 ± 1.37) compared to the control (2.66 ± 1.05). This was statistically significant in both genders (p = 001) and in >45 years old age group (p <0.05). The number of missing teeth was significantly higher in diabetic patients compared to control patients, specifically when missing >10 teeth and belonging to >55 years old age group (p <0.05).

Conclusion:

Our findings have shown a positive association between periodontal disease and diabetic patients, emphasizing the importance of early screening and diagnosis of diabetes and periodontitis in Saudi Arabia, which would help patients to avoid alveolar bone and tooth loss at early stages.

Expression of Vascular Endothelial Growth Factor Using Platelet Rich Fibrin (PRF) and Nanohydroxyapatite (nano-HA) in Treatment of Periodontal Intra-Bony Defects - A Randomized Controlled Trial

The study aims to assess the concentration of vascular endothelial growth factors (VEGF) with platelet rich fibrin (PRF) biomaterial, while using it separately or in combination with nanohydroxyapatite (nano-HA) for treating intra-bony defects (IBDs) using radiographic evaluation (DBS-Win software). Sixty patients with IBD (one site/patient) and chronic periodontitis were recruited randomly to test either autologous PRF platelet concentrate, nano-HA bone graft, a combination of PRF platelet concentrate and nano-HA, or alone conventional open flap debridement (OFD). Recordings of clinical parameters including probing depth (PD), gingival index (GI), and clinical attachment level (CAL) were obtained at baseline and 6 months, post-operatively. One-way analysis of variance (ANOVA) was used to compare four groups; whereas, multiple comparisons were done through Tukey’s post hoc test. The results showed that CAL at baseline changed from 6.67 ± 1.23 to 4.5 ± 1.42 in group I, 6.6 ± 2.51 to 4.9 ± 1.48 in group II, 5.2 ± 2.17 to 3.1 ± 1.27 in group III, and 4.7 ± 2.22 to 3.7 ± 2.35 in group IV after 6 months. The most significant increase in bone density and fill was observed for IBD depth in group III that was recorded as 62.82 ± 24.6 and 2.31 ± 0.75 mm, respectively. VEGF concentrations were significantly increased at 3, 7, and 14 days in all groups. The use of PRF with nano-HA was successful regenerative periodontal therapy to manage periodontal IBDs, unlike using PRF alone. Increase in VEGF concentrations in all group confirmed its role in angiogenesis and osteogenesis in the early stages of bone defect healing.

Effect of immediate versus delayed loadings of dental implants on the oral health-related quality of life in Saudi population. Experimental clinical trial

OBJECTIVES

To assess the effects of immediate and delayed loadings of dental implants on the overall quality of life (QoL) of patients. Methods: The prospective analysis was conducted in the Department of Periodontology Clinics, Faculty of Dentistry Hospital, King Abdulaziz University, Jeddah, Kingdom of Saudi Arabia. The study was conducted from November 2013 to August 2016 and was according to the principles of the Helsinki Declaration. Quality of life in 24 patients (10 males and 14 females), aged between 18-60 years were assessed. Among the patients, 8 were opted for immediate implant loading (Group I), while 16 have opted for delayed implant loading (Group II). The quality of life was analyzed using a QoL assessment scale before and after the implant loading. Results: Overall assessment revealed that the QoL among the patients immediately after loading of dental implant (Group I) was better as compared to the delayed loading of dental implant (Group II). The differences of functional and financial aspects were significant between both groups. The majority of the immediate implant's loadings have been performed in the anterior aesthetic zone and has a significant impact on the QoL. Conclusion: The results concluded that immediate loading of dental implant is better than the delayed loading of a dental implant with a prosthesis.

Awareness and practice about the association between periodontal diseases and diabetes mellitus: a cross-sectional study in Western Saudi Arabia among health care providers

Purpose

This study aims to assess the awareness and practices of dental and medical practitioners regarding the bidirectional relationship between periodontal diseases and diabetes mellitus.

Patients and methods

A cross-sectional survey of randomly selected dentists and physicians practicing in Jeddah. Participants were asked several questions concerning their awareness and practices on periodontal complications, and the bidirectional link between periodontal diseases and diabetes mellitus (DM).

Results

A total of 560 general practitioners (284 dentists and 276 physicians) participated in the study. There were no significant differences between the two groups regarding any sociodemographic characteristics. Overall, the awareness of all participants was low in all aspects. Moreover, dentists’ awareness and practices were significantly better than physicians as majority of the questions were about the association between periodontal diseases and DM.

Conclusion

The awareness and practices about the link between periodontal diseases and DM should be improved among dental and medical practitioners to effectively prevent and control periodontal diseases and DM.

Effects of Systemic Simvastatin on the Concentrations of Visfatin, Tumor Necrosis Factor-α, and Interleukin-6 in Gingival Crevicular Fluid in Patients with Type 2 Diabetes and Chronic Periodontitis

PURPOSE

The objective of this study is to explore the relationship between the levels of interleukin- (IL-) 6, tumor necrosis factor- (TNF-) α, and visfatin and simvastatin usage, in the gingival crevicular fluids (GCFs) of diabetic patients afflicted with chronic periodontitis.

METHODS

Eighty outpatients at the Periodontology Department, Faculty of Dentistry, University Dental Hospital (King Abdulaziz University), were categorized into 4 groups (20 patients per group), on the basis of radiological evaluation of bone loss, clinical attachment levels (CAL), probing depth (PD), and gingival indices: group 1 (healthy periodontium), group 2 (chronic periodontitis + type 2 diabetes), group 3 (chronic periodontitis), and group 4 (type 2 diabetes + chronic periodontitis + simvastatin). Enzyme-linked immunosorbent assays were used to measure IL-6, TNF-α, and visfatin levels.

RESULTS

Significantly elevated levels of IL-6, TNF-α, and visfatin were seen in group 2 in comparison to groups 1 and 3. Reduced levels were seen in group 4 due to simvastatin usage. Positive association was seen between periodontal variables and the levels of IL-6, TNF-α, and visfatin.

CONCLUSION

Periodontal destruction and diabetes have a synergistic effect on the elevation of inflammatory cytokine levels. Simvastatin may be beneficial in improving periodontal health among diabetic patients.

Treatment of a Gingival Injury From a Cosmetic Laser Burn: A Case Report

Gingival depigmentation is a periodontal plastic surgery procedure for the removal of pigmented gingiva. A gingival depigmentation procedure can be accomplished with the use of a laser; however, as described in this case report, laser burns can be associated with such a procedure, and if one occurs it must be subsequently managed. In this case, the patient presented with a large elliptical ulceration at the right maxillary premolar region. The underlying alveolar bone was exposed and the surrounding gingival margins were inflamed. After debridement of the area and removal of sequestrated bone, a bone graft and subepithelial connective tissue graft were placed using a microsurgery technique to correct the defect. This case report is intended to raise awareness regarding the potential complications of laser gingival depigmentation and present a possible treatment approach for such complications.

Piezocision as an adjunct to orthodontic treatment of unilateral posterior crossbite

Piezocision (corticotomy) is a minimally invasive approach that involves micro-incisions, piezoelectric incisions, and selective tunnelling for soft or hard tissue grafting. Piezocision has many uses in orthodontics, but its uses in cross-bite cases are limited. This case report illustrates the outcomes of a 19-year-old female patient with unilateral cross-bite that was treated with a minimally invasive piezocision with bone grafting in the affected side. In addition, she also had a functional shift, severe crowding, and mid-line shift. Therefore, the shift was eliminated using a quad helix expansion, she was treated with a fixed appliance, and a bimaxillary extraction of the first premolars was performed. The patient followed-up at 18 months, and the occlusion was stable with a pleasant profile. Piezocision can be used as an adjunct to the orthodontic treatment of adults to facilitate the treatment of complicated cases.

Validity and reliability of an Arabic version of the state-trait anxiety inventory in a Saudi dental setting

Objectives:

To test the psychometric properties of an adapted Arabic version of the state trait anxiety-form Y (STAI-Y) in Saudi adult dental patients.

Methods:

In this cross-sectional study, the published Arabic version of the STAI-Y was evaluated by 2 experienced bilingual professionals for its compatibility with Saudi culture and revised prior to testing. Three hundred and eighty-seven patients attending dental clinics for treatment at the Faculty of Dentistry Hospital, King Abdullah University, Jeddah, Kingdom of Saudi Arabia, participated in the study. The Arabic version of the modified dental anxiety scale (MDAS) and visual analogue scale (VAS) ratings of anxiety were used to assess the concurrent criterion validity.

Results:

The Arabic version of the STAI-Y had high internal consistency reliability (Cronbach’s alpha: 0.989) for state and trait subscales. Factor analysis indicated unidimensionality of the scale. Correlations between STAI-Y scores and both MDAS and VAS scores indicated strong concurrent criterion validity. Discriminant validity was supported by the findings that higher anxiety levels were present among females as opposed to males, younger individuals as compared to older individuals, and patients who do not visit the dentist unless they have a need as opposed to more frequent visitors to the dental office.

Conclusion:

The Arabic version of the STAI-Y has an adequate internal consistency reliability, generally similar to that reported in the international literature, suggesting it is appropriate for assessing dental anxiety in Arabic speaking populations.

Effectiveness of bovine-derived xenograft versus bioactive glass with periodontally accelerated osteogenic orthodontics in adults: a randomized, controlled clinical trial

Background

Periodontally accelerated osteogenic orthodontics (PAOO) combines periodontal therapy with orthodontic therapy, which minimises treatment time. This study compared the effectiveness of a bovine-derived xenograft with that of bioactive glass when combined with PAOO for the treatment of adult patients with moderate crowding of the teeth.

Methods

In this prospective, single-masked clinical trial, 33 orthodontic patients (20 women, 13 men; mean age 21.2 ± 1.43 [18 − 27] years), were randomly allocated to one of three groups. Group 1 underwent a modified corticotomy technique on the labial side only, whereas group 2 was treated with the same technique combined with PAOO using a bovine-derived xenograft and group 3 was treated in the same way but combining PAOO with bioactive glass. The total treatment duration was recorded from the start of active orthodontic treatment, immediately after corticotomy, and at the time of debonding. Probing depth was evaluated clinically and bone density and root length were evaluated radiographically on the day of surgery (baseline, T1), post-treatment at debonding (T2), and 9 months post-treatment (T3).

Results

The duration of orthodontic treatment was markedly reduced to an average of 11.4 ± 0.14 weeks in all groups. All probing depths were < 3 mm, the interdental papillae were well preserved, there was no loss of tooth vitality, and there was no evidence of significant apical root resorption at any time interval. All groups showed a decrease in mean bone density at T2 followed by an increase at T3. The net percentage change that occurred between baseline and 9 months post-treatment was significantly different between the three groups. Groups 2 and 3, where grafts were incorporated, demonstrated a statistically significant greater increase in bone density than group 1 at T3.

Conclusion

Combination of orthodontic treatment and periodontal surgery is an effective treatment for adult patients that decreases the duration of active treatment and reduces the risk of root resorption. Use of a bovine-derived xenograft with modified corticotomy provided superior benefits in terms of increased bone density than did the use of bioactive glass.

Trial registration

The study was retrospectively registered at ClinicalTrials.gov under Clinical Trial Registration Number: NCT02796911.

Comparison Between Dexamethasone and Ibuprofen for Postoperative Pain Prevention and Control After Surgical Implant Placement: A Double-Masked, Parallel-Group, Placebo-Controlled Randomized Clinical Trial

BACKGROUND

Postoperative pain is a potential adverse side effect of oral surgeries, and attempts should be made to prevent or minimize it. This study compares efficacy of preemptive ibuprofen and dexamethasone protocols for pain prevention or control after surgical implant placement.

METHODS

This prospective, double-masked, parallel-group, placebo-controlled, randomized clinical trial included 117 patients with planned dental implant placement. Patients were assigned to receive one of three different protocols: 1) 600 mg ibuprofen 1 hour before surgery and another 600 mg 6 hours after the first dose; 2) 4 mg dexamethasone 1 hour before surgery and another 4 mg 6 hours after the first dose; or 3) placebo. Rescue medication (1,000 mg acetaminophen) was made available to each patient, and they were instructed to take it as necessary. Pain intensity was evaluated via a 101-point numeric rating scale and a visual analog scale, and discomfort was evaluated using a four-point verbal rating scale hourly for the first 8 hours after surgery and three times daily for the following 3 days.

RESULTS

Ibuprofen and dexamethasone significantly reduced pain (Kruskal-Wallis; P <0.05) up to 3 days after surgery and discomfort (P <0.05) up to 2 days after surgery compared with placebo treatment. Both treatments reduced the number of painkillers taken and increased time before the first painkiller was taken (P <0.01).

CONCLUSION

Steroidal dexamethasone is as effective as non-steroidal ibuprofen for preventing or controlling postoperative pain and discomfort after surgical implant placement.

Corticotomy-assisted orthodontic treatment. A systematic review of the biological basis and clinical effectiveness

OBJECTIVES

To systematically review the literature to assess the quality of evidence related to corticotomy-assisted orthodontic treatment (CAOT) as adjunctive treatment in orthodontics.

METHODS

The study was conducted in the Faculty of Dentistry, King Abdulaziz University, Jeddah, Saudi Arabia between 2013 and 2014. Various electronic  databases were searched and abstracts were retrieved. Defined inclusion criteria were then applied to the obtained original articles for further evaluation by 2 examiners independently. The criteria of selection included human, or animal studies, which assessed some aspects of CAOT and/or the biological principles behind it. Case reports and series were excluded. The quality of the studies was evaluated by the methodological score for clinical trials developed.

RESULTS

Fourteen articles were retrieved initially, but only 12 articles were finally selected for the study. The CAOT was found to accelerate tooth movement by 2-2.5 folds when compared with conventional orthodontic tooth movement. The CAOT was found safe on periodontal health and exhibits no or little risk of root resorption. A localized turnover of alveolar spongiosa and the absence of a hyalinized zone was the acceptable biological explanation of CAOT. There is no evidence to support that CAOT enhances the movement of ankylosed teeth, closing old extraction sites, post-orthodontic stability, or transverse expansion.

CONCLUSIONS

Corticotomy-assisted orthodontic treatment should be considered with caution. Long term randomized clinical trials are still needed.

Awareness of Antimicrobial Prophylaxis for Infective Endocarditis Among Dental Students and Interns at a Teaching Hospital in Jeddah, Saudi Arabia

Introduction : Infective endocarditis is a serious infection of the heart endothelium and valves. It carries long-term health risks and compromises the heart condition. However, this condition has been rarely observed since the introduction of appropriate antibiotic prophylaxis. Dentists play a major role in preventing infective endocarditis in susceptible patients. In this study, we assessed the levels of awareness about antibiotic prophylaxis for infective endocarditis among students and young dentists at King Abdulaziz University, Jeddah, Saudi Arabia. Methods : This cross-sectional study included 367 dental students and dental interns who answered a questionnaire designed to assess their awareness levels; it included questions pertaining to demographic information and questions examining the general knowledge of the participants with regard to antibiotic prophylaxis for infective endocarditis. Results : An average of 50% of the participants clearly lacked knowledge regarding the conditions that require antibiotic prophylaxis, while an average of 65% provided correct answers pertaining to the conditions that do not require prophylaxis. Regarding dental procedures that require prophylaxis, the majority of responses were correct with an average of 71.2%. With regard to the type of antibiotic to be prescribed, 63.5% of the participants chose to prescribe 2 g of amoxicillin as a first-line antibiotic. Conclusion : The results of this study showed that the levels of awareness about antibiotic prophylaxis for infective endocarditis are below 100%. Awareness is essential because of the cardiac risks associated with the lack of appropriate treatment. Up-to-date and accurate knowledge is mandatory for all dental students and interns who see and treat patients on a daily basis.

Periodontal health and diabetes awareness among Saudi diabetes patients

PURPOSE

This study aimed to examine diabetic patients in Jeddah, Saudi Arabia, regarding their general diabetic and oral health-related awareness and practices, their awareness of the association of diabetes with periodontal disease, and their sources of diabetes-related information.

METHODS

Diabetic patients (n=454) who were receiving care at the diabetes clinic in King Abdulaziz University Hospital, Jeddah, Saudi Arabia, from October 2013 to May 2014, completed a six-part questionnaire assessing their sociodemographic characteristics, general and oral health awareness and practices, and sources of diabetes-related information. Descriptive statistics were used to report the results.

RESULTS

The responses indicated inadequate health-related practices in the surveyed group: 22.2% brushed their teeth twice daily, 73.6% never flossed their teeth, and while 80.2% visited a physician in the past year, only 12.6% visited a dentist during the same year. Of the respondents, 94.8% reported that they had never received advice on oral hygiene tasks in relation to diabetes from a health professional. Awareness about the diabetes and periodontal disease association was limited: 46.7% knew that diabetics have gum problems more often if their blood sugar stays very high, and only 21.8% knew that gum disease makes it harder to control blood sugar in diabetic patients. A significant association (P<0.05) was found between a higher level of education and greater general and oral awareness, as well as a significant association (P<0.05) between longer duration of disease, regular exercise, and regular visits to the physician and awareness about diabetes mellitus. Additionally, a significant association (P<0.05) was found between regular dental visits and both periodontal disease and diabetes awareness. Family and friends were the main source of diabetes-related information, and the Internet was the least likely source.

CONCLUSION

Customized educational programs should be planned for diabetic patients according to community needs.

Knowledge, attitude, and barriers towards the use of evidence based practice among senior dental and medical students in western Saudi Arabia

OBJECTIVES

To investigate the knowledge, attitude, and barriers using evidence based practice (EBP) by future Saudi dentists and physicians.

METHODS

A questionnaire adapted from an EBP questionnaire was distributed to dental and medical final year students and new graduates at King Abdulaziz University, Jeddah, Saudi Arabia during the 2012 to 2013 academic year. The questionnaire consisted of 14 multiple-choice questions, and 2 open ended questions and was divided into 5 sections assessing different categories. Data were grouped as dental (DS) and medical (MS) students. Descriptive and group comparison statistics were conducted.

RESULTS

Out of 400, 297 students responded (DS=207, MS=90) with a 74% response rate. The students' knowledge and attitude were low with no significant difference between the 2 groups. Students` knowledge and attitudes towards EBP were assessed: EBP course attendance (DS=40.1%, MS=13.3%; p=0.000), reading journals (DS=6.3%, MS=3.3%; p=0.313), awareness of EBP components (DS=7.7%, MS=0%; p=0.332), and awareness towards the strongest evidence for EBP (DS=58.9%, MS=53.3%; p=0.370). More than half of the students in both groups did not use EBP in their treatment (DS=85%, MS=84.4%; p=0.842). The greatest reported barriers were;  EBP is difficult to understand (DS=88.9%, MS=72.2%; p=0.000), and no time (DS=54.6%, MS=46.7%; p=0.210).

CONCLUSION

The reported knowledge and attitudes among the junior health care physicians is considered below the required competency standards. These findings highlight the urgent need for changes in the current educational strategies to assure successful implementation of EBP in Saudi Arabia. 

Validity and reliability of an Arabic version of the modified dental anxiety scale in Saudi adults

OBJECTIVES

To test the reliability and validity of an Arabic version of the modified dental anxiety scale (MDAS), and to correlate it with other demographic data.

METHODS

The original English version of the MDAS was translated into Arabic, and then translated back into English by experienced bilingual professionals. Four hundred and seventy-four patients referred to dental clinics for treatment at the Faculty of Dentistry Hospital, Jeddah, Kingdom of Saudi Arabia from November 2012 to June 2013 participated in the study. The assessment tool included questions regarding demographic characteristics, frequency of dental visits, the Arabic version of the MDAS, and the patient's rating of their current level of anxiety using a visual analogue scale (VAS).

RESULTS

The Arabic version of the MDAS had excellent internal consistency and reliability (Alpha coefficients >0.90). The scale was unidimensional, and the percentage of patients with dental anxiety was 48.3% (using a cutoff total score of >15) and with dental phobia was 2.5% (using a cutoff total score of >16). Younger patients, females, and infrequent visitors to the dentist were more anxious than those who were older, male, and frequent visitors. Visual analogue scale scores correlated significantly with individual items on the MDAS questionnaire and total anxiety score, supporting the criterion validity.

CONCLUSION

The Arabic version of the MDAS presented adequate internal consistency reliability, allowing its safe use to assess levels of dental anxiety in Arabic-speaking populations.