Economic and social determinants of health care utilization during the first wave of COVID-19 pandemic among adults in Ghana: a population-based cross-sectional study

BACKGROUND

The COVID-19 pandemic had socioeconomic effects in Africa. This study assessed the social and economic determinants of healthcare utilization during the first wave of COVID-19 among adults in Ghana.

METHODS

Information about individuals residing in Ghana was derived from a survey conducted across multiple countries, aiming to evaluate the impact of the COVID-19 pandemic on the mental health and overall well-being of adults aged 18 and above. The dependent variable for the study was healthcare utilization (categorized as low or high). The independent variables were economic (such as financial loss, job loss, diminished wages, investment/retirement setbacks, and non-refunded travel cancellations) and social (including food scarcity, loss of financial support sources, housing instability, challenges affording food, clothing, shelter, electricity, utilities, and increased caregiving responsibilities for partners) determinants of health. A multinomial logistic regression was conducted to identify factors associated with healthcare utilization after adjusting for confounders (age, gender, access to medical insurance, COVID-19 status, educational background, employment, and marital status of the participants).

RESULTS

The analysis included 364 responses. Individuals who encountered a loss of financial support (AOR: 9.58; 95% CI: 3.44-26.73; p < 0.001), a decrease or loss of wages (AOR: 7.44, 95% CI: 3.05-18.16, p < 0.001), experienced investment or retirement setbacks (AOR: 10.69, 95% CI: 2.60-43.88, p = 0.001), and expressed concerns about potential food shortages (AOR: 6.85, 95% CI: 2.49-18.84, p < 0.001) exhibited significantly higher odds of low healthcare utilization during the initial phase of the pandemic. Contrastingly, participants facing challenges in paying for basic needs demonstrated lower odds of low healthcare utilization compared to those who found it easy to cover basic expenses (AOR: 0.19, 95% CI: 0.06-0.67, p = 0.001).

CONCLUSION

Economic and social factors were associated with low healthcare utilization in Ghana during the first wave of the pandemic. Investment or retirement loss and financial support loss during the pandemic had the largest effect on healthcare utilization. Further research is needed to understand the connection between concerns about food shortages, welfare losses during pandemics and healthcare utilization during pandemics in Ghana.

Socio-economic factors associated with post-traumatic stress symptoms among adolescents and young people during the first wave of the COVID-19 pandemic

This study assessed the association between sociodemographic factors and post-traumatic stress symptoms (PTSS) among 18-24-year-olds during the first wave of the COVID-19 pandemic. This was a secondary analysis of data from 4508 individuals collected through an online survey conducted between June and January 2021. PTSS was measured as a dependent variable using the checklist for post-traumatic stress disorder in civilians. Age, birth sex, sexual, level of education, access to emotional and social support, and emotional distress were the independent variables. A multivariate logistic regression analysis was conducted to determine the associations between the dependent and independent variables while controlling for the country related confounding variables. Females (AOR:2.023), sexual minority individuals (AOR:1.868), those who did not disclose their sexual identify (AOR:1.476), those with poor access to emotional and social support (AOR:4.699) and individuals with no formal education (AOR:13.908), and only primary level education (AOR:4.521) had higher odds of PTSS. The study highlights the multifaceted nature of PTSS during the pandemic and suggests the importance of promoting access of young people, especially females, sexual minority individuals and those with low educational status, to emotional/social support to mitigate the probability of PTSS, especially among sexual minority individuals.

Influence of denture brushing on the surface properties and color stability of CAD-CAM, thermoformed, and conventionally fabricated denture base resins

PURPOSE

To assess the influence of denture brushing on the surface roughness, hardness, and color stability of conventional, thermoformed, and CAD-CAM denture base materials.

MATERIALS AND METHODS

Seven different denture base materials were included in this study; conventional heat-polymerized acrylic resin (PMMA) served as control, polyamide, acetal, two categories of milled acrylic discs (AvaDent and IvoCad), and two categories of 3D-printed resins (NextDent and FormLabs). The specimens were constructed according to manufacturers' instructions and then subjected to simulated brushing (20,000 cycles). According to the brushing method, the specimens were split into three groups, no brushing, brushing with water, and brushing with toothpaste. Surface roughness, hardness, and color change were evaluated before and after brushing. Collected data were analyzed using ANOVA, and post-hoc Tukey's tests (α = 0.05).

RESULTS

A significant difference was noted between the surface roughness of the tested materials before and after denture brushing (p < 0.05), and milled resin showed the least Ra values. Denture brushing with water significantly increased the Ra of PMMA (p = 0.004) and IvoCad (p = 0.032), while brushing using toothpaste did not show a significant increase. The brushing protocols did not alter the hardness of tested materials except that of PMMA (p = 0.001). The color stability of the tested materials showed comparable results with both brushing protocols.

CONCLUSION

The tested properties showed variations between the types of denture base resins. Hardness and color stability of CAD-CAM and thermoformed denture base resins were not altered by denture brushing and showed comparable results with both brushing methods. Surface roughness was the only property that showed alteration after denture brushing.

#implantology: A content analysis of the implant-related hashtags on Instagram

STATEMENT OF PROBLEM

Social media platforms such as Instagram have recently become popular among dentists, dental interest groups, and patients for sharing dental-related information. However, a study that dissects and analyzes implant-related posts on Instagram is lacking.

PURPOSE

The purpose of this study was to analyze the type of implant-related information on Instagram by highlighting the characteristics of the top-performing posts and assessing their usefulness as educational content.

MATERIAL AND METHODS

A list of 12 implantology-related hashtags on Instagram was searched, and, for each hashtag, data were acquired for the "Top 12 posts" listed by the Instagram search algorithm. The contents of each post, including the number of likes and followers, content type, poster role, post content, theme and type, account type, and accuracy of claims, were collected. Descriptive statistics were calculated, and comparisons were performed by using the Mann-Whitney U and Kruskal Wallis tests (α=.05).

RESULTS

The search identified 4 541 867 implant-related posts. The 2 most used hashtags were #dentalimplants (n=1 478 770) and #implant (n=1 303 575). Authorship and content analysis showed that dentists, including specialists, posted about 42% of the posts. More than half of the posts were in the form of pictures (62.5%), self-promotional (77.8%), and used for marketing purposes (61.8%). Most posts were not supported by evidence, and only 27.8% shared clinical facts. However, compared with self-promotional posts, most educational posts shared clinical facts with more likes, views, and followers (P<.001).

CONCLUSIONS

More than 4 million posts related to implant dentistry were identified on Instagram. Dental interest groups and patients authored most posts, with less contribution from dentists and specialists. Social media awareness among dentists may enhance the number of educational posts and provide a novel platform for networking and communication.

Child dental neglect and legal protections: a compendium of briefs from policy reviews in 26 countries and a special administrative region of China

Background

Child neglect is a public health, human rights, and social problem, with potentially devastating and costly consequences. The aim of this study was to: (1) summarize the oral health profile of children across the globe; (2) provide a brief overview of legal instruments that can offer children protection from dental neglect; and (3) discuss the effectiveness of these legal instruments.

Methods

We summarized and highlighted the caries profile and status of implementation of legislation on child dental neglect for 26 countries representing the World Health Organization regions: five countries in Africa (Nigeria, South Africa, Sudan, Tanzania, Zimbabwe), eight in the Americas (Argentina, Brazil, Canada, Chile, Mexico, Peru, Unites States of America, Uruguay), six in the Eastern Mediterranean (Egypt, Iran, Libya, Jordan, Qatar, Saudi Arabia), four in Europe (Italy, Latvia, Serbia, United Kingdom), two in South-East Asia (India and Indonesia) and one country (China) with its special administrative region (Hong Kong) in the Western Pacific.

Results

Twenty-five of the 26 countries have legal instruments to address child neglect. Only two (8.0%) of these 25 countries had specific legal instruments on child dental neglect. Although child neglect laws can be interpreted to establish a case of child dental neglect, the latter may be difficult to establish in countries where governments have not addressed barriers that limit children's access to oral healthcare. Where there are specific legal instruments to address child dental neglect, a supportive social ecosystem has also been built to facilitate children's access to oral healthcare. A supportive legal environment, however, does not seem to confer extra protection against risks for untreated dental caries.

Conclusions

The institution of specific country-level legislation on child dental neglect may not significantly reduce the national prevalence of untreated caries in children. It, however, increases the prospect for building a social ecosystem that may reduce the risk of untreated caries at the individual level. Social ecosystems to mitigate child dental neglect can be built when there is specific legislation against child dental neglect. It may be more effective to combine public health and human rights-based approaches, inclusive of an efficient criminal justice system to deal with child dental neglect.

Associations between mental health challenges, sexual activity, alcohol consumption, use of other psychoactive substances and use of COVID-19 preventive measures during the first wave of the COVID-19 pandemic by adults in Nigeria

BACKGROUND

The aims of this study were to assess: 1) the associations among sexual activity, alcohol consumption, use of other psychoactive substances and mental health during the COVID-19 pandemic; and 2) the associations between COVID-19 preventive measures, alcohol consumption and use of psychoactive substances.

METHODS

This was a secondary analysis of data collected from adults in Nigeria between July and December 2020. The variables extracted included change in sexual activity, alcohol consumption and use of other psychoactive substances, COVID-19 preventive behaviors (wearing face masks, washing hands, physical distancing), anxiety, depression, post-traumatic stress disorder (PTSD) and sociodemographic variables (age, sex, education, HIV status, employment status). Multivariable logistic regressions were conducted. A model was run to regress depression, anxiety, PTSD, increased alcohol consumption, and increased use of other psychoactive substances, on increased sexual activity. In separate models, anxiety, depression, and PTSD were regressed on increased alcohol consumption and on increased use of other psychoactive substances. Finally, three models were constructed to determine the associations between increased alcohol consumption and increased use of other psychoactive substances on three separate COVID-19 preventive behaviors. All models were adjusted for sociodemographic variables.

RESULTS

Increased alcohol consumption (AOR:2.19) and increased use of other psychoactive substances (AOR: 3.71) were significantly associated with higher odds of increased sexual activity. Depression was associated with significantly higher odds of increased alcohol consumption (AOR:1.71) and increased use of other psychoactive substances (AOR:3.21). Increased alcohol consumption was associated with significantly lower odds of physical distancing (AOR:0.59).

CONCLUSION

There was a complex inter-relationship between mental health, sexual health, increased use of psychoactive substances. The consumption of alcohol also affected compliance with physical distancing. Further studies are needed to understand the observed relationships.

A multi-country survey of the socio-demographic factors associated with adherence to COVID-19 preventive measures during the first wave of the COVID-19 pandemic

BACKGROUND

Health behaviours are influenced by individual characteristics including age, gender, education and economic level. This study aimed to assess the associations between individual-level determinants and adherence to COVID-19 preventive measures.

METHODS

We performed secondary analyses of international data collected using an online survey during the first wave of the COVID-19 pandemic between June and December 2020. The dependent variables were self-reported adherence to COVID-19 preventive measures (wearing of face masks, frequent washing/sanitizing of hands, physical distancing, working remotely). The independent variables were age, sex at birth (female vs male), having a chronic disease related elevated risk for severe COVID-19 (none/little, might be at increased risk, at increased risk), educational level completed (no formal education, primary, secondary vs college/university) and employment status (retiree, students, not employed vs employed). Four multivariate logistic regression analyses were conducted to determine the associations between the dependent variables and independent variables. Interaction terms with country-income level were tested in regressions to explore its moderating effect.

RESULTS

Out of 16,866 respondents, 12,634 (74.9%) wore masks or face coverings, 12,336 (73.1%) washed or sanitized their hands frequently, 11,464 (68.0%) reported adherence to physical distancing and 5,646 (33.5%) worked remotely. In adjusted analyses, increased age, college/university education, employment, and having risks for severe COVID-19 were associated with significantly higher odds of adhering to COVID-19 preventive measures. Retirees and students had lower odds of adhering to COVID-19 prevention measures than employed individuals. Males had significantly lower odds of wearing face masks (AOR: 0.901), frequent washing/sanitizing hands (AOR: 0.774) and working remotely (AOR: 0.875) compared to females. Country-income level generally moderated the above relationships such that the associations disappeared in lower income countries.

CONCLUSION

The study findings suggest that the individual socio-demographic factors-age, sex, employment status, education status and having a chronic disease - influence adherence to COVID-19 preventive measures. Findings further reiterate the need for health education and health promotion campaigns on preventive health measures to focus on subpopulations, such as younger males, students and retirees, that require targeted or unique messaging.

Fracture Strength of Composite Rest Seats: An In Vitro Comparative Study of Different Composite versus Amalgam Restorations

Occlusal rest provides support for removable partial dentures (RPD). Rest seats are ideally prepared in enamel, but the abutment teeth might be restored or need restorations. This study compared the fracture strength of abutments restored with composite to amalgam restorations after rest seat preparation. Disto-occlusal cavities were prepared in 30 extracted human maxillary premolars. The specimens were allocated in three groups (n = 10) based on the type of restoration. All the specimens were exposed to thermomechanical aging followed by cycling loading. Fracture strength was tested using a universal testing machine, and then, the fracture mode was recorded. The data were analyzed using Kruskal-Wallis test with a significance level set at 0.05. The fracture mode was recorded as catastrophic or non-catastrophic. The fracture strength between all tested groups showed no significant difference. The highest and lowest fracture strength were recorded on amalgam and Tetric N-Ceram groups, respectively. Composite Tetric N-Ceram showed equal distribution of fracture sites on the restorative materials and teeth, it also displayed the highest number of non-catastrophic fractures unlike other groups where the fracture occurred more within the restorations. The fracture strength of composite was comparable to that of amalgam restorations with prepared rest seats.

Social media information and its association with the adoption of COVID-19 preventive measures in four Latin American countries

Objective

The study aimed to assess the association between adherence to COVID-19 preventive measures and access to media information related to COVID-19.

Methods

A multi-country, cross-sectional study using an online survey was conducted from June to December 2020. The sample included 1,457 participants from Argentina, Brazil, Chile, and Mexico. The outcome variable was self-reported adherence to preventive measures (handwashing, social distancing, self-isolation, use of face masks, and working from home). The explanatory variable was self-report of following media information related to COVID-19 (watching or reading the news, following social media coverage). Multivariable logistic regression analyses were conducted to determine the associations.

Results

Following information on social media was positively associated with higher odds of practicing social distancing (AOR=5.39; 95%CI: 3.93-7.30), self-isolation (AOR=1.44; 95%CI: 1.08-1.92), use of face masks (AOR=16.84; 95%CI: 10.03-28.27), handwashing (AOR=6.95; CI 95%: 4.98-9.71), and working from home (AOR=1.85; 95% CI: 1.43-2.41). Differences in the use of social media for COVID-19 information were observed among the four countries.

Conclusion

Following social media was positively associated with adherence to COVID-19 preventive measures in Latin America. Social media may be effectively used for COVID-19 behaviour modification in Latin America.

Teledentistry from research to practice: a tale of nineteen countries

Aim

The COVID-19 pandemic has accelerated teledentistry research with great interest reflected in the increasing number of publications. In many countries, teledentistry programs were established although not much is known about the extent of incorporating teledentistry into practice and healthcare systems. This study aimed to report on policies and strategies related to teledentistry practice as well as barriers and facilitators for this implementation in 19 countries.

Methods

Data were presented per country about information and communication technology (ICT) infrastructure, income level, policies for health information system (HIS), eHealth and telemedicine. Researchers were selected based on their previous publications in teledentistry and were invited to report on the situation in their respective countries including Bosnia and Herzegovina, Canada, Chile, China, Egypt, Finland, France, Hong Kong SAR, Iran, Italy, Libya, Mexico, New Zealand, Nigeria, Qatar, Saudi Arabia, South Africa, United Kingdom, Zimbabwe.

Results

Ten (52.6%) countries were high income, 11 (57.9%) had eHealth policies, 7 (36.8%) had HIS policies and 5 (26.3%) had telehealth policies. Six (31.6%) countries had policies or strategies for teledentistry and no teledentistry programs were reported in two countries. Teledentistry programs were incorporated into the healthcare systems at national (n = 5), intermediate (provincial) (n = 4) and local (n = 8) levels. These programs were established in three countries, piloted in 5 countries and informal in 9 countries.

Conclusion

Despite the growth in teledentistry research during the COVID-19 pandemic, the use of teledentistry in daily clinical practice is still limited in most countries. Few countries have instituted teledentistry programs at national level. Laws, funding schemes and training are needed to support the incorporation of teledentistry into healthcare systems to institutionalize the practice of teledentistry. Mapping teledentistry practices in other countries and extending services to under-covered populations increases the benefit of teledentistry.

Associations between depression, fear of COVID-19 infection and students' self-care measures used during the first wave of the pandemic

BACKGROUND

COVID-19 lockdown resulted in the closure of schools with associated problems. The aim of this study was to determine the associations between depression, fear of contracting COVID-19 infection and the use of self-care measures by college students during the first wave of the COVID-19 pandemic.

METHODS

This was a cross-sectional study that collected data from undergraduate and postgraduate college students 18 years and older from 152 countries between June and December 2020. Study participants were recruited through crowdsourcing using various social media platforms including Facebook, Twitter, and Instagram, WhatsApp groups and emails to participants in the collaborators' networks. The dependent variables were fear of contracting COVID-19 and depression while the independent variable was students' self-care measures. Multivariable logistic regression models were conducted to assess the associations between the dependent and independent variables.

RESULTS

Of the 2840 respondents, 1305 (46.0%) had fears of contracting COVID-19 and 599 (21.1%) reported depression. The most common self-care measures were phone calls with friends/family (60.1%) and video chat (52.8%). Learning a new skill was significantly associated with higher odds of fear of contracting COVID-19 (AOR = 1.669) and lower odds of having depression (AOR = 0.684). Talking to friends/family through video chat (AOR = 0.809) was significantly associated with lower odds of feeling depressed while spending time with pets (AOR = 1.470) and taking breaks from the news/social media (AOR = 1.242) were significantly associated with higher odds of feeling depressed. Students from lower middle-income countries (AOR = 0.330) had significantly lower odds of feeling depressed than students from low-income countries.

CONCLUSION

Self-care strategies involving social interactions were associated with less depression. Coping strategies with more cognitive demands may significantly reduce the risk of fear of COVID-19. Special attention needs to be given to students in low-income countries who have higher odds of depression during the pandemic than students from other countries.

A multi-country study of the associations between HIV vulnerability status, perception of COVID-19 related stigma and post-traumatic stress symptoms during the first wave of the pandemic

BACKGROUND

This study investigated the associations between COVID-19 related stigma and post-traumatic stress symptoms (PTSS); and the associations between PTSS and COVID-19 related stigma, HIV status, COVID-19 status and key HIV population status.

METHODS

This was a secondary analysis of data of 12,355 study participants generated through an online survey that recruited adults from 152 countries between July and December 2020. The dependent variables were COVID-19-related stigma and PTSS. The independent variables were HIV status (positive/negative), transaction sex (yes/no), use of psychoactive drugs (yes/no), and vulnerability status (transaction sex workers, people who use psychoactive drugs, living with HIV, and COVID-19 status). The confounding variables were age, sex at birth (male/female), level of education, sexual minority individuals (yes/no) and country income level. Multivariable logistic regression analyses were conducted to determine associations between the dependent and independent variables after adjusting for confounders.

RESULTS

There were 835 (6.8%) participants who experienced COVID-19 related stigma during the pandemic and 3,824 (31.0%) participants reported PTSS. Respondents who were living with HIV (AOR: 1.979; 95%CI: 1.522-2.573), tested positive for COVID-19 (AOR: 3.369; 95%CI: 2.692-4.217), engaged in transactional sex (AOR: 1.428; 95%CI: 1.060-1.922) and used psychoactive drugs (AOR: 1.364; 95%CI: 1.053-1.767) had significantly higher odds of experiencing COVID-19 related stigma. Individuals with vulnerability status (AOR:4.610; 95%CI: 1.590-13.368) and who experienced COVID-19 related stigma (AOR: 2.218; 95%CI: 1.920-2.561) had significantly higher odds of PTSS.

CONCLUSION

Individuals with vulnerability status may be at increased risk for COVID-19 related stigma. Key and vulnerable populations who were living with HIV and who experienced stigma may be at a higher risk of experiencing PTSS. Populations at risk for PTSS should be routinely screened and provided adequate support when they contract COVID-19 to reduce the risk for poor mental health during COVID-19 outbreaks and during future health crisis with similar magnitude as the COVID-19 pandemic.

Knowledge of Saudi dental students and interns towards luting cements and their applications in fixed prosthodontics

BACKGROUND

Enhancement of students' knowledge is essential in improving their clinical skills and performance. Thus, the curriculum should be prepared to achieve a better outcome. The current study aimed to determine the dental students' and interns' basic knowledge towards dental luting cements and their application in dental practice to improve the theoretical and clinical training sections.

MATERIALS AND METHODS

A cross-sectional study was conducted among dental students and interns at three Colleges of Dentistry in the Kingdom of Saudi Arabia between September 2019-June 2020. An online questionnaire was used which included demographic data, questions about luting cement usage, cementation techniques, and commonly used cements in dental clinics. Descriptive analysis and chi-square test were used to show the association between level of dental education and the use of dental cements using SPSS software. The significance level was set at 5%.

RESULTS

The total respondents were 626 dental students/interns of whom 78.8% were undergraduate dental students. Participants who reported undergraduate studies as the source of information were 79.7%. The type of restoration was the main factor in luting cement selection (62.6%). Concerning the isolation technique in cementing laminate veneers, 49.7% used dri-angles, cotton rolls and saliva ejectors. Dual-cure resin cement was the most common cement used in all the mentioned restorations except in pressed porcelain laminate veneers and cement-retained implant-supported restorations.

CONCLUSIONS

Students' knowledge and practice in managing dental implants and porcelain laminate veneers need to be improved. The selection of a luting agent for a given restoration by students and interns was based on the basic knowledge, available cement, and the type of restoration. Awareness towards the management of short prepared teeth and custom-made cast posts and cores is also limited.

Differences in adoption of COVID-19 pandemic related preventive behaviour by viral load suppression status among people living with HIV during the first wave of the pandemic

BACKGROUND

Adherence to antiretroviral therapy and COVID-19 preventive behaviours among people living with HIV during the pandemic has received little attention in the literature. To address this gap in knowledge, the present study assessed the associations between viral load, adherence to antiretroviral therapy and the use of COVID-19 prevention strategies during the first wave of the COVID-19 pandemic. This was a secondary analysis of data generated through an online survey recruiting participants from 152 countries. Complete data from 680 respondents living with HIV were extracted for this analysis.

RESULTS

The findings suggest that detectable viral load was associated with lower odds of wearing facemasks (AOR: 0.44; 95% CI:0.28-0.69; p < 0.01) and washing hands as often as recommended (AOR: 0.64; 95% CI: 0.42-0.97; p = 0.03). Also, adherence to the use of antiretroviral drugs was associated with lower odds of working remotely (AOR: 0.60; 95% CI: 0.38-0.94; p = 0.02). We found a complex relationship between HIV positive status biological parameters and adherence to COVID-19 preventive measures that may be partly explained by risk-taking behaviours. Further studies are needed to understand the reasons for the study findings.

Effect of Different Scaling Methods on the Surface Topography of Different CAD/CAM Ceramic Compositions

This study evaluated the effect of ultrasonic and manual scaling using different scaler materials on the surface topography of computer-aided designing and computer-aided manufacturing (CAD/CAM) ceramic compositions. After scaling with manual and ultrasonic scalers, the surface properties of four classes of CAD/CAM ceramic discs: lithium disilicate (IPE), leucite-reinforced (IPS), advanced lithium disilicate (CT), and zirconia-reinforced lithium silicate (CD) of 1.5 mm thickness were evaluated. Surface roughness was measured before and after treatment, and scanning electron microscopy was used to evaluate the surface topography following the performed scaling procedures. Two-way ANOVA was conducted to assess the association of the ceramic material and scaling method with the surface roughness. There was a significant difference in the surface roughness between the ceramic materials subjected to different scaling methods (p < 0.001). Post-hoc analyses revealed significant differences between all groups except for IPE and IPS where no significant differences were detected between them. CD showed the highest surface roughness values, while CT showed the lowest surface roughness values for the control specimens and after exposure to different scaling methods. Moreover, the specimens subjected to ultrasonic scaling displayed the highest roughness values, while the least surface roughness was noted with the plastic scaling method.

Comparison of the color stability and surface roughness of 3-unit provisional fixed partial dentures fabricated by milling, conventional and different 3D printing fabrication techniques

OBJECTIVES

To compare the color stability and surface roughness of 3-unit provisional fixed partial dentures (FPDs) fabricated by milling, conventional, and different 3D printing fabrication techniques.

METHODS

A total sample of 160, 3-unit FPDs were subdivided into four groups; subtractive milled resin (SM), two 3D printed resins (Stereolithography; SLA and Digital Light Processing; DLP) and conventional self-cured polymethyl methacrylate resin (CM). Surface roughness (Ra) was assessed twice; at baseline (Ra1) and after artificial tooth brushing (Ra2). Color of the samples was measured after immersion in four different solutions (cola, coffee, black tea and distilled water) at three time intervals (1, 7 and 30 days). Comparisons of the Ra and the color change (∆E₀₀) were done using one-way ANOVA followed by multiple pairwise comparisons using Bonferroni adjusted significance level. Comparisons of the Ra at two stages (Ra1 and Ra2) were done using paired t-test. Univariate linear regression was performed followed by multivariable regression to assess the association between ∆E₀₀ and different factors (materials, solution, and time). Significance was set at P value <0.05.

RESULTS

The highest change in Ra following artificial tooth brushing was reported in the CM group, while the lowest change was reported in the SM group, with a significant difference between both groups (P<0.001). SM group had significantly lower ∆E₀₀ than the CM group followed by 3D printed SLA and DLP groups (P<0.001). Storage in coffee for 30 days showed the highest ∆E₀₀ values (P<0.001).

CONCLUSIONS

SM resin showed the least surface roughness and color change followed by 3D printed SLA resin. The difference in printing technology affected the tested properties with improved readings of 3D printed SLA resin.

CLINICAL SIGNIFICANCE

Milled provisional FPDs showed higher surface smoothness and color stability than those fabricated by SLA printing technology, but with no significant difference between both groups. Therefore, SLA printed resins can be an adequate substitute to milled resins in the fabrication of provisional FPDs to overcome the high expenses of milled provisional FPDs.

Career satisfaction amongst dental students and dentists in Saudi Arabia: A cross-sectional survey

INTRODUCTION

Dental students' satisfaction with their own career can significantly improve the quality of care provided to patients. The aim of the current study was to assess the level of career satisfaction amongst Saudi dental students and dentists.

MATERIALS AND METHODS

A cross-sectional survey was conducted from October 2019 to January 2020 all over Saudi Arabia. A sample of 750 Saudi dental students and dentists were invited to complete an online questionnaire. The questionnaire was composed of two sections of closed-ended questions. The first section included personal, professional background factors and level of career satisfaction assessed. The second section included different reasons for choosing dentistry as a career. Multivariable linear regression was used at significance <0.05.

RESULTS

Only 674 responded to the questionnaire. About half of the included respondents were males. Most of the participants were undergraduate students attended Saudi dental schools. 72.3% chose dentistry for helping other people. Graduated dentists had significantly lower satisfaction score than dental students (p = .007). Dentists, who chose dentistry because it is a secured job with good income (p < .001), had significantly lower satisfaction score than those who did not, whilst those who chose it for the social status had significantly higher satisfaction score than those who did not (p = .04).

CONCLUSION

Dental students and dentists were motivated to choose dentistry as it is an opportunity to help others and achieve good salary with appropriate social position in community. Dental students were more satisfied than dentists due to lack of financial responsibilities and absence of educational expenses.

Factors associated with an increase in tobacco use and alcohol drinking during the COVID-19 pandemic: A cross-sectional study of data from 105 countries

INTRODUCTION

The COVID-19 pandemic has inevitably led to monumental challenges, and alcohol drinking and tobacco use have unlikely been spared. This cross-sectional survey reports on factors associated with an increase in alcohol drinking and tobacco use during the COVID-19 pandemic.

METHODS

An online survey conducted in 2020, generated data from 14899 adults residing in 105 countries. Dependent variables were changes in alcohol drinking and tobacco use. Independent variables were age, sex, education level, job loss, lost or reduced wages, investment/retirement benefits, interrupted substance addiction care, and income level of the countries. Multilevel logistic regression analysis was computed to explore the associations between dependent and independent variables in adjusted models using the backward stepwise method. The probability of including or excluding a covariate was set at p(in)<0.05 and p(out)>0.1, respectively.

RESULTS

Of the regular alcohol consumers (N=4401), 22.9% reported an increase in their alcohol drinking. Of the regular tobacco users (N=2718), 31% reported an increase in their tobacco use. Job loss (Alcohol: AOR=1.26; Tobacco: AOR=1.32) and lost/reduced wages (Alcohol: AOR=1.52; Tobacco: AOR=1.52) were associated with higher odds of increased alcohol drinking and tobacco use. Many interruptions to addiction care (AOR=1.75) were associated with higher odds of increased alcohol drinking. Whereas no interruption to addiction care was associated with lower odds of increased alcohol drinking (AOR=0.77). Also, none (AOR=0.66) or some (AOR=0.70) interruptions to addiction care were associated with lower odds of increased tobacco use.

CONCLUSIONS

This global survey alludes to the unintended consequences of the current COVID-19 pandemic on alcohol drinking and tobacco use. It is critical that the strategies for emergency responses should include support to ameliorate the impact of financial distress and disruption in substance dependence treatment services.

A multi-country survey on access to healthcare and treatment services among individuals with critical medical care needs during the first wave of the pandemic

BACKGROUND

Healthcare services were significantly interrupted during the early phase of the COVID-19 pandemic. The aim of the present study was to determine the associations between sociodemographic factors and healthcare access during the first wave of the COVID-19 pandemic among individuals with critical care needs.

METHODS

This was a secondary analysis of the data of 5,156 participants recruited from 152 countries during the first wave of the COVID-19 pandemic. The dependent variables were self-reported difficulty of access to health care, challenges with obtaining medication, and the use of alternative medical services. The independent variables were age at last birthday; sex at birth, level of education, employment status and the macro-social vulnerability status. The confounding variable was the country income level. Three multivariable logistic regression analyses were conducted to determine the associations between the dependent variables and the independent variables after adjusting for the confounder.

RESULTS

Difficulty accessing health care services and obtaining medications was experienced by 1922 (37.3%) and 3746 (72.7%) participants respectively. Also, 1433 (27.8%) used alternative medical care. Retirees (AOR:1.59), unemployed (AOR:1.198), people living with HIV (AOR:2.36) and at increased risk of COVID-19 (AOR:2.10), people who used drugs (AOR:1.83) and transacted sex (AOR:1.971) had significantly higher odds for reporting difficulty with access to health care. Males (AOR:1.23), respondents with secondary level of education (AOR:1.39), retirees (AOR:2.19), unemployed (AOR:1.47), people living with HIV (AOR:2.46), people who used drugs (AOR:1.79), transacted sex (AOR:2.71) and those who might be (AOR: 1.66) and were at (AOR: 2.3) increased risk of severe COVID-19 had significantly higher odds for reporting difficulty with access to medications. People who used drugs (AOR:2.093) transacted sex (AOR:1.639), who might be (AOR: 1.211) and were at (AOR: 1.511) increased risk of severe COVID-19, and who had difficulty accessing usual healthcare (AOR: 9.047) and obtaining medications (AOR:2.16) had significantly higher odds of reporting alternative medical care use. People living with HIV (AOR:0.562) had significantly lower odds of using alternative medical care.

CONCLUSION

We identified populations who had challenges with access to healthcare and obtaining medications used alternative medical care except for people living with HIV. Priority attention should be given to alternative medical care use during future health pandemics.

Influences of Different CAD/CAM Ceramic Compositions and Thicknesses on the Mechanical Properties of Ceramic Restorations: An In Vitro Study

The aim of this study was to assess the influences of different CAD/CAM ceramic compositions and thicknesses on the surface roughness and hardness of ceramic restorations. Four different ceramics were used in the current study: lithium disilicate (LD), leucite reinforced (LE), advanced lithium disilicate (ALD), and zirconia-reinforced lithium silicate (ZLS). Each group included 30 specimens subdivided into three different ceramic thicknesses (0.5, 1 and 1.5 mm thicknesses). The microhardness was measured for all the specimens using a microhardness testing machine, while the surface roughness was measured using a non-contact optical profilometer at three intervals (before toothbrushing and after toothbrushing, with and without toothpaste). Three-way and two-way ANOVA were used to determine the factors influencing the surface roughness and microhardness. There was a significant difference in the surface roughness between the studied groups for all the thicknesses. The findings showed that ALD had the lowest surface roughness, while ZLS showed the highest surface roughness. Moreover, ALD, followed by ZLS, had the highest hardness, while LD and LE had the lowest hardness values. Regarding the thicknesses, both the 0.5 and 1 mm ceramic thicknesses showed a significantly lower surface roughness than the 1.5 mm thickness, while the 1.5 mm thickness showed a significantly higher microhardness than the 0.5 mm thickness. The surface roughness and hardness were significantly affected by the ceramic composition and type of filler. It is recommended to use 1.5 mm-thick ceramic materials for the fabrication of definitive full-coverage ceramic restorations, while veneers require 0.5 mm-thick materials. ALD is a promising CAD/CAM material that can be used for the fabrication of restorations with a proper strength in both anterior and posterior regions.

Fear of contagion, emotional stress and coping strategies used by adults during the first wave of the COVID-19 pandemic in Nigeria

BACKGROUND

The COVID-19 pandemic has induced high levels of stress. The aim of the study was to assess the relationship between emotional stress (COVID-19 related fear, anger, frustration, and loneliness) and the use of coping strategies among adults in Nigeria during the COVID-19 pandemic.

METHODS

Data from adults aged 18 years and above were collected through an online survey from July to December 2020. The dependent variables were COVID-19 related fear (fear of infection and infecting others with COVID-19), anger, frustration, and loneliness. The independent variables were coping strategies (use of phones to communicate with family and others, video conferencing, indoor exercises, outdoor exercises, meditation/mindfulness practices, engaging in creative activities, learning a new skill, following media coverage related to COVID-19) and alcohol consumption. Five logistic regression models were developed to identify the factors associated with each dependent variables. All models were adjusted for sociodemographic variables (age, sex at birth, and the highest level of education).

RESULTS

Respondents who consumed alcohol, followed media coverage for COVID-19 related information, and who spoke with friends or family on the phone had higher odds of having fear of contracting COVID-19 or transmitting infection to others, and of feeling angry, frustrated, or lonely (p < 0.05). Respondents who exercised outdoors (AOR: 0.69) or learned a new skill (AOR: 0.79) had significantly lower odds of having fear of contracting COVID-19. Respondents who practiced meditation or mindfulness (AOR: 1.47) had significantly higher odds of feeling angry. Those who spoke with friends and family on the phone (AOR: 1.32) and exercised indoors (AOR: 1.23) had significantly higher odds of feeling frustrated. Those who did video conferencing (AOR: 1.41), exercised outdoors (AOR: 1.32) and engaged with creative activities (AOR: 1.25) had higher odds of feeling lonely.

CONCLUSION

Despite the significant association between emotional stress and use of coping strategies among adults in Nigeria during the COVID-19 pandemic, it appears that coping strategies were used to ameliorate rather than prevent emotional stress. Learning new skills and exercising outdoors were used to ameliorate the fear of contracting COVID-19 in older respondents.

Is self-reported depression, HIV status, COVID-19 health risk profile and SARS-CoV-2 exposure associated with difficulty in adhering to COVID-19 prevention measures among residents in West Africa?

BACKGROUND

The aim of this study was to determine whether self-reported depression, coronavirus disease of 2019 (COVID-19) health risk profile, HIV status, and SARS-CoV-2 exposure were associated with the use of COVID-19 prevention measures.

METHODS

This survey collected data electronically between June 29 and December 31, 2020 from a convenient sample of 5050 adults 18 years and above living in 12 West African countries. The dependent variables were: social distancing, working remotely, difficulty obtaining face masks and difficulty washing hands often. The independent variables were self-reported depression, having a health risk for COVID-19 (high, moderate and little/no risk), living with HIV and COVID-19 status (SARS-CoV-2 positive tests, having COVID-19 symptoms but not getting tested, having a close friend who tested positive for SARS-CoV-2 and knowing someone who died from COVID-19). Four binary logistic regression models were developed to model the associations between the dependent and independent variables, adjusting for socio-demographic variables (age, gender, educational status, employment status and living status).

RESULTS

There were 2412 (47.8%) male participants and the mean (standard deviation) age was 36.94 (11.47) years. Respondents who reported depression had higher odds of working remotely (AOR: 1.341), and having difficulty obtaining face masks (AOR: 1.923;) and washing hands often (AOR: 1.263). People living with HIV had significantly lower odds of having difficulty washing hands often (AOR: 0.483). Respondents with moderate health risk for COVID-19 had significantly higher odds of social distancing (AOR: 1.144) and those with high health risk had difficulty obtaining face masks (AOR: 1.910). Respondents who had a close friend who tested positive for SARS-CoV-2 (AOR: 1.132) and knew someone who died of COVID-19 (AOR: 1.094) had significantly higher odds of social distancing. Those who tested positive for SARS-CoV-2 had significantly lower odds of social distancing (AOR: 0.629) and working remotely (AOR: 0.713). Those who had symptoms of COVID-19 but did not get tested had significantly lower odds of social distancing (AOR: 0.783) but significantly higher odds of working remotely (AOR: 1.277).

CONCLUSIONS

The study signifies a disparity in the access to and use of COVID-19 preventative measures that is allied to the health and COVID-19 status of residents in West Africa. Present findings point to risk compensation behaviours in explaining this outcome.

Influence of CAD/CAM Milling and 3D-Printing Fabrication Methods on the Mechanical Properties of 3-Unit Interim Fixed Dental Prosthesis after Thermo-Mechanical Aging Process

This study assessed the influence of CAD/CAM milling and 3D-printing fabrication methods on mechanical properties of 3-unit interim fixed dental prosthesis (IFDPs) after thermo-mechanical aging. Forty 3-unit IFDPs were fabricated on a mandibular right second premolar and second molar of a typodont cast. Samples were fabricated from the following materials; auto-polymerized polymethyl methacrylate (conventional resin), CAD/CAM PMMA (milled resin) and two different CAD/CAM 3D-printed composite resins; digital light processing Asiga (DLP AS) and stereolithography NextDent (SLA ND). Mechanical properties were compared between the studied materials using Kruskal−Wallis test, followed by multiple pairwise comparisons using Bonferroni adjusted significance. There was a significant difference in flexural strength and microhardness between the studied materials (p < 0.001), with the highest mean ± SD reported in the milled IFDPs (174.42 ± 3.39, 27.13 ± 0.52), and the lowest in the conventional IFDPs (98.02 ± 6.1, 15.77 ± 0.32). Flexural strengths differed significantly between the conventional IFDPs and all materials except DLP AS. The highest elastic modulus was recorded in the milled group, and the lowest in the SLA ND group (p = 0.02). In conclusion, superior flexural strength, elastic modulus, and hardness were reported for milled IFDPs. SLA ND printed IFDPs showed comparable mechanical properties to milled ones except for the elastic modulus.

Influence of Dental Education on Esthetics Self-Perception and Shade Selection

A discrepancy is encountered between the esthetic self-perception and the actual need for treatment. The aim was to determine the influence of dental education on the patients' attitude, esthetic self-perceptions, and shade selection. This cross-sectional study asked participants to select the perceived shade of their incisors using a shade guide, and to complete a self-administered questionnaire assessing their attitude regarding teeth shade. The color coordinates (L*, a*, and b*) of their actual shades were recorded clinically, using a digital spectrophotometer. A Pearson correlation assessed the relation between the perceived and actual color coordinates. A linear regression assessed the association between the attitude towards the esthetic self-perception, background factors, and actual shades. A clinical shade selection was done digitally for 536 participants, comprising 40.1% preclinical dental students, 37.3% clinical dental students, and 22.6% non-dental participants. The perceived and actual a* and b* values were significantly correlated in the preclinical students, and L* and b* were correlated in the clinical students. Those who had not received any dental education showed better attitude scores than the clinical students. The color-matching skills were improved by education; therefore, this emphasizes the importance of teaching color selection in dental schools. Dental esthetic self-perception is also improved by increasing knowledge and skills through exposure to a variety of comprehensive dental cases.

Associations between Emotional Distress, Sleep Changes, Decreased Tooth Brushing Frequency, Self-Reported Oral Ulcers and SARS-Cov-2 Infection during the First Wave of the COVID-19 Pandemic: A Global Survey

This study assessed the association between emotional distress, sleep changes, decreased frequency of tooth brushing, and self-reported oral ulcers, and the association between COVID-19 status and decreased frequency of tooth brushing. Using a cross-sectional online survey, data were collected from adults in 152 countries between July and December 2020. Binary logistic regression analyses were conducted to determine the associations between dependent (decreased frequency of tooth brushing, oral ulcers, change in sleep pattern) and independent (tested positive for COVID-19, depression, anxiety, frustration/boredom, loneliness, anger, and grief/feeling of loss) variables after adjusting for confounders (age, sex, level of education, employment status). Of the 14,970 participants data analyzed, 1856 (12.4%) tested positive for COVID-19. Respondents who reported feeling depressed (AoR: 1.375), lonely (AoR: 1.185), angry (AoR: 1.299), and experienced sleep changes (AoR:1.466) had significantly higher odds of decreased tooth brushing frequency. Respondents who felt anxious (AoR: 1.255), angry (AoR: 1.510), grief/sense of loss (AoR: 1.236), and sleep changes (AoR: 1.262) had significantly higher odds of oral ulcers. Respondents who tested positive for COVID-19 had significantly higher odds of decreased tooth brushing frequency (AoR: 1.237) and oral ulcers (AoR: 2.780). These findings highlight that the relationship between emotional distress and oral health may intensify during a pandemic.

Factors Affecting Clinical Decision-Making Among Dentists and Dental Students: A Crosssectional Study

PURPOSE

To determine the association between clinical decision-making approaches and personal and professional background factors.

MATERIALS AND METHODS

An electronic questionnaire was sent to 550 dentists and dental students all over Saudi Arabia from October 2019 to January 2020. The questionnaire assessed personal and professional background factors in addition to three different clinical scenarios, and each participant was asked to rate the importance of some factors that might affect clinical decision-making on a visual analog scale (VAS). Multivariate analysis of variance (MANOVA) was performed to assess the association between the exposure variables (background and professional factors) and the outcome variables, which were the three clinical decision-making approaches (patient-related, clinical-case, and operator-related factors). Regression coefficients (B), 95% CI, and the adjusted R2 of the models were calculated.

RESULTS

A total of 420 participants responded to the questionnaire (76.36% response rate). Clinical-case factors had the highest mean scores, while the operator-related factors had the lowest mean scores. Men were significantly less likely than women to consider any factor decisive (P < .001). General dentists and specialists other than prosthodontists/restorative dentists assigned significantly lower importance to operator-related factors (P = .003) and clinical-case factors (P = .005). However, there was no statistically significant difference between undergraduate students and prosthodontists/restorative dentists in considering all decisive factors.

CONCLUSION

Clinical-case factors were of greater importance compared to operator- and patient-related factors. General practitioners and specialists other than prosthodontists/restorative dentists gave lower attention to operator-related and clinical-case approaches, while experienced dentists showed greater importance to clinical-case and operator-related factors.

Self-assessment and peer-assessment of the psychomotor skills in preclinical prosthodontics: A prospective study

INTRODUCTION

Students' self-assessment and peer assessments are essential to understand the rubrics criteria and improve their psychomotor skills. The purpose of this study was to assess the impact of self-assessment score (SAS), peer-assessment score (PAS) and teacher assessment score (TAS) on the final scores of the psychomotor skills of dental students in a preclinical fixed prosthodontics course.

MATERIALS AND METHODS

A prospective study included D2 students in a preclinical fixed prosthodontics course for two consecutive academic years from September 2017 to May 2019. Students' performance of various procedures over 14 sessions was assessed by SAS, PAS and TAS. Repeated-measures ANOVA was used to assess differences between the three scores and control charts showed their change over time. Multivariable linear regression was used to assess the association between two outcome variables: TAS and the total preclinical score and the explanatory variables: SAS, PAS, TAS, gender and GPA. The significance level was set at 5%.

RESULTS

SAS had a significantly higher mean (80.21) than TAS (79.32) and PAS (78.58). SAS reached higher levels earlier than TAS and PAS. PAS had a stronger association with TAS than SAS (partial eta squared, η2 = 0.17 and 0.13), whereas SAS significantly predicted total preclinical score (p < .0001).

CONCLUSIONS

PAS helped develop the skills of dental students during training, while SAS had an impact on their total preclinical score. Different student-centred activities are needed to support students' preclinical training in fixed prosthodontics courses.

COVID-19, economic problems, and family relationships in eight Middle East and North African countries

OBJECTIVE

The aim was to assess the reported family relationships during the COVID-19 pandemic and the association between these relationships and individual, interpersonal, and country-level income in eight Middle East and North Africa (MENA) countries.

BACKGROUND

COVID-19 causes fear of infection, loss of loved ones, and economic problems that may affect family relationships.

METHODS

Data were collected from eight MENA countries using an online survey (July-August 2020). The dependent variable was change in family relationship during COVID-19, and the independent variables were individual, interpersonal, and country-level factors represented by sociodemographic factors, COVID-19 status, financial impact (whether participants lost or had reduced wages) and country income. Multilevel logistic regression analysis was conducted.

RESULTS

There were 1854 responses, mean (SD) age of 30.6 (9.9) years, 65.8% were female, 3.4% tested COVID-19 positive, and 20.8% reported lost/reduced wages. Family relationships were more likely to improve or remain unchanged (84.3%) for participants who had a history of COVID-19 (adjusted odds ratio [AOR] = 3.54, 95% confidence interval [CI]: [1.25, 10.01]). However, family relationships were more likely to not improve for those who knew someone who died of COVID-19 (AOR = 0.76, 95% CI [0.58, 0.99]) and those with lost/reduced wages (AOR = 0.69, 95% CI [0.52, 0.94]).

CONCLUSION

Family relationship improved or remained unchanged for those who tested positive for COVID-19 and did not improve for those who lost wages or lost someone due to COVID-19.

IMPLICATIONS

Policy makers should develop strategies to provide social and financial support to employees to reduce the losses and adverse social impact caused by the pandemic.

Associations between COVID-19 testing status, non-communicable diseases and HIV status among residents of sub-Saharan Africa during the first wave of the pandemic

BACKGROUND

This study determined if non-communicable disease status, HIV status, COVID-19 status and co-habiting were associated with COVID-19 test status in sub-Saharan Africa.

METHODS

Data of 5945 respondents age 18-years-old and above from 31 countries in sub-Saharan Africa collected through an online survey conducted between June and December 2020, were extracted. The dependent variable was COVID-19 status (testing positive for COVID-19 and having symptoms of COVID-19 but not getting tested). The independent variables were non-communicable disease status (hypertension, diabetes, cancer, heart conditions, respiratory conditions, depression), HIV positive status, COVID-19 status (knowing a close friend who tested positive for COVID-19 and someone who died from COVID-19) and co-habiting (yes/no). Two binary logistic regression models developed to determine associations between the dependent and independent variables were adjusted for age, sex, employment, sub region and educational status.

RESULTS

Having a close friend who tested positive for COVID-19 (AOR:6.747), knowing someone who died from COVID-19 infection (AOR:1.732), and living with other people (AOR:1.512) were significantly associated with higher odds of testing positive for COVID-19 infection, while living with HIV was associated with significantly lower odds of testing positive for COVID-19 infection (AOR:0.284). Also, respondents with respiratory conditions (AOR:2.487), self-reported depression (AOR:1.901), those who had a close friend who tested positive for COVID-19 infection (AOR:2.562) and who knew someone who died from COVID-19 infection (AOR:1.811) had significantly higher odds of having symptoms of COVID-19 infection but not getting tested.

CONCLUSION

Non-communicable diseases seem not to increase the risk for COVID-19 positive test while cohabiting seems to reduce this risk. The likelihood that those who know someone who tested positive to or who died from COVID-19 not getting tested when symptomatic suggests there is poor contact tracing in the region. People with respiratory conditions and depression need support to get tested for COVID-19.

Flexural Properties and Hardness of CAD-CAM Denture Base Materials

PURPOSE

To compare flexural strength, elastic modulus, and surface hardness of CAD-CAM milled, 3D-printed, and heat-polymerized denture base resins.

MATERIALS AND METHODS

A total of 120 specimens were fabricated from heat-polymerized acrylic resin (HP), milled resin (Avadent and IvoCad), and 3D-printed resin (ASIGA, FormLabs, and NextDent). The specimens were divided into 6 groups according to the type of denture base material n = 20/material, (10/flexural properties and 10/hardness). Flexural strength and elastic modulus of the specimens were evaluated by 3-point bending test and surface hardness by Vickers hardness test. To test flexural properties, the specimens were fabricated according to ISO 20795-1:2013 standards (64×10×3.3 ±0.2 mm). The dimensions for hardness test were 15×10×2.5 ±0.2 mm. Scanning electron microscope was used to evaluate the surface morphology of the fractured specimens. The means and standard deviations were calculated, followed by one-way ANOVA and Tukey post-hoc test (α = 0.05).

RESULTS

Milled resins showed significantly higher values for flexural strength, elastic modulus, and surface hardness, followed by HP then 3D-printed resins (P<0.001). In between milled groups, flexural strength of AvaDent was significantly higher than IvoCad (P<0.001), while elastic modulus and hardness didn't show significant difference. In between 3D-printed resins, ASIGA showed the highest flexural strength and elastic modulus, insignificantly with FormLabs (P = 0.595) and significantly with NextDent (P = 0.008). ASIGA also showed significantly the highest hardness among the 3D-printed groups. No significant difference was found between FormLabs and NextDent flexural strength (P = 0.357), elastic modulus (P = 1.00) and surface hardness (P = 0.987).

CONCLUSION

CAD-CAM milled resins had greater flexural properties and hardness compared to heat-polymerized acrylic resin and 3D-printed resins. Although 3D-printed samples showed the lowest values of tested properties, the flexural strength and modulus were above the clinically acceptable values. This article is protected by copyright. All rights reserved.

Sex differences in the experience of COVID-19 post-traumatic stress symptoms by adults in South Africa

BACKGROUND

The COVID-19 pandemic has created multiple mental health challenges. Many residents in South Africa face pre-existing elevated levels of stress and the pandemic may have had varying impacts on sub-populations. The aims of this study were to determine: 1) the factors associated with post-traumatic stress symptoms (PTSS) and 2) sex differences in the factors associated with PTSS in adults residing in South Africa during the COVID-19 pandemic.

METHODS

Study participants aged 18 years and above, were recruited for this cross-sectional study through an online survey implemented from June 29, 2020 to December 31, 2020. The outcome variable was PTSS; explanatory variables were sex at birth, COVID-19 status, social isolation and access to emotional support. Confounders considered were age, education level completed and current work status. Logistic regressions were used to determine the association between the outcome and explanatory variables after adjusting for confounders.

OUTCOMES

There were 489 respondents. Among all respondents, those who were older (AOR: 0.97; 95% CI: 0.95 - 0.99) and had access to emotional support from family and relatives (AOR: 0.27; 95% CI: 0.14 - 0.53) had significantly lower odds of PTSS. Respondents who felt socially isolated had higher odds of PTSS (AOR: 1.17; 95% CI: 1.08 - 1.27). Females had higher PTSS scores and higher odds of PTSS compared to males (AOR: 2.18; 95% CI: 1.41-3.39). Females (AOR: 0.27; 95% CI: 0.08 - 0.95) and males (AOR: 0.26; 95% CI: 0.11, 0.59) who had access to emotional support had significantly lower odds of PTSS than those who had no support. Females (AOR: 1.15; 95% CI: 1.04 -1.27) and males (AOR: 1.19; 95% CI: 0.11, 0.59) who felt socially isolated had higher odds of PTSS compared to those who did not feel socially isolated.

INTERPRETATION

Compared to males, females had higher scores and higher odds of reporting PTSS during the COVID-19 pandemic. Access to emotional support ameliorated the odds of having PTSS for both sexes, while feeling socially isolated worsened the odds for both sexes.

Factors Associated With Experiences of Fear, Anxiety, Depression, and Changes in Sleep Pattern During the COVID-19 Pandemic Among Adults in Nigeria: A Cross-Sectional Study

Background

Multiple facets of the pandemic can be a source of fear, depression, anxiety and can cause changes in sleep patterns. The aim of this study was to identify health profiles and the COVID-19 pandemic related factors associated with fear, depression, anxiety and changes in sleep pattern in adults in Nigeria.

Methods

The data for this analysis was extracted from a cross-sectional online survey that collected information about mental health and well-ness from a convenience sample of adults 18 years and above resident in Nigeria from July to December 2020. Study participants were asked to complete an anonymous, closed-ended online questionnaire that solicited information on sociodemographic profile, health profiles (high, moderate and low COVID-19 infection risk profile) including HIV status, COVID-19 status, and self-reported experiences of fear, anxiety, depression and changes in sleep patterns.

Results

In total, 4,439 participants with mean age of 38.3 (±11.6) years responded to the survey. Factors associated with higher odds of having COVID-19 related fear were health risk (p < 0.05); living with HIV (AOR: 3.88; 95% CI: 3.22-4.69); having COVID-19 symptoms but not tested (AOR: 1.61; 95% CI: 1.30-1.99); having a friend who tested positive to COVID-19 (AOR: 1.28; 95% CI: 1.07-1.53) and knowing someone who died from COVID-19 (AOR: 1.43; 95% CI: 1.24-1.65). The odds of feeling anxious was significantly higher for those with moderate or low health risk profile (p < 0.05); living with HIV (AOR: 1.64; 95% CI: 1.32-2.04); had a friend who tested positive for COVID-19 (AOR: 1.35; 95% CI: 1.08-1.68) or knew someone who died from COVID-19 (AOR: 1.53; 95% CI: 1.28-1.84). The odds of feeling depressed was significantly higher for those with health risk profile (p < 0.05); living with HIV (AOR: 2.49; 95% CI: 1.89-3.28); and respondents who had COVID-19 symptoms but had not taken a test (AOR: 1.41; 95% CI: 1.02-1.94). Factors associated with higher odds of having sleep pattern changes were having moderate and low health risk profiles (p < 0.05).

Conclusion

The study findings suggest that the pandemic may cause fear, anxiety, depression and changes in sleep patterns differently for people with different health profile, HIV status and COVID-19 status.

Differences in COVID-19 Preventive Behavior and Food Insecurity by HIV Status in Nigeria

The aim of the study was to assess if there were significant differences in the adoption of COVID-19 risk preventive behaviors and experience of food insecurity by people living with and without HIV in Nigeria. This was a cross-sectional study that recruited a convenience sample of 4471 (20.5% HIV positive) adults in Nigeria. Binary logistic regression analysis was conducted to test the associations between the explanatory variable (HIV positive and non-positive status) and the outcome variables-COVID-19 related behavior changes (physical distancing, isolation/quarantine, working remotely) and food insecurity (hungry but did not eat, cut the size of meals/skip meals) controlling for age, sex at birth, COVID-19 status, and medical status of respondents. Significantly fewer people living with HIV (PLWH) reported a positive COVID-19 test result; and had lower odds of practicing COVID-19 risk preventive behaviors. In comparison with those living without HIV, PLWH had higher odds of cutting meal sizes as a food security measure (AOR: 3.18; 95% CI 2.60-3.88) and lower odds of being hungry and not eating (AOR: 0.24; 95% CI 0.20-0.30). In conclusion, associations between HIV status, COVID-19 preventive behaviors and food security are highly complex and warrant further in-depth to unravel the incongruities identified.

Impact of the COVID-19 pandemic on student' sleep patterns, sexual activity, screen use, and food intake: A global survey

Background

The education sector experienced substantial impacts during the COVID-19 pandemic resulting from worldwide restrictions.

Purpose

To examine differences in the sleep patterns, sexual activity, screen use, and food intake of students and non-students during the COVID-19 pandemic.

Methods

This was a global cross-sectional study conducted in the second half of 2020 using multiple social media platforms to recruit study participants globally. A close-ended questionnaire was administered anonymously in English, French, Spanish, Portuguese, and Arabic to adults ages 18 and older. The outcome variables considered in analyses were changes in sleep pattern, sexual activity, screen use, and food intake. The explanatory variable was student status categorized as students vs. non-student. T-test, chi-square, and Mann Whitney U tests were used to assess differences between student and non-student populations. One logistic regression model was built for each outcome variable. Country of residence and country income level were included in the adjusted models.

Results

There were 17,008 participants of which 3,793 (22.3%) were students. Of the total sample, 4,889 (28.7%) reported changes in sleep, 4,642 (31.8%) reported increases in sexual activity, 10,278 (70.7%) reported increases in screen use, and 5,662 (40.2%) reported increases in food intake during the pandemic. Compared to non-students, students had significantly higher odds of reporting changes in sleep (AOR = 1.52), increases in sexual activity (AOR = 1.79), and increases in screen use (AOR = 1.36) but lower odds of reporting increase in food intake (AOR = 0.87).

Conclusion

Students displayed higher risk of experiencing changes in sleep, sexual behavior, and screen use during the COVID-19 pandemic. This has the potential to lead to broader adverse effects on students’ overall wellbeing. The findings and implications raise further obligations on the education sector to put extra-curricular support systems in place that address COVID-19 related behavior changes that have the potential to adversely impact students’ wellbeing.

Factors associated with COVID-19 pandemic induced post-traumatic stress symptoms among adults living with and without HIV in Nigeria: a cross-sectional study

BACKGROUND

Nigeria is a country with high risk for traumatic incidences, now aggravated by the COVID-19 pandemic. This study aimed to identify differences in COVID-19 related post-traumatic stress symptoms (PTSS) among people living and not living with HIV; to assess whether PTSS were associated with COVID-19 pandemic-related anger, loneliness, social isolation, and social support; and to determine the association between PTSS and use of COVID-19 prevention strategies.

METHODS

The data of the 3761 respondents for this analysis was extracted from a cross-sectional online survey that collected information about mental health and wellness from a convenience sample of adults, 18 years and above, in Nigeria from July to December 2020. Information was collected on the study's dependent variable (PTSS), independent variables (self-reported COVID-19, HIV status, use of COVID-19 prevention strategies, perception of social isolation, access to emotional support, feelings of anger and loneliness), and potential confounder (age, sex at birth, employment status). A binary logistic regression model tested the associations between independent and dependent variables.

RESULTS

Nearly half (47.5%) of the respondents had PTSS. People who had symptoms but were not tested (AOR = 2.20), felt socially isolated (AOR = 1.16), angry (AOR = 2.64), or lonely (AOR = 2.19) had significantly greater odds of reporting PTSS (p < 0.001). People living with HIV (AOR = 0.39), those who wore masks (AOR = 0.62) and those who had emotional support (AOR = 0.63), had lower odds of reporting PTSS (p < .05).

CONCLUSION

The present study identified some multifaceted relationships between post-traumatic stress, HIV status, facemask use, anger, loneliness, social isolation, and access to emotional support during this protracted COVID-19 pandemic. These findings have implications for the future health of those affected, particularly for individuals living in Nigeria. Public health education should be incorporated in programs targeting prevention and prompt diagnosis and treatment for post-traumatic stress disorder at the community level.

Effect of CAD/CAM Ceramic Thickness on Shade Masking Ability of Discolored Teeth: In Vitro Study

Shade matching is a common challenge that dentists face during fabrication of esthetic dental restoration. Thus, the aim of the current study was to assess the masking ability of two types of CAD/CAM ceramics for gaining high esthetic prosthesis. This in vitro study used a total sample size of 66 lithium disilicate (LD) and leucite reinforced (LR) CAD/CAM ceramics sub-grouped into three thicknesses: 0.5, 1, and 1.5 mm. Nine shades of natural dentin die materials were prepared as a replica of the underlying tooth structure. The difference in color (ΔE) and translucency parameter (TP) were assessed for both tested ceramics at the three thicknesses. One-way ANOVA was performed to compare the three thicknesses of each ceramic, followed by multiple pairwise comparisons between both ceramics. LR had significantly higher ΔE than LD at all thicknesses used unlike the case in TP. Thickness of 0.5 mm exhibited the highest ΔE and TP, while 1.5 mm thickness showed the lowest ΔE and TP in both ceramics. Increase in ceramic thickness had a great impact on both color masking ability of the underlying tooth structure and its translucency. The higher the ceramic thickness, the better the masking ability and the lower the translucency was reported.

Effect of Low Nanodiamond Concentrations and Polymerization Techniques on Physical Properties and Antifungal Activities of Denture Base Resin

Background: Denture base resin has some drawbacks. This study investigated the impact of nanodiamonds (ND) and autoclave polymerization on the surface characteristics, translucency, and Candida albicans adherence in polymethyl methacrylate (PMMA) denture base resin after thermocycling. Methods: Heat-polymerized PMMA discs (15 × 2 mm) with a total sample size n = 160 were studied. Specimens were categorized into two main groups (N = 80): conventional water-bath-polymerized PMMA (CP/PMMA) and autoclave-polymerized PMMA (AP/PMMA). Each group was subdivided according to the ND concentration into four groups (n = 20): unmodified PMMA as a control, and 0.1%, 0.25%, and 0.5% ND–PMMA. Scanning electron microscopy (SEM) was used to inspect the morphology of the ND and the ND–PMMA mixtures before heat polymerization. The specimens were exposed to thermal cycling (5000 cycles at 5 and 55 °C), then surface roughness was measured with a non-contact optical interferometric profilometer, contact angle with an automated goniometer, and translucency using a spectrophotometer. Colony-forming units (CFU) were used to determine the adherence of Candida albicans cells to the specimens. ANOVA and Tukey post hoc tests for pairwise comparison were utilized for the statistical analysis (α = 0.05). Results: Surface roughness was significantly reduced with ND addition to CP/PMMA (p ˂ 0.001), while the reduction was not statistically significant in AP/PMMA (p = 0.831). The addition of ND significantly reduced the contact angle, translucency, and Candida albicans count of CP/PMMA and AP/PMMA (p ˂ 0.001). The incorporation of ND in conjunction with autoclave polymerization of PMMA showed significant reduction in all tested properties (surface roughness, contact angle and Candida albicans adherence) except translucency (p = 0.726). Conclusions: ND addition to PMMA and autoclave polymerization improved the surface properties with respect to antifungal activities, while the translucency was adversely affected.

Associations between sexual orientation, financial security and relationships with family and peers during the COVID-19 pandemic in Nigeria

Background: This study aimed to determine whether factors associated with financial insecurity during the COVID-19 pandemic were associated with worsening relationships with family, peers and friends of sexual minorities living in Nigeria. Methods: Data were collected using an online survey conducted from 29th June to 31st December 2020. The outcome variable was the quality of relationship with family, friends and peers during the COVID-19 pandemic. The explanatory variables were the sexual orientation (lesbian, gay, bisexual, heterosexual), COVID-19 status, and financial security (job loss or reduced/lost wages because of the COVID-19 pandemic). Multilevel logistic regression analysis models with robust estimation were built and used to assess the association between the outcome and explanatory variables. The models were adjusted for sociodemographic profile (age, sex at birth, education status). Results: Being a sexual minority was associated with higher odds of worsened relationship with family (AOR: 1.49) and friends and peers (AOR: 2.38) during the pandemic. Having COVID-19 symptoms but not getting tested was significantly associated with higher odds of reporting worsening of the relationship with family (AOR: 1.69) and history of job loss (AOR: 1.68), while having formal education (p<0.05) was significantly associated with lower odds of reporting worsening of the relationship with family. The factors significantly associated with higher odds of reporting worsened relationship with friends and peers were testing positive for COVID-19 (AOR: 1.60), reduced wages (AOR: 1.24), and being older (AOR: 1.01). Attaining a college/university education was significantly associated with lower odds of worsened relationship with friends and peers (AOR: 0.31). Conclusions: The COVID-19 pandemic may increase the risk of negative disruptions in the relationships with family, friends and peers, especially for sexual minorities. National COVID-19 response programs should include plans to support those who face social disruption in managing the crisis.

Comparative Study of the Effectiveness of Laboratory-Formulated Polishing Pastes for Two CAD/CAM Ceramic Restorative Materials

PURPOSE

To evaluate the effect of different polishing pastes with different particle sizes on the surface finish of two different CAD/CAM ceramics.

MATERIALS AND METHODS

A total of 128 specimens were prepared of two CAD/CAM ceramics: lithium disilicate (12.4 × 14.5 × 2 mm) and monolithic zirconia (17.5 × 12.5 × 2.5 mm). They were divided randomly into 8 groups according to surface treatment (n = 8). Group 1 (control) was left as received after crystallization or sintering with no further surface treatment; Group 2 (glazed); Group 3 (positive control), where specimens were polished using standardized surface treatment (medium grit silicon carbide discs, rubber cup and pumice slurry, then rubber cup and toothpaste). For groups 4 to 8, in addition to silicon carbide and pumice slurry polishing, specimens were further polished using a diamond paste (DP), and polishing pastes of microzirconia (MZ), nanosilica (NS), nanodiamond (ND), and nanozirconia (NZ), respectively. Surface roughness (R_a ) was measured using noncontact profilometer. The mean values were compared using ANOVA and Post Hoc Tukey's test (α = 0.05). Specimens' surfaces were studied using a scanning electron microscope (SEM).

RESULTS

Positive control group and MZ exhibited significant R_a of lithium disilicate compared to control (p ˂ 0.001), glazed (p = 0.001), DPs (p = 0.002), NS (p ˂ 0.001), ND (p ˂ 0.001), and NZ (p = 0.002). In the case of zirconia, positive control showed a significantly higher R_a compared to all other groups (p ˂ 0.001). No statistical difference was found between all other polishing techniques (positive control, glazed, DPs, NS, ND, MZ, and NZ) (p > 0.05).

CONCLUSION

Polishing with ND, NZ, and NS lab-formulated pastes produced surfaces with comparable smoothness to control and glazed specimens for lithium disilicate and zirconia ceramic materials.

Accuracy of 3D Printed and Digital Casts Produced From Intraoral and Extraoral Scanners With Different Scanning Technologies: In Vitro Study

PURPOSE

To compare the accuracy of printed to digital casts produced from various intraoral and extraoral scanners with different scanning technologies.

MATERIALS AND METHODS

A conventional stone cast was fabricated from the reference typodont cast and scanned with two intraoral scanners (TRIOS 3 version 1.4.7.5, and Dental Wings version 2.1.0.421), and two extraoral scanners (S600 Arti, Zirkonzahn, and Ceramill map 600, Amann Girrbach GmbH). All digital scans were saved in the form of STL files and measurements were calculated using Geomagic analysis software. Two types of measurements were assessed on the casts: tooth- and arch-level measurements. Absolute errors were calculated by subtracting the measurements on 3D-printed, digital, and conventional stone casts from the measurements on the reference typodont cast. One-way ANOVA was used for comparing different measurement errors between groups. Linear regression was performed to determine the association between different explanatory variables, and the average measurement errors (dependent variable) adjusted to reference cast measurements. Regression coefficients (B) and 95% confidence intervals (CI) were calculated.

RESULTS

For both 3D printed, and digital casts, Dental Wings showed significantly greater error compared to other scanners and to the conventional stone cast at all measurements except AL (in the 3D printed modality only), while conventional casts showed the lowest error. Error was significantly higher in intraoral than extraoral scanners (B = 0.009, 95% CI = 0.005, 0.02), and in arch level measurements than tooth level measurements (B = 0.03, 95% CI = 0.01, 0.04), and significantly lower in 3D printed than digital casts (B = -0.04, 95% CI = -0.05, -0.04). There were no statistically significant differences between measurement errors of both arches (maxillary and mandibular arches).

CONCLUSIONS

Extraoral scanners showed higher accuracy than intraoral scanners, and 3D-printed casts showed higher accuracy than their digital counterparts. Dental Wings scanner had the greatest measurement error. This article is protected by copyright. All rights reserved.

Factors Associated with Financial Security, Food Security and Quality of Daily Lives of Residents in Nigeria during the First Wave of the COVID-19 Pandemic

An online survey was conducted to identify factors associated with financial insecurity, food insecurity and poor quality of daily lives of adults in Nigeria during the first wave of the COVID-19 pandemic. The associations between the outcome (experience of financial loss, changes in food intake and impact of the pandemic on daily lives) and the explanatory (age, sex, education level, anxiety, depression, HIV status) variables were determined using logistic regression analysis. Of the 4439 respondents, 2487 (56.0%) were financially insecure, 907 (20.4%) decreased food intake and 4029 (90.8%) had their daily life negatively impacted. Males (AOR:0.84), people who felt depressed (AOR:0.62) and people living with HIV -PLHIV- (AOR:0.70) had significantly lower odds of financial insecurity. Older respondents (AOR:1.01) had significantly higher odds of financial insecurity. Those depressed (AOR:0.62) and PLHIV (AOR:0.55) had significantly lower odds of reporting decreased food intake. Respondents who felt anxious (AOR:0.07), depressed (AOR: 0.48) and who were PLHIV (AOR:0.68) had significantly lower odds of reporting a negative impact of the pandemic on their daily lives. We concluded the study findings may reflect a complex relationship between financial insecurity, food insecurity, poor quality of life, mental health, and socioeconomic status of adults living in Nigeria during the COVID-19 pandemic.

Evaluation of the Accuracy of Digital Impressions Obtained from Intraoral and Extraoral Dental Scanners with Different CAD/CAM Scanning Technologies: An In Vitro Study

PURPOSE

To compare the accuracy of intraoral and extraoral scanners (IOSs and EOSs) with different scanning technologies.

MATERIAL AND METHODS

A phantom cast was used to simulate the patient's mouth. Polyether impression was made of the phantom cast and poured to fabricate stone casts. The stone casts were scanned by two IOSs (3shape Trios 3, 3S and Dental Wings, DW) and two EOSs (S600 Arti Zirkonzahn, ZK and Ceramill map 600 Amann Girrbach, AG) to obtain digital casts. Reference teeth (canines, premolar, and molars) dimensions were measured on the digital casts by Geomagic software and compared to measurements of the stone cast done by stereomicroscope. The dimensions were occluso-cervical mesio-distal, and bucco-lingual and their average was calculated. Differences between digital and stereoscopic measurements were assessed using paired t-test. Discrepancies between these measurements were calculated as differences and were compared among the four scanners using ANOVA.

RESULTS

The differences among the discrepancies of the four scanners were not significant overall (p = 0.969), in premolars (p = 0.932) or molars (p = 0.069) but significant in canines (p = 0.025). The discrepancies of the EOSs were ≤0.01 mm in canines and molars. DW had the greatest discrepancy in canines and molars.

CONCLUSIONS

The IOSs and EOSs had similar accuracy except in canines where EOSs performed better. The accuracy of scanning is affected by the smoothness and regularity of the teeth surfaces as in case of the canine.

Evaluation of Bacterial Leakage in Platform-Switching Dental Implant with Morse Taper Connection Under Thermocycling and Loading Effects: In Vitro Study

PURPOSE

The aim of this study was to test in vitro the bacterial microleakage at the Morse taper implant-abutment connection with switched platform subjected to functional load and thermocycling.

MATERIALS AND METHODS

A total of 48 Morse taper implant-abutment connections with switched platforms (12 implants per group) were used. The abutments were attached to implants and presented in four groups: group 1, control; group 2, subjected to thermocycling; group 3, subjected to cyclic compressive loading; and group 4, subjected to thermocycling and cyclic compressive loading. All groups were then inoculated in Eppendorf tubes including three types of bacterial suspensions: Enterococcus faecalis, Staphylococcus aureus, and Pseudomonas aeruginosa for 7 and 14 days to detect possibility of bacterial infiltration from outside to the internal chamber of the implant.

RESULTS

Implants not exposed to cyclic loading and thermocycling (group 1) and those exposed to thermocycling (group 2) exhibited no infiltration of E faecalis, S aureus, and P aeruginosa from outside to the inner chamber of the implant, while infiltration of P aeruginosa was only observed in implants subjected to cyclic loading only (group 3) and those subjected to cyclic loading in conjunction with thermocycling (group 4).

CONCLUSION

Microbial leakage at the implant-abutment connection is influenced by the applied load alone and in combination with thermocycling; however, E faecalis and S aureus did not leak at the implant-abutment connection even under these circumstances. Only P aeruginosa infiltrated inside the implant-abutment connection, which might be caused by its swarming motility.

Oral health and tobacco research in the Eastern Mediterranean Region in relation to the Framework Convention on Tobacco Control: a scoping review

Background

Tobacco use is associated with oral diseases. Evaluating research on tobacco use and oral health can provide insight into the prevailing situation and help engage dental personnel in tackling the tobacco problem.

Aims

This study aimed to map knowledge gaps on tobacco and oral health research in the Eastern Mediterranean Region based on four articles of the Framework Convention on Tobacco Control (FCTC). These were: article 12 - use of communication tools to promote tobacco education and awareness; article 14 - promotion of tobacco cessation; article 20 - exchange of information on determinants and outcomes of tobacco use; and article 22 - international cooperation to transfer expertise to strengthen national tobacco control strategies.

Methods

A scoping review was conducted that included publications on tobacco use and oral health in the Region. PubMed, Scopus, Web of Science, Google Scholar and Proquest theses were searched. Information extracted included: country, study type, whether more than one country was included and whether the publication addressed FCTC articles 12, 14, 20 or 22.

Results

In all, 322 publications were included, of which 82.0% were observational studies and 4.3% were clinical trials. Most publications (87.9%) were from the Islamic Republic of Iran, Jordan, Pakistan Saudi Arabia and Yemen. Only 32 (9.9%) publications included participants from more than one country. Of all the publications, 21.5% related to article 12 of the FCTC, 4.3% to article 14, 94.7% to article 20 and 6.5% article 22.

Conclusions

Research on oral health and tobacco needs to be better aligned with the FCTC articles.

Intention to seek esthetic dental treatment and the theory of planned behavior in Saudi dental students and the general population

STATEMENT OF PROBLEM

Tooth shade is of major concern for patients when receiving esthetic dental treatment. Understanding the motivating factors that drive patients' intentions to seek esthetic dental treatment helps in planning services.

PURPOSE

The purpose of this cross-sectional study was to assess the relationship between the intention to seek esthetic dental treatment and the theory of planned behavior (TPB), including attitude regarding tooth shade, perceived ability to seek treatment, and subjective norms of how others perceive tooth shade.

MATERIAL AND METHODS

The study included first-year dental students and clinic patients in a Saudi dental school (N=283). The shade of the maxillary central incisors was clinically assessed by using the Crystaleye spectrophotometer, and the L*, a*, and b* values were recorded. Participants were asked to select a shade that represented how others perceived their shades by using the VITA classical shade guide and to respond to a self-administered questionnaire based on a TPB assessing attitude regarding shade (9 items), perceived ability to seek esthetic treatment (7 items) on a 5-point Likert scale, and intention to seek esthetic treatment. The internal consistency of the TPB items was assessed, and scores were calculated. Logistic regression analysis was used to assess factors associated with the intention to seek esthetic treatment, including the TPB components controlled for L*, a*, and b* values in addition to age (α=.05).

RESULTS

Of all participants, 49.5% indicated that they intended to seek esthetic treatment. The most commonly perceived shades were B1, B2, A2, A1, and A3 (76%). In adjusted regression, the intention to seek esthetic treatment was significantly associated with a more positive attitude regarding shade (OR=2.31, 95% CI=1.54, 3.47) and a lower b* value (OR=0.74, 95% CI=0.59, 0.93), but not with shade coordinates (P values of L*=.94, a*=.64, and b*=.13).

CONCLUSIONS

Intention to seek esthetic dental treatment was associated with a positive attitude regarding the importance of shade and a greater perception of having a less yellow shade, regardless of the shade.

The effect of nanodiamonds on candida albicans adhesion and surface characteristics of PMMA denture base material - an in vitro study

Candida albicans is the main causative pathogen of denture stomatitis, which affects many complete denture patients. Objective: To evaluate the effect of different concentrations of nanodiamonds (NDs) added to polymethyl methacrylate (PMMA) denture base material on Candida albicans adhesion as well as on surface roughness and contact angle. Methodology: Acrylic resin specimens sized 10×10×3 mm³ were prepared and divided into four groups (n=30) according to ND concentration (0%, 0.5%, 1%, 1.5% by wt). Surface roughness was measured with a profilometer, and the contact angle with a goniometer. The effect of NDs on Candida albicans adhesion was evaluated using two methods: 1) slide count and 2) direct culture test. Analysis of variance (ANOVA) and Tukey's post hoc test were used in the statistical analyses. Results: Addition of NDs decreased the Candida albicans count significantly more than in the control group (p<0.05), with a lowest of 1% NDs. Addition of NDs also significantly decreased the surface roughness (p<0.05), but the contact angle remained the same. Incorporation of NDs into the PMMA denture base material effectively reduced Candida albicans adhesion and decreased surface roughness. Conclusion: PMMA/NDs composites could be valuable in the prevention of denture stomatitis, which is considered one of the most common clinical problems among removable denture wearers.