A comparison of the horizontal and vertical bitewing images in detecting approximal caries and interdental bone loss in posterior teeth: A diagnostic accuracy randomized cross over clinical trial.

Background/purpose: Horizontal bitewing radiographs are widely and frequently used in dentistry and are very reliable in diagnosing proximal caries and interproximal alveolar bone level. However, it is challengeable in detecting interproximal root caries, horizontal and/or vertical alveolar bone loss, and furcation involvements. The aim of this article was to assess the accuracy of vertical bitewing images in the diagnosis of caries and alveolar bone level compared to the horizontal bitewing technique. Materials and methods: Each one of the 20 patients had eight bitewing radiographs to get four horizontal bitewing (control) and four vertical bitewing (experimental) images for the same posterior area; a steel wire (3 mm) was used on the sensor plate to help measure the magnification later on. The radiographs were processed digitally and were evaluated for caries by two expert restorative specialists and for bone loss by two experienced periodontists. They were also compared to the "gold standard," which is using of both clinical and radiographic examination for diagnosis. They were blinded to each other during images evaluation. Results: Of the 20-patient sample size, 70% were male and 30% were female, with a mean age of 29.9. The average number of radiographs taken to achieve four standard bitewing radiographs was 5.9 ± 1.7 for vertical bitewings and 5.3 ± 1.3 for horizontal bitewing radiograph. The measurements from the cementoenamel junction (CEJ) to the level of crestal bone didn't show a significant difference between the horizontal and vertical bitewing radiographs. The detection of furcation area in the molar teeth was much higher in the vertical bitewing (100%) compared to the horizontal bitewing (57.5%) (P < 0.0001). Conclusion: The vertical bitewing radiograph has the upper hand over the horizontal bitewing radiograph in the detection of furcation involvement, caries detection, and alveolar bone loss. Therefore, it is highly recommended to use vertical bitewing in caries and patients with periodontal disease rather than the conventional horizontal bitewing.

COVID-19 Stigma Correlates with Burnout among Healthcare Workers: Evidence from Healthcare Workers Practicing in Saudi Arabia

Introduction COVID-19-related stigma is the level of stigma associated with being involved with the pandemic. It has been reported that a significant number of healthcare workers experienced anxiety, depression, stigmatization, physical violence, harassment during the COVID-19 pandemic;even the families of the healthcare workers were victims of discrimination and stigmatization. The aim of our study was to determine the prevalence of COVID-19-related stigma among the healthcare workers in Saudi Arabia and to assess the COVID-19-related stigma, its associated factors, and burnout correlate. Methods Web-based, self-administered questionnaire has been sent to healthcare workers' official emails through the internal communication department in the targeted hospitals. It includes the COVID-19-related stigma-validated scale "E16-COVID19-S” and two questions relative to the full Maslach Burnout Inventory assessing the burnout. The required sample is 377 based on the sample size calculation with a response rate of 50%. Results A total of 407 responses were received from the targeted population. Of them, 49.4% scored high on the COVID-19-related stigma scale. The correlation between the COVID-19-related stigma and burnout was found to be moderately positive and statistically significant (rs = 0.515, p= <0.001). Conclusion It has been found that gender, workplace capacity, ever taking COVID-19 test during the pandemic had a significant impact on scoring high on the COVID-19-related stigma scale. Moreover, there is a correlation between being stigmatized during the pandemic and being burned out.

Assessing knowledge of herbal medicine course for dental students.

BACKGROUND: The aims of this article are to assess dental students' knowledge about herbal medicine usage and the potential benefits and side effects, and to conduct a short course about herbal medicine. METHODS: All fourth-year pre-doctoral students were invited to participate in a herbal medicine course as a test while the sixth-year students were the control group. A survey was tested for validity and reliability. It comprised of 16 multiple choice questions was given before the course and one month after the course. The sum score of knowledge for each participant was calcuated based on the ability to identify the use of herbs in dentistry with high-quality evidence (correct answer) or total answer for periodontal disease and caries. RESULTS: The response rate for completing the study was 112 fourth-year students (73.7%) and 64 sixth-year students (39.0%). More than half of the participants (52.5%) were unsure about the importance of herbal medicine in dentistry. However, the majority also stated that the most common herbs used in dentistry were clove (62.9%), followed by curcuma turmeric (54.7%) and meswak (43.0%). The fourth-year students displayed evidence of a higher overall knowledge score after the course in herbal medicine related to periodontal disease in total and correct answers (mean 4.48 ± 4.13, 3.73 ± 3.31, respectively) compared to before the course (mean 0.84 ± 1.23, 0.74 ± 1.16, respectively) (p-value < 0.001). The post-course periodontal disease total and correct answers were statistically significant between fourth- and sixth-year students. CONCLUSION: Herbal medicine has a potential positive impact on dentistry. However, these effects are not fully investigated and received full attention in academic institute. This short educational program related to medicinal herbs can improve the knowledge of dental students. This will help increase the awareness about the use and potential side effects of herbal medicine in the dental field.

The short-term effect of different chlorhexidine forms versus povidone iodine mouth rinse in minimizing the oral SARS-CoV-2 viral load: An open label randomized controlled clinical trial study.

Several investigations evaluated the possibility of different types of mouth wash rinse in minimizing the SARS-CoV-2 load. However, results still controversial. The study aim is to assess the short-term efficiency of several over-the-counter mouth rinses and lozenges in minimizing the salivary viral load for SARS-CoV-2 in patients with confirmed COVID-19 in comparison to saline. This is a randomized controlled clinical trial with 4 arms. The recruited cases were randomized using a simple randomization technique and were assigned to chlorhexidine digluconate mouth rinse (CHX mouth rinse), 2 mg of chlorhexidine digluconate lozenges (CHX lozenges), povidone iodine mouth rinse (PVP-I mouth rinse) or saline as a control group. Saliva were collected from all study subjects by passive drool technique at two time points. First, prior to intervention with mouth rinse or the lozenges, the baseline saliva sample was collected. Second saliva samples were collected immediately after the mouth rinse. Real time PCR was conducted and the value threshold cycle (Ct) for each sample was recorded. Majority of the participants had an education level of high school or less (60%), were married (68.3), males (58.3%), and non-smokers (58.5%). No statistically significant differences between groups at the two times test (P > .05). However, a significant decrease of salivary viral load in all four groups combined (P-value for E genes = .027, and for S genes = .006), and in PVP-I mouth rinse specifically (P = .003 and P = .045, respectively). Povidone iodine mouth rinse showed a potential influence on the reduction of the viral load on a short-term basis. However, longer-term studies of the effect of these products should be conducted.

Suspected Adenovirus Causing an Emerging HEPATITIS among Children below 10 Years: A Review.

In October 2021, a case of acute hepatic failure without any known cause was identified in the United States of America. Upon further investigation, other children aged 1-6 years were reported to have the same liver failure, and some of them were positive for adenovirus 41 type F. On 21 April 2022, the Centers for Disease Control and Prevention (CDC) released an alert after 74 cases were identified in United Kingdom (UK) between 5 and 8 April in children below 10 years of age, some of whom were also found to be positive for SARS-CoV-2. All the patients showed symptoms such as vomiting, diarrhea, jaundice, and abdominal pain. The patients' liver enzymes were remarkably increased. A total of 650 cases had been reported from 33 countries as of 27 May 2022, among which 222 cases were reported in the UK alone. No connection with SARS-CoV-2 or its vaccine has been found so far. However, the suspected cause is adenovirus, including its genomic variations, because its pathogenesis and laboratory investigations have been positively linked. Until further evidence emerges, hygiene precautions could be helpful to prevent its spread.

Can periodontal pockets and caries lesions act as reservoirs for coronavirus?

The periodontal pocket and likely caries lesions may act as a reservoir and source of dissemination and development of systemic infections. While periodontal pockets have been found to harbor several viral species, there is no information on its ability to serve as a reservoir for the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). We have used a real-time polymerase chain reaction (RT-PCR) approach to evaluate SARS-CoV-2 in periodontal pockets and cavitated caries lesions in a cross-sectional study of 72 participants who were divided into six groups: symptomatic positive COVID-19 cases with periodontal pockets, symptomatic positive with cavitated caries lesions, asymptomatic positive with periodontal pockets, asymptomatic positive with cavitated caries lesions, positive control, and negative control. A total of 180 samples were interrogated by RT-PCR to amplify the SARS-CoV-2 E and S genes. SARS-CoV-2 was present in 41.7% of symptomatic positive COVID-19 cases with periodontal pockets and 16.7% of symptomatic positive with cavitated caries lesions. The mean Ct value of E and S genes in periodontal pockets patients were 36.06±0.46 and 30.06±6.73, respectively, and the mean Ct value for both genes in caries lesions patients were 35.73±4.14, and 34.78±1.93, respectively. The sensitivity, specificity, and accuracy to detect SARS-CoV-2 among periodontal pockets were 20.8% (95% CI 7.13-42.15), 100% (95% CI 73.54-100.0), and 47.2% (95% CI 30.22-64.51), respectively. Among cavitated caries lesions patients, they were 8.3% (95% CI 1.03-27.0), 100% (95% CI 73.54-100.0), and 38.9% (95% CI 23.14-56.54), respectively. SARS-CoV-2 can be detected in periodontal pockets and caries lesions, and these sites may act as reservoirs for the virus. However, the sensitivity of SARS-CoV-2 detection is low compared with other methods. To our knowledge, this report is the first to investigate the relationship between SARS-CoV-2 and periodontal pockets and caries.

Characteristics of Oral Manifestations in Symptomatic Non-Hospitalized COVID-19 Patients: A Cross-Sectional Study on a Sample of the Saudi Population.

PURPOSE: Few case reports and letters to the editor have been published regarding oral signs and symptoms in COVID-19 patients. The aim of the study therefore is to investigate different types of oral manifestations in COVID-19 patients as well as their prevalence. PATIENTS AND METHODS: The study is a cross-sectional study from a single medical center. A convenience sample was taken from all patients who were COVID-19 confirmed, symptomatic, and non-hospitalized. Demographic information, medical and travel history, general symptoms, and clinical examination results of the oral cavity were collected. RESULTS: This study included a total of 109 patients. Loss of taste was the most common oral manifestation of COVID-19 (43.4%), followed by erythema/desquamated gingivitis and coated tongue (7.3% each) and ulcers/blisters (6.4%). Loss of taste was the only symptom persisting for 10 days. Oral manifestations appeared as a single symptom (79.3%), and dorsum of tongue was the most common oral location (72.4%). CONCLUSION: Loss of taste was the most prevalent specific reported oral manifestation. Other nonspecific oral lesions/symptoms are controversial. It has been suggested that oral examinations of COVID-19 patients should be conducted as part of routine examinations to investigate any possible correlation between the disease and the oral cavity.

Infection Control Practices at the Dental Clinics in Jeddah, Saudi Arabia.

PURPOSE: The aims of this study were to determine the rate of compliance of infection control and estimate the incidence of COVID-19 in dental clinics in Jeddah, Saudi Arabia. MATERIALS AND METHODS: This is an ecological correlational study of randomly sampled dental clinics in the city of Jeddah. The 32-question survey used in the study was constructed based on the infection control guidelines/protocols during the COVID-19 pandemic released by the ADA, CDC, and SMOH. A sample of clinics from a dental clinic list in Jeddah city, using a simple random technique. RESULTS: Fifty-three dental clinics consented to participate in our study, while ten refused. Most of the dental clinics checked their patients' temperature (30.2%) and strictly required them to wear a surgical mask before entering the clinic (58.5%). Glove, gown, and face mask were the most common methods of infection control used during all dental procedures (98.1%, 96.2%, and 94.3%, respectively). Moreover, the incidence of COVID-19 was the highest among receptions/security (18.70%), followed by nurses (14.3%) and dentists (11.79%). CONCLUSION: As the incidence of COVID-19 among dental staff will continue to increase in the future, it is highly recommended that infection control guidelines are followed in all dental clinics.

Characteristics of First Cases of Coronavirus Disease 2019 and the Effort to Prevent the Early Spread of COVID-19 in Saudi Arabia.

PURPOSE: To characterize the overall trends in early cases of COVID-19 and to identify the key points of the government effort to minimize the infection. PATIENTS AND METHODS: A retrospective review and data were retrieved through online sources and the Saudi Ministry of Health daily announcements that were available online. The data included the number of infections per day, and the gender, nationality, location, source of infection, incidence, rate of recovery, and the rate mortality of COVID-19 patients in Saudi Arabia between March 1 and March 16, 2020. RESULTS: The incidence of COVID-19 increased in the first two weeks in Saudi Arabia, from zero cases on March 1 to more than 15 cases per day on March 16, with a total of 133 cases. The majority of patients were males (54.9%), of Saudi descent (54.9%), and had travel as their source of infection (57.1%). Most of the cases were in Makah (37.6%); however, there were increases in cases in all cities. Moreover, the Saudi government enacted several steps to minimize the spreading of infection. There was no statistical significance between source of infection with gender (p = 0.323). However, there was statistical significance between source of infection and nationality (p < 0.001). CONCLUSION: The incidence of COVID-19 cases is expected to continue to increase. However, the efforts of the Saudi government are crucial in minimizing the spread of this infection.