A Comparison of Pre-Emptive Co-Amoxiclav, Postoperative Amoxicillin, and Metronidazole for Prevention of Postoperative Complications in Dentoalveolar Surgery: A Randomized Controlled Trial.

OBJECTIVE: To compare the effectiveness of different oral antibiotics for prevention of dry socket and infection in adults following the surgical extraction of teeth under LA. METHODS: This randomized controlled study was conducted from 10 September 2020 until 10 May 2021. Forty-six patients were randomly allocated to three groups. Sixteen patients were in the postoperative co-amoxiclav (625 mg) group, fifteen in the preoperative co-amoxiclav (625 mg) plus postoperative metronidazole (500 mg) group and fifteen in the preoperative co-amoxiclav (625 mg) plus postoperative amoxicillin (500 mg) group. Evaluation of the postoperative signs of alveolar osteitis and infection was made by a dental surgeon five days postoperatively. Evaluation of the post-surgical extraction pain was made by patients immediately and five days postoperatively on standard 100 mm visual analogue scales (VAS). Furthermore, difficulty of surgery was recorded for all patients immediately postoperatively using (VAS). RESULTS: all antibiotics used in this study were effective. Only 15% of patients had painful alveolar osteitis and 2% had oral infections. There was no significant decrease in the number of patients with severe alveolar osteitis or infection for co-amoxiclav plus metronidazole and co-amoxiclav plus amoxicillin groups compared to co-amoxiclav group at 5 days post-operation (p-values: 0.715, 0.819 & 0.309). Clinically, metronidazole was more effective in protecting the extracted tooth socket from alveolar osteitis compared to co-amoxiclav and amoxicillin. Moreover, there were significant decreases in mean pain scores at 5 days post-operation compared with the levels of pain immediately after surgery (p-value: 0.001). CONCLUSIONS: Administration of a single preoperative dose of co-amoxiclav with a full postoperative dose of amoxicillin or metronidazole was more effective than conventional treatment with postoperative co-amoxilcalv in reducing the incidence of both alveolar osteitis and infection after surgical extractions. However, these differences were not statistically significant. Interestingly, patients in metronidazole group had the lowest incidence of dry socket.

Measuring the Level of Medical-Emergency-Related Knowledge among Senior Dental Students and Clinical Trainers.

OBJECTIVES: This study aimed to measure the level of medical-emergency-related knowledge among senior dental students and clinical trainers in Saudi Arabia. METHODS: This cross-sectional pilot survey was conducted at Taibah Dental College, Madina, Saudi Arabia between March 2017 and November 2018. Two hundred and seventy-five self-administered anonymous questionnaires on the management of common medical emergencies were distributed to all senior dental students and clinical trainers at Taibah Dental College. RESULTS: There was a serious lack of knowledge regarding the management of medical emergency scenarios among the participants. Only 54% of participants knew the correct management for some frequent and life-threating conditions such as "crushed chest pain", and only 30-35% of participants knew the correct management of deeply sedated patients with benzodiazepine overdose and crisis of hypoadrenalism. Moderate-quality knowledge (50-74% of participants responded correctly) was noted for the following conditions: sudden onset of brain stroke, psychiatric patient, unconscious patient with hypoglycemia, patient with postural hypotension, and patient with hyperventilation. Based on the scale of knowledge, there were significant differences in the level of knowledge between clinical trainers, senior dental students, and junior dental students (p ≤ 0.01). Almost all students and 90% of trainers declared the need for further training. CONCLUSIONS: The overall knowledge regarding the management of medical emergency crises in the dental chair was moderate. However, the scale of knowledge regarding the management of medical emergency crises has gradually increased with the number of years of experience. Most participants recognize the need for further training.

Influence of Energy Beverages on the Surface Texture of Glass lonomer Restorative Materials.

BACKGROUND AND OBJECTIVE: The objective of the study was to find whether energy beverages have an erosive effect, leading to a risk in the clinical performance of glass ionomer restorative materials. AIM: This study evaluated the influence of energy beverages on the surface texture of glass ionomer restorative materials. MATERIALS AND METHODS: Glass ionomer materials used were Ionofil Plus AC, GC EQUIA, and Ketac Molar; energy beverages are Code Red, Red Bull, and Power Horse. Specimens prepared were discs of 8 mm diameter and 3 mm thickness; specimens from each material were evaluated following aging with Code Red, Red Bull, and Power Horse energy beverages. Distilled water was used as a control. The surface roughness (Ra) was assessed by surface scanning interferometry. The surface roughness values (ΔRa and Ra) were measured for each specimen. The data were analyzed statistically using multiple repeated measures [analysis of variance (ANOVA)] and paired data t-test (p < 0.05 was considered as the significance level). RESULTS: The surface roughness (ΔRa and Ra) values before and after aging using Code Red, Red Bull, and Power Horse energy beverages differ significantly for all the materials regardless of the immersion time (p < 0.05). All the materials showed roughness changes after immersion periods of 1 day, 1 week, and 1 month. CONCLUSION: It can be concluded that all energy beverage solutions used in this study had an adverse effect on the surface roughness degradation of the tested glass ionomers with increasing immersion time. CLINICAL SIGNIFICANCE: Energy beverages have an erosive effect on glass ionomer, which influences the clinical importance of the material; it also has anticarious property because it releases the fluoride.

Chitosan Biomaterials for Current and Potential Dental Applications.

Chitosan (CHS) is a very versatile natural biomaterial that has been explored for a range of bio-dental applications. CHS has numerous favourable properties such as biocompatibility, hydrophilicity, biodegradability, and a broad antibacterial spectrum (covering gram-negative and gram-positive bacteria as well as fungi). In addition, the molecular structure boasts reactive functional groups that provide numerous reaction sites and opportunities for forging electrochemical relationships at the cellular and molecular levels. The unique properties of CHS have attracted materials scientists around the globe to explore it for bio-dental applications. This review aims to highlight and discuss the hype around the development of novel chitosan biomaterials. Utilizing chitosan as a critical additive for the modification and improvement of existing dental materials has also been discussed.

The Impact of Hyposalivation on Quality of Life (QoL) and Oral Health in the Aging Population of Al Madinah Al Munawarrah.

Hyposalivation (HS) affects aging individuals by causing pain and discomfort in the oral cavity. The aim here was to determine the impact of hyposalivation and the saliva pH on the quality of life and caries status of geriatrics population. A total of 138 male outpatients attending the Taibah University College of Dentistry (TUCoD) dental clinic were included in the study. The saliva flow, pH, Quality of Life (QoL), and caries status were recorded. The QoL was measured using the Arabic version of the Oral Health Impact Profile-14 (OHIP-14), and the caries status was recorded using the Decayed, Missed, Filled Teeth (DMFT) index. The mean age was 67.5 years and 64% were classified as having hyposalivation. The older respondents tended to have a lower saliva flow and pH compared to their younger counterparts. There was a significant inverse association (p = 0.02) between the caries status and mean saliva flow rate. There was also a significant (p < 0.001) positive correlation between caries and the OHIP-14 scores (Spearman's ρ = 0.293). The prevalence of hyposalivation was relatively high and there was an inverse relationship between the age, the saliva flow, and pH. Those with more caries reported significantly poor QoL.

Comparison of paracetamol, ibuprofen, and diclofenac potassium for pain relief following dental extractions and deep cavity preparations.

OBJECTIVES: To compare the effectiveness of different oral analgesics for relieving pain and distress in adults following the extraction of teeth and deep cavity preparations under local anesthesia. Methods: This randomized controlled study was conducted between November 2015 and May 2016. One hundred and twenty patients were randomly allocated to 3 groups. Forty patients were in the paracetamol (1 gram) group, 40 in the ibuprofen (400 mg) group and 40 in the diclofenac potassium (50 mg) group. Evaluation of the post extraction and deep cavity preparations pain was made by patients immediately postoperatively, 2, 4 and 6 hours postoperatively on standard 100 mm visual analogue scales (VAS). Furthermore, each patient was observed preoperatively and immediately postoperatively for signs of distress by using a 5 point face scale. Results: There were significant decreases in mean pain VAS scores for diclofenac potassium group compared to paracetamol and ibuprofen groups at 4 hours postoperatively (one-way Analysis of Variance: p=0.0001, p=0.001) and 6 hours postoperatively (p=0.04, p=0.005). Changes in distress scores from the preoperative score to the postoperative score were made using the paired sample t-test. There were significant decreases in distress scores between the preoperative and postoperative scores (p=0.0001). Conclusions: Diclofenac potassium was more effective than paracetamol or ibuprofen for reducing postoperative pain associated with tooth extraction and deep cavity preparation. Patients' distress levels can be alleviated by using preemptive analgesics.

The Effect of Preventive Agents (Mouthwashes/Gels) on the Color Stability of Dental Resin-Based Composite Materials.

The color of dental restorative material should be maintained throughout its functional lifetime in an oral environment. However, the frequent use of mouthwash may affect the color stability of these composite restorations. The aim of this study is to assess the effects of using various mouthwashes on the color stability of various dental restorative composite materials. For this purpose, four mouthwashes/gels (Flocare gel (0.4% stannous fluoride), Pascal gel (topical APF fluoride), Pro-Relief mouthwash (sodium fluoride), and Plax Soin mouthwash (sodium fluoride)), and distilled water as a control, were selected. These were divided into five groups: Group 1: Flocare gel; Group 2: Pascal gel; Group 3: Pro-Relief mouthwash; Group 4: Plax Soin mouthwash; and Group 5: distilled water (control). Prepared restorative materials samples were immersed in the groups of mouthwashes/gels and the distilled water (control) for 24, 48, and 72 h. The discoloration that all materials exhibited with all immersion groups was significantly different at each of the three time periods for all groups (p < 0.05). Results from immersion in Flocare gel, Pascal gel, Pro-Relief mouthwash, and Plax Soin mouthwash were statistically significant (p < 0.05). The color change chroma was not significant for Pro-Relief and Plax Soin mouthwash (p > 0.05). Mouthwashes/gels affect color shifting for all composite resin materials, and changes are exaggerated over time. However, discoloration effects are not perceptible to the human eye.

Surface Hardness of Dental Composite Resin Restorations in Response to Preventive Agents.

INTRODUCTION: To assess the impact of using preventive mouthwash agents on the surface hardness of various resins composites. MATERIALS AND METHODS: Hundred specimens were prepared from five types of composite resin material in a Teflon mold. Five specimens from each type of restorative materials (Herculite XRV Ultra, Estelite Σ Quick, Z Hermack, Versa Comp Sultan, and Empress Direct IPS) were evaluated posttreatment with immersion in four types of preventive mouthwashes gels and rinses - group 1: Flocare gel (0.4% stannous fluoride), group 2: Pascal gel (topical APF fluoride), group 3: Pro-relief mouthwash (Na fluoride), and group 4: Plax Soin mouthwash (Na fluoride) - at 37°C in a dark glass container at 24, 48, and 72 hours. Surface hardness measurement was made for each tested material. Statistically, we analyzed the mean values with one-way analysis of variance (ANOVA) and Tukey's test, with significance level of p < 0.05. RESULTS: All composite resin materials showed decrease in their surface hardness with the time elapsed (24, 48, and 72 hours) postimmersion in the preventive mouthwashes and gels except the Herculite XRV Ultra and Versa Comp Sultan materials. Flocare gel group showed increase in the surface hardness after 48 hours of immersion than the other periods and in Estelite Σ Quick after 72 hours. There was significant differences in all materials tested with the immersion in the preventive mouthwashes and gels, such as Flocare gel (0.4% stannous fluoride), Pro-relief mouthwash (Na fluoride), and Plax Soin mouthwash (Na fluoride) except Pascal gel (topical APF fluoride) (p > 0.05), at time intervals mentioned earlier (p < 0.05). CONCLUSION: The effect of preventive mouthwashes and gels on resin composite materials was decreased surface hardness with the time elapse of immersion for all materials except the Flocare gel group, which contains 0.4% stannous fluoride as a preventive ingredient increases the surface hardness after 48 h for Herculite XRV Ultra and Versa Comp Sultan and Estelite Σ Quick after 72 hours. CLINICAL SIGNIFICANCE: The preventive agents in the form of mouthwash and gel are used to prevent oral diseases that affect the surface hardness of composite resin, and this leads to occlusion, color stability, and surface roughness.

Pain and anxiety management for pediatric dental procedures using various combinations of sedative drugs: A review.

For fearful and uncooperative children behavioral management techniques are used. In order to control the pain and anxiety in pedodontic patients, pharmacologic sedation, anesthesia and analgesia are commonly used. Midazolam is commonly used as an oral sedation agent in children; it has several features such as safety of use, quick onset and certain degree of amnesia that makes it a desirable sedation agent in children. This review paper discusses various aspects of oral midazolam, ketamine and their combinations in conscious sedation including, advantages of oral route of sedation, pharmacokinetics, range of oral doses, and antagonists for clinical dental treatment procedures.

Effectiveness of benzocaine in reducing deep cavity restoration and post-extraction stress in dental patients.

OBJECTIVES: To investigate the effectiveness of topical anesthetic, 20% benzocaine in relieving pain and stress in patients following deep cavity restoration and extraction of teeth under local anesthesia (LA). METHODS: A prospective clinical trial was conducted from October 2014 until April 2015 at Taibah University, Al Madinah Al Munawarah, Kingdom of Saudi Arabia. Forty-five patients were included in the 20% benzocaine group, and 46 in the normal saline group. Evaluation of the dental stress was made pre-operatively and immediately post-operative treatment using the visual analogue scale (VAS). Furthermore, discomfort of the injections were recorded by the patients after each treatment on standard 100 mm VAS, tagged at the endpoints with "no pain" (0 mm) and "unbearable pain" (100 mm). RESULTS: There were statistically significant differences between the mean stress scores for patients in the benzocaine and normal saline groups post-operatively (p=0.002). There were significant differences between the mean pain scores for patients in the post buccal injection (p=0.001), post palatal injection (p=0.01), and the post inferior alveolar nerve block groups (p=0.02). Buccal, palatal, and inferior alveolar nerve block injections were more painful for patients in the normal saline group than the benzocaine group. CONCLUSION: This investigation has demonstrated that post-operative stress associated with deep cavity restoration and dental extractions under LA can be reduced by the application of topical anesthetic (20% benzocaine) at the operative site for intra-oral injections.

Effect of imaging powder and CAD/CAM stone types on the marginal gap of zirconia crowns.

OBJECTIVE: To compare the marginal gap using different types of die stones and titanium dies with and without powders for imaging. METHODS: A melamine tooth was prepared and scanned using a laboratory 3-shape scanner to mill a polyurethane die, which was duplicated into different stones (Jade, Lean, CEREC) and titanium. Each die was sprayed with imaging powders (NP, IPS, Optispray, Vita) to form 15 groups. Ten of each combination of stone/titanium and imaging powders were used to mill crowns. A light-bodied impression material was injected into the intaglio surface of each crown and placed on the corresponding die. Each crown was removed, and the monophase material was injected to form a monophase die, which was cut into 8 sections. Digital images were captured using a stereomicroscope to measure marginal gap. Scanning electron microscopy was used to determine the particle size and shape of imaging powders and stones. RESULTS: Marginal gaps ranged from mean (standard deviation) 49.32 to 1.20 micrometers (3.97-42.41 µm). There was no statistical difference (P > .05) in the marginal gap by any combination of stone/titanium and imaging powders. All of the imaging powders had a similar size and rounded shape, whereas the surface of the stones showed different structures. CONCLUSIONS: When a laboratory 3-shape scanner is used, all imaging powders performed the same for scanning titanium abutments. However, there was no added value related to the use of imaging powder on die stone. It is recommended that the selection of stone for a master cast be based on the hysical properties. PRACTICAL IMPLICATIONS: When a laboratory 3-shape scanner is used, the imaging powder is not required for scanning die stone. Whenever scanning titanium implant abutments, select the least expensive imaging powder.

Color stability of restorative materials in response to Arabic coffee, Turkish coffee and Nescafe.

OBJECTIVE: To evaluate the effect of Arabic coffee, Turkish coffee and Nescafe on the color stability of four different composite resins after a period of aging time 1, 7 and 30 days. MATERIALS AND METHODS: Twenty specimens from each type of tested composite resin material were prepared. Five specimens from each tested material (Z350 XT, Artist, GC and Z250) was evaluated after storage in Arabic coffee, Turkish coffee, Nescafe and distil water (control) at 37°C in a dark container for 1, 7 and 30 days. Color measurement was done using colorimeter based on the CIE L* a* b* color scale. Color differences ΔE*ab, Δb* and Δa* among specimens immersed in distil water and staining coffee beverages were evaluated overtime. Mean values were statistically analyzed with one-way analysis of variance (ANOVA), followed by Tukey test with p < 0.05 as significance level. RESULTS: All tested composite resins showed increase color change after a period of 1, 7 and 30 days. The color change ΔE*ab , Δb* and Δa* exhibited by Arabic coffee, in Turkish coffee and Nescafe except Δa*. The highest total color difference ΔE*ab after 30 days was in group A Arabic coffee (ΔE > 1.5 perceivable) and not perceivable in group B Turkish coffee and group C Nescafe. For Δb* all materials discolored toward yellowness after 30 days except Arabic coffee group which shifted from yellowness toward blueness (Δb*> 1.5 perceivable). CONCLUSION: The effect of staining beverages on the resin composite materials increases with time of aging toward yellowness and not perceivable in all groups except with Arabic coffee which had highest effect after 30 days and the discoloration shifted from yellowness to blueness perceivable.

Effect of energy drinks on the surface texture of nanoflled composite resin.

OBJECTIVE: To study the effect of three energy drinks on the surface roughness of nanoflled composite resins after different periods of aging time. MATERIALS AND METHODS: Composite resin disks, 6 mm diameter, 3 mm thickness were prepared from Filtec Z350 XT, Tetric EvoCeram and Filtec Z250 XT. Specimens fr/8om each material were tested after aging with Red Bull, Bison and Power Horse energy drinks and distilled water as a control. Specimens were stored at 37°C in dark containers for 1, 3 and 6 months. Surface roughness Ra was assessed using a surface scanning interferometry before and after each storage period. Surface roughness differences ΔRa and Ra among specimens were measured. Mean values were statistically analyzed using multiple repeated measured (ANOVA), variance and multiple comparisons of the mean values were done with Bonferroni test, with p < 0.05 as signifcance level. RESULTS: The surface roughness degradation change ΔRa and Ra value before and after occurred by Red Bull, Bison and Power Horse energy drinks was signifcantly different for all tested materials at all three times p < 0.05. All specimens showed increase in surface roughness changes after aging periods of 1, 3 and 6 months. The highest total surface roughness difference ΔRa and Ra was found in the Red Bull group after 6 months. CONCLUSION: Energy drinks used in this study had surface degradation effect on the tested composite resin materials. The surface roughness increased with aging time however, it was clinically acceptable in all test groups after 6 months. The effect of energy drinks solutions on the surface roughness parameter of resin composites depends on type of solution and its acidity contents.

Assessment of hepatitis B vaccination and compliance with infection control among dentists in Saudi Arabia.

OBJECTIVE: To evaluate hepatitis B virus (HBV) vaccine coverage and the use of infection control among dentists in Saudi Arabia. METHODS: This cross-sectional study was carried out during the Third International Conference at the King Abdulaziz University Faculty of Dentistry, held on March 2012 in Jeddah, Saudi Arabia. Saudi or expatriate dentists working in Saudi Arabia were included in the study. The questionnaires were designed to meet the objective of the study. RESULTS: A total of 402 dentists of whom 176 (44%) were male and 226 (56%) female took part in this study. Their mean age was 37.4 years. In all, 246 (61%) were general dentists and 156 (39%) specialists. Four-fifths (80.5%) of them had been vaccinated. Almost half (48.5%) had experience of needle stick injury, but none reported having been infected with HBV. Among the vaccinated dentists, 186 (57.5%) had not been screened for HBV antibodies. Younger dentists were more particular about vaccination and more careful in using protective wear. There was an association between protective barriers and HBV vaccination, but there was no association between history of needle stick injury and vaccination. CONCLUSION: Dental healthcare workers have a high risk of infection with HBV due to the nature of their work; so there should be a mandatory program to vaccinate dentists against HBV and to ensure application of protective measures during their practice.

Prevalence of first permanent molar caries in and its relationship to the dental knowledge of 9-12-year olds from jeddah, kingdom of saudi arabia.

The carious status of the first permanent molar (FPM) was studied in 432 school children (aged 9-12 years) from a randomly selected primary schools from Sharfia area of Jeddah, Kingdom of Saudi Arabia. The sample consisted of 108 children from each age group of 9, 10, 11, and 12 years old. In total, 24.5% had all of their FPMs sound and 6% had all FPMs carious. The prevalence of four sound FPMs varied according to age with the highest (33%) amongst the nine-year olds and the lowest (16.5%) in the oldest children (12 years). Almost one-third (32.5%) of the children, who knew the age of eruption of the FPMs, had all of their molars sound. The children who had received advice regarding oral hygiene from a dentist or parent had more sound FPMs compared to the children who did not receive any advice. The number of carious FPMs increased with age. The prevalence of caries of the FPM was high and increased with increasing age. The level of knowledge had a positive correlation with the caries levels amongst this cohort of scholars.