Impact of Protracted War Crisis on Dental Students: A Comparative Multicountry Cross-sectional Study.

BACKGROUND: The impact of conflict and war crisis on dental students is poorly understood. Given the prolonged conflicts and political instability in the Arabic-speaking countries, it is crucial to investigate the effect of these conditions on dental students. This study aimed to assess the impact of protracted war on dental students by comparing the personal, university, and wider context challenges they face across war-affected and unaffected countries. METHODS: A cross-sectional study was conducted including a convenience sample of dental students from 13 universities in 12 Arabic-speaking countries. Respondents were those at entry and exit points of their undergraduate dental training. A self-administered paper questionnaire collected anonymized data on sociodemographics, and personal, university, and wider context challenges that students were facing. Multivariable Poisson regression analyses were carried out. RESULTS: The overall response rate was 64.8%. The mean age was 21.2 (standard deviation = 2.1) years, with 68% of participants being female. After adjusting for age and sex, dental students in Arabic-speaking countries affected by protracted war crisis were significantly more likely to report wider context challenges compared to their counterparts in unaffected countries (n = 2448; beta = 1.12; 95% confidence interval: 1.10-1.13; P < 0.001). DISCUSSION: Dental students in Arabic-speaking countries affected by protracted war crisis were more likely to suffer from wider context challenges such as difficulties in attendance due to the deterioration of security and lack of flexibility of teaching time to accommodate the different circumstances induced by the war crisis. Supporting dental students in areas affected by protracted war crises is needed and may include developing online dental education programs.

Reproducibility of subtraction radiography in monitoring changes in approximal carious lesions in children: An in vivo study.

BACKGROUND: Laboratory studies have shown that digital subtraction radiography (DSR) can be a more effective tool, than conventional radiography, in monitoring changes in carious lesions. The clinical performance of the technique, however, has not been sufficiently researched. AIM: To compare the reproducibility of DSR to that of bitewing radiographs, in monitoring changes in approximal caries in the mixed dentition. A secondary aim was to determine whether assessment outcomes differed as a function of the method used. DESIGN: Six assessors evaluated 310 lesions first on bitewings, then with DSR. The overall reproducibility was evaluated via intra-class correlation coefficient (ICC). Intra- and inter-rater reproducibility were assessed using weighted Kappa. Paired t test was used to assess differences in the reproducibility across methods. RESULTS: The overall reproducibility for DSR was (ICC = 0.47, 95% CI = 0.31-0.56). Intra- and inter-rater reproducibility were 0.65 and 0.44, respectively. The overall reproducibility for bitewings was ICC = 0.45, 95% CI = 0.42-0.57. Intra- and Inter-rater reproducibility were 0.71 and 0.46, respectively. Differences in the reproducibility across methods were not statistically significant. Significantly more lesions were scored as progressed using DSR. CONCLUSIONS: The reproducibility of DSR in monitoring changes in approximal caries is comparable to that of bitewings. Additionally, DSR detected higher proportion of progression than bitewing assessments.

Use of the Hall technique by specialist paediatric dentists: a global perspective.

Background The Hall technique (HT) is popular with UK paediatric dentists (PDs). Global PDs perception/use of HT is unknown.Aim To investigate global PDs opinions/use of HT.Materials and methods A cross-sectional questionnaire of 26 questions was sent to specialist PDs across the globe.Results Responses of 709 PDs from six continents were obtained. The majority (n = 654, 92.32%) had heard about HT but only 50.6% (n = 358) used it, with wide country variations. Respectively, 37.5%, 31.5% and 31% were neutral, against or supportive of HT when they initially heard about it. Only 17% of HT users said it was always the treatment of choice for non-pulpal asymptomatic carious primary molars (NPACPMs), 62% would take a pre-operative radiograph, 65% would consider using high speed drills before HT, 63% would never consider HT under general anaesthesia, 56% would use HT under N2O sedation. Finally, in a clinical scenario of a NPACPM in a cooperative 6-year-old, 75% of PDs would choose conventional restorative methods over the HT.Conclusion The HT is recognised, but not used, by an outright majority of PDs across the globe. Identifiable barriers such as lack of training, perception as substandard dentistry and perceived lack of evidence reduced its use.

Dentists' intention to report suspected violence: a cross-sectional study in eight Arab countries.

OBJECTIVES: This study assessed dentists' intention in eight Arab countries to report suspected exposure to violence among patients and factors associated with this intention based on the theory of planned behaviour. METHODS: A cross-sectional study was conducted in 2016 including a convenience sample of dentists practising in public, private and academic sectors in Algeria, Egypt, Jordan, Kuwait, Libya, Palestine, Saudi Arabia and Yemen. Respondents answered a self-administered questionnaire collecting information about personal and professional background and perceived ability to identify victims of violence. The questionnaire assessed (on a scale from 1 to 10 using six negative statements) dentists' perception of healthcare system mandated reporting of suspected violence. Six statements were used to assess professional attitude towards reporting suspected violence. Logistic regression was used to assess the association between intention to report suspected violence and perceived ability, perception and attitude adjusting for confounders. RESULTS: The response rate was 65.2% (n=2936/4506) from general practitioners (70.9%) of mean age=31 years with 56.7% women. Of those, 68.8% intended to report and 52.2% considered themselves able to identify violence victims. The mean (SD) negative perception score=5.3/10 (2.1) and the mean (SD) professional attitude score=7.5/10 (1.9). In multivariate regression, intention to report was associated with professional attitude (OR 1.08, 95% CI 1.03 to 1.14), ability to identify violence victims (OR 1.76, 95% CI 1.45 to 2.12) and negative perception that reporting is not mandated (OR 0.89, 95% CI 0.85 to 0.94). Significant differences existed among countries in intention to report. CONCLUSION: Most dentists intended to report suspected violence and their intention could be explained by the theory of planned behaviour which offers a framework for professional development to support violence victims. Sharing of training resources, policies and guidelines is needed to ensure that practices similar to international guidelines are consistently adopted by dentists across Arab countries.

Smartphone App as an aid in the emergency management of avulsed teeth.

BACKGROUND/AIM: The initial response by bystanders to an avulsed tooth is a significant factor that can affect its survival and long-term outcome. This study was to assess the knowledge of emergency management of tooth avulsion in a group of schoolteachers and to compare the effects of three different educational interventions. METHODS: Baseline knowledge was assessed using a questionnaire developed for this study. The same questionnaire was used to test changes in the knowledge level following each educational intervention. A convenience sample of elementary and intermediate school teachers (n = 87) participated in this study. Teachers were divided into three groups: Group 1 (Lecture only) was given a 30-min lecture on the emergency management of tooth avulsion. Their knowledge was assessed immediately after the lecture. Group 2 (Lecture and App), the same lecture was given, but participants also had access to a smartphone App, Dental Trauma App (Dental Trauma AB, Linköping, Sweden), when assessed on their knowledge after the lecture. Group 3 (App), this group was only given the smartphone App to explore and had access to that when being assessed. RESULTS: All three interventions increased the knowledge of tooth avulsion management. A marked increase in the knowledge, regardless of the type of intervention, was observed in the following areas: handling the tooth on the ground (16-96.8%); holding the tooth while being cleansed (19.1-62.5%); and on the best storage medium (10.1-59.3%). Participants using the App only had a significantly higher mean score than participants receiving the lecture only (group 3; P = 0.019) and participants subjected to both Lecture and App (group 1; P = 0.000). CONCLUSION: The Dental Trauma App alone is an effective means of providing accessible knowledge to guide laypeople in managing tooth avulsion, and it can be superior to a lecture-based delivery of information.

A new approach to reliability assessment of dental caries examinations.

OBJECTIVES: The objective of this study is to evaluate reliability of the International Caries Detection and Assessment System (ICDAS) and identify sources of disagreement among eight Kuwaiti dentists with no prior knowledge of the system. METHODS: A 90-min introductory e-course was introduced followed by an examination of extracted teeth using the ICDAS coding system on the first day. Then three sessions of clinical examinations were performed. This study only used the data from the last session where 705 tooth surfaces of 10 patients were examined to assess bias in caries examination and on which codes the examiners had the highest disagreement. Compared with the gold standard, we evaluated bias of the ICDAS coding using three approaches (Bland-Altman plot, maximum kappa statistic, and Bhapkar's chi-square test). Linear weighted kappa statistics were computed to assess interexaminer reliability. RESULTS: Marginal ICDAS distributions for most examiners were significantly different from that of the gold standard (bias present). The primary source of these marginal differences was misclassifying sound surfaces as noncavitated lesions. Interexaminer reliability of the 3-level ICDAS (codes 0, 1-2, and 3-6) classification ranged between 0.43 and 0.73, indicating evidence of substantial inconsistency between examiners. The primary source of examiner differences was agreeing on diagnosing noncavitated lesions. CONCLUSION: This study highlights the importance of assessing both systematic and random sources of examiner agreement to correctly interpret kappa measures of reliability.

Knowledge, attitudes and practices of caregivers in relation to oral health of preschool children.

OBJECTIVE: To assess the knowledge, attitudes and practices of caregivers in Kuwait in relation to the oral health of preschool children. SUBJECTS AND METHODS: Questionnaires with multiple-choice questions were distributed to 334 caregivers of children under the age of 6 years attending vaccination centers in Kuwait. For each question, one of the multiple-choice answers was consistent with the consensus in the pediatric dental literature in relation to early childhood caries prevention, and was considered to be correct. The χ2 test, independent t test, ANOVA, and stepwise linear regression were used to assess the associations between the variables in question and p ≤ 0.05 was accepted as statistically significant. RESULTS: Of the 334 participants, 234 (70%) were between 20 and 40 years of age with a high school diploma or higher degree and had between 2 and 5 children. The mean knowledge score was 4.68 ± 1.87, the mean attitude score was 4.34 ± 0.88 and the mean practice score was 2.45 ± 0.99. Major weaknesses were reported in infant oral health-related concepts. Mothers had better knowledge than other caregivers (p < 0.001). Higher education was significantly associated with better knowledge (p = 0.003) and better practices (p = 0.017). In addition, knowledge, attitude and level of education were positively and significantly associated with practices (p < 0.005). CONCLUSIONS: Our study showed that caregivers had weak knowledge and practice in relation to the oral health of preschool children. Mothers and caregivers with higher education had better knowledge and practices. Education and attitude appeared to be favorable indicators of the caregivers' practices with regard to the oral health of their preschool children.

Guidelines for dental radiography immediately after a dento-alveolar trauma, a systematic literature review.

The objective with this study was to search for and to analyze the presence of scientific papers, guidelines, and recommendations in dental literature regarding which radiographs should be prescribed after a dento-alveolar trauma. We know from earlier that guidelines and recommendations are available in general in dental traumatology. The International Association of Dental Traumatology (IADT) has earlier developed guidelines for the management of dental trauma cases in general. There are also recommendations about useful intraoral radiographic methods when caries and periodontal disease are studied. An additional objective was to provide some guidelines for general practitioners about the most accurate radiographic examination immediately after a dento-alveolar trauma using intraoral radiographs or a common extraoral imaging method. Because radiographs are an important diagnostic tool for establishing a correct differential diagnosis after a trauma, radiographic guidelines and recommendations are of importance to be able to start the correct treatment. PubMed Central, Cochrane and World Wide Web were searched and the identified existing guidelines for different intraoral radiographic methods in dentistry were analyzed and found to be very few. Those that were identified were in general not so detailed and specific. In conclusion, we found an explicit need for more detailed guidelines regarding which intraoral and other dental radiographs should be prescribed initially in dental traumatology.

Laypeoples' preferred sources of health information on the emergency management of tooth avulsion.

AIM: When planning nationwide information campaigns on the emergency management of tooth avulsion, the populations' preference to different modes of information delivery should be taken into consideration. We currently lack information on that. The aim of this study was, therefore, to assess laypeoples' preferred sources of information on the emergency management of tooth avulsion. METHODOLOGY: This was a joint study undertaken by experts in media and experts in dental traumatology. Interview-assisted questionnaires were conducted on a sample of 579 adults from Kuwait. Subjects were asked to choose their three preferred sources of information on the emergency management of tooth avulsion. Subjects' responses and sociodemographic data were registered. The data were descriptively analyzed, and a chi-square test was used to assess the relation of the subjects' preferences to their registered demographics. RESULTS: The Internet, health care professionals, and TV were the three most preferred sources of information on the emergency management of tooth avulsion across all groups, regardless of the sociodemographic characteristics. Younger adults, singles and subjects with higher education significantly preferred the Internet. Older adults preferred TV. Family was a preferred source in geographic districts populated with extended families, while friends were a preferred source in geographic districts populated by expatriates. CONCLUSIONS: Younger people and those with higher education can be effectively targeted through the Internet, while it is more effective to target older people through TV. Information, on tooth avulsion management, given by health care professionals is preferred across all population segments.