Outcome of orthodontic palatal plate therapy for orofacial dysfunction in children with Down syndrome: A systematic review.

To evaluate the effects of orthodontic palatal plate therapy (OPPT) in the treatment of orofacial dysfunction in children with Down syndrome (DS). Indexed databases were searched. Clinical trials in DS allocated to test (treatment with palatal plates) versus control group (without palatal plates/special physiotherapy for orofacial stimulation) with follow-up of any time duration and assessing mouth closure, tongue position, active and inactive muscle function as outcomes. Study designs, subject demographics, frequency and duration of palatal plate therapy, method for assessment, follow-up period and outcomes were reported according to the PRISMA guidelines. Eight clinical studies were included. The risk of bias was considered high in three studies and moderate in 5 studies. The number of children with DS ranged between 9 and 42. The mean age of children with DS at the start of the study ranged between 2 months and 12 years. The duration of palatal plate therapy ranged between 4 months and 48 months. The follow-up period in all studies ranged from 12 to 58 months. All studies reported OPPT to be effective in improving orofacial disorders in children with DS. Most of the included studies suggest that palatal plate therapy in combination with physiotherapy/orofacial regulation therapy according to Castillo Morales/speech and language intervention seems to be effective in improving orofacial disorders in children with DS. However, the risk of bias of the included studies was high to moderate. Longitudinal trials with standardized evaluation methods, age of children at treatment initiation, treatment duration and standard orofacial outcomes are recommended.

The implant surface characteristics and peri-implantitis. An evidence-based update.

Peri-implantitis is an inflammatory disease of the peri-implant mucosa with the loss of supporting bone. Because of the absence of an un-inflamed connective tissue zone between the healthy and diseased sites, peri-implant lesions are thought to progress more rapidly than periodontal lesions, suggesting the importance of early diagnosis and intervention if possible. A number of risk factors have been identified that may lead to the initiation and progression of peri-implant mucositis and peri-implantitis, eg., previous periodontal disease, poor plaque control, inability to clean, residual cement, smoking, genetic factors, diabetes, occlusal overload, rheumatoid arthritis, increased time of loading and alcohol consumption. At present there is not much literature available, highlighting the relationship between implant surface characteristics and peri-implant diseases. Implant surface characteristics vary with respect to topography, roughness and clinical composition, including turned, blasted, acid etched, porous sintered, oxidized, plasma sprayed and hydroxyapatite coated surfaces and their combinations. So the aim of this review is to explore the relationship between the characteristics of implant surface, the prevalence and incidence of peri-implantitis. This would help to identify plausible influence of surface characteristics, oral hygiene instructions and maintenance of implants for the long-term uneventful success of implant therapy.

The prevalence, oral manifestations and management of viral hepatitis in Saudi Arabia: an update.

The aim of this review is to update healthcare professionals about the prevalence of various hepatitis viruses in the Saudi population. A perspective on the global and regional prevalence of hepatitis A, B and C viruses has also been given. The oral manifestations of hepatitis infection, the risks of patients and healthcare workers acquiring these infections, as well as the management of dental patients with hepatitis infection in the dental clinical setting has also been discussed. The universal precautions which should be observed while treating these patients have been reiterated, whereby detailed steps as pertaining to the management of these patients have been described, so as to optimize patient treatment, and at the same time to prevent dental healthcare workers from acquiring infection. The purpose of such management is therefore to ultimately improve the quality of life of patients infected with hepatitis viruses.

Miswak (Salvadora persica chewing stick): the natural toothbrush revisited.

The review encompasses the historical background, chemical composition of miswak (Salvadora persica) and the effects it has on oral health. Miswak is an Arabic word meaning "tooth cleaning stick" and is a natural toothbrush made from the twigs of Salvadora persica (S. persica). Not only is S. persica miswak used in several countries throughout the world, but in some cases, it has proved to be more beneficial as compared to its counterparts-a toothbrush and toothpaste. Additionally, how to prepare the miswak, proper use of it, and the techniques to use will be discussed. An overview of the antimicrobial, anticariogenic, antiplaque, and antigingivitis effects of miswak on oral health will be given in the context of in vitro experiments and clinical trials. Lastly, various oral hygiene studies will be discussed, in order to identify a common denominator between modern-day and the age-old practice of miswak. Recent scientific evidence regarding its probiotic role, cell viability and comparative cytotoxicity and future research trends would be highlighted. Miswak, a cultural and history-based oral hygiene tool is now being evaluated on scientific evidence. Through comparing the naturally-occurring and scientific evolution of S. persica's usage, we will be able to better understand the uniqueness of miswak, relative to that of other oral hygiene tools as being a solo oral hygiene tool of a significant part of the World population. It's hope that the review would help health care professionals to have better knowledge and awareness about miswak, to improve the quality of life of their culturally diverse patients population who are uninitiated for regular oral hygiene measures due to various constraints. The use of miswak can be added to the notion of primary health care approach (PHCA) and oral health promotion.

Dental extraction as a risk factor for bisphosphonate related osteonecrosis of the jaw in cancer patients: an update.

UNLABELLED: Osteonecrosis of the jaw (ONJ) is a complication related to the use of bisphosphonates (BPs). Patients receiving BPs for the treatment of malignancies are at an increased risk of developing bisphosphonate-related ONJ (BRONJ) as compared to patients receiving BPs for the treatment of other disorders such as osteoporosis. Additionally, tooth extractions have been suggested to increase the risk of BRONJ in individuals taking BPs. OBJECTIVE: To review the role of dental extraction as a risk factor for BRONJ in cancer patients. MATERIALS AND METHODS: Databases were searched from January 1999 up to and including July 2012 using various combinations of the following keywords: "bisphosphonate", "osteonecrosis of the jaw", "cancer", "oral" and "dental extraction". RESULTS: Twenty two studies were included. Eighteen studies assessed the relationship between BRONJ and dental extractions in cancer patients, reporting the overall prevalence of BRONJ following extraction in this group as 3.25 +/- 2.23%. Four studies did not report a correlation between BRONJ and extractions, and recommended protocols to avoid the complication. CONCLUSION: There is a plausible relationship between dental extractions and the development of BRONJ in cancer patients. Written informed consent must be obtained prior to dental procedures in patients at risk for developing BRONJ.

Orthodontic considerations for gingival health during pregnancy: a review.

Gingivitis is caused by several known systemic and local factors. Among systemic factors, the role of hormonal changes during pregnancy is well established. While presence of fixed orthodontic appliances alone may not cause gingivitis, factors such as pregnancy and poor oral hygiene combined together could precipitate acute gingival inflammation that may progress to a periodontal condition in a patient receiving orthodontic therapy. There has been an increase in the number of adult patients who are receiving orthodontic treatment. Orthodontic appliances could act as a potential plaque retentive source and aggravate inflammatory reactions that are seen during pregnancy. There is a lack of awareness regarding oral healthcare issues among patients who are pregnant and choose to seek orthodontic treatment. In addition, there is a need in the literature to outline management guidelines for patients who want to receive orthodontic treatment during pregnancy, with or without pre-existing gingival conditions. This review focuses on the aetiology of pregnancy gingivitis and the management of orthodontic patients during pregnancy. Our emphasis is on patient education, oral hygiene maintenance, preventive and treatment strategies for the management of gingival health in orthodontic patients during pregnancy. We also highlight some of the possible complications of initiating orthodontic treatment during pregnancy.

Bisphosphonate-related jaw necrosis: a team approach management and prevention.

Osteonecrosis means the process of bone death. Bisphosphonates (BPs) are becoming recognized increasingly as having a significant impact on dental treatments. BPs are the most widely used class of anti-resorptive drugs. They prevent bone resorption through osteoclast inhibition and are considered the standard of care for the management of metastatic bone disease. BPs are used for the treatment of skeletal disorders such as osteoporosis, hypercalcaemia of malignancy, osteolytic lesions arising from solid tumours and Paget's disease, breast cancer or prostate cancer. Jaw necrosis appears to be associated with the intravenous (i.v.) use of BPs. The aim of this review paper is to update the understanding of healthcare professionals to the osteonecrosis of jaws, mechanism of action and classification of BPs, management of the patients with BP-related osteonecrosis (BRON) of the jaws. An interdisciplinary approach has been emphasized to prevent and manage the condition. Finally, the role of dental practitioners including dental hygienists has been discussed to early diagnose the BRON and improve the quality of life of patients with the condition.

Halitosis among racially diverse populations: an update.

The aim of this paper is to highlight the cultural perceptions of halitosis to dental professionals. Halitosis (oral malodour or bad breath) is caused mainly by tongue coating and periodontal disease. Bacterial metabolism of amino acids leads to metabolites including many compounds, such as indole, skatole and volatile sulphur compounds (VSC), hydrogen sulphide, methyl mercaptan and dimethyl sulphide. They are claimed to be the main aetiological agents for halitosis. Gastrointestinal diseases are also generally believed to cause halitosis. In general, physicians and dentists are poorly informed about the causes and treatments for halitosis. The paper reviews the prevalence and distribution of halitosis, oral malodour, its aetiology, concepts of general and oral health and diseases and their perception among racially diverse population. Eating, smoking and drinking habits and understanding of halitosis as a social norm among different people has been highlighted. The treatment options have also been presented very briefly. A brief discussion about general importance within existing healthcare services has been highlighted. Oral malodour may rank only behind dental caries and periodontal disease as the cause of patient's visits to the dentist. It is a public social health problem. The perception of halitosis is different in culturally diverse populations. So the dental professionals should be aware of the cultural perceptions of halitosis among racially and culturally diverse populations. There is a need to integrate the cultural awareness and knowledge about halitosis among the dental professional for better understanding of halitosis to treat patients with the social dilemma of halitosis to improve the quality of life and well-being of individuals with the problem. It is concluded that dental professionals (especially dental hygienists) should be prepared to practice in a culturally diverse environment in a sensitive and appropriate manner, to deliver optimal oral health and hygiene care.

An in vitro antimicrobial comparison of miswak extract with commercially available non-alcohol mouthrinses.

The aim of this study was to assess the antimicrobial activity of eight commercially available mouthrinses and 50% miswak extract against seven microorganisms. Corsodyl, Alprox, Oral-B advantage, Florosept, Sensodyne, Aquafresh Mint, Betadine and Emoform mouthrinses were used while 50% aqueous extract of miswak (Salvadora persica) was used against Streptococcus faecalis, Streptococcus pyogenis, Streptococcus mutans, Candida albicans, Staphylococcus aureus and Staphylococcus epidermidis. The ditch plate method was used to test the antimicrobial activity. Inhibition zones of microorganisms around ditches were measured in millimetres. Range, mean and standard deviations were used for comparison of antimicrobial activity. Mouthrinses containing chlorhexidine was with maximum antibacterial activity, while cetylpyridinium chloride mouthrinses were with moderate and miswak extract was with low antibacterial activity. Further research is needed for the substantivity of these mouthrinses and further in vivo/in vitro studies are needed using Biofilm model to substantiate present findings. Dental professionals must exercise caution and provide guidance in assisting their patients in making informed choices regarding their use of mouthrinses for clinical efficacy.

Education level, oral hygiene and smoking habits of an elderly Saudi population in Riyadh.

The aim of this study was to assess the education level, oral hygiene and smoking habits of an elderly population in Riyadh City, Saudi Arabia. The study was conducted at various locations including King Saud University, College of Dentistry Hospital, Riyadh Medical Complex, Military Hospital, vegetable markets and elderly house holds. A convenient sample of two hundred and fourteen subjects, age ranged 50-89 years male and female, were interviewed for education level, oral hygiene and smoking habits. The results showed that twenty-five percent of the sample was illiterate while almost 23 percent were with University Education. Only 46 percent were toothbrush user and 44 percent miswak user. Almost 25 percent were smoker. It is concluded that oral hygiene practices were common and cigarette smoking was not very prevalent. Further studies are needed to look into the other areas of oral health related with elderly population in Saudi Arabia.

Oral hygiene, dietary pattern and smoking habits of Bedouin (nomadic Arabs) population in Saudi Arabia.

The estimated population of the Bedouins are up to two million in the Kingdom of Saudi Arabia, but relatively little information is available about them. The aim of the study was to assess the oral hygiene dietary pattern and smoking habits of Saudi Bedouins population around Medina, Qaseen and Khamis Moshayte areas. Five hundred and twenty five Bedouins (296 male, 229 female) with the age range 2-90 years were interviewed and examined clinically over a period of four months (July to October 1998). It was found that 25% of the subjects were miswak users, 30% used miswak and tooth brush, while 26% never cleaned their teeth. Almost 50% of the subjects were regular in their oral hygiene habits. Seventy percent were rice eaters while meat and dates were second and third preference. Tea was the most common drink with 2-3 teaspoons of sugar per cup. Only ten percent were cigarette smokers and less than 5% used shisha (traditional smoking pipe). It is concluded from the study that within the surveyed Bedouin population one fourth of them never cleaned their teeth while almost the same number used miswak (Chewing stick) to clean their teeth. Rice was the most common food item, while tea with refined sugar was the most common drink. Only 15% were smoker. Further research is needed with a larger and a more representative sample of Bedouins from the Kingdom of Saudi Arabia.

Smoking behaviour and knowledge in high school students in Riyadh and Belfast.

UNLABELLED: Smoking is one of the risk factor associated with onset, severity and progression of periodontal disease. AIM: The aim of the study was to examine the smoking behaviour and dental health knowledge of high school students in Riyadh and Belfast. MATERIALS AND METHODS: Eight schools from Riyadh and 6 from Belfast were randomly selected by cluster distribution sampling method. Two hundred and ninety students from Riyadh and 144 from Belfast were included giving an overall response rate of 85%. The age range was between 16-17 years. A questionnaire was used to assess demography, smoking habits, dental health knowledge and oral hygiene practices. RESULTS: The results showed that 18% of students were smokers; 24% in Belfast and 15% in Riyadh (x2 (1) = 4.29: P = 0.04). 24% of students in Belfast and 56% in Riyadh smoked at least 1 cigarette per day. 61% of students had bleeding gums although 85% stated that they brushed their teeth at least daily. Bleeding on brushing was common with 53% of Belfast students compared with 65% from Riyadh. Students in Belfast (2.51 +/- 1.15) had significantly higher mean scores for their knowledge about gum health compared with Riyadh students (2.21 +/- 1.44) (t = 2.29: P = 0.02). There was no differences in knowledge about oral health and smoking between the students. However, non-smokers from Belfast and Riyadh (3.32 +/- 1.60) had greater knowledge about oral health and smoking than those who smoked (2.81 +/- 1.45) (t = 2.73: P = 0.007). There was no difference in knowledge about gum health between smokers and non-smokers. CONCLUSIONS/RECOMMENDATIONS: Smoking is more prevalent in Belfast but more cigarettes are smoked in Riyadh. As non-smokers had greater knowledge of the ill-effects of smoking upon their oral health, there is a need to develop location specific interventions to control smoking habits in late adolescence.

Oral hygiene profile of subjects on renal dialysis.

The study was designed to assess the level of oral home-care among subjects on renal dialysis. The study included 90 subjects, 37 (41.1%) male and 53 (58.9%) female, on renal dialysis. The mean age was 45.63 +/- 16.77. Four indices were used; the plaque index (PI); the debris index (DI); the calculus index (CI) and the gingival index (GI). Results showed that all subjects did not have optimal oral hygiene, means of PI, DI, CI and GI., were 2.0444, 1.9556, 1.8944 and 1.8167 respectively. No significant differences were observed between male and female. Frequency of plaque distribution indicated that 69.9% of the individuals had poor oral hygiene. In conclusion, subjects on renal dialysis were at high risk for developing periodontal disease. It is recommended that, subjects on renal dialysis should be regularly examined by dentists for proper care.

Prevalence of ocular injuries, conjunctivitis and use of eye protection among dental personnel in Riyadh, Saudi Arabia.

AIMS: To find out the prevalence of ocular injury and infection among dental personnel in Riyadh, Saudi Arabia. PARTICIPANTS: Two hundred and four dental personnel. METHOD: A questionnaire completed by researchers and observation during practice. RESULTS: The response rate was 81%. Dentists and dental technicians had a similar prevalence (42.3%) of foreign bodies in their eyes during the period of one month. Almost 50.5% of dentists rarely had foreign bodies in their eyes, while only 22.2% of dental technicians claimed the same. The majority of dental surgery assistants (73.6%) never experienced foreign bodies in their eyes. Only 27.0% of female personnel had foreign bodies in their eyes as compared to 73.0% of male personnel, while only 28.5% of females had conjunctivitis as compared to 71.4% among male personnel. 75% of regular eye protector wearers (EPW) never had foreign bodies while 67.2% EPW never had conjunctivitis. Dental technicians were more prone to ocular injury, 13.8% as compared to 4.4% of dentists. Only 30% of the regular eye protector wearers suffered ocular injury. CONCLUSIONS: Protection of the eyes should be emphasised and practised at undergraduate level. The awareness of eye protection should be highlighted at all clinical and research symposia. Further studies should be conducted to assess the financial implications of ocular injuries and infections in dental institutions and practices. Recommendations are made for universal precautions and the observation of safety at work guidelines by all dental team members.

A comparative study of propolis and saline application on human dentin. A SEM study.

The purpose of this study was to compare the texture changes of dentinal surfaces after the application of propolis and saline. Twenty-four recently extracted human premolar teeth were obtained from the Division of Oral and Maxillofacial Surgery, King Saud University, College of Dentistry, Riyadh. The teeth were classified as sound, periodontally involved and with recession. Forty-eight, 3 x 3 mm dentin disc specimens were prepared and only 24 specimens were treated with propolis (pH 8.5) and saline (pH 6). They were treated in 4 categories i.e.: (1) no application of any material (control); (2) propolis for 60 seconds; (3) propolis for 120 seconds and (4) saline for 60 seconds. All experimental specimens were burnished with cotton pellet with propolis and saline for the prescribed time. All specimens were prepared for scanning electron microscopy (SEM) with sputter technique, (Blomlof and Lindskog, 1995), and examined in the SEM (Jeol, Japan) operated at 25 KV with a tilt angle between 0-30 degrees. The bar was 10 mm and magnification 2000x. There were dentinal tubules occlusion in all three groups of dentin treated with propolis for 120 seconds. The propolis was better than saline in occluding dentinal tubules. It may be suggested that further research is needed for double blind clinical trials of propolis in patients with dentinal hypersensitivity.

The relationship between periodontal disease and blood glucose level among type II diabetic patients.

The aim of this study was to determine the relationship between periodontal disease and the blood glucose level among type II non-insulin dependent diabetic mellitus (NIDDM) subjects. Forty subjects, 20 in each group, of healthy and diabetic subjects, ages ranged 20-70 years, were examined at King Saud University, College of Dentistry. Clinical examination included frequency of oral hygiene practices, periodontal status by using the Community Periodontal Index of Treatment Needs (CPITN), fasting blood glucose level (FBGL), and random blood glucose level (RBGL). Unstandardized orthopantomograms (OPGs) were taken for radiographic findings. The number of missing teeth (tooth loss) was assessed from the radiographs. The results showed that periodontal disease severity was high among diabetic subjects. Diabetic subjects brushed less frequently, and they had a higher blood glucose level than healthy subjects. The mean CPITN score was compared with mean blood glucose level and the severity of periodontal disease. There was a steady increase in blood glucose level with increase in CPITN scores, i.e., CPITN score 13.5 to 19.12 corresponded with 142 mg/dl and 173.2 mg/dl FBGL, and 184.2 and 199.12 mg/dl RBGL among diabetic subjects. The study indicated that diabetic subjects should improve their oral hygiene practices and control of blood glucose levels should be emphasized. Further studies are needed among diabetics and healthy subjects from the general population with better sampling techniques and a larger sample size.

Back & neck problems among dentists and dental auxiliaries.

In the practice of dentistry, stress, tension, and postural practices can contribute to back and neck problems. Two hundred and four dentists and dental auxiliary (87 males and 117 females) in Riyadh city, Saudi Arabia were surveyed to determine the prevalence of postural problems. The candidates were interviewed and observed during practice. The data obtained showed that 111 (54.4%) of the subjects complained of neck pain and 150 (73.5%) complained of back pain. Only 37% of those complaining of back pain sought medical help. Within the limitations of this study, it might be concluded that neck and back pain among dental personnel are not of a severe nature.

The effects of extracts of chewing sticks (Salvadora persica) on healthy and periodontally involved human dentine: a SEM study.

The popularity and availability of chewing sticks (Salvadora persica) in the Asia, Middle East and Africa make them a commonly used oral hygiene tool in those societies. Salvador persica chewing stick called miswak is frequently used in Saudi Arabia. The antimicrobial effects of miswak has been well documented. The aim of this study is to find our the effect of aqueous extracts of miswak on healthy and periodontally involved human dentine with Scanning Electron Microscopy (SEM) in vitro. 25% aqueous extract of freshly prepared miswak solution was used for the study. Twelve human premolars teeth (6 healthy and 6 with periodontal disease) recently extracted for orthodontic and periodontal reasons were used. 24 SEM specimens were prepared and treated with miswak extract with different conditions e.g. soaking and burnishing with miswak extract. Soaking the healthy and periodontally diseased root dentine in miswak extract resulted in partial removal of smear layer and occlusion of dentinal tubules was observed in dentine specimens burnished with miswak solution. Further research is needed to evaluate the effect of aqueous extract of miswak on etched human dentine at higher concentrations.

The antimicrobial effects of seven different types of Asian chewing sticks.

There are various plants, which are used as chewing sticks in different parts of the world. Several studies have been reported on the antimicrobial effects of chewing sticks on oral bacteria. The aim of this study was to compare the antimicrobial effect of aqueous extract of seven different types of chewing sticks found in Pakistan and other Asian countries. The ditch plate method was used to test the antimicrobial activity of seven Asian chewing sticks. It was found that at there was antimicrobial effect on Streptococcus fecalis at 50% concentration of Kikar (Acacia arabica) from Pakistan and Arak (Salvadora persica) from Saudi Arabia. The inhibition zones up to 2 mm were found in those two chewing stick extracts. It is recommended that the chewing sticks will be a great help in developing countries with financial constraints and limited oral health care facilities for their populations.