Assessing the Knowledge of HPV-Associated Oropharyngeal Squamous Cell Carcinoma, HPV Vaccination, and Practice Scope among Saudi Dental Students in the Western Region.

(1) Background: Human papillomavirus (HPV) infection is significantly associated with oropharyngeal squamous cell carcinoma (HPV-OPSCC), which is one of the fastest-growing cancer incidences globally. Dental practitioners play a crucial role in the primary and secondary prevention of HPV-OPSCC. There is little known about dental students' awareness regarding HPV-OPSCC and HPV vaccination, as well as their intention to promote 'primordial prevention' among their patients. HPV vaccine, and the extent of their professional responsibilities. (2) Methods: This cross-sectional study was conducted in the western region of Saudi Arabia and involved undergraduate dental students (n = 688) from six public and private dental schools. Participants were requested to complete a sequential-section anonymous online survey, with 257 successfully completing all sections of the questionnaire. The association between participant characteristics and HPV-OPSCC, HPV vaccination awareness ratings, and perceived engagement in prevention were analyzed using ANOVA and chi-squared testing. A binary logistic regression analysis was conducted to examine the variables linked to these outcomes. (3) Results: Generally, the overall level of awareness of HPV-OPSCC and HPV vaccination was acceptable, with an average score of 53.44 ± 29.3 out of 100. However, a significant knowledge gap was observed, with 53% of respondents being unaware of the common sites for HPV-OPSCC and 63.8% being uninformed of the appropriate age for HPV vaccination. Females and those with a prior history of sexually transmitted diseases (STDs) had considerably higher levels of HPV vaccination knowledge (p < 0.05). The participants showed a favorable attitude towards their responsibility of informing patients about HPV-OPSCC and advocating HPV immunization. (4) Conclusions: This study underscores the need to enhance dental students' understanding of HPV-OPSCC and HPV immunization, enabling them to effectively engage in primary and secondary preventative efforts against HPV-OPSCC.

Oral squamous cell carcinoma with synchronous follicular lymphoma: A rare case report.

The occurrence of oral squamous cell carcinoma synchronously with lymphoma arising primarily in cervical lymph nodes is rare. Here, we report a case representing an infrequent finding. A 66-year-old male who was diagnosed with right mandibular squamous cell carcinoma and was subsequently found to have a nodal follicular lymphoma as a second malignancy. The patient underwent surgical resection for the oral squamous cell carcinoma with right selective neck dissection. The multidisciplinary team's postoperative treatment strategy involved adjuvant radiotherapy for the oral squamous cell carcinoma, while adopting a close follow-up approach for the follicular lymphoma. After an 18-month follow-up, there were no evidence of disease progression. This case report highlights the diagnostic challenges of synchronous primary malignancies occurring in the head and neck region. It also underscores the importance to conduct a comprehensive clinical and histopathological examination to rule out the possibility of synchronous neoplasms.

Oral Nodular Fasciitis: A Case Report in an Uncommon Location and Review of the Literature.

Nodular fasciitis (NF) is a benign, self-limiting condition that is often misdiagnosed due to its resemblance to other lesions. Although NF is common, its occurrence in the oral cavity is rare and particularly challenging for both clinicians and pathologists. To date, no case has been reported in the retromolar area of the oral cavity. A 49-year-old male patient presented with a painless, rapidly growing, firm nodule in the right retromolar area. Histopathological examination revealed spindle cell proliferation with characteristics of NF and immunohistochemical analysis confirmed the diagnosis. The lesion was treated by conservative surgical excision, without recurrence at a one-year follow-up. In the current case, 54 cases of oral nodular fasciitis (ONF) have been documented. The majority of ONF-affected individuals are in their 40s, with a 1:1 male-to-female ratio. The buccal mucosa was the most commonly involved site followed by the tongue and labial mucosa. Histopathologically, the most prominent features were the proliferation of uniform spindle-shaped cells within a myxomatous and/or fibrotic background. A positive smooth muscle actin (SMA) stain was a consistent finding. Complete local excision remains the preferred treatment method, and no recurrences have been reported. This report underscores the importance of considering NF in the differential diagnosis of oral spindle cell lesions and emphasizes the need for a comprehensive evaluation to guide appropriate management.

Perineural Invasion Is a Significant Prognostic Factor in Oral Squamous Cell Carcinoma: A Systematic Review and Meta-Analysis.

(1) Objectives: This systematic review and meta-analysis aimed to summarize current evidence regarding the prognostic role of perineural invasion (PNI) in patients with oral squamous cell carcinoma (OSCC). (2) Methods: We searched Cochrane Central, ProQuest, PubMed, Scopus, Science Direct, and Web of Science, using relevant keywords to identify eligible articles. Two independent reviewers conducted two-stage screening, data extraction, and quality assessment. The risk of bias was assessed using the Newcastle-Ottawa Scale (NOS) criteria. All analyses were performed using comprehensive meta-analysis (CMA; version 3.3.070) software. (3) Results: The study included 101 published articles encompassing 26,062 patients. The pooled analyses showed that PNI was associated with significantly worse overall survival (OS; HR = 1.45, 95% CI: 1.32-1.58; p < 0.001), worse disease-specific survival (DSS; HR = 1.87, 95% CI: 1.65-2.12; p < 0.001), and worse disease-free survival (DFS; HR = 1.87, 95% CI: 1.65-2.12; p < 0.001). Similarly, both local recurrence-free survival (LRFS) and regional recurrence-free survival (RRFS) were worse in patients with PNI (HR = 2.31, 95% CI: 1.72-3.10, p < 0.001; and HR = 2.04, 95% CI: 1.51-2.74, p < 0.001), respectively. The random-effect estimate of three studies demonstrated that the presence of PNI was associated with worse failure-free survival (FFS; HR = 2.59, 95% CI: 1.12-5.98, p < 0.001). (4) Conclusions: The current evidence suggests that PNI can be used as an independent predictor of the prognosis for patients with OSCC. The presence of PNI was associated with worse OS, DFS, DSS, FFS, and with recurrence. Asian patients and patients with extra-tumoral or peripheral PNI invasion were associated with worse prognosis.

Digital technologies in dentistry in Saudi Arabia: Perceptions, practices and challenges.

Background: The aim of this study was to assess practicing dentists' characteristics and professional aspects that influence users to adopt Digital Technologies in Dentistry (DTD) in Saudi Arabia (SA). Moreover, we aimed to identify dentists' perceived barriers and challenges and to anticipate future potential developments towards implementing DTDs in their practices in SA. Methods: This analytical cross-sectional study based on a validated questionnaire was conducted using a snowball sampling technique to include a conveniently selected sample of dentists from all dental specialties currently working in SA. Results: The response rate was 64% completed and returned. A statistically significantly large share of Gen X (10.1%) used digital technologies (DTs) in dental practice compared with non-digital users. 40% received sufficient postgraduate education on DT, 92% agreed that DT should be included in the undergraduate dental curriculum. However, 79% actually gained skills or knowledge on DT through workshops and formal courses. 'Lack of practitioners' awareness', 'lack of education and pioneers' and 'lack of clinical evidence' were highlighted as the foremost barriers. Lower-frequency DT users believed that treating patients with DT makes treatment more predictable. Together, clinical trials and hands-on training courses can help overcome the barriers to the adoption of new dental technologies. Conclusions: Exploring technology adoption and usage amongst practicing dentists allows healthcare stakeholders and policymakers to set a clear direction towards the digitalisation of the healthcare system and within healthcare organisations. The study also highlighted the foremost barriers, challenges and actions towards the adoption of DTDs.

Dental Students' Perceptions Regarding Bioterrorism; a Cross-Sectional Study.

Introduction: During the COVID-19 outbreak, dental professionals have demonstrated their importance in combating mass casualty incidents. This study aimed to understand dental students' perceptions of their potential roles in a bioterrorism attack. Methods: This cross-sectional study used a self-administered anonymous questionnaire, which was sent to all dental students and interns at King Abdulaziz University, Saudi Arabia. Bivariate and multiple linear regression analyses were conducted to assess dental students' willingness to provide care during a bioterrorism attack, knowledge regarding bioterrorism and total number of roles a dentist should play during an attack. Results: This study included 472 dental students and interns. The mean knowledge score regarding bioterrorism was 3.3 ± 1.9 out of 5. A large majority of the respondents (83.8%) were willing to provide care during a bioterrorism attack. Students with a cumulative grade point average (GPA) of 4.5-5 were more likely to indicate that a dental professional should take on more roles during a bioterrorism attack than those with a GPA of 2.5-2.99. Fourth- and fifth-year dental students had lower knowledge scores regarding bioterrorism than dental interns (B: -0.71; SE: 0.30; 95% CI: -1.3--0.1 and B: -0.68; SE: 0.30; 95% CI: -1.3- -0.1, respectively). Conclusion: Despite the fact that dental curricula do not cover topics related to bioterrorism, most students would be willing to provide care under bioterrorism conditions. There is wide agreement among the students regarding the need to add bioterrorism-related educations to dental curricula.

The value of a specialized second-opinion pathological diagnosis for oral and maxillofacial lesions.

OBJECTIVES: An error in the diagnosis of an oral or maxillofacial lesion could potentially be detrimental to a patient's prognosis and management. Major discrepancies between the initial and subsequent diagnoses of head and neck pathologies range from 7 to 53%. This study determined the rate of discrepancies found in the diagnoses of oral and maxillofacial lesions after a second opinion in Saudi Arabia. METHODS: A retrospective single-center study was conducted by oral and maxillofacial pathology consultants to review all cases referred for a second opinion to the oral and maxillofacial pathology laboratory between January 2015 and December 2020. If the second-opinion diagnosis matched the original diagnosis, this was described as "agreement." If the second-opinion diagnosis did not match the original diagnosis but would not change the management or prognosis of a patient, this was classified as a "minor disagreement." If the second-opinion diagnosis resulted in the changing of a patient's management or prognosis, this was categorized as a "major disagreement." Chi-square test and Fisher's exact test were used to compare data between original and second-opinion diagnoses. A p-value of less than 0.05 was considered significant. RESULTS: Of 138 cases, 59 (43%) had an initial diagnosis and a second-opinion diagnosis that were in major disagreement. The most common tumor for which there was a major disagreement was squamous cell carcinoma. No single factor influenced the occurrence of major disagreements. CONCLUSIONS: Our evaluation reiterates the importance of obtaining a second opinion from a specialist in oral and maxillofacial pathology to improve the diagnostic accuracy for lesions. A formal system for this step, in addition to the obtaining of adequate clinical and radiographic information about a patient, is mandatory for the review of difficult cases.

Cytokines' Role in the Pathogenesis and Their Targeting for the Prevention of Frozen Shoulder: A Narrative Review.

Frozen shoulder (FS) is a common name for shoulder movement limitation with different degrees of shoulder rigidity and pain. It is characterized by varying developmental courses, different levels of shoulder movement limitation, and background ambiguity due to the multiplicity of its causative factors. Systemic inflammatory cytokines monitoring and restraining is easy to apply, fast to conduct, and needs lower costs compared to invasive methods for frozen shoulder stage evaluation and early controlling of its progress to the stage that necessitates surgical intervention. The aim of this review was to assess the recent findings concerning the role of cytokines in FS pathogenesis and the possibility of preventing or controlling their progress through targeting these cytokines by the new drugs candidates, such as hyaluronan (HA), botulinum toxin type A (BoNT A), Tetrandrine, tumor necrosis factor-stimulated gene-6 (TSG-6), and cannabidiol. Searching the PubMed site, we encountered out of 1608 records, from which 16 original studies were included for the quantitative construction of this systematic review screening of the recent studies to investigate the different FS pathogenic pathways. Most of the scenarios are centered around the inflammatory and fibrotic process triggered by synovial and capsular fibroblast stimulation. This mechanism depends mainly on alarmins cytokines, including thymic stromal lymphopoietin (TSLP), interleukin-33 (IL-33), and interleukin-25 (IL-25), with the stimulation of interleukin-1 α (IL-1α), interleukin-1 ß (IL-1ß), tumor necrosis alpha (TNF-α), cyclooxygenase-1 (COX-1) and cyclooxygenase-2 (COX-2) in a joint capsule. Different pathways of transforming growth factor- ß (TGF-ß) stimulation, resulting in overexpression of the fibrotic factors as tenascin C (TNC), fibronectin 1, collagen I (COL 1) and collagen III (COL III), and matrix metalloproteinases (MMPs) in the capsular or synovial/capsular fibroblasts. The overall investigation of these studies led us to conclude that the new drug candidates proved their efficiency in controlling the common pathogenesis of the inflammatory and fibrotic pathways of frozen shoulder and therefore represent a prospect for easy and early controlling and efficiently treating this serious disease.

Factors affecting the acceptance of teledentistry determined using the technology acceptance model: A cross-sectional study.

Objective: The aim of this pilot study is to identify the main predictors and barriers that influence user intention to adopt teledentistry services among the Saudi population. Methods: A total of 426 respondents completed a questionnaire. Our study used the technology acceptance model to predict how users will adopt teledentistry. An analysis of the factors that influence patient users' intention to utilize teledentistry was conducted using partial least square structural equation modeling. Results: Among the factors that influenced the intention to use teledentistry services, social influence positively affected the intention (ß = 0.18, t = 2.19, p-value = 0.03), whereas perceived risk negatively affected it (ß = -0.21, t = 2.69, p-value =0.01). Conclusion: The perception of risk was a major barrier to the adoption of teledentistry services, while social influence was a significant positive predictor. Using the findings of the study, policymakers and health service providers can gain a better understanding of the factors influencing the implementation of teledentistry.

Forecasting Head and Neck Cancer Trends in GCC Countries: Implications for Public Health Policy and Strategy.

Purpose: The data available on the incidence and mortality rates of head and neck cancer types (HNCs) in the Gulf Cooperation Council countries (GCC) have relied on global trends and covered only certain cancer sites, types or certain age groups. This study aimed to assess the incidence and mortality rates of head and neck cancer (HNCs) within the Gulf Cooperation Council (GCC) countries, providing insights into their geographic variability in 2020. Methods: Prediction of the magnitude of the disease to 2040 was explored based on demographic projections. Estimates of incidence and mortality and the population projections were extracted from the Global Cancer Observatory (GLOBOCAN) database and the United Nations Department of Economic and Social Affairs respectively for the time frame 2020 to 2040. Additionally, we analyzed the distribution of cases and deaths by age and sex for both time periods. Results: The analysis indicates varying patterns in HNC rates across GCC countries in 2020, with Oman and Saudi Arabia carrying the highest burden. Projections for 2040 reveal a substantial increase in new HNC cases and related deaths, particularly in Qatar, UAE, and Bahrain. Furthermore, incidence rates are predicted to rise significantly for individuals aged 50 and older, while remaining relatively stable for those under 50. With regards to sex, males generally exhibit higher rates, except in Qatar. Conclusion: HNC burden is anticipated to rise significantly in the GCC, with variations per age, sex and geographical location. By 2040, a 2-3-fold increase in HNCs in the GCC is anticipated, emphasizing the need for focused public health strategies to address this rising health challenge.

Oral Manifestations of COVID-19: A Cross-Sectional Study of Their Prevalence and Association with Disease Severity.

BACKGROUND: COVID-19, caused by SARS-CoV-2, has impacted the world in an unprecedented way since December 2019. SARS-CoV-2 was found in the saliva of patients, and entry points for the virus may have been through the numerous angiotensin-converting enzyme 2 receptors in the oral cavity. Oral manifestations of COVID-19 could contribute to the burden of oral disease. OBJECTIVE: To determine the prevalence of oral manifestations of COVID-19 in patients and their association with disease severity. METHODS: Interviews were conducted with adult participants diagnosed with COVID-19 between October 2021 and March 2022 to document their demographic and health status data, symptoms, and the presence of oral manifestations of COVID-19. Chi-square and the Fisher's exact test were used to compare data on the presence or absence of oral manifestations of COVID-19. RESULTS: Of 195 participants interviewed, 33% were 18 to 24 years old, 33% were 25 to 34 years old, and 75% were female. A total of 57 (29%) had oral manifestations; the most common were taste disorders (60%), xerostomia (42%), and oral ulcers (11%). There was no relationship between the severity of COVID-19 and the presence of the oral manifestations. CONCLUSION: Oral manifestations of COVID-19 were common among female patients and linked to certain general COVID-19 symptoms regarding frequency and extent.

Dental Students' Perception of Integrating E-learning During COVID-19: A Cross-Sectional Study in a Saudi University.

Purpose: The aim of this study was to assess dental students' perceptions and overall experiences regarding e-learning at King Abdulaziz University, Jeddah, Saudi Arabia, during the COVID-19 pandemic. Methods: This cross-sectional study was carried out from November 2020 through March 2021. A pre-structured, self-administered questionnaire was emailed to undergraduate dental students (second year through sixth year and dental interns). The final sample included 296 undergraduate dental students and interns. Univariate analysis was done to report the sample characteristics. Chi-square and Fisher exact with Monte Carlo were conducted to evaluate the preference of students regarding e-learning across characteristics of the study sample. Results: The majority of students preferred to integrate e-learning into traditional classroom lectures, although 51.7% did not favor it for clinical subjects. More than half of the sample believed that e-learning allowed excellent interactivity with the instructors. A higher percentage of second-year students preferred traditional learning (71%) than students in other years who preferred a combination of both traditional and online learning (P-value < 0.001). The mode of learning is not associated with marital status, though 36.4% of married students prefer e-learning (P-value = 0.4). Most dental students considered e-learning a positive experience. Conclusion: There were significant differences in the mode of learning preference between the preclinical and clinical years. Continuous monitoring of learners' needs, challenges, and outcomes is crucial to effectively evaluate e-learning in dental education.

Assessment of the Relationship between Maxillary Posterior Teeth and Maxillary Sinus Using Cone-Beam Computed Tomography.

Introduction: Because of the close contact between maxillary sinus and maxillary posterior teeth, procedural errors such as perforation of the sinus may occur during surgical intervention resulting in oroantral communication, which if not corrected, would develop into a fistula. The aim of this study was to evaluate the relationship between maxillary posterior teeth and maxillary sinus floor in a population of the western area of Saudi Arabia, and if age, gender, and size may affect such distance. Materials and Methods: This retrospective study evaluated 539 cone-beam computed tomography (CBCT) radiographs of patients over 20 years of age. Patients were divided into four groups according to age: group I (20-30 years), group II (31-40 years), group III (41-50 years), and group IV (more than 50 years). From coronal and sagittal images of CBCT, the vertical distance between the posterior maxillary root and the maxillary sinus was measured and classified according to its proximity to the maxillary sinus. Results: Gender and size did not significantly affect the distance between maxillary posterior root and maxillary sinus. However, there was a significant increase in this distance with increased age. Mesiobuccal root of the second molar was the nearest root to the maxillary sinus (0.8 ± 1.62, p < 0.001), while the buccal root of the first premolar was the farthest root (5.39 ± 3.26, p < 0.001). Conclusion: Regarding the population of this study, the buccal roots of the second molars are the closest to the sinus floor. Complications associated with maxillary molar extraction and implantation are greater at a younger age. Because the distance between posterior maxillary teeth and maxillary sinus was mostly type 1 (0-2 mm), clinicians are advised to perform CBCT to get a better understanding of the relationship between maxillary posterior roots and maxillary sinus before surgical intervention.

The Psychological Impacts of COVID-19 Pandemic among Emerging Adults: An Observational Cross-Sectional Study.

(1) Background: COVID-19 has had psychological impacts, particularly anxiety, depression, anger, and suicidal ideation, on the world's populace, including young persons who were prone to mental health disorders even before the pandemic. We described the psychological impacts of COVID-19 among emerging adults aged 18-30 years in Saudi Arabia. (2) Methods: A cross-sectional survey was done among a randomly sampled population in Saudi Arabia between July 2020 and May 2021 using the DSM-5 Self-rated Level 1 Cross-Cutting Symptom Measure and Ask Suicide Questionnaire. Logistic regression was used to assess participant characteristics associated with reporting symptoms of mental disorders under each of the 13 domains that would warrant further investigation. (3) Results: Approximately, 91% of participants experienced different mental health symptoms; these participants are more likely to be young, female students, those who had a history of being diagnosed with a mental disorder, and those diagnosed or treated for COVID-19. (4) Conclusion: This study strongly showed an increased prevalence of mental health symptoms among young persons during the COVID-19 pandemic. Addressing the mental health burden among young persons in time using simple, self-administered screening tools linked to interventions will prevent dire consequences in the future.

Trend Analysis of Head and Neck Neoplasms between 2012-2018 in Patients Residing in Al-Madinah, Saudi Arabia: A Retrospective Study.

OBJECTIVES: This study sought to present a view of head and neck neoplasms (HNN) prevalence with specific focus on sociodemographic determinants in Al-Madinah Province, Saudi Arabia. MATERIALS AND METHODS: This was a hospital-based retrospective study based on retrieval of histopathological data for a period of 6 years between 2012 and 2018. Data was collected from the archives of the Oral and Maxillofacial Pathology Laboratory at King Fahad Hospital (the only referral center for biopsy services) in Al-Madinah City. STATISTICAL ANALYSIS: An independent t-test and/or nonparametric (Mann-Whitney U test, chi-squared test) tests were used to determine the differences between groups. Statistical significance was set at the p-value < 0.05. RESULTS: Out of 96 patients, a total of 58 patients had valid biopsy data with preoperative diagnosis. Over three quarters of the cases (n = 44) were benign with only 24% were malignant. Males were more likely to be diagnosed with a benign tumor than females (54.5 vs. 45.6%, respectively), and malignancy was also more common in males (64.3 vs. 24.1). A significant difference was found in relation to mean age of older patients who were more likely to be diagnosed with malignant tumors (p = 0.001). CONCLUSIONS: The findings suggest that most of biopsied HNN cases are benign neoplasms. Age is a significant risk factor for head and neck malignancy in this region. Delays in diagnosis of HNN need to be explored.