Delayed eruption of permanent maxillary first molars among Saudi children: A cross-sectional study.

Aim: This retrospective cross-sectional study aimed to determine the prevalence of delayed development and eruption of permanent maxillary first molars (U6) and associated dental anomalies in a sample of Saudi children. Material and methods: In total, 10,232 panoramic radiographs from 9,672 patients were screened for delayed U6 eruption. Radiographs showing delayed U6 eruption were further examined for associated dental anomalies. The dental age of participants was estimated using The London Atlas of Human Tooth Development and Eruption. Result: Twenty cases of delayed U6 eruption were found, with a prevalence of 0.2%. Of these patients, 3 and 17 were males and females, respectively; 9 and 11 cases were unilateral and bilateral, respectively. Congenital absence of the adjacent permanent second molar was observed in 8 cases, and the congenital absence of permanent teeth, except the adjacent second permanent molar and third molar, was observed in 6 cases. Peg-shaped lateral incisors were observed in 6 females. No significant associations were observed between delayed U6 eruption and dental anomalies. Overall, the average delayed U6 eruption was 2.3 years for males and 2.8 years for females. Conclusion: Among a sample of Saudi children, the prevalence of delayed U6 eruption was 1 in 483 (0.2%) and five times higher in females. No significant associations were found between delayed U6 eruption and dental anomalies; however, congenital absence of the adjacent permanent second molar was observed in 40% of cases.

NeoPUTTY® Versus NeoMTA 2® as a Pulpotomy Medicament for Primary Molars: A Randomized Clinical Trial.

PURPOSE: The purpose of this randomized clinical trial was to evaluate the clinical and radiographic success of the premixed bioceramic (NeoPUTTY®) as pulpotomy medicament in primary molars in comparison to NeoMTA® 2. METHODS: Seventy primary molars indicated for pulpotomy in 42 children were randomly allocated into two groups: (1) a mineral trioxide aggregate (MTA) group (NeoMTA® 2); and (2) a premixed bioceramic group (NeoPUTTY®). Clinical and radiographic examinations of the molars following pulpotomy were conducted by two independent evaluators at six and 12 months. The data were analyzed using Fishe`s exact tests. RESULTS: At 12 months, the clinical and radiographic success for the MTA group were 100 percent (34 out of 34) and 94.1 percent (32 out of 34), respectively. For the NeoPUTTY® group, the clinical and radiographic success were 97.1 percent (34 out of 35) and 92.8 percent (32 out of 35), respectively. No significant differences were found between the two materials. CONCLUSIONS: NeoPUTTY® showed a comparable success to mineral trioxide aggregate in primary molar pulpotomies over 12 months. Further clinical trials with larger sample sizes and longer follow-up periods are recommended.

Sociobehavioural Factors Associated With Child Oral Health During COVID-19.

OBJECTIVES: The aim of this study was to identify the sociobehavioural factors that influenced children's oral health during the COVID-19 pandemic. METHODS: The online cross-sectional study was conducted in Al Jouf Province in the northern region of Saudi Arabia. A total of 960 parents of children aged 5 to 14 years were invited by multistage stratified random sampling. Descriptive, multinomial, and multiple logistic regression analyses were performed to estimate odds ratios and determine the relationship between independent and dependent variables. P < .05 was considered statistically significant. RESULTS: Of the 960 participants, 693 (72.1%) reported that their child had 1 or more untreated dental decay. The children of uneducated parents were 1.6-fold more likely to have 1 or more untreated dental decay (adjusted odds ratio [AOR], 1.66; 95% CI, 0.74-3.73; P < .001). The children of unemployed parents were 4.3-fold more likely to have a financial burden for a child dental visit (AOR, 4.34; 95% CI, 2.73-6.89; P < .001). Parents from a rural area were 26.3-fold more likely to have spent a lag period of over 2 years since their child's last dental visit (AOR, 26.34; 95% CI, 7.48-92.79; P < .001). Nursery-level children were 5.4-fold more likely to need immediate care (AOR, 5.38; 95% CI, 3.01-9.60; P < .001). CONCLUSIONS: The present study demonstrated a very high prevalence of 1 or more untreated dental decay in our cohort. Children of rural areas, uneducated, unemployed, widow/divorced, low- and middle-income parents and nursery school children were linked to poorly predictive outcomes of child oral health during the pandemic.

Evaluation of the Shear Bond Strength of Four Bioceramic Materials with Different Restorative Materials and Timings.

The objectives of this study were to evaluate the shear bond strength (SBS) of a resin composite (RC) and a resin-modified glass ionomer (RMGI) to four different bioceramic materials and to compare the effects of the immediate vs. delayed placement of restoration on the SBS. A total of 160 Teflon blocks and 40 blocks/material, were randomly filled with one of the bioceramic materials (NeoPUTTY®, NeoMTA2®, TotalFill® BC RRM™ Fast Set Putty, and ProRoot® MTA). The restoration was performed immediately or in a delayed time frame (after 7 days) using a Filtek™ Z350 XT Flowable composite (bonded to the bioceramic materials using Single bond universal 3M) or GC Fuji II LC® RMGI. The SBS test was performed at a crosshead speed of 1 mm/min, and the failure mode was evaluated under a digital microscope by one blinded examiner. One-way analysis of variance (ANOVA) with the Games-Howell post hoc test was used to compare the mean SBS between the groups. The mean SBS of the bioceramic materials to RC was significantly higher than to RMGI except for ProRoot MTA (p-value 0.65). The SBS values to RC were as follows: ProRoot MTA (7.64 MPa); NeoMTA2 (8.57 MPa) which was significantly higher than both NeoPUTTY (4.04 MPa) and TotalFill® BC RRM™ Fast Set Putty (4.38 MPa). For RMGI groups, ProRoot MTA showed the highest SBS (7.18 MPa), followed by NeoMTA2 (4.15 MPa), NeoPUTTY (1.62 MPa), and TotalFill® BC RRM™ Fast Set Putty (1.54 MPa). The delayed timing restoration showed a significantly higher SBS than the immediate, except for the immediate RMGI restoration with MTA. To conclude, the SBS of RC to the bioceramic materials was significantly higher than RMGI, except for ProRoot MTA. Both restorative materials had a significantly higher SBS to the MTA groups in comparison to premixed bioceramics. Delayed RC restoration had a higher SBS than immediate restoration. Similarly, delayed RMGI restoration had a higher SBS than immediate restoration with premixed bioceramic but not with MTA.

Risk Factors, Diagnosis, and Management of Halitosis in Children: A Comprehensive Review.

AIM: The present manuscript aims at providing a comprehensive overview of the epidemiology, risk factors, diagnostic aids, and management of halitosis in a pediatric population. BACKGROUND: Halitosis refers to bad breath from the mouth that seems unpleasant or offensive to others. This condition is prevalent worldwide, including all age-groups. However, studies on the pediatric population are limited. Self-confidence and personality development are important factors that the child builds up during their developmental stages. Halitosis may affect them both on personal and social aspects; hence, it is important to have beforehand knowledge and the modes to intercept it, paving the way to a positive growth of the child. REVIEW RESULTS: On reviewing the literature, the common risk factors for halitosis in children constituted predominantly oral factors that varied from poor oral hygiene, gingivitis, periodontal diseases, dental caries, tongue coating, mouth breathing, and so on. Their diagnosis commonly included the organoleptic test, sulfide monitoring, and gas chromatography along with the assessment of questionnaire by the parents and older children. The management was predominantly directed toward the identified source of halitosis along with instructions and counseling on the benefits of a good oral hygiene regime. CONCLUSION: The importance of cultivating a day-to-day practice of oral hygiene regime in the children will not only accustom them toward the benefits of good oral health but also help them to tackle halitosis and in turn their inhibitions associated with it. CLINICAL SIGNIFICANCE: Halitosis, though a prevalent condition experienced at various stages of life, is crucial to identify and manage, especially in the pediatric population owing to its influence on personal and on social aspects of life.

Knowledge and perception of parents regarding halitosis in their children in Saudi Arabia.

OBJECTIVE: To evaluate parents' knowledge about halitosis, and to compare parents' perception of halitosis in their children to the presence of halitosis clinically. METHODS: Children between 3 and 8 years attended to Dental University Hospital, King Saud University, were screened. Children satisfying inclusion criteria and their parents agreed to participate were included. Questionnaires regarding parents' knowledge and perception about halitosis in their children were filled by attending parents. Then, the assessment of halitosis in the participating children carried out by portable gas chromatograph device (OralChromaTM). RESULTS: A total of 67 children (44 girls and 23 boys) were included in this study with a mean age of 5.3 years (SD = 1.7). The majority of the questionnaires (n = 44, 65.7%) were filled by accompanying fathers. One in two (52.2%) parents obtained high knowledge score about halitosis. Parents' knowledge was significantly associated with the mean age of the children (P = 0.02). Thirty-nine (58.2%) parents perceived halitosis in their children. Gender, child's age, parents' education level, or family income were not associated with parents' perception of halitosis. Halitosis was detected clinically in 58 children (86.6%). Thirty-eight (57%) of parents' perception of halitosis was in consistency with OralChromaTM readings; however, there was no significant association between parents' perception and the OralChromaTM score. CONCLUSION: Half of the parents had good knowledge about halitosis and 6 in 10 parents perceived halitosis in their children which is quite less than the presence of halitosis detected clinically. Moreover, parents' perception was not associated with the OralChromaTM score.

Knowledge Levels and Educational Experiences among Dental Graduates in Saudi Arabia Regarding Child Abuse and Neglect: A National Study.

BACKGROUND: Child abuse and neglect (CAN) is considered a serious problem worldwide. Dentists have a significant role in recognizing and reporting CAN cases. AIM: The aim of this study was to assess the CAN-related knowledge and educational experiences among Saudi dental graduates. DESIGN: Self-administered questionnaires were distributed to dental graduates from all dental schools in Saudi Arabia (n = 1552). Bivariate and multivariate logistic regression analyses were performed to assess the associations between knowledge level and different predictors. RESULTS: A total of 988 dental graduates completed the questionnaire. The majority of them were dissatisfied with the amount of education they had received in their school (56.4%). Around 60% of the participants had inadequate knowledge regarding CAN. Graduates from government schools who received dental education about CAN and female participants had significantly higher odds of having adequate knowledge scores than others (odds ratio = 2.0, 3.1, and 1.7, respectively). Only 39.5% of the participants felt confident in their ability to identify CAN cases, and only 9.7% knew how to report such cases. CONCLUSIONS: Graduate dental students have insufficient knowledge about CAN. More time should be dedicated to educating students about this important topic in dental curricula.

Halitosis and Associated Risk Factors in Children: A Cross-sectional Study.

AIM: To investigate risk factors associated with halitosis in children using OralChroma™. MATERIALS AND METHODS: Sixty-seven children between the ages of 3 and 8 who attended a pre-general anesthesia assessment at the Dental University Hospital at King Saud University, Riyadh, Saudi Arabia, were enrolled in this study after satisfying the inclusion criteria. Demographic data, medical history, and oral hygiene practices were obtained by a standardized questionnaire completed by the parents of each child. Clinical dental examination was conducted to record the following: caries index (dmft/DMFT), simplified debris index (DI-S), modified gingival index (MGI), and Winkel tongue coating index (WTCI). Clinical halitosis was assessed using the OralChroma™ device that measures the concentration of volatile sulfur compounds (VSCs) including hydrogen sulfide (H2S), methyl mercaptan (CH3SH), and dimethyl sulfide (CH3SCH3). Statistics were completed using Spearman's correlation coefficient and Mann-Whitney U-test to assess the association with the VSC scores with continuous and binary variables, respectively. Then, multivariate linear regression analysis was performed to detect the degree of association. RESULTS: High VSC measures were detected in 58 children (87%). The dmft/DMFT was significantly associated with H2S level (ß = 26.84, p = 0.034) and CH3SH level (ß = 19.96, p = 0.016) after controlling possible confounders. There was no significant association of DI-S, MGI, and WTCI with the VSC measures. CONCLUSION: The result suggested that dmft/DMFT score (children's caries experience) is associated significantly with high levels of H2S and CH3SH in the sample studied. CLINICAL SIGNIFICANCE: Caries experience in children is a significant risk factor for halitosis and should be considered during the management of halitosis.

Halitosis in Children Undergoing Full Mouth Rehabilitation under General Anesthesia.

Interventions and management modalities of pediatric halitosis have been suggested in the literature, however, the effect of full mouth rehabilitation (FMR) under general anesthesia (GA) on pediatric halitosis was not reported. Therefore, the present study was conducted to investigate parents' perceptions of their child's halitosis before and after FMR under GA; and to evaluate the effect of FMR on clinical halitosis. Fifty-seven children between 3-8 years old, scheduled for FMR under GA, were included after satisfying the inclusion criteria and upon parental consent. Parents' perception of halitosis in their children was evaluated using a standardized questionnaire and a breath sample was collected to assess the level of volatile sulfur compounds (VSCs) using OralChromaTM before and after FMR under GA. Sixty percent (n = 34) of the parents perceived halitosis in their children before FMR and about 80% (n = 27) of them reported improvement in halitosis after FMR. Clinical halitosis was detected in 84.2% (n = 48) of the sample before treatment. A statistically significant reduction in halitosis was found in 56.3% (n = 27) of the children after treatment (p < 0.001). In conclusion, majority of parents perceived an absence or reduction of halitosis in their children following FMR and significant improvement of clinical halitosis.

Delayed Eruption of Permanent Lower Lateral Incisor in Relation to Compound Odontoma: A Case Report.

AIM: To report a delayed tooth eruption following late surgical removal of a compound odontoma in a 10-year-old child. BACKGROUND: Odontomas are the most common odontogenic tumors. They are usually asymptomatic and discovered during routine radiographic examinations or during an assessment of delayed tooth eruption. Odontomas are classified into compound or complex based on the microscopic structure of dental tissues. Early diagnosis and surgical removal of odontomas is the keyword for favorable results. CASE DESCRIPTION: This paper describes a case of compound odontomas in a 10-year-old boy that prevented eruption of the permanent mandibular lateral incisor. Extraction of mandibular primary lateral incisors and surgical excision of the compound odontomas was performed. After 3 years of follow-up, at the age of 13 years, the permanent lateral incisor erupted and approached the occlusal plane. CONCLUSION: Late surgical removal of odontomas resulted in a delayed eruption of the affected teeth. CLINICAL SIGNIFICANCE: Surgical removal of odontomas and regular follow-up to monitor the eruption of the affected teeth should be considered for the teeth with an open apex before considering orthodontic traction.

A Randomized Clinical Trial of NeoMTA Plus in Primary Molar Pulpotomies.

Purpose: The purpose of this study was to compare the success of pulpotomies in primary molars using a new type of mineral trioxide aggregate (MTA; NeoMTA Plus) with a conventional MTA (ProRoot MTA) as a pulpotomy medicament in primary molars. Methods: Eighty primary teeth in 28 patients were divided randomly, with 40 teeth in a control group (ProRoot MTA) and 40 teeth in an experimental group (NeoMTA Plus). A standardized pulpotomy technique was performed for each tooth. Clinical and radiographic follow-up examinations were conducted at three, six, and 12 months. Results: At 12 months, the clinical success for ProRoot MTA was 97.4 percent (38 out of 39) and the radiographic success was 94.9 percent (37 out of 39); for NeoMTA Plus, the clinical success was 100 percent (40 out of 40) and the radiographic success was 97.5 percent (39 out of 40). No significant differences were found between the two groups at all follow-up evaluations. Conclusions: NeoMTA Plus showed a high percent success, similar to that of ProRoot MTA. NeoMTA Plus is a potential pulpotomy medicament for primary teeth.

Effect of Sandblasting and Type of Cement on the Bond Strength of Molar Bands on Stainless Steel Crowns.

PURPOSES: The purposes of this study were to: (1) compare the bond strength of molar bands cemented to stainless steel crowns (SSCs) using glass ionomer cement (GIC), resin-modified glass ionomer cement (RMGIC), or polycarboxylate cement (PXC); and (2) assess the influence of sandblasting molar bands on the mean bond strength between the band and the SSC. METHODS: Sixty SSCs and 60 molar bands were used. The inner surfaces of 30 molar bands were roughened by sandblasting prior to cementation. The bond strength was measured after dislodging the SSC using a push-out test. RESULTS: In the nonsandblasted group, a significant difference was observed between PXC and RMGIC (P >.04). In the sandblasted group, a significant difference was observed between PXC and RMGIC (P >.02), while there was only a marginal difference between GIC and RMGIC (P >.05). The sandblasted group exhibited superior bond strength overall. However, the only significant improvement was observed for GIC (P >.03). CONCLUSIONS: PXC showed the highest bond strength of molar bands to SSCs, while RMGIC showed the lowest. Sandblasting the inner surface of bands enhanced the bond strength of different cements.

Micro leakage of composite resin restorations following contamination with primary teeth root canal filling materials: an in vitro study.

AIM: The aim of this in vitro study was to assess the microleakage of composite restorations following contamination of access cavity with root canal filling materials of primary teeth. MATERIALS AND METHODS: Forty primary canines were selected for this study. Standardized access cavity on the lingual surface of the canine was prepared. The margins of preparation were ended on enamel. The teeth were randomly assigned into 4 groups (10 teeth/group). Teeth in group 1 served as a control, no material applied. For the other 3 groups the access cavity was filled with one of the following root canal filling material: Zinc Oxide and Eugenol (ZOE), calcium hydroxide (Ca(OH)2) and Vitapex. The root canal filling paste was left for two minutes in the cavity then washed out. The access cavity then restored with composite resin. After thermocycling for 500 cycles, teeth were immersed in 1% methylene blue for 24 hours, and then sectioned longitudinally in bucco lingual direction. The microleakage evaluation was carried under stereo-microscope and the worst result for each section was recorded. The data were statistically analyzed using Kruskal-Wallis and Post Hoc tests. RESULTS: All samples in the ZOE group showed leakage. However, the control, Ca(OH)2 and Vitapex groups showed leakage in 30%, 40% and 50% of the tested samples respectively. Microleakage occurred more significantly in ZOE group in comparison to the other test groups (p=0.00). Nevertheless, there was no significant difference in microleakage between the control group, Ca(OH)2 and Vitapex groups. CONCLUSIONS: Contamination of the access cavity with primary teeth root canal filling materials showed different levels of leakage in composite resin restoration and the ZOE group showed the highest microleakage scores.

Knowledge, attitude and practice of pediatricians and pharmacists in Riyadh City toward the use of sugar free medications.

OBJECTIVE: This study was intended to assess the knowledge, attitude and practice of pediatricians and pharmacists about sugar free medications (SFMs) and their impact on oral health. MATERIALS AND METHODS: Self-administered close ended questionnaire was handed out to all pediatricians and pharmacists in five tertiary hospitals in Riyadh (King Khalid University Hospital, King Saud Medical City, King Fahad Medical City, Prince Sultan Medical Military City, Security Forces Hospital) to investigate the knowledge, attitude and practice concerning SFMs. RESULTS: Eighty-five pediatricians and 77 pharmacists participated in this study. The results showed that pediatricians and pharmacists have a good knowledge, but negative attitude toward SFMs. Only (5.9%) of pediatricians had formal undergraduate training which is significantly lower than pharmacists (15.6%) (p = 0.04). One-third of pediatricans and pharmacists prescribe or dispense SFMs. The most influencing factors toward prescription (pediatrician) of SFMs was the medical status of the patient (70.6%), while the most influencing factor of dispensing (pharmacists) SFMs was the availability in the pharmacy (64.9%). Two-third of pediatricians (67%) guide the parents about the risk associated with sugar-containing medications (SCMs) which is significantly higher than pharmacists (p < 0.0001). Also, 53% of pediatricians recommend oral hygiene instructions when prescribing SCMs which is also significantly higher than pharmacists (p = 0.0 02). CONCLUSION: There is a considerable knowledge about SFMs and its impact on dental caries, among pediatricians and pharmacists participated in this study. However, their attitude toward prescribing or dispensing SFMs was not positive and may be linked to the gap in knowledge. Further training and education of healthcare providers regarding the use of SFMs and its negative impact on dental caries has to be reiterated.

Knowledge and attitudes of pharmacists regarding oral healthcare and oral hygiene products in riyadh, saudi arabia.

BACKGROUND: To assess the knowledge and attitudes of pharmacists regarding oral healthcare and oral hygiene products in Riyadh city, Saudi Arabia. MATERIALS AND METHODS: A cross-sectional survey among a sample of the community pharmacies in Riyadh city was done. The survey comprised of 23 closed-ended questions divided into five basic sections. RESULTS: A total of 141 pharmacists participated in this survey. About half of the respondents had not met the dentists practicing close to their pharmacies, nor were they aware of the opening times of the practice. Most of the pharmacists stocked oral health-related products, which comprised of 10-15% of their total stock. Toothpaste was the most common among the oral healthcare products stocked, followed by toothbrushes and mouth rinses. A total of 93% pharmacists expressed an interest in further developing their oral healthcare knowledge through course attendance or oral health programs. Toothache or mouth ulcers were the most common dental problem for which patients approached the pharmacists for advice. Pharmacists advised patients complaining of dental pain to consult a dentist in 43% of cases, dispensed painkiller in 44% of cases, and in 13% of cases dispensed an antibiotic. CONCLUSIONS: The community pharmacists in Riyadh are under-used in the promotion of oral health. There is a need for training of pharmacists and providing them with access to information on available dental service and oral health products.

Apical microleakage of primary teeth root canal filling materials.

OBJECTIVE: The objective of this study was to evaluate in vitro apical microleakage of root canal filling materials for primary teeth. METHODS: Fifty extracted primary anterior teeth were distributed into 6 groups: 4 experimental groups; 1 negative control group; and 1 positive control group. Zinc oxide and eugenol (ZOE), Kri paste, calcium hydroxide (Ca(OH)(2)), and Vitapex were inserted into the canal using a lentulo spiral mounted in a slow-speed handpiece. All teeth were then subjected to a dye leakage test using 2% methylene blue as the tracer. RESULTS: The highest dye penetration was recorded for teeth filled with ZOE, with mean values of 9.01+/-1.23 mm. Vitapex showed the lowest dye penetration, with mean values of 4.02+/-1.79 mm. Comparison between groups showed significant difference when the Vitapex and Kri paste groups were compared to the ZOE group (P<.0001). Also, a significant difference between the Vitapex and Ca(OH)2 group (P=.014) was detected. The result showed no difference between Vitapex and Kri paste (P=.658) nor between Kri paste and Ca(OH)(2) (P=.185). CONCLUSIONS: All the resorbable root canal filling materials used in primary teeth showed apical leakage. The highest apical leakage was recorded for ZOE, while Vitapex showed minimum dye leakage.

Clinical evaluation of root canal obturation methods in primary teeth.

PURPOSE: This study evaluated in vivo 2 different obturation techniques (lentulo spiral mounted in a slow-speed handpiece and hand-held) in primary teeth. METHODS: The study was carried out on 24 children (mean age = 6.71 years) who had received 50 single-visit zinc oxide and eugenol (ZOE) pulpectomies in primary molars. The root canal filling materials were deposited into the canals either by a lentulo spiral mounted in a slow-speed handpiece or by a hand-held lentulo spiral. Evaluation of pulpectomized molars was performed by both authors immediately and 6 months following treatment using specific clinical and radiographic criteria. In cases of disagreement, the lower rank was selected. RESULTS: The study found 64% (16/25) optimal filling (if 1 or more of the canals having ZOE ended at the radiographic apex or up to 2 mm short of the apex) when the lentulo spiral mounted in the slow-speed handpiece was used. It also found a 96% (21/22) clinical success rate in the group obturated by the lentulo spiral mounted in a slow-speed handpiece vs 48% (12/25) optimal filling and a 92% (23/25) clinical success rate in the group obturated by a hand-held lentulo spiral. The radiographic success for over- and optimally filled canals, when combining both lentulo groups, was significantly greater than underfilled root canals (P = .009). CONCLUSIONS: There was no statistically significant difference between the 2 techniques of obturation, according to the quality of the root canal filling or success rate.