Intracranial Infections Arising From an Odontogenic Infection: A Report of 2 Cases.

Introduction: Intracranial empyema is a rare but serious and life-threatening infection. It is an accumulation of purulent material in the subdural or extradural space leading to development of subdural empyema or intracranial epidural abscess, respectively. The incidence of morbidity and mortality is high because the diagnosis is often unsuspected. Infections of dental origin could be responsible for such condition. Case reports: A 22-year-old female and 30-year-old male patients, both with no significant medical history, presented with subdural empyema and intracranial epidural abscess, respectively, both complicating pan-sinusitis of dental origin. Successful outcomes were achieved with surgical drainage of the lesions, antibiotic therapy, and extraction of affected teeth. Female patient underwent further management for neurological sequelae, while male patient was discharged without neurological complications. Discussion: Intracranial suppuration of odontogenic origin is an uncommon but extremely serious complication. The most common dental origins are caries with periapical involvement and periodontitis. Wisdom tooth extraction is the most common preceding dental procedure for this infection. A multidisciplinary approach is essential for the identification and treatment of suspected oral sources. Antibiotic therapy with surgical approach is the gold standard treatment. Conclusion: This sequel to odontogenic infection is quite rare, but it can be prevented by a good oral hygiene and removal of abscessed teeth.

Prevalence of impacted third molars: a radiographic study among a North African population.

INTRODUCTION: Third molars are the most commonly concerned teeth with the impaction. Impacted third molar (ITM) can be associated to various clinical pathologies Aim: To determine the prevalence of ITM, its pattern and associated affections in Tunisian patients. METHODS: The study reviewed panoramic radiographs of patients consulting the Fattouma Bourguiba University Hospital, Monastir (Tunisia). Orthopantomograms were analyzed to define the prevalence of ITM; its angulation, depth and relation with the anterior border of mandibular ramus. Associated pathologies were also assessed. RESULTS: Seven hundred and thirty patients were included (286 men and 444 women). The age ranged from 19 to 89 years. Half of the patients (50.3%) showed at least one ITM. The total number of ITM was 881 with a statistical difference between arches (respectively 34.3% and 65.7% in the maxilla and in the mandible). The most common number of ITM was two (35.4%). Level C of impaction was observed more frequently in the maxilla and level A in the mandible. The most common angulation was the vertical one for both arches. Seventy six percent of ITM were presented with class II in relation with the anterior border of mandibular ramus. There was no significant difference in the frequency of impaction between gender and sides. The number of ITM associated with pathological conditions was 199 (22.6%). The most frequently observed pathology was the distal caries on the second molars (11.7%) followed by the caries of the third molars (5.2%). CONCLUSION: The prevalence of ITM among Tunisian patients was high.

The relationship between obesity and oral-health status in North African adults: A comparative study.

INTRODUCTION: The strength of the association between obesity and oral health is still indecisive. OBJECTIVE: The objectives of the study were to compare some oral-health data between two groups involving obese (OG) and normal weight (NWG) participants and determine the influencing factors of the periodontal probing depth (PPD). METHODS: This was a cross-sectional study including 67 Tunisian adults [OG (n = 33, body mass index (BMI) > 30 kg/m2 ), NWG (n = 34, BMI: 18.5-25.0 kg/m2 )]. The plaque level was recorded using the plaque index (PI). Gingival index (GI) was used to evaluate gingival inflammation. The depths of the sulci/pockets were probed using a periodontal probe. Stimulated saliva was collected for 5 min, and salivary flow rate (SFR) was determined. Salivary baseline pH (SBpH) was measured. A multivariable regression analysis was performed between PPD and some independent variables [i.e. obesity status, age, sex, socioeconomic status, systemic diseases and PI data]. RESULTS: The OG and NWG were age- and sex-matched and included comparable percentages of participants with systemic diseases (27.3 vs. 29.4%, respectively). The OG included a higher percentage of participants having a low socioeconomic status (87.9 vs. 64.7%, respectively). Compared with the NWG, the OG: (i) had comparable values of daily toothbrushing frequency, PI, GI and tooth mobility, (ii) included comparable percentages of irregular brushers, of participants with periodontitis, PI classes [0-1]and [1-2]; and GI classes [0-1], [1-2] and [2, 3]; (iii) had a higher PPD (2.02 ± 0.41 vs. 2.35 ± 0.22 mm, respectively), (iv) had lower SBpH (7.59 ± 0.21 vs. 7.45 ± 0.22, respectively) and SFR (1.98 ± 0.28 vs. 1.60 ± 0.32 mL/mn, respectively) and (v) included a higher percentage of participants having a PI class [2, 3] (67.6 vs. 87.9%, respectively). The multivariable regression analysis revealed that only obesity status, age and PI classes influenced the PPD, altogether explained 29.62% of the PPD variance. CONCLUSION: Obesity poses a risk for oral health, and obese adults had altered PPD and lower BSpH and SFR. Dentists should make obese patients aware of the health risks of obesity in an attempt to reduce the potential oral complications associated with this epidemic.

Place of placebo therapy in the treatment of burning mouth syndrome: A systematic review.

Burning mouth syndrome (BMS) is defined as an idiopathic orofacial pain with intraoral burning or dysesthesia. This systematic review aimed to analyze the scientific literature with regard to the effectiveness of placebo therapy in patients with BMS. A literature search was conducted through the PubMed-indexed journals within MEDLINE®, Scopus, Cochrane Central Register of Controlled Trials (CENTRAL), and Trip databases from their inception to May 31, 2022. The search terms were defined by combining (medical subject headings (MeSH) terms OR keywords) "burning mouth syndrome" AND (MeSH terms OR keywords) "placebo". Methodological quality assessments were performed utilizing the Joanna Briggs Institute (JBI) Critical Appraisal tool to attribute scores from 1 to 11 to the selected studies. The literature search, study selection and data extraction were carried out by 2 authors. Disagreements between the authors were resolved by the 3rd author, if necessary. A total of 44 articles met the inclusion criteria. After assessing full-text articles for eligibility, 20 articles were excluded. Consequently, 24 articles were retained. A total of 21 studies included in this systematic review had a low score of bias. In 13 studies, a positive response to placebo was noted. Among them, 7 showed a placebo response indistinguishable from active treatment. These changes were more pronounced in patients receiving placebo therapy compared to active treatment in 1 study. Placebo therapy may occasionally be beneficial and ethically acceptable for patients with BMS. To get stronger evidence for the use of a placebo, future studies with standardized methodology and outcomes are required.

Assessment of learning by students in dental medicine: case of the faculty of Dental Medicine of Monastir (Tunisia).

INTRODUCTION: The teaching methods used in medical science are constantly evolving. To identify the involvement of students in their training, a study of their evaluation of the different teaching methods is essential. AIM: To evaluate the different teaching methods offered by the faculty of dental medicine of Monastir by students. METHODS: A descriptive and qualitative study was conducted among students in the 6th year of the faculty during the academic year 2020/2021. The data were collected through a questionnaire written in french evaluating the teaching methods. A focus group of ten persons was led to understand better student's opinions. RESULTS: Among the 240 enrolled students, 161 responded to the questionnaire. They considered themselves as fully (18.6%) or partially (66.4%) active learners. However, 67.1% of them judged their FMDM training below their expectations. Clinical education is the teaching method most appreciated by students (46.7%) followed by practical work (24.8) and lecture note (15.5%). CONCLUSION: This study showed that students are interested in studying dentistry. However, they criticize the teaching methods used which present a certain passivity.

Two Lip Carcinomas following Allogeneic Hematopoietic Stem Cell Transplantation: A Case Report and Literature Review.

BACKGROUND: Secondary solid cancers are severe complications in patients who have undergone allogeneic hematopoietic stem cell transplantation (AHSCT) for malignant and nonmalignant lymphohematopoietic diseases. OBJECTIVE: The aim of this work was to report a case of two lip carcinomas following AHSCT and to warn doctors about the importance of regular check-ups of patients who have received HSCT. Observation. A 57-year-old man was referred by the dermatology department for the management of exophytic budding lesions on the lower lip evolving since 5 months. The patient was in complete remission following allogeneic bone marrow transplantation for acute myeloid leukemia since five years. Clinical and histological findings confirmed the diagnosis of a squamous cell carcinoma of the two lesions. CONCLUSION: It is of paramount importance to seek an oral squamous cell carcinoma in the presence of persistent lesions in HSCT recipients.

Whitening Efficacy of 3% Carbamide Peroxide Gel Activated by Lactoperoxidase.

OBJECTIVE: The aim of this clinical study was to evaluate the effectiveness of a whitening toothpaste containing 3% carbamide peroxide and lactoperoxidase. Materials and methods. Participants were instructed to brush their teeth using an enzymatic-activated dentifrice following a particular procedure for three weeks. Color was recorded before and after treatment using a VITA Easyshade spectrophotometer. Differences in L ∗ (tooth color lightness), a ∗ (displacement along the red-green axis), and b ∗ (displacement along the yellow-blue axis) were measured before and after treatment using the paired t and the Wilcoxon signed-rank tests. Color changes (Δ E ) were calculated using the obtained measurements. RESULTS: Thirty-four volunteers were included. Δ E was 4.03. For the set of 348 teeth, a greater tendency towards green (lower a ∗ ) and blue (lower b ∗ ) was observed (p < 0.05). There were no significant differences in lightness after treatment. Mandibular central incisors showed a greater tendency towards green (lower a ∗ ) and blue (lower b ∗ ). Bleaching effectiveness was observed in both the upper and lower central incisors and in the lateral mandibular incisors. CONCLUSION: Based on these results, it may be concluded that brushing with an enzymatic-activated dentifrice is effective for whitening teeth.

A Muscular and Cerebral Physiological Indices Assessment for Stress Measuring during Virtual Wheelchair Guidance.

The work presented in this manuscript has the purpose to assess the relationship between human factors and physiological indices. We discuss the relationship between stress as human factor and cerebral and muscular signals as features. Ten male paraplegic, right-handed subjects were volunteers for the experiment (mean age 34 ±6). They drove a virtual wheelchair in an indoor environment. They filled five missions where, in each one, an environmental parameter was changed. Meanwhile, they were equipped with Electromyography (EMG) sensors and Electroencephalography (EEG). Frequency and temporal features were filtered and extracted. Principal component analysis (PCA), Fisher's tests, repeated measure Anova and post hoc Tukey test (α = 0.05) were implemented for statistics. Environmental modifications are subject to induce stress, which impacts muscular and cerebral activities. While the time pressure parameter was the most influent, the transition from static to moving obstacles (avatars), tends to have a significant impact on stress levels. However, adding more moving obstacles did not show any impact. A synchronization factor was noticed between cerebral and muscular features in higher stress levels. Further examination is needed to assess EEG reliability in these situations.

Motivation and attitudes of Tunisian students for choosing the dental profession.

BACKGROUND: The right motivation for choosing the future profession is crucial. Focusing on students' motivation for choosing dentistry as a career is very important in order to understand the reasons behind this decision. AIM: To determine the current motivations of first year dental students and the reasons for choosing dental medicine at the university of Monastir. METHODS: This was a cross-sectional and descriptive study led among the students registered at the faculty of dental medicine during the academic year 2016/2017. Foreign students as well as those repeating the year were not included in the present study. Information on the socio-demographic profile and motivation for choosing dentistry was collected using a self-administered questionnaire written in English. RESULTS: One hundred and sixty-nine students participated in the survey, representing a 77.9% response rate. One questionnaire was excluded because of incomplete answers. The majority of the students (69.6%) were self-motivated to study dentistry. A difference according to gender (54.8% and 73% respectively among males and females, p=0.04) was noted. Over half of them (53.6%) had relatives in the medical profession. The majority of dental students (64.9%) would have preferred to study medicine. The financial motive was the first (69.6%) for choosing dentistry and the profession's prestige was the second (61.3%). The majority of the respondents indicated that the chosen profession is prestigious (57.7%) and provides good income (63.1%). CONCLUSIONS: The right motivation for choosing the future profession is very important. The focusing on students' motivation for choosing dentistry as a career is very important in order to understand the reasons behind this decision.

Mental fatigue level detection based on event related and visual evoked potentials features fusion in virtual indoor environment.

The purpose of this work is to set up a model that can estimate the mental fatigue of users based on the fusion of relevant features extracted from Positive 300 (P300) and steady state visual evoked potentials (SSVEP) measured by electroencephalogram. To this end, an experimental protocol describes the induction of P300, SSVEP and mental workload (which leads to mental fatigue by varying time-on-task) in different scenarios where environmental artifacts are controlled (obstacles number, obstacles velocities, ambient luminosity). Ten subjects took part in the experiment (with two suffering from cerebral palsy). Their mission is to navigate along a corridor from a starting point A to a goal point B where specific flickering stimuli are introduced to perform the P300 task. On the other hand, SSVEP task is elicited thanks to 10 Hz flickering lights. Correlated features are considered as inputs to fusion block which estimates mental workload. In order to deal with uncertainties and heterogeneity of P300 and SSVEP features, Dempster-Shafer (D-S) evidential reasoning is introduced. As the goal is to assess the reliability for the estimation of mental fatigue levels, D-S is compared to multi layer perception and linear discriminant analysis. The results show that D-S globally outperforms the other classifiers (although its performance significantly decreases between healthy and palsied groups). Finally we discuss the feasibility of such a fusion proposal in real life situation.

Comparison of Periodontal Status Between Male Exclusive Narghile Smokers and Male Exclusive Cigarette Smokers.

Studies evaluating the effects of narghile use on the periodontium present conflicting conclusions. This study aimed to compare the periodontal status of exclusive narghile smokers (ENSs, n = 74) to that of exclusive cigarette smokers (ECSs, n = 74). Males aged 20-40 years were recruited to participate in this comparative study. Information concerning oral health habits (number of yearly visits to the dentist, daily toothbrushing frequency) and tobacco exposure were obtained. Clinical measurements were performed on all the existing teeth, except the third molars. The number of remaining teeth and decayed/missing/filled teeth (DMFT) were noted. The plaque levels were recorded using the plaque index of Löe and Silness. The gingival index modified by Löe was used to evaluate gingival inflammation. Teeth mobility was measured using bidigital mobility. The probing pocket depth was measured using a periodontal probe. Periodontal disease was defined as the presence of at least 10 sites with a probing depth ≥5 mm. Student's t and chi-square tests were used to compare, respectively, the two groups' quantitative and qualitative data. The two groups were matched for quantities of used tobacco, age, daily toothbrushing frequency, teeth mobility, number of remaining teeth, plaque index, and DMFT. Compared to the ECS group, the ENS group had a significantly lower number of yearly visits to the dentist (mean ± SD: 0.2 ± 0.5 vs. 0.1 ± 0.2), lower probing pocket depth (mean ± SD: 2.33 ± 0.63 vs. 2.02 ± 0.80 mm), and gingival index (median [interquartile]: 0.46 [0.10-0.89] vs. 0.00 [0.00-0.50]), and it included significantly lower percentages of smokers with periodontal disease (24.3% vs. 9.5%). In conclusion, chronic exclusive narghile smoking has fewer adverse effects on the periodontium than chronic exclusive cigarette smoking.

Preliminary findings on the correlation of saliva pH, buffering capacity, flow rate and consistency in relation to waterpipe tobacco smoking.

The aim of the present comparative study was to compare some salivary characteristics between exclusive waterpipe smokers (EWPS) and non-smokers. 72 males (36 EWPS) were recruited. The volume of stimulated saliva was determined and divided by the duration of saliva collection. The pH was measured directly using a pH meter. The buffering capacity was determined using a quantitative method which involved the addition of 10 µl HCl. Up to a total of 160 µL was titrated up to obtain a pH titration curve. At 50 µL of titrated HCl, buffering capacity was ranked into three categories: high, medium and low. EWPS and non-smoker groups had similar flow rates (1.81 ± 0.79 and 1.78 ± 1.14 mL min-1) and similar baseline pH (6.60 ± 0.37 and 6.76 ± 0.39). Statistically significant differences in the two groups' pH were observed from 30 to 160 µL of titrated up HCl. At 50 µL of titrated up HCl, the EWPS group compared to the non-smoker group had a significantly higher pH (4.79 ± 0.72 vs. 5.32 ± 0.79). To conclude, waterpipe tobacco smoking alters the buffering capacity but does not alter either salivary flow rates or the baseline pH and consistency.

Periodontal bone height of exclusive narghile smokers compared with exclusive cigarette smokers.

OBJECTIVE: To compare the periodontal bone height (PBH) of exclusive narghile smokers (ENS) with that of exclusive cigarette smokers (ECS). METHODS: Tunisian males aged 20-35 years who have been ENS for more than five narghile-years or ECS for more than five pack-years were recruited to participate in this comparative cross-sectional study. Information about oral health habits and tobacco consumption were gathered using a predetermined questionnaire. Plaque levels were recorded in four sites using the plaque index of Loe and Silness. The PBH was measured mesially and distally from digital panoramic radiographs of each tooth and expressed as a percentage of the root length. A PBH level ≤ 0.70 was applied as a cutoff reference value signifying bone loss. Student t-test and Chi(2) test were used to compare quantitative and qualitative data of both groups. RESULTS: There were no significant differences between the ENS (n=60) and ECS (n=60) groups regarding age and the consumed quantities of tobacco (28 ± 4 vs. 27 ± 5 years, 7 ± 3 narghile-years vs. 8 ± 3 pack-years, respectively). Compared with the ECS group, the ENS group had a significantly higher plaque index (mean ± SD values were 1.54 ± 0.70 vs. 1.84 ± 0.73, respectively). However, the two groups had similar means of PBH (0.85 ± 0.03 vs. 0.86 ± 0.04) and tooth brushing frequencies (1.1 ± 0.8 vs. 0.9 ± 0.6 a day, respectively) and had similar bone loss frequencies (15% vs. 12%, respectively). CONCLUSIONS: Both ENS and ECS exhibited the same PBH reduction, which means that both types of tobacco smoking are associated with periodontal bone loss.

When mental fatigue maybe characterized by Event Related Potential (P300) during virtual wheelchair navigation.

The goal of this study is to investigate the influence of mental fatigue on the event related potential P300 features (maximum pick, minimum amplitude, latency and period) during virtual wheelchair navigation. For this purpose, an experimental environment was set up based on customizable environmental parameters (luminosity, number of obstacles and obstacles velocities). A correlation study between P300 and fatigue ratings was conducted. Finally, the best correlated features supplied three classification algorithms which are MLP (Multi Layer Perceptron), Linear Discriminate Analysis and Support Vector Machine. The results showed that the maximum feature over visual and temporal regions as well as period feature over frontal, fronto-central and visual regions were correlated with mental fatigue levels. In the other hand, minimum amplitude and latency features didn't show any correlation. Among classification techniques, MLP showed the best performance although the differences between classification techniques are minimal. Those findings can help us in order to design suitable mental fatigue based wheelchair control.

Influence of mental fatigue on P300 and SSVEP during virtual wheelchair navigation.

The aim of this paper is to investigate the influence of mental fatigue on Positive 300 (P300) and Steady State Visual Evoked Potentials (SSVEP) during virtual wheelchair navigation. For this purpose, experimental protocols were setup in order to induce mental fatigue, P300 and SSVEP. Next, the correlation between mental fatigue and P300/SSVEP parameters were investigated. At the end, the best correlated features from both modalities were used as inputs for three classification techniques. Depending on the subject samples (healthy vs palsy), The best overall classification rate reached 80% for P300 modality. The results of this investigation constitute the first steps towards an anticipatory system that can assist the wheelchair driver during navigation, depending on his mental fatigue level.