Assessment of Dentists' Knowledge of Space Maintainer Indications After Primary First Molar Extraction: A Cross-Sectional Study.

Background Space maintainer appliances can potentially reduce the need for extensive orthodontic treatment in the future for children. However, they can also lead to various complications, such as an increased risk of dental caries and gingival diseases. It is crucial for dentists to carefully evaluate a decision each child's specific situation before deciding whether to apply a space maintainer or not. This study aimed to evaluate the knowledge of dentists at Damascus University, both at undergraduate and specialist levels, regarding when space maintainers should be recommended. Methods A cross-sectional study was conducted involving 158 dentists (151 at the undergraduate level and seven at the specialist level). The questionnaire included 13 questions, covering demographic information and self-assessment, and 10 scenarios that are commonly encountered in clinical practice. Results The response rate was 50%. A majority of the participants (85, 53.8%) demonstrated inadequate knowledge. No significant correlations were found between knowledge level and gender (P = 0.853), practice experience (P = 0.171), or self-assessment (P = 0.383). Conclusions Most dentists exhibited a lack of knowledge about space maintainers, with no correlation identified between knowledge level, gender, practice experience, and self-assessment. It is recommended that educational curricula be updated to ensure that clinicians have a better understanding of when to use space maintainers in children.

Assessment of oral health status and quality of life in hearing-impaired children from Syria.

AIM: This study aimed to evaluate the oral health status of children with hearing impairments and assess the relationship between various oral health factors and the Pediatric Oral Health-Related Quality of Life. MATERIALS AND METHODS: This observational cohort study involved 90 hearing-impaired children aged 6-12 years. Diagnostic tools such as pure-tone audiometry were used to evaluate their hearing abilities. Dental health was assessed by calculating DMFT, dmft, Plaque and Gingival indices. The oral health-related quality of life was measured using the POHRQoL. RESULTS: The severity of hearing impairment varied with 3% having severe hearing loss, 13% having profound hearing loss, and 83% having complete hearing loss. A high prevalence of dental cavities with 93% of children affected was found. DMFT score was similar between males and females (2.5 ± 0.3 vs. 2.3 ± 0.3 respectively). Males exhibited a higher mean dmft score (4.1 ± 0.5 vs. 3.3 ± 0.5), and a higher mean Plaque Index (1.9 ± 0.1 vs. 1.5 ± 0.1). On the other hand, females showed a higher mean Gingival Index (0.9 ± 0.1 vs. 1.1 ± 0.2). Results indicated a decreased OHRQoL with a mean POQL score of 6.4 ± 2.89. Spearman's test revealed a significant positive correlation between POQL total score and DMFT scores (P = 0.000), dmft scores (P = 0.000), Plaque Index scores (P = 0.000), and Gingival Index scores (P = 0.038). There was a weak positive correlation between hearing impairment severity and POQL total score, it was not statistically significant. CONCLUSIONS: Children who have hearing impairments exhibit poor oral health, and levels of dental caries, which can negatively impact their overall POHRQoL. Therefore, it is highly recommended to start specialized oral health education and comprehensive dental care programs to improve their OHRQoL.

A randomized controlled trial to assess parental satisfaction with computerized intraosseous anesthesia versus inferior alveolar nerve block in children.

This study aimed to compare parental satisfaction between two pediatric dental anesthesia techniques, computerized intraosseous anesthesia (CIA) and inferior alveolar nerve block (IANB). This study was designed as a split-mouth randomized controlled clinical trial. A total of 52 parents of children undergoing dental treatment were enrolled in the study. Each participant received both CIA and IANB anesthesia, with the order of administration randomized. Parental satisfaction was evaluated using the parental satisfaction of dental local anesthetic techniques scale (PSLAS). Statistical analysis revealed that parental satisfaction regarding CIA was higher than that for IANB with a significant difference (P ˂ 0.05). However, there was no difference regarding the age, gender or the education level of the parents. (P > 0.05). This study provides insights into parental satisfaction with pediatric dental anesthesia techniques and highlights the influence of socioeconomic factors on anesthesia decision-making. Within the limitations of this trial, it was concluded that CIA was significantly superior to IANB in overall parental satisfaction. However, parental satisfaction values were lower in CIA group regarding costs and concern from complications. In addition, it was concluded that there was no difference in satisfaction levels regarding the gender, age and education level of the parents.

Assessment of diagnostic accuracy and reliability of reveal fluorescence dental loupes in detecting molar incisor hypomineralization in children.

BACKGROUND: Molar-Incisor Hypomineralization (MIH) poses challenges to accurate diagnosis, impacting children's oral health. Traditional methods exhibit limitations, necessitating innovative approaches. This study aimed to evaluate the reliability and diagnostic accuracy Reveal Fluorescence Dental Loupes (RFDLs) for the detection of MIH METHODS: This cross-sectional study, adhering to STRAD guidelines, involved 38 healthy children (age 7-9) with MIH. Ethical approval and informed consent were obtained. Microscope images and Reveal loupes were employed for examinations. Validity was assessed against microscope results, and inter- and intra-examiner reliability were measured using ICC and Kappa coefficients. Sensitivity, specificity, and overall accuracy were calculated, with an AUC-ROC analysis for discriminatory ability. RESULTS: Intra-examiner reliability scores were excellent (Examiner 1: ICC 0.92, Examiner 2: ICC 0.94). Inter-examiner reliability (Kappa 0.92) indicated almost perfect agreement. Reveal demonstrated high sensitivity (82.61 %) and specificity (92.59 %), with an overall accuracy of 88.70 %. AUC-ROC analysis supported its robust discriminatory ability (AUC: 0.871). CONCLUSIONS: Reveal Fluorescence Dental Loupes emerged as a promising diagnostic tool for accurate MIH detection, particularly in outreach settings. The study highlights the transformative impact of accessible and reliable diagnostic tools on pediatric oral health outcomes. While acknowledging limitations and the absence of a gold standard, the findings contribute to advancing MIH diagnostic capabilities. Further research in diverse populations is warranted for comprehensive validation.

The Impact of a Web-Based Restorative Dentistry Course on the Learning Outcomes of Dental Graduates: Pre-Experimental Study.

BACKGROUND: Restorative dentistry plays a crucial role in dental practice, necessitating professionals to stay abreast with the latest advancements in the field. The advancement of technology has made web-based learning a widely used method of education delivery in dentistry, providing learners with extensive information and flexibility. OBJECTIVE: This study aims to evaluate how effective an online educational course in restorative dentistry is for dental graduates in Syria. METHODS: This study used a pre-experimental study design, with pretest and posttest assessments to measure changes in participants' knowledge and skills. A total of 21 dental graduates completed the online course in restorative dentistry, which was hosted on Moodle, using the learning management system of the Syrian Virtual University. Participants were provided with a suggested learning sequence and had the flexibility to navigate the course on their own and at their own pace. The course was developed based on the principles of web course design and web-based course development using the ADDIE (Analysis, Design, Development, Implementation, and Evaluation) general instructional design model. The pretest and posttest assessments consisted of 50 multiple-choice questions with a single correct answer, aligning with the course content. Furthermore, participants were asked to complete a course acceptance survey upon finishing the course. RESULTS: The results showed a significant improvement in the participants' knowledge of restorative dentistry, supported by a statistically significant P value of less than .05. The effect size of the difference between the pre and posttest indicated that the effect size, as indicated by ω2, demonstrated a significant 62.1% difference between the pre and posttest, indicating a high and statistically significant effect. Furthermore, the value derived from the Haridy obtained work ratio formula indicated that the educational program was effective, with an effectiveness amount of 3.36%. Additionally, 93% (n=19) of respondents expressed confidence in having gained the expected benefits from the educational course upon its completion. CONCLUSIONS: The findings indicated a notable enhancement in the participants' understanding of restorative dentistry. The participants' high satisfaction rate and positive feedback from the course acceptance survey further emphasize the favorable reception of the web-based learning approach. This study highlights the potential of web-based learning in dental education, opening the door for future research in this area. The findings of this study carry important implications for the design and implementation of web-based educational programs in dentistry, suggesting that such programs can serve as an effective tool for continuous professional development in the field.

Parental satisfaction and acceptance of silver diamine fluoride treatment for molar incisor hypomineralisation in pediatric dentistry: a cross-sectional study.

The study aimed to investigate parental satisfaction and acceptance of silver diamine fluoride (SDF) treatment for permanent molars affected by molar incisor hypomineralisation (MIH). This study was conducted in the pediatric dental department at Damascus University, Syria. This study was performed at the period from Jan 2023 to April 2023. In this cross-sectional study, a validated questionnaire employing a 5-point Likert scale was used to evaluate esthetics, ease of application, pain perception, and taste acceptability. Participants included 100 parents or guardians of children aged 6-9 years who had received SDF treatment in the past year. The findings of this study revealed high satisfaction levels (77.5%) with the treatment. Parents expressed contentment with the appearance of their child's molars after SDF application (58% agreed or strongly agreed) and found the application process easy and pain-free (100% agreed or strongly agreed). However, taste acceptability posed a challenge, with over half of the parents (53%) finding it unacceptable. Regression analysis underscored the significant impact of esthetics, ease of application, pain perception, and taste on parental satisfaction. Moreover, parents with higher education levels (graduate or postgraduate) exhibited higher acceptance rates compared to those with lower education levels (63.1% vs. 33.6%). Notably, parental gender and age did not significantly influence SDF treatment acceptance. This study provides critical insights into parental satisfaction and acceptance of SDF treatment for MIH-affected permanent molars. Despite concerns about tooth discoloration, the high satisfaction levels suggest that SDF holds promise as an effective treatment option. Parental education significantly influenced acceptance rates. This research highlights the importance of considering parental perspectives and tailoring communication strategies in pediatric dentistry, ultimately contributing to improved care for young patients with MIH.

Post-quake call for action: developing core competencies matrix for Syrian health workers in emergency time.

BACKGROUND: The recent earthquake in Syria has caused widespread devastation, leading to extensive damage and loss of life. Considering the diverse range of disasters and conflicts that have affected Syrian society, health workers must possess essential competencies to effectively manage various types of disasters, including earthquakes. Therefore, this study was undertaken to identify the specific competencies required by Syrian health workers to respond efficiently and effectively to earthquakes. METHODS: An exploratory qualitative study was conducted at the Medical Education Program MEP of the Syrian Virtual University SVU. Nine members of the research team of the MEP, who represent various health specializations in medicine, dentistry, nursing, and pharmacy, accepted to take part in this study. Among these, three members have been actively involved in providing health care in hospitals and the field during the Syrian earthquake on 6 February 2023. The Delphi process was adopted to identify competencies. Health workers involved in earthquake response were categorized into nine groups including medical doctors, dentists, pharmacists, nurses, psychological support professionals, medical students, allied healthcare professionals, on-site disaster teams, and managers. The final list was accepted if it achieved more than 80% agreement among the participants in the first, second, and final rounds. RESULTS: The study identified 74 competencies (12 knowledge items, 35 skills, and 27 attitudes) essential for health workers to respond effectively to earthquakes. They are categorized into five domains: "Preparing the team for the rescue process during and, after earthquakes, Implementation of the rescue process, Education and psychological support, Research, and development". CONCLUSION: A list of earthquake competencies was identified for health workers. It is hoped that this list will enhance a country's resilience and will enable decision-makers to support health workers in acquiring these competencies within a very strained health system in Syria and other countries.

Analyzing facial action units in children to differentiate genuine and fake pain during inferior alveolar nerve block: a cross-sectional study.

This study aimed to investigate the association between facial action units and pain levels in Syrian children, focusing on both genuine and fake pain expressions. A total of 300 Syrian children aged 6-9 years participated in the study. Pain levels were assessed using the validated Face, Legs, Activity, Cry, Consolability scale, and facial expressions were analyzed using the Facial Action Coding System. The children were asked to mimic their feelings after receiving a dental injection to elicit fake pain expressions. Statistical analysis, including multinomial logistic regression and chi-square tests, was conducted to determine the Action Units (AUs) associated with each pain level and to compare the differences between real and fake pain expressions. The results revealed significant associations between specific AUs and pain levels. For real pain expressions, the most activated AUs across different pain levels with positive coefficient values of correlation (P-value < 0.01) were analyzed. In contrast, for fake pain expressions, AU12 and AU38 were consistently observed to be the most activated. These findings suggest that certain AUs are uniquely associated with fake pain expressions, distinct from those observed in real pain expressions. Furthermore, there were no significant differences between boys and girls in terms of their genuine and fake pain expressions, indicating a similar pattern of AU activation (P-value > 0.05). It was concluded that AUs 4, 6, 41, and 46 were associated with mild pain, and AUs 4, 6, 41, 46, and 11 were associated with moderate pain cases. In severe pain, AUs 4, 6, 7, 9, 11, and 43 were associated. In fake pain feelings, AU43, AU38, and AU12 were the most activated with no difference between boys and girls.

Direct or indirect composite for restoring permanent first molars affected by Molar Incisor Hypomineralisation (MIH): a randomized clinical controlled trial.

AIM: This study was undertaken to compare direct composite resin restorations (DCRR) and indirect composite resin restorations (ICRR) for treating permanent first molars affected by MIH in terms of clinical performance. MATERIALS AND METHODS: This was a controlled, randomized, clinical split-mouth study. The studied sample consisted of 40 asymptomatic first permanent hypomineralised mandibular molars in 20 children aged between 7-11 years, these cases were divided randomly into two groups: Group 1 (experimental): 20 first permanent mandibular molars were restored with ICRR, and Group 2 (control): 20 first permanent mandibular molars that were restored with DCRR. The cavity was prepared using a diamond bur on a high-speed handpiece, and the prepared cavity was wiped with cotton moistened with sodium hypochlorite. The composite was applied directly with a total-etch bonding system. In the ICRR group, an impression for the prepared cavity was taken using a silicon-based material, and the restoration was adhesive with self-adhesive resin cement. The child's satisfaction with each of the two application techniques was assessed through the scale FACES. Restorations were evaluated during follow-up periods (3, 6, and 12 months) according to Modified USHPH criteria. RESULTS: The clinical success rate was 90% in the ICRR group versus 85% in the DCRR group after 12 months of follow-up without statistically significant differences (P = 0.218). Children were significantly more satisfied (P = 0.0351) with ICRR than DCRR. CONCLUSIONS: Both DCRR and ICRR can be considered effective restorations with acceptable clinical performance in the restoration of hypomineralised first permanent molars with an advantage of ICRR in terms of child acceptance of the restoration application technique.

Using a Modified Delphi Method for Identifying Competencies in a Syrian Undergraduate Neonatology Curriculum.

OBJECTIVES: There is a global shift toward competency-based medical education (CBME) to equip medical students with essential competencies required to meet healthcare needs. Syrian medical faculties lack a formal competency-based neonatology curriculum for undergraduate medical students. Therefore, our study aimed to develop a national consensus on the required competencies for undergraduate neonatology curricula in Syria. METHODS: This study took place at the Syrian Virtual University between October 2021 and November 2021. The authors used a modified Delphi method to determine neonatal medicine competencies. A focus group of three neonatologists and one medical education professional identified initial competencies. In the first Delphi round, 75 pediatric clinicians rated the competencies on a 5-point Likert scale. After formulating the results, a second Delphi round was conducted with 15 neonatal medicine experts. To reach an agreement, 75% of participants must score a competency as 4 or 5. Correlation coefficients were used to compare clinicians' first Delphi ratings with experts' second Delphi ratings. Competencies with a weighted response greater than 4.2 were considered essential. RESULTS: A list of 37 competencies (22 knowledge, 6 skills, and 9 attitudes) was identified after the second Delphi round, of which 24 were considered core competencies (11 knowledge, 5 skills, and 8 attitudes). The correlation coefficient for knowledge, skills, and attitudes competencies was 0.90, 0.96, and 0.80, respectively. CONCLUSIONS: Neonatology competencies have been identified for medical undergraduates. These competencies aim to help students achieve the required skills and enable decision-makers to implement CBME in Syria and similar countries.

Measurement of Humanity Among Health Professionals: Development and Validation of the Medical Humanity Scale Using the Delphi Method.

BACKGROUND: Despite the importance of humanism in providing health care, there is a lack of valid and reliable tool for assessing humanity among health professionals. OBJECTIVE: The aim of this study was to design a new humanism scale and to assess the validity of this scale in measuring humanism among Syrian health professional students. METHODS: The Medical Humanity Scale (MHS) was designed. It consists of 27 items categorized into 7 human values including patient-oriented care, respect, empathy, ethics, altruism, and compassion. The scale was tested for internal consistency and reliability using Cronbach α and test-retest methods. The construct validity of the scale was also tested to assess the ability of the scale in differentiating between groups of health professional students with different levels of medical humanity. A 7-point Likert scale was adopted. The study included 300 participants including 97 medical, 78 dental, 82 pharmacy, and 43 preparatory-year students from Syrian universities. The Delphi method was used and factors analysis was performed. Bartlett test of sphericity and the Kaiser-Meyer-Olkin measure of sample adequacy were used. The number of components was extracted using principal component analysis. RESULTS: The mean score of the MHS was 158.7 (SD 11.4). The MHS mean score of female participants was significantly higher than the mean score of male participants (159.59, SD 10.21 vs 155.48, SD 14.35; P=.008). The MHS mean score was significantly lower in dental students (154.12, SD 1.45; P=.005) than the mean scores of medical students (159.77, SD 1.02), pharmacy students (161.40, SD 1.05), and preparatory-year students (159.05, SD 1.94). However, no significant relationship was found between humanism and academic year (P=.32), university type (P=.34), marital status (P=.64), or financial situation (P=.16). The Kaiser-Meyer-Olkin test (0.730) and Bartlett test of sphericity (1201.611, df=351; P=.01) were performed. Factor analysis indicated that the proportion of variables between the first and second factors was greater than 10%, confirming that the scale was a single group. The Cronbach α for the overall scale was 0.735, indicating that the scale had acceptable reliability and validity. CONCLUSIONS: The results of this study suggest that the MHS is a reliable and valid tool for measuring humanity among health professional students and the development of patient-centered care.

Oral health-related quality of life and oral manifestations of Syrian children with congenital heart disease: a case-control study.

BACKGROUND: There was an immense need for studies evaluating the oral health status of Syrian children with congenital heart disease (CHD) and its impact on their quality of life. No contemporary data are available. The objective of this study was to investigate oral manifestations and oral health-related quality of life (OHRQoL) of children with CHD and compare them with healthy controls aged 4-12 years. METHODS: A case-control study was undertaken. A total of 200 patients with CHD and 100 healthy children belonging to the same patient's family were included. Decayed, missed, and filled permanent teeth index (DMFT) and decayed, missed, and filled primary teeth index (dmft), Oral Hygiene Index (OHI), Papillary Marginal Gingivitis Index (PMGI), and dental abnormalities were recorded. The Arabic version of the Child Oral Health-Related Quality of Life Questionnaire (COHRQoL, 36-item) which was divided into 4 different domains (Oral Symptoms, Functional Limitations, Emotional Well-Being, Social Well-Being) were studied. Chi-square test and independent- t-test were used to perform statistical analysis. RESULTS: CHD patients experienced more periodontitis, dental caries, poor oral health, and enamel defects. The dmft mean was significantly higher in CHD patients than in healthy children (5.245 vs. 2.660, P < 0.05). No significant difference was found between patients and controls in the DMFT Mean (P = 0.731). There was a significant difference between CHD patients and healthy children in the mean of the OHI (5.954 vs. 1.871, P < 0.05), and PMGI (1.689 vs. 1.170, P < 0.05). CHD patients have significantly higher enamel opacities (8% vs. 2%) and hypocalcification (10.5% vs. 2%) than controls. Also, the 4 COHRQoL domains, showed significant differences between CHD children and controls. CONCLUSIONS: Evidence about the oral health and COHRQoL of children with CHD was provided. Further preventive measures are still required to improve the health and quality of life of this vulnerable group of children.

Prevalence and clinical characteristics of molar-incisor hypomineralization in Syrian children: a cross-sectional study.

This study was undertaken to determine the prevalence of molar incisor hypomineralization (MIH) in Syrian children and to provide information about clinical patterns and severity of MIH lesions. A sample of 1138 children aged 8-11 years was recruited for this cross-sectional study. The diagnosis of MIH was made using the criteria of the European Academy of Paediatric Dentistry (EAPD) and the MIH/HPSMs short charting form was used to score the index teeth. The results showed that the prevalence of MIH in Syrian children was 39.9%. Demarcated opacities were the most prevalent pattern of MIH defects on Permanent first molars (PFMs) and permanent incisors (PIs). Spearman rank correlation showed that the mean number of PIs and HPSMs with MIH increased when the number of affected PFMs was increased (P < 0.001). Chi-square test resulted that girls showed a higher number of severe PFMs than boys did with a statistically significant difference (x2 = 133.1, P < 0.05). Moreover, Chi-square test showed that the number of severe PFMs is higher than the number of severe PIs with a statistically significant difference (x2 = 54.9, P < 0.05). In addition, the mean dmft/DMFT index in children with MIH was found to be significantly higher than children without MIH (P < 0.05). The findings emphasize the need for early identification and management of MIH in children to prevent adverse effects on their oral health.

A Novel Scale to Assess Parental Satisfaction of Dental Local Anesthetic Techniques in Children: A Cross-Sectional Study.

Background: Pain control is one of the most important aspects that can affect parental satisfaction of the dental care provided for children. Dental local anesthesia has the highest impact on pain sensation of the children. However, there is no scale in the literature to assess parental satisfaction of dental local anesthetic techniques. Objectives: This study was aimed to assess the parental satisfaction with dental local anesthetic techniques for their children through designing a scale that reflects satisfaction and to study the validity and reliability of this scale. Methods: A cross-sectional observational study was conducted on 150 parents (102 mothers and 48 fathers). Two techniques of local anesthesia were used for each child participated in this study (inferior alveolar nerve block and computerized intraosseous anesthesia). The developed scale consisted of 20 items in a 5-point Likert scale. Half of the items were written in a negative format. Internal consistency, validity, and factor analysis were performed in this study. Independent t-test was used to compare between the two techniques of anesthesia, between boys and girls and among fathers and mothers. Results: Parental satisfaction mean values were higher in the computerized intraosseous anesthesia group in comparison to inferior alveolar nerve block (P value <0.05). The T-test showed that there was no difference between boys and girls regarding parental satisfaction (P value >0.05). Furthermore, fathers show lower satisfaction in the computerized interosseous anesthesia group (P value <0.05). Excellent internal consistency of this scale was resulted as Cronbach's alpha reliability coefficient was 0.985. After factor analysis, seven factor components were retained by using varimax rotation. Conclusions: Findings of this study reported that the designed parental satisfaction of dental local anesthetic techniques scale (PSLAS) is a valid and reliable scale to be used. Moreover, this study showed that parental satisfaction was higher when computerized intraosseous anesthesia was used in comparison to inferior alveolar nerve block.

Remineralization of teeth with casein phosphopeptide-amorphous calcium phosphate: analysis of salivary pH and the rate of salivary flow.

AIM: To investigate the changes of salivary flow rate and salivary pH of Syrian children with mixed dentition following application of Casein Phosphopeptide-Amorphous Calcium Phosphate (CPP-ACP). METHODS: This study is part of a double-blind randomized controlled clinical trial. It included 50 children aged 6-8 who were randomly divided into two treatment groups to receive either CPP-ACP GC Tooth Mousse™ (Group A) or placebo (Group B) with 25 participants per group. After the application of the product in the mouth for 3 min, saliva samples were collected four times (T0, T1, T2, and T3) to measure salivary pH and the rate of salivary flow. RESULTS: There was no significant difference between group A and B in the mean value of salivary flow rate (t = 1.08, P = 0.28, 0.57 ± 0.28 versus 0.56 ± 0.38 respectively) and salivary pH (t = 0.61, P = 0.54, 7.28 ± 0.44 versus 7.25 ± 0.36 respectively). However, there was a significant difference between different time points (T0, T1, T2, and T3) in the mean value of salivary flow rate (0.41 ± 0.30, 0.65 ± 0.36, 0.53 ± 0.28, and 0.56 ± 0.34 respectively) and salivary pH (6.99 ± 0.44, 7.46 ± 0.36, 7.36 ± 0.32, and 7.26 ± 0.32 respectively). CONCLUSION: The application of the GC Tooth Mouse (CPP-ACP) was similar to placebo in increasing the salivary pH and salivary flow rate. TRIAL REGISTRATION: ISRCTN17509082, Registration date 22/11/2022.

A suggested scientific research environment measure SREM in medical faculties.

Background: Creating a supportive environment for scientific research is vital to improve the quality of research and its impact on development of society. This study outlines the development of a new scale that can measure the scientific research environment of postgraduate medical students. This tool aimed to allow medical institutions to measure their scientific research environment from the researchers' point of view. This may ensure an appropriate scientific research environment for researchers by identifying and overcoming obstacles. Methods: Based on literature, an initial list with 58 items was formulated. After discussing with postgraduate students and academic staff members from Damascus University and the Syrian Virtual University, A 38-item scale remained from the initial list of 58 items. To test the scale, postgraduate medical students (n = 30) were asked to fill the scale and answer 38 questions-with a 5-point Likert scale-twice in two separate occasions. The Pearson's correlation coefficient was performed to study the internal correlation. The internal consistency test was performed with Cronbach's Alpha, and the Test-Retest Reliability was conducted to study the reliability of the scale. Moreover, factor analysis was used to determine the sampling adequacy. Results: Thirty postgraduate medical students at Damascus University completed the 38-item scale. Scale scores in the sample displayed good reliability in relation to published results. Findings, showed an internal correlation among its sub-scales. The results showed an acceptable reliability values such as internal consistency (α = 0.863) and test-retest reliability (ICC = 0.093). KMO had a value bigger than 0.7 (KMO = 0.849) which indicate sampling adequacy, also, Bartlett's test of the sphericity was (1142.76, Df = 91, P-value = 0.000) which prove meaningful of the factor analysis. The results of varimax rotation found that five main factors were retained. Conclusions: The Scientific Research Environment Measure (SREM), can be suggested as an effective evaluation instrument which can be applied easily to assess the scientific research environment of postgraduate medical students. This would help the decision makers to support teaching, learning, and research environment through implementing new strategies that inspire postgraduate medical students and increase their engagement.

Preventive efficacy of 38% silver diamine fluoride and CPP-ACP fluoride varnish on molars affected by molar incisor hypomineralization in children: A randomized controlled trial.

Background: This randomized controlled trial aimed to compare the efficacy of silver diamine fluoride (SDF) and Casein Phosphopeptide-Amorphous Calcium Phosphate fluoride Varnish (CPP-ACPFV) in preventing caries development, enamel breakdown, and sensitivity on molars affected by molar incisor hypomineralization (MIH) in children. Methods: A total of 100 children aged 6 to 9 years were enrolled in the study with two contralateral permanent molars mildly affected by MIH. Affected molars were randomly and equally assigned to receive either SDF or CPP-ACPFV treatment. The interventions were applied at four different time points (baseline, 3, 6, 9 months), and the incidence of caries, caries progression, enamel breakdown, and sensitivity were assessed. Results: The findings of this study revealed significant differences in the incidence of caries between the groups treated with SDF and CPP-ACPFV ( P-value < 0.05). Similarly, there was a significant difference in caries progression between the two groups ( P-value < 0.05). However, no significant differences were observed in enamel breakdown scores between the treatment groups, as the majority of teeth in both groups exhibited a score of 0. Furthermore, there were no significant differences in sensitivity between the treatment groups throughout the study period. Conclusions: In conclusion, the results of this study provide evidence that molars treated with SDF demonstrated a lower incidence of caries and a higher rate of caries arrest compared to those treated with CPP-ACPFV. Both interventions showed promise in preventing enamel breakdown and improving sensitivity. These findings highlight the potential of SDF and CPP-ACPFV as effective treatments for caries prevention and management, emphasizing the importance of early intervention and appropriate dental care strategies in maintaining oral health. Trial registration: ISRCTN54243749 (13/01/2022).

The First Asynchronous Online Evidence-Based Medicine Course for Syrian Health Workforce: Effectiveness and Feasibility Pilot Study.

BACKGROUND: Evidence-based medicine (EBM) is critical for providing the best scientifically proven patient health care, and it is implemented worldwide in order to improve the quality of the delivered health care. However, not all Syrian health professionals are knowledgeable about the importance, methodology, and implementation of EBM. Providing web-based learning courses on EBM might be effective in improving the EBM knowledge of health care professionals. OBJECTIVE: This study was performed to test the effectiveness and the feasibility of an asynchronous web-based course on EBM in improving the competencies of Syrian health care professionals in terms of EBM. METHODS: A web-based course on EBM was developed in Arabic and uploaded onto the Syrian Virtual University platform. An electronic registration form was designed and distributed to medical groups on social media for registration to this web-based course. Both the pretest and posttest had the same 3 sections to measure the impact of this web-based EBM program on the knowledge, skills, and attitudes of the Syrian health care professionals. The posttest had an additional section for measuring the efficacy and ease of use of this program. Student paired 1-tailed t test was used to analyze the differences in the different assessment sections among the participants. RESULTS: Nineteen participants filled the electronic registration form, but 8 participants did not meet the inclusion criteria. Therefore, the pretest was sent to the remaining 11 participants (7 men and 4 women) who graduated from Syrian universities. Ten of them completed the pretest, while 7 of them completed the posttest. The web-based course was found to be effective in improving the participants' EBM knowledge, skills, and attitudes at P>.05. Further, the web-based EBM course was feasible and easy-to-use. CONCLUSIONS: In order for EBM to be implemented in Syria, continuous medical education training programs should be designed for clinical practitioners. Our study shows that asynchronous web-based medical education is an effective and a feasible means for introducing the concept of EBM, improving practitioners' skills, and promoting the positive attitudes of Syrian clinical practitioners toward EBM.

Bridging the gap between self-assessment and faculty assessment of clinical performance in restorative dentistry: A prospective pilot study.

PURPOSE/OBJECTIVES: The current study was undertaken to investigate whether self-assessment of clinical skills of undergraduate dental students could be bridged with faculty assessment by deliberate training over an extended period. A secondary aim was to explore students' perception of self-assessment and its effect on their learning and motivation. MATERIAL AND METHODS: A prospective pilot study was conducted at the Department of Restorative Dentistry at Damascus University. Sixteen students participated in the study, ranging in age between 22 and 23 years. A modified Direct Observation of Procedural Skills form with a grading rubric was used to register and guide students' self-assessment; both were pretested on four students before the study. In total, four clinical encounters were completed by each student. Students were trained on how to conduct proper self-assessment before and after each clinical encounter. A postcourse questionnaire was used to investigate students' perception of self-assessment. RESULTS: Bias in self-assessment decreased consistently after each encounter, and the difference in bias between the first (bias = 0.77) and the last encounter (bias = 0.21) was significant with a medium effect size (p = .022, d = 0.64). The percentage of disconfirming performance dimensions decreased from 39.7% to 26.9%. Students' ability to exactly pinpoint strengths improved consistently and significantly. However, their ability to pinpoint areas of improvement was volatile and showed no significant difference. Bland-Altman graph plots showed higher levels of agreement between self-assessment and faculty assessment. Moreover, students' perception of self-assessment was very positive overall. CONCLUSIONS: These findings suggest the possibility that the gap between self-assessment and faculty assessment could be bridged through deliberate training. Future longitudinal research using a larger sample size is still required to further explore whether self-assessment can be actively bridged with faculty assessment by deliberate training.

Identification of the role of oral health educators in elementary schools during COVID-19 pandemic: a competency framework.

OBJECTIVE: Oral health educators should have the required knowledge, skills and attitude in order to meet the increased needs of the Ministry of Education in Syria as well as to perform their duties in promoting oral health in children appropriately during the COVID-19 pandemic. Therefore, this study was undertaken to identify core competencies required for oral health educators in elementary schools during the COVID-19 pandemic. Qualitative exploratory study was undertaken. A focus group which consisted of 5 Medical Education postgraduates and 3 oral health educators' training team members were invited to formulate a preliminary list of basic competencies. Delphi technique was also adopted through inviting 12 experts in oral health education to evaluate and formulate a final list of elementary schools' oral health educators' competencies during the COVID-19 pandemic. RESULTS: A competency framework was developed. Fifty-five competencies were identified including 35 in cognitive domain, 12 skills and 8 attitude competencies. A list of essential competencies has been identified. These competencies should be addressed in training programs targeting oral health educators, which can consequently produce competent educators who can successfully promote and provide health care to all schoolchildren during the COVID-19 pandemic.