The Need for Protocol-Based Training in Delivering Bad News in Dentistry: A Cross-Sectional Survey Among Dental Professionals in Jeddah, Saudi Arabia.

AIM:  This study aimed to explore the awareness and utilization of protocols (e.g., the SPIKES protocol) for delivering bad news among dental professionals and the perceived need for such training. METHODS:  This study employed a cross-sectional design. A web-based self-administered questionnaire was distributed among dental students, general dentists, and dental specialists/consultants in Jeddah City through social media groups. The questionnaire included questions regarding the knowledge, attitudes, and practices of delivering bad news in dentistry and the use of the SPIKES protocol. Descriptive statistics and bivariate and multivariate analyses were performed to determine the research objectives. RESULTS:  Two hundred and twelve participants responded to the questionnaire, with an almost equal distribution between genders. Specialists/consultants and dental students comprised 87.8% of the respondents. Most respondents (70%) were unaware of any protocols for delivering bad news, and approximately 89% were unaware of the SPIKES protocol. Only 7% reported using the SPIKES protocol to deliver bad news. The bivariate analysis revealed two significant associations. The first association indicated a variation in awareness based on professional status, and the second suggested that experience in delivering bad news affected perceptions of the importance of protocol-based training. Logistic regression models revealed that specialist/consultant status was significantly associated with decreased awareness of protocols (OR = 0.287, 95% CI 0.091-0.903) as compared to general dentists and that other variables, including sex and experience in delivering bad news, did not indicate a statistically significant effect. CONCLUSION:  Most dentists in Jeddah reported the need to be familiar with and practice delivering bad news in dentistry. They agreed that it would improve patients' acceptance of bad news if it were performed in a systematic and organized manner (e.g., the SPIKES protocol).

The Approach to Dental Caries Prevention in a Case of Agenesis of the Major Salivary Glands: A Case Report.

Xerostomia leads to great challenges for patients and dentists in managing and maintaining oral health due to the high risk of developing dental caries. We discuss a case of a 10-year-old male patient who presented with complaints of decayed teeth and difficulty chewing and swallowing food. He had bilateral congenital stenosis and stricture of lacrimal ducts and a family history of lacrimal gland agenesis and Hashimoto's disease. The diagnosis reached was agenesis of all major salivary glands confirmed by saliva testing and ultrasound examination of the glands. Comprehensive preventative, restorative, and maintenance protocols based on caries management by risk assessment (CAMBRA) were implemented, including fissure sealants, amalgam and composite resin restorations, professional and home-applied fluoride, chlorhexidine mouthwash, frequent water consumption, and two-monthly recalls. We were able to stabilize the patient's risk of dental caries for over three years. The implementation of stringent restorative, preventive, and maintenance protocols is key to improving and maintaining oral health in severe cases of xerostomia.

Awareness of Nutrition Facts Labeling and Its Relation to Oral Health Practices and Caries Experience Among Adult Patients.

AIM: To investigate the relationship between the usage of nutrition facts labels (NFL) and oral and dietary practices and the decayed, missing, and filled teeth (DMFT) score. METHODS: A self-administered questionnaire was distributed to a convenient sample of 150 adult dental patients attending the King Abdulaziz University Dental Hospital in Jeddah, Saudi Arabia. Electronic dental records were accessed to record each patient's DMFT score. RESULTS: Only 38% (N=57) of the participants read the NFL on their food. A statistically significant association was found between patients' DMFT scores and the NFL reading. Participants who said they read NFLs had lower mean DMFT scores than those who said they did not (8.4 vs. 10.5). CONCLUSIONS: The results of this study demonstrate that there is low usage of NFL among participants. A significant association was noted between the reading of the NFL and caries experience as measured using the DMFT index.

Dental follow-up and maintenance index: the development of a novel multidisciplinary protocol.

OBJECTIVES: To develop a comprehensive yet simple dental follow up and maintenance protocol based on existing guidelines and recommendations. METHODS: A multidisciplinary team reviewed available maintenance and follow up guidelines and recommendations then developed a single protocol for adult dental patients. RESULTS: The protocol includes ten questions that categorize dental patients into one of three risk categories. Based on the risk category, each patient is assigned a recall interval and recommendations for in office and at home dental care. CONCLUSIONS: Development of a single multidisciplinary follow up and maintenance protocol.

Oral and Dental Health Status among Adolescents with Limited Access to Dental Care Services in Jeddah.

The purpose of this study was to assess the prevalence and associated factors of dental caries and periodontal diseases among 14⁻19-year-old schoolchildren with limited access to dental care services. A cross sectional study design was conducted during field visits to seven governmental schools in Al-Khomrah district, South Jeddah, over the period from September 2015 to May 2016. Clinical examinations and administered questionnaires were carried out in mobile dental clinics. The dentists carried out oral examinations using the dental caries index (DMFT), the simplified oral hygiene index (OHI-S), and the community periodontal index for treatment needs (CPITN). Statistical analyses were performed using SPSS 20. A total of 734 schoolchildren were examined. The prevalence of decayed teeth was 79.7% and was significantly higher among boys (88.9%) than girls (69.0%). About 11% of students had missing teeth, with a significantly higher figure among females than males (15.9% versus 7.3%); 19.8% of students had filled teeth. Moreover, a DMFT of seven or more was significantly more prevalent among males (43.3%) than females (26.8%), while the percentage of females with sound teeth was significantly higher than for males (20.4% and 9.6% respectively). The CPITN revealed 0, 1 and 2 scores among 14.6%, 78.2%, and 41.6% respectively. Males had a significantly higher percentage of healthy periodontal condition (23.8%) than females (3.8%). Dental caries prevalence was moderate to high, calculus and gingival bleeding were widespread among schoolchildren, and were more prevalent among students with low socioeconomic status.

Prevention of oral mucositis in children receiving cancer therapy: a systematic review and evidence-based analysis.

This systematic review investigated, critically appraised, and rated the evidence on agents used to prevent oral mucositis in children. A comprehensive search of the relevant literature was performed up to December 2011. Articles were included according to the inclusion/exclusion criteria and were critically appraised for validation and quality assessment using a checklist consisting of 18 categories. Each article was then rated for its strength of evidence. 16,471 articles were retrieved from 19 different databases and then reduced to 27 articles that fit the inclusion criteria. Five articles on oral care protocols supported their use to prevent oral mucositis in children. Seven articles on chlorhexidine mouthwash and three on laser therapy had conflicting evidence of its use. The preventative agents that were supported by one or two articles included: benzydamine mouthwash, iseganan mouthwash, granulocyte-macrophage colony-stimulating factor (GM-CSF) mouthwash, oral/enteral glutamine, oral propantheline and cryotherapy, oral cryotherapy, oral sucralfate suspension, prostaglandin E2 tablets, and chewing gum. The reduction in the rates of occurrence of oral mucositis when using agents of fair (B) to good (A) evidence ranged from 22% to 52%. In conclusion, this review suggests the use of oral care protocols to prevent oral mucositis in children because of their strength of evidence (fair to good). The authors suggest avoiding agents with fair to good evidence against their use (oral sucralfate suspension, prostaglandin E2 tablets, and GM-CSF mouthwash). Agents with conflicting evidence (chlorhexidine mouthwash (used solely), laser therapy, and glutamine) should also be avoided until further research confirms their efficacy.

Implementation of a hospital oral care protocol and recording of oral mucositis in children receiving cancer treatment : a retrospective and a prospective study.

PURPOSE: This retrospective/prospective study was carried out to implement a standardized hospital oral care protocol and record the incidence of oral mucositis for inpatients with childhood cancer. METHODS: The implementation process included stages of collaboration, consultation, education, and evaluation. The retrospective part of the study documented the existing hospital oral care protocol and audited medical records of all pediatric patients diagnosed with cancer over a 12-month period. The frequency of recorded oral mucositis and the rate of referral to the pediatric dentistry department were assessed. Following evaluation of the retrospective study, the literature was searched to create a new hospital oral care protocol. Referral to the dental department was standardized and frequent in-service presentations were given to staff. The oral mucositis scale was recorded daily for all inpatients, and compliance rates were assessed. RESULTS: Fifty-nine patients' medical records were audited during the retrospective study. Oral mucositis prevalence was clearly documented at 34%, while an additional 20% lacked a definitive diagnosis. During the prospective study, 38 patients were followed and had a verified incidence of oral mucositis of 33%. The rate of compliance of implementing the oral mucositis scale improved from 41% during the first 4 months to 87% during last 3 months. Referral rates to the dental department increased from 53% during the retrospective study to 100% during the prospective study. CONCLUSIONS: Mutual understanding and collaboration between the oncology and dental departments in hospitals is crucial for standardizing patient care and for improving oral care standards.

The pattern of combined maxillofacial and cervical spine fractures.

PURPOSE: Prompt recognition of cervical fractures in patients with facial fractures is of prime importance, as failure to diagnose such injuries carries a significant risk of causing neurologic abnormalities, long-term disabilities, and even death. The aim of this retrospective case study is to describe the different patterns of combinations of maxillofacial and cervical spine (C-spine) injuries to provide guidance in diagnosis and care of patients with combined injuries. PATIENTS AND METHODS: The trauma directory of 1 academic institution was searched for records of 701 patients admitted with cervical spine fractures between January 2000 and June 2006. Patients who did not sustain a facial fracture in addition to their C-spine fracture were excluded. The search was narrowed to 44 patients (6.26%) who presented with combined C-spine and facial fractures. Descriptive statistics were performed in which the frequencies of the variables were presented and then exploration of the interaction between the different variables was carried out. RESULTS: A 6.28% incidence rate of combined C-spine and maxillofacial fractures is noted in this study. The most common cause of trauma was motor vehicle accidents (45.5%), followed by falls (36.4%). In regards to the types of maxillofacial fractures, 27.3% of the cases presented with isolated orbital fractures and 13.6% with isolated mandibular fractures. A total of 68.2% of the combined C-spine and facial fracture cases involved orbital fractures of some form. The most frequent level of C-spine fracture was isolated C2 fractures (31.8%) followed by isolated C4 and C6 fractures (6.8% each). When the mechanism of trauma were compared to the types of C-spine and maxillofacial fractures, falls were found to be the most frequent mechanism causing both isolated orbital and C2 fractures. CONCLUSION: The rule of presuming that all patients with maxillofacial fractures have an unstable C-spine injury should stand. This should be emphasized in patients with orbital fractures and we plead for a higher index of suspicion for C-spine injuries in such patients.