Tissue Engineering of Necrotic Dental Pulp of Immature Teeth with Apical Periodontitis in Dogs: Radiographic and Histological Evaluation.

AIM: To evaluate tissue engineering technology to regenerate pulp-dentin like tissues in pulp canals of immature necrotic permanent teeth with apical periodontitis in dogs. STUDY DESIGN: The study was performed on 36 teeth in 12 dogs. The experiment was carried out using split mouth design. In each dog 3 teeth were selected for implementing the study procedure. Apical periodontitis was induced in Group A and B teeth. Group (A): immature upper left 2nd permanent incisors that were transplanted with a construct of autologous dental pulp stem cells with growth factors seeded in a chitosn hydrogel scaffold. Group (B): immature upper right 2nd permanent incisor that received only growth factors with scaffold. A third tooth in each dog was selected randomly for isolation of dental pulp stem cells (DPSCs). Both groups were closed with a double coronal seal of white MTA (Mineral trioxide aggregate) and glass ionomer cement. Both groups were monitored radiographically for 4 months and histologically after sacrificing the animals. RESULTS: There was no statistically significant difference in radiographic findings between group (A) and group (B) for healing of radiolucencies, while there was statistically significant difference between group (A) and group (B) regarding radicular thickening, root lengthening and apical closure. Histologically, group (A) teeth showed regeneration of pulp- dentin like tissue while group (B) teeth did not show any tissue regeneration. CONCLUSION: Dental pulp stem cells and growth factors incorporated in chitosan hydrogel are able to regenerate pulp- dentine like tissue and help in complete root maturation of non-vital immature permanent teeth with apical periodontitis in dogs.

Effect of Probiotic Lactobacillus reuteri on Salivary Cariogenic Bacterial Counts among Groups of Preschool Children in Jeddah, Saudi Arabia: A Randomized Clinical Trial.

OBJECTIVES: To evaluate the effect of probiotic Lactobacilli reuteri lozenges on caries-associated salivary bacterial counts (Mutans streptococci and Lactobacillus), dental plaque accumulation, and salivary buffer capacity in a group of preschool children. STUDY DESIGN: The study group consisted of 178 healthy children (aged 3-6 years). Children were randomly grouped: the experimental group (n = 90) received L. reuteri probiotic lozenges and the control group (n = 88) received placebo lozenges, twice daily, for 28 days. Salivary Mutans streptococci and Lactobacillus counts, and buffer capacity were assessed using chair-side caries-risk test (CRT®) kits. The Simplified Oral Hygiene index (OHI-S) was used to assess dental plaque accumulation at baseline and after 28 days. RESULTS: After 28 days, the experimental group had a statistically significant reduction in Mutans streptococci and lactobacilli (p = 0.000 and p = 0.020, respectively) and both groups had less plaque accumulation than at baseline. While the buffer capacity in the experimental group increased more than in the control group, it was not statistically significant (p = 0.577). Compliance was 90%, with no adverse events. CONCLUSIONS: Consumption of probiotic lozenges containing L. reuteri reduces caries-associated bacterial counts significantly. Probiotics consumption may have a beneficial caries-preventive effect.

Reliability and validity of the Children's Fear Survey Schedule-Dental Subscale for Arabic-speaking children: a cross-sectional study.

BACKGROUND: Early recognition of dental fear is essential for the effective delivery of dental care. This study aimed to test the reliability and validity of the Arabic version of the Children's Fear Survey Schedule-Dental Subscale (CFSS-DS). METHODS: A school-based sample of 1546 children was randomly recruited. The Arabic version of the CFSS-DS was completed by children during class time. The scale was tested for internal consistency and test-retest reliability. To test criterion validity, children's behavior was assessed using the Frankl scale during dental examination, and results were compared with children's CFSS-DS scores. To test the scale's construct validity, scores on "fear of going to the dentist soon" were correlated with CFSS-DS scores. Factor analysis was also used. RESULTS: The Arabic version of the CFSS-DS showed high reliability regarding both test-retest reliability (intraclass correlation = 0.83, p < 0.001) and internal consistency (Cronbach's α = 0.88). It showed good criterion validity: children with negative behavior had significantly higher fear scores (t = 13.67, p < 0.001). It also showed moderate construct validity (Spearman's rho correlation, r = 0.53, p < 0.001). Factor analysis identified the following factors: "fear of invasive dental procedures," "fear of less invasive dental procedures" and "fear of strangers." CONCLUSION: The Arabic version of the CFSS-DS is a reliable and valid measure of dental fear in Arabic-speaking children. Pediatric dentists and researchers may use this validated version of the CFSS-DS to measure dental fear in Arabic-speaking children.

The effectiveness of computerized anesthesia in primary mandibular molar pulpotomy: A randomized controlled trial.

OBJECTIVE: The technique of local anesthetic administration is an important consideration in the behavior guidance of a pediatric patient. The study hypothesized that there is no difference in the pain effectiveness in the experimental subjects with the use of single tooth anesthesia and the controls with the use of conventional technique (traditional inferior alveolar nerve block [IANB]).The purpose of this study was to compare the anesthesia effectiveness of traditional IANB; IANB using a computer-controlled local anesthetic delivery system (CCLAD); and intraligamental anesthesia (ILA) using CCLAD in pulpotomy of the primary mandibular second molars. METHOD AND MATERIALS: Ninety-one healthy 5- to 9-year-old children underwent pulpotomy of the mandibular second molars. They were randomly assigned into Group A (traditional IANB), Group B (IANB using CCLAD), or Group C (ILA injection using CCLAD). The effectiveness of anesthesia was measured during different steps of pulpotomy using the sounds, eyes, and motor (SEM) scale. The postoperative complications were recorded after 24 hours. RESULTS: For all five pulpotomy steps, the anesthesia effectiveness was similar among the three anesthesia techniques. Anesthesia effectiveness was not significantly different (based on SEM scores) between the three groups during clamp application, drilling of the tooth, entering the pulp, pulp extirpation, and removal of the clamp (P = .635, P = .996, P = .630, P = .945, and P = .101, respectively). There was no significant difference in postoperative complications between the three groups. CONCLUSION: The IANB anesthesia using CCLAD and periodontal ligament anesthesia using CCLAD were as effective as traditional IANB in anesthetizing the primary mandibular molars during pulpotomy.

Environmental Risk Factors in the Etiology of Nonsyndromic Orofacial Clefts in the Western Region of Saudi Arabia.

OBJECTIVES: Nonsyndromic orofacial cleft (NSOFC) etiology is multifactorial and heterogeneous. This study aimed to identify environmental risk factors related to NSOFC in the Western Region of Saudi Arabia. METHODS: A case-control study carried out in seven hospitals in two main cities (Jeddah and Maddina) over 2 years on parents of 112 infants with NSOFC (infants were also examined) and 138 infant controls, matched for age (<18 months), gender, and location, completed a questionnaire on 3-month pregestation and first trimester events. RESULTS: There was significantly increased NSOFC risk with twin pregnancies (P = .01, odds ratio [OR] = 9.5, 95% confidence interval [CI]: 1.15 to 78.4), maternal antibiotic use (P = .021, OR = 2.71, 95% CI: 1.11 to 6.62), antiemetic medication (P = .005, OR = 2.85, 95% CI: 1.3 to 6), severe morning sickness (P = .006, OR = 3.6, 95% CI: 1.34 to 9.65), illness (P = .009, OR = 2.19, 95% CI: 1.17 to 4.08), common cold/flu (P = .003, OR = 3.32, 95% CI: 1.48 to 7.58), Jorak smoking (P = .004, OR = 14.07, 95% CI: 1.55 to 128.1), and passive smoking (P = .05, OR = 2.05, 95% CI: 1.05 to 4.01). Reduced NSOFC risk was found with calcium supplementation (P = .02, OR = 0.32, 95% CI: 0.11 to 0.88), incense use (P = .03, OR = 0.58, 95% CI: 0.34 to 0.98), and maternal drinking water, with Zamzam water (which contains a high concentration of minerals) showing a significant protective effect compared with tap water (P = .01, 95% CI: 0.06 to 0.6) and bottled water (P = .02, 95% CI: 0.03 to 0.57). CONCLUSION: Twin births, maternal antibiotic use, antiemetic medication, severe morning sickness, common cold/flu, Jorak smoking, and passive smoking were associated with infants born with NSOFC. Calcium supplementation, incense use, and Zamzam water reduced the risk of NSOFC, raising the possibility of community preventive programs.

The pain-related behavior and pain perception associated with computerized anesthesia in pulpotomies of mandibular primary molars: A randomized controlled trial.

OBJECTIVE: The purpose of the study was to compare the pain-related behavior and the pain perception associated with three anesthetic techniques in pulpotomies of primary mandibular second molars: traditional inferior alveolar nerve block (IANB), IANB with computer-controlled local anesthetic delivery (CCLAD), and intraligamental anesthesia with CCLAD. METHOD AND MATERIALS: The sample comprised 91 randomly selected healthy children aged 5 to 9 years, who were scheduled for pulpotomy in the mandibular second molar. Patients were divided into three groups according to the type of anesthesia received. Group A received traditional IANB, group B received IANB with CCLAD, and group C received intraligamental anesthesia with CCLAD. Pain-related behavior and pain perception levels were assessed using the established behavior code and the Wong-Baker FACES Pain Rating Scale respectively. RESULTS: The mean of pain-related behavior was significantly lower (P < .001) in the intraligamental anesthesia with CCLAD group than in the other two groups. The pain perception scores were significantly higher in the traditional IANB group than in the IANB with CCLAD group, and the intraligamental anesthesia with CCLAD group (P = .044 and P < .001 respectively). The mean ± SD of the pain perception of IANB was 1.39 ± 0.200, IANB with CCLAD was 0.87 ± 0.133 and ILA with CCLAD was 0.13 ± 0.063. CONCLUSION: Intraligamental anaesthesia with CCLAD was clearly associated with less pain than the IANB with or without CCLAD.

Predicting changes in mandibular length and total anterior facial height using IGF-1, cervical stage, skeletal classification, and gender.

BACKGROUND: The purpose of this study was to predict the annual growth rate of the mandible and total anterior facial height using IGF-1 levels together with cervical stage, skeletal classification, and gender. METHODS: Twenty-five orthodontic patients (12 females and 13 males) had their cervical stages, blood-spot IGF-1 levels, and cephalometric parameters measured at 1-year intervals. The number of years each patient was followed up varied between 1 and 5 years resulting in 43 12-month intervals collected from 77 observations. Descriptive, bivariate, and regression analyses were used to analyze this data. RESULTS: The linear regression model for predicting the annual mandibular growth rate was significant at p < 0.01 with an R-square value of 0.52. We found that the average IGF-1 level for the interval, the change in IGF-1 level, and the presence of a skeletal class III pattern were statistically significant predictors of mandibular growth. The regression model for predicting the annual change in anterior facial height was significant at p < 0.01 with an R-square value of 0.42. We found that the change in IGF-1 level was the only statistically significant predictor of this outcome. CONCLUSIONS: The proposed method which combines IGF-1 levels with information that is readily available to clinicians can be used to predict the timing and intensity of the growth spurt. These factors together explain more of the observed individual variation in growth rate than any of the factors used in isolation.

Characteristics of dental fear among Arabic-speaking children: a descriptive study.

BACKGROUND: Dental fear has not only been linked to poor dental health in children but also persists across the lifespan, if unaddressed, and can continue to affect oral, systemic, and psychological health. The aim of this study was to assess the factor structure of the Arabic version of the Children's Fear Survey Schedule-Dental Subscale (CFSS-DS), and to assess the difference in factor structure between boys and girls. METHODS: Participants were 220 consecutive paediatric dental patients 6-12 years old seeking dental care at the Faculty of Dentistry, King Abdulaziz University, Saudi Arabia. Participants completed the 15-item Arabic version of the CFSS-DS questionnaire at the end of the visit. Internal consistency was assessed using Cronbach's alpha. Factor analysis (principal components, varimax rotation) was employed to assess the factor structure of the scale. RESULTS: The Cronbach's alpha was 0.86. Four factors with eigenvalues above 1.00 were identified, which collectively explained 64.45% of the variance. These factors were as follows: Factor 1, 'fear of usual dental procedures' consisted of 8 items such as 'drilling' and 'having to open the mouth', Factor 2, 'fear of health care personnel and injections' consisted of three items, Factor 3, 'fear of strangers', consisted of 2 items. Factor 4, 'fear of general medical aspects of treatment', consisted of 2 items. Notably, four factors of dental fear were found in girls, while five were found in boys. CONCLUSIONS: Four factors of different strength pertaining to dental fear were identified in Arabic-speaking children, indicating a simple structure. Most items loaded high on the factor related to fear of usual dental procedures. The fear-provoking aspects of dental procedures differed in boys and girls. Use of the scale may enable dentists to determine the item/s of dental treatment that a given child finds most fear-provoking and guide the child's behaviour accordingly.

Sleep habits in adolescents of Saudi Arabia; distinct patterns and extreme sleep schedules.

BACKGROUND AND STUDY OBJECTIVES: There is a need for comprehensive studies on adolescents' sleep habits in the Middle Eastern region. The aim of this study was to investigate the sleep-wake patterns, prevalence of excessive daytime sleepiness (EDS), and disturbed sleep among adolescents in Saudi Arabia and to identify the associated factors. METHODS: The study was a cross-sectional survey done on a random sample of 1035 high school students, ages 14-23 years, in Jeddah, Saudi Arabia. The response rate was 91%. Students filled a self-reported questionnaire that included sleep-wake questions, Pittsburgh Sleep Quality Index, Epworth Sleepiness Scale, Perceived Stress Scale, academic performance, and personal data. RESULTS: Students slept an average of 7.0 hours on school nights, with an average delay of 2.8 and 6.0 hours in weekend sleep and rise times, respectively. Around 1 in 10 students stayed up all night and slept after returning from school (exhibiting a reversed sleep cycle) on weeknights. This pattern was more prevalent among boys and students with lower grade point averages. The prevalence of sleep disturbance was 65%, and EDS was found in 37% of the students. Predictors of EDS were school type, stress, napping and caffeine use, while gender was a predictor of disturbed sleep. CONCLUSIONS: Adolescents in Saudi Arabia showed a high percentage of poor sleep quality. Compared with adolescents from other countries, they had a larger delay in weekend sleep and rise times. An alarming reversed sleep cycle on weekdays is present and highlights the need for further assessment.

Early prevention of childhood caries with maternal xylitol consumption.

OBJECTIVE: To evaluate the effect of maternal xylitol consumption on children's salivary mutans streptococci (MS) level, caries activity, and plaque accumulation in contrast with maternal fluoride varnish in a group of mother-child pairs. METHODS: In this randomized controlled trial, the study subjects were 60 mother-child pairs recruited from the pediatric dentistry clinic and the hospital well baby clinic at King Abdulaziz University, Jeddah, Kingdom of Saudi Arabia. The sample was recruited on the basis of maternal high salivary MS levels, and a child aged 10-36 months. The subjects were randomly assigned to experimental and control groups. Mothers in the experimental group chewed xylitol gum, 1.8 gram (66% xylitol by weight), 3 times/day for 3 months. Mothers in the control group received fluoride varnish. Both groups received oral hygiene instructions, dietary counseling, and restorative treatment. Children were examined after 6, 12, and 24 months from the initiation of the study to evaluate salivary MS levels, caries, and plaque accumulation. RESULTS: There was an increase in MS levels in the experimental and control children at 24 months, which was non-significant in the experimental group, and significantly higher in the control group when compared with the baseline (p=0.008). The decayed, missing, filled scores of the children in the experimental group showed no change after 24 months, contrary to the controls that showed a significant increase (p=0.001). Plaque scores revealed no differences over time or between the 2 groups. CONCLUSION: Compared with fluoride varnish, maternal xylitol consumption provided preventive outcomes on salivary MS and caries levels in children.

Impact of maternal xylitol consumption on mutans streptococci, plaque and caries levels in children.

AIM: The present study was designed to determine whether maternal xylitol consumption through regular chewing of xylitol gums can affect the salivary mutans streptococci (MS), dental caries, and dental plaque levels of their children. METHOD: Study sample included 60 mother and child pairs with high salivary mutans streptococcus (MS) levels. Samples were randomly divided into experimental group (30 pairs) and control group (30 pairs). Mothers in the experimental group received xylitol chewing gum treatment three times/day for three months, whereas the controls received fluoride varnish. Both groups received oral hygiene instructions, dietary counseling and restorative treatment. All children were examined after 6, 12 and 18 months from the initiation of the study to assess caries, plaque and salivary mutans streptococcus (MS) levels. RESULTS: Showed that at 18 month the percent of children with high streptococcus levels in the control significantly increased when compared to the increase in the experimental group. Throughout the study, dmft scores of experimental children showed marginal non significant increase compared to controls that showed higher scores. Plaque scores revealed statistically non significant decrease among both groups. CONCLUSIONS: Maternal xylitol consumption provided better preventive outcomes on salivary (MS) levels compared to fluoride varnish treatments.

Screening for human papillomavirus (HPV) in Egyptian women by the second-generation hybrid capture (HC II) test.

BACKGROUND: HPV infection is the main cause of cervical cancer and cervical intraepithelial neoplasia worldwide. The second-generation HC II test is a liquid hybridization assay designed to detect 18 HPV types. The aim of the present study was to detect the rate of HPV infection and its various genotypes among Egyptian women. MATERIAL/METHODS: We evaluated 166 Egyptian women. They were classified according to cytology into those with normal cytology, chronic nonspecific cervicitis, and squamous intraepithelial lesions (SILs). RESULTS: The overall prevalence of HPV DNA in the studied groups was 15.06% (25/166). Among the 25 HPV-positive women, 16 (64%) were infected with high-risk HPV types, 4 (16%) with low risk HPV types, while 5 (20%) had both types. Twenty-one (84%) of the infected women harbored at least one high-risk HPV type, while 9 (36%) harbored at least one low-risk HPV type. Values of HPV viral load for low-risk HPV infection showed no significant difference in the normal and chronic nonspecific cervicitis groups. But when HPV viral load of high-risk HPV infection was compared in the normal, chronic nonspecific cervicitis, and SIL groups, a significant difference was found. The same was detected between chronic nonspecific cervicitis and SIL and between normal cytology and SIL, suggesting an association between viral load and risk of SIL and, accordingly, cancer. CONCLUSIONS: It may be concluded that HPV testing using the HC II assay is a useful tool when combined with cytology in the diagnosis of high-risk HPV viral types in apparently normal tissues.