Predictors influencing dental clinic utilization in primary health care: A retrospective analysis of 233,069 patient records in Riyadh, Saudi Arabia.

Aim: This study aims to identify and address the predictors that promote or prevent the utilization of dental services in primary health care (PHC) centers located in Riyadh, Saudi Arabia, with an ultimate goal to increase the uptake of oral health care (OHC) services. Methodology: Registration data from 99 PHC centers was used. For each patient visiting a PHC center, information on the number of dental visits was captured. Continuous data was summarized as means, medians, and ranges, and categorical data as frequencies (%). The strength of association was reported as an incidence rate ratio (IRR) with 95% confidence interval (CI) and a p-value. Further analysis was conducted to illustrate the association between dental care visits and factors found independently significant in the final multivariate model using Karl Pearson correlation coefficient and t-test. All tests were two-sided and a p-value of p < 0.05 was considered significant. Results: The comorbidity profile of patients shows that 11,751(5%) were diabetic, while hypertension amounted to 10,712(4.6%). A statistically significant inverse correlation was observed between dental care visits and both age (r = -0.025, p < 0.001) and BMI (r = -0.013, p < 0.001). Mean dental care visits were significantly higher in patients without hypertension compared with those with hypertension (p < 0.001). Moreover, there was an approximate 4% increase in dental care visits among females compared to males, although this difference was not statistically significant. Conclusion: The study identified three predictors contributing to the low utilization of dental services in PHC centers in Riyadh. These include an inverse association between both age and body mass index (BMI) and the utilization of OHC. Additionally, the mean dental care visits were significantly higher for patients without hypertension in comparison to hypertensive patients.

Gender Variation, subject dispersion and citation impact in dental research: A bibliometric analysis of publications from 2009-2021.

Aim: This study probed into the gender variation, subject dispersion and citation impact of dental research with an objective to highlight the increasing influence of female authors in the field of dentistry. Methodology: The research employed bibliometric techniques to highlight gender variation in dental research as demonstrated in the Saudi Dental Journal (SDJ), over a period of thirteen years, 2009-2021. The examination comprised SDJ publications indexed in PubMed, with citation data extracted from Google Scholar on July 2023. The analysis encompassed the progressive growth of papers, authors, and citations, the gender distribution of authors, the co-authorship structure, subject dispersion, and collaboration patterns based on affiliation, both national and international. Results: 625 SDJ publications were identified in the PubMed database from 2009 to 2021. There was a notable rise in the volume of papers and the number of authors per year. The citation impact analysis revealed that these 625 papers achieved an average of 26 citations each. Remarkably, the representation of female authors increased from 0.47 to 2.23 authors per paper during the study period. The authorship pattern largely showed single-authorship, closely followed by a three-author pattern. Almost half the papers (48%) were a collaboration between male and female authors, with female authors solely producing about 15% of papers.The topological classification of papers revealed that the most considerable number of papers were on Periodontics, with the least number focusing on Oral and Maxillofacial Surgery. Female authors prominently contributed to Pediatric Dentistry and Periodontics papers. Conclusion: The study illustrates an encouraging trend of heightened female authorship in dental research over the years. Their increasing engagement not only enriches the academic diversity but also impacts the progressive evolution of dental science, contributing to a more inclusive and balanced society.

A Comprehensive Review of Factors That Influence the Accuracy of Intraoral Scanners.

Intraoral scanners (IOSs) have become increasingly popular in the field of dentistry for capturing accurate digital impressions of patients' teeth and oral structures. This study investigates the various factors influencing their accuracy. An extensive search of scholarly literature was carried out via PubMed, utilizing appropriate keywords. Factors evaluated in the included studies were categorized into three primary divisions: those related to the operator, the patient, and the IOS itself. The analysis demonstrated that the accuracy of intraoral scanning is influenced by various factors such as scanner selection, operator skill, calibration, patient's oral anatomy, ambient conditions, and scanning aids. Maintaining updated software and understanding factors beyond scanner resolution are crucial for optimal accuracy. Conversely, smaller IOS tips, fast scanning speeds, and specific scanning patterns compromise the accuracy and precision. By understanding these factors, dental professionals can make more informed decisions and enhance the accuracy of IOSs, leading to improved final dental restorations.

Application and Performance of Artificial Intelligence (AI) in Oral Cancer Diagnosis and Prediction Using Histopathological Images: A Systematic Review.

Oral cancer (OC) is one of the most common forms of head and neck cancer and continues to have the lowest survival rates worldwide, even with advancements in research and therapy. The prognosis of OC has not significantly improved in recent years, presenting a persistent challenge in the biomedical field. In the field of oncology, artificial intelligence (AI) has seen rapid development, with notable successes being reported in recent times. This systematic review aimed to critically appraise the available evidence regarding the utilization of AI in the diagnosis, classification, and prediction of oral cancer (OC) using histopathological images. An electronic search of several databases, including PubMed, Scopus, Embase, the Cochrane Library, Web of Science, Google Scholar, and the Saudi Digital Library, was conducted for articles published between January 2000 and January 2023. Nineteen articles that met the inclusion criteria were then subjected to critical analysis utilizing QUADAS-2, and the certainty of the evidence was assessed using the GRADE approach. AI models have been widely applied in diagnosing oral cancer, differentiating normal and malignant regions, predicting the survival of OC patients, and grading OC. The AI models used in these studies displayed an accuracy in a range from 89.47% to 100%, sensitivity from 97.76% to 99.26%, and specificity ranging from 92% to 99.42%. The models' abilities to diagnose, classify, and predict the occurrence of OC outperform existing clinical approaches. This demonstrates the potential for AI to deliver a superior level of precision and accuracy, helping pathologists significantly improve their diagnostic outcomes and reduce the probability of errors. Considering these advantages, regulatory bodies and policymakers should expedite the process of approval and marketing of these products for application in clinical scenarios.

Procedure Time and Students' Perception Comparing Full Arch Digital Scans with Conventional Impressions: A Cross-Over Randomized Experimental Trial.

Methods: Ninety-six dental students each prepared tooth #36 for an all-ceramic crown on typodont models and were then randomly assigned into either group A: performed digital scan first, or Group B: performed conventional impression first. Procedure time was recorded for both. Immediately following each procedure, students indicated their perceived procedure difficulty. After exposure to both techniques, they selected their preferred one. Results: There was a statistically significant difference between the mean procedure time of both techniques (P < 0.0001), where students spent 663.76 ± 442.50 seconds to complete the conventional impression and 293.32 ± 181.49 seconds to complete the digital scan. Females were significantly faster in completing the conventional impression compared to males. On the contrary, male students were faster in digital scanning than female students. There were no carryover effects in the duration and the initially performed procedure. 76% (73 of 96) of participants preferred digital scanning with no statistical significance shown between the preferred and initially performed procedure. Participants perceived conventional impressions to be more difficult than digital scans. There was a weak positive correlation between the VAS score and the procedure time for the digital technique (R = 0.25) and a moderate positive correlation for the conventional technique (R = 0.45). Conclusions: The digital technique was preferred and perceived as easier than the conventional among undergraduate dental students with no impression-making experience, suggesting their readiness for new technology uptake. However, no significant correlation was found between the initially performed procedure and preference.

Application and Performance of Artificial Intelligence Technology in Detection, Diagnosis and Prediction of Dental Caries (DC)-A Systematic Review.

Evolution in the fields of science and technology has led to the development of newer applications based on Artificial Intelligence (AI) technology that have been widely used in medical sciences. AI-technology has been employed in a wide range of applications related to the diagnosis of oral diseases that have demonstrated phenomenal precision and accuracy in their performance. The aim of this systematic review is to report on the diagnostic accuracy and performance of AI-based models designed for detection, diagnosis, and prediction of dental caries (DC). Eminent electronic databases (PubMed, Google scholar, Scopus, Web of science, Embase, Cochrane, Saudi Digital Library) were searched for relevant articles that were published from January 2000 until February 2022. A total of 34 articles that met the selection criteria were critically analyzed based on QUADAS-2 guidelines. The certainty of the evidence of the included studies was assessed using the GRADE approach. AI has been widely applied for prediction of DC, for detection and diagnosis of DC and for classification of DC. These models have demonstrated excellent performance and can be used in clinical practice for enhancing the diagnostic performance, treatment quality and patient outcome and can also be applied to identify patients with a higher risk of developing DC.

Quality and Readability Assessment of Internet-Based Information on Common Prosthodontic Treatments.

PURPOSE: To evaluate the readability and quality of patient-oriented information online among different common prosthodontic search areas using multiple quality and readability assessment tools. MATERIALS AND METHODS: The prosthodontic keywords most commonly searched by patients on the internet were included. The search was performed through two online search engines (Google and Yahoo) to create the study sample. The first 50 websites listed by each search engine were chosen for each keyword. The quality of each website's information was evaluated using the DISCERN questionnaire and the Health on the Net (HON) criteria. Readability assessment was performed using the Flesch-Kinkaid Reading Grade Level (FKRGL) and the Flesch Reading Ease Score (FRES). RESULTS: A total of 225 websites were included in the study. The median score for the DISCERN instrument indicated poor information quality. A significant difference was found between the educational and commercial websites in both quality and readability. Overall, the median readability indices showed that the websites' information was difficult to read. CONCLUSION: Internet-based health information on different prosthodontic treatments is difficult to read and poor in quality and readability. It is necessary for health care providers to establish and promote websites that have reliable, high-quality information about common prosthodontic treatments.

The Effectiveness of Students' Performance in Preclinical Fixed Prosthodontics Course in Predicting Subsequent Clinical Performance.

PURPOSE: To evaluate the correlation between students' achieved grades in a preclinical fixed prosthodontics course and their performance in the same discipline's clinical courses. MATERIALS AND METHODS: This study was conducted in 2019 on 76 students who passed all preclinical and clinical fixed prosthodontics courses. Their final examination grades in preclinical and clinical prosthodontics courses were compiled and made anonymous. The Statistical Package for the Social Sciences (SPSS Version 23) was used to analyze the data. Descriptive statistics and correlation coefficient were used to assess the relation between preclinical and clinical grades. RESULTS: A statistically significant positive correlation existed between the students' preclinical and combined clinical final examination grades (r = 0.45, p < 0.001). In relation to sex, females showed a significantly higher correlation (r = 0.56, p = 0.001) compared to males (r = 0.25, p = 0.1). In addition, students' clinical grade prediction from their preclinical performance was 20.5%. CONCLUSION: These findings emphasize the importance of preclinical courses and suggest that maximizing preclinical years' efforts can reflect positively on students' competence in their future clinical practice.

The relationship between patient's participation in shade selection and their satisfaction with their dental prostheses.

OBJECTIVES: Multiple studies have measured the degree of patients' satisfaction with their dental prostheses. Some found that the preliminary cause for dissatisfaction was attributed to the shade used in the fabrication their prostheses. Therefore, the aim of this study is to evaluate the relationship between patients' participation in the shade selection procedure and their satisfaction with their prostheses. MATERIAL AND METHODS: In this cross-sectional study, an online based questionnaire was distributed. Out of 475 participants, 374 who met inclusion criteria were enrolled in this study. A questionnaire consisting of 19 questions and two parts was utilized. Data were analyzed using IBM SPSS 25 with a level of significance (p value) ≤ 0.05. RESULTS: The majority of participants were involved in the shade selection procedure (81%) and satisfied with the shade of their dental prostheses (83.7%). Satisfaction rate was higher in patients who participated in shade selection (87.8%). One in every three patients wanted a lighter shade than that they currently have. All results were statistically significant. CONCLUSION: Patients' participation in their prostheses' shade selection increased their satisfaction with them. It is crucial that patients receive professional advice during shade selection for them to make an informed decision regarding the shade of their prostheses.

The Posterior Extension of the Palatal Rugae as an Anatomical Constraint for Soft Tissue Grafts in a Saudi Arabian Population.

Background The purpose of this study was to investigate the distal extension of the palatal rugae area as an anatomical constraint on the harvesting of palatal soft tissue grafts in a Saudi Arabian population. Additionally, factors that could affect or predict the extension were considered. Methods Three hundred seventy-four (374) dental casts from Saudi nationals currently residing in Riyadh (170 males and 204 females) were included. Two independent observers used a standardized probe to measure the posterior extent of the rugae on each stone cast bilaterally on a horizontal base. A sharp graphite pencil was used to mark the measurements from the origin of the rugae to their terminal ends on the cast, and a magnification lens was used to identify them. Using this technique, the most posterior extension of the rugae was marked and then analyzed. The normal approximation test for binomial distribution was used to determine the proportion of the subjects with rugael extensions beyond the mesial end of the upper second premolar, and logistic regression was used to see the association of this extension with other factors. Results The asymptotic chi-squared (p = 0.0002) McNemar tests revealed that the posterior distal extension of the rugae was not the same on both sides. A normal approximation test for the left side with 95% confidence intervals (CIs) with the "rugael extension proximal to the mesial end of the upper second premolar" category considered "success" found that the proportion of upper second premolars with rugael extensions proximal to the mesial end was not significantly different to the proportion of rugael extensions beyond the mesial end of the upper second premolars (95% CI: 48.69%-58.79%, p = 0.147). Conversely, the proportion of the upper second premolars with rugael extensions proximal to the mesial end was significantly lower than that beyond the mesial end on the right (95% CI: 35.92%-45.89%, p = 0.00004). Gender, age, and palatal shape did not significantly affect the posterior extension of palatal rugae. Conclusions The palatal rugae on the left side of a sample of the Saudi Arabian population do not considerably extend beyond the upper second premolar mesial aspect, which may provide reliable soft tissue grafts for esthetic mucogingival surgery.

A Morphometric Analysis of Palatal Rugae Patterns in a Saudi Arabian Population.

Background Palatal rugae patterns are useful in the field of forensic dentistry. Ethnicity has a significant effect on the development and final morphological pattern of palatal rugae. This study focused on a morphological analysis of the palatal rugae in a Saudi population to determine if any differences based on age and gender could support identifying an individual. Materials and methods This cross-sectional study conducted at the College of Dentistry, King Saud bin Abdul Aziz University for Health Sciences, was undertaken to evaluate 496 dental casts from the participant database of Saudi nationals from Riyadh. The rugae were delineated using a sharp graphite pencil under adequate light and magnification. The rugae patterns were classified based on the length, shape, and direction of the rugae by two observers as per Thomas and Kotze's criteria. Results The asymptotic chi-square McNemar test indicated bilateral symmetry for all the characteristics of the palatal rugae, except for the backward and forward directions of the rugae. Two-way analysis of variance (ANOVA) revealed a statistically significant interaction between the effects of age group and gender on the primary rugae count (F(3, 488) = 7.466, p <0.05)). In addition, age had a statistically significant effect on the fragmentary rugae (p <0.05), and gender had a statistically significant effect on the circular and backward patterns of the rugae (p<0.05). The females had a higher incidence of backward-directed rugae and the males had more circular rugae. No other significant difference was evident, based on gender. The logistic regression analyses showed a significant association between the circular (OR=1.298; 95% CI= 1.061-1.588) and backward (OR= 0.898; 95% CI= 0.828-0.975) palatal rugae and gender. Also, there was a significant association of the fragmentary palatal rugae (PR) (OR=1.274; 95% CI= 1.084-1.498) with the age group younger than 16 years. Conclusion In a Saudi Arabian ethnic group, the varying type of length of the palatal rugae patterns can be used to identify the age group while the direction and shape can be used to determine gender, although with limited accuracy. Post-mortem identification may benefit from using them along with other reliable forensic tools. There is a need to conduct continued research on diverse populations and ethnic groups in order to evaluate the PR potential in forensic dentistry.

Dental practitioners' and students' knowledge of medication related osteonecrosis of the jaw (MRONJ).

BACKGROUND: Medication-related osteonecrosis of the jaw (MRONJ) is a complication affecting patients who are being treated with antiresorptive or antiangiogenic medication. These patients require meticulous treatment planning and management strategies. This research aimed to assess the knowledge of dental practitioners and students in their professional years regarding MRONJ. METHODS: A cross-sectional study was conducted among 345 dental practitioners and students in their professional years of both genders, in governmental and private dental schools. The data was collected using an electronic and paper-based self-administered structured questionnaire with six sections. The data was entered and analyzed using SPSS Version 23, and a P-value <0.05 was considered significant. A Chi-square test was used to compare the categorical variables. RESULTS: Though more than half of the sample 68% received information about antiresorptive and antiangiogenic drugs during their studies, the level of knowledge was low. The primary diseases targeted by antiresorptive and antiangiogenic medications were not known by the majority of the sample. Almost half of the sample could not identify any antiresorptive or antiangiogenic medication and only 28.1% knew the correct definition of MRONJ. CONCLUSION: The level of knowledge regarding MRONJ is a concern, necessitating more educational courses and workshops.

COVID-19 Pandemic: Oral Health Challenges and Recommendations.

The aim of this article is to shed light on coronavirus disease 2019 (COVID-19) and its oral effects and risk of nosocomial transmission to update the knowledge of dental health care workers. A thorough literature search of the PubMed/Embase/Web of Science/Cochrane central database was conducted to identify the impact of COVID-19 on oral health. We reviewed the recommendations on the recent guidelines set by the Centers for Disease Control and Prevention infection control practices for dentistry, American Dental Association, and the World Health Organization. According to the available evidence, COVID-19 may have a negative impact on the oral health due to the infection itself and due to various other consequences such as therapeutic measures, xerostomia, and other complications of the COVID-19. In light of the above facts, dentists should be wary of the disease, its identification, mode of spread and impacts on the oral health. The dental personnel have been identified as at the highest risk of getting COVID-19 due to cross infection from contact with their patients and aerosols generated in routine dental procedures. As such, they should be aware of the modifications that need to be made to the practice to prevent transmission of the disease. It is evident that COVID-19 has a negative impact on the oral health and at the same time a significant transmission risk to the dental personnel and patients who visit the clinic. If the recommendations issued by the regulatory authorities are meticulously followed, the risk of disease transmission can be lessened.

Detecting the Second Mesiobuccal Canal in Maxillary Molars in a Saudi Arabian Population: A Micro-CT Study.

The aim of this study was to determine MB2 canal detectability in maxillary first and second molars obtained from a Saudi population using micro-CT. Maxillary first (n = 35) and second (n = 30) molars were scanned with micro-CT technology. The number of canals was recorded, and in case of having more than one canal, the level of extracanal detection was analyzed. The presence of extracanal was categorized based on the level they were first detected. Among the maxillary first molars, 28 (80%) and six (17%) teeth had two and three MB canals, respectively. Among the maxillary second molars, 24 (80%) and four (13%) teeth had two and three MB canals, respectively. The MB2 canal was detected at the chamber floor in 70% and 61% of the maxillary first and second molars, respectively. At 1 mm depth, the MB2 canal was found in 15% and 18% of the maxillary first and second molars, respectively. At 2 mm depth, the MB2 canal was found in 3% and 18% of the maxillary first and second molars, respectively. The remaining teeth had the MB2 canal at levels deeper than 2 mm. The MB2 canal was detected in 97% and 93%% of maxillary first and second molars, respectively. Among them, the MB2 canal could be immediately detected in 70% and 61% of the maxillary first and second molars, respectively, once the pulp chamber is exposed. However, the rest of the MB2 were observed at deeper levels in the root and this requires troughing preparation in the chamber floor.

Chemotherapeutic decontamination of dental implants colonized by mature multispecies oral biofilm.

AIM: No studies have tested disinfectants on mature multispecies oral biofilms on titanium substrata. The aim of this study was to investigate the efficacy of commonly used antimicrobial agents in decontamination of multispecies mature oral biofilm on sandblasted, large-grit, acid-etched (SLA) titanium implants. METHODS: SLA titanium disks were inoculated with dental plaque and cultured anaerobically for 21 days. The disks were rinsed with 0.9% NaCl, exposed for 2 min. to tetracycline paste, 1% Chlorhexidine gel (CHX), 35% phosphoric acid gel (Etch) or a novel chemical formula (0.3% cetrimide, 0.1% CHX and 0.5% EDTA) and then rinsed again with 0.9% NaCl. Bacteria were quantified from scanning electron micrographs of the implant surfaces. Living bacteria were quantified with confocal laser scanning microscopy (CLSM). RESULTS AND CONCLUSIONS: Rinsing the surfaces with 0.9% NaCl removed the majority of the biofilm. However, bacteria persisted in all specimens and none of the disinfectants was superior to the double saline rinse group. CLSM analysis showed that CHX and Etch groups had a statistically significant reduction of viable bacteria, although small. Overall the results show that many disinfection agents used in the clinic are ineffective in biofilm removal and leave live bacteria on the surface.

Fracture toughness of two lithium disilicate dental glass ceramics.

STATEMENT OF PROBLEM: IPS e.max CAD and IPS e.max Press (Ivoclar Vivadent AG) are lithium disilicate glass ceramics marketed as interchangeable materials indicated for the same clinical uses. However, different crystal sizes of lithium disilicate are formed during the processing of each of these materials, a factor that could lead to significantly different mechanical properties. As mechanical failure is always associated with a crack-initiation/crack-propagation process, fracture toughness (KIC) values could be useful in comparing different ceramics and possibly predicting clinical performance. PURPOSE: The purpose of this in vitro study was to determine and compare the KIC of IPS e.max CAD and IPS e.max Press. MATERIAL AND METHODS: The notchless triangular prism (NTP) specimen KIC test was used to determine and compare the KIC of IPS e.max Press and IPS e.max CAD. Twenty 6×6×6×12-mm NTP specimens of each material were prepared. IPS e.max CAD blocks were cut, ground, and then crystallized, while IPS e.max Press specimens were prepared by pressing IPS e.max Press ingots into molds obtained from 6×6×6×12-mm wax prisms, using the lost wax technique. Each specimen was mounted into a specimen holder, and custom grips were used to attach the specimen holder assembly to a computerized universal testing machine (model 4301; Instron Canada, Inc). The assembly was loaded in tension at a crosshead speed of 0.1 mm/min, and the KIC value was calculated based on the recorded maximum load at fracture. Fractured surfaces were characterized using scanning electron microscopy (SEM). Results were statistically analyzed using Weibull statistics and the Student t test (α=.05). RESULTS: Significantly (P<.05) higher KIC value was determined for IPS e.max Press than for IPS e.max CAD and, based on the Weibull modulus (m), IPS e.max Press was also more reliable. Fractured surfaces, characterized by SEM, showed a marked difference between the 2 materials, suggesting a more complete crystallization in IPS e.max Press, which was most likely responsible for the higher KIC determined. CONCLUSION: Within the limitations of this in vitro study, the results suggest that IPS e.max Press is superior to IPS e.max CAD with regard to the KIC and characteristic Weibull parameters.

Intra-operative application of chlorhexidine gel reduces bacterial counts in internal implant cavity.

A prospective clinical trial was conducted to assess the bacterial-inhibitory potential of 1% chlorhexidine (CHX) gel in the internal cavity of implant screw holes, when utilized at the time of implant placement. A total of 40 Straumann (S) and Nobel Biocare (N) implants were divided into test (ST or NT; implant + CHX gel) and control (SC or NC; implant only) groups. Total numbers of colony-forming units (CFUs ml(-1) ) were assessed at a minimum of 3 months postsurgery by aerobic and anaerobic culture. A set of specimens was stained with Gram stain. The mean sample-collection time was 110 d for the test population and 98 d for the controls. The use of 1% CHX gel significantly reduced bacterial counts in both the ST and NT samples by over three logs compared with controls. No statistical differences in the numbers of CFUs ml(-1) were evident between aerobic and anaerobic cultures. Differences in the numbers of CFUs ml(-1) between ST and NT groups were not statistically significant. Microscopic analysis showed mainly Gram-positive coccoid species in most samples.

Case for implant platform unswitching.

Platform switching was introduced to reduce marginal bone loss and therefore maintain the gingival architecture, leading to a more favorable esthetic result. In the patient presented, recession had resulted in the exposure of the implant neck and threads; this was managed with a custom-made additional prosthetic component. The result, although not ideal esthetically, provided an implant abutment interface that was easier for the patient to clean.