Effect of an educational intervention among Lebanese dentists on antibiotic prescribing: a randomized controlled study.

OBJECTIVES: To investigate whether an educational intervention could improve antibiotic prescribing among Lebanese dentists and assess antibiotic prescribing patterns regarding international guidelines. MATERIALS AND METHODS: An interventional randomized controlled trial was conducted from the first of April to the end of August 2017. This was an oral presentation of about 20 min based on a review of the literature and the international guidelines. Sixty dentists specializing in oral dental surgery or general practitioners participated in this study. All the patients who took a consultation over 2 months were involved. RESULTS: In this study, 950 antibiotic prescriptions were analyzed. A change was found only in antibiotics prescribed for tooth extraction and tooth extraction (impacted tooth). The intervention was impactful in raising the mean percentage of prescriptions compliant with indication and with the choice regarding antibiotics prescribed for prophylactic reasons. A dentist in the intervention group would have after the intervention period a mean percentage of prescriptions compliant with indication and with choice of 31.7% and 20.7%, respectively, above one in the control group. Despite the decrease in the overall number of antibiotics prescribed by dentists in the intervention group over time, this does not suggest that this was solely due to the effect of the intervention. CONCLUSION: This study highlights the importance of continuing medical education to optimize antibiotic use in dentistry. CLINICAL RELEVANCE: This study can serve as the basis for a future audit, training, and feedback intervention to increase dentists' awareness of recommended guidelines and optimal antibiotic use.

Assessment of COVID-19 vaccines acceptance in the Lebanese population: a national cross-sectional study.

BACKGROUND: Vaccines have become the best weapon for epidemic prevention and control in the absence of standard approved effective therapies. However, skepticism about the vaccine efficacy and safety is constantly reported. To our knowledge, there has been no study assessing COVID-19 vaccine acceptance in Lebanon. The primary objective of this survey is to assess the COVID-19 vaccines' acceptance and its related determinants in the Lebanese population. METHODS: A cross-sectional study was conducted in Lebanon from February 16 through February 25, 2021. Data was collected using an online questionnaire via social media platforms using the snowball technique. The questionnaire consisted of 47 questions related to sociodemographic and medical history, COVID-19 experience, knowledge, practice, and beliefs towards COVID-19 vaccines, including vaccines acceptance. Binary logistic regression was performed to identify factors associated with vaccine acceptance. RESULTS: A total of 1209 questionnaires were completed; around 63.4% have reported their acceptance for receiving the COVID-19 vaccine, while only 57% of participants registered themselves on the national platform. The multivariable analysis showed that a higher knowledge scale, living in an urban residential area, having hypertension, not having a food allergy, reporting a higher fear to experience COVID-19 infection, and receiving or wanting to receive influenza vaccine, were positive predictors of COVID-19 vaccines acceptance. CONCLUSIONS: Our findings support the need to improve knowledge about COVID-19 infection and vaccination through education and awareness programs. Specifically residents of rural areas should be targeted to optimize COVID-19 vaccine acceptance among the Lebanese population.

An evaluation of prophylactic and therapeutic antibiotic prescribing in Lebanese dental practice.

OBJECTIVES: To evaluate antibiotic prescribing patterns and correlates among Lebanese dentists. METHODS: A descriptive observational study was conducted, from the first of April to the end of May 2017. Dentists who specialized in oral dental surgery or general dental practitioners were eligible to participate in this study. All patients who sought consultation with the selected dentists over a 1 month period were included. KEY FINDINGS: A total of 2323 oral and dental procedures were performed by 60 dentists; 553 antibiotic prescriptions were prescribed, representing 23.8% (52.35% for prophylactic purposes and 47.65% for curative purposes). Prophylactic indications were mainly for implant surgery (36.3%) with only 1% appropriate. Curative use was mainly for periodontal abscesses/abscesses (indeterminate) (22.8%), followed by pulpal diseases and periradicular complications (20.5%); it was appropriate in only 1.7 and 1.9% of cases respectively. Amoxicillin-clavulanic acid was the antibiotic that was mostly prescribed for both curative and prophylactic uses (57.6 and 55.9%, respectively), followed by amoxicillin for prophylactic purposes and a combination of spiramycin plus metronidazole for curative purposes. Adherence to guidelines was low for both curative and prophylactic purposes (17.4 and 21.8%, respectively), but was better in patients who were younger [adjusted odds ratio(aOR) = 0.96], male (aOR = 0.40), or had cardiac disease with moderate or high infective endocarditis risk (aOR = 21.72), and when prescribed by oral surgeons (aOR = 0.15). CONCLUSIONS: This study showed evidence of the overuse of antibiotics among Lebanese dentists. It can serve as a basis for future studies to optimize antibiotic use among dentists in Lebanon.

The prevalence, distribution, and radiological evaluation of dentigerous cysts in a Lebanese sample.

PURPOSE: This study was performed to evaluate the prevalence, distribution, and radiological features (as per the Shear classification) of dentigerous cysts in a Lebanese sample. MATERIALS AND METHODS: It was an epidemiological, cross-sectional, 5-year retrospective study of 137 dentigerous cysts treated at Lebanese Army Dental Departments. The collected data comprised demographic and radiological information corresponding to patients from July 2015 to July 2020. Syndromic cases were excluded. Demographic data and the radiological features of cases were studied and analyzed. RESULTS: Dentigerous cysts were treated in 109 patients (58.7% males and 41.3% females; mean age: 28.3±16.3 years) out of 6,013 patients (52% males and 48% females), with a prevalence of 1.8%. Dentigerous cysts were more commonly found in patients in their second and third decades of life than in older age groups. Of the 109 patients, 22.9% had multiple dentigerous cysts. Of the 137 cysts, 71.5% were mandibular. The most prevalent anatomical location was the posterior mandible, followed by the posterior maxilla. The most commonly involved tooth was the mandibular third molar. Regarding radiological types, the central type was the most common (60.6%), followed by the lateral type (29.2%), and the circumferential type (10.2%). CONCLUSION: The results of this study were similar to studies of other populations in terms of distribution and features. Multiple non-syndromic dentigerous cysts were more common than reported in other studies, which warrants further clinical studies to reveal previously undetected factors.

Acceptance of COVID-19 vaccination and its determinants among Lebanese dentists: a cross-sectional study.

BACKGROUND: Dentists are at high risk of exposure to occupational Coronavirus Disease 2019 (COVID-19). Since vaccination is crucial to control COVID-19 pandemic, we aimed to assess COVID-19 vaccination acceptance and its determinants among Lebanese practicing dentists. METHODS: A cross-sectional online study was conducted between February 15 and 22, 2021, among dentists practicing in Lebanon. Prevalence of COVID-19 vaccine acceptance was estimated. A multivariable modified Poisson regression model was used to explore determinants of COVID-19 vaccine acceptance. RESULTS: In total, 86% of participants were willing to receive or have already received a COVID-19 vaccine. Having received the influenza vaccine during the COVID-19 pandemic was linked to a 12% increase in the COVID-19 vaccination acceptance rate. In addition, participants having moderate and high COVID-19 vaccination knowledge levels were more likely to accept receiving the vaccine, and participants whose fear of COVID-19 level was high were more likely to accept receiving the vaccine compared to those having a low fear level. Contrarily, those who visit the medical doctor only when needed and once a year were less likely to accept COVID-19 vaccine compared to participants who routinely visit the medical doctor. CONCLUSIONS: Our study showed a high level of acceptance of COVID-19 vaccination among Lebanese practicing dentists. And since knowledge about COVID-19 vaccination was associated with the vaccine acceptance, it should be improved and updated to further increase the acceptance rate. High acceptability of COVID-19 vaccination among dentists is expected to have a positive impact among the population in terms of increasing awareness and vaccine uptake.

Radiographic evaluation of non-syndromic third molar agenesis in two Mediterranean populations.

BACKGROUND AND AIMS: Third molar agenesis is a common finding across the world. Many studies have assessed third molar agenesis in different ethnicities and populations. However, there are no such studies in the Italian and Lebanese populations. Our study aims to evaluate the prevalence of third molar agenesis and study the pattern and distribution of agenesis in between genders in Italian and Lebanese Mediterranean populations and compare these findings with other global and Mediterranean populations' studies. METHODS: Retrospective chart review was conducted based on the history and orthopantomograms of adolescents aged 12 to 21 years to assess the agenesis of third molars in a sample of Italian and Lebanese populations by two experienced dental surgeons twice within 1 month. Descriptive and comparative tests were used to analyze the patterns of ageneses and make comparisons between the two samples. RESULTS: 23.4% of the studied sample had at least one third molar agenesis; females were more likely to have two or more third molar agenesis than males, but neither sex predisposition for single third-molar agenesis was recorded. Both the Italian and Lebanese subgroups seemed to have similar results. The maxillary right third molar was the most common third molar to be absent. Two or more ageneses were more common than one third molar agenesis. CONCLUSION: Our Mediterranean population results fall within the range reported in the literature and corroborate with the global average prevalence.

The Zygomatic Buttress as an Efficient Intraoral Donor Site for Limited Maxillary Reconstructions: A Case Series and Brief Literature Review.

Limited maxillary defects are commonly grafted with bone blocks harvested from the symphysis or the ramus; harvesting a second surgical site in the mandible increases both operative time and patient's postoperative morbidity. To overcome these disadvantages, the zygomatic buttress (ZB) was suggested as an alternative maxillary source of autogenous bone. This intraoral donor site has a natural convex shape and can be accessed along with the recipient site through the same flap design. We report a case series describing this uncommon technique of bone harvesting from the zygomatic buttress to reconstruct limited alveolar defects in the maxilla.

Trends in oral and maxillofacial radiology career: A survey.

PURPOSE/OBJECTIVES: To understand the professional aspirations of oral and maxillofacial radiologists (OMRs) by exploring their career choices and their association with educational background, engagement in professional activities, professional values, and overall level of career satisfaction. METHODS: This prospective cross-sectional study surveyed board-certified OMRs in the United States and Canada from September to December 2019. A web-based questionnaire was created comprising 37 multiple-choice questions and an open-ended question focusing on their opinions regarding the profession's future. A thematic approach qualitatively explored open questions. RESULTS: Of the 86 OMRs, 68, 10, and eight were board certified in the United States, Canada, and both countries, respectively. Activities considered "rewarding" included teaching and mentoring (65%) and radiologic reporting (55%). The majority spent approximately 20-30 h/week writing radiographic reports and less than 10 h in research. On an average, OMRs produced 21.9 (SD 12.8) reports per day. Activities considered less rewarding included administrative work (11%) and productivity pressure in institutions. OMRs working in academia reported higher incomes (p < 0.05). Finally, the majority of the OMRs were pleased with their career choices (79%). CONCLUSIONS: There is an association between the contemporary OMRs' satisfaction feeling, teaching/mentoring, and the future challenges of participating in multidisciplinary teams. Overall, diverse career choices lead OMRs to be proud of their profession and significantly satisfied.

Evidence-Based Clinical Efficacy of Leukocyte and Platelet-Rich Fibrin in Maxillary Sinus Floor Lift, Graft and Surgical Augmentation Procedures.

Bone augmentation techniques have increasingly been indicated for re-creating adequate bone height and volume suitable for dental implant sites. This is particularly applicable in the severely atrophic posterior maxilla where sinus perforation (ruptured Schneiderian membrane) is a very common complication and sinus floor elevation or lift is frequently considered a standard procedure. The augmentation of the maxillary sinus can be performed with or without grafting biomaterials. Herein, numerous biomaterials and bone substitutes have been proposed, primarily to sustain the lifted space. In addition, cytokines and growth factors have been used to stimulate angiogenesis, enhance bone formation as well as improve healing and recovery period, either as the sole filling material or in combination with bone substitute materials. Within such, is the family of autologous blood extracts, so-called platelet concentrates, which are simply the "product" resulting from the simple centrifugation of collected whole blood samples of the patient, immediately pre-surgery. Platelet-Rich Fibrin (PRF), a sub-family of platelet concentrates, is a three-dimensional (3-D) autogenous biomaterial obtained, without including anti-coagulants, bovine thrombin, additives, or any gelifying agents during the centrifugation process. Today, it is safe to say that, in implant dentistry and oral and maxillofacial surgery, PRFs (particularly, the pure platelet-rich fibrin or P-PRF and leukocyte and platelet-rich fibrin or L-PRF sub-classes) are receiving the most attention, essentially due to their simplicity, rapidness, user-friendliness/malleability, and cost-effectiveness. Whether used as the sole "bioactive" filling/additive material or combined with bone substitutes, the revolutionary second-generation PRFs have been very often associated with promising clinical results. Hence, this review aims to provide a 10-years update on the clinical effectiveness of L-PRF when applied/used as the "sole" biomaterial in maxillary sinus augmentation procedures. An electronic search using specific keywords for L-PRF and maxillary sinus augmentation was conducted in three main databases (PubMed-MEDLINE database, Google Scholar and Cochrane library) for the period between January 2009-February 2020. The quest yielded a total of 468 articles. Based on the pre-established strict inclusion/exclusion criteria, only seven articles were deemed eligible and included in the analysis. Surprisingly, of the 5 studies which used de-proteinized bovine bone mineral (DBBM) in combination with L-PRF, 60% acclaimed no significant effects and only 40% declared positive effects. Of the two articles which had used allogenous bone graft, 50% declared no significant effects and 50% acclaimed positive effects. Only one study had used L-PRF as the sole grafting material and reported a positive effect. Likewise, positive effects were reported in one other study using L-PRF in combination with a collagen membrane. Due to the heterogeneity of the included studies, this review is limited by the inability to perform a proper systematic meta-analysis. Overall, most of the published studies reported impressive results of L-PRF application as a grafting material (sole or adjuvant) in maxillary sinus augmentation and dental implant restorative procedures. Yet, distinct technical processing for L-PRF preparation was noted. Hence, studies should be approached with caution. Here in, in sinus lift and treatment of Schneider membrane, the formation of mature bone remains inconclusive. More studies are eagerly awaited in order to prove the beneficial or detrimental effects of PRFs, in general and L-PRFs, in specific; especially in their tissue regenerative potential pertaining to the promotion of angiogenesis, enhancing of cell proliferation, stimulation of cell migration and autocrine/paracrine secretion of growth factors, as well as to reach a consensus or a conclusive and distinct determination of the effect of leukocytes (and their inclusion) on inflammation or edema and pain; a call for standardization in PRFs and L-PRFs composition reporting and regimenting the preparation protocols.

Papillon-Lefèvre Syndrome: Diagnosis, Dental Management, and a Case Report.

AIM: This paper revisits Papillon-Lefèvre syndrome (PLS), addresses its diagnostic update and dental management, and reports a case of a 5-year-old Lebanese patient with consanguineously married parents. BACKGROUND: PLS, also known as "keratoris palmoplantaris with periodontopathia" and "hyperkeratosis palmoplantaris with periodontosis," is an extremely rare autosomal-recessive trait that combines a diffuse palmoplantar hyperkeratosis and a severe generalized, progressive prepubertal form of a precocious form of juvenile, aggressive periodontitis. CASE DESCRIPTION: We are reporting a 5-year-old boy that sustained a spontaneous loss of all his primary teeth. At consultation, he was under treatment for hyperkeratosis of his palms and soles. Detailed family history of the child revealed that the patient's parents, grandparents, and relatives were consanguineously married and two of his cousins displayed similar clinical signs (palmoplantar hyperkeratosis and premature loss of deciduous and most of the permanent teeth). CONCLUSION: PLS is an extremely rare disorder that usually becomes apparent from approximately 1-5 years of age. Genetic counseling should always be suggested to parents of affected children, informing them of chances of their offspring having the inherited disease.

Predictability of Craniofacial Skeletal Age with Geometric Morphometries.

AIM: This study aims to estimate skeletal age of craniofacial shape obtained from cone beam computed tomography (CBCT)-defined facial and basicranial landmarks using geometric morphometrics method in a random sample of growing patients, and explore the correlation between craniofacial shape and skeletal age as determined from hand and wrist radiograph. MATERIALS AND METHODS: Generalized Procrustes analysis (GPA) of craniofacial shape with estimation of centroid size was performed on CBCTs of 48 growing patients (mean age 11.7 ± 1.5 years). Greulich and Pyle method for skeletal age assessment were used for correlation with centroid size. Correlation among the variables relied on Pearson's coefficient and its 95% confidence interval was estimated. The model's R2 was calculated, (Cook's distances, Mahalanobis distances, leverage values, and studentized residuals) and multiple regression analysis performed using the Statistical Package for the Social Sciences (SPSS) version 22. RESULTS: Mean skeletal age was 11.9 ± 2.4 years. Centroid size (151.5 ± 7.2) was significantly correlated with chronological age (R = 0.616, 95% CI 0.355-0.789, p < 0.01) and skeletal age (R = 0.605, 95 % CI 0.331-0.794, p < 0.01). CONCLUSION: A new equation for determining craniofacial skeletal age was developed, using the centroid size of the craniofacial frame, gender, and the known chronological age. CLINICAL SIGNIFICANCE: A CBCT may be used for skeletal age assessment without additional hand wrist radiograph.

Dental and Skeletal Age Estimations in Lebanese Children: A Retrospective Cross-sectional Study.

AIMS AND OBJECTIVES: Assessing dental and bone ages is frequently required in a wide range of fields such as odontology, forensic science, as well as orthopedics. The aim of this study was to evaluate applicability of two methods of bone age assessment and two methods of dental age (DA) assessment for Lebanese children. MATERIALS AND METHODS: Skeletal age (SA) of 260 orthodontic patients (124 males, 136 females divided into four groups each) was consecutively assessed using Greulich and Pyle and Fishman's SMI methods. DA was evaluated using both Demirjian's and Willem's methods. Mean age was 11.89 ± 1.38 years for males and 11.75 ± 1.58 years for females. Data were collected and statistically analyzed using the SPSS software (IBM SPSS Statistics, version 21, USA). The differences between estimated DA, estimated SA, and chronological age (CA) were compared by gender and age group. RESULTS: Greulich and Pyle method showed nonsignificant difference with CA in male sample, while in both assessment methods, the difference between skeletal and CAs is significant in female sample. Results of Willem's method in the whole sample suggested a statistically nonsignificant difference, when compared to CA. Demirjian's method delivered higher mean value than Willem's assessment in both genders. CONCLUSIONS: Greulich and Pyle method is accurate for SA assessment in males and only in one group of females, while it significantly overestimates age in all other female groups. Willem's method is more suitable to assess DA in both genders. A strong correlation exists between both dental and skeletal assessment methods and CA.

Mesenchymal stem cells with osteogenic potential in human maxillary sinus membrane: an in vitro study.

OBJECTIVES: The aim of our study is to prove and validate the existence of an osteogenic progenitor cell population within the human maxillary Schneiderian sinus membrane (hMSSM) and to demonstrate their potential for bone formation. MATERIALS AND METHODS: Ten hMSSM samples of approximately 2 × 2 cm were obtained during a surgical nasal approach for treatment of chronic rhinosinusitis and were retained for this study. The derived cells were isolated, cultured, and assayed at passage 3 for their osteogenic potential using the expression of Alkaline phosphatase, alizarin red and Von Kossa staining, flow cytometry, and quantitative real-time polymerase chain reaction. RESULTS: hMSSM-derived cells were isolated, showed homogenous spindle-shaped fibroblast-like morphology, characteristic of mesenchymal progenitor cells (MPCs), and demonstrated very high expression of MPC markers such as STRO-1, CD44, CD90, CD105, and CD73 in all tested passages. In addition, von Kossa and Alizarin red staining showed significant mineralization, a typical feature of osteoblasts. Moreover, alkaline phosphatase (ALP) activity was significantly increased at days 7, 14, 21, and 28 of culture in hMSSM-derived cells grown in osteogenic medium, in comparison to controls. Furthermore, osteogenic differentiation significantly upregulated the transcriptional expression of osteogenic markers such as ALP, Runt-related transcription factor 2 (Runx-2), bone morphogenetic protein (BMP)-2, osteocalcin (OCN), osteonectin (ON), and osteopontin (OPN), confirming that hMSSM-derived cells are of osteoprogenitor origin. Finally, hMSSM-derived cells were also capable of producing OPN proteins upon culturing in an osteogenic medium. CONCLUSION: Our data showed that hMSSM holds mesenchymal osteoprogenitor cells capable of differentiating to the osteogenic lineage. CLINICAL RELEVANCE: hMSSM contains potentially multipotent postnatal stem cells providing a promising clinical application in preimplant and implant therapy.

Horizontal and vertical reconstruction of the severely resorbed maxillary jaw using subantral augmentation and a novel tenting technique with bone from the lateral buccal wall.

AIM: The aim of this study was to evaluate the effect of using the lateral wall bone in sinus lifting two-dimensional reconstruction on bone augmentation. PATIENTS AND METHODS: Ten patients affected by class V or VI maxillary atrophy with less than 3 mm of residual horizontal ridge were selected. Using a piezo-ultrasonic surgery tip bony lateral wall was cut. To expose native bone to the bone graft, multiple perforations, made through the cortical plate of the recipient site with a round bur. Once the bony buccal wall was adjusted it was fixed away from the ridge with two 1.5 x 13 mm bone fixation screws. Deficiencies created between the bony buccal wall and the ridge was filled with a mineralized cortical bone. A pericardium membrane was then placed on the graft. A biopsy for histologic evaluation was made. RESULTS: The data analysis in bone volume changes reported significant differences between the anterior and posterior locations before and after grafting (p < 0.05). The biopsy shows mature cancellous bone with predominantly lamellar structure. CONCLUSION: The use of the lateral wall bone in sinus lift surgery showed significant increase in bone volume.

Epidemiology of Oropharyngeal Candidiasis in Human Immunodeficiency Virus/Acquired Immune Deficiency Syndrome Patients and CD4+ Counts.

BACKGROUND: The present study was directed to evaluate the forms of oropharyngeal candidiasis (OPC) and their correlation with CD4+ cell counts in human immunodeficiency virus (HIV) patients. MATERIALS AND METHODS: This was a descriptive and analytical cross-sectional study carried out for a 2-year period, in which quantitative data collection methods were used. 50 patients with HIV infection were evaluated. Relationship between OPC and CD4+ was investigated. RESULTS: Five different clinical forms were noticed on examination: pseudomembranous candidiasis 20/38 (P) was the most common one (52.6%) followed by erythematous 5/38 (13.15%), angular cheilitis 5/38 (13.15%) (AC), a combination of AC and E 4/38 (10.52%) or AC, E and P 4/38 (10.52%). Candida albicans was the most frequent specie isolated in 35 cases of OPC (92%). Candida tropicalis was isolated in 2 cases (5.26%) and Candida glabrata in 1 case (2.64%). The majority of patients with OPC had cell counts 28/38 (73%) <200 cells/mm(3), followed by 9/38 (23%) at CD4+ cell counts of 201-499 cells/mm(3). CONCLUSION: Oral Candida colonization and invasive infection occur more frequently in HIV-positive patient and is significantly more common in patients with CD4+ cell counts <200 cell/mm(3).

Epidemiology and Relationships between CD4+ Counts and Oral Lesions among 50 Patients Infected with Human Immunodeficiency Virus.

BACKGROUND: The aim of this study was to evaluate the clinical lesions of human immunodeficiency virus (HIV)/acquired immune deficiency syndrome patients in the oral cavity, head and neck region and to determine their associations with level of immune suppression as measured by the CD4+ count. MATERIALS AND METHODS: In a descriptive cross-sectional study, 50 patients with a proven HIV infection were evaluated. Based on the clinical findings and CD4+ counts, the relationships between oral lesions and CD4+ cell count were investigated. RESULTS: The CD4+ count (cells/mm(3)) was <200, 200-500, and >500 in 32 cases (64%), 16 cases (32%) and 2 cases (4%) respectively, and the mean CD4+ count was 169.82 cells/mm(3) in males and 142.8 cells/mm(3) in females. All patients showed at least one oral manifestation. The most common oral lesion identified was pseudomembranous candidiasis accounting for 76% (38/50) followed by periodontal disease 34% (17/50), herpetic lesions and hairy leukoplakia 10% for each (5/50), gingivitis 8% (4/50), oral ulceration 8% (4/50), Kaposi's sarcoma 6% (3/50), and Non-Hodgkin lymphoma 2% (1/50). CONCLUSION: The CD4+ count was decreasing the presence, and the severity of oral lesions was increasing in this study. The presence of oral lesions may lead to a positive diagnostic of HIV. Disease progression is characterized by increased prevalence of some oral lesions as candidiasis, hairy leukoplakia, and Kaposi sarcoma. The severity of oral lesions was more pronounced with a CD4+ count <200 cells/mm(3).