An exploratory study of maternal diabetes and offspring use of dental services-Northern Ireland national cohort study.

INTRODUCTION: A small number of literature has posited a link between prenatal exposure to gestational diabetes mellitus and an increased risk of developmental defects in the enamel of offspring. However, the evidence remains inconclusive. AIMS: This study examined the relationship between the diabetes status of mothers and the use of dental services by offspring to that pregnancy. MATERIAL AND METHODS: Anonymised data from a cohort of mothers who carried a child to term in Northern Ireland between 2012 and 2017 and service use by the child were taken from administrative databases from March 2015 to September 2021. Descriptive statistics, differences in means and regression analyses were used to examine the relationship between service use and maternal diabetes status, controlling for covariates. RESULTS: In multivariate analyses that controlled inter alia for age and deprivation, diabetes status was negatively related to restoration, extraction, prevention, and total service use. In the analysis of the COVID period, pre-COVID prevention was negatively related to extractions, restorations, prevention and services in general. CONCLUSION: The relationship between maternal diabetic status and aspects of offspring use of dental services was contrary to that suggested in previous studies and warrants more detailed investigation using this valuable data resource.

Sugar content in infant formula: Accuracy of labeling and conformity to guidelines.

BACKGROUND: Infant formulae are a primary source of nutrition during the first years of life, to which sugars are frequently added. This may contribute to adverse dental health problems if consumed excessively when coupled with prolonged and nocturnal feeding habits. AIM: To assess the amount and type of dietary sugars in commercially available infant formulae in the UAE. DESIGN: Sucrose, glucose, and fructose were measured in 71 different brands of commercially available infant formulae for retail sale in the UAE. Analysis was performed using high-performance liquid chromatography with refractive index detection. Sugar values were compared with the reported levels on the nutritional labels. A comparison between findings, product labels, and international standards for infant formulae was performed. RESULTS: Of the 71 samples, 23 had detectable sugar levels, varying between sucrose, glucose, and fructose. Ten samples were found to have sugars contributing to more than 5% of total energy intake ranging between 5.68% and 27.06%. All infant formula packages had carbohydrate levels mentioned on the labels, but very few mentioned the added sugar content. CONCLUSIONS: Many infant formula products tested contained sugars that exceeded the standard recommended intake. Tighter regulations that monitor the amount of sugar in infant formulae and guidelines for comprehensive labeling systems are required.

The Effect of Chlorhexidine on Bacterial Contamination of Hall Technique Elastomeric Orthodontic Separators and Gingival Health: A Pilot Study

ABSTRACT Objective: To study the effect of chlorhexidine on elastomeric orthodontic separators (EOS) bacterial-colonisation and gingival-health in Hall technique (HT) patients. Material and Methods: Prospective in-vivo pilot clinical study of EOS bacterial colonisation and primary-molar gingival health assessment in 20 patients (mean age 5.45±1.27 years) requiring bilateral HT crowns (40 teeth). One side received 1-minute 0.12% chlorhexidine-soaked-EOSs (Chx-EOSs), and the other side dry-EOSs (NoChx-EOSs). The EOSs were removed five-days later and underwent a bacterial enumeration technique. Plaque (PI) and Gingival (GI) indices were assessed pre-, five-days and three-months post-treatment. Wilcoxon-Signed-Rank/McNemar-Chi-square statistics were used (p<0.05). Results: Baseline unused/packaged EOSs' sterility check yielded zero colony-forming-units (CFU) per millilitre, but 100% of the used EOSs became colonised by oral-microorganisms. An overall trend of lower mean CFU count in Chx-EOSs (3.415± 0.78 x105 CFU/ml) compared to NoChx-EOSs (6.157±1.48 x105 CFU/ml) was observed (p=0.009). Both NoChx-EOSs and Chx-EOSs insertion sites showed evidence of gingivitis with no difference between PI and GI indices by site over time. Conclusion: There was a lower trend of bacterial colonization in chlorhexidine treated EOSs and an occurrence of gingivitis pre/post HT-treatment regardless of EOS type. The lack of difference in the gingival health may be inconclusive due to this pilot's low power suggesting the need for robust large scale studies.

Teaching Cariology in Asia and Arabia.

The European Organisation for Caries Research education platform 2020 had the aim to assess the undergraduate curriculum in cariology in Asian and Arabian countries in order to support structured teaching of cariology in these countries with about almost half of the global population. Representatives of 4 Asian and 4 Arabian countries completed a comprehensive questionnaire on structure of dental education in their country in general and the extent, the content, the responsibilities, structure and standardization regarding cariology in particular. In spite of a wide range from very few universities (Lebanon 3) to larger numbers of dental schools (India 313, China 121, Russia 52) there were similar statements on the list of content for cariology teaching. Often the catalogue was close to the Undergraduate Core Curriculum in Cariology (UCCC) covering most of the 5 domains from basic science to dental public health, but a national curriculum for cariology or dentistry was mostly missing. With various departments being involved, a need of coordination is obvious. Most representatives thought it possible and feasible to teach a standardized curriculum in cariology on the basis of the UCCC. In conclusion, many Arabian and Asian countries have implemented modern, evidence-based curricula in their universities, but an obligatory national curriculum in cariology would be advisable to standardize the quality in teaching.

Characteristics of Pediatric Dental Treatment Provided under General Anesthesia in Dubai, United Arab Emirates: A Retrospective Analysis.

Background: Dental general anesthesia (DGA) is a widely utilized technique in pediatric dentistry and is indicated for a variety of cases such as very young children and children with special healthcare needs (SHCN). In the United Arab Emirates (UAE), there is a paucity of studies relating to this subject. Objective: To analyze the characteristics of DGA treatment in special healthcare needs and healthy children in the only postgraduate dental hospital in Dubai, UAE. Materials and Methods: A retrospective analysis was conducted on the electronic records of all Dubai Dental Hospital (DDH) pediatric patients who underwent DGA in the period between January 1st, 2016, and 29th of February 2020. Results: The study population consisted of 98 children. A total of 26 children had a medical condition and were categorized as SHCN. The most common justification for DGA was dental caries and a lack of cooperation due to young age. SHCN patients received significantly more preventive measures and significantly fewer pulp therapies than healthy patients. Conclusion: We found that the services provided under DGA for healthy pediatric patients differ from those provided to SHCN patients. Frequently missing recall appointments following DGA increased the likelihood of the need for further restorative dental treatment. These results highlight the importance of robust prevention and follow-up programs for children treated under GA.

What is the effect of preterm birth on permanent tooth crown dimensions? A systematic review and meta-analysis.

BACKGROUND: The permanent tooth formation process may be disrupted in preterm infants with potential discrepancies in size and subsequent occlusal disturbances. OBJECTIVE: To systematically analyse and quantitively synthesize the available evidence regarding the impact of preterm birth on permanent tooth crown dimensions. SEARCH METHODS: Unrestricted searches in 6 databases and manual searching of the reference lists in relevant studies were performed up to March 2021 (Medline via PubMed, CENTRAL, Cochrane Database of Systematic Reviews, Scopus, Web of Science, ProQuest Dissertations and Theses Global). SELECTION CRITERIA: Observational studies investigating permanent tooth crown dimensions in preterm and control full-term born individuals. DATA COLLECTION AND ANALYSIS: Following study retrieval and selection, relevant data were extracted, and the Newcastle-Ottawa scale was used to assess the selection, comparability, and outcome domains. Exploratory synthesis and meta-regression were carried out using the random effects model. RESULTS: Three studies were located from the initially retrieved records and the assessments with the Newcastle-Ottawa scale identified issues regarding the selection and comparability domains. Overall, the mesiodistal and the buccolingual dimensions of the permanent teeth in both dental arches tended to be smaller in children born prematurely than full term children. Subgroup analyses showed statistically significant differences for the extremely preterm to control group comparisons for the incisors and the first molars. Meta-regression showed a modificatory effect of gestational age and racial background but not of birth weight and gender on tooth size. The quality of available evidence was rated at best as moderate. CONCLUSIONS: Premature birth could potentially be associated with reduced tooth-crown dimensions in some permanent teeth especially in children born extremely preterm. Although the results from these observational studies should be approached with caution until more information becomes available, the possible clinical implications in terms of diagnosis and treatment planning should be considered. REGISTRATION: PROSPERO (CRD42020182243).

How Do Schoolchildren View Other Children Who Have Discolored Teeth?

OBJECTIVES: Facial look and expression affect how people are viewed by others. This study aimed to evaluate how schoolchildren in the Emirate of Sharjah, United Arab Emirates view their peers who have discolored teeth. MATERIALS AND METHODS: A cross-sectional study using randomized cluster sampling of Sharjah public schools was conducted. A previously developed and validated social attribute questionnaire was utilized to determine children's dental appearance-related judgments. Children aged 11-14 years were given photographs of subjects either with discolored teeth or without, and they were asked to rate them using six positive and five negative signifiers. The total attribute score (TAS) ranged from 11 (most negative) to 44 (most positive). A linear regression analysis and t-tests were performed to determine the effects of gender and age in mean TAS. RESULTS: TAS was significantly lower among discolored teeth photographs when compared with photographs without teeth discoloration (P = 0.004). TAS was found to be significantly higher with increased age (P = 0.035), but gender had no significant effect. CONCLUSION: Teeth discoloration resulted in more negative social judgment between Sharjah schoolchildren and their peers.

A single-centre investigator-blinded randomised parallel-group study protocol to investigate the influence of an acclimatisation appointment on children's behaviour during N2O/O2 sedation as measured by psychological, behavioural and real-time physiological parameters.

AIMS AND OBJECTIVES: To describe a study protocol of a randomised control trial (RCT) assessing the effectiveness, in reducing dental anxiety, of an acclimatising nitrous oxide sedation (N2O) session prior to actual dental treatment with N2O. MATERIALS AND METHODS: A single-centre investigator-blinded parallel-group RCT conducted in a postgraduate dental hospital in Dubai, United Arab Emirates (UAE). Anxious children requiring N2O (aged 5-15 years) will be randomly assigned to; a study group: children who will have a preparatory N2O trial experience or; a control group: children who will only have N2O explained to them. Treatment with N2O for both groups will start at the second visit. The following outcomes will be recorded: completion of dental treatment, anxiety scores at baseline and after treatment (using the Modified Child Dental Anxiety Scale faces), behaviour of the child (using Frankl Rating Behaviour Scale) and the acquisition of real-time physiological anxiety-related parameters (using E4® electronic wrist devices). RESULTS: The data will be analysed statistically. DISCUSSION: There is a paucity of research regarding dental N2O acclimatising appointments. This RCT will supplement existing literature. CONCLUSIONS: This RCT will report whether prior acclimatising of a child to N2O sedation is effective, or not, in improving dental treatment behaviour.

Use of the Hall technique by specialist paediatric dentists: a global perspective.

Background The Hall technique (HT) is popular with UK paediatric dentists (PDs). Global PDs perception/use of HT is unknown.Aim To investigate global PDs opinions/use of HT.Materials and methods A cross-sectional questionnaire of 26 questions was sent to specialist PDs across the globe.Results Responses of 709 PDs from six continents were obtained. The majority (n = 654, 92.32%) had heard about HT but only 50.6% (n = 358) used it, with wide country variations. Respectively, 37.5%, 31.5% and 31% were neutral, against or supportive of HT when they initially heard about it. Only 17% of HT users said it was always the treatment of choice for non-pulpal asymptomatic carious primary molars (NPACPMs), 62% would take a pre-operative radiograph, 65% would consider using high speed drills before HT, 63% would never consider HT under general anaesthesia, 56% would use HT under N2O sedation. Finally, in a clinical scenario of a NPACPM in a cooperative 6-year-old, 75% of PDs would choose conventional restorative methods over the HT.Conclusion The HT is recognised, but not used, by an outright majority of PDs across the globe. Identifiable barriers such as lack of training, perception as substandard dentistry and perceived lack of evidence reduced its use.

Hall technique crowns and children's masseter muscle activity: A surface electromyography pilot study.

BACKGROUND: Hall technique crowns (HTCs) alter the occlusion temporarily, potentially affecting jaw muscles, particularly the masseter - the primary jaw-closing muscle. AIM: To assess masseter muscle activity (MMA) in children treated with a unilateral HTC. DESIGN: In 12 children treated with a single HTC, bilateral MMA was recorded with surface electromyography (sEMG) for ten cycles of Rest Position (RP) and Maximum Voluntary Clenching (MVC) over 20 seconds immediately pre-HTC cementation (Pbase ), immediately post-HTC cementation (Pimmed ), at 2 weeks post-HTC cementation (P2w ) and at 6 weeks post-HTC cementation (P6w ). t test, ANOVA and post hoc statistics were used (P < .05). RESULTS: As expected, MMA was low at rest and increased during maximal jaw clenching (P < .0001). MMA (mean ± SD) increased significantly (P < .001) between RP and MVC at: Pbase [from 1.60 µV·s (±0.96) to 5.40(±2.30)]; Pimmed [1.57(±1.15) to 3.75(±1.87)]; P2w [1.39(±0.54) to 5.54(±1.45)] and finally P6w [1.46(±0.56) to 6.45(±2.56)]. Rest MMA at Pbase , Pimmed , P2w and P6w remained unchanged (P = .18) whereas Pbase clench MMA reduced by a third at Pimmed (P < .001), returned to and exceeded baseline levels at P2w (P = .822) and P6w (P < .001), respectively. CONCLUSIONS: This pilot study showed that Hall technique crowns may affect masseter muscle activity in children. Clench MMA was reduced immediately post-treatment but returned to and later exceeded baseline levels at 2 and 6 weeks, respectively. Rest MMA remained unchanged.

Enamel defects and caries prevalence in preterm children aged 5-10 years in Dubai.

Background: Enamel defects (EDs) are commonly reported dental findings in preterm/low birthweight children. EDs potentially increase caries susceptibility.Aim: To assess the prevalence of EDs and dental caries in a group of preterm children (aged 5-10 years) in Dubai, United Arab Emirates (UAE).Methodology: A retrospective cohort study of medical records of 62 preterm children (mean age 8.1 ± 1.54) and 62 full-term children (mean age 8.1 ± 1.73) of both genders born in a UAE children's hospital were studied. These children were dentally assessed for EDs and caries by a calibrated examiner.Results: EDs were 4.34 times more prevalent among preterm children [odd ratio (OR) = 4.338, CI 95% [2.010-9.366]. The prevalence of EDs in the pre-term group was 58.15%, significantly higher (P < 0.01) than the full-term control group (24.2%). Birth weight, intubation and type of delivery were statistically significant factors contributing to EDs. In the primary dentition, the mean dmft was 4.61 ± 4.30, while in the permanent dentition DMFT was 0.38 ± 0.99. There was a statistically significant difference in permanent teeth caries experience amongst pre-term children compared to the full-term control as measured by DMFT (P = 0.008).Conclusion: EDs and dental caries in permanent dentition in the pre-term group were significantly higher than the full-term group.

A single-centre investigator-blinded randomised parallel group clinical trial to investigate the effect of probiotic strains Streptococcus salivarius M18 and Lactobacillus acidophilus on gingival health of paediatric patients undergoing treatment with fixed orthodontic appliances: study protocol.

BACKGROUND: There is limited data on the beneficial effects of probiotics on the gingival health of patients undergoing treatment with fixed orthodontic appliances. This study aims to compare the effect of probiotic tablets combined with regular oral hygiene versus regular oral hygiene alone on gingival status in these patients. The effect of probiotic intake on plaque formation and salivary microbiome composition will be also assessed. METHODS AND ANALYSIS: This is a 3 month single-centre, single blind (clinical and laboratory examiners), parallel group randomised controlled two arm superiority trial. Fifty paediatric patients attending the Postgraduate Orthodontic Clinic at the Hamdan Bin Mohammed College of Dental Medicine (HBMCDM), Mohammed Bin Rashid University of Medicine and Health Sciences (MBRU), Dubai, United Arab Emirates, who meet the eligibility criteria will be recruited. Block randomisation with 1:1 allocation and concealment of allocation will be carried out. The treatment group will receive probiotic tablets containing Streptococcus salivarius M18 and Lactobacillus acidophilus together with regular oral hygiene versus the control group on regular oral hygiene alone. Clinical examination and collection of saliva for microbiome assay will be carried out at baseline and end of study. Self-reporting by patients will be used to document acceptability and adverse effects. Statistically significant decrease in gingival bleeding on probing in the treatment group will be classified as primary outcome of treatment success. Statistically significant reduction in Plaque Index, Gingival Index and shift in the composition of the oral microbiome in favour of beneficial bacteria are secondary outcomes indicative of efficacy of probiotic intake. ETHICS AND DISSEMINATION: Ethical approval for the study has been granted by the HBMCDM, MBRU, Institutional Review Board (Reference #: MBRU-IRB-2018-015). Study findings will be disseminated via publication in peer-reviewed journal. TRIAL REGISTRATION NUMBER: ISRCTN95085398.

A study protocol of a single-center investigator-blinded randomized parallel group study to investigate the effect of an acclimatization visit on children's behavior during inhalational sedation in a United Arab Emirates pediatric dentistry postgraduate setting as measured by the levels of salivary Alpha Amylase and Cortisol.

INTRODUCTION: Inhalation sedation is a proven safe method for reducing children's dental anxiety and has been used worldwide for decades. There is controversy regarding the use of acclimatization or familiarization visits for dental sedation treatment pathways for children. This may increase acceptance to the treatment based on desensitization and acclimatization principles underpinning many behavior management techniques. This study aims to identify whether, an inhalation sedation acclimatization visit is effective in reducing the stress level in anxious children as measured by salivary Alpha Amylase and Cortisol levels. METHODS: The study is a single-center, single blinded, parallel group 2 arm clinical trial. Children in need of inhalation sedation aged 5 to 15 years from September 2019 through March 2020 attending the Postgraduate Pediatric Clinic at the Hamdan Bin Mohammed College of Dental Medicine, in Dubai, will be allocated randomly and equally to either:At the initial visit a salivary sample will be collected at the beginning of the visit and the sedation need score will be recorded using the pediatric indicator of sedation need. Treatment for both groups will commence at the second visit. Salivary samples will be collected 15 minutes before the start of the treatment and 15 minutes after the conclusion of the treatment. The following outcomes will be recorded: completion of dental treatment, anxiety scores at baseline and after treatment using Frankl rating behavior scale and physiological anxiety related changes will be recorded using salivary Alpha Amylase and Cortisol levels. Mean changes of physiologic anxiety levels and corresponding 95% confidence intervals will be determined to compare the 2 treatments (sedation with familiarization and sedation without familiarization). DISCUSSION: This is will be the first study to measure the effect of the acclimatization visit of nitrous oxide inhalation sedation on the level of physiological anxiety and the behavior of the pediatric patients during treatment.