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Muhammad Nazir,1 Khalid S Almulhim,2 Ziyad AlDaamah,3 Salman Bubshait,3 Mohammed Sallout,3 Salman AlGhamdi,3 Jehan Alhumaid1 1Department of Preventive Dental Sciences, College of Dentistry, Imam Abdulrahman Bin Faisal University, Dammam, 31441, Eastern Province, Saudi Arabia; 2Department of Restorative Dental Sciences, College of Dentistry, Imam Abdulrahman Bin Faisal University, Dammam, 31441, Eastern Province, Saudi Arabia; 3College of Dentistry, Imam Abdulrahman Bin Faisal University, Dammam, 31441, Eastern Province, Saudi ArabiaCorrespondence: Muhammad Nazir Tel +966-543569615Email manazir@iau.edu.saPurpose: Dental fear is associated with the avoidance of dental visits and negative oral health outcomes. It is important to assess distribution of dental fear and preference for emergency dental treatment among adult population during COVID-19. Therefore, the purpose of this study was to evaluate dental fear and emergency dental treatment among adults in COVID-19 quarantine centers in Greater Dammam, Saudi Arabia.Materials and Methods: Male and female adults (N=606) in quarantine centers for COVID-19 participated in this cross-sectional study (June–July 2020). Dental Fear Survey was used to collect data on dental fear. The participants also provided their responses about emergency dental treatment/dental attendance patterns in addition to demographic information.Results: The mean DFS score of the sample was 39.08 ± 19.47, and 23.1% of the participants were a little fearful and 22.6% were highly fearful. About 36.8% reported that they would prefer to visit a dental office in case of dental emergency mostly for dental pain and fractured tooth during the COVID-19 pandemic. Only 10.4% of the participants reported visiting a dentist in less than 3 months, 35.8% in less than 6 months, 52.5% between 6 and 12 months and more, and 1.3% never visited the dentist. DFS scores significantly differed among participants who visited the dentist in less than 3 months (31.86 ± 14.57), less than 6 months (37.70 ± 18.57), between 6 and 12 months and more (40.78 ± 20.23), and never visited the dentist (65.75 ± 14.74) (P < 0.001). The timing of last dental visit (P < 0.001), female gender (P 0.039), and dental pain (P < 0.001) were the significant predictors of dental fear.Conclusion: Dental fear was common among adults with a predilection for the female gender. Increased dental fear was significantly related to dental pain and reduced dental attendance. Only one-third of adults were willing to perform emergency dental visits.Keywords: dental anxiety, emergency treatment, dental visits, pandemic

Muhanad Alhareky,1 Muhammad Ashraf Nazir,1 Lamia AlGhamdi,2 Mariam Alkadi,2 Noura AlBeajan,2 May AlHossan,2 Jehan AlHumaid1 1Department of Preventive Dental Sciences, College of Dentistry, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia; 2College of Dentistry, Imam Abdulrahman Bin Faisal University, Dammam, Saudi ArabiaCorrespondence: Muhammad Ashraf NazirDepartment of Preventive Dental Sciences, College of Dentistry, Imam Abdulrahman Bin Faisal University, P. O. Box 1982, Dammam, 31441, Saudi ArabiaTel +966-38574928Email manazir@iau.edu.saPurpose: Dental anxiety is a barrier to dental care utilization and is associated with poor oral health outcomes. The aim of the study was to assess the relationship between dental anxiety of mothers and dental caries of their children in the Eastern Province, Saudi Arabia.Methodology: A cross-sectional study was conducted on a sample of mother–child pairs (N= 199) in Dammam, AlKhobar, and Dhahran, Saudi Arabia. Dental caries experience among children was determined using dmft/DMFT indexes following the World Health Organization’s guidelines. Maternal dental anxiety was assessed by using the Modified Dental Anxiety Scale (MDAS).Results: The mean ages of mothers and children were 33.98 ± 5.41 and 6.74 ± 2.29 years, respectively. The mean dmft score was 4.3 ± 3.99 in primary dentition and the mean maternal dental anxiety score was 13.89 ± 5.33. Ninety-two percent of mothers had low to extreme dental anxiety and only 8% reported no dental anxiety. Dental caries experience in primary teeth was higher in children of dentally anxious mothers (mean dmft 4.45 ± 3.92) than the children of mothers who were non-anxious (mean dmft 2.56 ± 4.59) (P=0.07). The mean maternal anxiety score was significantly higher in children with untreated decay in primary dentition (14.49 ± 5.08) than those with sound primary dentition (12.24 ± 5.67) (P = 0.008). The study also found a statistically significant correlation between maternal dental anxiety and untreated decay in the primary dentition (Pearson’s r =0.171, P = 0.015).Conclusion: Dental anxiety was highly prevalent among mothers in the present study. There was a significant relationship between maternal dental anxiety and untreated decay in the primary dentition. Awareness should be raised among dentally anxious mothers to reduce the burden of dental caries in their children.Keywords: caries, dental fear, access to oral care, children

Balgis Gaffar,1 Jehan Alhumaid,1 Muhanad Alhareky,1 Faisal Alonaizan,2 Khalid Almas1 1Preventive Dental Sciences Department, College of Dentistry, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia; 2Restorative Dental Sciences Department, College of Dentistry, Imam Abdulrahman Bin Faisal University, Dammam,Saudi ArabiaCorrespondence: Balgis Gaffar Tel +966 542269941Email bgosman@iau.edu.saAbstract: Recently, there have been many global outbreaks of diseases. The latest is the coronavirus disease of 2019 (COVID-19) pandemic. The virus has spread worldwide and is transmitted mainly through droplets or by touching contaminated surfaces. Globally, healthcare systems are challenged due to a lack of workplace safety and professional obligations in addition to the rapid spread of the virus. Dental facilities are at greater risk due to the nature of dental care. The aim of this review study was to provide a situational analysis within dental facilities during the new COVID-19 outbreak. Published papers concerning dental facilities and COVID-19 were retrieved from PubMed, search engines, and organizational websites. All data were reviewed, arranged into themes, and then categorized either as strengths or weaknesses with respect to addressing the COVID-19 pandemic in dental facilities, and accordingly, threats and possible opportunities to the handling of the pandemic were identified. Preparedness of dental facilities during the current pandemic is a weakness that needs to be addressed promptly. Shortage of dental care providers, cyber security, economic losses, and ethical challenges are possible threats due to the current outbreak. Coordination and prompt communication among all healthcare providers during such outbreaks is a strength that needs to be supported. This strengths, weaknesses, opportunities, and threats (SWOT) analysis can be a useful tool for guiding decision-making as it is crucial during the current pandemic to work on weaknesses, avoid threats, and utilize all future opportunities.Keywords: COVID-19, dental clinics, SWOT, preparedness, challenges

Background: There is inconsistent evidence about the association between Helicobacter pylori (H. pylori) and dental diseases with possible effect of environmental factors. The aims of the study were to assess (1) the association between gastric and oral H. pylori colonization and (2) the association between oral colonization of H. pylori and dental diseases.Methods: A cross-sectional study was conducted in King Fahad University hospital in Khobar, Eastern Saudi Arabia in 2017. Patients admitted to the Endoscopy Unit were recruited and clinically examined for plaque, decayed teeth (D), filled teeth (F), missing teeth (M), periodontal pocket depth (PPD), attachment loss (AL), and gingival bleeding in addition to assessing their age, gender, education, tooth brushing, flossing, and tobacco use with a questionnaire. Pooled dental plaque samples were collected and analyzed using nested polymerase chain reaction PCR to detect oral H. pylori. Gastroscopy was used to extract biopsies to assess gastritis and the presence of gastric H. pylori using Giemsa stain. Regression analysis was used to assess differences between patients with and without gastritis, oral H. pylori and gastric H. pylori in the percentage of sites with gingival bleeding, PPD, CAL, D, M, and F with adjustment for confounders.Results: One hundred twenty patients were included. Most of them brushed daily (82.6%) and had university education (45.7%). Of these, 34.2% had gastric H. pylori and 5% had oral H. pylori. No significant association was observed between the percentage of sites with gingival bleeding, mean PPD, AL, F, and either gastritis, the presence of oral or gastric H. pylori. Patients with gastritis had significantly higher number of D and M than patients without gastritis (P = 0.03).Conclusions: In this study, the presence of gastric and oral H. pylori in patients with good oral hygiene and moderate socioeconomic status is not significantly associated with periodontal diseases. Patients with gastritis tend to have a higher number of decayed and missing teeth. [ABSTRACT FROM AUTHOR]

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Background: Comparing the effectiveness of virtual and traditional learning methods is crucial for understanding their impact on knowledge transmission in different subjects. The objective of this cross-sectional study was to explore dental students' perceptions and satisfaction levels with their experiences in virtual learning compared to traditional classroom learning. Methods: A cross-sectional survey was administered to all dental students in the College of Dentistry across preclinical (3rd and 4th year) and clinical (5th and 6th year) levels using Google Forms. The questionnaire included items from the validated student survey component of the Blended Learning Toolkit, the Quality Matters Higher Education Rubric, and the Web Learning Project Student Survey. Results: With a 93% response rate from 313 students, the survey results indicated a strong preference (87%) for traditional learning among 3rd-year preclinical students who favored it over virtual learning, contrasting with 54% of 6th-year clinical year students. Most of the students acknowledged that traditional learning facilitates the use of various instructional methods while virtual learning hinders interactions among each other ( p = 0.068). However, virtual lectures were perceived as more organized (70% to 89%, p = 0.014). Gender differences were minimal in preference for virtual learning, but male students significantly preferred traditional methods ( p = 0.001). Conclusion: The results indicate a preference for traditional over virtual learning, especially among males and preclinical dental students, emphasizing the need for an integrated approach that combines the structured benefits of virtual learning with the interactive advantages of traditional classrooms.

Introduction: Peer assessment in dental and medical education is a key tool for evaluating attitudes and communication skills, serving as an effective formative learning method. It not only boosts academic performance and encourages lifelong learning and reflective practice but also fosters collaboration, effective communication, and constructive feedback among peers., Objective: This study aimed to assess dental students' satisfaction and perceptions regarding implementing peer assessment in case presentations, including contribution to their learning., Methods: This cross-sectional study involved third (n = 26), fourth (n = 54), and sixth (n = 71) dental students divided into five groups. Each student received peer assessments (n = 8) from the students of the other groups regarding their clinical presentation. At the end of the process, students were invited to complete an anonymous 9-item questionnaire to assess student perceptions of the peer-assessment process. Data were analyzed to evaluate students' perception and satisfaction with the peer assessment task. The bivariate analysis explored associations among questionnaire items., Results: A total of 151 students participated in the current study. Results showed a high level of agreement for most of the students regarding their preparedness for peer and self-assessment. More than 75% of the students at all academic levels found it challenging to evaluate their peers. Student satisfaction scores increased with the level of education, (4.076, 4.214, and 4.246 out of five, respectively) with moderate correlations between peer evaluation characteristics., Conclusion: Peer assessment appears to enhance learning and professional development in dental students. Students' satisfaction with peer assessment grows with education level, reflecting its role in fostering critical evaluation skills and feedback., (© 2024 American Dental Education Association.)

Objective: This bibliographic analysis was designed to review all dental publications in the Kingdom of Saudi Arabia (KSA) and evaluate the effect of international collaboration on the impact of published articles., Methods: The Web of Science (WOS) database was used to extract all related published articles in the KSA from 1982 to 2021. The keywords were connected using Boolean Operators to download related articles. Downloaded articles were screened according to the following inclusion criteria: collaboration journal category, journal discipline, number of citations, number of authors, and impact factor. After applying the inclusion criteria and excluding single-author articles, 5,689 documents were included in the final analysis. The chi-square test and two-independent samples t -test were used to determine the statistical significance between the variables., Results: A significantly higher proportion of articles with international collaboration (51.4%) were published in dental journals than those published nationally (43.3%) or within the institutional level (41.8%) ( P  < 0.0001). In addition, the average number of citations (9.28 ± 23.8) ranged from 0 to 749, received by an article and the impact factor of the journal in which the article was published, significantly higher in the case of internationally collaborative work compared with national or within institutional collaboration ( P  < 0.0001)., Conclusion: International collaboration positively affected the impact factor, number of citations, and quartile rank of published articles. Moreover, the number of co-authors in different countries contributes to the international collaboration effect., Competing Interests: The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (© 2023 The Authors. Production and hosting by Elsevier B.V. on behalf of King Saud University.)

This paper aimed to evaluate the impact of an oral health programme targeting prisoners in eastern Saudi Arabia. The reach, effectiveness, adoption, implementation and maintenance (RE-AIM) strategy was used as the evaluation framework to assess both process and outcome. This annual programme included four stations: an interview, an educational session, dental examination and treatment. Programme indicators included the number of prisoners reached, percent improvement in oral health practices, teeth present in the mouth and percent reduction in dental treatment needs. A non-experimental pre- and post-programme evaluation design was implemented. Prisons in eastern Saudi Arabia were visited once a year from 2016 to 2019. The evaluation used primary data collected during the visits in the form of clinical examination and surveys. The number of beneficiaries increased from 270 to 634, and three cities within the Eastern province were covered. The percent of inmates who smoke and consume sugary drinks decreased by 24 and 30%, respectively; however, there was a 25% reduction in regular toothbrushing using a fluoridated toothpaste. The long-term outcomes showed an improvement in the overall oral health condition and treatment needs: periodontal treatment needs and surgical procedures were reduced by 91 and 79%, respectively. The programme was successful based on the RE-AIM framework. This is the first sustainable oral health programme targeting prison inmates in the Middle East. The findings indicate that the oral health programme had positive effects on prisoners' oral health and achieved its objectives. Such programmes can help address health disparities among populations., (© The Author(s) 2023. Published by Oxford University Press. All rights reserved. For permissions, please email: journals.permissions@oup.com.)

Introduction: Physicians promote oral health by screening for oral pathologies, providing emergency help, and referring patients to dentists. The literature consistently reports a robust association between periodontal disease and systemic diseases. However, it is not fully known if physicians in Saudi Arabia are aware of the oral-systemic disease links. Therefore, the study aimed to evaluate physicians' awareness of the oral-systemic disease links and their association with patients' referral to dentists and patients' access to oral care., Methods: This cross-sectional study was conducted (June 2019-January 2020) on physicians working in private and public hospitals in the Eastern province of Saudi Arabia. The physicians (n = 333) responded to a paper-based self-administered and pilot-tested questionnaire which inquired about their awareness of oral-systemic disease links and patient referral to dentists. The reliability of items of oral-systemic disease links was evaluated by calculating Cronbach's alpha (0.84)., Results: Most participants (92.8%) agreed/strongly agreed that oral health is associated with systemic health. Half of the sample (50.8%) referred patients to dentists during the last month. Almost 80.5% believed that more patients will be referred to the dentists because of their awareness of the oral-systemic disease links and 84% believed that more patients will access oral care services if patients were aware of the oral-systemic disease links. The participants who referred patients to the dentists during the last month (P = 0.038), believed that more patients will be referred (P = 0.001), and believed that more patients will access oral care (P = 0.003) demonstrated significantly higher oral-systemic disease links awareness score. The adjusted model showed patients' referral to dentist (OR = 1.96.10, P = 0.006) and believing in more patients accessing oral care (OR = 2.05, P = 0.044) were associated with significantly increased awareness of the oral-systemic disease links., Conclusion: Most physicians in the study were aware of the oral-systemic disease links. Increased awareness of the oral-systemic disease links was significantly associated with the referral of patients to dentists and belief in improved patients' access to oral care services., Competing Interests: The authors have declared that no competing interests exist.

Objective: To evaluate the influence of gross domestic product (GDP), government expenditures on education and health (% of GDP), per capita sugar consumption, and years of schooling on caries experience (DMFT) in 12-year-old children globally., Methods: The study analyzed global data of GDP, sugar consumption, years of schooling, expenditure on education and health, and DMFT from 69 countries. Information about DMFT and sugar consumption was retrieved from the World Health Organization while data of other study variables were available from the United Nations Development Program. Data were compared among low, middle, and high-income countries., Results: Sugar consumption (p = 0.005) and years of schooling increased progressively from low-income to high-income countries (p < 0.001). The greater percentage of GDP was spent on health (6.55 ± 2.94) than on education (3.48 ± 2.60). Upper-middle-income countries had the highest mean DMFT score (2.23 ± 1.23) and per capita sugar consumption (33.28 ± 14.06). High-income countries spent 4.33% of their GDP on education followed by low-income countries (3.92%) (p = 0.037). Similar trends were observed with regards to the percentage of GDP spent on health (p = 0.003). Univariate analysis showed a significant negative correlation between the percentage of GDP spent on education (r = -0.252, p = 0.037) and DMFT. Significant correlation remained in multivariate analysis; the percentage of GDP spent on education and DMFT in children (B = -0.128, p = 0.028)., Conclusion: Low, middle, and high-income countries demonstrated significant inequalities regarding caries experience, sugar consumption, and share of GDP spent on health and education. Increasing the share of GDP on education may reduce caries burden in children globally., (© 2021 American Association of Public Health Dentistry.)

Objective: The coronavirus disease (COVID-19) pandemic has disrupted healthcare systems worldwide, resulting in decreased and delayed hospital visits of patients with non-COVID-19-related acute emergencies. We evaluated the impact of the COVID-19 pandemic on the presentation and outcomes of patients with non-COVID-19-related medical and surgical emergencies. Method: All non-COVID-19-related patients hospitalized through emergency departments in three tertiary care hospitals in Saudi Arabia and Bahrain in June and July 2020 were enrolled and categorized into delayed and non-delayed groups (presentation ≥/=24 or <24 h after onset of symptom). Primary outcome was the prevalence and cause of delayed presentation; secondary outcomes included comparative 28-day clinical outcomes (i.e., 28-day mortality, intensive care unit (ICU) admission, invasive mechanical ventilation, and acute surgical interventions). Mean, median, and IQR were used to calculate the primary outcomes and inferential statistics including chi-square/Fisher exact test, t-test where appropriate were used for comparisons. Stepwise multivariate regression analysis was performed to identify the factors associated with delay in seeking medical attention. Results: In total, 24,129 patients visited emergency departments during the study period, compared to 48,734 patients in the year 2019. Of the 256 hospitalized patients with non-COVID-19-related diagnoses, 134 (52%) had delayed presentation. Fear of COVID-19 and curfew-related restrictions represented 46 (34%) and 25 (19%) of the reasons for delay. The 28-day mortality rates were significantly higher among delayed patients vs. non-delayed patients (n = 14, 10.4% vs. n = 3, 2.5%, OR: 4.628 (CI: 1.296−16.520), p = 0.038). Conclusion: More than half of hospitalized patients with non-COVID-19-related diagnoses had delayed presentation to the ED where mortality was found to be significantly higher in this group. Fear of COVID-19 and curfew restrictions were the main reasons for delaying hospital visit.

Rapid antigen detection of SARS-CoV-2 has been widely used. However, there is no consensus on the best sampling method. This study aimed to determine the level of agreement between SARS-CoV-2 fluorescent detection and a real-time reverse-transcriptase polymerase chain reaction (rRT-PCR), using different swab methods. Fifty COVID-19 and twenty-six healthy patients were confirmed via rRT-PCR, and each patient was sampled via four swab methods: oropharyngeal (O), nasal (N), spit saliva (S), and combined O/N/S swabs. Each swab was analyzed using an immunofluorescent Quidel system. The combined O/N/S swab provided the highest sensitivity (86%; Kappa = 0.8), followed by nasal (76%; Kappa = 0.68), whereas the saliva revealed the lowest sensitivity (66%; kappa = 0.57). Further, when considering positive detection in any of the O, N, and S samples, excellent agreements with rRT-PCR were achieved (Kappa = 0.91 and 0.97, respectively). Finally, among multiple factors, only patient age revealed a significant negative association with antigenic detection in the saliva. It is concluded that immunofluorescent detection of SARS-CoV-2 antigen is a reliable method for rapid diagnosis under circumstances where at least two swabs, one nasal and one oropharyngeal, are analyzed. Alternatively, a single combined O/N/S swab would improve the sensitivity in contrast to each site swabbed alone.

Background: Oral xylitol products have been labeled as a caries preventive measure; however, their use is still limited. This study aims to summarize the evidence on the effectiveness of xylitol-containing products in dental caries prevention with a focus on dental caries as the primary outcome rather than other pseudo outcomes., Materials and Methods: A structured literature search was conducted to identify the studies related to the efficiency of products containing xylitol for the prevention of caries. The literature search was conducted through the following databases: Medline, PubMed (Central), SCOPUS, Web of Science (WoS), Open Grey, and the Cochrane Library and included papers published between 1966 and March 2020. Fixed- and random-effect models were used to obtain pooled estimates through meta-analysis., Results: Evidence-based results of this study showed that xylitol is easily available in the form of various products, but clinically tested products are few in markets. The literature review has also concluded that the most effective xylitol product in caries prevention was (100%) xylitol, chewed or consumed three to five times per day, after meals with a total dose of 5-10 g of xylitol per day. Products included xylitol-containing lozenges, candies, and chewing gum, foods based on xylitol, and xylitol-containing toothpaste and mouth rinse. Results showed that xylitol-containing products significantly prevented caries compared with the other (control) non-xylitol products. Pooled estimates using the combined fixed and random effects of standardized mean difference were -0.099 [95% confidence interval (CI): -0.149, -0.049] and -0.089 (95% CI: -2.04, 0.026), respectively., Conclusion: This review concluded that xylitol should be part of an overall strategy to decrease and prevent dental caries. Dosage and frequency should be considered strictly when prescribing xylitol as a caries preventive measure., Competing Interests: There are no conflicts of interest., (Copyright: © 2022 Journal of International Society of Preventive and Community Dentistry.)

This study assessed the effect of nano-hydroxyapatite incorporation into resin infiltrant on the mineral content, surface tomography, and resin tag penetration of demineralized enamel. Forty specimens were exposed to a demineralized solution to form subsurface caries lesions. The lesions were treated with negative control, a resin infiltrant (ICON), ICON with 5% nano-hydroxyapatite (NHA, Sigma-Aldrich), or ICON with 10% NHA. Mineral density was assessed using microcomputed tomography scans at various stages of the experiment. Specimens were scanned by scanning electron microscope (SEM) for surface analysis and resin tag penetration. Analysis of variance was used to assess the difference among groups. Specimens treated with ICON and 5% or 10% NHA showed the most favorable mineral density regarding the percent change in mineral content (32.4% and 29.7%, respectively), compared to 8.8% in teeth treated with ICON alone and -1.8% in teeth in the control group. SEM showed that teeth treated with ICON or ICON with 5% or 10% NHA had a smooth surface. The resin penetration in all tested groups showed high-quality resin tags, regardless of the treatment protocol. NHA resin infiltrant (ICON with 5% or 10% NHA) effectively enhanced the artificial enamel caries surfaces in terms of smooth surfaces, mineral density, and resin penetration.

The incorporation of remineralizing additives into sealants has been considered as a feasible way to prevent caries by potential remineralization through ions release. Thus, this systematic review aimed to identify the remineralizing additives in resin-based sealants (RBS) and assess their performance. Search strategies were built to search four databases (PubMed, MEDLINE, Web of Science and Scopus). The last search was conducted in June 2020. The screening, data extraction and quality assessment were completed by two independent reviewers. From the 8052 screened studies, 275 full-text articles were assessed for eligibility. A total of 39 laboratory studies matched the inclusion criteria. The methodologies used to assess the remineralizing effect included microhardness tests, micro-computed tomography, polarized-light microscopy, ions analysis and pH measurements. Calcium phosphate (CaP), fluoride (F), boron nitride nanotubes (BNN), calcium silicate (CS) and hydroxyapatite (HAP) were incorporated into resin-based sealants in order to improve their remineralizing abilities. Out of the 39 studies, 32 studies focused on F as a remineralizing agent. Most of the studies confirmed the effectiveness of F and CaP on enamel remineralization. On the other hand, BNN and CS showed a small or insignificant effect on remineralization. However, most of the included studies focused on the short-term effects of these additives, as the peak of the ions release and concentration of these additives was seen during the first 24 h. Due to the lack of a standardized in vitro study protocol, a meta-analysis was not conducted. In conclusion, studies have confirmed the effectiveness of the incorporation of remineralizing agents into RBSs. However, the careful interpretation of these results is recommended due to the variations in the studies' settings and assessments.

The burden of autism spectrum disorder (ASD) in Saudi Arabia remains unclear with a dearth of literature, which focus on risk factors, prevalence, or interventions. This study is a review of the published literature related to dental experiences of children with ASD in Saudi Arabia. Twenty-two studies were included in this review, based on the predefined inclusion criteria which examined dental disease prevalence in children with ASD, identified the risk factors and the potential barriers to oral care. Results uncovered a lack of systematically published studies from Saudi Arabia which might have led to the limited development of effective oral health policies in the Kingdom. Identification of research gaps and potential intervention policies are needed to improve the oral health and quality of life of children with ASD in Saudi Arabia., Competing Interests: The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (© 2021 The Author. Production and hosting by Elsevier B.V. on behalf of King Saud University.)

Objective: To assess the remineralizing abilities and compare the flexural strength and elastic modulus of different bioactive pit and fissure sealants., Materials and Methods: Human enamel samples were randomly and blindly sealed with one of the following bioactive materials: BioCoat (Bc), ACTIVA KIDS (Av) and BeautiSealant (Bu). Seal-it (Si) was used as a non-bioactive sealant beside a control blank (B) group with no sealant. The sealed samples were subjected to a pH-cycling model (7 days of demineralization-remineralization cycles). The enamel surface hardness change (SHC), scanning electron microscopy-energy dispersive X-ray spectroscopy (SEM-EDX) and polarized light microscopy were used to assess the remineralizing abilities of the studied sealants. Flexural strength and elastic modulus were also assessed following the ISO 4049 protocols. One-way analysis of variance (ANOVA) was used to analyze the results., Results: Bc sealant showed the highest FS and EM ( p < 0.05). The contact with Bc and Bu sealants showed significantly lower %SHL ( p < 0.05) in comparison to the other. These findings were supported by the results of SEM-EDX and polarized imaging by showing higher percentages of calcium and phosphate ions with the former sealants and thinner demineralized enamel bands., Conclusion: In this study, Bc showed the highest flexural strength. Bc and Bu sealants outperformed the other studied sealants in terms of their remineralization abilities.

Background: Currently, world is suffering from a respiratory disease names as COVID-19. This is a novel coronavirus (n-CoV), a new strain which has not been previously identified in humans and it has spread in more than 100 locations internationally due to which it is termed as "public health emergency of international concern" (PHEIC) by the World Health Organization So far, no study done as yet to assess whether the dental workforce is aware about the facts and myths related to Covid-19 awareness., Objective: This study aims to analyze and compare the level of awareness about the facts and myths related to COVID-19 amongst faculty, dental students and prep year students of the College of Dentistry (COD) as part of an awareness campaign., Methods: An awareness test about COVID-19 was designed using information from the World Health Organization's (WHO) Myth Busters Awareness webpage. The questionnaire was administrated online to faculty and students, of the College of Dentistry and preparatory year students who had applied for the admission to the dental college using a secure enterprise online assessment platform (Blackboard). The tests were administered over a period of three months from March to June 2020. A written informed consent was obtained., Results: The online COVID-19 awareness test was administered to 810 participants, out of which 325 (40%) were prep year students, 429(53%%) were dental students, and 56 (7%) were faculty members. Analysis of the results showed that 86% of the Faculty were able to correctly identify the facts and the myths related to COVID-19 followed by 81% of the prep year students and 74% of the dental students. Preparatory year student's knowledge related to COVID-19 was found to be high when compared to dental students (26.47±4.27, 23.67±6.2). Student to faculty knowledge score did not differ significantly (p = 0.808)., Conclusion: This study reports about a successful pilot test conducted to assess the perceived knowledge about facts and myths related to corona virus amongst the dental workforce., Competing Interests: The authors have declared that no competing interests exist.

This study aims to assess differences in biofilm bacterial composition between patients with low and high caries. Patients without a medical problem and with no history of antibiotic use, mouth wash or fluoride application in the previous 3 months were recruited. Caries was recorded at cavitation level; score was calculated by a national mean (dmft of 4.8 and DMFT of 2.7). Pooled biofilm samples were collected from mesial, distal, buccal, lingual, and occlusal surfaces. Based on caries experience, individuals were classified into low and high caries and both groups were compared regarding bacteria identified using 16S rRNA gene sequencing, and molecular phylogenetic analysis of the isolates was performed. A total of twenty seven randomly selected samples with low ( n  = 13) and high ( n  = 14) caries. Identification of oral bacteria was performed using 16S rRNA sequence, Rothia mucilaginosa and R. aeria were identified in low caries individuals, while R. dentocariosa was detected in high caries individuals. Two Streptococcus spp. were identified only in low caries S. salivarius and S. gordonii whereas S. sanguinis, S. mitis, S. sinensis, S. rubneri, S. vestibularis, S. cristatus and S. massiliensis were identified only in individuals with high caries. This study revealed the absence of R. mucilaginosa in the high caries subjects and its coexistence with the low caries subjects. Streptococcus mutans was insignificant contributor of caries among samples, while, Streptococcus sanguinis was the main constituent of high caries Saudi patients., Competing Interests: The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (© 2021 The Author(s).)

Parental attitudes toward the importance of oral hygiene have an impact on the formation of their children's oral habits and the prevalence of oral diseases. Our aim was to assess the association between parents' education and socioeconomic status and their children's oral health. A cross-sectional study was conducted between the years of 2018 and 2020 in the eastern province of Saudi Arabia among primary school children. Two pre-calibrated dentists performed the clinical examination of the children, and a self-administered validated questionnaire was obtained from their parents. Clinical examination was performed on 589 children with an age range of 3 to 14 years, where 47% were males and 53% were females, 70% with dental caries. Both parents with higher education and a high monthly income were significantly associated with lower prevalence of decayed teeth in their children, respectively. Mother's education, age, gender and application of sealant were found significantly associated with the high prevalence of caries. High prevalence of tooth decay was reported among school children in the eastern province of Saudi Arabia. A high educational level of parents and high income were correlated with a lower prevalence of decayed teeth, similarly to the situation in the case of presence of medical insurance.

This study aimed to analyze the enamel remineralization efficacy of a novel fluoridated bioactive glass (F-BG) toothpaste compared to a standard fluoride toothpaste. Seventy-two enamel blocks (N = 72) were divided into groups of twenty-four blocks according to the toothpaste exposure-group 1: brushed with distilled water, group 2: brushed with fluoride toothpaste (Colgate TM ), and group 3: brushed with F-BG toothpaste (BioMinF TM ). Pre-brushing, enamel blocks were demineralized using 6 wt.% citric acid (pH = 2.4). Tooth brushing was performed using a mixture of respective toothpaste and artificial saliva (AS), and each enamel block received 5000 linear strokes. The samples were assessed for surface micro-hardness (to estimate Vickers hardness number, VHN), surface roughness (Ra), and volume loss/gain using micro-computed tomography (micro-CT). The highest increase in the VHN was noticed for group 3 (117.81) followed by group 2 (61.13), and all the intragroup comparisons were statistically significant ( p < 0.05). Demineralization increased the Ra values, and a decrease was observed post-remineralization for all the groups. The maximum Ra decrease was observed for group 3 (-223.2 nm) followed by group 2 (-55.6 nm), and all the intragroup comparisons were again statistically significant ( p < 0.05). Micro-CT investigation revealed that the enamel volume decreased after demineralization and increased after remineralization among all groups. The F-BG toothpaste showed greater enamel surface micro-hardness (increased VHN), smoother surface (low roughness), and better volume restoration (remineralization) in comparison to the fluoride toothpaste.

Background: Early use of high-flow nasal cannula (HFNC) decreases the need for endotracheal intubation (EI) in different respiratory failure causes. While HFNC is used in coronavirus disease 2019 (COVID-19)-related acute hypoxemic respiratory failure (AHRF) under weak recommendations, its efficacy remains to be investigated., Objectives: The primary objective was to examine HFNC efficacy in preventing EI among COVID-19 patients with AHRF. Secondary objectives were to determine predictors of HFNC success/failure, mortality rate, and length of hospital and intensive care unit (ICU) stay., Patients and Methods: This is a prospective cohort study conducted at a single tertiary care centre in Saudi Arabia from April to August 2020. Adult patients admitted to the ICU with AHRF secondary to COVID-19 pneumonia and managed with HFNC were included. We excluded patients who were intubated or managed with non-invasive ventilation before HFNC., Results: Forty-four patients received HFNC for a median duration of 3 days (interquartile range, 1-5 days). The mean age was 57 ± 14 years, and 86% were men. HFNC failure and EI occurred in 29 (66%) patients. Patients in whom HNFC treatment failed had a higher risk of death (52% versus 0%; P = 0.001). After adjusting for confounding factors, a high SOFA score and a low ROX index were significantly associated with HFNC failure (hazard ratio [HR], 1.42; 95% confidence interval [CI], 1.04-1.93; P = 0.025; and HR, 0.61; 95% CI, 0.42-0.88; P = 0.008, respectively)., Conclusions: One-third of hypoxemic COVID-19 patients who received HFNC did not require intubation. High SOFA score and low ROX index were associated with HFNC failure., Competing Interests: There are no conflicts of interest., (Copyright: © 2021 Saudi Journal of Medicine & Medical Sciences.)

Objective: The aim of this study was to investigate the prevalence of dental anomalies in the Eastern Province of Saudi Arabia using the digital Orthopantomography (OPG)., Methods: A retrospective radiographic study was performed in which digital OPGs of 1189 subjects, ages ranging between 7 and 65 years were reviewed, and 1104 fulfilled inclusion criteria. Statistical analysis was performed. The OPGs were reviewed for congenitally missing teeth, impactions, ectopic eruption, supernumerary teeth, odontomas, dilacerations, taurodontism, dens in dente, gemination and fusion., Results: OPGs of 1104 patients with mean age 35.32 ± 16.63 were included. The total prevalence of developmental anomalies in this study was 36.3% (401/1104). Male and female subjects with anomalies were 133 (33.2%) and 268 (66.8%) respectively. The prevalence of dilacerated teeth 300 (30.2%), congenitally missing teeth was 246 (24.7%), supernumerary teeth 18 (1.8%), talon cusp and taurodontism were seen in one patient each 1 (0.1%). Of these, a total of 15 (1.5%) anomalies were noted in pediatric patients., Conclusions: Dilaceration was the most prevalent anomaly (30.2%) in the studied sample followed by congenitally missing teeth (23.4%). Talon cusp, concrescence/fusion, and taurodontism were the least prevalent anomalies., Competing Interests: The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (© 2021 Published by Elsevier B.V. on behalf of King Saud University.)

Objective: To evaluate empathy and its related factors among undergraduate dental students and interns enrolled in a public dental college in Dammam, Saudi Arabia., Materials and Methods: This cross-sectional study used the Jefferson Scale of Empathy-Health Profession Students (JSE-HPS) version to determine empathy in 362 dental students and interns in Dammam, Saudi Arabia. The JSE-HPS is a 20-item 7-point Likert scale questionnaire, and its score ranges from 20 to 140 with high values indicating increased empathy. Influences of age, gender, class year, previous year's grade point average (GPA), educational attainment of parents, and monthly family income on empathy were evaluated., Results: Of 501 enrolled students and interns, 362 returned completed questionnaires, and the response rate of the study was 72%. The sample's empathy score (JSPE-HPS scale) ranged from 70 to 129 with a mean of 96.75 (±13.76). Most participants believed that empathy is important for effective communication with patients (96.1%) and can improve the provider-patient relationship (95.6%). Females demonstrated a significantly higher mean empathy score (99.98 ± 14.01) than males (92.72 ± 12.35) ( P < 0.001). Similarly, the participants with high GPA (98.06 ± 13.69) had significantly greater mean empathy scores than those with low GPA (94.84 ± 13.68) ( P =0.029). The mean empathy score increased significantly from junior students (3 rd and 4 th year students) to senior students (5 th and 6 th year students) and interns ( P =0.008). Multiple linear regression analysis showed that class year ( B  = 2.03, P =0.006) and GPA ( B  = 8.67, P =0.003) were significant factors associated with empathy., Conclusions: Empathy is important for effective patient communication and improved provider-patient relationship. Female gender, high GPA, and class years were associated with empathy. Empathy should be integrated into dental curricula for effective student learning and positive patient care outcomes., Competing Interests: The authors declare that there are no conflicts of interest., (Copyright © 2021 Muhammad Nazir et al.)

Purpose: In 2017, Saudi Arabia introduced a 120% tax on energy drinks and a 50% tax on soft drinks. The impact of this policy on the consumption of sugar-sweetened beverages (SSB) among schoolchildren is not known in this country. The present study evaluated the impact of the excise tax on SSB consumption in the tri-city metropolitan area of Dammam-Khobar-Dhahran, Eastern Province, Saudi Arabia., Materials and Methods: A repeated cross-sectional design was used to examine the difference between pre- and post-tax SSBs consumption among schoolchildren (12-14 years old) in Dammam-Khobar-Dhahran cities. A beverage-consumption frequency questionnaire was completed by 453 participants before the tax implementation and 334 participants after the tax implementation. The tax on soft drinks was increased by 50% and on energy drinks by 120%. Pre-tax data were collected in May 2017 and post-tax data in April 2018., Results: The proportion of participants who consumed energy drinks was 46.1% (95% CI: 42-51) before tax implementation, decreasing to 38.4% (95% CI: 33-44) after tax implementation, a reduction of nearly 8%. 92.5% (95% CI: 90-95) of the participants consumed soft drinks before tax implementation and 94.6% (95% CI: 92-97) did so after tax implementation, an increase of about 2%., Conclusions: The study showed no statistically significant impact of tax implementation on the consumption of energy drinks and soft drinks in this sample of children.

Objective: To evaluate awareness and attitudes of dental students and interns about patient safety culture in Dammam, Saudi Arabia., Materials and Methods: This cross-sectional study was conducted on 272 undergraduate dental students and interns using the Safety Attitudes Questionnaire (SAQ) from November 2019 to January 2020. The SAQ consists of six domains: teamwork climate, safety climate, job satisfaction, stress recognition, perception of management and work conditions. The score of SAQ ranges from 0 to 100, and a cut-off ≥75 is considered a positive attitude of patient safety., Results: The study included 47.1% of males and 52.9% of females with a mean age of 22.58 ± 1.3 years. Few participants (9.9%) showed a positive attitude of patient safety culture. Nearly one-third of participants (35.7%) attended a course on patient safety and 31.6% reported experiencing adverse events by them or their families. Out of six domains, job satisfaction showed the highest mean score (70.25) and 75.4% of participants felt proud to practise in the dental clinic. Female students demonstrated a significantly higher mean score of stress recognition (64.28 ± 18.98) than male students (56.98 ± 22.53) (P 0.004). The mean SAQ score increased significantly from fourth year students to interns (P < .001)., Conclusions: A small percentage of students demonstrated a positive attitude of patient safety and only one-third attended a patient safety course. The job satisfaction domain was highly rated and patient safety culture significantly improved from junior to senior students. Dental curricula should include patient safety courses to improve the quality and safety of patient care., (© 2020 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.)

Background/aims: Traumatic dental injuries (TDIs) in children frequently occur in schools where teachers can play an important role in their management. Therefore, the aim of this study was to assess schoolteachers' knowledge and the factors that determine their management of TDIs., Materials and Methods: This cross-sectional study was conducted in the Eastern Province of Saudi Arabia from January to June 2018. Data were collected through an online pre-tested questionnaire. The questionnaire collected demographic data and included questions that assessed participants' knowledge and management practices for TDI. Chi-square test and multivariate logistic regression analysis were performed., Results: A total of 443 teachers were included in the study, and 72.5% of the participants were females. The prevalence of TDIs was 49% yet only 7.2% of the participants reported managing dental trauma. Fights (22.8%) and falls (21.7%) were the most common causes of dental injuries. Mean TDI knowledge score was 2.75 ± 2.05, but only 47.2% were willing to receive training about TDI management. Regarding supportive environments, 75.8% of teachers reported having safety playgrounds, however 10.6% reported having a nurse in schools. After controlling for other variables, male respondents were 3.85 times more likely to manage TDIs than female respondents (P = .001). Similarly, previous knowledge of dental trauma management (OR = 4.32, P < .001) and having less than 50 students in class (OR = 2.61, P = .021) were significantly associated with TDI management., Conclusion: The teachers demonstrated inadequate knowledge about TDIs which were highly prevalent in primary schools. Male gender, having knowledge of TDI management and teaching less students were associated with increased likelihood of TDI management. There is a crucial need for the reinforcement of policies that support school safety and a supportive environment., (© 2020 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.)

Background: The ''gate control" theory suggests pain can be reduced by simultaneous activation of larger diameter nerve fibers using appropriate coldness, warmth, rubbing, pressure, or vibration. This study investigated the efficacy of a device combining cold and vibration, for needle-related procedural pain in children. Methodology . A total of 51 children aged 5-12 years participated in this randomized controlled clinical trial. Half of the children were in the control group and received maxillary buccal infiltration, by injecting 1.8 ml of 2% lidocaine with 1 : 100,000 adrenaline using topical anesthesia 20% benzocaine gel for 15 seconds, while the other half were in the test group and received the same anesthesia using a commercially available external cold and a vibrating device. A face version of Visual Analogue Scale (VAS) was used as a subjective measure to assess the child's pain experience. The parents were requested to evaluate the child's ability to tolerate pain using a behavioral/observational pain scale. Sound, Eyes, and Motor (SEM) scale and Faces, Legs, Activity, Cry, and Consolability (FLACC) scale were used to record the child's pain as perceived by the external evaluator. T -test or Mann-Whitney U -test was used for scale variables, paired sample T -test or Wilcoxon rank t -test was used for before and after data, and chi-square was used for categorical variable, based on the results of normality test., Results: The results showed a statistically significant reduction in pain after the injection for the test group compared with control using VAS scale (mean = 6.68 (1.09) and 8.42 (0.50); p =0.001) and FLACC scale (mean = 5.92 (1.05) and 8.16 (0.54); p =0.002), but not when using SEM scale (mean 3.22 (0.42) and 4.24 (2.74); p =0.08)., Conclusions: Combined external cold and vibrating devices can be an effective alternative in reducing experienced pain and fear in children undergoing infiltration dental anesthesia. This study was registered with clinical trial registry of the United States National Institutes of Health (NIH) at ClinicalTrials.gov (NCT03953001)., Competing Interests: The authors declare that there are no conflicts of interest regarding the publication of this paper., (Copyright © 2021 Muhanad AlHareky et al.)

The novel coronavirus disease 2019 (COVID-19) has been acknowledged as a pandemic by the World Health Organization (WHO). The aim of this study was to review guidelines issued by different health regulatory bodies amid the COVID-19 outbreak and financial constraints faced by dentists globally. Relevant papers and news articles were identified in Google Scholar and PubMed. The search was made using the keywords "COVID-19," "COVID-19 and dentistry," and "the financial impact of COVID-19 on dentistry." Studies and news articles published in languages other than English were excluded and a final selection of 53 relevant studies, guideline documents, and news articles were made. The outbreak of COVID-19 has affected all businesses including general dental practices, which are suffering huge financial losses as they have been advised to provide only emergency dental care. These recommendations should be appreciated as a positive step but they have caused serious financial implications for dental practices. It can be concluded that current dental practice globally is limited to the provision of emergency treatments only. This step is appreciative, but has resulted in huge financial losses sustained by dental care providers (DCPs) worldwide. The governments and health regulatory bodies of developed countries are trying to help dental practices to evolve from this troublesome situation, but there is no visible policy from the underdeveloped world that could help the DCPs to save their practices from closing down due to the financial constraints., Competing Interests: None declared., (European Journal of Dentistry. This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial-License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/).)

The novel coronavirus disease 2019 (COVID-19) has affected the whole world and has now been declared a Pandemic by the World Health Organization (WHO). Although the mortality rate of this virus is low, it is especially potent against people with underlying systemic conditions. Dentistry is a profession where the doctor, as well as the dental staff, works in close vicinity to the patient's mouth. Dental education has two core components; didactic and clinical training (including patient care). Dental education has been interrupted in the past due to certain events (Arab Spring and SARS outbreak). Currently, the pandemic of COVID-19 has disrupted dental education globally as most of the dental schools and universities in the world have closed amidst the COVID-19 outbreak. Teledentistry is a subspecialty of telemedicine that helps in the provision of educational activities, advice, and diagnosis about treatment over a distance with the help of technology like video conferencing. The current overview summarizes the potential role of teledentistry in continuing the dental educational process in terms of delivery of didactic components, clinical training, and patient care. It can be concluded that with modern updated devices and tools, teledentistry can be an effective way to prevent disruption of dental education and it can be utilized in continuing the dental educational process in this critical time of the COVID-19 outbreak., (Copyright: © Pakistan Journal of Medical Sciences.)

Objectives: Parents play a crucial role in health-related practices of children with autism spectrum disorder (ASD). This study assessed the association between oral health status and oral health practices of children with ASD in relation to their parental attitudes and comfort in providing oral care., Methods: This cross-sectional study included 75 children with ASD attending the special needs schools in Eastern Saudi Arabia from 2015-2018. Parents responded to a self-administered questionnaire assessing their attitudes toward oral health and comfort in providing oral care for children. The clinical examination assessed dental caries (decayed, extracted, and filled: (DMF and def)), gingival disease, and plaque accumulation. The Pearson correlation coefficient was used to assess the relationship between the study variables, while ANOVA followed by post hoc was used to assess the differences., Results: Prevalence of dental caries in primary teeth was 76% and 68% in the permanent dentition with a mean of 0.85 ± 1.9 and 1.03 ± 2.9, respectively. Thirty-one participants had gingival problems, mean gingival index was 1.03 ± 0.88, and mean plaque index was 0.95 ± 0.43. Half of the parents supervised their children's brushing, which was significantly associated with plaque accumulation ( p  = 0.004), gingival disease ( p  < 0.0001), and def ( p  = 0.02). Parental attitudes and comfort in providing oral health care were not associated with oral health status of ASD children; however, positive parental attitudes were associated with lower sugar consumption ( p  = 0.043). An inverse correlation was observed between comfort in providing oral health care with gingival and plaque scores r  = -0.18 and -0.23, respectively., Conclusions: The data are indicative of poor oral health practices and status among ASD children. Parents' oral health care practices seem to be reactive rather than proactive. Positive parental attitudes were associated with lower sugar consumption. Greater comfort in providing care was negatively correlated with plaque accumulation and gingival problems., Competing Interests: The authors declare that they have no competing interests., (Copyright © 2020 Jehan AlHumaid et al.)

Objective: To evaluate the association between oral health problems and sociodemographic factors with the intention to quit smoking and join the tobacco cessation program among schoolchildren., Materials and Methods: This cross-sectional study included a sample of 10-12 grade male students from public high schools in different cities of the Eastern province of Saudi Arabia. Schoolchildren responded to a pilot-tested questionnaire about self-reported oral health problems and the intention to quit smoking. Bivariate and multivariate logistic regression analyses were performed., Results: Out of 587 schoolchildren, 199 were smokers with a smoking prevalence of 33.9%. Significantly higher proportions of smokers than nonsmokers had tooth sensitivity ( P  = 0.029) and dryness of the mouth ( P  = 0.001). Most smokers (75.9%) had a family history of smoking, and 51.8% started smoking within the last two years. Tooth sensitivity (56.3%), dental cavities (52.8%), and dental pain (44.7%) were highly prevalent among smokers. About one-third of smokers expressed their intention to quit smoking (38.2%) and join a smoking cessation program (33.7%). Tooth sensitivity (OR = 3.7, P  = 0.004) and dental pain (OR = 2.84, P  = 0.014) were significantly associated with quitting smoking. In addition, smokers with tooth sensitivity (OR = 3.22, P  = 0.007) had higher odds of joining a smoking cessation program than those without tooth sensitivity. The smokers who started smoking within the last two years (OR = 3.97, P  = 0.002) were more likely to quit smoking than those who initiated smoking for more than two years., Conclusion: Oral health problems were highly prevalent among smokers. Tooth sensitivity was significantly associated with quitting smoking and joining a cessation program in children. The awareness about the adverse effects of smoking on oral health should be part of regional, national, and global tobacco prevention policies and programs., Competing Interests: The authors declare that there are no conflicts of interest regarding the publication of this paper., (Copyright © 2020 Muhammad Nazir et al.)

This commentary summarizes the psychological effects of the COVID-19 pandemic and the people's response to the steps taken by the Saudi government to decrease the impact of this psychological trauma and stress. It is concluded that people are responding well to the threat of psychological trauma imposed by this disease and are following the instructions of their government and health regulatory body. (PsycInfo Database Record (c) 2020 APA, all rights reserved).

Leadership courses are being increasingly integrated into dental curricula. The study aimed to assess the validity and reliability of student evaluation of teaching (SET) instrument among dental students and to evaluate the effectiveness of teaching in a new leadership course over a period of three years. This cross-sectional study was conducted on fourth-year undergraduate dental students ( N  = 260) who took a practice management course over three consecutive years from 2014 to 2016. A 29-item SET questionnaire was administered among students who were willing to participate in the study. Out of 260 students, 185 returned completed surveys and the response rate was 71.15%. Factor analysis (principal component analysis) showed the validity of four dimensions of the SET instrument. Total variance explained by four dimensions was 62.80%. Cronbach's alpha for the instrument was 0.95 and each dimension had fairly high internal consistency (>0.80). Treating students with respect (94%), accepting different viewpoints of students (94.1%), being flexible/open-minded (92.5%), and preparedness in the course (91.9%) were the most common effective teaching traits. Over the period of three years, 16 items showed improvement in teaching and there was a significant improvement in four items ( P < 0.05). In conclusion, it was found that SET is a valid instrument to evaluate the effectiveness of teaching in nonclinical courses in dentistry. This instrument should be used longitudinally to compare the effectiveness of teaching., Competing Interests: The authors declare that there are no conflicts of interest regarding the publication of this paper., (Copyright © 2020 Muhammad Nazir et al.)

Background: Dental students face a variety of challenges as they enter the dental profession. The study aimed at assessing dental students' opinions about their perceived future career challenges in the dental profession and the associated factors., Materials and Methods: This cross-sectional study of 637 students representing different public and private dental colleges was conducted in Saudi Arabia. The participants responded to a pretested questionnaire conducted online., Results: There were 59.7% ( n  = 380) of males and 40.3% ( n  = 257) of females, and the mean age of the students was 21.80 (±2.14) years. The majority of participants thought that they will have difficulties in establishing their private clinic (63.9%) and finding a government job (>60%). Senior students were more likely to perceive getting a government job (OR = 1.79, P = 0.02), securing an admission into specialty program (OR = 2.75, P = 0.001), and establishing a private dental clinic (OR = 2.51, P = 0.001) as future career challenges than junior students. Similarly, female gender was associated with increased perception of challenges about finding a government job (OR = 1.911, P = 0.002), getting an admission into specialty program (OR = 1.5, P = 0.038), and establishing a private clinic (OR = 2.02, P = 0.001). In addition, low academic score and low level of father's education were associated with increased odds of perceiving challenges of finding a government job and getting an admission into specialty programs., Conclusions: Establishing a private clinic and getting a government job were the most common career challenges. Senior students, female students, and students with low academic scores had increased likelihood of facing employment and academic-related difficulties., Competing Interests: The authors declare that there are no conflicts of interest regarding the publication of this paper., (Copyright © 2020 Sarah Fita et al.)

Background: Chemomechanical methods such as Papacarie were developed as alternate dental caries removal methods to overcome major disadvantages of the conventional drilling technique. However, few studies have demonstrated the efficacy of Papacarie for caries removal using scanning electron microscope (SEM)., Objectives: The purpose of this study was to compare the efficacy and efficiency of Papacarie and the conventional bur method in caries removal from primary teeth., Materials and Methods: In this in vitro study, 30 freshly extracted, human primary molars with dentinal caries were obtained from the outpatient clinics at the Dental Hospital of Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia. Each tooth was sectioned mesiodistally into two halves through the center of the lesion, and each half was randomly subjected to caries removal by Papacarie (Group I) and excavation using the conventional bur method (Group II). Time taken (efficiency) for removal of caries was noted using a stopwatch. Samples were then examined under SEM for presence of bacterial colonies (efficacy). For efficiency, data were analyzed using chi-square, and for efficacy, using t -test., Results: There was no significant difference in the presence of bacteria in both groups under SEM (Papacarie = 23.3%; conventional method = 16.7%; P = 0.52). However, significantly more time was taken for caries removal with Papacarie (mean = 351.56 s) than with the conventional bur method (mean = 158.41 s) ( P < 0.0001)., Conclusion: Papacarie is as effective in removing dentinal bacteria as the conventional caries removal method but is less efficient, as the time taken for excavation was longer., Competing Interests: There are no conflicts of interest., (Copyright: © 2019 Saudi Journal of Medicine & Medical Sciences.)

Background and Aims: Monitoring oral diseases is needed to allocate resources, plan health services and train dental workforce. Caries is one of the oral diseases most commonly included in oral health surveillance systems. The present study assessed (1) caries data availability in the administrative regions of Saudi Arabia and (2) factors associated with this availability., Methods: We collected caries data in the period 2008-2018 in Saudi Arabia (outcome variable). The explanatory variables included region-level factors: (a) socio-economic indicators (percentage of individuals with university education, percentage of category A governorates, percentage of owned houses, households with computers, internet and smart phones) and, (b) oral health research potential indicators (number of Dental Public Health (DPH) specialists, Ministry of Health (MoH) dentist to population ratio and number of dental schools). ArcGIS was used for data visualization and logistic regression was used for analysis., Results: Twenty-two studies provided caries data for 46.2% of the regions which were inhabited by 84.7% of the population. Region-level data availability was associated with the number of dental schools (OR = 1.63) with 61.5% of the regions correctly classified. More regions were correctly classified when population to MoH dentist ratio (76.9%) and the number of DPH specialists (92.3%) were included., Conclusions: Caries data were available for half of the administrative regions in Saudi Arabia and data availability was associated with higher number of dental schools. The presence of DPH specialist provided the critical mass to collect caries data.

Objective: This study assessed the association between caries preventive measures including regular dental checkups, twice a day tooth brushing using fluoridated toothpaste and pit and fissure sealants on one side and the presence of caries among primary schoolchildren in the Eastern Province of Saudi Arabia., Materials and Methods: A cross-sectional study was conducted in 2016 including 1198, 6-12-year-old children from 13 randomly selected schools. The outcome variable was caries presence. The explanatory variables were brushing twice a day using fluoridated toothpaste, the presence of sealant and regular dental checkups. Multivariable logistic regression model was conducted to assess the associations controlling for confounders (age, gender, ability to get treatment, being health insured and school) using SPSS version 20.0., Results: Data of 921 participants (83.8%) were available. The prevalence of caries was 63.5%, whereas 67.6% brushed their teeth twice a day, 28.3% visited the dentist for regular checkups and 7.6% had sealant. In multivariable regression, out of the three main explanatory variables, only having regular checkups was significantly associated with caries presence (OR = 0.65, 95% CI = 0.48, 0.88)., Conclusions: Lower odds of caries presence were associated with regular dental checkups but not with regular brushing or having sealant.

Aim: The present randomized clinical study compared the 18 months performance of self-adhering flowable composite with a conventional flowable composite in anterior Class V restorations., Materials and Methods: Totally, 20 patients, each with two moderate cervical carious lesions, participated in this single-center study. Forty restorations were allocated on a random basis by one examiner not involved in the restoration or the evaluation procedures, In each patient, one lesion was allocated to be restored using self-adhering flowable composite [Fusio liquid dentin (FL)] and the other to be restored using conventional flowable composite [Tetric Flow (FF)]. The allocation sequence of the restorations was concealed from the operator in sequentially numbered, opaque, sealed, and stapled envelopes. An operator restored all the preparations in accordance to the manufacturer's instructions. Finishing and polishing of the restorations were done immediately after placement. Evaluation of the restorations was done in accordance to the United States Public Health Services (USPHS), modified Ryge criteria. Statistical analysis was completed with Statistical Package for the Social Sciences (SPSS) version 20.0 (IBM Product, Chicago, USA)., Results: One case could not be reassessed at 18 months follow-up in both groups. No significant differences were detected between the tested materials from baseline to those of 18 months using the modified USPHS criteria., Conclusion: Self-adhering flowable composite exhibited acceptable clinical performance comparable with the conventional flow-able composite in anterior Class V restorations over an 18-month period. Nevertheless, the findings of this study must be validated by a longer clinical study., Clinical Significance: Self-adhering flowable composite exhibited clinical performance comparable with the conventional flowable composite in Class V restoration.

Objective: The aim of the present study was to directly compare Carisolv and Papacarie regarding the volume of removed tissue (RT) and dentin mineral density (DMD) after excavation., Materials and Methods: Twenty permanent molars were randomized into two groups where caries was excavated using Carisolv or Papacarie followed by removal of softened tissue by a blunt instrument. X-ray microtomography was used to scan teeth before and after excavation generating two- and three-dimensional images that were used to calculate the percentage of RT relative to baseline tooth tissue volume and DMD that was categorized into sound dentin (>1.11 g/cm 3 ) and residual caries (≤1.11 g/cm 3 ). The two groups were compared using t-test Fisher exact test., Results: DMD was higher after Papacarie than Carisolv (mean = 1.70 and 1.14, p = .14) with higher percentage of cases with sound dentin (70 and 60%, p = 1.00). The percentage of RT was lower after Papacarie than Carisolv (7.40 and 8.95%, p = .31) with 22.95% less RT in cases that ended with sound dentin after excavation., Conclusions: There was higher DMD, more sound dentin and less RT when Papacarie was used compared to Carisolv.

Background: Health education advocates regular dental visits to improve oral health. There is a need to verify the outcomes associated with various dental visits patterns., Objective: To assess the relationship of reported and clinically assessed oral health outcomes in Saudi children with their dental visits' pattern., Methods: This cross-sectional study included 6-12-year-old schoolchildren from six cities in the Eastern Province of Saudi Arabia in 2015. Parents responded to a questionnaire about dental visit patterns. Through a clinical examination, the presence of caries, sealants and need for referral was assessed. Univariate and multivariate regression was used to assess the association between dental visit patterns and pain in the past 6 months, presence of untreated caries and need for referral after controlling for confounders., Results: Of the 3000 questionnaires distributed, 2306 (76.9%) parents responded. Significantly higher odds of pain were associated with visiting when in dental pain (odds ratio = 6.81) and never visiting a dentist (odds ratio = 3.44), whereas significantly lower odds were associated with regular checkups (odds ratio = 0.28). No significant association was observed with visits after recall by dentists., Conclusion: Regular checkups initiated by parents are associated with better reported oral health outcomes in terms of pain, while recall by dentists has no impact on oral health., Competing Interests: There are no conflicts of interest.

Objectives: This study assessed dentists' intention in eight Arab countries to report suspected exposure to violence among patients and factors associated with this intention based on the theory of planned behaviour., Methods: A cross-sectional study was conducted in 2016 including a convenience sample of dentists practising in public, private and academic sectors in Algeria, Egypt, Jordan, Kuwait, Libya, Palestine, Saudi Arabia and Yemen. Respondents answered a self-administered questionnaire collecting information about personal and professional background and perceived ability to identify victims of violence. The questionnaire assessed (on a scale from 1 to 10 using six negative statements) dentists' perception of healthcare system mandated reporting of suspected violence. Six statements were used to assess professional attitude towards reporting suspected violence. Logistic regression was used to assess the association between intention to report suspected violence and perceived ability, perception and attitude adjusting for confounders., Results: The response rate was 65.2% (n=2936/4506) from general practitioners (70.9%) of mean age=31 years with 56.7% women. Of those, 68.8% intended to report and 52.2% considered themselves able to identify violence victims. The mean (SD) negative perception score=5.3/10 (2.1) and the mean (SD) professional attitude score=7.5/10 (1.9). In multivariate regression, intention to report was associated with professional attitude (OR 1.08, 95% CI 1.03 to 1.14), ability to identify violence victims (OR 1.76, 95% CI 1.45 to 2.12) and negative perception that reporting is not mandated (OR 0.89, 95% CI 0.85 to 0.94). Significant differences existed among countries in intention to report., Conclusion: Most dentists intended to report suspected violence and their intention could be explained by the theory of planned behaviour which offers a framework for professional development to support violence victims. Sharing of training resources, policies and guidelines is needed to ensure that practices similar to international guidelines are consistently adopted by dentists across Arab countries., Competing Interests: Competing interests: None declared., (© Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2018. All rights reserved. No commercial use is permitted unless otherwise expressly granted.)

Objectives: To assess the satisfaction of first-year dental students with gamification and its effect on perceived and actual improvement of academic writing., Methods: Two first-year classes of dental undergraduate students were recruited for the study which extended over 4 months and ended in January 2015. A pre-intervention assessment of students' academic writing skills was performed using criteria to evaluate writing. The same criteria were used to evaluate the final writing assignment after the intervention. Students' satisfaction with game aspects was assessed. The per cent change in writing score was regressed on scores of satisfaction with game aspects controlling for gender. Perceived improvement in writing was also assessed., Results: Data from 87 (94.6%) students were available for analysis. Students' overall satisfaction with the gamified experience was modest [mean (SD) = 5.9 (2.1)] and so was their overall perception of improvement in writing [mean (SD) = 6.0 (2.2)]. The per cent score of the first assignment was 35.6 which improved to 80 in the last assignment. Satisfaction with playing the game was significantly associated with higher percentage of improvement in actual writing skills [regression coefficient (95% confidence interval) = 21.1 (1.9, 40.2)]., Conclusion: Using gamification in an obligatory course for first-year dental students was associated with an improvement in academic writing skills although students' satisfaction with game aspects was modest and their willingness to use gamification in future courses was minimal., (© 2016 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.)

Background: Laser etching has several advantages as compared with conventional acid etching. However, results of earlier studies on conditioning surfaces with erbium, chromium:yttrium-scandium-gallium-garnet (Er, Cr:YSGG) before application of the fissure sealant have been inconclusive., Aim: The study aimed to evaluate the microtensile strength of resin-based fissure sealant bonded to primary enamel conditioned by Er, Cr:YSGG laser with varying power outputs., Materials and Methods: Fifty sound primary first molars were randomized into the following five groups based on pretreatment choice: Group 1: 3.5 W laser etching + acid etching; Group 2: 2.5 W laser etching + acid etching; Group 3: 3.5 W laser etching with no acid; Group 4: 2.5 W laser etching with no acid and Group 5: acid etching with no laser. Acid etch was performed with 35% orthophosphoric acid for 30 s. Laser etching was performed with Er, Cr:YSGG (2780 nm) laser using G6 tips and 600 μm diameter, 2.5 W or 3.5 W power outputs, pulse duration of 140 μs and a repetition rate of 20 Hz. Sealant was applied on the buccal surface followed by an incremental buildup with composite resin. Microtensile bond strength was assessed and compared among the five groups using one- and two-way ANOVA., Results: There was no statistical difference in the mean bond strength between groups except in Group 4 (9.66 MPa) (Group 1: 15.57 MPa; Group 2: 14.18 MPa; Group 3: 14.78 MPa; Group 5: 14.63 MPa)., Conclusion: Pretreatment with 3.5 W Er, Cr:YSGG laser alone results in microtensile bond strengths similar to that produced by acid etching, indicating that enamel etching using 3.5 W Er, Cr:YSGG laser would result in the long-term success of pit and fissure sealants in primary teeth., Competing Interests: There are no conflicts of interest.

Objective This study was performed to assess the clinical and radiological outcomes of a revascularization procedure in immature teeth with apical periodontitis using platelet-rich plasma (PRP). The PRP protocol and conventional revascularization protocol, which used a blood clot as the scaffold, were compared. Methods Thirty non-vital immature permanent teeth were randomly categorized into two groups. After disinfecting the root canal space with triple antibiotic paste (1:1:1 ciprofloxacin, metronidazole, and cefaclor), a tissue scaffold was created using either PRP or a blood clot (control) and covered with white mineral trioxide aggregate. All cases were followed up clinically and radiographically for 12 months. Differences in bone density, root length, and lesion size were calculated using preoperative and postoperative computed tomography images. The means of the differences in individual parameters in the blood clot and PRP groups were compared using the Mann-Whitney U test. Results After 5 months, sensitivity tests (cold and electric pulp tests) elicited a delayed positive response in 23 sites. At 12 months, cone-beam computed tomography revealed resolution or a decrease in lesion size and an increase in bone density in all 30 (100%) teeth. Additionally, continued root development was observed in 22 (73%) teeth and early root growth was observed in the test group (mineral trioxide aggregate with PRP). Conclusions The results of this study suggest that PRP can serve as a successful scaffold for regenerative endodontic treatment. With the exception of a significant increase in root length, the results of treatment with PRP were not significantly different from those of the conventional protocol using a blood clot as the scaffold.

The aims of this study were to assess agreement among instructors in scoring preclinical dental procedures, the effect of this agreement on grades, and factors associated with agreement and grades differences. Twenty-six instructors from five clinical specialties participated in a scoring exercise at the College of Dentistry, University of Dammam, Saudi Arabia, in January 2015. Instructors blindly and independently scored 19-20 anonymous students' procedures, filling forms with rating scales as used in preclinical lab sessions. Their scores were compared to those of gold standard instructors in the same specialty. Percent agreement and having one letter grade difference from gold standard instructors were assessed, and associated factors were investigated after controlling for the effect of specialty/student. Agreement between instructors and their specialty gold standards occurred in 54.3% of decisions, with only 12.8% similar scores and 52.8% of scores representing underestimation in relation to gold standards. Instructor-related variables accounted for 40-50% of the variation in percent score as well as percent agreement and percent difference between instructors and gold standards. Educational background and teaching experience were significantly associated with less agreement among instructors and odds of one letter grade difference. Modest agreement existed among instructors in scoring various preclinical procedures, and there was a considerable percentage of one letter grade difference from gold standard instructors. Some factors associated with these outcomes are non-modifiable, but corrective measures are needed to increase agreement in scoring among instructors.