Dental Research Day

Abstracts

Dental Research Day Abstract

Ahmed Jamleh, Khalid Alfouzan, Abdulmohsen Alfadley, Lubna Alkadi, Abdullah Alhezam. College of Dentistry, King Saud bin Abdulaziz for Health Sciences, Riyadh, Saudi Arabia

Introduction
The root canals of the maxillary first and second molars have been described as having the most intricate morphology of all maxillary teeth [1]. This is attributed to the high prevalence of a second mesiobuccal canal (MB2) in their mesiobuccal roots that is highly variable in its location [2]. Failure to locate MB2 in maxillary molars has been associated with an increased treatment failure rate [3].

Objectives
The aim of this study was to determine MB2 canal detectability in maxillary first and second molars obtained from a Saudi population using microcomputed tomography (micro-CT)
.
Methods
Ethical approval for this experiment was obtained from the institutional review board of King Abdullah International Medical Research Center (RC10/043). Maxillary first (n = 35) and second (n = 30) molar teeth, with intact MB roots and fully formed apices, were selected and scanned at an isotropic resolution of 13.6 microns with micro-CT technology (SkyScan 1172, Bruker microCT, Kontich, Belgium).
The acquired images were reconstructed into cross-sectional slices. The slices in the MB root were observed starting from the pulp chamber floor level until the apex.
The number of canals was recorded. In case of having more than one canal, the presence of extra-canal was categorized based on the level they were first detected at as follows: 0 level (chamber floor), 1 mm level (1 mm apical from the floor), 2 mm level (2 mm apical from the floor), and greater than 2 mm level (more than 2 mm apical from the floor). The images were analyzed by three calibrated endodontists.

Results
The reconstructed MB roots and their cross sections were analyzed (Figure 1). Table 1 shows number of canals in the MB root of maxillary first and second molars.
Further analysis was performed on the MB roots which have more than one canal. The MB2 canal was detected at the chamber floor in 70% and 61% of the maxillary first and second molars, respectively. At 1 mm depth, the MB2 canal was found in 15% and 18% of the maxillary first and second molars, respectively. At 2 mm depth, the MB2 canal was found in 3% and 18% of the maxillary first and second molars, respectively. The remaining four maxillary first molars and one maxillary second molar had the second MB canal at levels deeper than 2 mm (Table 2).

Conclusion
The high prevalence of MB2 in maxillary molars, which are often undetected and missed during root canal treatment, creates a significant clinical challenge [3]. This micro-CT study might provide dental practitioners with the fact that extra MB canals are found at deeper levels in the maxillary molars. The micro-CT is now considered the gold standard in tooth morphology studies [1, 4]. Its advent has facilitated interactive image manipulation and enhancement to reconstruct and visualize the area of interest as a 3D volume from various angles.

The MB2 canals, when present, were detected at the chamber floor level in 70% and 61% of the tested maxillary first and second molars, respectively. However, the rest were detected at deeper levels which addresses the importance of performing more dentinal removal at the chamber floor to improve effectiveness of detecting MB2 in maxillary molars [2, 5]. Based on our results, selective dentinal removal (troughing) of up to 2mm will allow the clinician to locate the MB2 canals in 88% and 97% of the tested teeth in total (Table 2).

Abdulrahman Alharbi, Faisal Alkahmis, Yazeed Al Naser, Ahmad Alquraishi, Abdulwahab Aldubyan, Malek Alotaibie,1 Saud Aliedy, Abdulmajeed Alahmry, Nawaf Aljahdali, Omar Almutairi, Abed Al-Hadi Hamasha,. College of Dentistry, King Saud bin Abdulaziz for Health Sciences, Riyadh, Saudi Arabia.

Objectives
Dentine hypersensitivity is dental pain which is sharp in character and of short duration, arising from exposed dentin surfaces in response to stimuli, typically thermal, evaporative, tactile, osmotic, chemical or electrical; and which cannot be ascribed to any other dental disease. The aim of the present study was to explore the prevalence of dentine hypersensitivity among adults living in Riyadh city, Saudi Arabia, and assess the related risk indicators for this condition.

Methods
The present study is a cross-sectional observational, analytical study of the prevalence of dentine hypersensitivity and its associated factors. The sample size was 550 participants. Participants were asked to sign consent forms before the interviews and clinical examination. The inclusion criteria were Saudi participant and 18 age and above. On the other hand, the exclusion criteria were children, edentulous participants, subjects with systemic syndromes, subjects who are wearing fixed orthodontic appliance, subject who have fixed prosthesis and subject with teeth bleaching within the last 6 months.

Results
The prevalence of dentin hypersensitivity among Saudi population in Riyadh city is 51,3%. No significant association between dentine hypersensitivity with demographic, behavioral, dietary and medical variables were observed except with intermediate education and teeth brushing.

Discussion:
The present study is the first study to assess dentine hypersensitivity among adult dental patient in Saudi Arabia. The number of patients examined for dentine hypersensitivity was high, thus give more confidence in our study. All examinations were conducted in the dental clinics of the College of Dentistry, which give more accuracy in assessing the condition with proper illumination and the use of 3-in-one syringe. 
However, generalizability of the result should be considered with caution, since the sample is a convenient sample and dental patient might not be a representative to all Saudi patients. Inter-examiner variation was assessed, however, having multiple examiners is a source of bias itself. 

Conclusion
About 51.3% of Saudi examined suffered from dentine hypersensitivity. The mean number of teeth with dentine hypersensitivity was significantly related to less education and excessive tooth brushing..

Abdullah M. Alonazi,1 Ziyad M. Alosaimi,1 Mohammed M. Aldosari,1 Abdulaziz H. Fakih,1 Rakan B. Aldosari,1 Prof. Abed Al-Hadi Hamasha. College of Dentistry, KSAU-HS, Riyadh, Saudi Arabia

Objectives:
To measure the prevalence of dental fear and associated factors among male students at National Guard schools

Methods:
A cross-sectional study was conducted among students aged 10-17 years. The assessment tool of this study was a self-reported questionnaire filled by students or their legal guardians. The questionnaire included 33 questions including students' demographics and experience in dental fear. Also, questions about the most frightening factors as well as factors that make students feel better in the dental clinics were included.
Data analysis was conducted using SPSS software. Frequency distributions with numbers and percentages of demographics, frightening factors and comforting factors were conducted. Chi-square tests were used to assess the relationship between the presence of fear among different categories of age, income, and educational status. The p-value was considered significant if it is less than 0.05.

Results:
The response rate was 87% (427 from 491). Dental fear was reported by 29.1% of the participants. Tooth extraction feared the worst (49%) followed by root canal treatment (16%), gum treatment (9.3%) and tooth filling (9.1%). The main sources of fear were related to dental procedures and noise from drilling teeth. The fear was originated from childhood experience (41%) and only 13% of participants related their fear to what they heard from other people's experience. Female dentists (73%), the good reputation of the dentist (55%), and elegance and cleanness of the clinic (47%) were found to reduce fear. The good appearance and neatness of the dentist, attitude of the receptionist, and decreased waiting time were not considered as major factors in reducing dental fear.

Conclusion:
Dental fear was present in about one third of students of the National Guard schools. The most fearful dental procedure was tooth extraction. The procedure of dental treatment and the drilling noise feared worst from inside the clinic. The students' fear was originated from their previous painful and annoying experiences. A good reputation of the dentist, clinic cleanliness and female gender of dentists were reported as helping factors in reducing dental fear.

Ikram Ul Haq, Khalid Al-Fouzan. College of Dentistry, King Saud bin Abdulaziz for Health Sciences, Riyadh, Saudi Arabia

Objectives
Citation impact (CI) calculates the number of citations received in scholarly publications. It represents the total number of citations to articles divided by the number of articles. Further, the citation analysis can be applied on a single article, published work of an author, on an academic journal, research productivity of an institution, and total scholarly output of the specific specialty and country. The main aim of this report is to analyze the CI of dental research produced by Saudi Arabian affiliated authors published during the last ten years from 2009 to 2018.

Methods
Data for this study have been retrieved from Web of Science (WoS) database. WoS classified dental research under "Dentistry Oral Surgery Medicine". Research productivity in dental sciences by Saudi Arabia with CI produced during 2009-2018 has been searched and downloaded for analysis.

Results
WoS produced the list of 1,771 documents produced by Saudi Arabian researchers on dentistry during the period of 2009-2018 with an average of 177 publications per year. These publications received 10,320 citations with the CI of 5.83.  The analysis of data by year reveals that older publications have higher CI. The subcategory of "Engineering biomedical" in dentistry got maximum impact factor. Review articles received the highest citations as compared to Original research articles. Organization-wise data shows that the research carried out in the hospital sector have the highest number of citations as compared to teaching institutions. Impact factor journals especially Q1 received high citations. Dr. Khalid Al-Hezaimi publications have received the CI of 16.36, even higher than some US researchers. The research collaboration by Saudi Arabian authors with the researchers of the University of Michigan, USA got maximum citations while by country analysis shows that research collaboration with Italy, Germany and Japan have more citations as compared to the US, Egypt and England.

Conclusion
The findings of this report will guide the Saudi Arabian dental researchers that they should write on novel and innovative ideas. They should try to publish their research in Q1 impact factor journals and with the collaboration of talent-rich countries.

Sarah Bin Muharib, Mashael Althunayan, Latifa Algudaibi, Amal Alzahrani, Ghaida Almugbel, Bahija Basheer. College of Dentistry – King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia

Introduction:
Some complications in the teeth cannot be solved except with tooth extraction which cause partial Edentulism, and unfortunately represent the beginning of new problems.1,2 Various changes could be observed in the size as well as the shape of the mandible with progressive development in the growth and function of the jaws that differ on the basis of age, gender, and dental status. 3,4

Objectives
The aim of this study was to measure and evaluate the morphological changes of the mandible, with respect to age and gender in partially edentulous and fully dentate subjects using panoramic radiographs.

Methods
The study included 150 partially edentulous patients and 150 fully dentate patients who were enrolled in College of Dentistry, KSAU-HS between January, 2015 and December, 2018. The panoramic radiographs were taken using digital Planmeca machine. Five mandibular morphological and anatomical parameters were measured; Condylar height (CH), gonial angle (GA), ramus height (RH), antegonial notch depth (AND), and ramal notch depth (RND).

  • Gonial Angle (GA): the angle between the imaginary tangential line along the posterior border of the mandibular ramus and the inferior border of the mandible.
  • Condylar Height (CH): the distance between line perpendicular to the ramus tangent line at the level of the most lateral image of the condyle and the line perpendicular to the ramus tangent line at the level of the most superior image of the condyle. CH will be the perpendicular distance between the lines.
  • Ramus Height (RH): the distance between line perpendicular to the ramus tangent line at the level of the most lateral image of the ramus. RH will be the distance between the lines.
  • Antegonial Notch Depth (AND): the distance along a perpendicular line from the deepest point of the antegonial notch concavity to a tangent to the inferior cortical border of the mandible.
  • Ramal Notch Depth (RND): the distance along a perpendicular line from the deepest point of the ramus notch concavity.

Descriptive statistics, including the mean and standard deviation were calculated for all the measurements in both the test and control groups. Chi-square analysis to assess the relationship between dental status with respect to age and gender of the participants. Independent t-test was used to compare morphological measurements of the mandible with age, gender and dental status. The level of significance was set at P value less than 0.05

Results
There was a statistically significant difference in the mean values of GA between the test and control groups (p value= 0.00). However, no significant differences were observed in RH, RND, CH and AND between the groups (figure 2). A statistically significant increase in the mean values of GA in partially edentulous subjects was observed in the study which coincides with many studies which concludes that there will be an increase of GA in the area of tooth loss.5 Regarding the gender differences, female showed larger mean values for all variables except for AND, but the difference was not significant (table1). GA is significantly larger among younger age group, but there was no significant difference in the CH, RH, RND and RND between the two age groups (Table2).
.
Conclusion
This study concluded that there is no association between the changes in the morphological measurements with respect to age and gender except in GA where younger subjects has higher GA values. Also, it concludes that GA, was significantly higher in partially edentulous group compared to fully dentate. It highlights the consequences of tooth loss on the mandibular morphology, and it can be useful as standards for further comparison studies between fully dentate, partially and completely edentulous subjects.

Khalid AlDeraa, Afra El Rashid, Hamad Alissa, Suliman Alrafaa, Waad Almadhi, Sarah Alsougi, Hadeel Bawazir.

Objectives
Endodontic treatment considered as significant part of daily dental practice. Since 1960 endodontics started to be recognized as a separate specialty in most countries Over the years, armamentarium of root canal therapy continues to evolve, and many technologies have been introduced in order to facilitate endodontic procedures and for favorable outcomes. The aim of this study is to gather information regarding endodontic practice and attitude of general dental practitioners and endodontists in Riyadh city, Kingdom of Saudi Arabia
.
Methods
In this cross-sectional study a self-administered questionnaire was distributed in 2018 to 400 of general dental practitioners and endodontists working in private hospitals in Riyadh city regarding their routine practice in endodontic treatment. Riyadh city is divided into five areas according to the city municipality zones map. Randomly selected private dental clinics from each district and each clinic received hand-delivered questionnaires. The questionnaires were hand-collected at the same day.

Results
The questionnaire was distributed to 400 general practitioners and endodontists who working in private clinics in Riyadh city, Saudi Arabia. Completed replies were obtained from 258 of them giving response rate of 64.5%. 45% (n=109) of the GPs were mostly used barbed broach to extirpate the pulp tissue, 35% (n=6) of the endodontists were mostly used K-files. In regard to preparing the canals, 45.2% (n=109) general practitioners used rotary nickel titanium and 19.9% (n=48) used stainless steel hand files. 47% (n=8) specialists used rotary nickel titanium and none of them used stainless steel hand files. The most common technique used for obturation was lateral condensation among general practitioners 56.6% (n=136) and specialists 41% (n=7). Type of sealer mostly used was Resin based sealer (AH26, AH+) by GPs 63.3% (n=152) and endodontists 47% (n=8) and among most of the years of experiences. GP's 64%(n=154) and endodontist 47% (n=8) used commonly composite restoration as post obturation filling material.
.
Discussion:
Our study was conducted in private clinics only, because most specialists working in governmental institutes and dental schools are fallowing the quality guidelines of endodontic practice (Alfouzan, 2010). The response rate in this study was 64.5%, which considered representative of the current endodontic practice performed by the GPs and endodontists in private dental centers in Riyadh city in compared to study done by Khalid Alfouzan (Alfouzan, 2010). The questionnaire was hand delivered and collected in the same day, which obtained a higher response rate in comparable to online distribution (Nulty, 2008).

Conclusion
It is concluded that endodontic practice in a private sector in Riyadh city, the capital of Saudi Arabia where fewer endodontists and more GPs are there, is improving compared to other studies in the previous years like in using rubber dam isolation and when to prescribe antibiotics. However, they still need more education in many aspects. For example, giving informed consent before root canal treatment and using magnification.
Recommendation: to assure the competency of the practitioners in clinical practice, the continuous education, well-prepared courses and workshops should be mandatory in a regular basis in order to fill the gaps and to ensure updating knowledge and improving the attitude toward the standard endodontic practice.

Acknowledgments: We thank all the general dental practitioners and endodontists for taking the time and answering the questions.

Azzam Al-Jundi, Salah Sakka, Hicham Riba, Thaer Ward, Reem Hanna College of Dentistry, King Saud bin Abdulaziz University for Health Sciences.

Introduction:
The long duration of orthodontic treatment is a major patients' concern. A non invasive method of accelerating tooth movement in a physiological manner is needed.

Objectives
The aim of the study was to evaluate the effects of Er: YAG laser application during orthodontic treatment of deep bite and to evaluate its analgesic effect during that movement.

Methods
A prospective randomized controlled clinical trial (RCT) was performed on 30 patients with deep bite. Sample was divided into two groups:
(A), 15 patients (orthodontic treatment-control group) and
(B), 15 patients (orthodontic treatment and Er:YAG Laser - laser group).
The tooth movement was evaluated as the primary outcome variable by measuring angular and linear changes on three progress lateral cephalometric radiographs (T1, T2 and T3); Lateral cephalograms were taken before treatment (T1), immediately after finishing the stage of leveling and alignment (T2) and after completion of the intrusion stage (T3). Laser parameters used for hand-piece No 2062: 400 mj/10 Hz/4 W and for hand-piece No 2060: 400 mj/15 Hz/6 W. The levels of pain and discomfort were evaluated and ranked according to a visual analog scale. Paired t-tests or Wilcoxon matched-pairs signed-rank tests were used to detect significant differences.

Results
The main findings of the treatment were:
(1) Significant positive difference in the rates of tooth intrusion movement on the experimental group compared with the control group at the baseline to T2and T3 interval and the tooth movement rate was approximately 3 times faster in the experimental group.
(2) The pain score in the experimental group was significantly lower compared with the control group on day 3 as on day 7.

Discussion:
The present findings have shown that the Er:YAG laser therapy significantly accelerated tooth movement. The rate of tooth movement in the experimental group was 2 to 4 times greater than that in the control group. The resulting increased speed of incisors intrusion agrees with those from Iino et al ,in their animal study. The present findings have also corroborated the clinical observations of Wilcko et al and Hajji et al who reported similar significant reductions in treatment times.
In this study the mean time needed for intrusion of upper incisors in the control group was 95.8 days while in the experimental group was 59 days. Therefore, the time for treatment was 38.4% less compared with the control group. Similar findings were reported by Kawasaki and Shimizu and Yoshida et al. Ngan et al proved that, after an orthodontic procedure, pain and soreness occur after 24 to 48 hours. Thus the first follow up score after laser therapy was recorded on day 3.
This study found a highly significant decrease in pain scores in the experimental group on day 3 compared with day 1. Similar findings were reported by Fujiyama et al. as they observed significant pain reduction with laser therapy immediately after insertion of separators until day 4. Kim et al. also suggested that low level laser therapy might be an effective method of reducing orthodontic pain.

Conclusion:
The application of Er:YAG laser is an effective mean to speed orthodontic tooth movement with a significant reduction in pain and discomfort after application.

Ahmad Alsuawari, Hossam Almalki, Fahad Alotaibi, Abdulrahman Alrajhi, Ahmad Jadoh, Faisal Alghanem, Waleed Albaradie,1 Nwaf Alawad,  Abdulelah Alotaibi, Nawaf Alotaibi, Mojahed Alfozan, Vidyulatha Krishna. College of Dentistry, King Saud Bin-Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia.

Introduction:
Reviewing the dental literature, multiple studies have been conducted in the past to assess the level of knowledge related to oral cancer screening and prevention among medical and dental undergraduate students.1-3 In Saudi Arabia, very few studies 4-6 have been reported which assessed the level of knowledge related to oral cancer among undergraduate medical and dental students. However, there are no known studies till date that have been done to assess the differences in the knowledge and practices related to oral cancer among medical and dental practitioners in Riyadh.

Objectives
The aim of the study was to assess knowledge, practices and opinion related to oral cancer among medical and dental practitioners in Riyadh, Saudi Arabia

Methods
A total of 550 practitioners participated in the study. Convenient sampling technique was used to recruit participants. Practitioners who aren't involved in examination of oral cavity, were excluded from the study. Therefore, practitioners participating in the study were either general dentists, dental specialists, general medical practitioners or medical specialists. The knowledge, practices and opinions of the participants was assessed using a self-reported structured questionnaire, which was distributed at various private and government hospitals/polyclinics in Riyadh.  Knowledge was assessed based on 19 items and then the mean scores were categorized into high (greater than equal to 14), medium (10-13) and low knowledge (greater than equal to 9). ANOVA was used to evaluate the differences in mean knowledge scores between the four groups and descriptive statistics was used to describe their practices and opinions.

Results
About 69% of the participants were males and 31% were females. The results showed that in general about 65% of medical professional and 63% of dental professional have moderate to high knowledge related to oral cancer.
Dental specialists and medical GP were the most knowledgeable professionals about oral cancer followed by medical specialist and the least knowledgeable professional were dental GP's. The difference was statistically significant (p=0.048).
The percentage knowledge scores was not related to training of oral cancer before graduation or training after gradations. The highest knowledge of oral cancer was reported among professional with less than 5 years of experience and those with more than 15 years of experience. (Table 1) The mean scores of knowledge related to oral cancer is presented in figure 1. Dental Specialist score the highest followed by medical and dental GP's while the medical specialist scores the lowest. When the practitioners were asked about their interest in receiving further training on the knowledge of oral cancer, the highest percentage were among medical specialist followed by dental specialists.

Conclusion
The study reported that knowledge about oral cancer risk factors and clinical presentation was low among more than one third of health care professionals. Furthermore, results shows that most health care professionals recognize their deficiencies and are interested in receiving additional training on oral cancer screening and prevention.

Meshael Abuabat, Resident, Saudi Board of Prosthodontics, National Guard Health Affairs, Riyadh

Introduction:
Congenital absence of one or more teeth has an adverse effect on esthetics, phonetics and function. This clinical situation is a challenge to prosthodontists, orthodontists and periodontists in terms of formulation of a treatment plan that will yield the best long-term outcomes.

Clinical Presentation:
This case report describes esthetic management of a 22-year old smoker patient with congenitally missing maxillary premolars who had a previous orthodontic treatment in which canines were distalized and implants were placed in its position.

Treatment Objectives:

  1. To achieve adequate peri-implant soft tissues contour by fabrication of provisional implant supported crowns with subsequent addition of flowable composite. 
  2. To achieve esthetics by restoring the implants with canines and reshaping both canines into premolars as well as multiple veneers on the maxillary anterior teeth.
  3. To achieve function by establishing canine guidance to provide posterior disocclusion and by occlusal equilibration to eliminate undesirable interferences.

Treatment Outcome:
Although the implants were not in a favorable positioned, the use of customized zirconia abutments made it possible to obtain an acceptable esthetic result. One-month follow-up showed well-integrated restorations and the soft tissues appeared healthy

Conclusion:
This case report demonstrates that management of patients with congenitally missing teeth, particularly with anterior dental esthetic problems, should follow an interdisciplinary approach rather than a multidisciplinary approach to prevent possible complications and improve the treatment outcomes.

Rima A Safadi, Abdulaziz AlRomaizan, Rana Al Shagroud, Darshan Divakar, Saeed Alshieban. College of Dentistry, King Saud bin Abdulaziz for Health Sciences, Riyadh, Saudi Arabia

Introduction:
Great emphasis has been laid on enhancing the reliability and the accuracy of grading epithelial dysplasia since its severity has been correlated with the likelihood of malignant transformation and management protocols [1-5]. Although several grading systems have been proposed, epithelial dysplasia grading still suffers from intra and inter-examiner variability [6-15]. K19 is an intermediate cytoplasmic filament known to be expressed in stem cells and basal cell layer of stratified squamous epithelium. It has been strongly correlated with the presence of epithelial dysplasia [16-18 ].  K19  immunostain impact has not yet been assessed in terms of improving epithelial dysplasia grading systems reliability.

Objectives
This is the first study that aimed to assess the impact of utilizing K19 immunostain paired with hematoxylin and eosin (H and E) stain to enhance inter and intra-examiner reliability while assigning grades to dysplastic epithelial tissue of the upper aerodigestive tract.

Methods
The archives of the Department of Pathology at King Abdul Aziz Medical City/ King Fahad Hospital were searched for specimens histopathologically diagnosed with epithelial dysplasia of the upper aerodigestive tract for 2013-2018. The study sample consisted of 122 sections that fulfilled the inclusion criteria. Each paraffin block had three sections cut: one immunostained for K19 and two for H and E stain. Stained slides were rotated among the three examiners for 6 rounds: 3 grading based on H and E stain alone and 3 grading based on paired K19 and HandE stains. Keratinizing status of the epithelium was recorded. The results were analyzed using Krippendorff's alpha, ROC curve, Chi-square test and binary logistic regression.

Results
Upon the use of paired K19 and H and E stains, intra-examiner grading reliability coefficients were improved for examiners 1, 2, 3 from 0.70, 0.69, 0.78 to 0.73, 0.88, 0.91, respectively. Inter-examiner reliability coefficients were improved from 0.55 to 0.73 (Krippendorff alpha). The accuracy of identifying the diseased cases (high-grade dysplasia) increased from 0.82 to 0.94 (ROC curve). Binary logistic regression revealed that K19 positivity is significantly associated with the non- keratinizing status of surface epithelium (Bivariate logistic regression=0.001).

Conclusion
Paired K19 immunostain with H and E regular stains proved to increase intra and inter-examiner reliability and reduce grading variability by highlighting the extension of dysplastic epithelial cells  within epithelial thickness thus identifying the involved epithelial  third and assigning a more reliable and better reproducible grade. Requesting K19 immunostain for non keratinized dysplastic epithelium grading is thus strongly advised.

Khalid Al Bawardi, Sulaiman Al Sanea, Bassam Al Otaibi, Mashari Alanazi, Hussain Al Fifi, Faisal Al Shehri, Saud Al Saeed, Abdulkareem Al Ghamdi, Faisal Al Omran, Mohammed Alanazi, Abdullah alrushaid, Bahija Basheer. College of Dentistry, King Saud bin Abdulaziz for Health Sciences, Riyadh, Saudi Arabia.

Introduction:
There are high concerns about dental practitioners' perception, knowledge and attitude toward radiation protection especially with the variety of radiographs, their radiation doses and the effect on variety of patients. It is to be noted that there has been no internationally published data about the KAP of dental professionals in Riyadh, KSA regarding the biological hazards and radiographic protection techniques. Therefore, this has led to an increased interest to evaluate KAP towards radiation hazards and protection among dental professionals in Riyadh.

Objectives
To evaluate knowledge, attitude and perception among dental students, dentists and dental staff toward dental radiation and to assess the difference in knowledge between dental students, dentists and dental staff.

Methods
A cross-sectional study was designed to obtain information from dentists, dental staff, and dental students. 550 dental professionals participated in this study. The information was collected from each participant through a structured questionnaire consisting of 39 close-ended questions. Statistical analysis included Chi-square to test the association of KAP with gender, occupational sector and educational qualification and one-way analysis of variance to compare the difference in means of KAP between the three different groups of professionals.

Results
Out of the 550 dental professionals who participated in the study, 293(53%) were dental students, 83(15%) were dental staff, and 174(32%) were dentists. Dental students showed higher KAP values toward radiation hazards protection followed by dentists and dental staff.

Discussion:
Upon literature review, there was a lack of studies evaluating the knowledge of radiological hazards in Kingdom of Saudi Arabia especially in Riyadh. Previous studies such as the one by Arnout et. al,1(2014) included only dental students whom 87.5% of them considered x-rays to be harmful, yet the present study showed only 63.5% of dental students who considered x-rays to be harmful. In a study by Dölekoğlu et. al,2 (2011),  67% of dentists said that they use digital radiography, while in the present study only 27.6% of dentists are using digital radiography.
It can be inferred from this study that there is lack of knowledge in regard to radiation protection protocols and radiation hazards itself. However dental students showed the highest KAP values that could be attributed to new and fresh knowledge regarding radiology courses.

Conclusion
From the results obtained in the study, it was concluded that KAP level with regard to radiation protection was higher among dental students compared to dentists, and the least KAP level was found with dental staff. Considering the results of this study it is critical that all radiology departments need to continue professional development; by doing more radiation protection workshops and training courses, preparation and distribution of posters on the protection and safety against radiation in order to raise the awareness among dental professionals.

Ghaida AlMoqbel, Reem AlKaoud, Azzam AlMeshrafi, Shahad BinAteeq, Saleh Sonbol, Sharat Pani, College of Dentistry, King Saud bin Abdulaziz for Health Sciences, Riyadh, Saudi Arabia

Introduction:
Extensive dental care in children is often performed under general anesthesia (GA). The primary barrier for dental care under GA is cost, and daycare anesthesia reduces the cost of dental treatment. In Saudi Arabia, there is lack of information on the type of patients or pattern of dental procedures done under such single day settings.

Objectives
The aim of the study is to create a pattern chart, which will serve as a baseline indicator of procedures performed in a daycare general anesthesia setting.

Methods
A retrospective review of the hospital records of patients receiving dental treatment under GA between April 2013 and March 2018 were performed. The study included complete records of patients aged 14 years or younger. Age, gender, health condition, number of treated teeth, and type of procedure were obtained from the records. Uncompleted records were excluded. Of 575 files reviewed a total of 547 complete records were analyzed. Descriptive analyses were subjected to the Chi-Square test to examine significance

Results and discussion
The results of this study show that children with mild systemic disorders were treated safely under day care GA. Increased drug safety combined with increasing hospital costs, have meant that most dental procedures are now performed in a day-care anesthesia setting. 6,10,11 Most of our cases underwent comprehensive dental restorations and extractions. This seems to be correlated with the current level of caries experienced in Saudi Arabia. 14 Over the past six years there has been a significant reduction in the number of extractions and an increase in the number of zirconia crowns. However, Chen Y et al, (2016), found a pattern of an increase in the extraction of primary teeth.

Conclusion
Day care surgery is an effective means of providing dental care under GA. The reduction in the number of teeth being treated per patient over the past six years seems to suggest that the reduction of costs can increase access to dental care under GA.

There has been a reduction in the number of extractions and increase in advanced restorative procedures per case. A pattern of cases under general anesthesia, helps to understand not only the rationale for treatment, but also the type of treatment rendered.

Maha Alatyan, Atheer Aldaham, Afnan Alzomaili, Ghaida Abalhassan, Hend Almuziri, Mona AlJofan, Reem Al-Kaoud, Dr. Vidyullatha Gopalakrishna, Dr. Bahija Basheer. College of Dentistry, King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia

Introduction:
Child Abuse and Neglect (CAN) is a major problem of concern worldwide including Saudi Arabia where most of the CAN cases are detected in hospitals. Child maltreatment in Saudi Arabia started to attract the attention of healthcare professionals after a number of cases were reported in the media in the early 1990s.1 As per the statistics given by the National Family Safety Program, in 2016, the prevalence of child neglect in Saudi Arabia was 51.5%, physical abuse was 33.7%, sexual abuse was 27.4% and emotional abuse was 16.8%.2
According to National Family Safety Program registry, most of cases of CAN in Saudi Arabia are detected in hospitals.2 However, few Saudi studies have been reported in relation to the knowledge and attitude toward CAN among healthcare professions.3,4,5 Thus, healthcare professionals play an important role in identifying and reporting CAN cases.

Objectives
To assess knowledge and attitudes towards Child Abuse and Neglect (CAN) among medical and dental undergraduate students and interns in Riyadh, Saudi Arabia.

Methods
This cross-sectional study recruited 351 participants using convenient sampling. The participants included undergraduate medical and dental students in the final year of their academic study and medical and dental interns. Data were collected through a self-administrated structured questionnaire . it is comprised of four sections as follows: Section one: Participants' socio-demographic and background details including age, gender and field of professional education. Section two: participants' knowledge about the social indicators and risk factors. Section three: participants' knowledge about clinical presentations associated with CAN. Section four: participants' attitudes and opinion on CAN. The data were statistically analyzed using IBM SPSS (version 22). Descriptive statistics, chi-square test and T-test were used to perform the statistical analysis. The significance level was set at 5%

Results
Among the 351 participants who met the inclusion criteria,179 (51%) were males and 172 (49%) were females. About 57.5% of the participants received formal training on CAN during their undergraduate study(Figure 1). Mean knowledge score related to CAN was 6.81+1.17 for medical participants and 6.35+1.35 for dental participants, and the difference was statistically significant (p=0.001) (Figure 2). Most participants believed that the main barrier for not reporting a suspected CAN is the fear of consequences (Medical=82.4%, Dental=68.5%, P= 0.01). About 77% of the participants agreed to the need for further training in dealing with CAN(Figure3).

Discussion
Formal training on CAN during undergraduate study period or later enhances the ability of health care professionals to detect and report suspicious cases. The mean score of knowledge among medical students and interns were significantly higher than dental students and interns (p=0.001). This result was similar to the findings by Deshpande et al.8 comparing medical and dental residents. Interestingly, the subjects in this study were more satisfied with the CAN knowledge background that was provided by the medical/dental schools, when compared with the previous studies by Mogaddam et al. and Hussein et al.3,6 This finding suggests that the new educational curriculums pays more attention to important social issues such as CAN. Furthermore, fear of family anger, fear of violence or unknown consequences to the child victim and lack of knowledge were considered as the main barriers to report CAN by both medical and dental participants. These results were relatively comparable to a study that was done by Al-Dabaan et al.5

Conclusion
This study showed that only two thirds of the participants have adequate knowledge regarding CAN. To increase the awareness about the diagnosis and referral procedures, academic institutes should consider seminars and continuous education courses instead of relying on lectures only.

Randa Ibrahim, Ali Abdullah, El-Refaie  Kenawy, Hend  El-Kafrawy College of Dentistry, King  Saud bin Abdulaziz University for Health Sciences, Riyadh - Saudi Arabia)

Introduction:
Despite the fact that success in aesthetic restorations depends greatly upon adhesion success, the bonding interface still remains the weakest spot of dental restorations. Secondary caries and dental adhesives' poor durability are the two main reasons for the replacement of the resin-based restorations, a situation prompting the need for improvements to obtain multifunctional dental adhesives which are capable of simultaneously improving various performances.

Objectives
The present study focused on the development and characterization of novel bio-composite nanofiller with antibacterial properties; via formulating hydroxyapatite nanoparticles combined with quaternary ammonium salts of polyethylenimine (QPEI/Hap).

Methods
Hydroxyapatite (Hap) nanorods were produced by hydrothermal process and coated by Polyethyleneimine (PEI) via electrostatic adsorption, followed by two steps polymeric reaction for quaterisation. Powder characterization was done using XRD, FTIR and TEM before and after polymer coating, and bioactivity was evaluated using XRD after 7 days' soaking in simulated body fluid. An experimental ethanol–based one-bottle adhesive resin was formulated with 0.2, 0.5, 1, 2 and 5% QPEI/Hap nanofiller concentrations. The formulated adhesives were evaluated for their colloidal stability, antibacterial activity, Ultimate Tensile Strength, and Micro-Shear bond strength to dentin compared to commercial dental adhesives (Clearfil S3 Bond and Clearfil Protect Bond). The raw data was collected, tabulated and analyzed using one way analysis of variance test, followed by Paired T-test for Antibacterial activity, and Tukey HSD test for mechanical properties with significance at P less than equal to 0.05.

Results
Overall characterization measurements (FTIR, TEM, X-ray diffraction) confirmed successful surface modification of Nano hydroxyapatite particles with PEI polymer, with a mean  particle size of 20.8 nm.

  1. The results of ADT reflected that samples with low filler content (0.2% QPEI-Hap) showed a significant bacterial reduction (p greater than 0.05) of approximately 82% against S. mutans and 29% against E. coli.
  2. Diametral compression test results showed greater mean values (47plus minus2.19- 43.2 plus minus 4.97 MPa) for samples containing 0.2–0.5 wt. % NPs which is about 15-25 % higher than that of the tested commercial filler (Clearfil S3 bond, 37.4 plus minus 3.28).
  3. Statistical analyses showed positive effect of filler type and concentration on the strength of dental adhesives bond (p greater than 0.05), with average micro-shear bond strength values for the experimentally prepared adhesive of 0.2% and 0.5% QPEI-Hap nanofiller, were 57-72 % higher than that of the control commercial bond CS3 (11.03 plus minus 1.843).

Discussion:
In this study polyethyleneimine (PEI) was used as a cationic surfactant coated on HAp nanoparticles instead of silanization process; to induce matrix/filler interaction and enhance dispersion properties of Hap nanoparticles in the organic liquid media (experimentally prepared bonding agent). Hydrophobicity of quaternary ammonium salts (QPEI) is considered to be beneficial to overcome the problems of high solubility and hygroscopic action of Hap nanoparticles to avoid filler deterioration.  Its resilience as a polymer was also useful to counteract the brittleness and inferior mechanical properties of HAp for better durability. This surfactant gained additional advantage by further rendering the adhesive antibacterial against both Gram positive and negative bacteria.

Conclusion
Within the limitation of the present study, it can be concluded that QPEI-Hap nanoparticles may be regarded as a promising  alternative to other fillers for dental adhesives. Henceforward, in vivo and in vitro experiments are necessary to evaluate the long-term antibacterial properties of this newly proposed single bottle self- etching dentin bonding system and to conclude the benefit of its antibacterial properties for other clinical applications.

Faisal Alzeghaibi, Abdulaziz Jammah, Abdulmohsen Bin Hassan, Ahmad Alanazi, Ali Alrezgi, Khalid Alotaibi, Khalid Alderaa, Muhannad Alotaibi, Waleed Alkhulaifi,  Yasser Aloufi, Ziyad Alghmadi, Abeer Alrumayyan.  College of Dentistry, King Saud bin Abdulaziz for Health Sciences, Riyadh, Saudi Arabia

Introduction:
Follow-up appointments are necessary for some conditions to ensure the effectiveness of the treatment. Studies have shown that distance can be a barrier to attend follow-up appointments which might be necessary for these conditions. For example, breast cancer treatment requires follow-up care, and can place a significant travel burden on patients.1 In Saudi Arabia Albarakati et al. found that women are more affected to miss their appointment, on other hand attendance to the appointments is less in the holy Ramadan month due to fasting.2 However, no studies have been conducted in regards to distance and transportation and their relationship with not attending dental appointments. Due to the high percentage of patients skipping dental appointment and the geographic location of MNG-HA and KSAU-HS college of dentistry dental clinics we think of conducting this study.

Objectives
The aim of this study is to see if the distance to the KSAU-HS dental clinics and MNG-HA dental clinics are a barrier to attend follow-up appointments. Also, to see what other factors might affect the attendance of patients to their morning or afternoon appointments, including cost of transportation and the time of the appointments.

Methods
According to the power calculation, a convenient sample was selected. the sample size was 550 participants in the KSAU-HS and MNG-HA waiting areas, in Riyadh, Saudi Arabia. The questionnaire consists three main parts. First, demographics, which includes age, gender, area of resistance. Second, transportation issues, such as, the time taken to reach the dental clinics and how many kilometers travelled to get there. Third, barriers of attending dental appointments were asked in a liker-scale, for instance, if the cost of transportation affected their attendance, or if they preferred a nearby privet clinic, plus if the time of the appointment played a role. Questionnaire was distributed to the participants alongside the informed consent form. Data was analyzed using SPSS IBM version 22 program using Chi-square test.

Results
Surprisingly, patients who lived in a distance between 16-30 km were the most group to attend their dental appointments and the least group of patients to be affected by the availability of transportation [figure 1]. In addition, the group of patients that needed 30-60 minutes were also the most group to attend their dental appointments and the least to be affected by the availability of transportation [figure2]. The majority of the patients disagreed when asked if the cost of transportation was causing them a barrier to attend dental appointments [figure 3]. However, most of them agreed that they preferred to go to a nearby privet dental clinic or attending an afternoon dental appointment than going to their dental appointments at morning times [figure 3]. Plus, the patients also agreed on that they would skip their dental appointment due to traffic jams on the way[figure 3].

Conclusion
Since there is a shortage of studies in that field we decided that we shall do a survey asking the patients if travel and transportation caused a burden to them to attend their appointments, and if that was the cause of the high percentage of patients skipping their appointments. In regard to our method we used a questionnaire that was handed to the patients in dental clinic at KSAU-HS and MNG-HA dental center as hard copy. The results revealed that people living between 16 to 30 Kilometers from the clinics were the most group to attend the appointments. Also, skipping dental appointments due to traffic was the most to be agreed on for attending the appointments. For future studies we recommend to include more question about barriers of attending appointments, such as, if they usually attend their appointments on time, and to shorten the questionnaire and lastly to reduce "Neutral" options as it is the easier choice for the patients to consider.

Nouf Albesher, Ashwag Alfadhel, Asma Alshareef, Manal Aljamal, Nourah Alaqaili, Thoraia Kinani, Prof. Abed Al-Hadi Hamasha. College of Dentistry, King Saud bin Abdulaziz for Health Sciences, Riyadh, Saudi Arabia.

Introduction:
The risk of developing dental caries by exposure to Secondhand smoke (SHS) may be explained by three major mechanisms. 1) Direct exposure of the developing teeth buds to chemicals of smoke, leading to delay formation and impair mineralization.  2) Damaging the salivary glands by chemicals of smoke resulting in a decreased salivary flow which affect buffering capacity and cleansing. 3) SHS impairs immune system of children and increases colonization of Streptococcus mutants which have been attributed in the formation of dental caries. 
Reviewing the international dental literature, there no agreement on the relationship of SHS with dental caries. This is the first Saudi Study to address this issue among Saudi Children.

Objectives
To explore the relationship between dental caries and exposure to SHS among Saudi children in primary, mixed and permanent teeth.

Methods
The present study was approved by the IRB of King Abdullah International Medical Research Center, Saudi Arabia [SP 18/ 436/R]. The target sample was children aged between 6-13 years old in their mixed dentition stage, from different regions in Riyadh, Saudi Arabia. Children who did not provide consent forms singed by their legal guardians, children with systemic syndromes, and children who are wearing fixed orthodontic appliances were excluded from the study.
The study was conducted using questionnaire and clinical dental examination. The questionnaire included demographic data, oral hygiene practice and children's general health. Smoking status of parents including type and duration of smoking, as well as in-house smoking were also questioned.
Clinical examinations were conducted by six calibrated senior dental students by means of a mouth mirror and dental explorers under artificial light using the DMF index of the World Health Organization's basic methods. Inter-examiner reliability was checked by Kappa statistics.
Data was analyzed using the IBM SPSS statistical program version 23. Statistical tests included independent samples t-test to compare the different in means of DMFT among children with or without secondhand smoking status..

Results
Of the 301 participating children, 43.4% were males and 56.6 were females. The mean age was 9.16 years. The mean DMFT of primary, mixed, and permanent teeth were 4.83, 6.36, and 1.53 teeth respectively. (Figure 1) 
The results showed that only 8 mothers (2.7%) were smokers, 7 of them smoke inside their house. Higher numbers of fathers were smokers 110 (37%) and 82% smoke inside their houses.  Cigarettes were the commonly used. In addition 17% of the sample has other family members (other than parents) who are smokers and 7% smoke inside the house. (Figure 2)
The mean number of DMFT in primary, mixed  and permanent dentition was higher in children with smoking fathers, mothers and smoking others; however the difference did not reach a statistically significant level except in smoking mothers in permanent teeth (p = 0.005). (Figure 3).

Discussion and Conclusion
The results of this study indicated an increased number of smoking mothers and fathers reaching 37%. This increase number of smoking parents is coupled with higher percentage of smokers inside homes and among their children (85%).

The prevalence of dental caries among children reached a high level of 6.36 teeth per subject. The distribution of dental caries according the status of their smoking parent indicated an increase in the number of dental caries among exposed children. This study is the first study in Saudi Arabia to address this issue. The outcome of this study is an alarming signal to all parents and health care providers that continuing smoking specially among children will jeopardize their dental health.

Raneem Nafesah, Shahad Quwayhis, Shahad Meaigel, Raghad Almedlej, Rana Alolieq, Malak Almutairi, Shahd Alzamil, Abeer Alrumayyan. College of Dentistry, King Saud bin Abdulaziz for Health Sciences, Riyadh, Saudi Arabia.

Introduction:
Missing teeth are routinely replaced with fixed dental prostheses (FDP); thus, knowing the patient's oral health related quality of life (OHRQoL) after placement of FDP and factors that could affect patients' quality of life in addition to their oral hygiene practice is important.

Aims and objectives:
This study aims to measure the relationship between OHRQoL in relation to fixed dental prostheses and oral hygiene practice of adults in Riyadh, Saudi Arabia.

Materials and Methods:
A survey was distributed in hard and soft copy forms. Target subjects were adults above the age of 18 years who have FDP and living in Riyadh.  The questionnaire contained 4 domains: demographic data, medical history, characteristics of the prostheses and oral hygiene practice as well as OHIP-14 questionnaire which measures OHRQoL. The data was descriptively analyzed. Chi-square was used to evaluate the relationship between the four domains and OHRQoL. One-way ANOVA was used to compare between the means of OHIP-14 scores and the other categorical variables.
 
Results:
The study included 528 subjects. More than half of the participants (56.9%) have poor OHRQoL which was associated with female gender, full time employment and low income. The presence of toothache, periodontal diseases, oral abscess and broken teeth were all associated with poor OHRQoL. Diabetic participants were also found to have poor OHRQoL. As for oral hygiene practice, 47% of the subjects did not receive oral hygiene instructions after placement of their FDP. It was also found that 53.4% of the study population brush only once daily. Moreover, the majority of the subjects have never used interdental brush or super-floss.
 
Discussion:
Most studies focused on a specific type of prosthesis such as implants and measured patients' OHRQoL in relation to that specific type.1-7 To our knowledge, this is the first study to measure oral hygiene practice and patient's OHRQoL with FDP in Riyadh, Saudi Arabia. In this study, majority of the participants had poor OHRQoL which comes in disagreement with other studies.8,9 Most of the subjects with poor OHRQoL were females, suggesting that females are more critical about their dentofacial appearance.10,11 Most of the participants didn't receive oral hygiene instructions after prostheses placement. Moreover, brushing using toothbrush and toothpaste was the most commonly used method for teeth cleaning, and other oral hygiene aids were never or rarely used by the subjects.
 
Conclusion and Recommendations:
The results of this study show that the majority of the study population have poor OHRQoL. Some local factors as well as systemic diseases such as diabetes have negatively affected participants' OHRQoL. Additionally, a large number of the subjects didn't receive oral hygiene instructions after prostheses placement; therefore, dentists' awareness regarding giving postoperative oral hygiene instructions should be increased to ensure the durability of the prosthodontic appliances and improve patients' oral health related quality of life. Further studies are recommended in different areas of Saudi Arabia to identify other risk factors affecting OHRQoL.

Sarah Alhusseini, Nouf Alqahtani, Hind Alfehaid, Rasha Alomar, Nouf Almayouf,  Norah Aljuhaimi, Atheer Almasoud,  Abed Al-Hadi Hamasha. College of Dentistry, King Saud bin Abdulaziz for Health Sciences, Riyadh, Saudi Arabia.

Introduction:
The knowledge of prevalence of different traits of malocclusion among specific population is essential for planning the need and provision for orthodontic service to enhance quality of life. Dental malocclusion is considered the third highest prevalence among oral pathologies. Although dental malocclusion is not a life-threatening condition, the impaired mastication, the psychosocial distress and its effect on periodontal conditions increase the need for exploring the prevalence and its associated risk factors. The aim of this study is to detect prevalence of malocclusions in population of Saudi Arabia using WHO index.

Objectives:
The aim of this study is to detect the prevalence of malocclusion among Saudi adults population in order to establish a baseline and a reliable reference point, thus increasing the population awareness and implement solutions that proportionate with the extent of the problem.

Methods:
An observational cross-sectional study of the prevalence of adults with malocclusion in Riyadh, Saudi Arabia. The study was conducted in waiting areas of King Abdulaziz Medical City (KAMC) and College of Dentistry at KSAU-HS by using questionnaires and clinical examinations by using WHO index which is consisted of 14 different occlusal characteristics. The observed data was recorded in a prepared form by seven experienced examiners. All the examiners involved in the study were calibrated, and inter-examiner reliability was calculated. Data analysis using SAS, including frequency and chi-square test. P-value of less than 0.05 was considered significant.

Results:
Among a total of 350 subjects, 30% male and 70% female were examined and assessed for prevalence of malocclusion and associated risk indicators. Figure 1 shows the distribution of the sample according to the prevalence of malocclusions. Out of 350 adults, the most prevalent occlusal trait was increased overjet (42.5%) followed by crowding of anterior teeth (41.5%), whereas anterior open bite was the least prevalent characteristic (4%). Association of some occlusal traits with different risk indicators from demographics and habits have been found. Oral habits showed in Figure 2 were present in 204 subjects (58.2%), with subjects showing more than one habit. Mouth breathing was present in (42.3%), followed by tongue thrusting, speech problems and thumb sucking with  a rate of (11%), (5.7%) and (5.3%) respectively.

Conclusion:
Our study showed that some malocclusion characteristics are more prevalent than other and some oral habits might play an important role in the development of malocclusion. This reflects the need of increasing awareness among citizens and their dental practitioners regarding malocclusion. That can be accomplished by advocating interceptive orthodontic treatment or early corrective orthodontics before reaching adulthood using social media and campaigns. This will improve facial and dental appearance and thus reduce the stigma that some people feel about their teeth . Other studies are recommended to be done in not only Saudi Arabia, but also worldwide using the WHO index to give results that are more accurate .To identify any other risk indicators for malocclusion.

Shahad Meaigel, Nouf Al Qahtani, Latifa AlGudaibi, Naila A.Shaheen, Ali Aboalela, College of Dentistry, King Saud bin Abdulaziz for Health Sciences, Riyadh, Saudi Arabia

Objectives:
The aim of this study is to assess dental and medical practitioners; clinical examination habits, current knowledge, attitude and the pattern of referral of patients with oral and oropharyngeal cancer (OC/OPC) in Riyadh.

Methods:
This cross-sectional study was conducted using self-reported questionnaire that was distributed randomly among dental and medical practitioners in MNGHA, Riyadh. The questionnaire was consisted of six main sections: demographic data, knowledge, detection and examination habits, pattern of referral, preventive role and training needs. Data analysis was preformed using SAS, including frequency and chi-square test. P - value of less than 0.05 was considered significant.

Results:
A total of 174 completed questionnaires were received. Medical and dental practitioners showed comparable results regarding their knowledge about alcohol, smoking and age as risk factors for oral and oropharyngeal cancer. There was a difference in the pattern of referral between groups in terms of their chosen departments of referrals (figure 1), and duration of intra-oral ulcer necessitating urgent referral (figure 2). For examination habits, significantly higher proportion of medical doctors (47%) would never examine the patient in the course of initial examination when compared to dental practitioners (17%). Most of the participants consider pre-existing lesion, alcohol and smoking as factors that would influence their decision to perform an examination of OC/OPC. Most common sites to examine are shown in (figure 3).

Conclusion:
Medical and dental practitioners showed differences in practice, knowledge and attitude of OC/OPC. if addressed and improved, these practices can lead to better treatment outcomes with reduced morbidity and mortality rates. OC/OPC patients would benefit from early diagnosis and immediate referral to specialist care. Therefore, there is a need for both groups to obtain systemic educational updates.

Sundus Altuwayjiri, Azhar Alanazi, Hussah Alodwene, Samar Alarfaj, Nouf Alhamlan, Najla Alrejeye, Samar Al Hayek, Emad Masuadi, Mohammad Awawdeh. College of Dentistry, King Saud bin Abdulaziz for Health Sciences, Riyadh, Saudi Arabia.

Introduction:
Direct bonding technique is the method of applying orthodontic brackets directly onto the patient`s teeth individually or sectional. Indirect bonding technique is when the operator positions the bracket on all teeth at once, using prefabricated guide trays prepared from a working cast in the laboratory where the brackets are positioned accurately on the models in the first step. The aim of this study is to compare between direct and indirect bracket bonding techniques in terms of accuracy and efficiency while utilizing 3D Technology for models reproduction of identical models for both techniques.

Methods:
10 pairs of casts have been randomly chosen to compare direct and indirect bracket bonding techniques. They have been scanned by Ceramill map 400 digital scanner and saved in STL format. The file was printed utilizing a 3D printer (ProJet MJP 3600). Five independent operators have received 2 cases for the direct bonding technique and their identical duplicate for the indirect bonding technique. Double silicon technique was used for the indirect technique, the trays were made by vacuum machines (Plast Vac P7) and (BIOSTAR, Scheu). All operators are novel in the field of orthodontics (third year dental students) and have received the same training. All models were blindly evaluated by two different independent assessors. Each assessor repeated the evaluation at two different occasions with minimum interval of 72 hours.

Results:
The accuracy in positioning the brackets in the correct place using the indirect method was as good as the direct bonding method with no statistical significant difference between the two groups (Paired sample t-test; p greater than 0.05).
The study data showed that longer total time was needed to place the brackets in the indirect technique compared to the direct approach. However, when taking only the clinical time in consideration; the indirect method needed 50% less time.
No significant differences was detected both in Inter and intra assessor grading, however the junior assessor scores seemed to be consistently higher, the more senior assessor evaluation was more consistent in both reading.

Conclusion:
Indirect bonding takes almost double the total time, but shorter clinical time and as accurate as the direct bonding technique. The indirect method saved almost 50 % of the clinician's time, but was more demanding on the lab technicians. This study concluded that indirect bonding techniques should be utilized much more as it save more than 50% of clinic time and produce accurate bracket positions. Further In Vivo studies arerecommended to confirm these findings.

Maram AL-Jabry, Mohammed Awawdeh, Dr. Khulud Alkadi, Nawaf Alshahrani Graduated student of Health Informatics, King Saud bin Abdulaziz for Health Sciences, Riyadh, Saudi Arabia.

Objectives
The aim of this study was to evaluate the patient's knowledge, understanding and comprehension of the information given to them at the start of the treatment regarding the instruction of oral hygiene (OHI) during Orthodontics treatment, the risks of orthodontic treatment and the care of the fixed orthodontics appliance.
The specific objectives of the study were:

  • To compare between two educational methods and evaluate them through which one patient understands best the risks of orthodontic treatment, OHI and instruction related to Orthodontic treatment.
  • To evaluate if their comprehension is related to their age, gender and socioeconomic class.

Methods
The sample groups were in the range of 12-16 years old. There was 49 participant (23 received teaching through leaflet; 26 received teaching via Augmented Reality) The population were paired in similar age, gender and school grades. Then they were randomly allocated to one of the two teaching method (Augmented reality or Leaflet). The Augmented Reality (AR) technique was used to educate half of the sample, while the other half was educated via traditional methods using paper-based leaflets. Comprehension of the oral hygiene Instructions among participants, and their awareness of the risks of orthodontics treatment, was then assessed. The study tool was a validated survey which was knowledge-based. The survey was used in previous similar study in English. Validation of the Arabic translation was done through various stages inclusive of content and face validation. The Questionnaire was filled twice; before and after the educational intervention. The first occasion was the base line for the study. The data acquired from the patients was analyzed using Paired samples t-test (SPSS ver. 24).
Results
The results showed that the educational material played via AR have higher impact (205 %) on teenage patients compared to leaflet.  Also, by observing behaviors of the patients while reading or being engaged with AR in the clinic, it was obvious that patients were more focused while engaged with AR than reading the leaflet. The feedback from participating patients was highly positive and favorable toward AR. The improvement in the AR group was statistically significantly higher than that for the group using the traditional methods (Paired samples t-test shows significant between AR and leaflet; p = 0.003) The increase of mean score of the patients in the knowledge based survey in the videos was 4.35 points, while for the leaflet it was 2.13 points.

Conclusion
Using AR had greater impact on educating Orthodontic patients than leaflets. AR is an affordable and effective method for educating Orthodontic patients. Utilization of trending technologies to enhance the educational experience in healthcare is foreseen.

Noura Alghurairi, Reuof Alessa, Rahaf Alalwan, Huda Alaqail, Mohammed Awawdeh,  Emad Masuadi. College of Dentistry, King Saud bin Abdulaziz for Health Sciences, Riyadh, Saudi Arabia

Introduction
Obtaining dental records is crucial in dentistry. Throughout the years a lot of companies had produced and improved intraoral 3D (three-dimensional) scanners to capture 3D virtual images of the teeth. Both Sirona and KaVo companies produced 3D lab scanners that have high-quality standards of optical measuring systems. These scanners were used in dental labs to scan dental casts and impressions. Since these systems had recently been introduced to the market, not enough studies had evaluated their accuracy and efficiency. This study aimed to evaluate the precision and validity of two new 3D lab scanners in producing duplicated digital impressions, compared to the traditional method of dental cast duplications.

Materials and Methods
Pair of dental casts (upper and lower) were duplicated by using elastic putty mould to make ten copies of each. Following that the total of twenty models were scanned in each scanner (Sirona and KaVo) separately by three different calibrated operators. Each operator repeated the scan with an interval of 48 hours. This allowed assessing inter and intra operator variation. fifteen measurements of each model were obtained in the three different planes (vertical, horizontal, and transfers) following the same protocol. Measurements were obtained manually using a Boley gauge and digitally by the scanner company software. The two scanners that were assessed were; inEos X5 Sirona Scanner and KaVo SMD ARCTICA CAD/CAM Scanner.

Results
The coefficient of variations was between 1% - 8% although statistically significant in some groups, but clinically the differences were insignificant and within the accepted range. Repeated Measurements ANOVA and Paired t-test confirmed these findings. Correlations between the inter and Intra operator reliability were assessed using the Intraclass Correlation Coefficient (ICC). The reliability of the increased distance of the measurement seems more consistent. The variations of Correlations among operators increased as the distance measured decreased, despite the fact that all operators were calibrated respectively. This was explained by the fact that both manual and digital measurements relied heavily on the operators identifying specific landmarks. Operators' feedback were that KaVo was easier to learn. However, time-wise Sirona seemed more efficient. As the average time for the Sirona scanner was less by half a minute with average scanner time (4.3 and 3.8). In all cases, the average second time was always less than the first time. Based upon various parameters recorded, both scanners proved to be accurate with no clinically significant differences detected between the groups.

Conclusion
These two scanners were reliable tools to scan and reproduce digital dental records. One system seemed to be more efficient time-wise than the other. Clinical measurements obtained by the clinicians could vary and be less reliable with small distances. Further studies are needed to utilize 3D superimpositions software to determine the precision of these systems.

Fatimah Alssafi, Abeer R Alshehry, Renad Alshunaiber, Aljazy Alshubaiki, Hoda Alemam, Abed Al-Hadi Hamasha. College of Dentistry, King Saud bin Abdulaziz for Health Sciences, Riyadh, Saudi Arabia

Abstract

Objectives
Reviewing the dental literature, studies assessed gender differences in oral health behavior and attitude are scarce and limited to dental students. Attributable to lack of understanding of the gender differences in beliefs and behaviors among Saudi population, this study investigated variations in males and females beliefs and behaviors toward oral health and assessed the influence of oral health believes on the oral health behaviors among each gender.

Methods
A cross-sectional study was designed to obtain information from patients attending the outpatient clinics in King Abdulaziz Medical City. Of the 553 self-reported questionnaires, 519 were successfully received comprising 251 males and 268 females. The questionnaire consisted of demographic questions along with 25 questions about belief- and behavior-related oral health. The statistical analysis involved frequency distribution and chi square tests. P- value was considered was considered significant at value of less than 0.05.

Results
The participants expressed high beliefs of the importance of tooth brushing (95-98%), importance of carbohydrates to caries (92-93%) and importance of regular dental visits (90-94%). Despite the comparable beliefs among genders, females were found to act more positively than males in terms of tooth brushing (gap=18% vs. 31%), dental visits (gap=13% vs. 24%), and carbohydrate consumption (gap=15% vs. 23%).
When comparing beliefs and behaviors towards the importance of oral health styles we found a gap of 12-45% between those who believe of health behaviors and those who actually adopt them.

Conclusion
The study presents valuable information about the discrepancies between beliefs and behaviors among Saudi patients. It also indicated that females act more positively toward oral health than males. Educational campaigns that are conducted to increase the knowledge about oral health need to be replaced with other campaigns targeting shifting behaviors toward adopting healthier behaviors specifically among males.

Lolowh Almogbel, Prof. Abed Al-Hadi Hamasha,  Abeer Alshehri, Fatimah Alssafi, Hanan Alghamdi, Alanoud Alajmi, Dr. Zainul Rajion. College of Dentistry, King Saud bin Abdulaziz for Health Sciences, Riyadh, Saudi Arabia.

Abstract

Objectives
Upon reviewing the literature, the prevalence of many systemic conditions such as diabetes, hypertension, asthma and rheumatoid arthritis were reported to be high in Saudi Arabia.  The relationship of these conditions with tooth loss among Saudi population was not investigated. Therefore, the aim of this study is to explore the relationship between tooth loss and most common medical conditions among Saudi dental patient.

Methods
The study participants were 250 Saudi patients who were randomly selected from the College of Dentistry database at King Saud bin Abdulaziz University for Health Sciences in Riyadh, Saudi Arabia. The participants were requested to fill self-administered questionnaires related to their demographic as well as general health questions concerned with systemic medical conditions, if present. Missing teeth were determined after examining the Orthopentagram radiographs and reviewing the Romexis ® and Salud software databases. Descriptive statistics, Independent t-test and multiple linear regression models were performed using SPSS software.

Results
The mean number of missing teeth among the study population was 5.8 teeth per person. Patients who reported diabetes, hypertension, rheumatoid arthritis, cardiovascular diseases, or osteoporosis have higher mean number of missing teeth compared with the subjects who are healthy. A multiple linear regression analysis model revealed that diabetes, hypertension and rheumatoid were significant predictors of missing teeth among Saudi population.

Conclusion
These results highlight the effect of medical conditions on loss of teeth.

Renad Abdulaziz Alshunaiber, Shahad Meaigel, Arwa Aldeeri, Haya Alzaid, Naila A. Shaheen, Abdallah Aadlan. College of Dentistry, King Saud Bin-Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia.

Abstract

Objectives
To estimate the prevalence of self-medication for oral health problems, to identify the most commonly used medicaments, to identify sources of obtaining these medicaments and sources of information for using them, to identify the reasons of self-medication instead of seeking professional healthcare advice, and to identify the most common oral health predictors for self-medication

Methods
Cross-sectional study based on a structured close-ended questionnaire among adults visiting shopping malls in five regions of Riyadh. Two stages of sampling techniques were used; cluster and simple random sampling, of which Riyadh city was clustered into five regions and two shopping malls in each region were selected randomly. The questionnaire consisted of two main sections, demographic and questions assessing the practice of self-medication. The data was analyzed using SAS, in which interval variables were reported in terms of mean and standard deviation, frequency distribution for categorical variables. All categorical and interval variables were compared statistically using Chi-Square test for independence and T-test, respectively. P-value of less than 0.05 was considered significant.

Cross-sectional study based on a structured close-ended questionnaire among adults visiting shopping malls in five regions of Riyadh. Two stages of sampling techniques were used; cluster and simple random sampling, of which Riyadh city was clustered into five regions and two shopping malls in each region were selected randomly. The questionnaire consisted of two main sections, demographic and questions assessing the practice of self-medication. The data was analyzed using SAS, in which interval variables were reported in terms of mean and standard deviation, frequency distribution for categorical variables. All categorical and interval variables were compared statistically using Chi-Square test for independence and T-test, respectively. P-value of less than 0.05 was considered significant.

Cross-sectional study based on a structured close-ended questionnaire among adults visiting shopping malls in five regions of Riyadh. Two stages of sampling techniques were used; cluster and simple random sampling, of which Riyadh city was clustered into five regions and two shopping malls in each region were selected randomly. The questionnaire consisted of two main sections, demographic and questions assessing the practice of self-medication. The data was analyzed using SAS, in which interval variables were reported in terms of mean and standard deviation, frequency distribution for categorical variables. All categorical and interval variables were compared statistically using Chi-Square test for independence and T-test, respectively. P-value of less than 0.05 was considered significant.

Results
The majority of the 400 participants indicated the usage of self-medication for oral health problems (63.25%), with a higher percentage among females (69.44%). Gender and nationality were significantly associated with self-medication (P-value 0.005 and 0.049). Salt in hot water locally (52.57%) and Paracetamol (47.43%) systemically were the most frequently used. Pharmacy shops were the main source of these medicaments (66.01%). Similarly, the advice for using these medicaments was mainly given by pharmacists (53.36%). Lack of time was reported to be the main reason for practicing self-medication (54.55%), with abscess, toothache and gingival bleeding being the main predictors.

Conclusion
Self-medication was found to be a common practice. This could be a dangerous finding due to possible complications and delaying of proper intervention. Therefore, educational campaigns to raise the awareness, besides reinforcing the evidence based guidelines on medicaments utilization are required.

Abeer Al-Mthen, Amrita Geevarghese, Amal Almutairi, Amjad Alghaihab, Huda Alemam, Waad Alsaadi. College of Dentistry, King Saud bin Abdulaziz for Health Sciences, Riyadh, Saudi Arabia

Abstract

Objectives
Malocclusion has an effect on the oral health and on the quality of life by affecting the function, appearance, social life, and self-esteem of individuals. This study aimed to investigate malocclusion in 11-14-year-old patients attending King Abdulaziz Medical City in Riyadh, Saudi Arabia using Dental Aesthetic Index (DAI) and its impact on their oral health-related quality of life using oral health quality of life measure (OHRQoL).

Methods
A cross-sectional study survey was used. The sample included were children 11-14 years old from King Abdulaziz Medical City (KAMC) and two public female schools of Riyadh. Physically and mentally disabled children and those who are undergoing or have undergone orthodontic treatment were excluded. Data was collected through parent's questionnaire, child perception questionnaire 11-14 (CPQ11-14), and Dental Aesthetic Index (DAI), and then it was statistically tested by non-parametric tests.

Results
A total of 246 children participated in the study; 73.98% of which were females. Malocclusion was found to be absent or minor in (37.6%), definite in (22.4%), severe in (14.4), and very severe in (24.4%) of the participants. The mean CPQ11-14 score was reported as (19.8). Domain-specific scores showed that the highest mean score were for oral symptoms and the lowest were seen for social well-being. The severity of malocclusion was significantly associated with higher mean CPQ11–14 scores in the social well-being domain. Tongue thrusting was the only bad oral habit that was significantly associated with presence of malocclusion (p= .028)

Conclusion
Severe malocclusion appears to have a negative impact on social well-being of children aged 11-14 in Saudi Arabia.

Waad Aldebasi, Abed Al Hadi Hamasha, Aljoud Alsolaihim, Renad Alshunaiber, Haifa Alturki, Lana Alaskar. College of Dentistry – King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia

Abstract

Objectives
To assess the effect of BMI on DMFT, periodontal pockets, and oral soft tissue variations as well as to assess the impact of several demographic, social, behavioral, and health factors on the relationship between BMI and oral health.

Methods
A systematic random sample of 250 outpatients and their adult companions were included. Questionnaires for sociodemographic, behavioral, medical and physical conditions were distributed and collected. Full clinical oral examinations were conducted to assess dental caries, restorations, extractions, pocket depths and soft tissues changes. Each subject was examined by two different examiners to corroborate the findings. BMI was assessed using a height and weight scale. Statistical analyses included descriptive statistics; independent samples t-tests, one-way analysis of variance, correlation coefficient, Chi-square, and logistic regression analysis were analyzed using SPSS program.

Results
About 67% of participants were either overweight or obese. The mean DMFT was significantly increased by increasing BMI value. However, pocket depths were not significantly related to an increase in BMI. In the bivariate analyses, there were significant associations between BMI and the following variables: age, education, smoking, tooth brushing, hypertension, diabetes, use of medication and traumatic ulcer. Logistic regression analysis revealed significant relationship between BMI with DMFT in the presence of education of less than high schools, current smoking status, presence of any medical problem, and presence of edematous gingiva.

Conclusion
There is an observed relationship between BMI and oral health status. Subjects who had increased BMI were more likely to have a higher DMFT score. Other risk indicators for this relationship include lack of education, presence of edematous gingiva, smoking, and presence of medical condition.

Abdullah AlBawardi, Mohammed Alsalem, Abdulaziz Almudhi. College of Dentistry, King Saud bin Abdulaziz University for Health Sciences

Abstract

Objectives
To determine the accuracy of orthodontic bracket placement and to compare bracket height using Boone gauge, Wick type gauge, and Swivel head bracket height gauge among inexperienced dentists.

Methods
A total of 600 teeth bonded with orthodontic brackets by 10 dental interns with no prior bonding experience. Each subject had to bond 20 teeth for each of the height gauges, a total of 60 bonded teeth per subject. Thirty typodonts were set-up inside phantom heads in a pre-clinical lab to simulate actual clinical setting. Ideal positioning measurements were handed out to the interns prior to bonding. Teeth were then removed from typodonts and placed inside acrylic molds; photographs were then taken from a standardized jig and imported into a computer. The position of each bonded bracket was then measured using Adobe Photoshop after calibration, and brackets' vertical positioning errors were measured. The height of the acrylic mold was calculated prior to taking photographs in order to calibrate Photoshop to the exact measurements. This way accuracy can be achieved. All of the photos were taken from one camera that was fixed to a standardized jig in one position. This way it was made sure that reliable measurements were obtained. Data were analyzed using SPSS software. One-Way ANOVA was applied to determine the difference in means between the three groups.

Results
Significant differences were seen between the means of the vertical heights for the three gauges and the ideal measurements (p  0.05). Boone gauge demonstrated higher accuracy than the Wick type gauge, and the Swivel head bracket height gauge, however, the difference between the three gauges was not statistically significant. ANOVA revealed that gauge type and tooth position influence the accuracy of the bracket placement position.

Conclusion
Significant differences were seen between ideal measurement and all height gauges. Boone gauge was the closest to ideal, but that finding was not significant. Accuracy was influenced by the tooth type and position, which indicates a relationship between the tooth type and the used accuracy of the height gauge. So, experience in bracket positioning is an essential factor for an accurate orthodontic bracket position.

Mohammed Alsalem, Abdulelah Aldahash, Waleed Alfayez, Omar Alsammahi, Tariq Alduhaimi, Abdullah Alehaideb, Amritha Geevarghese. College of Dentistry, King Saud bin Abdulaziz University for Health Sciences.

Abstract

Objectives
This study aimed to evaluate how dental practitioners and the general population differ in their perception of altered smile aesthetics based on viewing images of a digitally manipulated smile.

Methods
A smile photograph of a female individual was selected and digitally manipulated to create changes in buccal corridor space (BCS), the amount of gingival display, midline diastema, and midline shift. These altered images were rated by two groups: 149 general dental practitioners and 155 randomly selected adult laypeople from the general population. Smile aesthetics scores were calculated and comparisons between groups were performed using Student's t-test and one-way analysis of variance (ANOVA).

Results
The results showed that profession and gender affected BCS and midline diastema attractiveness ratings (P less than 0.05). Wide BCSs, a gingival display of 3 mm or more, and the presence of a midline diastema of any size were rated as unattractive by all groups.

Conclusion
The findings of this study showed that the general population accepts a wider range of deviation compared with dentists. Therefore, when aesthetic treatment to obtain a harmonious smile is performed, clinicians must be careful about imposing their own beauty norms upon patients. The type and degree of deviation from the norm and the opinion of the patient need to be taken into consideration.

Mohammed Alsalem, Antonio Delgado, Rita Almeida. College of Dentistry, King Saud Bin-Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia.

Abstract Template (250-300 words)

Objectives
To evaluate the effect of mechanical brushing with different commercial toothpastes on the chemical degradation and surface changes of stainless steel orthodontic brackets.

Methods
A number of 50 stainless steel orthodontic brackets were randomly divided into 6 groups: 4 groups treated with fluoridated toothpastes (n=l0) and 2 non-treated groups (n=5). The sample size was selected based on Power analysis. Orthodontic appliances were simulated and immersed in test tubes containing artificial saliva. The treated groups were subjected to 93 brushing cycles (3 brushings per day, during 31 days) with different Sensodyne®toothpastes: Rapid, Repair and Protect, Whitening and Daily Care. The untreated groups were divided into two groups: negative control group exposed to mechanical brushing without toothpaste, and the non-treated group sample, only immersed in artificial saliva. The brackets were submitted to an initial and final evaluation by energy-dispersive X-Ray Spectroscopy (EDS) and scanning electron microscopy (SEM).

Results
A statistically significant decrease in iron was observed in the experimental group treated with Sensodyne®Rapid. The remaining tested toothpastes and the non-treated groups did not cause changes with statistical significance in the material's chemical composition. Considering the surface changes, a statistically significant increase in the number of the characteristics present on the bracket slots was found in all experimental groups undergoing brushing with toothpastes. Mechanical brushing and immersion in artificial saliva did not result in statistically significant surface alterations.

Conclusion
Sensodyne®Rapid caused chemical degradation of the stainless-steel brackets resulting in a significant decrease of iron. All tested toothpastes caused morphological changes on the brackets surface.

Meshael Abuabat, Ministry of National Guard, National Guards Health Affairs, Riyadh, Saudi Arabia

Abstract

Objectives:
The purpose of this review is to identify literature related to occlusal vertical dimension (OVD) increase in terms of conservative and alternative management, clinical considerations and techniques to evaluate the vertical dimension (VD), prosthetic concept, magnitude of increase, adaptation and stability of altered VD and effect on muscle activity and speech.

Methods:
A comprehensive search of the literature was performed by using PubMed, Medline and Cochrane Library with the following keywords: "increasing vertical dimension", "occlusal vertical dimension", "altered vertical dimension", "resting vertical dimension", "rest position" and "tooth wear". Further, the literature search was endorsed by manual searching through reference lists of the selected articles. The search was limited to articles written in English. A total of fifty-seven references were reviewed.

Results:
There are various methods reported in the literature to determine the loss of OVD. Majority preferred fixed method of increasing the VD over removable methods and one study recommended using both. Adaptation to the altered VD is influenced by various factors and several techniques of assessment have been proposed. The potential factors influencing adaptation to the increase in the OVD include: magnitude of OVD increase, adaptation period, method of increasing the OVD and occlusion scheme. The most common techniques of patient adaptation assessment proposed in the literature include: evaluation of subjective patient symptoms, palpation of masticatory muscles inter-occlusal space measurement, radiographic measurement and speech evaluation. Regarding stability of the altered vertical dimension, 2 schools of thought exist. The first expressed concerns regarding relapse of OVD to its original value, phonetics and muscle activity when altering the VD. The second believes that VD is adaptable and that changes in the OVD are maintained because of an alteration in the length of the muscles.

Conclusion:
Increasing the OVD should be considered only if comprehensive prosthodontic rehabilitation is indicated and the determination of OVD increase should be based on more than one method to improve the accuracy of the recording procedure.

Mohammed Misfer Al dosari, Salman Rasheed, Abdullah alonazi, Mohammed alzahrani, Emad alshehri, Ali Aldalaan, Dr. Zainule Rajion. College of Dentistry, King Saud bin Abdulaziz for Health Sciences, Riyadh, Saudi Arabia

Abstract

Objectives
The study was aimed to assess level of awareness and knowledge among parents on oral health of their children. .

Methods
This is cross sectional study. A questionnaire survey was carried out among parents which covered various aspects of knowledge, attitude, and their role in oral health of their children. The collected data were tabulated, and presented as frequency distributions for responses to every question.

Results
The study showed that, majority of parents (40.7%) brush their children teeth once daily. Most of the children brush their teeth before sleep (53.4%) and performed mouth rinses after food (70%).
Regarding to the frequency of dental visits, most of the participants responded that they take their child when they feel pain (36.7%). Regarding to diet category, the most common answer was the child consumes 1-3 times of fruits per week (55.6) percent. A significant association was found between educational level and parent's awareness. The higher level of education gave correct answers of awareness questions

Conclusion
From the present study, there is a lack of awareness and knowledge among parents on oral health of their children in Riyadh. There is lack of awareness and knowledge among participants.

Rakan Bahkeet Aldosari, Sarah Almotlaq, Ziyad Alosaimi, Abdullah Altammami, Abdulaziz Fakih,Faisal Alsanee, Ahmed Alhomaied. College of Dentistry, King Saud bin Abdulaziz for Health Sciences, Riyadh, Saudi Arabia.

Abstract

Objectives
Oral health related quality of life (OHRQoL) reflects people's comfort when eating, sleeping, and engaging in social interaction; their self-esteem; and their satisfaction with respect to oral health. Therefore the aim of the study is to evaluate the oral health related quality of life for patients who were attending the Cardiac center in King Abdulaziz Medical City (KAMC) in Riyadh and to relate this to age, social status, financial status, dental visits and Smoking habits.

Methods
OHRQoL was distributed to Patients attending Cardiac center in KAMC. After obtaining an ethical approval, a convenient sample size of 300 patients (184 male and 116 female) was used. We excluded patients under the age of 17, patients with mental disability and patients outside National Guard Health Affairs facility. The questionnaires were then analyzed using IBM SPSS statistics 22

Results
The mean age of our sample was 49 year. About 34.7% of participants had a high school education, 42.7 were employed, 22.7% had a salary from SAR8700 to SAR11999, and 65.3 were married. About 57.7% had an excellent social life and 40.4 of the participants visited the dentist only if there is pain.
The mean OHIP score of the study participants was 10.8 with statistical significant relation with marital status (p less than 0.004). Singles scored 6.2 while widowed scored 13.6. subjects who lived with their family score the lowest while the subjects who lived in rented home scored higher OHIP scores (p less than 0.002). Finally, after calculating the functional limitation indicators in the questionnaire that were distributed we found that physical pain and physical disability had the highest mean score 0.96 and 0.92 while the lowest was functional limitations 0.53.

Conclusion
This study attempted to provide some insight and attention into oral health related quality of life (OHRQol) of patients attending cardiac center.

Abdulrahman Alotaibi, Mohammad Aleissa,Menwer Alenazi, Faisal Alshehri, Saud Aljohani. DR.Amritha Geevarghese. College of Dentistry, King Saud bin Abdulaziz for Health Sciences, Riyadh, Saudi Arabia

Abstract

Objectives
The objective of this study was to evaluate the Prevalence of Medical Emergencies Events in Dental Office and to Assess Dental Team Preparedness.

Methods
This a cross-sectional questionnaire study was performed at National Guard Health Affairs' (NGHA) five dental centers in Riyadh. The sample size was fixed at 200 participants. The questionnaire included questions on demographic data, professional qualification, emergency management trainings obtained, number and type of medical emergencies, knowledge and skills in managing / preventing emergencies.

Results
Response rate for the study was 81 percent and considering the missing data and incomplete questionnaires only 153 questionnaires were finally used for analysis. Almost 30 percent of the respondents reported to have encountered a medical emergency during the past three months. In agreement with other studies, vasovagal syncope was reported to be the most common medical emergency faced during dental practice Emergency training received during undergraduate days was found to be better among the dentist group when compared to dental auxiliaries. Almost 90% of the participants felt a real need of improving the emergency management skill.

Conclusion
The study has found that 90.2 percent of the respondents unsatisfied  with their level of training in managing  medical emergencies and therefore need more training. We cannot assume that the data obtained by self-estimation of competence is equal to external evaluation. We are recommending that dentist and dental auxiliary have to take further training in dealing with medical emergencies. The organization have to be sure dentist and dental auxiliary have valid emergency training certification and also having routine check for all the equipment needed for medical emergency.

Abdulmajed Alturki, Abed Al-Hadi Hamasha, Mohammed N. Aldosari, Saud Aljohani, Ibrahim Aljabali, Faris Aljaghwani, Rakan Alotaibi, Nasser Alhufaiyan. College of Dentistry, King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia

Abstract

Objectives
The aim of this study was to evaluate the oral health status and factors associated with access and utilization of dental healthcare services among the elderly male population in Riyadh, Saudi Arabia. The objectives were 1) to evaluate the oral health status of the elderly population in Saudi Arabia, 2) to question the access of the elderly population to dental services, and 3) to investigate the link between lack of access and utilization of dental services with poor oral health status if present.

Methods
This study surveyed 350 male participants aged 65 and above living in Riyadh, Saudi Arabia. Both community dwellers and nursing home residents were included. The assessment tools for this study included a questionnaire-based interview and a clinical examination. Data were analyzed using chi-square and T tests.

Results
This study found that only 32.6% of participants are visiting the dental office properly. Participants who are not utilizing dental services were found to have a mean DMF score of 20.98. Moreover, participants who reported transportation, financial reasons, lack of insurance and dental fear as barriers to accessing dental treatment are utilizing dental services less properly than those who didn't. Furthermore, factors like income, place of residence, smoking, and oral hygiene practices significantly affect utilization of dental services by the elderly population in Riyadh, Saudi Arabia.

Conclusion
In general, the elderly male population in Saudi Arabia are not accessing and utilizing dental services properly, and consequently, have poor oral health. Additionally, dental insurance, financial reasons, transportation, fear of dental treatment, and lack of perceived needs are significant barriers to accessing and utilizing dental services by the elderly males in Saudi Arabia.

Mohammed Nasser Aldosari, Mohammed Awawdeh, Abdullah Mohammed Altammami
Mohammed Almalki, Emad Masuadi College of Dentistry, King Saud bin Abdulaziz University for Health Sciences, Riyadh - Saudi Arabia

Abstract

Objectives
To evaluate the accuracy of the liner measurements of the face conducted using the Proface system in comparison to measurements from direct anthropometry

Methods
Twelve Soft tissue facial landmarks were identified and labelled on five mannequin heads, direct measurements obtained by three independent assessors separately to assess reproducibility using digital poly-gauge. Every measurement was taken three times to assess repeatability; this was done in three different occasions with minimum of 24 hours interval to eliminate recall bias. In addition, calibrated and standardized 3D images using the Pro-face were captured and the same measurements were obtained using the same protocol. A total of 1080 Readings were recorded.

Results
There was no clinical significance difference in measurements obtained by 3D scans and direct anthropometry. Inter-operator, Intra-operator and Methods mean differences were below one millimeter, which is non-significant clinically. Repeated Measurements ANOVA and Paired t-test confirmed these findings. However, there were significant differences in some of the measurements between the heads, which might be a result of variations in identifying some of the points.

Conclusion
The precision and accuracy found in digital 3D photogrammetry from the Proface system is adequate for the anthropometric needs of nearly most of craniofacial and orthodontic purposes and accurate as compared to direct anthropometry.

Aljazy Hamad Alshubaiki, Mashael Al Thunayan, Sarah Alobaidy, Reem Alwakeel, Jood Alessa, Ruba Alhaudayris, Sara Almotlag. College of Dentistry, King Saud bin Abdulaziz for Health Sciences, Riyadh, Saudi Arabia

Abstract

Objectives
This research aims to assess the level of oral health literacy of the caregivers and its association with the oral health status of pediatrics patients

Methods
Convenient sample of 300 caregiver/children were recruited from pediatric dental clinics at King Abdulaziz Medical City (KAMC) Riyadh, Saudi Arabia. Self-administered questionnaires comprised of five components, which was completed by a caregiver. Comprehensive Measure of Oral Health Knowledge (CMOHK) questionnaire was used to record the Oral health literacy (OHL) of the caregiver. Oral health status of the child was obtained from the child's dental records. This would include the measure the oral health status of the child by recording his/her Decayed-Missing-Filled-Teeth (DMFT) index. Chi-square, Fisher's exact t-test and ANOVA were used.

Results
Results: Caregivers' oral health literacy was associated with children's oral health status. OHL in this study, more than half of the participants were having adequate oral health literacy (53.0%). OHL was correlated with multiple variables and it was found to be significant with education level of the caregivers, monthly income, medical condition of the child, and gender of the caregiver (P less than 0.05).

Conclusion
In this study, we found that caregivers mostly have poor oral health literacy. We assessed the knowledge that the caregivers lack in order to increase the awareness of the health care providers when meeting the caregivers of pediatric patients.

Menwer Awaed Alenazi, Amritha Geevarghese, Nasser Alghofaili, Abdulrahman Obaid, Mohammed Alhamdan, Abdulrahman Alotaibi, Mohammed Aleissa, Menwer Alenazi, Faisal Alshehri. College of Dentistry, King Saud bin Abdulaziz for Health Sciences, Riyadh, Saudi Arabia

Abstract

Objectives
The aim of this study is to assess the dental practitioners' use of social media, and to investigate the potential benefits of social media use in dental practice.

Methods
This cross-sectional study was conducted in selected private and government dental clinics in different areas in Riyadh, Saudi Arabia. A self-administered questionnaire consisting of 30-items was conveniently distributed to selected private and government dental clinics.

Results
The overall response rate was 77.3%. 51.8% of the participants were using social media within their dental practice. Twitter was the most commonly used program (35.4) while WhatsApp (4 %) was the least used. Education was the main purpose (43.4%) of using social media, while entertainment was the least (8%). 62.3% of participants used social media as marketing tool for improving their dental practice.

Conclusion
The majority of the participants indicated that social media has improved dental practice and become an indicator of successful practice.

Rawan Al-Rethia, Abdulaziz Al-Dayel. Ministry of National Guard, National Guards Health Affairs, Riyadh, Saudi Arabia

Abstract

Introduction
Class III malocclusion is primarily a skeletal condition characterized by the protrusion of the mandible, or the retrusion of the maxilla, or both. Ideally, diagnosis of this discrepancy should be made early, during the primary dentition.
Orthodontic treatment alone, or in combination with orthognathic surgery, usually resolves most cases of class III malocclusion after growth completion. Conversely, oral rehabilitation of partially edentulous patients is challenging and sometimes requires surgical, orthodontic and prosthetic treatments.

Case Report
Thirty years old twin sisters were referred to prosthodontic clinics for full mouth rehabilitation in National Guard Dental Center. They reported that they were unhappy with their masticatory function and with the esthetic appearance of their smile. Medical evaluation revealed that the patients presented satisfactory general health. They underwent orthodontic treatment; the older sister did orthognathic surgery to correct the anteroposterior discrepancy between the arches without any prosthetic planning prior to surgery while the younger sister did not.

Intraoral examination revealed that the older sister who had the surgery performed, had multiple missing teeth and almost edge to edge teeth relationship with tendency to class III, the younger sister had an anteroposterior discrepancy between the dental arches and multiple missing teeth. The maxillary and mandibular arches were classified as Kennedy class I for the older sister, and class II modification 1 for both arches for the younger sister.

The optimum treatment objective, in these cases, is to correct the skeletal discrepancies between the maxilla and the mandible. Other essential objectives included are the replacement of missing teeth in both arches, establishment of a stable occlusal relation, and improvement of the patient's facial and dental esthetics.

The younger sister will undergo a comprehensive orthodontic and prosthodontic planning prior to surgery by having her diagnostic wax up on the mock surgery casts ( centric mounting ) , while the older sister underwent the surgery without any prosthetic consultation nor planning
The main goal of this multidisciplinary approach is the reestablishment of facial and dental harmony, functional occlusion, as well as health and stability of the orofacial structures.

The aim of this case report is to compare the end results of treatment of a partially edentulous patient with class III skeletal malocclusion prosthetically planned before or after the orthognathic surgery.

Abdulmajeed Alwohaibi, Fouad Salama, Faika Abdelmegid, Mohamed El-Agamy, Hassan Ka'abi. Ministry of National Guard, National Guards Health Affairs, Riyadh, Saudi Arabia

Abstract

Objectives:
The aim of this cross-sectional population-based in vivo study was to assess the effect of green tea and honey solutions on the level of salivary Streptococcus mutans.

Methods:
A convenient sample of 30 Saudi boys aged 7-10 years were randomly assigned into 2 groups of 15 each. Saliva sample was collected for analysis of level of S. mutans before rinsing. Commercial honey and green tea were prepared for use and each child was asked to rinse for two minutes according to their group. Saliva samples were collected again post intervention (after rinsing). The collected saliva were prepared for S. mutans calculation per mL of Saliva.

Results:
The mean number of S. mutans before and after rinsing with honey and green tea solutions were 2.28* 108(2.622*108), 5.64 *107(1.03*108), 1.17*109(2.012*109) and 2.59*108 (3.668*108) respectively. A statistically significant reduction in the average number of S. mutans at baseline and post intervention in the children who were assigned to the honey (P=0.001) and green tea (P=0.001) groups was found. The data also showed no significant difference in the mean ranks of number of S. mutans between honey and green tea groups both at baseline (p=0.19) and post intervention (P=0.051).

Conclusion:
A single time mouth rinsing with honey and green tea solutions for two minutes effectively reduced the number of salivary S. mutans of 7-10 years old Saudi boys. Honey and green tea solutions should be considered as a potential procedure in prevention of caries in children.

Abdulrahman K. Obaid, Nasser Al Shrim, Mohammed AlDosari, Ibrahim Aljabali, Abdullah Altammami, Emad Alshehri. College of Dentistry, King Saud bin Abdulaziz for Health Sciences, Riyadh, Saudi Arabia

Abstract

Objectives
Children obtain living skills and knowledge from their mothers and up to a specific age they rely on their mothers in forming their habits. Mothers play a critical role in preventing dental problems in children. This research aim to evaluate mother's knowledge about oral health in primary schools of National Guard, Riyadh. Saudi Arabia

Methods
This cross-sectional study was done in King Abdullaziz Iskan City primary schools of National Guard in Riyadh, Saudi Arabia. 13 primary school received number from (1-13). 2 schools were selected using cluster random sample. 400 students of the selected schools were handled a self-administrated questionnaires to be filled by their mothers after taking the permission of school principle. The questionnaire was categorized into 5 groups with 27 MCQ's. Data entry and processing done on SPSS version 22 software (Chicago, IL, USA). Descriptive and inferential data analyses were generated by using the "chi-square test" to test the association between different variables with the level of significance at P/0.05, P-value of equal or less than 0.05 was considered significant in this study.

Results
The completed questionnaires were 257. The response rate is of 64% after data orientation and clearance. Age, income, and level of education were considered in this study to see the relationship between these factors and other various questions related to mothers' knowledge about oral health. Demographic distribution illustrated in table 1. In table 2, all of mothers with or above bachelor degree know that there was relationship between oral and general health while 93% of mothers below bachelor degree know that so there was significance relationship with knowing if there was relationship between oral and general health and mother education level (P value = 0.014). In table 3, family with high income know about fluoride more than family with low income (P Value =.034) also there was significance relationship between family income and number of dental visit (P Value = .022).

Conclusion
Mother's knowledge, about the importance of oral health need to be improved. Coordinated efforts by dentists and other health professionals are required to impart dental health education about oral health and preventive care among mothers.