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   Table of Contents - Current issue
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July-December 2018
Volume 5 | Issue 2
Page Nos. 67-132

Online since Friday, September 14, 2018

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EDITORIAL  

Salute to men of vision: Riyadh Colleges of Dentistry and Pharmacy became Riyadh Elm University in January 2018 p. 67
HA Mosadomi
DOI:10.4103/1658-6816.241176  
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REVIEW ARTICLE Top

Stability of anterior open bite correction treated with posterior teeth intrusion using temporary anchorage devices. A systematic review p. 69
Mohammed K Al-Dhubhani
DOI:10.4103/sjos.SJOralSci_21_18  
Anterior open bite (AOB) could be corrected by intrusion of the posterior teeth using temporary anchorage device (TAD). However, stability of such approach is still not obvious. The aim of this paper is to systematically review the available scientific evidence regarding the stability of AOB correction on treated with posterior teeth intrusion using TADs. Electronic databases and certain orthodontic journals were searched. Randomized controlled trials (RCTs), nonRCTs (nRCTs), and retrospective studies (RTSs) investigating the stability of AOB correction treated with intrusion of maxillary, mandibular posterior teeth or both using any type of TAD were retrieved. Both reviewers were involved in data extraction and analysis, and any disagreements were resolved by discussion. Three RTSs and one nRCT were recognized. Low level of scientific evidence was identified after assessment of the risk of bias of the involved studies with no related RCT was performed. Although, overbite relapsed after debonding, positive overbite is maintained in all 95 participants of the involved studies. Overbite relapse could not be explained by the relapse of posterior teeth intrusion only. Weak scientific evidence supports that correction of the AOB by posterior teeth intrusion using TAD is stable approach at the short and long term.
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ORIGINAL ARTICLES Top

In vitro assessment of simulation teeth in a preclinical teaching program p. 75
James Dudley
DOI:10.4103/sjos.SJOralSci_26_18  
Introduction: The aim of this study was to investigate the effect of two processes (cycles of incubator drying and sectioning with a diamond blade) on the weight of different anatomical types of simulation teeth used in the proposed assessment process in a preclinical dental teaching program. Materials and Methods: Sixty-eight new unprepared reference plastic Columbia teeth of 17 different anatomical types were cleaned, dried, and sectioned with a diamond blade and the change in weight recorded. Four hundred and four teeth including 210 teeth prepared for a variety of different crown preparations, 68 reference teeth of 17 different anatomical types and 68 sectioned teeth of 17 different anatomical types were cleaned, dried, and subjected to three incubator cycles of 60°C for 24 h. The change in weight was recorded before and after each cycle. Results: The average percentage of tooth lost through sectioning for all teeth was 2.7% which varied from 2.3% in smaller diameter teeth to 3.1% in larger diameter teeth. There was no significantly different percentage tooth loss between the different anatomical tooth types (global P = 1.0000). The average loss of tooth weight over the duration of all incubator cycles for all teeth was 1.64%. When controlled for clustering, there was no statistically significant difference in weight across the time periods within each of the tooth groups. Conclusion: The testing conditions employed in this study did not produce a statistically significant loss in tooth weight and showed initial promise in the proposed protocol of assessment of simulation teeth on a large scale.
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Expression of stem cell marker CD44 in selected benign and malignant salivary gland tumors p. 80
Manal Abdulaziz Alsheddi, Afnan Aljuaid, Dalia Mohammed
DOI:10.4103/sjos.SJOralSci_20_18  
Background: Salivary gland (SG) tumors are among the unique neoplasms exhibiting complex histological features. The histogenesis remains unclear, and several pathways have been proposed. CD44 is a hyaluronic acid receptor that plays an essential role as an adhesion molecule for extracellular matrix components. The aim of the study is to investigate the expression of CD44 in selected SG tumors and determine its contribution to different biological behaviors of the tumors. Materials and Methods: CD44 expression was examined in 31 tumors using immunohistochemistry. CD44 was expressed in neoplastic cells of all tumors. Results: In pleomorphic adenoma, expression was more prominent in areas with ductal differentiation compared to myxoid areas. In all tumors, the proportion of tumor cells with positive staining ranged from 30% to 100%, except in adenoid cystic carcinoma, which expressed 10%–30% positive cells in two of the three samples analyzed. In conclusion, CD44 is expressed in epithelial neoplastic cells of pleomorphic adenoma, myoepithelioma, mucoepidermoid carcinoma, and adenoid cystic carcinoma. The relatively weak CD44 expression in plasmacytoid cells and myxoid areas of pleomorphic adenoma may indicate a more mature phenotype. Conclusion: There was no differential staining of CD44 among selected tumors. Further studies with a larger sample size and proper documentation are required.
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In vitro comparative assessment of cleaning working time efficiency between hand and rotary instrumentation in endodontic retreatment p. 84
Musaed Al-Tammami, Hassan Selim, Nouf Al-Yemni, Mona Al-Dawsari, Login Brekeit
DOI:10.4103/sjos.SJOralSci_59_17  
Aims and Objectives: The aim is to compare the time taken to perform two endodontic retreatment techniques by three dental interns and endodontist, and in addition, to assess the leftovers of endodontic material left after the treatment by both interns and endodontists. This will help us to make a conclusion based on our research and provide recommendations to increase productivity and efficiency in dental procedures by youngsters. Materials and Methods: A total of 80 extracted noncarious human teeth with straight canal with fully formed apices which were previously obturated were chosen. Teeth were randomly divided into two main groups and then subdivided further into three groups of interns (Group A) and one group of endodontist (Group B). Retreatment was performed using hand files and rotary system with and without chloroform. Radiovisiograph was taken before, and then time was calculated. The remaining gutta-percha or sealer on the root canal wall was visually scored with the aid of an endomicroscope. Results: The mean times obtained (in min) were analyzed using one-way analysis of variance, which revealed no statistically significant difference between the working time utilized for retreatment and the examiners (P < 0.05). Two-way cross-tabulation showed endodontist was more likely to remove the obturating material completely from the root canal than dental interns. Chi-square test showed this association to be statistically significant (P < 0.05). Conclusions: Although there was no statistically significant difference between the working time, all methods left remnants of obturating material on the canal walls which showed significant disparity among Group A and Group B. However among all groups, endodontists removed the remnants completely.
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Effect of King Salman Center for Children's Health-sponsored school-based oral health education programs on oral health knowledge of government school students in Riyadh city, Saudi Arabia p. 90
Abdulaziz Al-Shammery, Mohammad Abdul Baseer, Ashraf Kamel, Sara Al-Shammery, Osamah M Almugerien, Abdulrahman Dahham Alsaffan
DOI:10.4103/sjos.SJOralSci_8_18  
Aims and Objectives: To evaluate the effectiveness of school-based oral health educational (OHE) projects on oral health knowledge of government primary and intermediate students sponsored by King Salman Center for Children's Health (KSCCH) in Riyadh city, Saudi Arabia. Materials and Methods: OHE data of 2013–2014 semesters and 2014–2015 first semesters of government (n = 813) primary and intermediate school students were extracted from the KSCCH projects undertaken by Riyadh Elm University, Riyadh, Kingdom of Saudi Arabia. Student's oral health knowledge was assessed before and after OHE by administering pre/post-questionnaire. Total and topic-specific knowledge scores were reported and compared between gender, nationality, and educational level using nonparametric Mann–Whitney U-test and Wilcoxon's signed-rank test. Results: After the educational session, high and medium knowledge score categories showed an increase of 20.3% and 5.2%, respectively. On the contrary, low knowledge score category showed a decrease of 25.5% participants. This observed change was statistically significant (P ≤ 0.001). Comparison of correct responses between pretest and posttest showed statistically significant (P < 0.05) increase in correct responses in all the questions, except on the knowledge of effect sweet retention on teeth. Non-Saudi nationals and students in the intermediate level demonstrated significantly high mean knowledge ranks at posttest assessment (P < 0.001). Conclusions: Educational projects sponsored by KSCCH demonstrated a definite positive impact on oral health knowledge of government primary and intermediate school students in Riyadh city, Saudi Arabia. For prolonged retention of oral health knowledge, repetition and reinforcement of OHE are necessary.
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Awareness of orthodontic modalities and preference of appliance and payment options in Saudi Arabia p. 98
Naif A Bindayel
DOI:10.4103/sjos.SJOralSci_5_18  
Background: Awareness of available treatment devices and methods influences the seeking of appropriate treatment. With the lack of prior orthodontic awareness baseline, the present study aims to measure awareness level of various orthodontic treatment options along with ranking available orthodontic appliances and payment options. Materials and Methods: A total of 350 Saudi participants have completed a survey listing various orthodontic modalities next to its images, as well as payment plan options. Likert awareness scale was used to assess the awareness of nine orthodontic modalities and participants were asked to rank the most preferred orthodontic appliance and payment method options. Results: Stainless steel and ceramic brackets, along with clear aligners displayed moderate-to-high awareness levels. However, statistically significant lower recognition of early treatment tools, namely, expander, headgear, and functional appliances was evident (P < 0.01). The studied group has ranked ceramic brackets as first and lingual brackets as least preferred orthodontic appliance (P < 0.01). Conclusions: Community awareness program along with dental practitioners should aim toward improving population's knowledge on dentofacial orthopedic treatments in specific, as per the study findings.
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Evaluation of degradation in the performance of orthodontic wires after immersing in acidulated phosphate fluoride prophylactic agent: An in vitro study p. 104
Geeta Maruti Doddamani, Trisha Ghosh, Kenneth F H. Tan
DOI:10.4103/sjos.SJOralSci_37_17  
Introduction: Fluoride prophylactic agents, such as acidulated phosphate fluorides (APFs), are being used extensively to prevent demineralization of white spot lesion around orthodontic brackets. However, corrosion has been reported in the acid fluoride solution prophylactic agents altering the mechanical properties of wires. Aim: The aim of the study was to evaluate the degradation in performance of four major orthodontic wires after short-term immersion in APF oral prophylactic agent. Materials and Methods: Four types of orthodontic wires were selected, namely, nickel-titanium wire, beta-titanium wire, stainless steel wire, and cobalt-chromium-nickel wire. These were immersed in a solution of APF-gel or APF-containing mouthwash. Surface changes of treated wires were observed under scanning electron microscope (SEM). The tensile strength of the wires was measured using universal testing machine. The data obtained were noted and subjected for statistical analysis using factorial ANOVA test. Results: SEM showed greater surface corrosion in nickel-titanium and beta-titanium wires and less surface corrosion in stainless steel and cobalt-chromium-nickel wires. Cobalt-chromium-nickel wires showed a higher mean tensile strength followed by stainless steel, beta-titanium, and nickel-titanium wires, respectively, when used with control and mouthwash immersion. With APF-gel, higher mean tensile strength was recorded in stainless steel wires. Conclusions: There was degradation in the performance of orthodontic wires after short-term immersion in the APF prophylactic agent. Greater surface corrosion was observed in nickel-titanium and beta-titanium wires, and less surface corrosion was observed in stainless steel and cobalt-chromium-nickel wires.
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Public awareness and knowledge of dental implants in Riyadh, Saudi Arabia p. 110
Mohammed Al-Rafee, Heba Ismail Adam, Turki Saad Alharbi, Alanoud Abdelmohsen Almojel
DOI:10.4103/sjos.SJOralSci_6_18  
Aims: The aim of this study is to explore the knowledge and information concerning dental implants as a substitute for missing teeth among general society in Riyadh, Saudi Arabia. Materials and Methods: In this descriptive cross-sectional study, a standardized questionnaire of 17 questions was used to assess the public awareness of dental implant in Riyadh by assessing, awareness, knowledge, sources of information, and attitude toward dental implants. The questionnaires were distributed to the people in public places. A total of 747 patients were included in this survey. Results: In this study, it was found that 56% of 747 participants are aware of dental implant as the option of replacement for missing teeth. About 48.9% knew the correct location of the dental implant in the mouth. About 85.5% stated that the main disadvantage is the cost. The main source of information from the dentist 34.4%, followed by friends 29.9%. The majority of the participants 78.3% believed only specialists could provide implant treatment. Conclusion: This study concluded that there is reasonable awareness and knowledge about dental implant. However, it is limited to general information, and there is a need for more public awareness about dental implant.
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Oral hygiene and maintenance habits among fixed partial denture wearers p. 115
Lama Mana AlQabbaa, Mohammad R Rayyan
DOI:10.4103/sjos.SJOralSci_12_18  
Aim: This study aimed to investigate oral hygiene and maintenance habits of fixed partial denture (FPD) wearers. Materials and Methods: A total of 200 patients (93 males, and 107 females) answered a questionnaire regarding their oral hygiene habits and awareness of specific measures to maintain proper hygiene underneath their FPDs. Results: The most patients (n = 166, 83%) did not use any special aid to maintain hygiene underneath pontics. The majority of them (n = 178, 89%) reported that their dentist did not inform them about these aids. In addition, 150 patients (75%) reported that they were not advised by the dentist to book recall visits. Conclusion: There is a lack of awareness among FPD wearers regarding the specific measures needed to maintain proper hygiene underneath FPDs. Dentists should be obligated to educate their patients regarding the maintenance of proper oral hygiene under their prostheses.
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Financial costs comparison between replacing a tooth with a dental implant or with a fixed dental prosthesis or saving the tooth with endodontic therapy in Riyadh and Al-Hasa p. 119
Rakan Shaheen, Hussein Al Nasser, Mustafa Al Salem, Moayed Al Abdulwahab, Abdullah Al Nasser, Abdulrahman Dahham Al Saffan
DOI:10.4103/sjos.SJOralSci_42_18  
Background: Extracting a decayed tooth and replacing it or trying to save it is one of the most common chief complaints, and every patient is given a variety of viable treatment options. Cost of each option plays a major role in the patient's decision. Aim: The aim was to compare the costs of three treatment modalities in the private dental clinics in Riyadh and Al-Hasa, dental implants placement to replace a missing tooth or to replace a missing tooth with a fixed dental prosthesis (FDP), or to save the tooth with endodontic treatment and crown lengthening and an FDP. Materials and Methods: An interview-based survey was done in the private dental clinics in both Riyadh and Al-Hasa. Convenience sampling was used to choose the clinics. Results: A total of 52 clinics were surveyed. Average costs of a single ceramo-metal, all ceramic and zirconium FDP were 589, 857, and 1241 S. R., respectively. Average costs of a 3-unit ceramo-metal, all ceramic, and zirconium FDP were 1595, 2329, and 3402 S. R., respectively. Average costs of randomized control trials of anterior and posterior teeth were 507 and 733 S. R., respectively. The average cost of the crown lengthening surgical procedure was 411 S. R. Average baseline cost for a single dental implant was 3907 S. R., and the average cost for placing an immediate dental implant was 2972 S. R. Moreover finally, the average cost for replacing the anterior and posterior teeth with dental implants were 3199 and 3176 S. R., respectively. Patients nowadays are faced with a variety of treatment options to replace or save a tooth, one of the most important factors in this decision-making process in the financial factor. This research's results revealed that the highest discrepancy margin in the price was for the treatment with implant therapy, followed by the replacement with a 3-unit FDP and finally the procedures to try and save the tooth. Conclusion: Treatment with implant therapy in both Riyadh and Al-Hasa is still the costliest treatment modality compared to the other modalities, but by a smaller cost margin compared to what it used to be in previous years.
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CASE REPORTS Top

The use of mass spectrophotometry to detect resorcinol–formaldehyde-induced discoloration and resorption of primary teeth: A report of two cases p. 125
Huda Othman Althabit, Sharat Chandra Pani, Hezekiah Adeyemi Mosadomi, Zuhour Ibrahim
DOI:10.4103/sjos.SJOralSci_23_18  
Resorcinol–formaldehyde (RF) has been known to cause red stains in the permanent teeth. While the use of this material in permanent teeth is controversial, there is little known about the effects of RF resin on primary teeth. A 6-year-old male and 9-year-old female (siblings) presented with a complaint of discoloration and mobility of the primary molars. On clinical examination, the teeth showed red discoloration as well as stains around restorations placed on them. Periapical radiographs revealed a radiolucency surrounding the affected teeth. On extraction, it was observed that the red discoloration extended to the tooth surface. Hematoxylin and eosin staining was done on two decalcified extracted teeth while two specimens (one from each patient) were subjected to gas chromatography–mass spectrometry (GC-MS) system (TRACE™ Ultra, Thermo Fisher Scientific, Waltham MA, USA). Histological examination showed signs of coagulative necrosis, while the GC-MS examination revealed the presence of a resorcinol spike confirming the initial diagnosis of RF therapy. The affected teeth were extracted and a long-span band and loop space maintainer placed in the younger child. The older child was observed for the eruption of the permanent tooth. RF resin can result in the discoloration and early exfoliation of primary teeth. This case report highlights the risks of using RF therapy in primary teeth.
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Oral drug-induced lichenoid reaction in pediatric age group p. 130
Abhishek Dhindsa, Shalini Garg, Nilika Choupal, Sumit Singla, Neetu Jain
DOI:10.4103/sjos.SJOralSci_30_18  
Mucocutaneous diseases in the pediatric population are extremely rare and, hence, can have both psychological and behavioral bearing. Mucosal conditions in children include herpetic stomatitis, vesiculobullous lesions, aphthous and traumatic ulcerations, candidiasis, lichen planus, and drug-related mucosal lesions. This case report deals with a rare presentation of a 4-year-old child reporting with an extensive involvement of oral cavity with erythematous, ulcerative, and pigmented areas associated with drug intake.
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