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   Table of Contents - Current issue
Coverpage
July-December 2019
Volume 6 | Issue 2
Page Nos. 45-115

Online since Monday, August 19, 2019

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EDITORIAL  

Expanding collaborative dental research between “Town” and “Gown” for the oral health benefits of the society p. 45
Abdullah R AlShammery
DOI:10.4103/sjos.SJOralSci_53_19  
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REVIEW ARTICLE Top

Oral mucositis in children associated with hematopoietic stem cells transplant p. 47
Sarah A Mubaraki
DOI:10.4103/sjos.SJOralSci_31_19  
Oral mucositis is one of the most common complication of Hematopoietic stem cell transplant. It is extremely painful and affect the quality of life. 67%–99% of the patients develop oral mucositis and they are at a high risk of developing various infections. Several methods was introduced aiming to reduce the incidence and severity of oral mucositis. The objective of this review is to summarize the different modalities to reduces the incidence and severity of oral mucositis. The review includes human clinical trails with or without randomization, meta-analysis and systematic review. The review suggests that proper oral hygiene, mouth lubricant and the epidermal growth factor can help to reduce the severity of oral mucositis.
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ORIGINAL ARTICLES Top

Dental students' preferences regarding teaching methods in Riyadh p. 54
Huda I Tulbah, Eman M Alhamdan, Amal S Alqahtani, Ghaida A Alduhayan, Lamees S Albedaiwi
DOI:10.4103/sjos.SJOralSci_44_19  
Objectives: The objectives of this study are to identify and compare the preferences of male and female undergraduate dental students on different aspects of teaching lectures and clinical courses in two major dental schools in Riyadh: the College of Dentistry of King Saud University (KSU) and Riyadh Elm University (REU). Materials and Methods: A questionnaire of three parts was formulated: Part 1 contained demographic data; Part 2 covered information about: the length and timing of lectures, schedule announcement, attendance, having materials before sessions, interactive sessions, and getting handouts and clinical demonstrations; and Part 3 covered preferences regarding logbooks, written assignments, quizzes, resources, team-based learning (TBL), and student feedback. The questionnaire was distributed to male and female undergraduate dental students in two dental schools in Riyadh. A stratified random sampling method was applied to collect a sample of 345 participants. Results: Among the participants, 159 were from KSU and 186 were from REU and 183 were male and 162 were female. About 74% of the dental students preferred the use of logbooks, and 40% preferred not to have written assignments. A total of 63% preferred using several resources, and REU students (72%) stated this preference more. More than half of the students (58%) agreed on having frequent quizzes. More REU (61%) than KSU students (38%) preferred (TBL). The majority (78%) preferred to take their feedback into consideration. Conclusions: This study illustrated that logbooks, writing assignment, and quizzes are learning styles that are still acceptable by dental students. Teachers should consider the feedback from the students when evaluating course outlines.
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The impact of dental anxiety on the salivary cortisol and alpha-amylase levels of children undergoing dental treatment p. 60
Majed AlMaummar, Huda Othman Althabit, Sharat Chandra Pani
DOI:10.4103/sjos.SJOralSci_54_19  
Background and Aim: The purpose of this study was to assess the salivary cortisol and salivary alpha-amylase levels in children aged between 6 and 9 years immediately prior to dental treatment. Methodology: A total of 183 patients aged between 6 and 9 years who were awaiting dental treatment were administered the Arabic version of the Children's fear survey – dental subscale and accordingly allocated to one of three groups: phobic patients, anxious patients, and control group. Patients' heart rate in the waiting area, salivary cortisol, and salivary amylase were compared among the groups. Results: The results of the study showed that amylase and cortisol levels had a significant association with the level of dental fear. The phobic patients had the highest levels of salivary amylase and salivary cortisol levels with no significant associations observed with either heart rate. Control and anxious patients had significantly lower amylase levels when compared to phobic patients. There was no significant difference between the salivary cortisol levels of anxious and phobic patients. Conclusions: Within the limitations of this study, we can conclude that salivary amylase is a good indicator of acute stress that can differentiate between anxiety and dental fear, while salivary cortisol is a good indicator of the phobia induced by a flight or fight response.
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Burning mouth syndrome in Southwestern Saudi Arabian population – Part I: Prevalence p. 65
Khalil Assiri, Ali Azhar Dawasaz, Arwa Alshehri, Fatema Mohammad, Yagoub Alyami
DOI:10.4103/sjos.SJOralSci_64_18  
Introduction: Burning mouth syndrome (BMS) is a chronic, spontaneous, nonremitting, painful burning sensation in the oral mucosa with no identifiable local lesion. The aim of this study was to determine the prevalence of BMS in Abha, Saudi Arabia. Materials and Methods: Patients attending for dental care completed a questionnaire before examination. A general health screen was then performed during which information about various conditions and medications was collected. Reports of burning/pain sensation were recorded using visual analog pain scale. Details of the dental examination, panoramic radiographs, and a structured interview concerning orofacial pain and discomfort were recorded. Results: Of 2264 patients screened, 159 were identified as having a potential diagnosis of BMS. The prevalence of BMS was 7.03% (primary in 2.87% and secondary in 4.15%). The highest prevalence was in patients aged >65 years. Forty-two percent of the 159 cases had primary BMS. There were more cases of type 1 diabetes in the group with secondary BMS. The tongue was the most common site of BMS (in 81.9%). The mean visual analog pain scale score was 4.3. Altered taste sensation was reported by 15.9% of patients and xerostomia by 47.6%. Patients taking antihypertensive medication were more prone to secondary BMS. The tongue, soft palate, and lower gums were significantly more likely to be affected (P ≤ 0.05). Conclusion: This is the first reported population-based prevalence data for BMS in the Saudi Arabian population and contributes to the nascent literature on the epidemiology of BMS.
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Patient's satisfaction with dental clinics and treatment at Riyadh Elm University p. 72
Abdulrahman Al Saffan, Rana Babsail, Yasmen Al Shilawy, Yara Alsoqair, Lamis Murshid, Rawan Alshehri, Shahad Alshehri, Lama Al Marshad
DOI:10.4103/sjos.SJOralSci_71_18  
Background: Satisfaction of the patient plays a key role in determining the correlation between the quality of health-care services provided and the patients' trust. The objective of this study was to determine the level of satisfaction regarding the quality of dental care among patients at dental clinics of Riyadh Elm University. Materials and Methods: Self-administrated questionnaire was distributed to patients attending clinics of Riyadh Elm University. Questionnaire consisted of items on appointment availability, satisfaction with the performance of the reception, satisfied with your treating practitioner, treatment fees, satisfied with the level of cleanliness/sterilization, compassionate and caring of the support staff and treatment provider, and finally overall evaluation of the services received within the clinics. Results: A total of 600 questionnaires were collected from the electronic system used in the dental clinic of Riyadh Elm University. 89% of the participants agreed that it was easy to get an appointment in the dental clinics and 59% were very satisfied with the performance of the reception. Majority of the participants were satisfied with the treatment provider (80%), 82% were satisfied with treatment fees, 74% patients were very satisfied with the cleanliness, 81% agreed that the treating practitioner and supporting staff were compassionate and caring, and most of the participants were satisfied with services received in the dental clinic of Riyadh Elm University. Conclusions: Dental clinic of Riyadh Elm University has been successful in achieving participant's satisfaction regarding the services, staff, treatment, and fees.
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Incidence of attention-deficit and hyperactivity disorder among school children in Riyadh city and its association with body burden of mercury leached from dental amalgam fillings: A cross-sectional study p. 77
Fatmah Nasser Almotawah, Mahmoud Abdullateef, Haya Alkanhal, Maha Albukairi, Reema Alsaif, Lamya Almejrad, Abdulrahman Alzahrani
DOI:10.4103/sjos.SJOralSci_20_19  
Objectives: The objectives of this study are to determine the association between the incidence of attention-deficit and hyperactivity disorder (ADHD) in children of mothers with and without amalgam fillings. Design: The study design was a cross-sectional descriptive study. Setting: The study was conducted at a dental college's clinic in Riyadh, Saudi Arabia. Participants: In total, 869 children (512 males and 357 females) aged 6–12 years and 796 mothers were included. Children suffering from hearing impairment, language impairment, or learning disabilities or those diagnosed with mental health problems were excluded from the study. Primary and Secondary Outcome Measures: The primary outcome measures included the results of the Vanderbilt scale used for ADHD diagnosis in children and the mercury concentration in 1 ml saliva samples obtained from both the mother and the children. The secondary outcome measures included the number of dental amalgam restorations in the oral cavity determined through a dental examination of children and their mothers. Methodology: A consent form was signed by the mothers who agreed to participate in our study, they were all examined for amalgam presence and a saliva samples were collected and digested. Results: Children with ADHD showed significantly higher levels of mercury in saliva than did children without ADHD. The mothers who had dental amalgam fillings during pregnancy had significantly higher mercury levels than did the mothers who did not have dental amalgam fillings. Conclusion: Prenatal mercury exposure is associated with a higher risk of ADHD behavior. Further research can be carried out to identify the toxic effects of mercury on different body organs owing to dental amalgam fillings. The study scale can be further increased to obtain a more accurate percentage of ADHD cases in Saudi Arabia.
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Antibacterial effect of fluorinated graphene and zinc oxide nanoparticles incorporated in zinc oxide-based sealers on Enterococcus faecalis (in vitro study) p. 81
Aaripaka Sridevi, J Sindhu, DN Naveen, DN Nirupama, Mohan Thomas Nainan
DOI:10.4103/sjos.SJOralSci_26_19  
Background: Incorporation of nanoparticles with antibacterial properties plays an essential role in the success of endodontic therapy. Aim: The aim of this study is to evaluate the antimicrobial efficacy of zinc oxide (ZnO)-based sealer incorporated with fluorinated graphene and ZnO nanoparticles against Enterococcus faecalis. Subjects and Methods: Sixty human extracted mandibular premolars with single canal were selected. After biomechanical preparation of all teeth and inoculation with E. faecalis, teeth were divided into three groups according to the type of the tested sealer, Group 1: Teeth were obturated with ZnO-based sealer only, Group 2: Teeth were obturated using sealer incorporated with fluorinated graphene, and Group 3: Teeth were obturated using sealer incorporated with ZnO nanoparticles. Each group was subdivided into two subgroups according to the timing of filling removal and culture sample. Subgroup A: Obturation removal and culture sample were taken after 1 week. Subgroup B: Obturation removal and culture sample were taken after 3 weeks. The number of colonies forming units was counted to assess the effect against E. faecalis. Data were recorded, tabulated, and statistically analyzed using the Kruskal–Wallis test was applied to find significance among the groups (1, 2, and 3). The Mann–Whitney U-test was applied to find significance between the groups. The Wilcoxon signed-rank test was applied to find significance between two-time intervals (24 h to 1 week, 24 h to 2 weeks) in each group. P < 0.05 was considered as statistically significant. Results: After 3 weeks from obturation, fluorinated graphene had a better antibacterial effect and there was a significant difference between the three tested groups. Conclusion: After 1- and 3-weeks samples after obturation fluorinated graphene had a better antibacterial effect and there was a significant difference between the three tested groups.
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Effect of law enforcement system (Saher) on maxillofacial injuries caused by road traffic accidents in Riyadh p. 88
Nasser Alasseri, Raed S Almanea, Mohammed S Algarni, Saud S Alajmi, Waleed S Jeleudan, Munirah I Alsaeed
DOI:10.4103/sjos.SJOralSci_3_18  
Background: Road traffic accident (RTA) is one of the major causes of facial injuries apart from other body injuries. Aims and Objectives: The aim of this study was to assess the effectiveness of law enforcement system (LES) on maxillofacial injuries caused by RTAs in Riyadh. Materials and Methods: The objective was achieved by conducting a comparison of RTA - related facial injuries before and after the introduction of Saher. A retrospective study on patients admitted to Prince Sultan Medical City Oral and maxillofacial surgery department of 10 years divided equally before and after the introduction of the LES. Data were collected from the hospital's electronic database regarding the patients' age, sex, gender, date, time, and type of injury. Results: The severity and the number of injuries from RTAs were considerably reduced with the introduction of the system. Conclusion: LES plays a huge role toward controlling how road users use the roads and consequently, the number of accidents reported.
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Diversity and clinical presentation of Candida species in human immunodeficiency virus patients with oral candidiasis p. 96
Varun Nair, Arvind Shetti
DOI:10.4103/sjos.SJOralSci_74_18  
Background: Change in the distribution profile of nonalbicans Candida species (spp.) can be an indication of immunosuppression or drug resistance to oral candidiasis in patients with human immunodeficiency virus (HIV). Thus, it is essential to analyze the association of the profile of varied Candida spp. Objective: The study aimed to collect the baseline data of diversity in the Candida spp. in HIV patients with oral candidiasis and correlate it with clinical presentations. Materials and Methods: A total of 200 HIV patients with CD4 count<200 cells/μL were included in the study. A presumptive diagnosis of oral candidiasis was made, and different clinical forms of candidiasis were recorded. The oral swab samples collected from the patients were sent to the microbiological laboratory for culture. Different Candida spp. were isolated, and an association was analyzed with various variables, including clinical presentation, CD4 count, and duration of antiretroviral therapy (ART). A correlation between CD4 count and ART duration was also assessed. Results: Pseudomembranous candidiasis was the most (46.50%) prevalent type identified in HIV patients. Candida albicans was the most prevalent (68%) spp. in HIV patients. Clinical form of candidiasis was significantly associated with isolated spp. (P < 0.00001). CD4 counts (P < 0.001) and ART (P = 0.03) duration significantly differed among clinical forms of candidiasis. ART duration was significantly correlated with CD4 count (r = 0.18; P = 0.01). Conclusion: The study suggests the significance of various Candida spp. in the prediction of disease progression and immune suppression levels in HIV-infected oral candidiasis patients. Intensifying the concentration of nonalbicans spp. isolated in these studies predicts the change in immune status.
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Dental anxiety at Riyadh Elm University Clinics p. 101
Ashraf M. F. Kamel, Ahmad S Al-Harbi, Fahad M Al-Otaibi, Fahad A Al-Qahtani, Abdullah M Al-Garni
DOI:10.4103/sjos.SJOralSci_33_19  
Context: Anxious patients are difficult to manage and tend to avoid dental treatment. Aim: The aim of this study is to explore dental anxiety (DA) among patients visiting Riyadh Elm University (REU) clinics. Materials and Methods: Dental patients were first oriented about the purpose of the study and then signed consent before filling a ten-item quantitative DA questionnaire that included demographic variables of age, gender, and educational level. Responses were scored on a scale of 1–4 for each question, and an overall questionnaire score of 40 was obtained. Low anxiety was considered with at or below 15, moderate anxiety between 16 and 27, and high anxiety at or above 28. Statistical analysis was performed with frequencies and cross-tabulation by Chi-square and Student's t-test. Results: Of 365 respondents, the majority (50.1%, n = 183) showed moderate anxiety followed by 104 participants (28.5%) showing high anxiety while only 78 participants (21.4%) exhibited low DA. Among the high DA group, 81% were female (n = 84) while 19% were male (n = 20) and this difference was statistically significant. High DA was recorded in patients aged 13–18 (25%) and 19–25 years (27%) compared to other age groups; however, the difference was statistically insignificant. Furthermore, schoolchildren demonstrated high DA (53%) compared to other educational levels, yet the difference was not statistically significant. Conclusion: A considerable number of patients attending REU dental clinics exhibited DA that was more intense among female patients, younger age groups, and the less educated individuals.
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CASE REPORT Top

Necrotizing fasciitis of the face and neck following a dental procedure p. 113
Manoj Bhaskaran, Robin George Manappallil, Rajesh Manuel, Jayasree Gopi
DOI:10.4103/sjos.SJOralSci_34_19  
Necrotizing fasciitis (NF) is a severe, life-threatening infection of the soft tissue, characterized by the rapid progression of necrosis in the superficial fascia and subcutaneous tissue. The involvement of the face is a rare scenario. The patient being described underwent root canal procedure for the right upper premolar following which she developed NF involving the face and neck. She underwent extensive debridement of necrotic tissue and was discharged in stable condition.
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