Hani T. Fadel

Root caries and risk profiles using the Cariogram in different periodontal disease severity groups

Abstract Objectives. To study root caries and risk profiles using the Cariogram in relation to periodontal disease severity and to analyse indicators associated with high caries risk. Material and methods. A cross-sectional examination was carried out on 112 patients with periodontal disease from two government clinics in Saudi Arabia. The investigation comprised a questionnaire, bitewing radiographs, measurement of salivary secretion rate, buffering capacity and cariogenic microorganisms, and registration of periodontal status, plaque amount and coronal and root caries/fillings (DFT and RDFT). The data were then entered into the Cariogram pedagogic model to illustrate the caries risk profiles. Results. Patients were grouped according to periodontal disease severity into one of three groups: (1) gingivitis (n = 44); (2) mild-to-moderate periodontitis (n = 33); and (3) severe periodontitis (n = 35). The prevalence of RDFT in the total sample was 17%. There were no statistically significant differences between the three groups in number of root lesions or mean ‘Actual Chance to Avoid New Cavities’ (Chance-AC) according to the Cariogram. Of the total sample, 22% displayed high caries risk (Chance-AC ≤40%). The most significant risk indicators in high caries risk patients were infrequent use of fluoride and unfavourable salivary and microbial parameters. Conclusions. Root surface lesions and high caries risk were present in about one-fifth of the patients referred for periodontal treatment. A combination of risk indicators rather than a single one contributed to the increased risk. Caries and risk profiles were not significantly correlated with periodontal disease severity.

Profiles of Dental Caries and Periodontal Disease in Individuals With or Without Psoriasis

BACKGROUND Psoriasis is a chronic inflammatory disease that is manifested on the skin. Studies of oral health in psoriasis patients are limited. The aim of this study is to assess the experience and risk of caries and periodontal disease in individuals with and without psoriasis. METHODS The material consisted of 89 individuals with mild-to-moderate chronic plaque psoriasis and 54 without psoriasis, recruited at the University Hospital in Gothenburg, Gothenburg, Sweden. Psoriatic arthritis (PsoA) was diagnosed in 25 of the individuals with psoriasis. All participants answered questionnaires and were subjected to saliva sampling and oral radiologic and clinical examinations. Two computer applications were used for illustration of oral disease risk profiles. RESULTS Individuals with psoriasis had lower salivary pH, fewer remaining teeth, fewer sites with probing depth ≤4 mm, and a lower radiographic alveolar bone level than individuals without psoriasis (P <0.05). Most of the differences remained significant after controlling for confounders. Differences in alveolar bone levels were no longer significant, particularly after introducing the confounder sex into the regression model. Similar numbers of decayed and filled teeth, sites with deep pockets, sites that bled on probing, and risk profiles were observed. Individuals with PsoA exhibited a lower stimulated salivary secretion rate than those without psoriasis (P <0.05). CONCLUSIONS There were no differences in profiles of caries and periodontal disease experience and risk between individuals with and without psoriasis. Fewer remaining teeth were observed in individuals with psoriasis. However, the exact reason for tooth loss could not be identified. Meanwhile, the reduced salivary pH in individuals with psoriasis and salivary secretion in individuals with PsoA may pose some risk for future caries.

Caries Risk and Periodontitis in Patients With Coronary Artery Disease

BACKGROUND There is considerable variation in studies on the oral health of patients with coronary artery disease (CAD). The aims of this investigation are to study the caries risk profile using the Cariogram computer program and the periodontal disease severity in patients with CAD. METHODS A total of 127 participants (54 test and 73 control) were included. Participants were asked about their general health and daily habits. Clinical examinations, radiographs, and salivary sampling were performed. Cariologic data were entered into the computer program for risk-profile illustration. The onset of CAD conditions was also documented. RESULTS Compared with controls, participants with CAD consumed less sugar, used fluoride toothpaste less frequently, and had significantly less favorable periodontal parameters (P <0.005). Generally, differences in cariologic parameters between the two groups were not significant. Significantly more participants with CAD exhibited low salivary-secretion rates than controls. The actual chance (percentage) of avoiding new cavities according to the Cariogram was low in the test and control groups (31% and 40%, respectively; P <0.05). Only gingival recession was correlated with the onset of CAD. CONCLUSIONS Test and control groups had a relatively high caries risk. More severe periodontal disease was observed in participants with CAD.

Comparing dental students’ perceptions of their educational environment in Northwestern Saudi Arabia

Objectives: To compare the perceptions of dental students over a 5-year period. Methods: This cohort study was carried at Taibah University, College of Dentistry, Al-Madinah Al-Munawwarah, Saudi Arabia between 2009 and 2014. Data was obtained using the Dundee Ready Education Environment Measure (DREEM), which consists of 50 items, 4 of these were irrelevant to this cohort and were excluded. All students registered in 2009 were included and followed up in 2014. Their responses were compared using the paired student’s t-test. Results: Thirty-four students completed the questionnaire in 2009, and 30 of them participated in 2014 (12% drop out rate). The mean domain and total scores decreased over time. The mean scores for 6 items decreased significantly, while 4 of them had a significant increase. The lowest mean score in 2009 regarding support for stressed students increased (p=0.004) in 2014. However, the highest mean score in 2009 related to having a good social life, reduced (p=0.007) in 2014. This could be an indication of the high workload and its impact on their social lives. Conclusion: Student’s perceptions were relatively low at the beginning, and remained low throughout the study. There were no significant changes in mean domain, and total scores and although scores of some items improved, most decreased over the study period.

Student Perception of the Educational Environment in Regular and Bridging Nursing Programs in Saudi Arabia using the Dundee Ready Educational Environment Measure

BACKGROUND Taibah University offers regular nursing (RNP) and nursing bridging (NBP) bachelor programs. We evaluated student perception of the learning environment as one means of quality assurance. OBJECTIVES To assess nursing student perception of their educational environment, to compare the perceptions of regular and bridging students, and to compare the perceptions of students in the old and new curricula. DESIGN Cross-sectional survey. SETTING College of Nursing at Taibah University, Madinah, Saudi Arabia. PATIENTS AND METHODS The Dundee Ready Educational Environment Measure (DREEM) instrument was distributed to over 714 nursing students to assess perception of the educational environment. Independent samples t test and Pearson’s chi square were used to compare the programs and curricula. MAIN OUTCOME MEASURE The DREEM inventory score. RESULTS Of 714 students, 271 (38%) were RNP students and 443 (62%) were NBP students. The mean (standard deviation) DREEM score was 111 (25). No significant differences were observed between the programs except for the domain “academic self-perceptions” being higher in RNP students (P<.001). Higher mean DREEM scores were observed among students studying the new curriculum in the RNP (P<.001) and NBP (P>.05). CONCLUSION Nursing students generally perceived their learning environment as more positive than negative. Regular students were more positive than bridging students. Students who experienced the new curriculum were more positive towards learning. LIMITATIONS The cross-sectional design and unequal gender and study level distributions may limit generalizability of the results. Longitudinal, large-scale studies with more even distributions of participant characteristics are needed.

Antibiotic Prescribing for Oro-Facial Infections in the Paediatric Outpatient: A Review

There are many reports on the complications associated with antibiotics abuse during the treatment of paediatric patients, particularly those related to antimicrobial resistance. The dental profession is no exception; there is growing evidence that dental practitioners are misusing antibiotics in the treatment of their paediatric patients. This review is directed to dental practitioners who provide oral healthcare to children. It is also directed to medical practitioners, particularly those working in emergency departments and encountering children with acute orofacial infections. A systematic search of literature was conducted to explore the clinical indications and recommended antibiotic regimens for orofacial infections in paediatric outpatients. The main indications included cellulitis, aggressive periodontitis, necrotizing ulcerative gingivitis, and pericoronitis. Amoxicillin was found to be the most commonly recommended antibiotic for short durations of 3–5 days, with metronidazole or azithromycin being the alternative antibiotics in penicillin-sensitive patients.

Antibiotic Self-Medication for Oral Conditions: Characteristics and Associated Factors

Objective: To investigate the prevalence and contributing factors of antibiotic self-medication for oral conditions in dental patients. Material and Methods: A questionnaire was distributed to 501 patients attending Taibah University Dental College and Hospital, Al Madinah, Saudi Arabia during late 2016. Questions were on socio-demographic characteristics, and pattern of antibiotic self-medication for oral disease. Statistical analysis was performed using IBM SPSS software version 21. Statistical significance level was set at p ≤.05. Results: Age range was 15-64 years (29.08±9.32 years) with 297 females (59.3%) and 204 males (40.7%). 135 patients (27%) self-medicated with antibiotics for oral disease. This practice was statistically significantly associated with the older adults (p=0.001), lack of medical or dental insurance (p=0.014 and 0.007, respectively), and poor dental attendance (p=0.021). A number of 26 (25.7%) perceived analgesics as antibiotics. Amoxicillin-clavulanic acid was the most commonly cited antibiotic by 18 patients (17.8%). Dental pain was the most frequently reported oral condition. Pharmacists were the most common source for antibiotic prescription cited by 58 (57.4%). Conclusion: Antibiotic self-medication for oral disease is associated with the use of broad-spectrum antibiotics for non-indicated clinical oral conditions. The practice was encouraged by lenient behavior of pharmacists, lack of health insurance, and poor dental attendance.

Association between body mass index, diet and dental caries in Grade 6 boys in Medina, Saudi Arabia

The prevalence of obesity is increasing in Saudi Arabia and although caries is associated with obesity, this association has not been investigated in Medina. This study aimed to determine the association between dental caries, body mass index (BMI) and dietary habits of 12-year-old boys from four geographically distinct schools in Medina. Mean BMI was 22.17 kg/m² (± 5.15); 41% had normal BMI, 25% were overweight and 30% were obese. The mean Decayed, Missing and Filled Teeth (DMFT) score was 1.46 (± 2.04). Those in the normal BMI range had a significantly higher prevalence of caries (57%) and DMFT score (1.92) compared with the overweight and obese groups (P < 0.05). These differences remained significant after controlling for possible confounders via linear regression. Mean BMI was significantly lower in boys with severe compared with mild or no caries. Normal and underweight participants had an almost 2 times greater risk of developing caries compared with their overweight and obese counterparts. The children had poor dietary habits and there were no significant associations between dietary variables and caries.