Manal A. Awad

Measuring the Effect of Intra-oral Implant Rehabilitation on Health-related Quality of Life in a Randomized Controlled Clinical Trial

The importance of assessing the impact of treatments for chronic conditions on an individuals quality of life has been well-established. In this randomized clinical trial, oral-health-rclated quality of life, measured with the Oral Health Impact Profile (OHIP), was compared between two groups of edentulous patients. One group (n = 54) received mandibular implant-supported overdentures, and the other group (n = 48) received conventional dentures. Assessments were performed pre-treatment and two months after the prostheses were delivered. The multivariate model showed that implant treatment was significantly associated with lower post-treatment OHIP scores (p = 0.0002), indicating a better quality of life. In addition, pre-treatment OHIP scores, treatment allocation, age, sex, and marital status explained 31% of the variation in post-treatment OHIP scores (F = 0.0001). These results suggest that implant treatment provides significant short-term improvement over conventional treatment in oral-health-related quality of life.

Sex differences in denture satisfaction.

OBJECTIVES Males and females differ in their responses to many health conditions and treatments. The aim of this randomized clinical trial was to determine whether there are differences in the way that male and female edentulous elders rate their satisfaction with new mandibular implant overdentures (IODs) and conventional dentures (CDs), at 6 and 12 months following delivery. METHODS Edentulous elders (n=256) were randomly assigned to receive maxillary conventional dentures and either mandibular overdentures supported by two implants with ball attachments or conventional dentures. Participants rated their general satisfaction, as well as other features of their dentures (comfort, stability, ability to chew, aesthetics, etc.) prior to treatment and 6 and 12 months after delivery. RESULTS Ratings of satisfaction with IODs were significantly higher than with CDs. Six months after delivery, females in the CD group rated their general satisfaction and satisfaction with ability to chew and aesthetics significantly lower than did the males. The sex differences in the CD group remained at 12 months after delivery. However, males and females in the IOD group rated their general satisfaction and all six subcategories equally. CONCLUSIONS Elderly females are less satisfied with conventional dentures than elderly males with regards to aesthetics and ability to chew, but equally satisfied with implant overdentures. At 6 and 12 months after delivery, elderly edentulous males and females wearing mandibular implant overdentures were significantly more satisfied than those wearing conventional dentures.

Implant Overdentures and Nutrition A Randomized Controlled Trial

We conducted a randomized clinical trial to determine whether providing simple mandibular implant overdentures (IODs) to elderly individuals would give them a significantly better nutritional profile than those who receive complete dentures (CDs). Two hundred fifty-five edentate patients > 65 yrs were randomly assigned to receive maxillary CDs and mandibular IODs (n = 128) or CDs (n = 127). Six-month and one-year post-treatment outcomes were blood plasma levels of homocysteine (tHcy), vitamin B12, vitamin B6, albumin, serum folate, and C-reactive protein concentrations, as well as dietary intake. The association between treatment and tHcy levels was not statistically significant. A decline of folate from baseline values in both study groups, as well as those of vitamins B6 and B12 and albumin, was observed. Significant between-group differences were detected in food preparation and in the individuals’ ability to chew a variety of foods. This study suggests that implant overdentures do not have a more positive effect on the nutritional state of elderly edentate individuals at 6 and 12 mos post-treatment than new complete dentures. However, those wearing IODs are significantly more likely to take in their nutrients through fresh, whole fruits and vegetables. (International Clinical Trial Registration#: ISRCTN24273915)

Do Implant Overdentures Improve Dietary Intake? A Randomized Clinical Trial

People wearing mandibular two-implant overdentures (IOD) chew food with less difficulty than those wearing conventional complete dentures (CD). However, there is still controversy over whether or not this results in better dietary intake. In this randomized clinical trials (RCT), the amounts of total dietary fiber (TDF), macronutrients, 9 micronutrients, and energy in diets consumed by persons with IOD and CD were compared. Male and female edentate patients ≥ 65 yrs (n = 255) were randomly divided into 2 groups and assigned to receive a maxillary CD and either a mandibular IOD or a CD. One year following prosthesis delivery, 217 participants (CD = 114, IOD = 103) reported the food and quantities they consumed to a registered dietician through a standard 24-hour dietary recall method. The mean and median values of TDF, macro- and micronutrients, and energy consumed by both groups were calculated and compared analytically. No significant between-group differences were found (ps > .05). Despite quality-of-life benefits from IODs, this adequately powered study reveals no evidence of nutritional advantages for independently living medically healthy edentate elders wearing two-implant mandibular overdentures over those wearing conventional complete dentures in their dietary intake at one year following prosthesis delivery (International Clinical Trials ISRCTN24273915).

Oral cancer in young Jordanians: potential association with frequency of narghile smoking

OBJECTIVE The aim of this study was to investigate the relationship between narghile (water-pipe) smoking and the age of patients when diagnosed with oral cancer. STUDY DESIGN Patients with oral cancer registered in the Jordanian National Cancer Registry were asked about frequency of cigarette, narghile, and alcohol use. Relationship between age at diagnosis and risk factors was assessed using multiple regression analysis. RESULTS In this sample, 66% of patients were cigarette smokers, and 36% and 17% were narghile smokers and alcohol drinkers, respectively. The multivariate regression analysis adjusted for sex, cigarette smoking, and alcohol drinking found that narghile smokers were significantly younger when diagnosed with oral cancer compared with nonsmokers. CONCLUSIONS Narghile smoking is an independent risk factor associated with the development of oral cancer at a younger age. Prospective studies of its effect on the earlier development of oral cancer are needed to establish a cause-effect relationship.

Assessment of gingival health among school children in Sharjah, United Arab Emirates

Objectives: The present study evaluated the gingival condition among school going children in Sharjah, United Arab Emirates and determined its relationship with tooth brushing frequency, diet and dental caries. Materials and Methods: Four hundred and five children participated in the study. There were 232 boys (57%) and 173 (43%) girls. Children were grouped based on age as ≤6 years (n = 84) mean age 4.72 ± 0.50 and >6 years (n = 321) mean age 8.47 ± 1.65. The amount of dental plaque and gingival condition were assessed on the inner and outer surface of six index teeth using Silness and Loe and Loe and Silness criteria. Dental caries status was assessed using WHO 1997 criteria. Dental examination, tooth brushing frequency and 24 h diet chart were recorded by calibrated dentists. Logistic regression analysis was used to determine the predictors of gingivitis. Results: Increase in decayed, missing, and filled teeth values corresponds to increase in plaque index and gingival index scores (P ≤ 0.05). A logistic regression analysis of the predictors of gingivitis showed that males were 2.11 times less likely to have gingivitis compared with females (odds ratio [OR]: 0.47,95% confidence interval [CI]: 0.24-0.93, P = 0.03) and children aged ≤6 years were 3.06 times less likely to have gingivitis than those aged >6 years (OR: 0.33, 95% CI: 0.17-0.62, P = 0.00). Tooth brushing frequency and diet were not significant predictors. Conclusion: Current study clearly demonstrated that female gender and children more than 6 years were more likely to have gingivitis.

Dental anxiety: Prevalence and associated factors

Objectives: This study aimed to estimate the prevalence of dental anxiety and examine the socio-demographic associations of dental anxiety among a representative sample of UAE college populations. Materials and Methods: Four hundred and thirteen college students of Sharjah University in the UAE completed Modified Corahs Dental Anxiety Scale (MDAS) (47% males and 53% females). The survey also included questions in a yes/no format with which respondents rated attributions for their anxiety. Results: Prevalence of dental anxiety (MDAS score of 13 or more) was 36%, with overall severity represented by a mean score of 11.52 (SD: 4.88). Students who visited their dentist more than two years ago had significantly higher MDAS scores compared with those who visited their dentist less than two years ago (t-test, P =0.02). Compared with female students, a significantly higher proportion of males indicated that their last visit to the dentist was more than two years ago (17% vs. 30%, respectively, χ 2 -test, P =0.002). In addition, more than half of the students (55%) perceived a need for a checkup and 54% indicated that they visited the dentist because of problems with their teeth. Conclusions: The findings of this study indicate that although dental anxiety was not associated with gender and frequency of dental visits, feeling of lack of control and pain anticipation were strong predictors of anxiety. These results highlight the important role that dental healthcare providers could play in counseling anxious patients to reduce the impact of these factors on seeking dental care.

Effectiveness of teaching International Caries Detection and Assessment System II and its e-learning program to freshman dental students on occlusal caries detection

Objective: To assess the feasibility of teaching International Caries Detection and Assessment System (ICDAS) II and its e-learning program as tools for occlusal caries detection to freshmen dental students in comparison to dental graduates with 2 years of experience. Materials and Methods: Eighty-four freshmen and 32 dental graduates examined occlusal surfaces of molars/premolars (n = 72) after a lecture and a hands-on workshop. The same procedure was repeated after 1 month following the training with ICDAS II e-learning program. Validation of ICDAS II codes was done histologically. Intra- and inter-examiner reproducibility of ICDAS II severity scores were assessed before and after e-learning using (Fleiss′s kappa). Results: The kappa values showed inter-examiner reproducibility ranged from 0.53 (ICDAS II code cut off ≥ 1) to 0.70 (ICDAS II code cut off ≥ 3) by undergraduates and 0.69 (ICDAS II code cut off ≥ 1) to 0.95 (ICDAS II code cut off ≥ 3) by graduates. The inter-examiner reproducibility ranged from 0.64 (ICDAS II code cut off ≥ 1) to 0.89 (ICDAS II code cut off ≥ 3). No statistically significant difference was found between both groups in intra-examiner agreements for assessing ICDAS II codes. A high statistically significant difference (P ≤ 0.01) in correct identification of codes 1, 2, and 4 from before to after e-learning were observed in both groups. The bias indices for the undergraduate group were higher than those of the graduate group. Conclusions: Early exposure of students to ICDAS II is a valuable method of teaching caries detection and its e-learning program significantly improves their caries diagnostic skills.

Perceived outcomes and satisfaction of Saudi parents and their children following dental rehabilitation under general anesthesia: A 2-year follow-up.

Purpose: To investigate the perceived clinical outcome and parents’ satisfaction after dental rehabilitation under general anesthesia over a follow-up period of 2 years. Materials and Methods: A prospective study of questionnaire data obtained from 352 pediatric patients before and after treatment of early childhood caries with full dental rehabilitation under general anesthesia. Questionnaires focused on oral symptoms, functional limitations, and emotional and social well-being before and after dental treatment. Cases were followed up for 2 years postoperatively. Results: A dramatic disappearance of symptoms was reported from parents’ perspective. There was a high satisfaction rate (99.14%) also among parents of the children included in the study. Conclusion: Children with early childhood caries do not necessarily express it verbally as pain. The disease has a lot of other expressions affecting childrens behavior and habits, including the ability to sleep, thrive, and socialize. This study contributes to the existing literature that full dental rehabilitation under general anesthesia [dental general anesthesia (DGA)] has an immediate positive impact on the physical and social quality of life of children suffering from early childhood caries as well as on their families. Postoperative preventive care, early diagnosis, and treatment of recurrent caries are key factors to maintain postoperative outcome of DGA.

Most Radiolucent Lesions of the Jaw Are Classified as Granulomas and Cysts in a US Population

Article Title and Bibliographic Information Frequency and distribution of radiolucent jaw lesions: a retrospective analysis of 9723 cases. Koivisto T, Bowles WR, Rohrer M. J Endod 2012;38:729-32. Reviewer Manal A. Awad, BDS, MSc, PhD Purpose/Question To determine the frequency, most common sites, and demographic differences in the distribution of radiolucent lesions of the jaw Source of Funding Professional organization Type of Study/Design Retrospective cohort study Level of Evidence Level 2: Limited-quality, patient-oriented evidence Strength of Recommendation Grade Grade C: Consensus, disease-oriented evidence, usual practice, expert opinion, or case series for studies of diagnosis, treatment, prevention, or screening