Qasem Alomari

Smoking Prevalence and Its Effect on Dental Health Attitudes and Behavior among Dental Students

Objective: To determine smoking prevalence and its effect on dental health attitudes and behavior among dental students in Jordan. Subjects and Methods: A cross-sectional study of 314 dental students was conducted at Jordan University of Science and Technology. Subjects were surveyed using a modified version of the Hiroshima University Dental Behavior Inventory (HU-DBI) questionnaire. Multivariate logistic regression analyses were performed to study differences between male smokers and nonsmokers only. Results: The response rate was 83.7%, with 48% males and 52% females. The prevalence of smoking was 17.2%. Smoking was more prevalent among male students (31%) than female (4.3%). For male students, the multivariate logistic regression analysis showed 6 items that were different between smokers and nonsmokers. Nonsmokers tended to brush their teeth more often than smokers (OR 8.67, 95% CI 1.66–45.25); claimed that they had never been professionally taught how to brush their teeth (OR 11.15, 95% CI 1.89–65.67); believed that they spend too much time brushing their teeth (OR 12.24, 95% CI 2.0–75.05); were more concerned about having bad breath (OR 41.86, 95% CI 3.44–58.75) and were more concerned about the color of their gums (OR 8.04, 95% CI 1.55–41.84). Conclusions: Smoking prevalence among male dental students in Jordan was high, 7 times greater than for females. Male smokers and nonsmokers had different attitudes and oral health behaviors as indicated by the study survey.

Effect of Cavity Disinfection on Postoperative Sensitivity Associated with Amalgam Restorations

This clinical study assessed the postoperative cold sensitivity reported by patients following the Class I and Class II amalgam restoration of primary carious lesions after different cavity treatments. One hundred and twenty patients, each with a previously untreated tooth requiring an amalgam restoration due to the presence of a carious lesion, were included. Sixty teeth had lesions that were radiographically judged to be located in the middle third of dentin, and another 60 were located in the inner third of dentin. Six different cavity treatment regimens were used: Group 1--no treatment; Group 2--calcium hydroxide liner (Life); Group 3--cavity varnish (Copalite); Group 4--resin modified glass ionomer liner (Vitrebond); Group 5--dentin adhesive resin liner (Single Bond); Group 6--chlorhexidine disinfectant (Consepsis). Patients were telephoned on days 2 and 7 postoperatively and asked whether they experienced sensitivity to cold, and if so, its duration and intensity. If sensitivity remained up to day 7, patients were also contacted on days 30 and 90. The Kruskal-Wallis test showed postoperative sensitivity to be significantly different among cavity treatments at days 2, 7 and 30 (p = 0.026, 0.044, 0.015, respectively). Lesion depth also affected postoperative sensitivity at day 2, with 27% of teeth with middle-third lesions producing pain, and 58% of those with lesions extending to the inner third producing pain (p = 0.000). This difference showed up at 7 and 30 days (p = 0.001, 0.015, respectively). Of the 51 teeth with sensitivity at day 2, 17 had mild pain, 26 were moderately painful and 8 had severe pain; each category reduced in degree of sensitivity and number with time. It would seem that medium-term (beyond 30 days) postoperative sensitivity is affected neither by the method of cavity treatment nor the depth of lesion, although, in the shorter-term, these factors do influence the postoperative sensitivity reported.

Restorative Treatment Decisions for Deep Proximal Carious Lesions in Primary Molars

Aim: To assess clinicians’ individual variables that might influence decision-making for the restoration of deep proximal carious lesions in primary molars. Methods: A precoded questionnaire that sought participants’ treatment choices for a deeply carious second mandibular primary molar as depicted in a simulated periapical radiograph, along with a specific clinical scenario, was distributed among a random sample of 157 dentists and 15 paediatric dentists. Participants were asked to answer all questions. After combining the pulpotomy and pulpectomy treatment choices under a “pulp therapy” category, a binary dependant variable was constructed. Logistic regression of the ratio of the participants who would restore the questioned tooth by the methods in question, was run. Results: A total of 155 dentists (116 males and 39 females) completed the survey, giving a response rate of 90 %. Of these 53 % of dentists recommended pulpotomy followed by definitive restoration and 39% recommended removal of caries and restoration without pulp therapy. In the logistic regression model, males and graduates from English language undergraduate dental programs had higher probabilities of restoring without prior pulp therapy (P<0.03 and P<0.02, respectively). Compared with graduates of Asian dental programs, dentists who graduated from Eastern Europe and the Middle East showed lower likelihoods of restoring the tooth without prior pulp therapy (P<0.01 and P<0.004, respectively). Dentists who treated an average of 6–16 child patients during a week had a lower probability of restoring the tooth without prior pulp therapy than those who were not currently involved in treating children (P<0.01). No other measured variables were associated with the participant’s treatment choices. Conclusions: The lack of agreement among dentists regarding their optimal treatment recommendations for deep proximal carious lesions appears to be due mainly to inter-individual, educational training and practice characteristics factors.

Clinical Evaluation of Posterior Resin Composite Restorations Placed by Dental Students of Kuwait University

Objective: To investigate the survival rate over a 3-year period of posterior resin composite restorations placed by dental students of Kuwait University. Materials andMethods: Posterior resin composite restorations placed by 5th-, 6th- and 7th-year dental students between 2004 and 2005 were evaluated. All patients with posterior composite restorations placed during this period of time were recalled. Of the 204 eligible patients, 139 attended the recall. 432 posterior resin composite restorations were evaluated clinically and radiographically according to the United States Public Health Service criteria. For each restoration, the survival time and/or reasons for failure were recorded. Descriptive statistics and logistic regression analysis were used to analyze the data at a statistically significant level of p < 0.05. Results: At 3 years, the survival rate of the restorations was 95.1%, resulting in an annual failure rate of 1.7%. Recurrent caries was the most common cause of failure (71.4%). Oral hygiene and gender and age of the patient were the factors that affected the failure rate of the restoration (p < 0.05). Other factors such as tooth type and location, type of cavity, type of liner used and level of the student who performed the procedure did not affect the failure rate (p > 0.05). Conclusion: Dental students of Kuwait University were able to place resin composite restorations in posterior teeth with a low annual failure rate. Recurrent caries was the most common cause of failure of posterior resin composite restorations. Oral hygiene was the most important factor in determining the survival of resin composite restorations.

Relative contribution of restorative treatment to tooth extraction in a teaching institution.

Teeth can be extracted due to multiple factors. The aim of this retrospective cross-sectional study was to identify the relative contribution of restorative treatments to tooth loss. The study reviewed records of 826 patients (1102 teeth). Patients gender, age and education were obtained. In addition to the main reason for extraction (caries, periodontal disease, pre-prosthetic extraction, restorative failure and remaining root), the following information was collected about each extracted tooth: type, the status of caries if any (primary or secondary) and pulpal status (normal or reversible pulpitis, irreversible pulpitis, necrotic or root canal treated) and type and size of restoration, if present. Following data collection, descriptive analysis was performed. A log-linear model was used to examine the association between restorative treatment and tooth loss and between reasons for tooth loss and type of tooth. Lower molars followed by upper molars were the most commonly extracted teeth. Teeth with no restorations or with crowns were less likely to be extracted (P < 0·001). Lower and upper molars and lower premolars were more likely to be extracted due to restorative failure, while lower anterior teeth were more likely to be extracted due to periodontal disease (P < 0·05). Twenty two per cent of the extractions was due to restorative failure, and at least 65·9% of these teeth had secondary caries. Gender, age and educational level were factors that affect tooth loss. In conclusion, teeth receiving multiple restorative therapies were more likely to be extracted.

Restorative Treatment Thresholds: Factors Influencing the Treatment Thresholds and Modalities of General Dentists in Kuwait

Objectives: This study investigated the thresholds at which general dentists in Kuwait would restore approximal and occlusal carious lesions and examined the demographic characteristics of the dentists in relation to their decision making. Subjects and Methods: The study population consisted of a random sample of 185 general dentists practicing in the Ministry of Health of Kuwait. A survey questionnaire was administered. The questionnaire presented different stages and locations of carious lesions; the participants were asked to identify the stage at which a restoration is required under different conditions, the preparation technique, and their choice of restorative material. Results: For approximal carious lesions, 74 (40%) of the participants reported that they would restoratively intervene when the carious lesion reached the outer third of the dentin. A total of 91 (49.2%) reported the use of traditional class II restorations. For occlusal carious lesions, 128 (69.2%) said they would intervene when lesions reached the middle third of the dentin. 146 (78.9%) said they would remove the carious tissue only in their preparation. For both approximal and occlusal lesions, the participants preferred resin composite as the material for restoration. Conclusions: The respondents tended to delay restorative intervention until dentinal penetration of the caries. Resin restorative materials were used in conservatively prepared cavities. Participants chose a conservative approach for occlusal lesions but still believed in a traditional approach when it concerned approximal lesions. Experience, university dental education, and participation in continuous education courses were most significantly related to restorative treatment.

Recurrent caries at crown margins: making a decision on treatment.

Objective: To evaluate dentists’ treatment choices for a crowned tooth with varying degrees of recurrent caries. Materials and Methods: A total of 158 dentists participated in the study. A paper patient case (PPC) depicting a radiograph showing varying degrees of recurrent caries at the crown margin was used: PPC1 = small carious lesion away from crown margin; PPC2 = small carious lesion at crown margin; PPC3 = small carious lesion at crown margin extending onto the root, and PPC4 = large carious lesion at the margin; PPC5–PPC8 had the same carious conditions as PPC1–PPC4, respectively, but the teeth were non-vital. Participants were asked to indicate their choice of treatment from a list of options for each PPC. Crown removal tendency was computed after dichotomization of the responses for the different cases for each participant. Demographic information, educational background and practice characteristics were collected. Descriptive statistics, logistic regression analysis and paired-sample t test were used to analyse the data at a statistically significant level of p < 0.05. Results: For PPC1 and PPC5, most of the participants recommended management without crown removal (p < 0.05). For PPC6, there was wide disagreement about management (p = 0.81). For all other PPCs, the majority of participants chose to remove the crown before making a treatment decision (p < 0.05). Logistic regression analysis showed that the size of the lesion, vitality of the tooth, participants’ age as well as the undergraduate training background of dentists were factors that affected treatment decisions. Conclusion: The data showed a lack of agreement among dentists regarding the management of recurrent caries around crown margins. Size of the lesion, vitality of the tooth, educational training and experience appeared to be the main factors that affected their decisions.

The Effect of Combining Radiographs and DIAGNOdent With Visual Examination on Detection and Treatment Decisions of Noncavitated Occluso-dentinal Caries.

The aim of this laboratory study was to evaluate the effectiveness of incorporating radiographic examination and DIAGNOdent with visual examination for the detection and treatment of noncavitated occluso-dentinal caries. Four examiners examined the occlusal surfaces of 160 extracted posterior teeth. Teeth were examined three times with a one-month interval in between. The first examination was visual (V), the second examination was visual with radiograph (VR), and the third examination was visual with radiograph and DIAGNOdent (VRD). Examiners were asked to detect the presence of caries (if any) and identify the extent of caries (if present; ie, enamel or dentin). The examiners were also asked to choose a treatment for each tooth. The examined teeth were later sectioned, and the presence of caries was charted as 0 = no caries, 1 = caries confined to enamel, 2 = caries in the outer dentin, and 3 = caries in the inner dentin. Sensitivity, specificity, area under the curve (Az values), rank correlation coefficient, interexaminer reproducibility, and McNemar χ(2) tests were calculated. VR had statistically higher specificity and lower sensitivity than V and VRD. The means of Az values ranged from 0.58 to 0.63, with no statistical difference between the three examinations (p>0.05). The means of the rank correlation coefficients with histology for detection of dentinal caries were 0.48, 0.23, and 0.44 using V, VR, and VRD, respectively. Interexaminer reproducibility was best for V alone. The percentages of teeth indicated for restorative treatment were 31%, 33%, and 41% using V, VR, and VRD, respectively. The percentages of teeth correctly treated according to histology were 69.4%, 70.0%, and 67.5% using V, VR, and VRD, respectively. There was no difference in the accuracy of treatment decisions between the three examination points (p>0.05). The addition of radiographs and DIAGNOdent to visual examination did not have a significant effect on the improvement of the detection or treatment decisions of examiners of noncavitated occluso-dentinal carious lesions.