Zaid B. Al-Bitar

Mixed Dentition Analysis in a Jordanian Population

OBJECTIVE To examine the applicability of the Tanaka and Johnston method of prediction in a Jordanian population and to develop a new prediction method for this specific population if necessary. MATERIALS AND METHODS Three-hundred and sixty-seven Jordanians (193 female, 174 male, mean age 15.5 years) were randomly selected to represent 0.1% of 10th grade schoolchildren from Amman, Jordan. The mesiodistal crown diameters of the permanent teeth were measured and compared with the predicted values derived from the Tanaka and Johnston equations. RESULTS Significant sexual dimorphism was found in tooth sizes. The correlation coefficients between the total mesiodistal width of the mandibular permanent incisors and that of the maxillary and mandibular canines and premolars were found to be 0.60 and 0.66, respectively. There were significant differences between the actual measurements and measurements derived from the Tanaka and Johnston equations. New linear regression equations were derived for both genders to allow tooth size prediction in Jordanians. CONCLUSIONS There is a limitation in the application of the Tanaka and Johnstons prediction method to a Jordanian population. It is important to use separate equations for male and female patients.

Knowledge, educational experiences and attitudes towards child abuse amongst Jordanian dentists

BACKGROUND Signs of physical abuse often present in the oro-facial region and dentists are in a strategic position to recognise and report suspected cases. The aim of this study was to assess the knowledge, educational experiences and attitudes of Jordanian dentists towards child abuse and to assess their educational needs. METHODS A cross-sectional survey of a random sample of Jordanian dentists (n=400) was conducted using an anonymous, self-administered structured questionnaire. RESULTS The response rate was 64%. Thirty-four per cent (n=88) of the respondents reported having formal training in recognising and reporting child abuse, and 42% (n=106) had post-qualification/continuing education training on the topic. Half of the dentists (127/256) suspected a case of child abuse in the past 5 years, but only 12% (31/256) reported their suspicions. The main reasons for not reporting suspicions of abuse were fear from anger of parents (43%), uncertainty about diagnosis (41%) and uncertainty about referral procedures (41%). Those dentists who had formal training in dental school (P=0.0001) and post-qualification courses in child abuse (P=0.006) were significantly more likely to report suspicions. CONCLUSIONS A significant gap existed between recognising signs of physical child abuse and responding effectively. Improvements in child abuse education and continuing education courses are advised to provide dentists in Jordan with adequate knowledge of indicators of physical child abuse and to inform them on the protocol to follow when suspicions arise.

Tooth size discrepancies among Jordanian schoolchildren

The aims of this study were to determine the tooth size discrepancies (TSD) in a representative sample of Jordanian schoolchildren and to compare TSD between genders. Dental casts of 367 (174 males and 193 females; mean age 15.5 years) Jordanian schoolchildren were selected. Anterior and overall Bolton ratios were determined using a digital calliper. Differences between genders were analyzed using a t-test. The results showed that there were no significant differences in the TSD between males and females. The percentages of subjects with more than 2 standard deviations for the anterior and overall ratios were 23.7 and 9.5, respectively.

A comparison of health-related quality of life between Jordanian and British orthognathic patients

The aim of this study was to assess health-related quality of life (HRQoL) in adult Jordanian patients referred for orthognathic treatment, and to compare this with previously published data from a British cohort. Thirty-eight Jordanians (21 females and 17 males; aged 16-31 years) who were about to commence a course of orthognathic treatment completed a generic HRQoL questionnaire [Short-Form 36 (SF-36)] and a condition-specific orthognathic quality-of-life questionnaire (OQoLQ). The questionnaires were completed prior to commencing any pre-surgical orthodontic treatment. The data were compared using the Mann-Whitney U-test for independent groups with non-normally distributed data. There were no statistically significant differences between the Jordanian males and females for any of the OQoLQ or SF-36 items; hence, the groups were combined for analysis. When comparing the OQoL data with that of the British sample, there was no statistically significant differences for three of the four domains: dentofacial aesthetics (P = 0.726), social aspects (P = 0.096), or the awareness of dentofacial aesthetics (P = 0.066). There was, however, a significant difference for oral function (P = 0.016), with the Jordanian group reporting a poorer quality of life (QoL) (mean value 10.9) than the British cohort (mean value 8.4). However, it is questionable whether this difference would be of clinical relevance. While it was not possible to directly compare the results of the SF-36 questionnaires with the same British cohort, Jordanian patients had generally lower scores, and therefore a poorer QoL, than reported in other studies. These differences may be cultural or may be due to differences in the health care systems criteria for funding, and this needs further investigation.

The effect of temporomandibular disorders on condition-specific quality of life in patients with dentofacial deformities

OBJECTIVE This study investigated the effect of temporomandibular disorders on quality of life (QOL) of patients with dentofacial deformities. STUDY DESIGN A case-control study was performed involving 3 age- and gender-matched groups: 38 preoperative participants, 38 postoperative participants, and 39 control participants. Temporomandibular joints were assessed using the Research Diagnostic Criteria for Temporomandibular Disorders (RDC/TMD axis I), and QOL was assessed using the Orthognathic Quality of Life Questionnaire (OQLQ) and the Short-Form Health Survey (SF-36). RESULTS Significantly lower OQLQ scores were found in postoperative patients with one or more RDC/TMD findings; the domains in which these occurred were mental health, dentofacial esthetics, and awareness of dentofacial esthetics for patients with myofascial pain; social aspects and awareness of dentofacial esthetics for patients with disk displacement with reduction; and all domains for patients with arthritis (all P < .05). CONCLUSIONS Despite the variable effect of orthognathic treatment on TMDs, the presence of TMDs in patients after treatment can have a negative effect on their QOL.

Oral Candida colonization in patients with fixed orthodontic appliances: The importance of some nutritional and salivary factors

We investigated the relationship between fixed orthodontic appliances and oral Candida colonization. The influence of some important nutritional and salivary factors was also investigated. These factors included: hemoglobin, vitamin B12, ferritin and folate levels, salivary flow rate, salivary pH, tobacco smoking and dietary habits. Patients enrolled in this study were adolescent patients aged 12-18 years who attended the Orthodontics Department/University of Jordan Hospital for the provision of fixed metallic orthodontic appliances. Salivary samples were collected on the first visit prior to bonding, one month and four months later. All patients were investigated for serum vitamin B12, serum ferritin, red-cell folate, complete blood count, salivary pH, and salivary flow rate. Data were obtained from the patients regarding tobacco smoking and dietary habits. We found that Candida colonization did not increase after bonding of fixed orthodontic appliances. None of the local oral factors investigated was correlated with Candida colonization. Only two systemic factors (serum vitamin B12 and red-cell folate) were significantly (P<0.05) associated with Candida colonization during the study period. It was obvious that metallic fixed orthodontic appliances did not encourage oral Candida colonization during the four months study period. On the other hand, it seems that nutritional factors like serum vitamin B12 and red-cell folate can influence oral Candida colonization more than tobacco smoking, dietary and salivary factors. Key words:

Anxiety and post-traumatic stress symptoms in orthognathic surgery patients.

Objective: To assess the impact of orthognathic surgery in terms of anxiety and stress levels in pre-treatment and post-treatment groups compared with controls and the role of previous trauma exposure on anxiety and stress levels following treatment. Materials and methods: A case–control study was performed involving three age-gender matched groups: 38 ‘pre-surgery’, 39 ‘post-surgery’ and 39 ‘control’ subjects. All subjects had assessment of dental anxiety, post-traumatic stress responses and frequency of previous distressing events. Seventeen subjects were followed up prospectively for 1 year after surgery. Results: ‘Post-surgery’ group reported lower dental trait anxiety (S-DAI) scores than other groups (P = 0.001). S-DAI was significantly associated with frequency of previous traumatic events in ‘pre-surgery’ and ‘post-surgery’ groups (P < 0.01), and was significantly associated with post-traumatic stress disorder (PTSD) symptoms in ‘pre-surgery’ subjects (P < 0.01) who had the highest PTSD symptoms among the three groups (P = 0.005). Symptom severity (IES-R) levels were significantly associated with frequency of previous distressing dental events in ‘pre-surgery’ (P < 0.05) and ‘post-surgery’ groups (P < 0.01). Post-operative S-DAI and IES were significantly associated with pre-operative PTSD symptoms (P < 0.01). Conclusions: The two orthognathic groups were associated with low levels of anxiety and PTSD symptoms in comparison with the control group of the study. Trauma exposure prior to orthognathic treatment can be considered as a risk factor for the development of dental anxiety and PTSD symptoms. The need to improve communication between patients and team is emphasized, especially during the assessment of patients’ emotional state pre-operatively, in addition to discussing psychological issues and psychosocial treatment implications.

Proportions of the aesthetic African-Caribbean face: idealized ratios, comparison with the golden proportion and perceptions of attractiveness

BackgroundIn the absence of clear guidelines for facial aesthetic surgery, most surgeons rely on expert intuitive judgement when planning aesthetic and reconstructive surgery. One of the most famous theories regarding “ideal” facial proportions is that of the golden proportion. However, there are conflicting opinions as to whether it can be used to assess facial attractiveness. The aim of this investigation was to assess facial ratios of professional black models and to compare the ratios with the golden proportion.MethodsForty photographs of male and female professional black models were collected. Observers were asked to assign a score from 1 to 10 (1 = not very attractive, 10 = very attractive). A total of 287 responses were analysed for grading behaviour according to various demographic factors by two groups of observers. The best graded photographs were compared with the least well-graded photographs to identify any differences in their facial ratios. The models’ facial ratios were calculated and compared with the golden proportion.ResultsDifferences in grading behaviour were observed amongst the two assessment groups. Only one out of the 12 facial ratios was not significantly different from the golden proportion.ConclusionsOnly one facial ratio was observed to be similar to the golden proportion in professional model facial photographs. No correlation was found between facial ratios in professional black models with the golden proportion. It is proposed that an individualistic treatment for each ratio is a rather better method to guide future practice.

Undergraduate experience and self-assessed confidence in paediatric dentistry at the University of Jordan Dental School.

INTRODUCTION The aims of the study were to audit the number and types of clinical procedures completed by the undergraduate dental students in the paediatric dentistry course at the University of Jordan Dental School and to present data on self-reported confidence in a variety of aspects of paediatric dentistry. MATERIALS AND METHODS A retrospective audit of clinical logbooks for the entire class of 120 dental students in their fifth clinical year was performed. Key clinical procedures performed in the paediatric clinics were recorded including treatment performed on both primary and permanent teeth. Students were requested to complete an anonymous questionnaire to assess confidence related to six activities using a visual analogue scale (VAS). RESULTS All students performed restorations in primary teeth with the majority providing approximal restorations (91%), pit and fissure restorations (89%) followed by stainless steel crowns (81%). In addition, all students performed a pulpotomy for a primary tooth, extraction of a primary tooth and fissure sealants. Only a quarter of the students treated a traumatised incisor. Students considered themselves most confident (VAS ≥ 7) in performing operative dentistry, examination, diagnosis and treatment planning and providing preventive therapy. They were least confident in the management of dento-alveolar trauma (VAS = 3.8). CONCLUSION Students at the University of Jordan Dental School were found to have good experience of clinical paediatric operative dentistry with the majority performing pulp therapy, preformed crowns and extractions. Deficiencies have been reported in student exposure to dental trauma, and these are being addressed.

Oral Health-Related Quality of Life Changes Following Third Molar Surgery in a Jordanian Population : Effect of Demographic and Clinical Factors on the Immediate Postoperative Period

Objective: This study aimed to evaluate oral health-related quality of life (OHRQOL) changes following third molar surgery, and investigate demographic and clinical variables’ effect on (OHRQOL) in the first postoperative week. Methods: 45 subjects had surgical removal of lower third molar/s by one surgeonat Jordan University hospital from March 2011 to November 2011, following a standardized protocol. Patients’ demographics and clinical data were recorded. (OHRQOL) was evaluated before surgery using the Oral Health Impact Profile (OHIP)-14. On postoperative days (PD) 1, 3, 5 and 7, patients completed the (OHIP)-14 & the condition-specific (HRQOL) instrument. Results: A significant deterioration in OHRQOL was seen on (PD)1(P=0.000), and (PD)3 (P=0.000), except for psychological discomfort and disability domains. On (PD)5, no difference was found, however, females had significantly lower OHRQOL levels than males on (OHIP)-14 (P=0.008) and the domains: physical (P=0.048), psychological (P=0.016) and social disability(P=0.018). Conclusions: Third molar surgery was associated with deterioration in patients’ OHRQOL on the first three postoperative days. Females had a slower recovery, with no effect of other factors on patients’ recovery pattern.