Objectives: The aim of this article is to establish a comprehensive nation-wide prevalence of malocclusion traits on the sagittal, vertical, and transverse planes of space in Saudi Arabia. Materials and Methods: A systematic search was conducted in three databases (Medline via PubMed, Embase, and Web of Science) and complemented with a manual search of Google Scholar and the reference list of included studies. Original studies of Saudi Arabian healthy individuals at any age were included. The quality and the risk of bias of the included studies were assessed using the Joanna Briggs Institute’s appraisal tool. The data about the selected malocclusion traits on the sagittal, vertical, and transverse planes of space were extracted and pooled. Results: Out of 7163 identified titles, 11 studies were finally included. The risk of bias was high in two studies, moderate in eight studies, and low in one study. The studied age groups were from early childhood to late adulthood, with a total sample size of 19,169 participants. The majority of the studies recruited their sample from school/public sources, whereas the remaining three studies recruited their sample from dental (non-orthodontic) clinics. Conclusions: Within the limitations of this study, pooled prevalence of Angle’s Class I molar relation in Saudi Arabia was similar to other populations but Angle’s Class II and Class III molar relations were lower and higher, respectively. These differences could be attributed to population-related differences in craniofacial morphology. Teeth crowding, teeth spacing, and midline shift, along with increased overjet and overbite, were among the most common malocclusion traits occurring in Saudi Arabia.

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Background: Complete and uneventful recession coverage should be the aim of gingival recession treatment. Systematic reviews have said that coronally advanced flap with connective tissue graft (CTG) is the gold standard for gingival recession treatment. Minimally invasive procedures with optical magnification allow minimal tissue manipulation and precise adaptation of wound edges helping in faster and uneventful healing, thus bringing about a satisfactory clinical and patient outcome. Thus, the following study compares the clinical- and patient-related outcomes of modified microsurgical tunnel technique (MMTT) and modified coronally advanced flap (MCAF) using CTG in the coverage of multiple adjacent Miller’s class I and II gingival recessions. Materials and Methods: Gingival recession patients were selected and were assigned randomly to either MMTT+CTG or MCAF+CTG. Clinical parameters were evaluated at 1, 3, and 6 months. Patient’s satisfaction level was assessed by measuring root coverage esthetic score, hypersensitivity, and morbidity. The statistical analysis was performed using commercially available software SPSS version 14. Descriptive statistics were expressed as mean±standard deviation for each parameter. Intragroup comparison was done by using the paired T-test. Intergroup comparison was done using the independent Student’s T-test. The significance level was set at P = 0.05. Results: MMTT+CTG showed a statistically significant greater clinical- and patient-related outcome. Conclusion: MMTT+CTG, being a closed procedure, preserves the blood supply, helps in faster healing, and does not compromise the esthetics. All these lead to decreased morbidity and increased patient satisfaction which makes MMTT a superior technique than the conventional procedure in gingival recession treatment.

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Objective: The need to assess oral health-related quality of life (OHRQoL) has grown increasingly in the healthcare sector over the past few decades. The Dental Impact on Daily Living (DIDL) assessment is a tool created to measure OHRQoL. The aim of this study was to complete a cross-cultural adaptation of the DIDL to yield a valid and reliable Indonesian version for use as an official instrument to assist in further OHRQoL research in Indonesia. Materials and Methods: The original English version of the DIDL was translated and validated. Content validity and face validity were considered. Psychometric testing for test–retest reliability was analyzed among 32 subjects, while internal consistency using Cronbach’s alpha and clinical oral health status using the DMF-T index to obtain convergent validity of the questionnaire were checked among 278 subjects. Results: The study subjects showed a good understanding of how to complete the Indonesian language version of the DIDL questionnaire, and conceptual and semantic equivalence (content and face validity) were noted. Further, test–retest reliability was noted (intraclass correlation coefficient range: 0.975–1 and Cronbach’s alpha: 0.942), whereas convergent validity suggested a correlation between DMF-T and DIDL questionnaire of −0.502 with significance at alpha of 5% (P = 0.00), which means that decreasing the DMF-T outcome will increase the satisfaction using the DIDL among research subjects. Conclusion: Cross-cultural adaptation of the DIDL yielded a valid and reliable Indonesian version. The DIDL questionnaire is a promising questionnaire that can be applied to measure OHRQoL in Indonesians.

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Background: Parental dental fear and anxiety (DFA) is an important factor, which has an impact on adolescence receiving dental treatment and maintenance of their oral health. It is necessary to recognize and know how parental DFA affects the dental treatment of children and adolescents. Aim: This narrative review was planned with the objective of evaluating parental DFA influence on adolescent dental treatment. Materials and Methods: A broad search of literature published between 2005 and 2021 from electronic databases through Scopus, PubMed, Web of Science, Google Scholar was performed. We included the studies in which parental dental anxiety was a major criterion affecting different dental health conditions. Articles referring to adolescents facing different oral health problems were also included. This narrative review included 12 articles of which 8 cross-sectional studies, 3 longitudinal studies, and 1 descriptive study, all of which met the inclusion criteria and the specified age group of adolescents ranging between 10 and 19 years. Results: After screening 83 abstracts, 12 articles were selected, which included all the inclusion criteria. In this study, we found that parental DFA showed a positive association with their adolescent’s DFA, which hinders the dental treatment received. Conclusion: Parental DFA influences the adolescent behavior and can impact the seeking of dental treatment. Hence, it is important to address parental DFA prior to the intervention and treatment. An appropriate address will facilitate in reducing or eliminating DFA in adolescents.

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Objective: The aim of this study was to evaluate the bibliometric profile of dental scientific production related to coronavirus disease-2019 (COVID-19) in Scopus (2019–2020). Materials and Methods: This was a descriptive, observational, comparative, and retrospective study. All manuscripts on COVID-19 in dentistry were published between December 2019 and December 2020. The variables were measured objectively through Scopus (SciVal). For the extraction of the manuscripts, the following keywords were used: “Covid-19” and “Dentistry” with its multiple MeSH terms using the Boolean operators “OR” and “AND”. On June 14, 2021, 843 manuscripts corresponding to the period January 2019 to December 2020 were downloaded, normalized, and refined through metadata analysis. Results: The largest number of manuscripts was published in the International Journal of Current Research and Review, Oral Oncology, Oral Diseases, British Dental Journal, and Journal of Dental Education with 54, 50, 49, 48, and 44 manuscripts, respectively. These are the most productive indexed scientific journals on COVID-19. The most productive institutions were Saveetha University, Universidade de São Paulo, and King’s College London, with 42, 33, and 27 manuscripts, respectively. In 2019, there were only two scientific publications on COVID-19. In 2020, the largest amount, 228 manuscripts, were published in Q1 journals, followed by 210 manuscripts in Q3 journals, and only 194 manuscripts were published in Q4 journals. Conclusions: Currently, there is a notable increase in global academic production in Scopus on the impact of COVID-19 in dentistry, whereas Brazil is the only South American country with three highly productive universities.

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Aims: Several factors influence the development of white spot lesions (WSLs), and one of these is fixed orthodontic appliances. This study aims to evaluate the awareness, preventive strategies, and management of WSLs among a group of Orthodontists. Materials and Methods: A qualitative methodology was applied; four focus groups made up a purposive sample from Orthodontists with various training backgrounds while working within the same healthcare services. Results: Three main themes emerged: awareness and ability to diagnose WSLs, perceived influences on the development of WSLs, and prevention and management strategies and barriers to care delivery. All focus groups agreed that there is a need for continuous prevention and preventive strategies of WSLs, particularly among orthodontic patients. There was also a consensus that orthodontic treatment should be delayed until WSLs are managed appropriately. Conclusions: Within the limitation of this study, WSLs were collectively agreed to be a significant issue during fixed orthodontic therapy, and continuous professional development for Orthodontists should include risk factors evaluation, diagnosis, prevention, and management of WSLs.

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Aims: The aim of this study was to evaluate the efficacy of 0.2% chlorhexidine and 4% tulsi extract as toothbrush decontaminants. Materials and Methods: Of 100 children, who attended the outpatient unit of Department of Pediatric dentistry, 81 children, who satisfied all the inclusion criteria were subjected to systematic sampling, after arranging them in the alphabetical order and were grouped into three. The first child came under Group I, second under Group II, third under Group III, fourth one again under Group I, and so on till the 81st child. In the baseline phase, the children were provided precoded toothbrushes and toothpastes and instructed to place those brushes to be put after use, in single-use glasses. After obtaining the baseline value of Streptococcus mutans colony count, the participants of Group I was given 0.2% chlorhexidine, Group II was given 4% tulsi extract, and distilled water for Group III, to be used as toothbrush decontaminants for 5 days. The toothbrushes were then collected back, and were subjected to microbial analysis. Statistical analysis was performed by using Kruskal–Wallis one-way analysis of variance (ANOVA) and Mann–Whitney U test with P < 0.05. Results: All test solutions, 0.2% chlorhexidine and 4% tulsi extract, except for distilled water, showed a statistically significant reduction of S. mutans count. There was no statistical difference between the efficacies of 4% tulsi extract and 0.2% chlorhexidine, although the latter showed a better reduction. Conclusion: Tulsi extract may well be a perfect replacement to chlorhexidine for reducing the S. mutans count in the child toothbrushes.

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Objectives: To evaluate self-assembling peptides (SAP) for caries prevention and arrest in primary tooth enamel in vitro. Materials and Methods: Overall, 180 extracted primary teeth were used. In the prevention experiment (n = 20 samples per group), self-assembling peptide for prevention (SAPP), fluoride varnish/mouthwash (FV/FMW), casein-phosphopeptide amorphous-calcium phosphate (CPP-ACP), and nanohydroxyapatite (nHA) were applied. Samples were subjected to a demineralizing pH cycling for 14 days. In the arrest experiment (n = 15/group), 60 samples were pre-demineralized; induced lesions were treated using self-assembling peptide for repair (SAPR), FV, CPP-ACP plus fluoride, and resin infiltration (RI) and submitted to pH cycling. Mineral loss and its differences as well as lesion depth were determined using transversal microradiography. Numerical data were tested for normality using Shapiro–Wilk’s test and were compared using Kruskal–Wallis test followed by pairwise comparisons utilizing multiple Mann–Whitney U tests with Bonferroni correction. The significance level was set at P < 0.05 within all tests. Results: FV (median: −46.3 [interquartile range: 175.52] vol% × µm) and FMW (−33.35 [124.65] vol% × µm) prevented caries significantly more effectively than all other groups (P < 0.001), which did not show significant preventive effects. RI (median: 4949.70 [1637.20] vol% × µm) and FV (median = 6076.05 [5190.08] vol% × µm) arrested lesions, whereas SAPR and CPP-ACPF did not show such arrest. Conclusions: FV and FMW showed the largest caries-preventive effect, whereas RI and FV arrested lesion progression in primary tooth enamel in vitro.

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Objective: This study aimed at determining the influence of adding silicon dioxide nanoparticles (nano-SiO₂) to soft relining materials on C. albicans adhesion, surface roughness, and contact angle. Materials and Methods: Eighty heat-polymerized acrylic resin disks were constructed and relined by using auto-polymerized acrylic soft liners (COE-SOFT, GC Co., Tokyo, Japan). The specimens were categorized into two groups according to the tests conducted. Group A was composed of 40 specimens for evaluating antifungal activity, and Group B was composed of 40 specimens for testing surface roughness and contact angle. Each group was subcategorized into four subgroups (n = 10) according to the concentration of nano-SiO₂ added to the soft-liner powder: control, 0.25%, 0.5%, and 1.0% by weight. The colony forming unit (CFU) was used to assess C. albicans count. A profilometer was used to measure the surface roughness values (Ra; μm). The sessile drop method was used to evaluate the contact angle (^o) by using a goniometer. Analysis of variance and Tukey’s post hoc tests (α = 0.05) were used for the data analysis. Results: In comparison with the unmodified group, the 0.25% and the 0.5% nano-SiO₂ groups exhibited significantly lower C. albicans counts (P < 0.001), surface roughness (P < 0.001), and contact angles (P < 0.001). The exception was the 1% group, which exhibited higher C. albicans count, surface roughness, and contact angles than lower-concentration nano-SiO₂ groups; however, these values in the 1% group were still less than their respective values in the control group. Conclusion: The addition of 0.25% and 0.5% nano-SiO₂ to an auto-polymerized acrylic soft liner decreased C. albicans adhesion, surface roughness, and contact angle.

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Aims: This study was conducted to assess the effect of the addition of yttrium oxide (Y₂O₃) nanoparticles on the tensile bond strength, tear strength, shore A hardness, and surface roughness of soft-denture lining material. Materials and Methods: Y₂O₃ NPs with 1.5 and 2 wt.% were added into acrylic-based heat-cured soft-denture liner. A total of 120 specimens were prepared and divided into four groups according to the test to be performed (tensile bond strength, tear strength, surface hardness, and surface roughness). Results: There was a highly significant increase in tensile bond strength between the soft liner and the acrylic denture base, tear strength, and hardness at both concentrations as compared to the control group, whereas there was a nonsignificant difference between 1.5wt% of Y₂O₃ nanoparticles and the control group, and between 1.5wt% and 2wt% of Y₂O₃ nanoparticles. But there was a significant difference between 2wt% of Y₂O₃ nanoparticles and the control group. Conclusion: The Y₂O₃ nanoparticles impregnated in soft-lining materials increased the mechanical properties of both tensile bonding strength and tear strength. Also, there was a significant increase in hardness but there was no change in surface roughness of acrylic-based denture soft-lining materials.

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Aim: This study explored perceptions of dental postgraduates regarding the impact of contemplative practice in a patient care aspect. Materials and Methods: The qualitative research approach using semi-structured interview was employed. Postgraduate students from the General Dentistry Residency Training Program were selected by purposive sampling by considering sex and working experience. The retrieved data were transcribed using a verbatim technique and analyzed using framework analysis. Results: There were 12 students participating in this research. The retrieved data were analyzed and categorized into two main themes, which were mindfulness and humanized patient-centered care paradigm. Mindfulness can be categorized into four subthemes to represent its required skills, including concentration, deep listening, emotional regulation, as well as critical thinking and problem-solving skill. There were six subthemes for humanized patient-centered care paradigm, which were understanding in patients’ context, development of individualized comprehensive treatment planning, treatment with humanization and compassion, management with phycological integrated care, rapport establishment with patients, and good attitudes toward special care needs patients. These skills are considered necessary for patient-centered dental practice, which could be expected from the learning process through contemplative practice. Conclusion: This research supports the implementation of contemplative practice in dental education, as the data demonstrated the positive impact of contemplative practice in both personal and professional perspectives. These included the cultivation of mindfulness and other relevant skills, which were required for humanized patient-centered care in dental practice.

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Introduction: The purpose of this study was to establish a formula for cervical vertebral bone age (CVBA) based on the morphological changes of cervical vertebrae on cephalometric radiographs in Vietnamese subjects between 7 and 18 years of age. Materials and Methods: This study included 180 children and adolescents (92 boys, 88 girls), between 7 and 18 years of age, selected from the craniofacial morphology studies of the Faculty of Odonto-Stomatology, Ho Chi Minh University of Medicine and Pharmacy. The cephalometric and hand-wrist radiographs of each subject were taken simultaneously and evaluated. Eleven hand-wrist skeletal maturity indicators of Fishman were grouped into five stages: initiation and acceleration, transition, deceleration, maturation, and completion stage. A multivariate regression analysis was conducted to assess the correlation between the stages of hand-wrist BA and the morphological characteristics of the second, third, and fourth cervical vertebrae on the cephalometric radiographs. Results: A formula for CVBA was proposed as follows: CVBA = 1.92+ 0.04 * α2 + 0.03 * α4 –1.12*AB3/BC3 + 3.17 * h4/w4, where α2 and α4 are anteroinferior border angles of C2 and C4; AB3/BC3 is the ratio of inferior to anterior dimension of C3; h4/w4 is the ratio of height to width of C4. The means and standard deviations of five stages of CVBA will be as follows: CVBA I= 1.527 ± 0.906; CVBA II= 2.732 ± 0.568; CVBA III= 3.762 ± 0.589; CVBA IV= 5.077 ± 0.840; and CVBA V= 5.820 ± 0.661. Conclusion: The quantitative CVBA method could be useful to assess the level of skeletal maturation in orthodontic and orthopedic treatments.

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Background: Barrier enclosure systems were suggested as the protective equipment for aerosol-generating procedures. Objective: The aim of this study was to investigate the efficiency of dental barriers in aerosols and splatters reduction during an ultrasonic scaling. Materials and Methods: Two types of dental barriers: (1) metal frame with plastic wrap (MFPW) and (2) plastic shield chamber (PSC) were investigated. Ultrasonic scaling was performed on dental phantom head with and without the use of dental barriers. To detect the splatter contamination, the water system of the scaler was circulated with 0.1% fluorescein dye and filter papers were set at several parts of dental chair, body of an operator, and assistance. For bioaerosol production, water containing 10⁷ colony-forming unit (CFU)/mL of Lactobacillus acidophilus was used as a water coolant system of the scaler. Results: The total surface contamination found on the body of the operator was significantly decreased when using both MFPW and PSC barriers (P < 0.05). A significant reduction on the assistant’s body and the dental chair was only observed when PSC was used (P < 0.05). For bacterial aerosols, both barriers significantly reduced the number of bacterial colonies when compared with no barrier used (P < 0.05). The percentages of total colonies reduction for MFPW and PSC were 78.13 (±1.69) and 69.24 (±2.49), respectively. However, no difference in the total number of bacterial colonies was observed between the two types of barriers. Conclusion: A dental barrier system was effective in aerosols and splatters reduction during an ultrasonic scaling.

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Objective: There is a paucity of data regarding the effect of fabrication techniques and compositions of CAD/CAM milled, 3D-printed, and polyamide flexible denture base resin materials (DBRMs) on the surface roughness (SR), surface hardness (SH), and impact strength (IS). Therefore, this study aimed to evaluate the SR, SH, and IS of CAD/CAM milled, 3D-printed, and polyamide flexible DBRMs. Materials and Methods: Ninety specimens were constructed from different DBRMs and divided into three groups (CAD/CAM, 3D-printed, and polyamide DBRMs; n = 30) with specific measurements: 15 × 10 × 2.5 mm for SR and H tests and 80 × 10 × 4 mm notched specimen for IS test. SR meter and Vickers micro SH tester were used to measure SR and SH, respectively, whereas the IS was evaluated using Charpy’s impact testing machine. Data were collected and statistically analyzed using one-way analysis of variance and post hoc Tukey’s tests (α=0.05). Results: There were significant differences between the tested materials (P< 0.05). The CAD/CAM milled showed lowest SR when compared with 3D-printed resin and polyamide flexible resin (P< 0.05); however, there was a significant increase in SH of CAD/CAM milled and 3D-printed DBRMs when compared with polyamide materials (P< 0.05). There was a significant increase in IS of polyamide and CAD/CAM milled resins when compared with 3D-printed DBRMs (P < 0.05). Conclusion: CAD/CAM milled resins showed high IS and SH with lower SR.

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Aim: The puppet theater, due to its artistic and educational characteristics, could allow children to develop oral health self-care in an attractive and fun way. The aim of this study was to evaluate the impact of puppet theater on oral health knowledge and oral hygiene in preschoolers from a Peruvian public school. Materials and Methods: An analytical, longitudinal, and quasi-experimental study was conducted in 132 preschoolers divided into three age-matched groups (3, 4, and 5 years old) from August to November 2019 in a Peruvian public school. At 4 weeks and 4 months after performing the puppet theater, a validated questionnaire of five closed questions was used to evaluate oral health knowledge, and the Greene–Vermillion index [only bacterial plaque index (BPI) part] was used to evaluate oral hygiene, considering good (0–0.6), fair (0.7–1.8), and poor (1.9–3.0). The theater sessions were held every week for the first month and every 2 weeks for the following 3 months. To analyze the levels in the BPI, the Wilcoxon and Friedman test was used to compare related measures, and to compare the knowledge for each question of the questionnaire, the McNemar and Cochran’s Q tests were used, considering a P-value less than 0.05. Results: The BPI in relation to age (3, 4, and 5 years), before and after 4 months of performing the puppet theater, was 1.9 [confidence interval (CI): 1.7–2.0], 1.8 (CI: 1.6–1.9), and 1.8 (CI: 1.7–2.0), decreasing to 0.9 (CI: 0.8–1.0), 0.8 (CI: 0.7–0.9), and 0.9 (CI: 0.8–1.00), respectively. In relation to gender (men and women), it was 1.8 (CI: 1.7–2.0) and 1.8 (CI: 1.7–1.9), decreasing to 0.9 (CI: 0.8–1.0) and 0.8 (CI: 0.8–0.9), respectively. In relation to origin (urban or rural), it was 1.8 (CI: 1.7–1.9) and 1.8 (CI: 1.4–2.2), decreasing to 0.9 (CI: 0.8–0.9) and 0.8 (CI: 0.7–0.9), respectively. The level of BPI and oral health knowledge improved significantly (P < 0.001) over time in all preschoolers, except in those who came from the rural area (P > 0.05). Conclusion: The application of the puppet theater positively influenced the preschoolers in such a way that it significantly improved their oral health knowledge and oral hygiene at 4 weeks and 4 months, in both genders of 3, 4, and 5 years of age, and in those whose origin was the urban area. However, no significant improvements in oral health knowledge and oral hygiene were observed in those preschoolers whose origin was the rural area.

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