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   2020| January-February  | Volume 10 | Issue 1  
    Online since February 20, 2020

 
 
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ORIGINAL ARTICLES
Perception of dental students and laypersons to altered dentofacial aesthetics
Khalid Aldhorae, Basema Alqadasi, Zainab M Altawili, Ali Assiry, Anas Shamalah, Salah addin Al-Haidari
January-February 2020, 10(1):85-95
DOI:10.4103/jispcd.JISPCD_340_19  
Aims and Objectives: The aims of the study were to comprehensively assess the perception of altered dentofacial aesthetics between dental students and laypersons and to identify the threshold where different variables such gender and clinical training impair dentofacial attractiveness. Materials and Methods: Ten photographs were digitally manipulated involving three facial, two smile, four dental, and one gingival components. Fifty images were randomized and rated according to attractiveness by two groups dental students which subdivided into preclinical students and clinical students, and laypersons. The participants evaluated the original and manipulated images using a visual analog scale. The responses were then analyzed using Mann–Whitney U test. Results: The results showed threshold levels of noticeable differences between varying levels of discrepancy. The overall perception of aesthetics was high among dental clinical students with the highest perception toward facial profile and the lowest toward gingival margin height. Of the respondents, no differences were found in the perception between male and female participants. Dental students perceived aesthetic components more accurately than laypersons. Conclusion: Dental students group had a better perception of dentofacial aesthetics than included laypersons. Unlike gender, clinical training has a substantial positive effect on the assessment of beauty. Dental students sub divided into dental preclinical students and dental clinical students (clinical training is a variable of all subgroups).
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Oral health–related quality of life and oral hygiene practice of adults with fixed dental prostheses in Riyadh, Saudi Arabia
Abeer Alrumyyan, Shahad Quwayhis, Shahad Meaigel, Raghad Almedlej, Rana Alolaiq, Raneem Bin Nafesah, Malak Almutairi, Shahd Alzamil
January-February 2020, 10(1):62-68
DOI:10.4103/jispcd.JISPCD_347_19  
Objectives: Missing teeth are routinely replaced with fixed dental prostheses (FDPs); thus, knowing the patient’s oral health–related quality of life (OHRQoL) after placement of FDP and factors affecting their quality of life in addition to their oral hygiene practices is important. This study aimed to measure OHRQoL with FDPs and oral hygiene practices of adults in Riyadh, Saudi Arabia. Materials and Methods: A survey was distributed in hard and soft copy forms. Target subjects were adults older than 18 years with FDP and living in Riyadh. The questionnaire contained four domains: demographic data, medical history, characteristics of the prostheses and oral hygiene practices, and Oral Health Impact Profile (OHIP)-14 questionnaire, which measures OHRQoL. Results: The study included 528 subjects. More than half of the participants (56.6%) had poor OHRQoL, which was associated with female gender, full-time employment, and low income. The presence of toothache, periodontal diseases, oral abscess, and broken teeth were all associated with poor OHRQoL. Participants with diabetes were also found to have poor OHRQoL. As for oral hygiene practices, 47% of subjects did not receive oral hygiene instructions after the placement of their FDP. It was also found that 53.4% of the study population brush only once daily. Conclusion: Many factors can have an influence on OHRQoL. Both dentist and patient awareness regarding postoperative oral hygiene instructions should be increased to ensure the durability of the prosthodontic appliances and improve patients’ OHRQoL.
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REVIEW ARTICLES
Assessing dental light-curing units’ output using radiometers: A narrative review
Cendrella Assaf, Jean-Claude Fahd, Joseph Sabbagh
January-February 2020, 10(1):1-8
DOI:10.4103/jispcd.JISPCD_407_19  
Introduction: This review aimed to describe dental radiometers and discuss their effectiveness compared to other light-testing devices. Materials and Methods: The search for light-curing units (LCUs), radiometers, and other light-measuring tools available on the market was accomplished on data found on PubMed, Wikipedia, and Google. Results: LCUs are prone to deterioration due to several reasons such as the light’s limited life span, the worsening of the LCU’s filters, light guide, and light tip end; consequently, decreased photopolymerization and insufficient resin conversion may occur. A regular light output assessment is highly recommended in dental daily practice as well as before any new LCU purchase to make sure the light features meet the factory specifications delivered by the manufacturer and they remained stable through time. Discussion: Irradiance values reported by radiometers do not match accurately with those delivered by laboratory power meters. Therefore, dental practitioners as well as dental students are advised to control regularly every LCU by using the same handheld radiometer.
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ORIGINAL ARTICLES
Oral Manifestations in HIV-TB Co- infected Patients and Their Correlation with CD4 Count in Telangana State, India
Ashalata Gannepalli, Ayinampudi B Krishna, Pacha V Baghirath, Balistty Hari Vinay, Sana Khaled, Bushra Anjum
January-February 2020, 10(1):21-35
DOI:10.4103/jispcd.JISPCD_448_18  
Aims and Objectives: Human immunodeficiency virus (HIV)-related oral lesions are often an early finding, and they reflect the underlying immunosuppression, and tuberculosis (TB) coinfection can have further deteriorating effect. Hence, a cross-sectional study was conducted to evaluate clinical and oral presentations of patients coinfected with HIV–TB, correlating with various parameters such as the type of TB with CD4 cell count, the type of TB with oral manifestations, site of the lesion, oral manifestations with CD4 cell counts, age, and gender. Materials and Methods: A cross-sectional study was conducted among selected 200 patients coinfected with HIV–TB, registered at Gandhi Medical College, Hyderabad, Telangana, India, and demographic data, CD4 count, diagnosis of TB, and clinical presentation of TB were correlated with site, age, gender, and the type of lesions in the oral cavity. Data were analyzed using the Statistical Package for the Social Sciences (SPSS) software, (IBM SPSS), version 20 (Chicago, IL, USA), with the chi-square test, and the significant P value for all the parameters was considered as <0.05. Results: A total of 200 patients with HIV–TB coinfection, who presented with oral lesions of 258 coinfected cases, were examined. Among which, 129 patients were with pulmonary tuberculosis (PTB), 61 patients with extrapulmonary TB, 2 patients with disseminated TB, and 8 patients with PTB and pneumonia. There were multiple oral manifestations involving different sites of oral cavity, oral candidiasis (28.5%), angular cheilitis (24.5%), linear gingival erythema (21.5%), oral hairy leukoplakia (1.5%), melanotic pigmentation (29.0%), ulcers (20.0%), depapillation of tongue (26.5%), lobulated tongue (12.0%), hairy tongue (11.5%), and papules (10.0%). The correlation of the type of TB with CD4 cell count, oral lesions with the type of TB in tongue, labial mucosa, and palate was significant. Conclusion: A total of 77.5% patients coinfected with HIV–TB had shown oral manifestations emphasizing that the presence of oral lesions can be considered as a strong indicator of coinfection. The oral lesions might be used as a clinical indicator or screening mechanism in patients who were HIV seropositive for TB coinfection and should be necessarily evaluated for TB.
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The effect of secondhand smoking on dental caries among schoolchildren in Riyadh, Saudi Arabia: A cross-sectional study
Abed Al-Hadi Hamasha, Ashwaq A Alfadhel, Asma A Alshareef, Manal M ALjamal, Nouf B Albesher, Nourah M Alaqaili, Thoraya S Kinani
January-February 2020, 10(1):69-75
DOI:10.4103/jispcd.JISPCD_400_19  
Aim: The aim of this study was to explore the relationship between dental caries and exposure to secondhand smoking in mixed teeth among Saudi children. Materials and Methods: A cross-sectional study was designed to target schoolchildren aged between 6 and 13 years in their mixed dentition stage. A cluster random sample of schools teaching first to sixth grades from different regions in Riyadh city was used. Data were obtained by self-reported questionnaires and clinical dental examinations. Questionnaires comprised sections related to sociodemographic, behavioral, health characteristics, and questions related to mother and father smoking status, type, and duration of smoking, and whether parents smoked inside homes or not. The clinical dental examination was based on the basic methods of the World Health Organization criteria for decayed, missing, and filled teeth (DMFT) (1997). Statistical analyses included descriptive statistics, t test, and one-way analysis of variance. Results: Of the 302 participating schoolchildren, 56% were females, 72% were Saudi nationals, and 84% were of normal weight. Of the total 3246 teeth examined, DMFT was found in 1922 teeth (mean DMFT = 6.36). Only eight mothers (2.7%) were smokers, seven of them smoked inside their homes. Majority of fathers were smokers (110, 37%) and 82% smoked inside their houses. It had been found that 26% of schoolchildren were exposed to secondhand smoking. The mean DMF scores were higher among schoolchildren with smoking fathers and mothers, and the difference was statistically significant (P = 0.05). Conclusion: The DMFT among Saudi schoolchildren was 6.36. Children, who are exposed to secondhand smoking by their family members, are more likely to have dental caries in their mixed dentitions.
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Comparison of the anchorage value of the first molars supported with implant and first molars supported with second molar during en masse retraction
M Kaladhar Naik, Garadappagari Dharmadeep, Yellampalli Muralidhar Reddy, Sreekanth Cherukuri, Kranthi Praveen Raj, Vishnuvardhan Reddy
January-February 2020, 10(1):9-15
DOI:10.4103/jispcd.JISPCD_262_19  
Aims and Objectives: The aim of this study was to determine the efficacy of mini-implants as adjuncts for intraoral anchorage units for en masse retraction of maxillary anterior teeth in bimaxillary dentoalveolar protrusion cases. Materials and Methods: The study sample consisted of 15 patients (10 females and 5 males). The samples were compared for anchorage loss with the implant-supported molar and conventional molar contralaterally in both the maxilla and mandible after six months of retraction period. The mini-implants used were 1.5mm in diameter and 8mm in length and were inserted in the first and third quadrant between the roots of second premolar and first molar under local anesthesia at an angle of 45°. For en masse retraction, active tiebacks with ligating (100g) were used bilaterally extending from molar hooks to J-hook on a 0.019” × 0.025” stainless steel arch wire. Lateral cephalograms were taken before and after retraction for assessing the loss of anchorage in maxillary and mandibular first molars. Results: Anchorage loss of 1.46mm in the maxilla and 1.36mm in mandible was found with conventional molar anchorage, whereas no statistically significant anchorage loss was found in the implant-supported molar side. Conclusion: Implant-supported molar side showed better anchorage compared with the conventional molar side. Hence, implant-supported molar can be used as an absolute anchorage unit in the en masse retraction of anterior teeth.
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Effect of hyaluronic acid in modifying tensile strength of nonabsorbable suture materials: An in vitro study
Sudhir R Varma, Mohammed Jaber, Salim A Fanas, Vijay Desai, Arij M Al Razouk, Sara Nasser
January-February 2020, 10(1):16-20
DOI:10.4103/jispcd.JISPCD_343_19  
Background and Aims: In periodontics and other surgical disciplines, sutures play a detrimental role in healing of wound. The use of chemical adjuncts to boost healing has been experimented in recent years. The aim of this study was to evaluate the role of hyaluronic acid rinse in influencing the tensile strengths of commonly used sutures. Materials ad Methods: Two commonly used nonabsorbable suture materials, silk and polyamide, were used for this in vitro study. Tensile strengths of the suture materials were determined by pre- and post-immersion in hyaluronic acid (test) and chlorhexidine (control). A Tinius Olsen Universal Testing Machine was used to assess the tensile strength of the samples. The variables were assessed for normality using the Kolmogorov–Smirnov test. The Wilcoxon signed rank test and Mann–Whitney U test (for quantitative data within two groups) were used for quantitative data comparison of all the clinical indicators. The level of significance was set at P ≤ 0.05. Results: Polyamide showed better stability in terms of tensile strength when compared to silk. Hyaluronic acid as a chemical adjunct did not alter the tensile strengths of both suture materials pre- and post-immersion. Conclusion: This in vitro study has shown a promising property of hyaluronic acid with relation to stabilization of tensile strength of suture materials, which needs to be evaluated in clinical settings.
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Stakeholder perception of the professional role and competence of Swedish dental hygienists: A questionnaire and interview study
Jonas Erdenborg, Sebastian Malmqvist, Nadja Bjurshammar, Gunnar Johannsen, Margareta Hultin, Annsofi Johannsen
January-February 2020, 10(1):54-61
DOI:10.4103/jispcd.JISPCD_363_19  
Objectives: This study investigated stakeholder opinions on the competence and role of dental hygienists in Sweden. Materials and Methods: A questionnaire was sent by e–mail to 94 stakeholders in eight Swedish counties. The survey queried the competence of recently graduated dental hygienists in skills in collaboration, communication, and problem–solving, and in clinical skills. In addition, 10 stakeholders from different Swedish dental organizations agreed to one–on–one deep interviews. Open–ended questions focused on dental hygienist competence to perform dental hygienist skills and tasks and to collaborate with other dental professionals and health–care professionals. Further topics concerning the dental hygienist included their future role and working in other European countries. The interviews were transcribed and then coded using qualitative conventional content analysis methods. Results: The stakeholder consensus in both the questionnaires and the interviews was that the dental hygienist profession is essential to modern dental care. The professional knowledge possessed by dental hygienists is unique and their role has developed and broadened over the years. Furthermore, the qualitative content analysis of the deep interviews identified a core category: The dental hygienist is an important profession for good oral health. Conclusion: Dental hygienists, responsible for prevention and oral health promotion, are an important members of the modern dental team. The need for dental hygienists to collaborate with other dental and general health–care professionals to meet the future demands of society will increase.
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Estimation of dental anxiety levels before and after dental visit in children with visual impairment using Modified Dental Anxiety Scale in braille text
Veena Shivanna, Yash Jain, Rathna Valluri, Vinod Birra, Vinod Kumar, Kranti Kiran Reddy Ealla
January-February 2020, 10(1):76-84
DOI:10.4103/jispcd.JISPCD_361_19  
Objective: Dental anxiety and fear of dental treatment in special children has been recognized as a public health dilemma. Dental anxiety (being the fear of unknown in a dental setting) would definitely have a substantial effect on the children with visual impairment. Assessment of the dental anxiety makes it possible to design intervention programs aimed at reducing the anxiety levels in children with visual impairment. Thus, the aim of this study was to assess the dental anxiety levels before and after dental visit in children with visual impairment using Modified Dental Anxiety Scale (MDAS) printed in braille. Materials and Methods: A total of 144 institutionalized children with visual impairment in the age group of 6–13 years, residing at an institutionalized blind school, participated in the study. Dental anxiety was assessed pre- and post-dental-screening visit using MDAS printed in braille. Statistical analysis was performed using the Wilcoxon matched-pairs signed rank test. Results: Of 144 children, just before dental screening visit, 78 (54.1%) had severe dental anxiety, 52 (36.11%) had mild anxiety, and 14(9.72%) reported no anxiety, whereas after dental education, only 28 (19.44%) had severe anxiety, 22 (16.66%) had mild anxiety, and 94 (63.88%) reported no anxiety. Conclusion: In our study, there was a significant decrease in dental anxiety after dental screening and education. Therefore, proper behavior management techniques and dental health education programs would decrease dental anxiety in children with visual impairment.
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Faculty members’ attitude toward establishing a business center in the Dental School Clinic, King Saud University
Amal Saeed Al-Qahtani, Huda Ismaeel Tublah, Yasmeen Riyadh Talic, Noor Khouqeer
January-February 2020, 10(1):46-53
DOI:10.4103/jispcd.JISPCD_327_19  
Aims and Objectives: The aim of this study was to evaluate the faculty members’ attitude toward establishing a business center in the College of Dentistry, King Saud University, Riyadh, Saudi Arabia. Materials and Methods: A structured questionnaire comprised three sections: demographic variables such as gender and age, questions regarding the faculty’s attitude toward a dental college business center, and a comparison between a business center and private clinics. Statistical analysis was performed to compare the groups with scale response variable; independent t-test, analysis of variance, and factor analysis were also conducted. Results: The study results show that 43 respondents were men and 26 were women. Twenty respondents were ranked in the position of assistant professor, whereas 38 were ranked as associate professors, and 11 as professors. In total, 88.5% of female faculty members supported the idea of establishing a business center at the dental college, whereas 65% of male faculty members supported the same idea. There is a statistically significant difference among them (P < 0.05). The factor analysis extracted three factors named as “treatment accessibility,” “treatment effectiveness,” and “treatment cost.” The factor loading ranges from 0.652 to 0.867, and altogether they explain 79% of the total data variance. Conclusion: Our study proved that 65.1% of male and 88.5% of female dental faculty of the college supported the idea of establishing a business center at the dental college as funding is needed to invest in dental education and research programs in order to formulate the next generation of practitioners to serve the population. This study will add to the progress of establishing a business center in dental education and provides the patient with a treatment accessibility and effectiveness in a low-cost budget.
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Intra-lesional medicaments for the management of intra-osseous lesions of maxilla and mandible - systematic review
Komal Smriti, Evit John, Kalyana-Chakravarthy Pentapati, Srikanth Gadicherla, Manish Bhagania
January-February 2020, 10(1):36-45
DOI:10.4103/jispcd.JISPCD_295_19  
Aims and Objectives: This study aimed to review the success or remission of intralesional medicaments in the management of intraosseous lesions in the oral cavity. Materials and Methods: A comprehensive search was performed in two databases (PubMed and Scopus). Research articles, case reports, case series, and clinical trials were included. Review articles, lesions not involving the bone, incomplete reporting, any other treatment other than intralesional medicaments to treat intraosseous bone lesions, publications without any treatment, and letter to editor were excluded. Data on remission (complete, partial, or no remission), details and regimen of the intervention, number of participants, and follow-up in months were recorded. Results: A total of 653 publications were available for title and abstract screening after the removal of duplicates. Seven articles were excluded, which were not in English. After title and abstract screening, a total of 88 publications were available for full-text screening. Fifty-five articles were included in qualitative synthesis. A total of 168 patients from 55 publications were evaluated. Minimum follow-up was 1 month and maximum was 264 months. More than two-third (n = 38) of the publications were case reports on single patient. More than two-third (n = 38) of the publications had complete remission. Conclusion: Intralesional medications have shown variable success rates. Extensive lesions may undergo intralesional medications followed by surgical management.
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The oral health status of attendees and residents in United Arab Emirates care homes
Banan Almazrooei, Fatemeh Amir Rad, Alexander Milosevic
January-February 2020, 10(1):101-106
DOI:10.4103/jispcd.JISPCD_349_19  
Objectives: This cross-sectional study assessed the oral health status of attendees and residents in United Arab Emirates (UAE) care homes. Materials and Methods: All care homes identified from the UAE Ministry of Health website were selected and all attendees or residents included. Medical conditions were classified according to World Health Organization (WHO) criteria. Oral and dental status was recorded on the WHO Oral Health Assessment form for adults and demographic details were recorded separately. The three examiners had training and calibration exercises before conducting the dental examinations with an overall mean inter-examiner κ of 0.67. Results: A total of 107 patients participated in the study with a mean age of 67.5 years (standard deviation [SD] = 15.65 years). The mean age of men (n = 57) (69.2 years, SD = 16.3) was not significantly different to the mean age of women (65.5 years, SD = 14.8, P > 0.05). The American Society of Anaesthesiologists (ASA) classification of mild disease was present in 71 participants, whereas 27 were classified with severe systemic disease. Multiple medical problems were common (n = 28), followed by endocrine disease (n = 26) and mental health problems (n = 20). Gingivitis and/or periodontitis were present in 58 (72%) of 81 dentate participants (26 participants were edentate). Overall mean decayed, missing, filled teeth (DMFT) was 23.2 (SD = 9.0) but mean DMFT in men was significantly greater (26.5) than women at 19.8 (P < 0.001). Age had a weak positive correlation with DMFT, Spearman’s rho = +0.43 (P < 0.001). Eighteen participants of 88 (20.5%) complained of pain or soreness at the time of examination. The frequency of tooth brushing/cleaning the mouth was not correlated to participants’ mobility (being bed-bound). Age and gender were predictive for DMFT but not education or ASA classification. Gender and ASA classification predicted periodontal status. Conclusion: Oral health was generally poor with pain and discomfort present in a high number of care home residents/attendees. Carers require training in oral health as dental care is a priority for this group.
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Knowledge and attitudes of dentists toward adhesive system selection: A cross-sectional study from Palestine
Naji Ziad Arandi, Mohammad Thabet
January-February 2020, 10(1):107-115
DOI:10.4103/jispcd.JISPCD_385_19  
Aim: The aim of this study was to determine the attitudes and knowledge of dentists in Palestine toward selecting adhesive agents for different clinical procedures and to investigate whether the time of clinical practice influences their choices. Materials and Methods: A questionnaire was randomly sent by e-mail to 500 dentists registered with the Palestinian Dental Association. The questionnaire consisted of nine close-ended questions. The first two questions focused on demographics, whereas the other questions aimed to evaluate the respondents’ knowledge toward selecting adhesive agents for different restorative procedures. Statistical Test Used: Statistical analysis was carried out using the Statistical Package for the Social Sciences software, version 16.0 (IBM, Armonk, New York). Descriptive analysis was obtained and the frequency of distribution was calculated in percentages. Nonparametric chi-square test was used to analyze the difference in the distribution of the preference of different bonding choices overall for every treatment scenario. Fisher’s exact test with the Monte Carlo method was used to verify the association between the adhesive agent of choice and years of experience. Results: The response rate was 74%. The respondents’ choices were significantly different in all suggested treatment procedures (P < 0.05). A correlation was found between time since graduation and the choice of adhesive agent (P < 0.05). Conclusion: Irrespective of restorative treatment scenario, respondents’ selection of adhesive agents diverged from recommendations made by the literature. Further efforts should be made to improve the level of knowledge of general dentists on this topic.
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Accuracy of panoramic radiography for degenerative changes of the temporomandibular joint
Silvio R Oliveira, Rudyard dos Santos Oliveira, Ernesto D Rodrigues, José Luiz C Junqueira, Francine K Panzarella
January-February 2020, 10(1):96-100
DOI:10.4103/jispcd.JISPCD_411_19  
Background: Temporomandibular joint (TMJ) morphologies are complex, and changes in joint components have been studied extensively. TMJ conditions have many different etiologies, appearances, and relevant clinical significance. Objective: The objective of this study was to evaluate the concordance of the diagnosis of degenerative changes in the TMJ in panoramic radiographs. Materials and Methods: Cone beam computed tomography (CBCT) was used as a reference standard. Images of 84 patients (168 TMJs), 61 females (72.6%) and 23 males (27.4%) with an average age of 47.4 years, were evaluated by three radiologists who established the presence or absence of degenerative changes in the jaw heads. The data were collected and organized in a spreadsheet. Concordance between evaluators was analyzed using agreement percentages, statistical κ, and confidence intervals. In the analysis of compliance with CBCT, sensitivity, specificity, predictive positive and negative values, and probabilities of false positives and negatives were also calculated. All inferential tests were performed with a 5% significance level. Results: The percentage of agreement among raters in panoramic radiographs ranged from 66.7% to 82.9%, considered mild to moderate. Correlation between radiographic and tomographic images ranged from 45.5% to 64.9% in the inter-evaluator reviews, representing a very mild agreement. Sensitivity ranged from 28.6% to 58.7% and specificity from 66.7% to 100.0%. Positive predictive value ranged from 77.1% to 100.0%; the negative predictive value was lower, ranging from 32.2% to 54.8%. The probability of false negatives was higher than that of false positives, ranging from 45.2% to 67.8%. Conclusion: The rater did not reach acceptable diagnosis levels.
  263 46 -
Parental Preference for Parental Separation and Their Satisfaction Regarding Their Children Dental Treatment in Pediatric Dental Clinics in Saudi Arabia
Heba J Sabbagh, Ohoud T Sijini
January-February 2020, 10(1):116-123
DOI:10.4103/jispcd.JISPCD_280_19  
Aims and Objectives: Behavior management of child dental patients is essential for the provision of high-quality dental care and is influenced by parental preference. Therefore, this cross-sectional study aimed to assess parental satisfaction regarding dental treatment and different behavior management methods used with their children in a pediatric dental specialty setting at King Abdulaziz University Dental Hospital (KAUDH) in Jeddah, Saudi Arabia. In addition, it aimed to assess parental preference for parental separation and factors related to their preference. Materials and Methods: All parents of children attending the pediatric dental clinic at KAUDH in Jeddah, Saudi Arabia from September 2017 to June 2018 were included in this study. They were interviewed over the phone and were asked to complete a questionnaire on their acceptance of the behavior management techniques used with their children and their satisfaction with the treatment provided. Results: Of 549 parents, 283 agreed to participate (51.5% response rate). In 254 (89.7%) cases communication and communicative guidance were used, whereas 38 (13.4%) cases involved the use of N2O. Parental separation was preferred by 68 (24%) parents, and not preferred by 215 (76%). No significant relation was anticipated between the covariance and the dependent factor of parental preference (P > 0.05). The main reason for parents not preferring parental separation was “safety and protection,” as reported by 106 parents. On the contrary, the main reason for parental preference for separation was to “improve child’s behavior.”Conclusion: Parental satisfaction with the treatment outcome and behavior management methods was found to be acceptable. Most parents did not prefer parental separation, primarily because of concerns regarding safety and protection.
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