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Objective: This systematic review was aimed to assess the prevalence of apical periodontitis (AP) in Saudi Arabia, focusing on individual-level prevalence and the frequency of AP in endodontically versus untreated teeth. Methods: This review followed the PRISMA guidelines and involved searches in several databases, including PubMed-MEDLINE, Cochrane-CENTRAL, and EMBASE, without date restrictions until August 19th, 2023. Eligibility criteria encompassed studies using CBCT, panoramic, and periapical radiographs to diagnose AP in the Saudi population. The meta-analysis employed a random-effects model due to high heterogeneity among studies. Results: From 359 records, 13 studies were included, indicating a 40% prevalence of AP in individuals and a 6% prevalence across all teeth within the Saudi population. Root canal-treated teeth demonstrated a higher prevalence at 47%. The data revealed a substantial prevalence of AP compared to global averages, with first molars being the most affected. Studies showed moderate risk of bias and significant heterogeneity. Conclusion: The high occurrence of AP in Saudi Arabia, particularly in root-treated teeth, emphasizes the need for enhanced endodontic care and more accurate diagnostics. Urgent improvements in dental health policies and further research are essential to understand AP's impact and improve oral health outcomes.

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Objective: The aim of this systematic review was to assess the prevalence of periodontal disease among Saudi Arabian adults based on studies conducted from 1992 to 2023. Methods: The study protocol was registered in PROSPERO. Three databases (MEDLINE, EMBASE and Cochrane library) and the Saudi Dental Journal were searched for published literature up to June 2023 using prespecified search strategy. Quality of included studies was checked using the risk of bias in population-based prevalence studies tool. Results: The systematic review included 15 studies that assessed the prevalence of periodontal disease in Saudi Arabia. Most of the studies used non-confident case definitions. The pooled estimate of periodontal disease prevalence in Saudi Arabia based on the data of 14 which included 6,596 individuals is 51% (95% CI: 35.99, 73.05). Conclusion: Periodontal disease is a significant public health issue in Saudi Arabia, with a substantial prevalence among the included participants. Nevertheless, the existing studies exhibit methodological disparities and regional limitations. Therefore, while the results shed light on the pressing nature of periodontal disease in Saudi Arabia, further comprehensive research is imperative. A more accurate estimate, coupled with effective strategies, can be achieved through broader, multidisciplinary collaborations and the prioritization of a national oral health survey in Saudi Arabia.

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OBJECTIVES: To examine socioeconomic and ethnic variations in the provision of health advice by dental professionals. METHODS: Data were from the National Health and Examination Survey (NHANES) (2015-2018). Socioeconomic position (Poverty-income ratio and education) and ethnicity were the main exposures. The outcome variable of interest was whether participants received health advice regarding the "benefits of quitting cigarettes," "benefits of monitoring blood sugar levels," and "importance of oral cancer screening". Logistic regression analysis was used to examine the relationship between socioeconomic factors/ethnicity, and health advice after adjusting for covariates. RESULTS: The analysis included a total of 5524 people aged eighteen and above who had complete data. Black and Hispanic individuals had higher odds of receiving advice on smoking (OR = 1.49, 95% CI: 1.04-2.12 and OR = 1.48, 95% CI: 1.05-2.07, respectively) and glucose monitoring (OR = 3.00, 95% CI: 2.03-4.43 and OR = 3.14, 95% CI: 2.04-4.82, respectively), but no significant difference for cancer screening advice.Higher poverty-income ratios (PIR) were associated with lower odds of receiving smoking advice (OR = 0.91, 95% CI: 0.84-0.98), but no significant associations were observed for glucose monitoring or cancer screening advice. The study's findings reveal a social gradient in the provision of cancer advice, with individuals having higher education levels, particularly university education (OR = 1.69, 95% CI: 1.24-2.31), showing significantly higher odds of receiving cancer screening advice CONCLUSION: The study highlights significant variations in health advice provision in dental settings, with education level, ethnicity, and smoking status playing prominent roles, emphasizing the need for targeted interventions to promote equity and cultural competence in delivering health advice in dental settings. PRACTICE IMPLICATION: The results emphasize the importance of strong policies and ongoing education for dental professionals to ensure optimal treatment and prevention.

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OBJECTIVE: This cross-sectional study aimed to investigate the association between electronic health (eHealth) literacy and oral health outcomes, including the number of teeth and brushing frequency. METHODS: A total of 478 participants were included in the study and assessed for their eHealth literacy levels. Demographic variables, including age, gender, income, and education, were collected. The participants' number of teeth and brushing frequency were also recorded. Multiple regression analyses were performed to examine the relationship between eHealth literacy and oral health outcomes, adjusting for sociodemographic variables. RESULTS: The study sample consisted of both males (66.5%) and females (33.5%), with a mean age of 31.95 years. Among the participants, 16.95% were classified as having inadequate eHealth literacy, 24.06% had problematic eHealth literacy, and the majority (59.00%) demonstrated sufficient eHealth literacy. There was a significant association between eHealth literacy and oral health outcomes. Individuals with problematic eHealth literacy had a higher likelihood of having a greater number of teeth (RR = 1.12, 95% CI: 1.05-1.20, p < 0.001) compared to those with inadequate eHealth literacy. Similarly, individuals with sufficient eHealth literacy showed a higher likelihood of having more teeth (RR = 1.14, 95% CI: 1.07-1.21, p < 0.001) compared to the inadequate eHealth literacy group controlling for age, gender, income, and education. Individuals with problematic eHealth literacy exhibited a tendency towards lower odds of irregular brushing (OR = 0.39, 95% CI: 0.15-1.02, p = 0.054), although this result was marginally significant. In contrast, individuals with sufficient eHealth literacy had significantly lower odds of irregular brushing frequency (OR = 0.24, 95% CI: 0.10-0.62, p = 0.003) compared to the inadequate eHealth literacy group. CONCLUSION: The findings suggest a positive association between eHealth literacy and oral health outcomes. Improving eHealth literacy may have implications for promoting better oral health behaviors and outcomes.

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INTRODUCTION: Frailty is a syndrome characterised by decline in functional ability and increasing vulnerability to disease and associated with adverse outcomes. Several established methods exist for assessing frailty. This scoping review aims to characterise the development and validation of frailty indices based on laboratory test results (FI-Lab) and to assess their utility. METHODS: Studies were included in the review if they included data concerning the development and/or testing an FI-Lab using the deficit accumulation method. Studies were identified using PubMed/MEDLINE, Embase (Elsevier), OpenGrey and Google Scholar from 2010 to 2021. Two reviewers independently screened all abstracts, and those that met the inclusion criteria were reviewed in detail. Data extracted included details about the study characteristics, number, type and coding of laboratory variables included, validation, and outcomes. A narrative synthesis of the available evidence was adopted. RESULTS: The search yielded 915 articles, of which 29 studies were included. In general, 89% of studies were conducted after 2016 and 51% in a hospital-based setting. The number of variables included in FI-Labs ranged from 13 to 77, and 51% included some non-laboratory variables in their indices, with pulse and blood pressure being the most frequent. The validity of FI-Lab was demonstrated through change with age, correlation with established frailty indices and association with adverse health outcomes. The most frequent outcome studied was mortality (79% of the studies), with FI-Lab associated with increased mortality in all but one. Other outcomes studied included self-reported health, institutionalisation, and activities of daily living. The effect of combining the FI-Lab with a non-laboratory-based FI was assessed in 7 studies with a marginal increase in predictive ability. CONCLUSION: Frailty indices constructed based on the assessment of laboratory variables, appear to be a valid measure of frailty and robust to the choice of variables included.

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Aim: The Parents' view to the oral health of their children is a significant factor that can impact oral health practices and behaviors. The aim of this research was to investigate how parental assessment of their child's oral health associates with caries experience in children receiving dental treatment at the hospital of Taibah University Dental College. Materials and Methods: This cross-sectional study enrolled 127 children who underwent dental treatment at Taibah University Dental College and Hospital during 2020-2021. Dental caries experience was assessed using the dmft/DMFT index, and parental rating of oral health was obtained through a questionnaire. Three logistic regression models were used to assess the correlation between dental caries experience and parental rating of oral health while controlling for sociodemographic and behavioral factors. Results: Most parents rated the oral health of their child as good (60.4%), followed by excellent (18.8%) and very good (15.6%). The mean dmft/DMFT score was 3.47 ± 3.46, with 43.8% of children having high/very high dental caries experience. Logistic regression analysis showed that children whose parents rated their oral health as poor were more likely to have high/very high dental caries experience compared to those rated as excellent/very good/good/fair (adjusted odds ratio = 4.45, 95% confidence interval 1.23-16.07). Conclusion: This study suggests a link between parental assessment of their child's oral health and an elevated prevalence of dental caries in children. The study found that children whose parents rated their oral health as suboptimal had higher odds of having high dental caries experience. These findings emphasize the significance of parental perception of their child's oral health and suggest a necessity for customized interventions to enhance parental knowledge and practices concerning children's oral health.

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PURPOSE/OBJECTIVE: This study aimed to identify factors that were associated with high burnout and investigate the prevalence of burnout among academic dental staff during the COVID-19 pandemic. METHOD: A cross-sectional online survey was carried out among academic dentists who are working in multiple dental schools in Arab countries. The Copenhagen Burnout Inventory was used to assess participants' work-related burnout. Logistic regression was used to assess the factors that increase the risk of burnout among academic dentists. RESULTS: Of the 254 participants who took part in the study, 141 were males (55.5%). The average age of the participants in the study was 42.1 years (standard deviation = 10.0). The prevalence of burnout among participants was 44.9% (n = 114). Using a fully adjusted logistic regression model, age (odds ratio [OR] = 1.05, 95% confidence interval [CI]: 1.01-1.09, p = 0.008) and gender (OR = 0.54, 95% CI: 0.31-0.94, p = 0.03) were significant variables associated with high overall burnout. Female individuals had a substantially reduced risk of experiencing high personal burnout than male participants (OR = 0.56, 95% CI: 0.32-0.98, p = 0.043) in the personal burnout subdomain. While in the patient's burnout subdomain, age (OR = 1.04, 95% CI: 1.00-1.08, p = 0.048), type of speciality (OR = 2.44, 95% CI: 1.02-5.83, p = 0.044), and teaching place (OR = 2.49, 95% CI: 1.21-5.11, p = 0.013) were associated with higher burnout. CONCLUSION: This study concluded that gender and age are characteristics that increase the risk of higher burnout among academic dentists during the COVID-19 pandemic.

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OBJECTIVE: Many studies have been conducted to understand the association between e-cigarette use and different periodontal parameters, but the effect of conventional smoking in explaining this association remain to be elucidated. This study aimed to assess the association between e-cigarettes and self-reported periodontal disease, and whether smoking status explains this association. METHODS: This cross-sectional study was based on secondary data analysis of 8,129 participants of the National Health and Nutrition Survey (NHANES) 2015 -2018. E-cigarette use and smoking status were collected through questionnaires. Self-reported periodontal diseases and bone loss were derived from the 8-item CDC/AAP questionnaire. The associations between e-cigarette use and self-reported periodontal diseases were tested in logistic regression models adjusting for demographic factors, socioeconomic indicators, smoking status, diabetes and dental visits. Additionally, to test the effect of smoking on the relationship, three fully adjusted logistic regression models stratified by smoking status were constructed. RESULTS: E-cigarettes ever users and current users had higher odds of self-reported periodontal disease (OR = 1.43, 95% CI: 1.18, 1.73) and bone loss (OR = 1.80, 95% CI: 1.30, 2.49) respectively compared to non-users after adjusting for smoking and potential confounders. In the regression models stratified by smoking status, e-cigarette was only significantly associated with self-reported periodontal disease variables among current smokers, but not among previous or never smokers. CONCLUSION: E-cigarette use is associated with self-reported periodontal disease. However, smoking status appears to explain the relationship between e-cigarette use and periodontal disease. CLINICAL SIGNIFICANCE: This population-based cross-sectional study shows that e-cigarette use is associated with self-reported periodontal disease. Smoking status appears to explain the association. Dental professionals should consider the effect of conventional smoking and comprehend the risks of e-cigarette on oral health and its benefits when used as a smoking cessation aid.

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Aim: To investigate factors determining the need for general anesthesia (GA) to deliver dental treatment for adult people with intellectual and developmental disabilities (IDD). Methods: This study involved a retrospective review of medical records of adult patients with IDD who received dental treatment under GA at Tabuk Specialist Dental Center, Saudi Arabia, between 2018 and 2020. Demographic characteristics and dental-related details, level of cooperation, and methods of delivering dental treatment were collected. Results: A total of 86 adult patients with IDD were included. The mean age of the study participants was 34.8 years (standard deviation [SD] 6.5), and the majority were males (n = 47, 54.7%). Eighteen patients had aphasia (20.9%), 16 had epilepsy (18.6%), and 10 had cerebral palsy (11.6%). Most dental treatments delivered were complex dental treatments (n = 39, 45.3%) followed by dental extraction (n = 25, 29.1%), and non-surgical periodontal therapy (n = 22, 25.5%). Females had higher odds of undergoing GA compared to males (Odds ratio (OR) =6.79, 95% Confidence intervals (CI): 1.62-28.41). Furthermore, patients who had aphasia had higher odds of undergoing GA compared to patients who had no medical conditions (OR = 14.03, 95% CI: 1.05-186.7). Conclusion: Being female or having aphasia are independent factors related to the need for GA to deliver dental treatment for Saudi adults with IDD.

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Background: The COVID-19 pandemic has placed an enormous strain on global health. Due to precautionary measures, the epidemiology of health conditions may have been affected. Saudi Arabia imposed a lockdown order on March 25, 2020. This study investigated the impact of the pandemic lockdown on injuries in a level-I trauma center in King Abdulaziz Medical City, Riyadh, Saudi Arabia. Methods: This retrospective study identified all injured patients seeking emergency care during the lockdown period (March 25-June 21, 2020) and a similar period in two previous year (March 25-June 21) 2018 and 2019. The collected data included patients' demographics, injury types, mechanisms, and health outcomes. Results: Two hundred sixty nine injured patients sought emergency care during the lockdown, while 626 and 696 patients were treated in the same period of 2018 and 2019, respectively. There was a significant reduction in motor vehicle crashes (OR: 0.47; 95% CI: 0.31-0.73) and burns (OR: 0.24; 95% CI: 0.08-0.66), coupled with a significant increase in assault injuries (OR: 2.20; 95% CI: 1.30-3.74) in the lockdown period compared to 2019. Apart from the intensive care unit (ICU) admission and hospital length of stay, there were no differences between the two periods in the health outcomes. ICU admission was significantly reduced by 57% during the lockdown period (OR: 0.43; 95% CI: 0.22-0.83). Mechanisms of injuries were not significant predictors of deaths or ICU admission or both in the lockdown period. Conclusion: The COVID-19 lockdown had a clear impact on the volume and mechanisms of injuries. The findings highlight that injury risk factors are modifiable and emphasize the importance of public health measures for preventing injuries and the significance of maintaining trauma services capacity during pandemics.

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OBJECTIVE: We examined the association between tooth loss, periodontal diseases, and frailty among older American adults. DESIGNS, SETTINGS, AND PARTICIPANTS: Data from the National Health and Nutrition Examination Surveys (NHANES) 2011-2014 was used. We included 2368 community-dwelling adults aged 60 years and older. Frailty was measured with the 49-item frailty index. Oral health indicators included number of teeth and periodontal disease. A composite nutritional intake variable based on 13 micronutrients from the dietary assessment was created. Negative binomial regression was used to test the association between oral health and frailty. The first model was adjusted for age and gender, the second model was additionally adjusted for nutritional intake, and the third model was additionally adjusted for other covariates. RESULTS: For each additional tooth, the rate ratio (RR) for frailty was 0.99 [95% confidence interval (CI) 0.98-0.99] in the fully adjusted model. Similarly, participants with moderate-severe periodontitis had 1.08 RR (95% CI 1.02-1.14) for frailty index compared with participants with no periodontitis after adjusting for age, gender, and poor nutritional intake. The association lost significance in the fully adjusted model. CONCLUSIONS AND IMPLICATIONS: Oral health is associated with the frailty index, and nutritional intake appears to have a modest effect on the association. Periodontal disease has a weaker association with frailty compared with number of teeth. The findings highlight the importance of maintaining good oral health at older age and incorporating oral health indicators in routine geriatric assessments. Future research should investigate the role of potential mediating factors in this association.

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OBJECTIVE: To assess the association between self-rated oral health and frailty index among older American adults aged 60 years and over. MATERIALS AND METHODS: Data from the National Health and Nutrition and Examination Survey from 2011 to 2014 were used. Self-rated oral health was assessed based on a single question "rate the health of your teeth and gum". A frailty index of 49-items covering multiple systems was created. Age, gender, ethnicity, poverty-income ratio, education, poor nutritional intake and smoking were used as covariates. Weighted negative binomial regression was used to test the association between self-rated oral health and frailty index adjusting for the covariates. RESULTS: A dose response relationship was observed between self-rated oral health and frailty index. The rate ratios (RR) of frailty index were 1.03 (95% CI 0.95-1.13), 1.15 (95% CI 1.05-1.25), 1.30 (95% CI 1.17-1.45) and 1.41(95% CI 1.28-1.54) for participants who rated their oral health very good, good, fair or poor, respectively, compared with those who rated their oral health excellent after adjusting for covariates. CONCLUSION: Poorer self-rated oral health is associated with higher rates of frailty index. This highlights the importance of oral health as a predictor of frailty and the adequacy of using self-rated oral health in health surveys and clinical practices when conducting a comprehensive clinical oral examination is not feasible.

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Objective: The aim of this research was to assess the association between periodontitis and grip strength among older American adults. METHODS: Data from the National Health and Nutrition Examination Survey 2011/2012 and 2013/2014 were used. Oral health status and hand grip strength were clinically assessed. Three outcome variables were used: (1) handgrip strength <30 kg for men, <20 kg for women; (2) handgrip strength <26 kg for men, <16 kg for women; and (3) mean maximum grip strength. The main exposure was the case definition of periodontitis. Logistic and linear regression models were constructed for grip strength definitions and the mean grip strength, respectively, adjusting for covariates. RESULTS: The study included 1953 participants. The mean age was 68.5 years, and 47.2% were males. The prevalence of low grip strength (<30 kg for men, <20 kg for women) was 7.4% in men and 13.6% in women. Periodontitis was significantly associated with grip strength (OR 1.53, 95% CI: 1.03, 2.27) in the unadjusted model. Periodontitis was also significantly associated with maximum grip strength (Coefficient 1.05, 95% CI -1.99, -0.09) in a model adjusted for age and gender. However, in all the fully adjusted models there was no statistically significant association between periodontitis and grip strength. CONCLUSION: Low grip strength appeared to be more common among persons with moderate/severe periodontitis. The observed association is probably attributed to older age and common risk factors for periodontitis and frailty.

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OBJECTIVE: To systematically review longitudinal studies on the association between oral health and frailty indicated by any validated scale or index. BACKGROUND: Frailty and poor oral health are common among ageing populations; however, evidence from longitudinal studies is scarce. METHODS: Three databases (MEDLINE, EMBASE and LILACS) were searched for published literature up to July 2018 using prespecified search strategy. Grey literature was searched using OpenGrey and Google Scholar. Quality of included studies was checked using the Newcastle-Ottawa Quality Assessment Scale (NOS) for longitudinal studies. RESULTS: Five longitudinal studies from three countries (Mexico, Japan, and UK) that examined the association between oral health and frailty were identified. All studies used Fried's frailty phenotype criteria for measuring frailty. Oral health indicators were number of teeth, periodontal disease, oral functions (functional dentition with occluding pairs and maximum bite force), use of removable dentures, accumulation of oral health problems and dry mouth symptoms. The studies showed significant association of number of teeth (two studies), oral functions (two studies), accumulation of oral health problems and number of dry mouth symptoms with frailty incidence, whereas periodontal disease showed inconsistent associations. CONCLUSION: This systematic review identified significant longitudinal associations between oral health indicators and frailty that highlight the importance of oral health as a predictor of frailty in older age. There is a need for further research exploring the role of nutrition as a mediator of the relationship between oral health and frailty.

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OBJECTIVE: To examine if socioeconomic inequalities exist in periodontal disease among adult with optimal oral health behaviours. MATERIALS AND METHODS: Data were from the Adult Dental Health Survey 2009, a national survey of England, Wales and Northern Ireland. Overall, 4738 participants aged 35 years and older were included in the analysis. Periodontal disease indicated by pocket depth or loss of attachment ≥4 mm, and gingival bleeding were used as periodontal outcomes. Education and deprivation indicated socioeconomic position. Behavioural factors were dental visits, toothbrushing and smoking. The subset of adults with and without optimal health related behaviours included 2916 and 1822 participants, respectively. The associations between periodontal disease and socioeconomic position were tested adjusting for demographic and behavioural factors. Additional models stratifying the sample to those with and without optimal behaviour subgroup were constructed. RESULTS: Education and deprivation were significantly associated with periodontal disease in the partially adjusted models. In the analysis of those with optimal behaviours, only deprivation and highest level of education showed significant association with periodontitis (PD), but not with gingival bleeding. Among those without optimal behaviours, all socioeconomic factors were associated with all outcomes except deprivation and PD. CONCLUSIONS: Oral health behaviours marginally contributed to inequalities in gingival bleeding and periodontal disease. Socioeconomic inequalities were attenuated among those with optimal behaviours and persisted among those without optimal behaviours. Behaviours appeared to be an effect modifier for the relationship between periodontal outcomes and socioeconomic factors.

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