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OBJECTIVE: To investigate the prevalence of key endodontic pathogens and their association with the clinical features and the cause of apical periodontitis. METHODS: The study population included patients referred to Khartoum Dental teaching Hospital, Sudan for endodontic treatment. Samples were collected from single-rooted teeth carious or traumatised teeth with clinical and radiographic evidence of apical periodontitis. The endodontic pathogens Porphyromonas endodontalis, Fusobacterium nucleatum and Treponema denticola were quantified by real time polymerase chain reaction (qPCR). The prevalence of each species was identified at both a low detection threshold (>50 bacteria) and a high detection threshold (>1000 bacteria). RESULTS: 75 patients (mean age 30.1 yrs SD 10.1) were included in the analysis. The most prevalent bacterium at both the low and high threshold was F. nucleatum followed by T. denticola at the low threshold and P. endodontalis at the high threshold. There was no association with symptoms at the low detection threshold, but at high threshold P. endodontalis was associated with swelling, adjusted odds ratio (OR), 9.32 95%CI 1.11- 78.66, P=0.04. All species were more prevalent in apical periodontitis due to caries only at the low detection threshold, OR=5.01 (P=0.006) for T. denticola; 4.84 (P=0.01) for F. nucleatum; and 3.62 (P=0.03) for P. endodontalis. CONCLUSION: There was a high prevalence of the F. nucleatum, T. denticola and P. endodontalis in apical periodontitis associated with caries. None of these bacterial were associated with pain but the presence of P. endodontalis at high levels was associated with swelling.

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Water scarcity and frequent drought spells are becoming critical challenges to sustainable agricultural development, especially in arid and semiarid regions. Thus, this work aims to investigate the effect of deficit irrigation and varying mulching materials on soil moisture content, salt distribution, and potato yield. The experiment consisted of three irrigation regimes (I100%, I80%, and I60%) of crop evapotranspiration (ETc), designated as I100%, I80%, and I60% of ETc, and five mulching treatments viz. (i) without mulch (WM), (ii) poultry manure mulch (PMM), (iii) rice straw mulch (RSM), (iv) white plastic mulch (WPM), and (v) black plastic mulch (BPM), which were continued for two consecutive growing seasons. The results showed that soil salinity was affected by mulching and irrigation levels as the salt content increased from the initial soil salinity. Moreover, I60% recorded the highest salt accumulation in the soil profile for WM treatment compared to the rest of the irrigation and mulching treatments. It was also revealed that PMM remained unmatched by significantly producing the highest potato yield compared to other mulching materials. However, the average potato yield decreased by 13.83% and 29.16% in the 2016 season for I80% and I60% and by 12.95% and 30.91% in the 2017 season, respectively, in comparison to full irrigation (I100%). So, when sufficient irrigation water is available, full irrigation (I100%) and PMM treatment are recommended to achieve the maximum potato tuber yield, which has a minimum impact on increasing salinity. However, when the discharge is insufficient, deficit irrigation (I80%) and PMM treatment are recommended to conserve 20% of the irrigation water applied with a minimum reduction in tuber yield and a slight increase in soil salinity.

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OBJECTIVE: To evaluate the effects of the patient-dentist relationship on dental anxiety among young adult Sudanese patients. MATERIALS AND METHODS: In this cross-sectional study, 864 patients attending outpatient dental clinics of the governmental dental hospitals in Khartoum, Sudan were recruited; 51.2% were males and 48.8% were females, with an age range of 18-24 years. The questionnaire used evaluated the socio-demographics, education levels, economic status, patient experience, and also included the Dental Anxiety Scale, Corah (J Dent Res 1969 48: 596). RESULTS: High dental anxiety was reported by 22.2%, 29.5% reported moderate dental anxiety, and 48.3% reported low or no dental anxiety. There were statistically significant associations between dental anxiety and gender, time lapse since the previous dental visit (P < 0.004) and the reason for the previous visit (P < 0.001). In addition, the dental clinic environment (P < 0.002), the time waiting before seeing the dentist (P < 0.001) and the overhearing of pain expressed by other patients (P < 0.001) were also statistically significant. Negative comments by the treating dentist also had a statistically significant impact (P < 0.032). In contrast, a clear explanation of related dental care (P < 0.008), as well as the allowance of adequate time to discuss oral health (P < 0.006), had significantly positive effects. CONCLUSION: The study showed that the patient-dentist relationship had a significant association with dental anxiety, and may be an important target for improving the delivery and standards of oral health in dentally anxious patients in this region.

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This study aimed to evaluate the secondary outcomes of gender and arch and their impact on pain reduction following initial endodontic therapy. 185 medications, including placebo were prepared, and 170 participants completed the trial. Group 1, received a single dose of Paracetamol alone (G-1), Group 2 received combined Ibuprofen/Paracetamol (G-2). Group 3 received combined Mefenamic acid/Paracetamol (G-3), group 4 received combined Diclofenac K/Paracetamol (G-4) and Group 5 received a placebo (G-5). There were no statistically significant differences in pain reduction between males and females whilst there were statistically significant differences between them and the placebo group. All combinations of Paracetamol performed better in pain reduction than the placebo among females, while there were no statistically significant differences among males. In conclusion, there were no differences in pain reduction between males and females, and arch for the tested analgesics taken immediately following initial endodontic therapy in teeth with irreversible pulpitis.

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BACKGROUND: Fixed orthodontic appliances render teeth cleaning arduous, thus when orthodontic treatment is associated with inadequate oral hygiene practice, development of white spot lesions (WSLs) imposes a significant risk on the dentition. Salivary reservoir of calcium, magnesium, phosphorous and fluoride counteracts demineralization and encourages remineralization providing protection against caries challenge. The investigation of the factors leading to WSLs' development is mandatory for appropriate prevention strategies planning. The present study aimed at evaluating the prevalence, pattern of distribution and contributing factors to WSLs' development, among orthodontic patients attending orthodontic departments in teaching institutes in Khartoum. METHODS: This cross-sectional descriptive, analytical clinical based study was carried out among fixed orthodontic patients attending teaching institutes in Khartoum State. All patients visiting the clinics for their follow up during a 3 months period and fulfilling the inclusion criteria were included. The International Caries Detection and Assessment System (ICDAS) served as a guide for standardized visual caries assessment. Saliva samples were collected from a sample of patients and the levels of calcium and phosphorus were measured. Patients were interviewed regarding their oral hygiene habits (frequency of tooth brushing, use of interdental brushes and mouth washes). Frequency distribution tables as well as graphs, Pearson's correlations and Spearman's correlation were used in the statistical analysis. RESULTS: The overall prevalence of WSLs was 61.4%. The prevalence for each tooth was: 48.1% in the canine, 32.3% in the lateral incisor, 31.6% in both the central incisor and the first premolar, 27.2% in the second premolar and 8.9% in the first molar. No significant relationship between WSLs prevalence, age and gender or oral hygiene measures was found. There was no significant difference in calcium and phosphorus level between participants with WSLs or those with sound teeth (p-values for calcium and phosphorus were 0.154 and 0.567 respectively). CONCLUSIONS: Within the limitations of this study it was found that WSLs among fixed orthodontic patients represented an issue of concern. High prevalence of WSLs was recorded among orthodontic patients in Sudan, indicating a need for more stringent prevention programmes and oral hygiene practices prior to initiation of orthodontic treatment.

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INTRODUCTION: The present clinical trial aimed to evaluate the efficiency of paracetamol alone and in combination with 3 different nonsteroidal anti-inflammatory drugs for control of post-endodontic pain. METHODS: The inclusion criteria were moderate to severe pain of irreversible pulpitis, by using the Verbal Rating Scale and a 4-10 score on the Numerical Rating Scale, on anterior or premolar teeth, as well as the absence of signs and symptoms of apical periodontitis. One hundred eighty-five trial medications with placebo were prepared, and 170 participants completed the trial. There were 5 groups. P-group received 4 gelatinous capsules of a single dose of paracetamol alone. The IP-group received similar capsules of a single dose of combined ibuprofen/paracetamol. MP-group received combined mefenamic acid/paracetamol, and DP-group received combined diclofenac K/paracetamol. A Plb-group received doubled gelatinous capsules with no medications as a single dose, which had the same weight and appearance as the medicated capsules, to be the placebo. RESULTS: Pain intensity was measured after initial endodontic therapy and instrumentation by using the Verbal Rating Scale and Numerical Rating Scale. IP-group (ibuprofen/paracetamol) had the most pain reduction, followed by DP-group (combined diclofenac K/paracetamol), then MP-group, followed by P-group, whereas Plb-group had the least pain reduction (P < .05). CONCLUSIONS: The combination of ibuprofen/paracetamol, taken immediately after initial endodontic therapy and root canal preparation in teeth with irreversible pulpitis, reduced post-endodontic pain (ClinicalTrials.gov no.: NCT02417337).

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OBJECTIVES: The aims of this study were to evaluate patient satisfaction with fixed prosthesis following placement and to assess the oral health and oral hygiene practices awareness by survey questionnaire. MATERIALS AND METHODS: One hundred and ninety-two questionnaires were filled by patients wearing fixed prosthesis; the questionnaire included the subjective perception of treatment with fixed prosthesis, patients' perception of clinical outcome, regarding esthetics, masticatory function, speech, and together patient's attitude toward oral hygiene measures. RESULTS: Results showed that 84% of the patients were satisfied with their fixed prosthesis, while only 46.4% of patients were satisfied with the chewing ability. In concern, with esthetic outcome, 80% of patients showed that they were satisfied with the esthetic. The results showed that a high significantly number of patients did not use any form of interdental aids' to clean their fixed prosthesis (94%). The main reason for not using any dental aids' (91.1%) was a lack of post fixed prosthodontics instructions and not been informed by the dentist. CONCLUSION: High percentages of patients were satisfied with their fixed prosthesis. The most important finding of this study was that majority of patients showed a lack of knowledge regarding post fixed prosthodontics instructions and the significance of maintenance of fixed prosthesis using dental aids'. Of particular concern was the majority of dentists did not pay attention to the post treatment instructions concerning the maintenance of fixed prosthesis.

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OBJECTIVE: The aim of the present investigation is to identify tooth shade among a group of Sudanese patients. MATERIALS AND METHODS: Total number of patients was 227. Participant's age ranged from 15 to 72 years, which, was divided into four groups. The tooth included in the study was either right or left sounds maxillary central incisor. Vita Easyshade was used to select the tooth shade. Investigation of the differences of Commission International de l'Eclairage (CIELab) coordinates among gender and state of origin was conducted together with an examination of the relationship between CIELab coordinates and age. One-way analysis of variance was used to test the differences in L*, a* and b* according to state of origin. RESULTS: Results showed that A3 was the most common classical tooth shade respectively. There was highly significant difference in L* between males and females (P = 0.002). There was a significant relation between tooth shade and age (P = 0.026). There was a high significant association between classical tooth shade and Sudan regions (P = 0.00). CONCLUSION: In conclusion, most common classical shade was A3, women's teeth were lighter than men's. There was a relation between ethnic background and tooth shade.

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Purpose. There are limited data about the gingival health status in Yemeni children. The aim, therefore, was to assess oral hygiene status and prevalence and severity of gingivitis among Yemeni preschool and school children. Materials and Methods. A total of 5396 children were included from 5 representative Yemeni governorates: Sana'a, Hajjah, Hodeida, Hadramaut, and Taiz. Five-year olds (1292) were recruited from private kindergartens while 12-year olds (4104) were selected from public primary schools. Gingival health status was assessed using the plaque index (PI), calculus index (CAI), and gingival index (GI) on the 6 Ramfjord teeth. The latter index was used to categorize gingivitis severity at the subject level. Data were analyzed using simple hypothesis testing, as well as ordinal regression. Results. The 12-year old children had significantly much higher mean PI, CAI, and GI (P < 0.001) with 78.6% presenting with gingivitis and 47.8% with moderate gingivitis. In contrast, the figures were 27.2% and 3.1% in the younger group (P < 0.001). There were significant variations according to gender, area of residence, and governorate. Regression analysis revealed that mean PI (OR = 35), mean CAI (OR = 7.7), male gender (OR = 1.6), living in rural areas (OR = 1.4), and being from Hajjah or Sana'a were independent risk factors of gingivitis severity in the older group. For the 5-year olds, the determinants were mean PI (OR = 122), male gender (OR = 1.4), and living in Sana'a or Taiz. Conclusions. Bad oral hygiene and moderate gingivitis are highly prevalent among Yemeni preschool and school children. Geographical location appeared as important independent risk factors of gingival inflammation.

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The aim of the present study was to evaluate the quality of root canal treatment performed by undergraduate dental students at the University of Khartoum. Assessment was by examination of periapical radiographs of completed endodontically treated teeth, performed by undergraduate dental students. A total of 166 postoperative periapical radiographs compromising 265 roots were included. The quality of endodontic treatment was examined in relation to the length of the root filling in relation to the radiographic apex, the density of the obturation according to presence of voids and the taper of root canal fillings. Adequate length of the root filling was found in 34.7% of the maxillary teeth and in 10.9% of mandibular teeth in this study. Adequate density was found in 38.87% of maxillary and 16.98% of mandibular teeth and appropriate taper was found in 40% of maxillary and 16.6% of mandibular teeth. Overall 24.2% in all evaluated teeth were found to have a root filling of an acceptable quality. This result may be because of insufficient preclinical endodontic training of the students' operators or because of the introduction of students to endodontic clinical practice late in their program.

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INTRODUCTION: The purpose of this in vitro study was to evaluate the sealing ability of the readymade temporary filling and hand mixed materials by assessing coronal microleakage. MATERIALS AND METHODS: Standardized access cavities were prepared in 80 intact human permanent premolar teeth. They were divided randomly into four experimental groups (n=20). The teeth were restored using one of the temporary materials including Cavisol, Litrak, Zinc phosphate cement, Zinconol (IRM). Thermocycling was applied on the specimens. Methylene blue dye was applied and penetration was evaluated under stereomicroscope. Grading of the microleakage pattern was from 1 to 3, with 3 providing the best seal. Results were analyzed using one-way ANOVA test (P<0.05). RESULTS: Microleakage of Cavisol and Litrak samples achieved grade 3; whereas zinc phosphate cement and Zinconol samples absorbed the dye into the bulk of the materials. Cavisol was found to exhibit the best seal amongst the four tested materials followed by Litrak, zinc phosphate cement, and Zinconol. There was a statistically significant difference in the microleakage scores obtained between the materials (P<0.01). CONCLUSION: Among the four materials tested, readymade temporary filling provided the best sealing ability over hand-mixed. This study emphasizes the importance of correct placement and sufficient thickness of temporary filling materials in endodontic access cavities to ensure a tight seal.

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INTRODUCTION: The purpose of the present study was to evaluate postoperative pain after root canal treatment at the Department of Conservative Dentistry, Faculty of Dentistry, University of Khartoum, Sudan. METHODS: Two hundred thirty-four patients were included in this study; age range was 18-62 years. Conventional endodontic treatment was carried out in the included teeth by the undergraduate dental students in a single visit or multiple visits. The chemomechanical preparation of root canals was done by a modified double-flared technique with combination of hand instruments. Postoperative pain was recorded by each patient by using visual analogue scale in well-defined categories at 2 time intervals, 12 hours and 24 hours. RESULTS: Data were analyzed with the chi(2) test. The overall incidence of postoperative pain was 9.0% after 12 hours and 24 hours. Postoperative pain developed in 15.9% of the patients with history of preoperative pain, whereas 7.1% had postoperative pain among those without history of preoperative pain. There was no significant difference in postoperative pain between single-visit and multiple-visit root canal treatment (RCT). CONCLUSIONS: Within the limitations of the present study there was a low incidence of postoperative pain after conventional RCT. No significant difference exists in postoperative pain after single-visit or multiple-visit RCT.

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INTRODUCTION: The aim of the present study was to compare hand stainless steel K-files and Nickel-Titanium Profile 0.04 taper 29 series rotary instruments for their efficiency, procedural errors and time consumed in preparation of root canal system. MATERIALS AND METHODS: A total of 46 maxillary and mandibular first premolars extracted for orthodontic purposes were collected (two contralateral teeth from each individual). The samples were divided into two groups of 34 canals each. Teeth in the first group were prepared with stainless steel hand K-files while the second groups were prepared with profile 0.04 taper series 29 rotary files. Preparation period was recorded for both groups. Impression material was introduced into the prepared canals so that the replica of prepared canals was achieved. These were assessed under stereomicroscope to assess the efficiency in preparing canals in respect to canal smoothness, ability of impression material to flow and quality of taper.Statistical analyses were performed using t-test, Chi-square and Fishers exact tests. RESULTS: RESULTS showed significantly shorter preparation time for Profile than K-file. 8.8% of the canals prepared with K-files showed canal blockage, while all canals prepared with Profile remained patent. Alterations in working length working distance appeared in 23.5% of canals prepared with K-file and 11.7% in canals prepared with Profile. Failed instruments in K-files were significantly higher, mostly deformation (P<0.001). Profiles failed instruments were in the form of fracture and no deformation was detected. Both systems showed unsatisfactory walls smoothness and flow. CONCLUSION: Within the limitation of this study it was concluded that Profile 0.04 taper series 29 rotary systems prepare canals more rapidly, and have lower incidences of fracture and blockages, and only limited loss of working length. Canal preparation with K-file was time consuming and showed higher incidence of deformed instruments; overall, rotary instruments seem to offer greater advantages.