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Prevalence and Risk of Dental Erosion in Patients with Gastroesophageal Reflux Disease: A Meta-Analysis

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Prevalence and Risk of Dental Erosion in Patients with Gastroesophageal Reflux Disease: A Meta-Analysis Oleg O. Yanushevich, Igor V. Maev, Natella I. Krikheli, Dmitrii N. Andreev , Svetlana V. Lyamina , Filipp S. Sokolov, ,Marina N. Bychkova, Petr A. Beliy and Kira Y. Zaslavskaya

Moscow, Russia; correspondence: dna-mit8@mail.ru vs@mail.ru (S.V.L.); ru (P.A.B.);

evalence and risk of GERD) compared to PubMed, EMBASE, searched for studies n dates ranging from ics (the total sample number of patients ontrols (if available)) dies involving 4379 e of DE was 51.524% trols. An association el (OR 5.000, 95% CI: only used validated studies that did not n the presence of DE n: The meta-analysis bout half of patients

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Article

Dental News

Abstract Abstract: Aim: The present paper aims to systematize data concerning the prevalence and risk of dental erosion (DE) in adult patients with gastroesophageal reflux disease (GERD) compared to controls.

Materials and methods: Core electronic databases, i.e., MEDLINE/ PubMed, EMBASE, Cochrane, Google Scholar, and the Russian Science Citation Index (RSCI), were searched for studies assessing the prevalence and risk of DE in adult GERD patients with publication dates ranging from 1 January 1985 to 20 January 2022.

Publications with detailed descriptive statistics (the total sample size of patients with GERD, the total sample size of controls (if available), the number of patients with DE in the sample of GERD patients, the number of patients with DE in the controls (if available)) were selected for the final analysis. Results: The final analysis included 28 studies involving 4379 people (2309 GERD patients and 2070 control subjects). The pooled prevalence of DE was 51.524% (95 CI: 39.742–63.221) in GERD patients and 21.351% (95 CI: 9.234– 36.807) in controls. An association was found between the presence of DE and GERD using the randomeffects model (OR 5.000, 95% CI: 2.995–8.345; I2 = 79.78%) compared with controls. When analyzing studies that only used validated instrumental methods for diagnosing GERD, alongside validated DE criteria (studies that did not specify

the methodologies used were excluded), a significant association between the presence of DE and GERD was revealed (OR 5.586, 95% CI: 2.311–13.503; I2 = 85.14%). I2 Conclusion: The meta-analysis demonstrated that DE is quite often associated with GERD and is observed in about half of patients with this extremely common disease of the upper gastrointestinal tract.

1. Introduction Gastroesophageal reflux disease (GERD) is one of the most common gastrointestinal disorders, which is caused by a dysfunction of the motor-evacuation function of the gastroesophageal zone leading to spontaneous and regularly repeated retrograde reflux of the gastric and duodenal liquids into the esophagus1,2. According to a recent meta-analysis by Nirwan JS et al. in 2020—which summarized the results of 102 studies—the global prevalence of GERD is 13.98% (95% CI: 12.47–15.56) 3.

A characteristic feature of GERD is a chronic, recurrent pattern of symptoms that has a significant negative impact on the patient’s quality of life 2,4. The classic clinical manifestations of the disease are heartburn, belching, and regurgitation; however, in some cases, GERD may be characterized by complex atypical symptoms, also referred to as extraesophageal syndromes5,6.In the largest prospective multicenter cohort Quarter III

Prevalence and Risk of Dental Erosion in Patients with Gastroesophageal Reflux Disease: A Meta-Analysis

study, i.e., ProGERD (n = 6215), atypical symptoms were detected in 32.8% of patients with heartburn7.

According to the global Montreal Consensus (2006), a cough, laryngitis, bronchial asthma, and erosion of dental hard tissues of reflux etiology are extraesophageal syndromes that are significantly associated with GERD 8.

Dental erosion (DE) refers to non-carious lesions of the hard tissues of the tooth (mainly enamel and, in some cases, dentin) that are induced by a chemical reaction involving acids and that lead to demineralization processes independently of a bacterial factor9,10. DE leads to aesthetic defects and, in the case of prolonged progression, dentin exposure and the development of hypersensitivity, which has a negative impact on the quality of life 11,12. According to the latest review, the average global incidence of DE among the adult population is 20–45%13. Moreover, on the epidemiological level, there has been an increase in the frequency of DE in all age groups, which may indicate an increasing influence of risk factors for this pathology in the

population14,15. The genesis of DE is multifactorial and may be related to external acidifying factors (diet and lifestyle) and internal factors (chronic reflux of gastric contents into the oral cavity; recurrent vomiting) (Table 1) 10,13.

GERD is the most common trigger of DE, which is a result of the retrograde reflux of acidic gastric contents into the oral cavity5,6,16–18. According to several early systematic reviews, the incidence of DE in adult GERD patients is 32.5–38.96% 19,20.

Furthermore, various studies have noted that the higher the severity of erosive damage to the hard tissues of the teeth in GERD patients compared to controls6,21. To date, a large number of published studies on the prevalence of DE in patients with GERD have accumulated around the world, requiring systematization to objectify the global prevalence. The present paper aims to systematize data concerning the prevalence and risk of dental erosion (DE) in adult patients with gastroesophageal reflux disease (GERD) compared to controls.

Table 1. Factors leading to the development of DE.

External

Internal

1. Dietary factors: 1. Chronic reflux of gastric contents • carbonated drinks; into the oral cavity: • drinks with low pH (less than 3.5–4); • GERD. • fruit juices; • sour fruits; • ketchup and vinegar; • wine; • vitamin C chewable tablets/wafers.

2. Medications: • acetylsalicylic acid; • preparations of iron.

2. Recurrent vomiting: • bulimia; • chronic alcoholism; • vomiting during pregnancy.

3. Chlorinated pool water 4. Industrial and environmental respirable agents

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Prevalence and Risk of Dental Erosion in Patients with Gastroesophageal Reflux Disease: A Meta-Analysis

Dent. J. 2022, 10, 126 2. Materials and Methods

3 of 11 disagreements were resolved by discussion until reaching a consensus.

2.1. Study Sources and Search which allowed the resulting data to be included in a meta-analysis; studies in the adult A search was carried out in MEDLINE/PubMed, 2.4. Statistical Analysis population of patients with GERD. Studies conducted on specific patient populations EMBASE, Cochrane, Google Scholar, and the Statistical datathe processing was carried out using (diseases and conditions that may affect objectivity and comparability of data) were Russian Science Citation Index (RSCI) for studies the specialized software MedCalc 20.023 (MedCalc excluded from the analysis. In cases of duplicated results in two publications (from published between 1 January 1985 and 20 January Ostend,one Belgium) in Microsoft different or the same Software, electronic database), was selected for the final Windows analysis. The methodological quality each of the included studiesWA, was assessed usingresults the Newcastle– 2022 (inclusive) based on the analysis of titles and 11 of(Microsoft, Redmond, USA). The are Ottawa Scale (NOS). abstracts of entries within these databases.

The presented as the pooled frequency of DE in GERD following keyword combinations were used to patients/controls and a 95% confidence interval 2.3. Data Extraction search the MEDLINE/PubMed database: “dental (95% CI). Heterogeneity between different studies Two investigators (D.N.A. and F.S.S.) independently extracted data using standardized erosion [Title/Abstract] OR dental erosions was assessed Cochrane’s Q testGERD, and criteria I2 test.for forms. The[Title/ year of publication, country,using methodology for diagnosing Significant heterogeneity was noted for results at p Abstract] OR acid erosions [Title/Abstract] OR diagnosing DE, the total sample size of patients with GERD, the total sample size of controls 2 < 0.05 and I > 50.

The probability of a publication erosive toothwear [Title/Abstract](if available), AND reflux the number of patients with DE in the sample of patients with GERD, and the number of patients with DE in the sample of controls (if available) were analyzed.

Any was estimated by constructing a funnel plot [Title/Abstract]”. The corresponding terms in error disagreements were resolved by discussionaccording until reachingto a consensus. and calculations the Begg–Mazumdar English were used for searching in the Google Scholar and RSCI database. 2.4. Statistical Analysiscorrelation test and Egger’s test.

Statistical data processing was carried out using the specialized software MedCalc

2.2. Study Selection 3. Results 20.023 (MedCalc Software, Ostend, Belgium) in Microsoft Windows 11 (Microsoft, RedThe criteria for the meta-analysis were as follows: mond, WA, USA). The results are presented as the pooled frequency of DE in GERD relevant publications in peer-reviewed periodicalsand 3.1.

Search Results patients/controls a 95% confidence interval (95% CI). Heterogeneity between different assessed A using Cochrane’s test electronic and I2 test. Significant heterogeneity was in English or Russian; publicationsstudies with was detailed search of Q the databases returned results at p <243 0.05 and I2 > 50. The papers probability for of a publication was estimated descriptive statistics, which allowednoted theforresulting scientific further error analysis.

Of by constructing funnel plot and calculations the Begg–Mazumdar data to be included in a meta-analysis; studies ain these, 157 studiesaccording were to excluded becausecorrelation they and Egger’s test. the adult population of patients with test GERD. Studies were not original clinical studies (83 reviews and conducted on specific patient populations (diseases systematic reviews; 31 experimental studies; 33 3. Results and conditions that may affect the objectivity clinical observations; 10 other irrelevant studies).

3.1. Search Results and comparability of data) were excluded from The 86databases remaining studies were analyzed in detail A search of the electronic returned 243 scientific papers for further analyfor compliance with the inclusion criteria, which led the analysis. In cases of duplicated sis. results in two Of these, 157 studies were excluded because they were not original clinical studies (83 reviews and systematic 31 experimental studies; 33 clinical to thereviews; exclusion of 58 studies (Figure 1). observations; publications (from different or the same electronic otheranalysis. irrelevant studies).

86 remaining studies analyzed in detail were for comFinally,Thethe remaining 28were original studies database), one was selected for the10final pliance with the inclusion criteria, which ledand to the exclusionin of the 58 studies considered eligible included final (Figure 1).

The methodological quality of each of the included Finally, the remaining 28 original studies were considered eligible and included in the final Dent. J. 2022, 10, x FOR PEER REVIEW 4 of 12 meta-analysis (Table 2) 21–48. studies was assessed using the Newcastle– meta-analysis (Table 2) [21–48].

Ottawa Scale (NOS).

2.3. Data Extraction Two investigators (D.N.A. and F.S.S.) independently extracted data using standardized forms. The year of publication, country, methodology for diagnosing GERD, criteria for diagnosing DE, the total sample size of patients with GERD, the total sample size of controls (if available), the number of patients with DE in the sample of patients with GERD, and the number of patients with DE in the sample of controls (if available) were analyzed. Any

14

Figure 1. CONSORT detailing the study selection strategy.

Figure 1. CONSORT diagram detailingdiagram the study selection strategy.

Table 2. Characteristics of selected studies.

Dental News Study, Year

Country

Quarter III

Methodology for Diagnosing Criteria for Diagnosing Total GERD Total Control GERD DE Patients Persons

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Prevalence and Risk of Dental Erosion in Patients with Gastroesophageal Reflux Disease: A Meta-Analysis

Table 2. Characteristics of selected studies.

Dent. J. 2022, 10, 126

Table 2. Characteristics of selected studies.

16

Study, Year

Country

Methodology for Diagnosing GERD

Criteria

Järvinen, V. et al., 1988 [22]

Finland

Endoscopy

Dental e

Meurman, J.H., et al., 1994 [23]

Finland

Endoscopy

Dental e

Silva, M.A., et al., 2001 [24]

Brazil

Endoscopy

Dental e

Muñoz, J.V., et al., 2003 [21]

Spain

Clinical presentation + endoscopy + pH-metry

Dental e

Jensdottir, T., et al., 2004 [25]

Denmark

Clinical presentation + endoscopy + pH-metry

Dental e

Oginni, A.O., et al., 2005 [26]

Nigeria

Clinical presentation + endoscopy

Dental e

Moazzez, R., et al., 2005 [27]

UK

Clinical presentation + pH-metry + manometry

Dental e

Maev, I.V., et al., 2005 [28]

Russian Federation

Clinical presentation + endoscopy + pH-metry

Dental e

Benages, A., et al., 2006 [29]

Spain

Not specified

Dental e

Di Fede, O., et al., 2008 [30]

Italy

Clinical presentation + endoscopy + pH-metry

Dental e

Stojsin, I., et al., 2010 [31]

Serbia

Clinical presentation

Dental e

Yoshikawa, H., et al., 2012 [32]

Japan

Clinical presentation + endoscopy

Dental e

Tantbirojn, D., et al., 2012 [33]

USA

Not specified

Optical

Picos, A.M., et al., 2013 [34]

Romanian

Clinical presentation + endoscopy + pH-metry

Dental e

Alavi, G., et al., 2014 [35]

Iran

Clinical presentation + endoscopy

Dental e

Roesch-Ramos, L., et al., 2014 [36]

Mexico

Clinical presentation + endoscopy + pH-metry + manometry Dental e

Vinesh, E., et al., 2016 [37]

India

Not specified

Dental e

Reddy, V.K., et al., 2016 [38]

India

Clinical presentation + endoscopy + pH-metry

Dental e

Milani, D.C., et al., 2016 [39]

Brazil

Questionnaire Symptom’s questionnaire for gastroesophageal reflux disease

Dental e

Wei, Z., et al., 2016 [40]

China

Not specified

Dental e

Tumashevich, O.O., et al. 2016 [41]

Russian Federation

Not specified

Dental e

Li, W., et al., 2017 [42]

China

Clinical presentation + endoscopy

Dental e

Ramachandran, A., et al., 2017 [43]

India

Clinical presentation + endoscopy

Dental e

Warsi, I., et al., 2019 [44]

Pakistan

Clinical presentation + endoscopy

Dental e

Ramugade, M.M., et al., 2019 [45]

India

Clinical presentation

Dental e

Jacob, S., et al., 2019 [46]

India

Not specified

Dental e

Picos, A., et al., 2020 [47]

France, Romania

Modified GerdQ questionnaire

Dental e

Smirnova, T.A., et al., 2021 [48]

Russian Federation

GerdQ questionnaire

Dental e

Dental News

Quarter III

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Prevalence and Risk of Dental Erosion in Patients with Gastroesophageal Reflux Disease: A Meta-Analysis

4 of 11

Criteria for Diagnosing DE

Total GERD Patients

Total Control Persons

Dental examination (Eccles and Jenkins criteria)

20

NA

Dental examination (Eccles and Jenkins criteria)

117

NA

Dental examination (Eccles and Jenkins criteria)

31

14

H-metry

Dental examination (Eccles and Jenkins criteria)

181

72

H-metry

Dental examination (Lussi index)

23

57

Dental examination (Smith and Knight criteria)

125

100

Dental examination (Smith and Knight criteria)

31

7

Dental examination (Eccles and Jenkins criteria)

88

NA

Dental examination (Eccles and Jenkins criteria)

181

72

Dental examination (Smith and Knight criteria)

200

100

Dental examination (Eccles and Jenkins criteria)

30

30

Dental examination (Smith and Knight criteria)

40

30

Optical scan

12

6

Dental examination (BEWE scale)

60

60

Dental examination

31

71

60

60

Dental examination

142

NA

Dental examination (O’Sullivan index)

91

114

Dental examination (Smith and Knight criteria)

143

274

Dental examination (BEWE scale)

39

681

Dental examination

103

25

Dental examination (Smith and Knight criteria)

51

50

Dental examination (BEWE scale)

25

25

Dental examination

187

NA

Dental examination (Lussi index)

100

100

Dental examination (BEWE scale)

12

NA

Dental examination (BEWE scale)

141

122

Dental examination

45

NA

nometry

H-metry

H-metry

H-metry

metry + manometry Dental examination (Eccles and Jenkins criteria)

H-metry

re for

18

Dental News

Quarter III

and 2070 healthy subjects) performed in Brazil (n = 2) [24,39], the UK (n = 1) [27], DenThe final analysis included 28 studies involving 4379 people ( markand (n Risk = 1) of [25], India (n = in 5) Patients [37,38,43,46,47], Iran healthy (n = 1)subjects) [35], Spain (n =A2)Meta-Analysis Prevalence Dental Erosion withand Gastroesophageal Reflux Disease: 2070 performed in[21,29], Brazil (n = 2) [24,39], Italy (n = 1) [30], China (n = 2) [40,42], Mexico Nigeria 1) [26], Pak- Iran (n = 1) [3 mark(n(n== 1) 1) [36], [25], India (n =(n5)=[37,38,43,46,47], istan (n = 1) [44], Russia (n = 3) [28,41,48], Italy Romania = 1) [47],(nSerbia (n = 1) [31], (n = 1) [36], N (n = 1)(n [30], China = 2) [40,42], Mexico USA (n = 1) [33], Finland (n = 2) [22,23], France = [44], 1) [47], and(nJapan (n = 1) [32]. istan (n(n = 1) Russia = 3) [28,41,48], Romania (n = 1) (n = 1)[21,24–27,29–36,38–43,45,47].

[33], Finland (n = 2) [22,23], France The control population was represented in USA 21 studies In (n = 1) [47] The control population wastorepresented in 21 studies [21,24–2 most studies, validated instrumental examination methods were used diagnose GERD mostexamination studies, validated examination (n = 17) [21–28,30,32,34–36,38,42–44], and dental wasinstrumental used to diagnose DE methods were (n = 17) [21–28,30,32,34–36,38,42–44], and dental using validated Eccles and Jenkins criteria (n = 7) [21–24,28,29,31], Smith and Knight examination w validated Eccles and Jenkins criteria (n = 7) [21–24,28,2 (n = 6) [26,27,30,32,39,42], Basic Erosive Wear using Examination (BEWE) (n = 5) [34,40,43,46,47], (n =analysis, 6) [26,27,30,32,39,42], Basic Erosive (BEW 3.2. Description of the Studies the a random-effects modelWear was Examination used, as and the Lussi index (n = 2) [25,45]. The NOS assessment identified eight studies with a low The final analysis included 28 studies involving there was significant heterogeneity between both and the Lussi index (n = 2) [25,45]. The NOS assessment identified risk of bias (scores 7 orGERD more) [21,25,27,30,39,40,42,43].

4379 people (2309 patientsofwith and 2070 groups (I2 GERD I2 [21,25,27,30,39,40,42,43]. control = 98.21%; p risk of bias (scores = of 96.95%, 7 or more)

healthy subjects) performed in Brazil (n = 2) 24,39, < 0.0001). Sub-analysis of the data showed that 3.3.=Prevalence of DE in(n GERD Patients 3.3.pooled Prevalence of DE in GERD the UK Denmark = 1) 25 , India (n = Dent.the prevalence of DEPatients in GERD patients was Dent.(n J. 2022,1) 10,[27], x FOR PEER REVIEW 6 of 12 J. 2022, 10, x FOR PEER REVIEW 35 21,29 5) 37,38,43,46,47, Iran (n = 1) , Spain (n = 2) , Italy (n 46.497% (95 CI: 30.125–63.266) The pooled prevalence of DE in GERDThe patients controlsof was 51.524% pooledand prevalence DE in GERD patients and = 1) 30, China = 2) 40,42, Mexico = 1) 36, (95 Nigeria in(95 Europe, 65.644% (95 CI: 45.560–83.170) in Asia, respectiv CI: 39.742–63.221) and(Figure 21.351% (95InCI: 9.234–36.807), (95 CI:(n39.742–63.221) and(n 21.351% CI: 9.234–36.807), respectively 2). the anal44 28,41,48 (n = 1) 26ysis, , Pakistan (n = 1) , Russia (n = 3) , and 41.902% (95 CI: 11.019–76.927) in 2control = 98.21%; p < 0.0001). Su groups (I2GERD 96.95%, a random-effects model was used, asIshowed there was he (I2GERD 96.95%,asI2control =ysis, 98.21%; p < 0.0001). heterogeneity Sub-analysis of=the data thatsignificant a random-effectsgroups model was=used, there between both REVIEW was significant 6 of 12 . 2022, 10, x FOR PEER REVIEW 6 of 12 31 Dent. J. 2022, 10, x FOR PEER 2 2 prevalence Romania (n = 1) 472, Serbia (n the = 1) ,2USA (n = 1)of33DE , in America (Figure 3). the pooled of DE in GERD patients was 46 pooled prevalence GERD patients was 46.497% (95 CI: 30.125–63.266) in Eugroups (I = 96.95%, I = 98.21%; p < 0.0001).

Sub-ana control groups (I = 96.95%, I47 control = 98.21%; p < 0.0001).GERD Sub-analysis of the data showed in Asia, and 41.902% rope, (95 CI: 45.560–83.170) Finland (n = 2) 22,23GERD , France (nrope, = 1)65.644% , and(95Japan (n that in CI: 45.560–83.170) Asia, and 41.902% (9565.644% CI: of 11.019–76.927) in America the pooled prevalence DE in GERD patients was 46.49 that the pooled prevalence of DE in GERD patients was 46.497% (95 CI: 30.125–63.266) groups (I = 96.95%, I = (Figure 98.21%; p 3). < 0.0001). Sub-analysis of the data showed that = 1) 32. groups The (Icontrol population represented 2GERD = 96.95%, I2control = (Figure 98.21%;was p 3). < 0.0001).

Sub-analysis of thein data showed that Europe, 65.644% CI: 45.560–83.170) Asia, and 41.902% the pooled prevalence of DE in (95 GERD patients was 46.497% (95 CI:in 30.125–63.266) in Eu21,24–27,29–36,38–43,45,47 inpooled Europe, 65.644% 45.560–83.170) Asia, and 41.902% (95 CI: 11.019–76.927) in the prevalence of DE in (95 GERD patients was 46.497% (95 CI:in 30.125–63.266) in CI: Eu. CI: In most studies, in 21 studies rope, 65.644% (95 45.560–83.170) in Asia, and 41.902% (95 CI: 11.019–76.927) in America America (Figure 3). rope, 65.644% (95 CI: 45.560–83.170) in Asia,methods and 41.902% (95 CI: 11.019–76.927) (Figure 3).in America America (Figure 3). validated instrumental examination were (Figure 3). used to diagnose GERD (n = 17) 21–28,30,32,34–36,38,42–44, and dental examination was used to diagnose DE using validated Eccles and Jenkins criteria (n = 7) 21–24,28,29,31, Smith and Knight (n = 6) 26,27,30,32,39,42, Basic Erosive Wear Examination (BEWE) (n = 5) 34,40,43,46,47 , and the Lussi index (n = 2) 25,45. The NOS assessment identified eight studies with a low risk of bias (scores of 7 or more) 21,25,27,30,39,40,42,43. 3.3.

Prevalence of DE in GERD Patient The pooled prevalence of DE in GERD patients and controls was 51.524% (95 CI: 39.742–63.221)and 21.351% (95 CI: 9.234–36.807), respectively (Figure 2). In 2GERD

2control

Figure 2. Pooled frequency of DE in patients with GERD and controls.

Figure 2. Pooled frequency of DE in patients with GERD and controls.

Figure 2. Pooled frequency of DE in patients with GERD and

Figure 2. Pooled frequency of DE in patients with GERD and controls.

Figure 2. Pooled frequency of DE in patients with GERD and controls.

Figure 2. Pooled frequency of DE in patients with GERD and controls.

Figure 3. Pooled frequency of DE in patients with GERD in different regions of the world.

3.4. Risk of DE in GERD Patients

Compared with controls, there was a significant association between the presence of DE and GERD according to the fixed effects model (OR 4.384, 95% CI: 3.607–5.329). HowFigure 3. Pooled frequency of DE in patients with GERD in different regions of the world.the high heterogeneity of the results of the included studies (I 2 = 79.78%, 95% ever, given Figure 3. using Pooled frequency of DE in patients GERD in d CI: 69.82–86.46), the riskfrequency was recalculated model (OR 5.000, 95% Figure 3. Pooled of DE ina random-effects patients with GERD inwith different reg 3.4. Risk of DE in GERD Patients CI: 2.995–8.345) (Figure 4). When analyzing studies that used only validated instrumental methods for diagnosing criteria (studies that did not specCompared with controls, there was a significant association between the presence of GERD, alongside 3.4. Riskvalidated of DE inDE GERD Patients methodologies were excluded), a significant association between the presence of DE DE and GERD according to the fixed effects model (OR 4.384, 95% CI:ify 3.607–5.329).

HowCompared with controls, there was a significant a and(IGERD was also revealed (OR 5.586, 95% CI: 2.311–13.503; I2 = 85.14%). The probability 2 = 79.78%, ever, given the high heterogeneity of the results of the included studies 95%

DE and GERD according to the fixed effects model (OR

Figure 3. using Pooled frequency of DE in patients GERD in different regions of the world.

CI: 69.82–86.46), the riskfrequency was recalculated model (OR 5.000, 95% Figure 3. Pooled of DE ina random-effects patients with GERD inwith different regions of the ever, given the world. high heterogeneity of the results of the CI: 2.995–8.345) (Figure 4). When analyzing studies that used only validated instrumental CI: 69.82–86.46), the risk was recalculated using a ran methods for diagnosing GERD, alongside validated DE criteria (studies that did not spec3.4. Risk of DE in GERD Patients CI: 2.995–8.345) (Figure 4). When analyzing studies tha ify methodologies were excluded), a significant association between the presence of DE Compared with controls, there was a significant association theGERD, presence of validated DE methods forbetween diagnosing alongside and GERD was also revealed (OR 5.586, 95% CI: 2.311–13.503; I2 = 85.14%). The probability

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Dental News

DE and GERD according to the fixed effects model (OR 95% CI: 3.607–5.329).

Howify4.384, methodologies were excluded), a significant associ 2 = 79.78%, Quarter III CI: 2.311–1 ever, given the high heterogeneity of the results of theand included studies 95% 95% GERD was also (I revealed (OR 5.586, CI: 69.82–86.46), the risk was recalculated using a random-effects model (OR 5.000, 95%

(2309 patients with GERD the UK (n = 1) [27], Den35], Spain (n = 2) [21,29], Nigeria (n = 1) [26], Pak[47], Serbia (n = 1) [31], ], and Japan (n = 1) [32].

27,29–36,38–43,45,47]. In e used to diagnose GERD was used to diagnose DE 29,31], Smith and Knight WE) (n = 5) [34,40,43,46,47], d eight studies with a low

6 of 12

d controls was 51.524% vely (Figure 2). In the analub-analysis of the data showed eterogeneity between boththat 6.497% in Eualysis(95 of CI: the30.125–63.266) data showed % (95 CI: 11.019–76.927) in America 97% (95 CI: 30.125–63.266) % (95 CI: 11.019–76.927) in

d controls.

different regions of the world.

gions of the world.

association between the presence of R 4.384, 95% CI: 3.607–5.329). Howe included studies (I 2 = 79.78%, 95% ndom-effects model (OR 5.000, 95% at used only validated instrumental E criteria (studies that did not speciation between the presence of DE 13.503; I2 = 85.14%). The probability

Prevalence and Risk of Dental Erosion in Patients with Gastroesophageal Reflux Disease: A Meta-Analysis

Dent. J. 2022, 10, 126

6 of 11

3.4. Risk of DE in GERD Patients

3.4. Risk of DE in GERD Patients Compared with controls, there was a significant association between the presence Compared with controls, of there wasGERD a significant significant association between the3.607–5.329). presence DE and according toathe fixed effects model (OR 4.384, 95% CI: association between theHowever, presence of DE and of DE and GERD was also revealed (OR 5.586, given the high heterogeneity of the results of the included studies (I2 = 79.78%, 2 GERD according to the fixed effects model (OR 95% CI: 2.311–13.503; I = 85.14%).

The probability 95% CI: 69.82–86.46), the risk was recalculated using a random-effects model (OR 5.000, 95% Dent.

J. 2022, 10, x CI: FOR 3.607–5.329).

PEER REVIEW 7 of 12 4.384, 95% However, (Figure given 4). theWhen of analyzing publication bias was assessed by constructing CI: 2.995–8.345) studies that used only validated instrumental high heterogeneity of themethods resultsfor of diagnosing the included a funnel plot and based on calculations of the GERD, alongside validated DE criteria (studies that did not specify studies (I2 = 79.78%, 95% CI: 69.82–86.46), the risk Begg–Mazumdar test and the Egger’s test.

A methodologies were excluded), a significant association between the presence of DE and 2 was recalculated using aofGERD random-effects model visual analysis of the funnel-shaped scattering publication biasrevealed was assessed by constructing a funnel plot based on calculations was also (OR 5.586, 95% CI: 2.311–13.503; I and = 85.14%).

The probability (OR 5.000, 95% CI: 2.995–8.345) (Figure 4).anddiagram (Figure didanalysis notand reveal publication bias wastest assessed

by Egger’s constructing a 5) funnel plot based on significant calculations ofofthe Begg–Mazumdar the test. A visual of theany funnel-shaped When analyzing studies scattering that only validated asymmetry.

In significant addition, the results the Begg– of theused Begg–Mazumdar test the test.

A visual analysis of the funnel-shaped diagram (Figure 5) and did not Egger’s reveal any asymmetry.

Inof addition, the instrumental methods results for diagnosing GERD, Mazumdar test (p > 0.05) and the Egger’s scattering diagram (Figure 5) test did (p not> 0.05) revealand anythe significant asymmetry.

In addition, the of the Begg–Mazumdar Egger’s test (p > 0.05) allowed for test the alongside validated DE criteria that did (p >(p0.05) for thetest presence significant results of(studies Begg–Mazumdar testbias >to0.05) and the Egger’s (p > 0.05) of allowed for the presence ofthe significant publication be allowed excluded. not specify methodologies were excluded), publication bias to be excluded. presence of significant publication bias to be excluded.

Figure Figure4.4.Forest Forestplot plotshowing showingthe thecumulative cumulativerisk risk(OR) (OR)ofofDE DEininGERD GERDpatients patients[21–48].

[21–48].

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Figure5.5.AAfunnel funnelplot plotestimating estimatingthe thelikelihood likelihoodofofa apublication publicationbias biaswhen whencalculating calculatingthe therisk risk(OR) (OR) Figure DEininpatients patientswith withGERD. GERD. ofofDE Quarter III

4. Discussion

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Prevalence and Risk of Dental Erosion in Patients with Gastroesophageal Reflux Disease: A Meta-Analysis

4. Discussion GERD is a widespread acid-dependent disease that In the studies conducted to date, the frequency of develops when the motor function of the upper DE in GERD patients varies widely from 3.226% to gastrointestinal tract is impaired1. Approximately one 95.604% 21–48. Through the pooling of the results of third of patients with GERD present with atypical the 28 selected studies in the present meta-analysis, extraesophageal symptoms 6,7. DE is the most the pooled incidence of DE in GERD patients was common dental manifestation of GERD and is caused determined as 51.524% (95 CI: 39.742–63.221). by persistent retrograde reflux of acidic gastric Moreover, compared with healthy subjects, GERD contents into the oral cavity 16,17,49. These pathological significantly increases the risk of developing DE with changes in the hard tissues of the teeth are more an OR of 5.000 (95% CI: 2.995–8.345). The data often localized on the vestibular (buccal), occlusal, obtained are consistent with the latest systematic and lingual surfaces of the teeth 6 . reviews indicating that GERD is a significant risk , 126 of 11 18,20,52. In consideration of this fact, The development of DE within GERD occurs stage factor for 7DE by stage. Initially, under the influence of repeated lifestyle and diet changes can be recommended for acid attacks, there is a gradual degradation of the GERD patients to prevent DE (sleeping with the head 4. Discussion tooth pellicle, which serves to protect the tooth hard of the bed raised; exclusion of excessive consumption GERD is a widespread acid-dependent disease that develops when the motor function tissue from the effects of acids 5,49. The loss of the of carbonated drinks, drinks with a low pH, sour fruits, of the upper gastrointestinal tract is impaired [1]. Approximately one-third of patients pellicle leadspresent to direct contact of hydrochloric drugs). In addition to the implementation with GERD with atypical extraesophageal symptomsacid [6,7]. DEand is thecertain most common , x FOR PEER REVIEW 8 of 12 dental manifestation of GERD surface and is caused by initiation persistent retrograde of acidic gastric refluxate with the enamel and of its reflux of careful individual oral hygiene (the use of rinsing contents into the oral cavity pathological changes in the hard with tissues neutral of demineralization at pH <[16,17,49].

5.5 dueThese to the dissolution agents pH), remineralizing therapy at the teeth are more often localized on the vestibular 49,50(buccal), occlusal, and lingual surfaces of hydroxyapatite crystals (Figure 6) .

Deep DE home with the use of remineralizing gels, and regular of theThe teeth [6]. development of DE within GERD occurs stage by stage. Initially, under the in6,53 leads toThe the opening of dentinal tubules and the examinations by a dentist .

DE within GERD occurs stage by stage.

Initially, under the fluence ofdevelopment repeated acidof attacks, there is a gradual degradation of the tooth pellicle, which 5 influence of repeated acid attacks, there is a gradual degradation of the tooth pellicle, development of hypersensitivity .

Saliva, which Oral care products can help prevent (or at least reduce serves to protect the tooth hard tissue from the effects of acids [5,49]. The loss of the pellicle which serves to protect the tooth hard tissue from the effects of acids [5,49].

The loss of the contains bicarbonates, antimicrobial substances, DE).

There is good evidence that hydroxyapatite leads to direct contact of hydrochloric acid refluxate with the enamel surface and initiation pellicle leads to direct contact acid refluxate with the enamel surface and of its demineralization at pH < of 5.5hydrochloric duethe to themain dissolution of hydroxyapatite crystals (Figure calcium, and phosphates, is protective containing (calcium phosphate) products are working initiation of its demineralization at pH < 5.5 due to the dissolution of hydroxyapatite crystals 54,55 6) [49,50].

Deep DEhalt leadsdemineralization to the opening of dentinal tubules and the well development ofthe hy- case of hyposalivation, it is advisable element that can and promote .

In (Figure 6) [49,50]. Deep DE leads to the opening of dentinal tubules and the development persensitivity [5]. Saliva, which contains bicarbonates, antimicrobial substances, calcium, the mineralization . However, to usesubstances, saliva substitutes in addition to stimulating of hypersensitivityof [5].dental Saliva,hard whichtissues contains50,51 bicarbonates, antimicrobial and phosphates, is the main protective element that can halt demineralization and procalcium,patients, and phosphates, is the main protective element that can halt demineralization in GERD hyposalivation is often observed, natural salivation through the consumption of mote the mineralization of dental hard tissues [50,51]. However, in GERD patients, hyand promote the mineralization of dental hard tissues [50,51]. However, in GERD patients, especially in obese individuals, which is also important sugar-free chewing gum and specialized lozenges posalivation is often observed, especially in obese individuals, which is also important in hyposalivation is often observed, especially in obese individuals, which is also important 53 32,51 DEgenesis genesis [32,51]. in DE . containing xylitol .

As part of DE prevention, periodic in DE genesis [32,51]. use of antacids and alginates after reflux episodes is possible. According to the latest recommendations, antisecretory therapy using proton pump inhibitors (PPIs) is the first-line therapy for the induction and maintenance of clinical remission of GERD 56,57. With the dental manifestation of GERD, empirical observations indicate it is reasonable to use PPI therapy twice a day for three months to prevent further damage 5,6. In a randomized controlled trial using optical coherence tomography in GERD patients with associated DE, it was shown that PPI therapy (esomeprazole 20 mg twice a day) reduces the demineralization of dental hard tissue compared with a placebo58. In another longitudinal non-comparative study with a follow-up period of 1 year, the use of PPIs helped in halting the progression of DE in 74% of GERD patients 59.

There are several limitations of our study. First, the studies included in the meta- analysis are Figure 6.

6. Schematic Schematic model model of of DE DE formation formation in in GERD GERD patients. patients.

Figure characterized by significant heterogeneity in both the methods In the studies conducted to date, the frequency of DE in GERD patients variesused widelyto diagnose GERD and the criteria for from 2828 selected studies from 3.226% 3.226%to to95.604% 95.604%[21–48].

[21–48].Through Throughthe thepooling poolingofofthe theresults resultsofofthe the selected studdiagnosing DE. Secondly, in certain studies, subjective

24

in present meta-analysis, the pooled incidence of DEofinDE GERD patients was determined iesthe in the present meta-analysis, the pooled incidence in GERD patients was deterDental News as 51.524% (95 CI: (95 39.742–63.221).

Moreover, compared with healthy subjects,subjects, GERD mined as 51.524% CI: 39.742–63.221).

Moreover, compared with healthy significantly increasesincreases the risk of DE with anDE ORwith of 5.000 (95% 2.995–8.345).

GERD significantly thedeveloping risk of developing an OR ofCI: 5.000 (95% CI:

Quarter III

Prevalence and Risk of Dental Erosion in Patients with Gastroesophageal Reflux Disease: A Meta-Analysis

diagnostic tools were used to diagnose GERD, e.g., questionnaires, rather than objective instrumental diagnostic methods. In addition, the limitation of this study is that the protocol of systematic review was not registered in the PROSPERO registry. However, in terms of the number of studies assessed, this meta-analysis is by far the largest to evaluate the prevalence and risk of DE in adult patients with GERD by summarizing relevant results.

5. Conclusions Present meta-analysis demonstrates that DE is quite often associated with GERD and observed in about half of patients with this extremely common disease of the upper gastrointestinal tract. Given this association, it is advisable to more actively identify patients at a high risk of DE among patients with GERD and refer them to a dentist for the timely prevention and correction of this dental pathological process.

Author Contributions: The concept and design of the study—O.O.Y., I.V.M. and N.I.K.; collection and processing of material—D.N.A. and F.S.S.; statistical data processing—D.N.A. and F.S.S.; writing the text D.N.A., S.V.L., F.S.S. and M.N.B.; editing—O.O.Y., I.V.M., N.I.K., S.V.L., P.A.B. and K.Y.Z. All authors made a significant contribution to the preparation of the work. All authors have read and agreed to the published version of the manuscript.

Funding: This research received no external funding.

Institutional Review Board Statement: Not applicable.

Informed Consent Statement: Not applicable.

Data Availability Statement: MedCalc Database for statistical analysis: https://cloud.mail.ru/ public/ Y3aV/WRppBDEgM (accessed on 27 June 2022) and PRISMA statement: https://cloud.mail. ru/ public/5AZG/bKGRzL4f9 (accessed on 27 June 2022).

Conflicts of Interest: The authors declare no conflict of interest.

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References 1. Maret-Ouda, J.; Markar, S.R.; Lagergren, J. Gastroesophageal Reflux Disease: A Review. JAMA 2020, 324, 2536–2547.

2. Fuchs, K.H.; Meining, A. Current Insights in the Pathophysiology of Gastroesophageal Reflux Disease.

Chirurgia 2021, 116, 515–523.

3. Nirwan, J.S.; Hasan, S.S.; Babar, Z.U.; Conway, B.R.; Ghori, M.U. Global Prevalence and Risk Factors of Gastro-oesophageal Reflux Disease (GORD): Systematic Review with Metaanalysis. Sci. Rep. 2020, 10, 5814.

4.Chatila, A.T.; Nguyen, M.T.T.; Krill, T.; Roark, R.; Bilal, M.; Reep, G. Natural history, pathophysiology and evaluation of gastroesophageal reflux disease. Dis. Mon. 2020, 66, 100848.

5. Ghisa, M.; Della Coletta, M.; Barbuscio, I.; Marabotto, E.; Barberio, B.; Frazzoni, M.; De Bortoli, N.; Zentilin, P.; Tolone, S.; Ottonello, A.; et al. Updates in the field of non-esophageal gastroesophageal reflux disorder.

Expert Rev. Gastroenterol. Hepatol. 2019, 13, 827–838.

6. Durazzo, M.; Lupi, G.; Cicerchia, F.; Ferro, A.; Barutta, F.; Beccuti, G.; Gruden, G.; Pellicano, R. Extra-Esophageal Presentation of Gastroesophageal Reflux Disease: 2020 Update. J. Clin. Med. 2020, 9, 2559.

7. Jaspersen, D.; Kulig, M.; Labenz, J.; Leodolter, A.; Lind, T.; Meyer-Sabellek, W.; Vieth, M.; Willich, S.N.; Lindner, D.; Stolte, M.; et al. Prevalence of extra-oesophageal manifestations in gastro-oesophageal reflux disease: An analysis based on the ProGERD Study. Aliment.

Pharmacol. Ther. 2003, 17, 1515–1520.

8. Vakil, N.; van Zanten, S.V.; Kahrilas, P.; Dent, J.; Jones, R.; Global Consensus Group. The Montreal definition and classification of gastroesophageal reflux disease: A global evidence-based consensus. Am. J. Gastroenterol.

2006, 101, 1900–1920.

9. Schlueter, N.; Amaechi, B.T.; Bartlett, D.; Buzalaf, M.A.R.; Carvalho, T.S.; Ganss, C.; Hara, A.T.; Huysmans, M.D.N.J.M.; Lussi, A.; Moazzez, R.; et al. Terminology of Erosive Tooth Wear: Consensus Report of a Workshop Organized by the ORCA and the Cariology Research Group of the IADR. Caries Res. 2020, 54, 2–6.

10. Warreth, A.; Abuhijleh, E.; Almaghribi, M.A.; Mahwal, G.; Ashawish, A. Tooth surface loss: A review of literature. Saudi Dent. J. 2020, 32, 53–60.

11. Twetman, S. The evidence base for professional and self-care prevention—Caries, erosion and sensitivity.

BMC Oral Health 2015, 15, S4.

12. West, N.; Seong, J.; Davies, M. Dentine hypersensitivity. Monogr. Oral Sci. 2014, 25, 108–122.

13. Schlueter, N.; Luka, B. Erosive tooth wear—A review Quarter III

Prevalence and Risk of Dental Erosion in Patients with Gastroesophageal Reflux Disease: A Meta-Analysis

on global prevalence and on its prevalence in risk groups. Br. Dent. J. 2018, 224, 364–370.

14. Jaeggi, T.; Lussi, A. Prevalence, incidence and distribution of erosion. Monogr. Oral Sci. 2014, 25, 55– 73.

15. Martignon, S.; Bartlett, D.; Manton, D.J.; Martinez Mier, E.A.; Splieth, C.; Avila, V. Epidemiology of Erosive Tooth Wear, Dental Fluorosis and Molar Incisor Hypomineralization in the American Continent. Caries Res. 2021, 55, 1–11.

16. Marsicano, J.A.; de Moura-Grec, P.G.; Bonato, R.C.; Sales-Peres, M.C.; Sales-Peres, A.; Sales-Peres, S.H. Gastroesophageal reflux, dental erosion, and halitosis in epidemiological surveys: A systematic review. Eur. J. Gastroenterol. Hepatol. 2013, 25, 135–141.

17. Lee, R.J.; Aminian, A.; Brunton, P. Dental complications of gastro-oesophageal reflux disease: Guidance for physicians. Intern. Med. J. 2017, 47, 619– 623.

18. Ortiz, A.C.; Fideles, S.O.M.; Pomini, K.T.; Buchaim, R.L. Updates in association of gastroesophageal reflux disease and dental erosion: Systematic review. Expert Rev. Gastroenterol. Hepatol. 2021, 15, 1037–1046.

19. Pace, F.; Pallotta, S.; Tonini, M.; Vakil, N.; Bianchi Porro, G. Systematic review: Gastro-oesophageal reflux disease and dental lesions. Aliment. Pharmacol.

Ther. 2008, 27, 1179–1186.

20. Picos, A.; Badea, M.E.; Dumitrascu, D.L. Dental erosion in gastro-esophageal reflux disease. A systematic review. Clujul Med. 2018, 91, 387–390.

21. Muñoz, J.V.; Herreros, B.; Sanchiz, V.; Amoros, C.; Hernandez, V.; Pascual, I.; Mora, F.; Minguez, M.; Bagan, J.V.; Benages, A. Dental and periodontal lesions in patients with gastro-oesophageal reflux disease. Dig. Liver Dis. 2003, 35, 461–467.

22. Järvinen, V.; Meurman, J.H.; Hyvärinen, H.; Rytömaa, I.; Murtomaa, H. Dental erosion and upper gastrointestinal disorders. Oral Surg. Oral Med. Oral Pathol. 1988, 65, 298–303.

23. Meurman, J.H.; Toskala, J.; Nuutinen, P.; Klemetti, E. Oral and dental manifestations in gastroesophageal reflux disease. Oral Surg. Oral Med. Oral Pathol. 1994, 78, 583–589.

24. Silva, M.A.; Damante, J.H.; Stipp, A.C.; Tolentino, M.M.; Carlotto, P.R.; Fleury, R.N. Gastroesophageal reflux disease: New oral findings. Oral Surg. Oral Med. Oral Pathol. Oral Radiol. Endod. 2001, 91, 301–310.

25. Jensdottir, T.; Arnadottir, I.B.; Thorsdottir, I.; Bardow, A.; Gudmundsson, K.; Theodors, A.; Holbrook, W.P. Relationship between dental erosion, soft drink consumption, and gastroesophageal reflux among

28

Dental News

Icelanders. Clin. Oral Investig. 2004, 8, 91–96.

26. Oginni, A.O.; Agbakwuru, E.A.; Ndububa, D.A. The prevalence of dental erosion in Nigerian patients with gastro-oesophageal reflux disease. BMC Oral Health 2005, 5, 1.

27. Moazzez, R.; Anggiansah, A.; Bartlett, D.W. The association of acidic reflux above the upper oesophageal sphincter with palatal tooth wear. Caries Res. 2005, 39, 475–478.

28. Maev, I.V.; Barer, G.M.; Busarova, G.A.; Pustovoit, E.V.; Polikanova, E.N.; Burkov, S.G.; Yurenev, G.L. Dental manifestations of gastroesophageal reflux disease.

Klin. Med. 2005, 11, 33–38.

29. Benages, A.; Muñoz, J.V.; Sanchiz, V.; Mora, F.; Mínguez, M. Dental erosion as extraoesophageal manifestation of gastro- oesophageal reflux. Gut 2006, 55, 1050–1051.

30. Di Fede, O.; Di Liberto, C.; Occhipinti, G.; Vigneri, S.; Lo Russo, L.; Fedele, S.; Lo Muzio, L.; Campisi, G. Oral manifestations in patients with gastro-oesophageal reflux disease: A single-center case-control study. J. Oral Pathol. Med. 2008, 37, 336–340.

31. Stojsin, I.; Brkani ́c, T.; Slavoljub, Z. Reflux disease as an etiological factor of dental erosion. Srp. Arh. Celok.

Lek. 2010, 138, 292–296.

32. Yoshikawa, H.; Furuta, K.; Ueno, M.; Egawa, M.; Yoshino, A.; Kondo, S.; Nariai, Y.; Ishibashi, H.; Kinoshita, Y.; Sekine, J. Oral symptoms including dental erosion in gastroesophageal reflux disease are associated with decreased salivary flow volume and swallowing function. J. Gastroenterol.

2012, 47, 412–420.

33. Tantbirojn, D.; Pintado, M.R.; Versluis, A.; Dunn, C.; Delong, R. Quantitative analysis of tooth surface loss associated with gastroesophageal reflux disease: A longitudinal clinical study. J. Am. Dent. Assoc. 2012, 143, 278–285.

34. Picos, A.M.; Poenar, S.; Opris, A.; Chira, A.; Bud, M.; Berar, A.; Picos, A.; Dumitrascu, D.L. Prevalence of dental erosions in GERD: A pilot study. Clujul Med. 2013, 86, 344–346.

35. Alavi, G.; Alavi, A.; Saberfiroozi, M.; Sarbazi, A.; Motamedi, M.; Hamedani, S. Dental Erosion in Patients with Gastroesophageal Reflux Disease (GERD) in a Sample of Patients Referred to the Motahari Clinic, Shiraz, Iran. J. Dent. 2014, 15, 33–38.

36. Roesch-Ramos, L.; Roesch-Dietlen, F.; RemesTroche, J.M.; Romero-Sierra, G.; Mata-Tovar, C.J.; Azamar-Jácome, A.A.; Barranca-Enríquez, A. Dental erosion, an extraesophageal manifestation of gastroesophageal reflux disease. The experience of a Quarter III

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Prevalence and Risk of Dental Erosion in Patients with Gastroesophageal Reflux Disease: A Meta-Analysis

center for digestive physiology in Southeastern Mexico.

Rev. Esp. Enferm. Dig. 2014, 106, 92–97. [CrossRef] 37. Vinesh, E.; Masthan, K.; Kumar, M.S.; Jeyapriya, S.M.; Babu, A.; Thinakaran, M. A Clinicopathologic Study of Oral Changes in Gastroesophageal Reflux Disease, Gastritis, and Ulcerative Colitis. J. Contemp. Dent.

Pract. 2016, 17, 943–947.

38. Reddy, V.K.; Poddar, P.; Mohammad, S.; Saha, S. Association between dental erosion and possible risk factors: A hospital-based study in gastroesophageal reflux disease patients. J. Indian Assoc. Public Health Dent. 2016, 14, 154–159. Available online: https://www. jiaphd.org/text.asp?2016/14/2/154/183814 (accessed on 19 January 2022).

39. Milani, D.C.; Venturini, A.P.; Callegari-Jacques, S.M.; Fornari, F. Gastro-oesophageal reflux disease and dental erosions in adults: Influence of acidified food intake and impact on quality of life. Eur. J. Gastroenterol. Hepatol.

2016, 28, 797–801.

40. Wei, Z.; Du, Y.; Zhang, J.; Tai, B.; Du, M.; Jiang, H. Prevalence and Indicators of Tooth Wear among Chinese Adults. PLoS ONE 2016, 11, e0162181.

41. Tumashevich, O.O.; Rumyantsev, V.A.; Galochkina, A.B. Dental Syndrome in Gastroesophageal Reflux Disease. Exp. Clin. Gastroenterol. 2016. Available online:https://www.nogr.org/jour/article/view/61/61 (accessed on 19 January 2022).

42. Li, W.; Liu, J.; Chen, S.; Wang, Y.; Zhang, Z. Prevalence of dental erosion among people with gastroesophageal reflux disease in China. J. Prosthet. Dent. 2017, 117, 48–54.

43. Ramachandran, A.; Raja Khan, S.I.; Vaitheeswaran, N. Incidence and Pattern of Dental Erosion in Gastroesophageal Reflux Disease Patients. J. Pharm.

Bioallied Sci. 2017, 9, S138–S141.

44. Warsi, I.; Ahmed, J.; Younus, A.; Rasheed, A.; Akhtar, T.S.; Ain, Q.U.; Khurshid, Z. Risk factors associated with oral manifestations and oral health impact of gastrooesophageal reflux disease: A multicentre, crosssectional study in Pakistan. BMJ Open 2019, 9, e021458.

45. Ramugade, M.M.; Sayed, A.; Sapkale, K.D.; Sonkurla, S. Evaluation of Nexus of Dental Erosion and Gastroesophageal Reflux Disease: A Hospital-based Crosssectional Study. J. Clin. Diagn. Res. 2019, 13, ZC17–ZC20.

46. Jacob, S.; Babu, A.; Sasidharan Latha, S.; Vivekanandan Glorine, S.J.; Surendran, L.; Gopinathan, A.S. Independent Variables of Dental Erosion among Tertiary Care Hospital Patients of a Developing Country.

J. Int. Soc. Prev. Community Dent. 2019, 9, 612–618.

47. Picos, A.; Lasserre, J.F.; Chisnoiu, A.M.; Berar, A.M.; d’Incau, E.; Picos, A.M.; Chira, A.; des Varannes, S.B.; Dumitrascu, D.L. Factors associated with dental

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erosions in gastroesophageal reflux disease: A crosssectional study in patients with heartburn. Med. Pharm. Rep. 2020, 93, 23–29.

48. Smirnova, T.A.; Novozhilova, O.A.; Kochubeinik, A.V.; Smirnov, D.V. Dental mask for gastroesophageal reflux disease. Dent. Everyone 2021, 2, 18–23.

49. Ranjitkar, S.; Kaidonis, J.A.; Smales, R.J. Gastroesophageal reflux disease and tooth erosion.

Int. J. Dent. 2012, 2012, 479850.

50. Featherstone, J.D.B.; Lussi, A. Understanding the chemistry of dental erosion. Monogr. Oral Sci. 2006, 20, 66–76.

51. Ranjitkar, S.; Smales, R.J.; Kaidonis, J.A. Oral manifestations of gastroesophageal reflux disease. J. Gastroenterol. Hepatol. 2012, 27, 21–27.

52. Lechien, J.R.; Chiesa-Estomba, C.M.; Calvo Henriquez, C.; Mouawad, F.; Ristagno, C.; Barillari, M.R.; Schindler, A.; Nacci, A.; Bouland, C.; Laino, L.; et al.

Laryngopharyngeal reflux, gastroesophageal reflux and dental disorders: A systematic review. PLoS ONE 2020, 15, e0237581.

53. Marshall, T.A. Dietary assessment and counseling for dental erosion. J. Am. Dent. Assoc. 2018, 149, 148– 152.

54. Min, J.H.; Kwon, H.K.; Kim, B.I. Prevention of dental erosion of a sports drink by nano-sized hydroxyapatite in situ study. Int. J. Paediatr. Dent. 2015, 25, 61–69.

55. Meyer, F.; Amaechi, B.T.; Fabritius, H.O.; Enax, J. Overview of Calcium Phosphates used in Biomimetic Oral Care. Open Dent. J. 2018, 12, 406–423.

56. Chapelle, N.; Ben Ghezala, I.; Barkun, A.; Bardou, M. The pharmacotherapeutic management of gastroesophageal reflux disease (GERD). Expert Opin.

Pharmacother. 2021, 22, 219–227.

57. Hunt, R.; Armstrong, D.; Katelaris, P.; Afihene, M.; Bane, A.; Bhatia, S.; Chen, M.H.; Choi, M.G.; Melo, A.C.; Fock, K.M.; et al. World Gastroenterology Organisation Global Guidelines: GERD Global Perspective on Gastroesophageal Reflux Disease. J. Clin. Gastroenterol.

2017, 51, 467–478.

58. Wilder-Smith, C.H.; Wilder-Smith, P.; Kawakami Wong, H.; Voronets, J.; Osann, K.; Lussi, A. Quantification of dental erosions in patients with GERD using optical coherence tomography before and after double blind, randomized treatment with esomeprazole or placebo. Am. J. Gastroenterol. 2009, 104, 2788–2795.

59. Wilder-Smith, C.H.; Materna, A.; Martig, L.; Lussi, A. Longitudinal study of gastroesophageal reflux and erosive tooth wear. BMC Gastroenterol. 2017, 17, 113.

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A Video-Game-Based Oral Health Intervention in Primary Schools—A Randomised Controlled Trial Ahmad Aljafari: Rawan ElKarmi, Osama Nasser, Ala’a Atef, Marie Therese Hosey

, correspondence:

ahmad.jafari@ju.edu.jo

Moscow, Russia; vs@mail.ru (S.V.L.); ru (P.A.B.);

valence and risk of GERD) compared to PubMed, EMBASE, searched for studies dates ranging from ics (the total sample number of patients ontrols (if available)) dies involving 4379 of DE was 51.524% rols. An association el (OR 5.000, 95% CI: only used validated studies that did not n the presence of DE n: The meta-analysis bout half of patients

dentistry journal

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Article

Dental News

Abstract Back ground: Poor oral health practices and high levels of dental caries have been reported among children in the developing world. Video games have been successful in promoting oral health in children. The aim of this study was to assess the impact of an oral-health-education video game on children’s dietary knowledge and dietary and toothbrushing practices; Methods: Two Schools in Amman, Jordan were randomly selected and assigned to either intervention or control. Six- to eight-year old children took part. The intervention group played the oral-health-education video game; the control group received no intervention. The groups were compared in terms of changes in: child dietary knowledge, dietary and toothbrushing practices, plaque scores, and parental familiarity with preventive treatments. Data were submitted to statistical analysis with the significance level set at p ≤ 0.05.

Results: Two hundred and seventyeight children took part. Most (92%) had carious teeth. At baseline, children reported having more than one sugary snack a day and only 33% were brushing twice a day. Most parents were unaware of fluoride varnish (66%) or fissure sealants (81%). At follow-up, children in the intervention group had significantly better dietary knowledge, and parents in both groups became more familiar with fluoride varnish. There were no significant changes in children’s plaque scores, toothbrushing and dietary practices, or parental familiarity with fissure

sealants in either group. Conclusions: Using an oral-health-education video game improved children’s dietary knowledge. However, future efforts should target children together with parents, and need to be supplemented by wider oral-health-promotion.

1. Introduction Dental caries affects a significant number of young children across the globe1 . Children in developing countries and those living with poor socio-economic circumstances in developed countries are more likely to be affected2. Jordan as a developing country, is no exception.

A previous study revealed that 76% of six-year-old and 46% of twelve-yearold children in Jordan have dental caries3 with no significant reduction over the last few decades4.Caries is a multifactorial disease that can be influenced by oral hygiene and dietary practices. Cariogenic foods and drinks are regularly consumed by most children in Jordan5. Only half report brushing their teeth once or more a day. In addition, dental attendance is poor, and usually only when in pain6.

Findings of a recent study suggest that lack of awareness of evidence-based dietary and oral hygiene practices is prevalent in Jordanian families7. In fact, the majority of parents do not recognise the importance of fluoride in toothpaste or the reduction of sugar intake frequency, and many had difficulties in identifying sources of sugar in their diet7. It is clear that children in Jordan are in need of oral health promotion. The World Quarter III

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A Video-Game-Based Oral Health Intervention in Primary Schools—A Randomised Controlled Trial

Health Organization’s (WHO) Ottawa Charter recommends the delivery of health education as part of health promotion8, and knowledge remains an essential component needed to achieve behaviour change9. Video games are easy to deliver, require less manpower, and have been successfully used to deliver education on a variety of education and health- related topics10 , 11 . An oral health education video game evaluated at a hospital was found to be as effective as a dental health educator in improving children’s recognition of healthy foods and drinks, and in reducing children’s sweetened drink consumption12, 13.

However, waiting until children attend for dental care to deliver oral health education is often too late, especially in countries and populations that attend only when in pain. As such, there is a need to explore whether video games can contribute to oral health education in other, non-clinical, settings. Most schools in Jordan have computer rooms with internet access, and 62% of the pupils reported that they have used those facilities during their education14. In addition, 75% of Jordanians own a smartphone, and 80% have access to the internet at their homes15. The aim of the current study was to evaluate whether introducing an oral health education video game at schools can improve children’s dietary knowledge and dietary and toothbrushing practices, and parents familiarity with preventive treatments including toothpaste, fluoride varnish, and fissure sealants.

As such, the null hypothesis for this study was that playing an oral health education video game does not lead to significant changes in children’s dietary knowledge, dietary habits, oral hygiene habits, or parental familiarity with preventive treatments.

2. Materials and Methods 2.1. Trial Design This was a two-armed prospective Randomised Controlled Trial (RCT). Two schools in Amman, Jordan were randomly selected then assigned into two groups: 1. Intervention group: children played an oral health education video game in school, and were given instructions to play the game at home.

2. Control group: Received no intervention. The study was registered in the ISRCTN registry (registration number: ISRCTN16292972,

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registration date: 25 February 2020). The Consolidated Standards of Reporting Trials (CONSORT) were applied to ensure thorough design and reporting. Procedures followed were in accordance with the Helsinki Declaration of 1975, as revised in 2000. Ethical approval was granted by Jordan University Hospital’s Institutional Review Board (reference number: 2019/176). Written parental consent was sought and both children and parents were informed that they did not have to answer any questions and could withdraw from the study at any time without giving an explanation and without any impact on their care.

2.2. Participants The target population was children in the first and second grade (six- to eight-years old) in Amman, Jordan. The inclusion criteria for the schools taking part were to: (i) be a school in Amman, Jordan, (ii) have both boys and girls, and (iii) have at least 120 students in first and second grade. The inclusion criteria for children were: (i) to be in first or second grade and (ii) to not suffer from a diagnosed learning disability.

Children absent from school on the day of data collection or whose parents declined to take part in the study were excluded.

2.3. Interventions Children in the intervention group played an oral health education video game in their school’s computer lab under the supervision of researchers ON and AAT. They were also given written and verbal instructions to download the game at home. Children in the control group did not receive any intervention. The video game was based on a previously developed Englishspeaking game 12.

The oral health education content was based on Public Health England’s (PHE) ‘delivering better oral health’16 and included recommending twice daily toothbrushing with at least a 1000 ppm fluoride toothpaste, reducing sugar frequency, promoting the ‘Eatwell Plate’ as well as promoting regular dental visits and the application of fluoride varnish and fissure sealant to the permanent molars of high caries risk children. The game maintained most of the ‘script’ of the English-speaking game. However, some changes and upgrades were necessary; Quarter III

A Video-Game-Based Oral Health Intervention in Primary Schools—A Randomised Controlled Trial

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2.3. Interventions in the Modern interventionStandard group played an oral (MSA), health education video game Children into in children are asked to classify into translation Arabic items that the 3 of 11 their school’s computer under the supervision ON and AAT. They were developing new labanimations andof researchers graphics, ‘healthy’ and ‘unhealthy’. also given written and verbal instructions to download the game at home. Children in the changing some food and drink items to make control group did not receive any intervention. them culturally suitable, furthertodevelopment ofat home.

2.4.2.

Secondary Outcome Measures also The given written and verbal instructions download the game Children the video game was based on a previously developed English-speaking gamein [12]. the original game’s ‘toothbrushing’ and ‘visiting 1.

Changes in dietary and toothbrushing practices control not receive any was intervention.

The oralgroup healthdid education content based on Public Health England’s (PHE) ‘deliverThe video game was based on a previously developed English-speaking game [12]. the dentist’ sections, and finally, the addition of reported by children using toothbrushing and diet ing better oral health’ [16] and included recommending twice daily toothbrushing with at The oral health education content wasreducing based on sugar Publicfrequency, Health England’s (PHE) least a 1000ppm fluoride promoting the‘delivering ‘Eatwell in-game rewards totoothpaste, positively reinforce healthy diaries. betteras oral health’ [16] and included recommending twice toothbrushing withvarnish at least Plate’ well as promoting regular prototype dental visits and the daily application of fluoride choices.

The developed was then the 2.

Changes in dietary practices reported by a 1000 ppmsealant fluoridetotoothpaste, reducing sugar frequency, ‘Eatwell as and fissure the permanent molars of high caries promoting risk children.

The gamePlate’ mainpiloted along with the study’s outcome measures parents using the Child Dietary Questionnaire well asmost promoting and the application of fluoride some varnish and fissure tained of the regular ‘script’ dental of the visits English-speaking game. However, changes and 17 inupgrades a convenience sample of seventeen children .

The CDQ measures dietary intake in four (CDQ) sealant towere the permanent of high risk Standard children. The game maintained most necessary;molars translation intocaries Modern Arabic (MSA), developing of the ‘script’ of the English-speaking game.

However, some changes and upgrades were and parents attending the dental department domains: Fruits and vegetables, sweetened drinks, new animations and graphics, changing some food and drink items to make them culturnecessary; translation into Modern Standard Arabic (MSA), developing new animations atally asuitable, large public hospital.

Participants would non-core foods, and fat from dairy. further development of the original game’s ‘toothbrushing’ and ‘visiting the and graphics, changing some food and drink items to make them culturally suitable, further dentist’ sections, and finally, the addition of in-game rewards to positively reinforce play the game on a smart device and examine 3.

Changes in children’s toothbrushing habits, development of the original game’s ‘toothbrushing’ and ‘visiting the dentist’ sections, and healthy choices.outcome measures, and then would and the study’s changes to parental recognition of finally, the addition of in-game rewards to positively reinforce healthy choices.

The developed prototype was then piloted along with the study’s outcome measures provide feedback.

The researchers recorded fluoride toothpaste concentration and in-office The developed prototype was then piloted along with the study’s outcome measures in a convenience sample of seventeen children and parents attending the dental departin a feedback convenience sample ofnotebook seventeen children andused parentssimple attending the dental department this in a then preventive treatments, recorded using a parental ment at a large public hospital. Participants would play the game on a smart device and at a largeanalysis public hospital.

Participants would play the game on a smartquestionnaire. device and examine content to note the participants’ opinions examine the study’s outcome measures, and then would provide feedback. The researchthe study’s outcome measures, and then would provide feedback. The researchers recorded ers recorded feedback in a game notebook and then used content analysis to note the and refinethis the video thesimple study’s 4. Changes in children’s plaque scores using the this feedback in a notebook then used simple content analysis to note the participants’ participants’ opinions andFigure refine the1video game and the study’s outcome measures.Oral Fig- Hygiene Index (SOHI)18. outcome measures. displays some parts Simplified opinions and refine the video game and the study’s outcome measures. Figure 1 displays 1 displays some parts of the game. ofure the game.

5. Number of children downloading and playing some parts of the game. the game at home recorded using Google and Unity developer tools.

2.4.3. Data Collection At baseline, children in both groups completed the PDQ under the researchers’ supervision to assess their dietary knowledge. They were also given diet and toothbrushing diaries, and a parental questionnaire to complete at home and return to the researchers. In addition, researcher (AA) performed an oral examination for children in both groups and recorded their dmft and plaque score. Three months after the intervention, the schools were revisited. Children from both groups were reexamined to note their plaque scores and the children completed the PDQ, diet and toothbrushing diaries, and parental questionnaire once again.

Figure1.1.The Thevideo videogame. game.

Figure

2.4. Outcomes 2.4.1. Primary Outcome Measures 1. Changes in children’s dietary knowledge recorded using a Pictorial Dietary Questionnaire (PDQ)12. The PDQ contains 70 food and drink

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2.5. The Dental Examination The examination took place in a well-lit room and the recommendations outlined by the WHO’s manual were followed19. The examiner (AA) noted the child’s decayed, missing due to caries, and filled teeth in primary dentition (dmft). Caries was recorded at the ‘obvious decay experience’ level, defined as ‘caries that can be visualised through the enamel or lesions where it has advanced to form a frank cavity’. No radiographs were taken for caries detection. The examiner also recorded the children’s plaque score according to the S-OHI17.

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A Video-Game-Based Oral Health Intervention in Primary Schools—A Randomised Controlled Trial 2.7. Randomisation and Blinding

Dent. J. 2022, 10, 90

To ensure examiner calibration, AA underwent a pilot process by examining and comparing dmft and plaque score results in a sample of six children with another well-experienced examiner (RE) prior to the commencement of the trial.

Inter-rater Kappa scores were 0.88 for caries and 0.70 for plaque score. Intra-rater Kappa score for caries for examiner AA was 0.94.

2.6. Sample Size Based on the results of a previous study13, the primary outcome measure’s (PDQ) expected mean score is 54.7, the expected standard deviation is 8, and the expected mean difference is 5.0. As such, a study with 95% power will require a total sample of 136 participants (68 per group) with completed datasets to compare between groups using a twotailed independent samples t-test at 5% level of significance.

2.7. Randomisation and Blinding A list of all schools in Amman fitting the inclusion criteria was obtained (121 schools). Computergenerated numbers were used to randomly select two schools to be invited to take part. The two schools were randomised into control and intervention groups using a simple computergenerated randomisation number. Researcher AA, who was responsible for performing the dental examination and contributed to data analysis, was blinded to group allocation. Only after data analysis was completed were group allocations revealed.

2.8. Statistical Methods All data were entered into SPSS 20. Descriptive statistics for all explanatory variables were recorded and provided overall and by study group. ShapiroWilk test was used to determine data normality for each continuous variable.

An Independent Samples Student t-test was used to compare the two groups whenever a normal distribution was present, while a MannWhitney-U test was used when the data did not follow a normal distribution. Paired Samples Student t-tests were used to compare baseline and follow-up scores for each group whenever a normal distribution was present. Chi-square test was used to assess differences in categorical variables between groups. Related Samples McNemar test was used to assess changes in

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Dental News

A list of all schools in Amman fitting the inclusion criteria was obtained Computer-generated numbers were used to randomly select two schools to take part. The two schools were randomised into control and intervention g simple computer-generated randomisation number. Researcher AA, who w for performing the dental examination and contributed to data analysis, w groupcomputer-generated allocation. Only afterrandomisation data analysis was completed were AA, group allocat simple number.

Researcher who was for performing the dental examination and contributed to data analysis, wa 2.8. Statistical Methods categorical variables baselinewere and group allocation.

Only after databetween analysis was completed group allocatio follow-up.

The significance level for all tests was All data were entered into SPSS 20. Descriptive statistics for all explana 2.8.

Statistical were and provided and by study group. Shapiro-Wilk tes set atrecorded p ≤Methods 0.05.

Data overall analysis was performed All datadata were entered SPSScontinuous 20. Descriptive statistics for all explanato determine for each variable.

An Independent Sam according tonormality the into intention-to-treat principle; were recorded and overall and by study group.

Shapiro-Wilk test t-test was all used to provided compare the twoto groups whenever a normal distribution data for those assigned either group were determine data normality fortest each continuous variable.

An Independent while a Mann-Whitney-U was used when the data did not follow aSam no included.

Outcome variables withwhenever more than 5% t-test used to compare the t-tests two groups a normal distribution tion.was Paired Samples Student were used to compare baseline and follw of values missing at test follow-up werethe handled using while a Mann-Whitney-U was used when data not follow a normal for each group whenever a normal distribution wasdid present.

Chi-square tes aPaired five-step multiple imputation.

Student t-tests were used between to compare baseline andSamples follow-uM assessSamples differences in categorical variables groups.

Related each whenever a normal distribution was present.

Chi-square testfo w wasgroup used to assess changes in categorical variables between baseline and assess differences in categorical variables between groups.

Related Samples M 3.

Results significance level for all tests was set at p ≤ 0.05. Data analysis was perform was to assess changesprinciple; in categorical between baseline and foll to used the intention-to-treat data variables for all those assigned to either gr significance level forvariables all tests was at p ≤ 0.05. analysis was performed cluded.

Outcome withset more than 5%Data of values missing at follow3.1.

Recruitment the intention-to-treat principle; data for all those assigned to either group we dled using a five-step multiple imputation.

Data collection took November Outcome variables with moreplace than 5%between of values missing at follow-up were ha 2019 and March 2020.

On 15 March 2020, the a 3. five-step multiple imputation.

Results

Jordanian government shut down schools for the Recruitment 3.3.1.

Results remainder of the school year due to the COVID-19 Data collection took place between November 2019 and March 2020.

3.1. Recruitment pandemic.

A total of 278 children were recruited 2020, thecollection Jordaniantook government shut down schools2019 for the of th Data place between November andremainder March 2020.

O (143 in the intervention group, 135 in the control duethe to the COVID-19 pandemic. total schools of 278 children were recruited (14 2020, Jordanian government shutAdown for the remainder of the sch group). group, 135 in the control Figure 2were details recruitment tovention the COVID-19 pandemic.

A totalgroup). of 278 children recruited (143 inand thed Figure recruitment data collection by group. group, 1352indetails the control group). Figure and 2 details recruitment and data collectio by group.

Figure Recruitment flowchart.

Figure 2. 2.

Recruitment flowchart.

3.2. Sample Description

3.2. Sample Description participants’ basic characteristics can be seen in Table 1. The children The The participants’ basic characteristics can be was 6.5 years (SD = 0.5). Dental examinations were performed for 244 child seen in Table 1.

The children’s mean age baseline. Two hundred and fourteen (88%) had caries in at was least one primar 6.5 years (SD = 0.5).

Dental examinations mean dmft score was 5.1 (range: 0–12, SD = 3.0). Parents ofwere 223 children (77% performed for 244 children (88%) at baseline.

Two hundred and fourteen (88%) had caries in at least one primary tooth. The mean dmft score was 5.1 (range: 0–12, SD = 3.0). Parents of 223 children (77%) completed parental questionnaires at baseline. The mean age of mothers was 35.1 Quarter III

A Video-Game-Based Oral Health Intervention in Primary Schools—A Randomised Controlled Trial

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parental questionnaires at baseline. The mean age of mothers was 35.1 (range: 21–50, SD = 6.35) while the mean age of fathers was 41.8 (range: 28–75, SD = 7.65) years.

Table 1. The participants’ basic characteristics.

Table 1. The participants’ basic characteristics.

Age dmft Mother’s age Father’s age First grade Second grade Male Female Both parents unemployed At least one parent employed Mother attended primary school only Mother attended secondary school or higher Father attended primary school only Father attended secondary school or higher

Intervention Group

Control Group

Mean ± SD

Mean ± SD

6.5 ± 0.5 5.3 ± 2.9 34.8 ± 6.6 41.8 ± 8.1 n (%) 69 (48%) 74 (52%) 77 (54%) 66 (46%) 12 (11%) 95 (89%) 32 (30%) 76 (70%) 40 (38%) 66 (62%)

6.5 ± 0.5 4.8 ± 3.0 35.4 ± 6.1 41.8 ± 7.3 n (%) 65 (48%) 70 (52%) 65 (48%) 70 (52%) 10 (9%) 98 (91%) 12 (11%) 96 (89%) 14 (13%) 94 (87%)

snacks a day (Range: 0–6 , SD = 0.9), while those in the control group had 1.6 sugary snacks a day (Range:the 0–6, SD at = baseline.

1.1). A total ofmean 147 children All children assigned to either group completed PDQ The score (69 intervention, 78 control) completed dietary 3.3. Children’s Dietary Knowledge of children in the intervention group was 56.5 out of 70 (Range: 38–66, SD = 5.9), while for All children assigned to either group completed diaries at the three-month follow-up. Children in the PDQ control group itThe wasmean 57.2 score (Range: 41–66, SDthe = 4.9).

Three months after thehaving intervention, intervention groups reported 1.1 sugary the at baseline. of children snacks a day post-intervention (Range: 0–3, SD = in the intervention group was 56.5 out of 70 261 children (130 Intervention, 131 Control) re-took the PDQ. Mean post-intervention PDQ 0.9), while those in the control group reported (Range: 38–66, SD = 5.9), while for the control score was 57.8 (Range: 36–68, SD = 6.3) in the intervention group, and 57.5 (Range: 41–66, group it was 57.2 (Range: 41–66, SD = 4.9). Three having 1.3 (Range: 0–6, SD = 1.0). There were SD = 5.1) in the group. improvement in the dietary knowledge of children in months after the control intervention, 261The children (130 no statistically significant difference between the intervention groupre-took was statistically significant (Pairedscores samples p = 0.019 *; 95% Intervention, 131 Control) the PDQ. Mean the groups’ at t-test follow-up (Independent samples Mann-Whitney-U test p = 0.12). post-intervention PDQ score was 57.8 (Range: CI = 0.21–2.35), unlike the control group (Paired samples t-test p = 0.60). An independent 36–68, SD = 6.3) in the intervention group, and samples t-test to compare the groups post intervention showed no statistically significant 57.5 (Range: 41–66, SD = 5.1) in the control group. 3.5. Parent-Reported Dietary Intake differences (p = 0.12).

The improvement in the dietary knowledge of Two hundred and twenty-three parents (72%) children in the intervention group was statistically completed the CDQ at baseline, detailing the significant (Paired samples t-test p = 0.019 *; 95% child’s food intake. One hundred and seventy3.4. Child-Reported Dietary Practices CI = 0.21–2.35), unlike the control group (Paired one parents (80 intervention, 91 control) reTwo hundred andAn five children (74%) completed three-day dietary at baseline. completed the CDQ at the diaries three-month followsamples t-test p = 0.60). independent samples Children in the intervention group had on average 1.2 sugarysamples snacks at-tests day (Range: up. Independent revealed 0–6, that t-test to compare the groups post intervention there were no statistically significant differences showed no statistically significant differences (p SD = 0.9), while those in the control group had 1.6 sugary snacks a day (Range: 0–6, between the groups in terms of food intake at = 0.12).

SD = 1.1). A total of 147 children (69 intervention, 78 control) completed dietary diaries at follow-up. the three-month follow-up.

Children in the intervention groups reported having 1.1 sugary Table 2 summarises the participants’ dietary 3.4.

Child-Reported Dietary Practices knowledge and practices before and after Two hundred and five children (74%) completed snacks a day post-intervention (Range: 0–3, SD = 0.9), while those in the control group three-day dietary diaries at baseline. Children in the intervention and notes the recommended reported having 1.3 (Range: 0–6, SD = 1.0). There were no statistically significant difference the intervention group had on average 1.2 sugary (range: 21–50, SD = 6.35) while the mean age of 3.3. Children’s Dietary Knowledge fathers was 41.8 (range: 28–75, SD = 7.65) years.

between the groups’ scores at follow-up (Independent samples Mann-Whitney-U test p = 0.12).

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Table 2. Participants’ dietary knowledge anddietary practices before afterbefore the intervention.

Table 2. Participants’ knowledge andand practices and after the intervention.

Domain Dietary knowledge

PDQ score

Control Intervention

Number of sugary snacks

Control Intervention

Fruits and vegetables (recommended ≥ 14) Dietary practices

Fat from dairy (recommended = 0) Sweetened drinks (recommended ≤ 1) Non-core foods (recommended ≤ 2)

Control Intervention Control Intervention Control Intervention Control Intervention

Baseline Mean ± SD

Follow-Up Mean ± SD

57.5 ± 5.1 57.2 ± 4.9 56.5 ± 5.9 57.8 ± 6.3 Intergroup difference at follow up p = 0.12 1.3 ± 1.0 1.6 ± 1.1 1.1 ± 0.9 1.2 ± 0.9 Intergroup difference at follow up p = 0.12 14.7 ± 5.3 13.4 ± 5.5 13.6 ± 5.9 14.1 ± 6.9 Intergroup difference at follow up p = 0.36 7.5 ± 4.9 6.7 ± 5.2 7.7 ± 5.3 7.6 ± 4.9 Intergroup difference at follow up p = 0.46 2.4 ± 1.7 2.5 ± 1.7 2.6 ± 1.8 2.5 ± 1.7 Intergroup difference at follow up p = 0.81 2.7 ± 1.3 2.8 ± 1.7 3.3 ± 1.6 3.1 ± 1.5 Intergroup difference at follow up p = 0.91

p-Value 0.60 0.019 * 0.20 0.92 0.06 0.61 0.25 0.95 0.84 0.62 0.65 0.57

* p ≤ 0.05.

CDQ score in each food category17 Two hundred and eighteen parents (78%) 3.6. Children’s Plaque Score 3.6. Children’s Plaque Score completed a questionnaire on the child’s oral Two hundred and had forty four children (88%) at hadbaseline. their plaque score recorded at baseline Two hundred and forty four children (88%) hygiene habits One hundred and sixty and at three-month plaque score at baseline was (Range:re-took 0.50–2.30, their plaque score recorded atthe baseline andfollow-up. at fiveMean parents (78 intervention, 871.16 control) SD = 0.30) in the intervention group and 1.09 (Range: SD = 0.39) in the control the three-month follow-up.

Mean plaque score the questionnaire at 0.20–2.20, the three-month follow-up. group.

At the three-month meanthere plaque score 1.17 (Range: 0.50–2.00, at baseline was 1.16 (Range: 0.50–2.30 , SD = follow-up, At follow-up, were nowas statistically significant SD = 0.29) the intervention group and 1.21between (Range: 0.33–2.00, SD study = 0.35) for the control 0.30) in the intervention group andfor1.09 (Range: differences the two groups in A Mann-Whitney U test was used compare the groups in terms (Chi-square of plaque score 0.20–2.20, SD = 0.39) in group. the control group. At terms of to toothbrushing frequency change at follow-up revealed statistically significant differences (p = 0.08). p = the three-month follow-up, mean plaque and score p =no 0.65), parental supervision (Chi-square was 1.17 (Range: 0.50–2.00, SD = 0.29) for the 0.51), or knowledge of fluoridated toothpaste 3.7. Child-Reported Toothbrushing Practices intervention group and 1.21 (Range: 0.33–2.00, SD concentration (Chi-square p = 0.14).

One hundred and ninety-one children (69%) completed toothbrushing diaries at = 0.35) for the control group. A Mann-Whitney U The children’s mean3.9. toothbrushing frequency was times a dayTherapies (range: 0–3, test was used to comparebaseline. the groups in terms of Parent’s Knowledge of1.7 Preventive SD = 0.44) in the revealed interventionTwo group,hundred and 1.3 times a day (range: 0–3, SD = 0.74) in the plaque score change at follow-up and and nineteen parents (79%) control group.(pOne hundred answered and forty children (54 intervention, control) completed no statistically significant differences = 0.08). questions regarding86their familiarity toothbrushing diaries at the three-month Mean toothbrushing frequency with cariesfollow-up. preventive treatment provided at thereported wasPractices 1.6 times a day (range: 0–3, SD =at 0.47) in the intervention group, and in the 3.7. Child-Reported Toothbrushing dental office baseline.

One hundred and sixtycontrol group 1.4 times a day seven (range: 0–3, SD = 0.80).

A Mann-Whitney test confirmed One hundred and ninety-one children (69%) parents (78 intervention, 89Ucontrol) restatistically significant between two groups in at toothbrushing frequency completed toothbrushing no diaries at baseline.

Thedifferences answered the the questionnaire the three-month at follow-up (p = 0.81).was follow-up. There was a statistically significant children’s mean toothbrushing frequency 1.7 times a day (range: 0–3, SD = 0.44) Toothbrushing in the increase 3.8. Parent-Reported Practicesin the percentage of parents reporting intervention group, and 1.3 times a day (range: familiarity with fluoride varnish at follow-up in Two hundred and eighteen parents (78%) completed a questionnaire on the child’s oral 0–3, SD = 0.74) in the control group.

One hundred both groups (intervention group Related Samples hygiene habits at baseline. One hundred and sixty-five parents (78 intervention, 87 control) and forty children (54 intervention, 86 control) McNemar test p = 0.035 *, Control group Related re-took the questionnaire at the three-month follow-up. At follow-up, there were no completed toothbrushing diaries at the three- SamplesMcNemar test p = 0.019 *). There was statistically significant differences between the two study groups in terms of toothbrushing month follow-up. Mean toothbrushing frequency also a significant improvement in the control frequency (Chi-square p = 0.65), parental supervision (Chi-square p = 0.51), or knowledge reported was 1.6 times a day (range: 0–3, SD = group’s familiarity with fissure sealants (Related of fluoridated toothpaste concentration (Chi-square p = 0.14).

0.47) in the intervention group, and in the control Samples McNemar test p = 0.002 *). group 1.4 times a day (range: 0–3, Knowledge SD = 0.80).

TableTherapies 3 summarises changes in children’s oral 3.9. Parent’s of Preventive A Mann-Whitney U test confirmed no statistically hygiene practices and parents’ familiarity with Two hundred and nineteen parents (79%) answered questions regarding their familiarsignificant differences between the two groups in preventive treatments before and after the ity with caries preventive treatment provided at the dental office at baseline. One hundred toothbrushing frequency at follow-up (p = 0.81). intervention. and sixty-seven parents (78 intervention, 89 control) re-answered the questionnaire at the 3.8. Parent-Reported Toothbrushing Practices

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three-month follow-up. There was a statistically significant increase in the percentage of Quarter III parents reporting familiarity with fluoride varnish at follow-up in both groups (intervention group Related Samples McNemar test p = 0.035 *, Control group Related Samples

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McNemar test p = 0.019 *). There was also a significant improvement in the control group’s familiarity with fissure sealants (Related Samples McNemar test p = 0.002 *).

Table 3 summarises changes in children’s oral hygiene practices and parents’ familiarity with preventive treatments before and after the intervention.

Table 3. Oral hygiene practices and familiarity with preventive treatments.

Table 3.

Oralparental hygiene practices and parental familiarity with preventive treatments.

Domain Oral hygiene practices

Plaque score

Brushing frequency

Child brushes twice or more daily Child brushes supervised Parent not sure of correct toothpaste concentration Parental familiarity with preventive treatments

Parent familiar with fluoride varnish Parent familiar with fissure sealants

Control Intervention Control Intervention Control Intervention Control Intervention Control Intervention Control Intervention Control Intervention

Baseline Mean ± SD

Follow-Up Mean ± SD

p-Value

1.09 ± 0.39

1.21 ± 0.35

0.01 *

1.16 ± 0.30 1.17 ± 0.29 Intergroup difference at follow up p = 0.08 1.3 ± 0.74 1.4 ± 0.72 1.7 ± 0.44 1.6 ± 0.47 Intergroup difference at follow up p = 0.81 n (%) n (%) 32 (29%) 35 (41%) 40 (37%) 32 (41%) Intergroup difference at follow up p = 0.65 17 (16%) 8 (10%) 15 (14%) 12 (15%) Intergroup difference at follow up p = 0.51 71 (65%) 56 (64%) 64 (59%) 42 (55%) Intergroup difference at follow up p = 0.14 38 (35%) 44 (49%) 36 (33%) 39 (50%) Intergroup difference at follow up p = 0.94 19 (17%) 30 (65%) 23 (21%) 17 (22%) Intergroup difference at follow up p = 0.001 *

0.29 0.60 0.65 0.14 0.99 0.13 0.99 0.82 0.06 0.019 * 0.035 * 0.002 * 0.99

* p ≤ 0.05.

3.10. Video Game Usage Patterns 4. Discussion One hundred and ten parents (77%) an in the intervention group answered a question Playing oral health promotion video game 3.10. Video Game Usage Patterns availability of a smart device at home for the child play the video game at school improved the tochildren’s dietary One hundred and ten regarding parents the (77%) in the intervention. Ninety-four of them (86%) indicatedas thatevident a device is available. only knowledge, by theirHowever, improved intervention group answered a question 39 participants (27%)device downloaded the game at homequestionnaire as noted by Google Play’son developer pictorial dietary scores followregarding the availability of a smart console.

Usingvideo Unity Developer tools it was noted that children spent a mean ofparental 8.20 min Participating in the study improved at home for the child to play the game up. (range = 0–18.32, SD = 5.15) playing the game every day in the first month, min intervention. familiarity with fluoride varnish and 4.44 fissure (range =indicated 0–20.18, SD = 6.30) adaily in the second month, andsample then 4.40 min (range = 0–15.28, Ninety-four of them (86%) that sealants.

The study is representative SD =only 5.47) 39 daily in the third month. device is available. However, participants of children in public schools in Jordan and

(27%) downloaded the game at home as noted the findings highlight the high prevalence of 4. Discussion

by Google Play’s developer console. Using caries and poor oral health practices in this oral health promotion video game at school improved the children’s dietary Unity Developer tools it was Playing noted an that children population. Children participating in the study knowledge, as evident by their improved pictorial dietary questionnaire scores on followspent a mean of 8.20 min (range = 0–18.32, SD were eating more than one sugary snack a up. Participating in the study improved parental familiarity with fluoride varnish and = 5.15) playing the game every day in the first day and consuming more sweetened drinks fissure sealants. The study sample is representative of children in public schools in Jordan month, 4.44 min (range = 0–20.18, SD = 6.30) and non-core foods and fewer fruits and and the findings highlight the high prevalence of caries and poor oral health practices in daily in the second month, and then 4.40 min vegetables than recommended17. Only a third this population. Children participating in the study were eating more than one sugary (range = 0–15.28, SD = 5.47) daily in the third were brushing their teeth twice a day and snack a day and consuming more sweetened drinks and non-core foods and fewer fruits month. most were unsupervised. Their parents were and vegetables than recommended [17]. Only a third were brushing their teeth twice a not Their sure parents of the correct toothpaste day and most were unsupervised. were not surefluoride of the correct fluoride concentration or the benefits of fissure sealant toothpaste concentration or the benefits of fissure sealant and fluoride varnish. Although and fluoride varnish.

Although the introduction the introduction of a standalone video game led to some improvement in children’s dietary of a standalone game led to habits, some knowledge, it did not lead to significant improvementsvideo in toothbrushing, dietary improvement in children’s dietary knowledge, it did not lead to significant improvements in toothbrushing, dietary habits, or plaque scores,

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suggesting that this type of intervention might be best provided within wider oral health promotion programmes that include other elements such as school toothbrushing20 and fluoride varnish application21. Furthermore, the importance of socioeconomic factors must be acknowledged. Our sample constituted of public school children in an urban area of a developing country. ‘Upstream’ action tackling socioeconomic determinants remains necessary22. Our findings confirm the results of a previous study that used an earlier version of the game 13, and are in line with the results of other studies investigating video game- based nutritional interventions23, 24 and smart phone application-based oral health interventions 25, 26.

Improvements in children’s dietary knowledge in this study were lower than those reported previously13. This is most likely because followup in the current study was significantly longer, although the difference in population and the change in setting from hospital to school could also be contributing factors. An improvement in parental familiarity with fluoride varnish was noted at follow up. This was likely due to the dentist visit itself motivating parents to learn more in terms of oral health. It is also possible that parents learned from re-doing the questionnaire, or that they were simply giving a socially desired answer 27. In a previous study, dentists cited parental motivation as a key barrier to preventive care delivery28. This underlines the importance of involving parents ‘directly’ in future oral health promotion efforts.

In our study, we could not measure how often the parents played the game with their child.

A previous study has found that families with less parental educational attainment had reduced engagement with a standalone home care computer game 29. The COVID-19 pandemic caused an acceleration towards online learning in Jordan and the world. This highlights the importance of developing digital, evidence-based, child-friendly oral health education that can be incorporated into schools’ online curriculums; however, our findings also raise questions whether some less affluent families can engage with such learning opportunities or are at risk of being left behind and missing schoolteacher support. Children need capabilities, including knowledge,

opportunity, and motivation in order to achieve behaviour change 9. Successful oral health promotion programmes incorporate a variety of interventions30. As such, providing a healthy school environment is needed for the success of future programmes in Jordan and similar developing countries. Video games can be used to provide knowledge and motivation on oral disease prevention in children and individuals under high risk, such as those undergoing orthodontic treatment, but they need to be part of wider approaches that advocate for stricter control of cariogenic foods in public schools and better in-school health facilities that can support toothbrushing programmes and fluoride varnish application. This study had its limitations. First, we had planned to roll out the study to a number of different schools, but data collection was interrupted by COVID-19related school closures. Second, some findings of this study could be due to the participants merely taking part in the study or coming into contact with the research team 27 . Third, some measures were self-reported, meaning that some might have given socially desired answers.

Nonetheless, we used a dietary questionnaire that was recommended for the targeted age group 31 and there is some evidence that childreported diaries are reliable32. Forth, study groups were randomly assigned on school level and not on participant level. However, this was important since assigning groups on a participant level would have risked sample contamination within schools. Finally, it would have been beneficial to track video game usage patterns by participant. However, that would have required participants to have usernames and passwords to log in; a step that we felt might deter some parents and children from using the game at home. The study also had its strengths.

First, care was taken during sample selection and blinding. Second, recruited families largely represent the population in terms of education and employment 33. Finally, as far as we are aware, this is the first evaluation of an evidencebased Arabic-language-speaking oral health video game.

A Video-Game-Based Oral Health Intervention in Primary Schools—A Randomised Controlled Trial

5. Conclusions Using a standalone oral health education video game in school leads to improved dietary knowledge in children that is retained for at least three months but does not result in behaviour changes in terms of dietary or oral hygiene practices. Future efforts should target children in settings where they are accompanied by parents and the oral health education delivered needs to be supported by wider oral health promotion.

Author Contributions: All authors have made substantive contribution to this study and/or manuscript, and all have reviewed the final paper prior to its submission. A.A. (Ahmad Aljafari) performed study supervision and design, data collection, data analysis, and manuscript writing; R.E. performed study design, data collection, manuscript writing; O.N. and A.A. (Ala’a Atef) performed data collection and analysis, M.T.H. performed study design and manuscript supervision. All authors have read and agreed to the published version of the manuscript.

Funding: This study was funded by The Borrow Foundation—United Kingdom (reference: University of Jordan/Video-game).

Institutional Review Board Statement: Ethical approval was granted by Jordan University Hospital’s Institutional Review Board (reference number: 2019/176; date: 08/08/2019). The study was conducted in accordance with the Declaration of Helsinki, and approved by the Institutional Review Board.

Informed Consent Statement: Informed consent was obtained from all subjects involved in the study.

Data Availability Statement: The datasets used and/or analysed during the current study are available from the corresponding author on reasonable request.

Conflicts of Interest: The authors declare no conflict of interest.

References 1. Petersen, P.E. The World Oral Health Report 2003: Continuous improvement of oral health in the 21st century-the approach of the WHO Global Oral Health Programme. Community Dent. Oral Epidemiol. 2013, 31, 3–24.

2. Marthaler, T.M. Changes in dental caries 1953– 2003. Caries Res. 2004, 38, 173–181.

3. Rajab, L.D.; Petersen, P.E.; Baqain, Z.; Bakaeen, G. Oral Health Status Among 6- and 12-year-old Jordanian Schoolchildren. Oral Health Prev. Dent.

2014, 12, 99–107.

4. Rajab, L.D.; Hamdan, M.A.M. Early childhood caries and risk factors in Jordan. Community Dent. Health 2002, 19, 224–229.

5. Sayegh, A.; Dini, E.; Holt, R.; Bedi, R. Oral health, sociodemographic factors, dietary and oral hygiene practices in Jordanian children. J. Dent.

2005, 33, 379–388.

6. Rajab, L.D.; Petersen, P.E.; Bakaeen, G.; Hamdan, M.A. Oral health behaviour of schoolchildren and parents in Jordan. Int. J. Paediatr. Dent. 2002, 12, 168–176.

7. ElKarmi, R.; Aljafari, A.; Eldali, H.; Hosey, M.T. Do expectant mothers know how early childhood caries can be prevented? A cross-sectional study.

Eur. Arch. Paediatr. Dent. 2019, 20, 595–601.

8. World Health Organization. An International Conference on Health Promotion: The Move Towards a New Public Health; Ottawa Charter for Health Promotion: Ottawa, ON, Canada, 1986.

9. Michie, S.; West, R. Behaviour change theory and evidence: A presentation to Government.

Health Psychol. Rev. 2013, 7, 1–22.

10. Vogel, J.J.; Vogel, D.S.; Cannon-Bowers, J.; Bowers, C.A.; Muse, K.; Wright, M. Computer Gaming and Interactive Simulations for Learning: A Meta-Analysis. J. Educ. Comput. Res. 2006, 34, 229–243.

11. Primack, B.A.; Carroll, M.V.; McNamara, M.; Klem, M.L.; King, B.; Rich, M.; Chan, C.W.; Nayak, S. Role of Video Games in Improving Health-

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Related Outcomes: A Systematic Review. Am. J. Prev. Med. 2012, 42, 630–638.

12. Aljafari, A.; Rice, C.; Gallagher, J.E.; Hosey, M.T. An oral health education video game for high caries risk children: Study protocol for a randomized controlled trial. Trials 2015, 16, 237.

13. Aljafari, A.; Gallagher, J.E.; Hosey, M.T. Can oral health education be delivered to high-cariesrisk children and their parents using a computer game?-A randomised controlled trial. Int. J. Paediatr. Dent. 2017, 27, 476–485.

14. Ministry of Education. ICT Use and Diffusion in Schools in Jordan; Ministry of Education: Amman, Jordan, 2012.

15. Pew Research Center. Social Media Use Continues to Rise in Developing Countries, but Plateaus across Developed Ones; Pew Research Center: Washington DC, USA, 2018.

Available online: https://www.pewresearch. org/global/2018/06/19/global-technology-useappendix-d-detailed-tables/ (accessed on 4 November 2021).

16. Public Health England. Delivering Better Oral Health: An Evidence-Based Toolkit for Prevention, 3rd ed.; Public Health England: London, UK, 2017.

Available online: https://assets.publishing.service. gov.uk/government/uploads/system/uploads/ attachment_ data/file/605266/Delivering_ better_oral_health.pdf (accessed on 4 November 2021).

17. Magarey, A.; Golley, R.; Spurrier, N.; Goodwin, E.; Ong, F. Reliability and validity of the Children’s Dietary Questionnaire; a new tool to measure children’s dietary patterns. Int J. Pediatr. Obes.

2009, 4, 257–265.

18. Greene, J.G.; Vermillion, J.R. The Simplified Oral Hygiene Index. J. Am. Dent. Assoc. 1964, 68, 7–13.

19. World Health Organization. Oral Health Surveys Basic Methods, 5th ed.; WHO: Geneva, Switzerland, 2013.

A Video-Game-Based Oral Health Intervention in Primary Schools—A Randomised Controlled Trial

20. MacPherson, L.M.D.; Anopa, Y.; Conway, D.I.; McMahon, A.D. National Supervised Toothbrushing Program and Dental Decay in Scotland. J. Dent. Res. 2012, 92, 109–113.

21. Weintraub, J.A.; Ramos-Gomez, F.; Jue, B.; Shain, S.; Hoover, C.I.; Featherstone, J.D.B.; Gansky, S.A. Fluoride varnish efficacy in preventing early childhood caries. J. Dent. Res. 2006, 85, 172–176.

22. Allen, M.; Allen, J.; Hogarth, S.; Marmot, M. Working for Health Equity: The Role of Health Professionals; UCL Institute of Health Equity: London, UK, 2013.

23. Baranowski, T.; Baranowski, J.; Cullen, K.W.; Marsh, T.; Islam, N.; Zakeri, I.; Honess-Morreale, L.; Demoor, C. Squire’s Quest! Dietary outcome evaluation of a multimedia game. Am. J. Prev.

Med. 2003, 24, 52–61.

24. Turnin, M.C.; Tauber, M.T.; Couvaras, O.; Jouret, B.; Bolzonella, C.; Bourgeois, O.; Buisson, J.C.; Fabre, D.; Cance-Rouzaud, A.; Tauber, J.P.; et al.

Evaluation of microcomputer nutritional teaching games in 1876 children at school. Clin. Trial 2001, 27, 459–464.

25. Jacobson, D.; Jacobson, J.; Leong, T.; Lourenco, S.; Mancl, L.; Chi, D.L. Evaluating Child Toothbrushing Behavior Changes Associated with a Mobile Game App: A Single Arm Pre/Post Pilot Study. Int. J. Clin. Pediatr. Dent. 2019, 41, 299–303.

26. Scribante, A.; Gallo, S.; Bertino, K.; Meles, S.; Gandini, P.; Sfondrini, M.F. The Effect of Chairside Verbal Instructions Matched with Instagram Social Media on Oral Hygiene of Young Orthodontic Patients: A Randomized Clinical Trial. Appl. Sci. 2021, 11, 706.

28. Aljafari, A.; ElKarmi, R.; Kussad, J.; Hosey, M.T. General dental practitioners’ approach to caries prevention in high-caries-risk children. Eur. Arch.

Paediatr. Dent. 2020, 22, 187–193.

29. Reynolds, P.A.; Donaldson, A.N.; Liossi, C.; Newton, J.T.; Donaldson, N.K.; Arias, R.; Haria, P.; Huntington, C.; Alharatani, R.; Hosey, M.T. How families prepare their children for tooth extraction under general anaesthesia: Family and clinical predictors of non-compliance with a ‘serious game’. Int. J. Paediatr. Dent. 2019, 29, 117–128.

30. MacPherson, L.M.D.; Ball, G.E.; Brewster, L.; Duane, B.; Hodges, C.-L.; Wright, W.; Gnich, W.; Rodgers, J.; McCall, D.R.; Turner, S.; et al. Childsmile: The national child oral health improvement programme in Scotland. Part 1: Establishment and development.

Br. Dent. J. 2010, 209, 73–78.

31. Roberts, K.; Flaherty, S.J. Review of Dietary Assessment Methods in Public Health; National Obesity Observatory: Oxford, UK, 2010.

32. Gil, G.S.; Morikava, F.S.; Santin, G.C.; Pintarelli, T.P.; Fraiz, F.C.; Ferreira, F.M. Reliability of self-reported toothbrushing frequency as an indicator for the assessment of oral hygiene in epidemiological research on caries in adolescents: A cross-sectional study. BMC Med. Res. Methodol.

2015, 15, 1–7.

33. Department of Statistics [Jordan] and ICF. Jordan Population and Family Health Survey 2017–18: Key Findings; Department of Statistics [Jordan]: Amman, Jordan; ICF: Rockville, MA, USA, 2019.

27. Parsons, H.M. What happened at Hawthorne?

New evidence suggests the Hawthorne effect resulted from operant reinforcement contingencies. Science 1974, 183, 922–932.

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Clinical Management of Interproximal and Occlusal Caries in Children and Adolescents How Often Are Dental Care Workers

by Canadian A SurveyCharacteristics Exposed toDentists: Occupational Community Anne-Marie Dentistry Moreau, DMD, MSc;

that Put Them at Higher Risk of Exposure management, the presence of Abstract cavitated enamel should be the main and Transmission of COVID-19?

pediatric dentist in private Purpose: practice in Quebec and a Early restorative interventions may Abstract former resident in pediatric have important implications in young dentistry at Université patients, and the International Caries Sonica Singhal, Introduction: Occupational characteristics de Montréal, Montréal, Classification and Management of dental care — including closed environBDS, MPH, PhD, FRCD(C) Quebec.public health dentist System strongly recommends ment, proximity to staff and patients nonand surgical strategies in the management the use of aerosol-generating procedures Sarah-Ève Dumais dental caries.

We risk aimed to assess — of put workers at high of COVID-19 sonica.singhal@mail.utoronto.ca management of interproximal Pelletier, DMD, MSc; exposure and transmission. We describe pediatric dentist at the and occlusal caries in situations children that and the frequency of workplace Children’s Dental Centre in potentially adolescents (≤18 years of age) by increase the risk of exposure to Queensland, Australia.

Canadian dentists.

COVID-19 in dental care compared with Christine Warren, MPH epidemiologist

Caroline Nguyen Ngoc, DMD, MS; assistant professor, department of restorative dentistry, faculté de PhD Erin Hobin, médecine dentaire,scientist Université de Montréal, Montréal, Quebec.

Pierre H. Rompré, MSc; Duy-Dat Vu, DMD, Brendan Smith,MSc PhD statistician, department scientist of stomatology, faculté de médecine dentaire, Université de Montréal, Montréal, Quebec.

other occupations including health care.

Methods: Methods: We conducted a cross-sectionelectronic survey was created and al An study using sociodemographic and ocsent to members of Canadian provincial cupational data from the 2016 Canadian regulatory dental bodies.

The survey census linked to workplace characteristics included 11 questions on demographic from the Occupational Information Netfactors and dataset.

3 clinical on work (O*NET) We situations assessed fredental caries management. quency of workplace indicators using an intensity score from 0 (low) to 100 (high) Results: from O*NET on exposure to infection or The response was 4.6% (n = 702). disease, physical rate proximity to others, inTo treat interproximal carious lesions door controlled environments, standard limited to enamel, 442 (63.0%) protective equipment anddentists specialized proreported using surgical caries removal tective equipment.

indication to restore, and non-surgical interventions for non-cavitated lesions confined to enamel should be prioritized. Results show that a good Inproportion respondents Results: 2016, 87 815 of Canadians worked have a lower restorative in the 5 dentistry occupations threshold, of interest: particularly for interproximal lesions. dentists; denturists; dental hygienists and

dental therapists; dental technologists, Dentaland caries is a multifactorial technicians laboratory assistants; and disease resulting from a poor dental assistants. These occupations were balanceranked between routinely in thedemineralization top 10 of all occuand examined remineralization tooth pations in terms of of exposure to 1 Studies show that caries structure. workplace indicators that increase the risk one of the most ofremain exposure to COVID-19.

Dentalcommon hygienists infectious diseases worldwide in the and dental therapists, dental assistants, 2 21st century.

In Canada, although dentists and denturists, rank as the top 4 the incidence oforder, dental has occupations, in that withcaries the highest decreased significantly in the last 40 exposure to disease or infection and physiyears, a quarter of children and more cal proximity to others combined. than half of adolescents still have Conclusions: Compared with other occu3 at least one carious tooth. pations, dental care workers are atClearly, a higher caries in children and adolescents risk of occupational exposure to COVID-19. remains a problem in dental practices These results support the development of worldwide, including Canada. workplace guidance to reduce the risk of Cariestransmission management an everCOVID-19 and is enhance the evolving field of research aimed well-being of the dental care workforce. at

improving knowledge in various on a permanent molar and 502 dentists therapeutic approaches. In the last (71.5%) did the same for a primary decade, there has been a paradigm fromhealth early caries tooth. For occlusal cariousislesions, the“for shift Occupational risk assessment a method estimating riskssurgical from exposure to 1 300 management to more conservative, corresponding numbers were various levels of a workplace hazard.” As workplace transmission was observed early in correspondence: non-restorative based dentists for a2permanent molar the COVID (42.7%) 19 pandemic, characterizing the role of the workplace approaches in COVID-19 exposure on the remineralization potential and 269 (38.3%) for a primary molar. duy.dat.vu@umontreal.ca and transmission became an important public health consideration.

Age, year of graduation and province of carious lesions confined to the 3 enamel or even those affecting of practice appear haveHealth a significant Republished from the Journal of Agencies, including theto World Organization, the Canadian Centre for Occupational 4 4restorative threshold.

5guidelines dentin.

As a result, new impact on the Health and Safety and the Centers for Disease Control and Prevention (CDC), emphasize the Canadian Dental Association for the to diagnosis and management the importance of understanding the risk of exposure and transmission of COVID-19 of interproximal and occlusal caries Conclusions: associated with varying occupations and implementing workplace safety or mitigation have been created to help dentists, According to the latest evidencestrategies accordingly.

All Rights Reserved based recommendations for caries including the well-known

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December 2021

Clinical Management of Interproximal and Occlusal Caries in Children and Adolescents by Canadian Dentists: A Survey

International Caries Management System.5

Classification

and

For any recommended change in treatment modality that require behaviour modification, it is reasonable to determine whether such recommendations are implemented in practice.

Surveys are common tools to assess the practice of health care professions. Several studies6-8 have been conducted to evaluate caries management in adults, many using the same survey to determine at which stage of carious lesion evolution dental practitioners decided on surgical removal of tooth structure. Treatment modalities were evaluated as well. Although there are fewer studies evaluating caries management in children and adolescents, a calibrated survey adapted for the pediatric population was recently used in France and Australia.6,9,10 In 1994, a study of the management of carious lesions on a first permanent molar of 12-year-old adolescents was conducted in Ontario.8 The purpose of our study was to assess management of interproximal and occlusal caries in children and adolescents by Canadian dentists, using a validated survey similar to those used in France and Australia, not only to establish a national baseline, but also to compare our findings with those of other countries. The secondary objective was to assess differences in treatment modalities relative to sociodemographic data.

Materials and Methods Using REDCap, an online protected server, available in English and French, we adopted a survey developed by Michèle Mullet-Bolla and Sophie Doméjean, lead authors of similar studies conducted in France and Australia; this survey has been validated.10 However, a few questions were adapted to better address demographic factors and newer caries management strategies. The main components, such as figures, photographs and radiographs, were not altered so as to conform as much as possible to the original survey for data comparison.

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Recruitment Strategy We contacted all Canadian provincial dental regulatory authorities and/or associations, asking them to send the survey to their members directly or in a newsletter. Thus, no email lists were sent to the research team. Dental regulatory authorities in Quebec, Ontario, Saskatchewan and Nova Scotia accepted the offer and sent the survey to their members. According to the most recent figures from the Canadian Dental Association (CDA) in 2013, there were 21,109 registered dentists in Canada. When we add up just the organizations that accepted our request, that resulted in 14,574 in 2013. With more recent figures from Quebec in 2016, the extrapolated numbers can reach up to about 15,029 for our sample size. To increase our sample size, the Canadian Dental Association also agreed to share the survey on its Online Advice & Searchable Information Service (Oasis) platform.

Survey Design and Variables Demographic data, collected in questions 1–8, included participants’ year of birth, gender, year of graduation, university of graduation, province of practice and practice environment, type of practice, level of training post-dentistry and frequency of treating children. Questions 9–11 served the main objective of the study: to determine at what stage of a carious lesion Canadian dentists treat caries by surgical removal of tooth structure in primary and permanent dentition. These questions consisted of clinical scenarios combined with radiographic representations and/or images corresponding to caries lesions 1–6, in the International Caries Detection and Assessment System (ICDAS).11 Collected data included choice of lesions where a restoration with caries removal would first be performed for interproximal and occlusal carious lesions on primary and permanent teeth, preparation techniques and restorative materials.

Responses were then analyzed in relation to the various sociodemographic factors.

Statistical Analysis A sample size of at least 402 respondents was needed, to provide a bilateral confidence interval of 0.1 based on a ratio of 0.5 and using the exact calculation method of Clopper-Pearson.

Quarter III

Furthermore, at the provincial or regional level, a sample of 104 dentists by province or region would give a confidence interval of 0.2 based on a ratio of 0.5. Data were saved on the secure REDCap server and exported into Excel 365 (Microsoft, Redmond, Wash., USA). SPSS v. 26 was used for statistical analysis using descriptive statistics with Χ2 tests and logistic regression analyses. The level of statistical significance was set at p < 0.05. The Χ2 test and logistic regression analyses were used to test a relationship between the stages at which participants will first remove dental caries and the independent variables, for both occlusal and proximal lesions. Residual traces and influence analysis were performed to highlight any discrepancies in the data that may need attention, to ensure that no errors were captured when the participant completed the survey. To ensure good data export, a minimum of 15 mock surveys was used in both English and French versions and excluded from analysis.

Ethics Approval Ethics approval was obtained from the Comité d’éthique de la Recherche en Santé of the Université de Montréal.

Results A total of 702 dentists completed the survey appropriately, yielding a response rate of approximately 4.6%. Participants ranged in age from 23 to 81 years (mean 49 years; Table 1). To obtain more statistically significant results, we grouped the western provinces (British Columbia, Alberta, Saskatchewan and Manitoba) and the eastern provinces (New Brunswick, Nova Scotia, Prince Edward Island and NewfoundlandLabrador). For university of graduation, participants were collapsed into 4 groups: Quebec, Ontario, other Canada and United States/international. Most participants (56.3%) treated children aged 6–15 years ≥ 5 times a week.

Younger children (<6 years old) were treated less frequently: 1–4 times a week.

Restorative Threshold Various stages of interproximal and occlusal carious lesions were illustrated and described to the participants (Figures 1 and 2). They were then asked to choose the earliest stage at which

they would intervene with restorative treatment (Figures 1 and 3). For interproximal lesions, 502 (71.5%) participants would intervene in a lesion confined to the enamel in a primary tooth and 442 (63.0%) would do the same for a permanent tooth. For occlusal lesions, most participants would intervene once a lesion has progressed into the dentin for both a primary tooth (432, 61.5%) and a permanent tooth (399, 56.8%).

Restorative Technique and Material For interproximal lesions, 383 (54.6%) participants favoured the traditional GV Black class II preparation technique for primary dentition, while 281 (40.0%) preferred a boxslot preparation. In the permanent dentition, 406 (57.8%) participants chose the box-slot preparation, and 212 (30.2%) chose the traditional class II preparation. For occlusal lesions, removal of carious tissue only was the most popular option in both primary (565, 80.5%) and permanent dentition (557, 79.3%).

For interproximal lesions on a primary tooth, dentists preferred to restore with resin-bonded composite (275, 39.2%), amalgam (240, 34.2%) and resin-modified glass-ionomer (75, 10.7%). On a permanent tooth, resin-bonded composite was greatly favoured (584, 83.2%) compared with amalgam (58, 8.3%). For occlusal lesions, resinbonded composite was again preferred over amalgam for a primary tooth (332, 47.3% vs. 207, 29.5%) and a permanent tooth (590, 84.0% vs.

40, 5.7%).

We found a significant difference in the use of amalgam for primary teeth in Quebec compared with other provinces (p < 0.001). In Quebec, for interproximal caries on a primary tooth, 78.6% (151/192) of responding dentists chose amalgam as a restorative material. In Ontario, only 12.6% (53/422) of dentists chose amalgam, compared with 55.2% (233) who preferred resin-bonded composite. Amalgam was also the first choice for dentists in both eastern and western provinces, but with lower percentages than Quebec, 44.0% (11) and 38.7% (24), respectively.

Caries Detection and Management on an Occlusal Surface Both photographic and radiographic representations of tooth 85 (Figures 4a and 4b) were presented to participants, who were

Clinical Management of Interproximal and Occlusal Caries in Children and Adolescents by Canadian Dentists: A Survey

asked to classify the occlusal lesion (no lesion, confined to enamel, extending into dentin). They were then asked to determine how they would treat it and which material they would use if they were to restore, no matter their treatment choice (Table 2).

We used multiple logistic regression analyses to assess all factors, but only the statistically significant findings are reported in Table 3. Odds ratios (with 95% confidence intervals) were used to show whether participants were more likely to delay restoration until the lesion had extended into dentin versus treating lesions confined to the Clinical Management Demographic Factors Influencing Restorative enamel.of Interproximal and Occlusal Caries in Children and Adolescents by Canadian Dentists: A Survey Thresholds Clinical Management of Interproximal andJ Occlusal in Children Can DentCaries Assoc 2022;88:m3 and Adolescents by Canadian Dentists: A 8, Survey March 2022

We used Χ2 analysis to assess the influence of demographic factors on the restorative thresholds for interproximal and occlusal carious Demographic characteristics of survey respondents (n = 702). lesionsTable in 1:primary and permanent dentitions.

Demographic factor

No. dentists (%)

Table 1: Demographic characteristics of survey respondents (n = 702).

Gender MaleDemographic factor Gender Female Male Location of practice Female Quebec Location Ontario of practice Quebec Western provinces Ontario Eastern provinces Western provinces Age group, years Eastern ≤ 35 provinces Age group, years 36–45 ≤ 35 46–55 36–45 > 55 46–55 Missing > 55 Missing

No.372 dentists (%) (53.0) 330 (47.0) 372 (53.0) 330 (27.4) (47.0) 192 422 (60.2) 192 62 (27.4) (8.8) 422 25 (60.2) (3.6) 62 (8.8) 25 (21.2) (3.6) 149 149 (21.2) 149 159 (21.2) (22.6) 149 239 (21.2) (34.0) 159 (22.6) 6 (0.9) 239 (34.0) 6 (0.9)

J Can Dent Assoc 2022;88:m3 March 8, 2022

Demographic factor Year of graduation Demographic 1989 and earlier factor Year of graduation 1990–1999 1989 and earlier 2000–2009 1990–1999 2010 and after 2000–2009 University of graduation 2010 and after Quebec University of graduation Ontario Quebec Other Canada Ontario USA and international Other Canada Practice environment USA and international Urban Practice environment Rural or remote Urban Missing Rural or remote Missing

No. dentists (%) No.239 dentists (%) (34.0) 155 (22.1) 239 127 (34.0) (18.1) 155 181 (22.1) (25.8) 127 (18.1) 181 (30.7) (25.8) 215 275 (39.2) 215 (30.7) 92 (13.1) 275 119 (39.2) (17.0) 92 (13.1) 119 (77.2) (17.0) 542 142 (20.2) 542 18 (77.2) (2.6) 142 (20.2) 18 (2.6)

Table 2: Participants’ assessment of carious status and choice of management of tooth 85 presented in Figure 4.

Assessment % (no.)

Table 2: Participants’ assessment of carious status and choice of management of tooth 85 Response presentedrate, in Figure 4.

Carious status (n = 702) Assessment No carious lesion Carious status (n 702) Lesion confined to =enamel No carious lesion into dentin Lesion extending Lesion confined to enamel Uncertain Lesion extending into dentin Treatment (n = 699) Uncertain None/follow-up Treatment (n = treatment 699) Topical fluoride (varnish, gel) None/follow-up Silver diamine fluoride Topical fluoride Fissure sealing treatment (varnish, gel) Silver diamine fluoride Prepare and restore carious part(s) only Fissure sealing Prepare and restore whole fissures Prepare restore carious part(s) only Materialand used if restoration (n = 670) Prepare and restore whole fissures Amalgam Material used if restoration (n = 670) Composite Amalgam Conventional GIC Composite Resin modified GIC Conventional GIC Combination of GIC and composite Resin modified GIC Compomer Combination of GIC and composite Other Compomer Note: GIC = glass ionomer cement.

Other

50

Note: GIC = glass ionomer cement.

Dental News

Response 6.3rate, (44)% (no.)

46.7 (328) 6.3 (44) 39.3 (276) 46.7 7.7 (328) (54) 39.3 (276) 7.7 (54) 11.1 (78) 13.2 (93) 11.1 10.1 (78) (71) 13.2 (93) 5.4 (38) 10.1(310) (71) 44.1 5.4 (109) (38) 15.5 44.1 (310) 15.5 (170) (109) 24.2 46.4 (326) 24.2 3.4 (170) (24) 46.4 12.7(326) (89) 3.4 3.3 (24) (23) 12.7 (89) 4.4 (31) 3.3 1.0(23) (7) 4.4 (31) 1.0 (7)

Quarter III

Clinical Management of Interproximal and Occlusal Caries in Children and Adolescents by Canadian Dentists: A Survey J Can Dent Assoc 2022;88:m3 March 8, 2022

Table 3: Demographic factors that were significantly related to a delay in the restorative threshold until a lesion had extended into dentin vs. treating lesions confined to the enamel for various types of teeth and lesions.

Independent factor

OR (95% CI)

p

0.238 (0.66–0.858)

0.028

36–45 vs. ≤ 35

1.907 (1.113–3.267)

0.019

> 55 vs. ≤ 35

2.003 (1.219–3.293)

0.006

10.302 (1.913–55.475)

0.007

36–45 vs. ≤ 35

0.605 (0.377–0.971)

0.037

> 55 vs. ≤ 35

0.617 (0.388–0.983)

0.042

1.842 ((1.306–2.599)

< 0.001

Ontario vs. Quebec

0.657 (0.449–0.962)

0.031

Other Canada vs. Quebec

0.516 (0.311–0.854)

0.01

International

0.436 (0.274–0.693)

< 0.001

Ontario vs. Quebec

0.608 (0.421–0.878)

0.008

East vs. Quebec

0.232 (0.097–0.555)

0.001

1989 and before vs. after 2010

0.610 (0.398–0.936)

0.024

1990–1999 vs. after 2010

0.572 (0.363–0.901)

0.016

2.054 (1.039–4.060)

0.038

Interproximal lesions on a primary tooth Province East vs. Quebec Age, years

Frequency of treating children aged 6–15 years Never vs. ≥ 5 times/week Interproximal lesions on a permanent tooth Age, years

Gender Female vs. male Occlusal lesions on a primary tooth University of graduation

Province

Occlusal lesions on a permanent tooth Year of graduation

Frequency of treating children aged 6–15 years Rarely vs. ≥ 5 times/week

Note: CI = confidence interval, OR = odds ratio. OR > 1 = more likely to treat lesions in dentin, OR < 1 = less likely to treat lesions in dentin.

Clinical Management of Interproximal and Occlusal Caries in Children and Adolescents by Canadian Dentists: A Survey

Clinical Management of Interproximal and Occlusal Caries in Children and Adolescents by Canadian Dentists: A Survey J Can Dent Assoc 2022;88:m3 March 8, 2022 Figure 1: Stage at which participants (%) chose to intervene with restorative treatment of interproximal caries in primary and permanent dentition.

%

• White/brownish discolouration in the enamel visible after air-drying

• White/brownish discolouration in the enamel visible without air-drying

• No cavitation

• Demineralization located in inner half of the enamel

• No radiographic signs of caries

• No radiographic signs of caries

• Localized enamel breakdown without visible demineralization in the dentin • No radiographic signs of dentinal involvement

• Underlying dark shadow from dentin • Carious lesion in outer third of the dentin on radiograph

• Distinct cavity with visible dentin • Carious lesion in middle third of the dentin on radiograph

• Considerable loss of tooth substance with possible pulpal involvement • Carious lesion in inner third of the dentin on radiograph

Primary tooth

Carious lesion description

Figure 2: Images and text descriptions provided to participants asked to report their restorative threshold for occlusal caries.

2

3

4

5

6

1

2

3

4

5

6

Permanent tooth

1

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Quarter III

and Adolescents by Canadian Dentists: A Survey J Can Dent Assoc 2022;88:m3 March 8, 2022 Clinical Management of Interproximal and Occlusal Caries in Children and Adolescents by Canadian Dentists: A Survey

Figure 3: Stage at which participants (%) chose to intervene with restorative treatment of occlusal caries in primary and permanent J Can Dent Assoc 2022;88:m3 dentition.

March 8, 2022

Figure 3: Stage at which participants (%) chose to intervene with restorative treatment of occlusal caries in primary and permanent dentition.

%

%

Figure 4a): Photograph of tooth 85.

Figure 4b): Radiographic image of tooth 85.

Figure 4a): Photograph of tooth 85.

Figure 4b): Radiographic image of tooth 85.

Discussion

similar proportions (Table 1). A higher response rate from dentists practising in Ontario and Discussion The aim of this study was to obtain the first Quebec was obtained because only a few other data set in Canada on the management of carious provincial regulatory authorities agreed to send by to thosetheir in themembers. other age categories in similar proportions The aim of this study was to obtainand the first data set in Canada lesions affecting primary permanent teeth onthefollowed survey Furthermore, of 1). Adentists higher response rate fromindentists practising in Ontario thechildren managementand of carious lesions affecting primary and permanentthe(Table in adolescents and to compare 21 109 practising Canada in 2013, Discussion 12 provincial andwere Quebec obtained because a few other teeth in children adolescents and to compare data based data based onand social demographic factors.

The on8912 in was Ontario and 4720only in Quebec. social demographic factors. response rate forlow this research response rate for thisThe research was (4.6%)was regulatory authorities agreed to send the survey to their members. followed the other age categories ininsimilar proportions The aim of this study other was obtain the first dataelectronic set in Canada on Furthermore, ofthis theinstudy 21,109 dentists practising Canada in 2013, low (4.6%) compared withtoother studies using surveys. compared with studies using electronic Resultsbyofthose show that most dentists 12 practising in Ontario (Tableto 1). A response ratein from dentists the management of carious lesions affecting primary and permanent 8912 were inhigher Ontario and 4720 Quebec.

For example, recent study Australia using same surveytend surveys.

Fora example, a in recent study intheAustralia treat interproximal carious lesions and Quebec wasrestore obtained lesions because only a few other provincial teethainresponse children andsurvey anda toresponse comparerate data based onsurgically had rate ofadolescents 8%.10 A better might have using the same had response rate of and confined to the 9 regulatory authorities agreed to send the tend survey to their members. social demographic factors.

Thethe response rate for have this research 10 obtained been by also mailing survey.

However, thisbeen was was notenamel: Results of70.9% this studyfor show most dentists to treat interproximal 8%. a that primary tooth and 62.6% A better response rate might Furthermore, of the 21,109 and dentists practising Canada into2013, low (4.6%) compared with other the studies usingwomen electronic 9 feasible because of limited funding.

Mensurvey. and weresurveys. almostforcarious lesions surgically restore lesions confined the a permanent tooth.

According tointhe latest obtained by also mailing However, 12 8912 were in Ontario 4720 in Quebec.

For example, a recent study in Australia using of the same survey equally represented (53.0% vs. 47.0%, respectively) in our study.

Therecommendations, enamel: 70.9% for a and primary tooth and 62.6% for a permanent the presence of cavitated this was not feasible because limited 10 had a response of women 8%.

A dentists better response rate might haveenamel 13 presence of response rate wasrate highest among > 55 years ofequally age, closely tooth. According to theindication latest recommendations, is the main to restore.the funding.

Men and were almost Nonbeen obtained by(53.0% also mailing survey.9 However, this was notcavitated Results of this study show that mostcan dentists to treat interproximal represented vs.the 47.0%, respectively) carious lesions betend treated with limitedresponse funding. Men and women were almostnon-surgical carious lesionsand surgically and restore methods, lesions confined infeasible our because study.ofThe rate was highest conservative suchto the represented (53.0% vs. 47.0%, respectively) study. Theas enamel: 70.9% for a primarypit tooth and 62.6% sealants for a permanent Jequally Can Dent Assoc 2022;88:m3 ISSN: 1488-2159 7 of 10 among dentists > 55 years of age,in our closely oral hygiene control, and fissure response rate highest dentistsage > 55categories years of age, closely tooth.

According to the latest recommendations, the presence of 14 followed bywas those inamong the other in and various forms of fluoride.

For interproximal

Clinical Management of Interproximal and Occlusal Caries in Children and Adolescents by Canadian Dentists: A Survey

caries, it is difficult to correlate the presence of radiolucent lesions with the presence of clinical cavitation. A study by Pitts and Rimmers15 showed cavitation in only 40.6% of permanent teeth with a radiolucency extending to the outer half of the dentin. In primary teeth, only 28.3% of teeth had a cavitation with a radiolucency extending to that level. For radiolucencies in the enamel, cavitations were present in 10.6% of permanent teeth and 2.9% of primary teeth.

Participants were more conservative when managing carious lesions on occlusal surfaces than on interproximal surfaces. An indication for surgical treatment of an occlusal carious lesion is the presence of a dentin shadow under the enamel (ICDAS code 4) or the presence of a cavitation (ICDAS codes 5 and 6).5 Most participants first intervened surgically for a lesion with an ICDAS code of 4 (Figure 3).

However, many dentists had an aggressive approach and reported surgically treating a molar with no carious dentin involvement: 38.4% on a primary tooth and 43.2% on a permanent tooth.

According to our multiple logistic regression analyses, dentists aged 36–45 years old and those > 55 years old were twice as likely to delay restoration until the lesion had extended into the dentin for interproximal caries on a primary tooth, compared with dentists aged ≤ 35 years. On the other hand, for permanent teeth, dentists 36–45 years old were less likely to delay restoration until the lesion had extended into dentin for interproximal caries than those who were ≤ 35 years old. Some reports in the literature demonstrate that younger dentists are less conservative,8,10 while others show that they are more conservative when treating dental caries.7,16 For interproximal and occlusal lesions, dentists in Quebec were more conservative than dentists in Ontario or eastern provinces.

In terms of university of graduation, dentists from Quebec universities were less aggressive.

A recent Canadian study on core cariology curriculum among the 10 accredited Canadian dental schools showed that all schools included

54

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teaching of non-surgical methods for treating dental caries. It concluded that harmonization of didactic and clinical teaching was necessary in all dental schools.17 This finding may explain the differences found between the different universities.17,18 Our results highlight the fact that there are barriers to the adoption of new recommendations on non-surgical techniques for dental caries.

First, the teaching of caries prevention and restoration has been found to be inconsistent between departments in medical schools. Most clinicians supervising students are part-time employees, and it has been shown19 that they often lack consistency. Problems have occurred with respect to student assessment systems in clinics. Students often receive more points for carrying out a restoration, or they have requirements to fufill.19 Thus, young dentists may continue habits learned in clinical practice at dental school, sometimes in opposition to what they learned didactically.

Other barriers have been identified in private practice. Dentists may be reluctant to accept change, sticking to old dogma. Practices can be overloaded and dentists may find that integration of new approaches takes too much time. Inadequate continuing education or the lack of encouragement to participate in continuing education in cariology may be another barrier. Patients may have certain expectations, lack openness to new therapeutic approaches and fail to comply with new approaches. Finally, barriers can be caused by the health care system or insurance coverage.

Most insurance coverage reimburses surgical treatments, but rarely supports prevention or new methods.20 Our results suggest that Canadian dentists choose a surgical approach earlier than Australian dentists. In Keys’ 2019 research,10 most respondents (55.5% for permanent dentition and 42.7% for primary dentition) surgically treated an interproximal carious lesion that had reached the internal third of the dentin. For occlusal lesions, Australian dentists were also more conservative: 62% first intervened surgically for an ICDAS code 4 lesion on a primary tooth and 53.8% on a Quarter III

permanent tooth.10 Other studies on permanent teeth also suggest that Canadian dentists are more aggressive in their treatment of dental caries.1,9,16,21 In one study, 60% of Ontarian dentists would have treated an interproximal lesion confined to the enamel of a permanent tooth in a 12 year old. For an occlusal carious lesion, they would do the same 62% of the time. Results are similar to those of our study, revealing that trends have not changed much in 25 years, even though knowledge in cariology has advanced tremendously.8 In our study, choice of techniques and materials varied according to the type of dentition and the province of practice. In primary dentition, the technique of choice was the traditional GV Black class II preparation. In permanent dentition, the more conservative boxslot preparation was favoured. It is encouraging to see that the new recommendations for minimally invasive preparations, such as the box-slot, were respected by most Canadian dentists for permanent teeth. These results are consistent with the widespread use of resin-bonded composites in permanent teeth, which can be placed in more conservative cavity preparations thanks to their bonding properties.22 The advantages of retaining more tooth structure include maintenance of pulp vitality, placement of more durable dental restorations and, ultimately, long-term retention of the tooth in the mouth.14 The more prevalent use of amalgam for primary molars in Quebec compared with Ontario can be explained by the dental coverage program offered by the Quebec government. This program only covers amalgam restorations for posterior teeth in children < 10 years of age. In Ontario, no such restrictions exist. This seems to indicate that despite the availability of more conservative material, Quebec dentists still use amalgam for the most part, given the coverage for their patients.

One limitation of this study is the low participation rate (4.6%), even with a 1-month reminder from the Quebec Order of Dentists to Quebec dentists. Results must be interpreted with caution given the selection bias and the possible low representation of the study

population. However, this study provides the first data on the management of interproximal and occlusal caries in primary and permanent dentition in children and adolescents in Canada.

A second limitation is the low representation of dentists from western and eastern Canada, with Quebec and Ontario dentists forming the large majority of our sample (87.6%). Another limitation is the fact that survey answers may differ from the actual practices of dentists. To prevent bias, there was no indication of what would be a “good” or “bad” answer in the survey; the questions were neutral and without judgement. The last limitation was the treatment options offered to survey participants. For example, when asked about the management of occlusal caries, choices of fluoride or pit and fissure sealant were available, but not a combination of these. This was deliberate, as we wanted to remain as faithful as possible to the original survey. The only change that was made in the clinical questions was the addition of silver diamine fluoride as a treatment option to reflect contemporary recommendations.23 Conclusion In summary, Canadian dentists appear to treat interproximal carious lesions more prematurely than recommended by current principles. There is a body of evidence supporting the removal of carious tissue and the placement of a restoration only in the presence of non-cleansable cavitated lesions. However, as only about 10% of interproximal lesions limited to the enamel will present a cavitation,15 it can be concluded that within the limitations of this study, a proportion of Canadian dentists have not integrated the latest evidence-based guidelines, resulting in less conservative practices when compared to other countries, such as Australia.10 Adoption of changes in the management of interproximal caries seems to be slower than that for occlusal caries. This study confirms the presence of barriers to the adoption of new recommendations, in this case, of non-surgical techniques for caries management.

Continuing education on conservative, nonsurgical interventions is available and should be encouraged by dental regulatory authorities and associations to facilitate diffusion of knowledge.

Clinical Management of Interproximal and Occlusal Caries in Children and Adolescents by Canadian Dentists: A Survey

References 1. Innes NPT, Schwendicke F. Restorative thresholds for carious lesions: systematic review and meta-analysis. J Dent Res. 2017;96(5):501-8.

2. Kassebaum NJ, Bernabé E, Dahiya M, Bhandari B, Murray CJL, Marcenes W. Global burden of untreated caries: a systematic review and metaregression. J Dent Res. 2015;94(5):650-8.

3. The state of oral health in Canada. Ottawa: Canadian Dental Association; 2017. Available: https:// www.cda-adc.ca/stateoforalhealth/ (accessed 2021 Dec. 2).

4. Innes NPT, Frencken JE, Bjørndal L, Maltz M, Manton DJ, Ricketts D, et al. Managing carious lesions: consensus recommendations on terminology. Adv Dent Res. 2016;28(2):49-57.

5. Pitts NB, Ismail AI, Martignon S, Ekstrand K, Douglas GVA, Longbottom C, et al. ICCMS guide for practitioners and educators. London, UK: ICDAS Foundation; 2014. Available: https://www.iccms-web. com/uploads/asset/59284654c0a6f822230100.pdf (accessed 2021 Dec. 2).

6. Doméjean S, Léger S, Maltrait M, Espelid I, Tveit AB, Tubert-Jeannin S. Changes in occlusal caries lesion management in France from 2002 to 2012: a persistent gap between evidence and clinical practice.

Caries Res. 2015;49(4):408-16.

7. Rechmann P, Doméjean S, Rechmann BM, Kinsel R, Featherstone JDB. Approximal and occlusal carious lesions: restorative treatment decisions by California dentists.

J Am Dent Assoc. 2016;147(5):328-38.

8. el-Mowafy OM, Lewis DW. Restorative decision making by Ontario dentists. J Can Dent Assoc.

1994;60(4):305-10,13-6.

9. Halawany HS, Salama F, Jacob V, Abraham NB, Moharib TNB, Alazmah AS, et al. A survey of pediatric dentists’ caries-related treatment decisions and restorative modalities — a web-based survey. Saudi Dent J. 2017;29(2):66-73.

10. Keys T, Burrow MF, Rajan S, Rompre P, Doméjean S, Muller-Bolla M, et al. Carious lesion management in children and adolescents by Australian dentists. Aust Dent J. 2019;64(3):282-92.

11. Pitts N. “ICDAS” — an international system for caries detection and assessment being developed to facilitate caries epidemiology, research and appropriate clinical management. Community Dent Health. 2004;21(3):193-8.

12. Dentistes autorisés à exercer au Canada en 2013, par province. Ottawa: Canadian Dental Association;

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2013. Available: https://www.cda-adc.ca/fr/services/ fact_sheets/dentistincanada.asp (accessed 2021 Dec. 2).

13. Ismail AI, Sohn W, Tellez M, Amaya A, Sen A, Hasson H, et al. The International Caries Detection and Assessment System (ICDAS): an integrated system for measuring dental caries. Community Dent Oral Epidemiol. 2007;35(3):170-8.

14. Schwendicke F, Frencken JE, Bjørndal L, Maltz M, Manton DJ, Ricketts D, et al. Managing carious lesions: consensus recommendations on carious tissue removal. Adv Dent Res. 2016;28(2):58-67.

15. Pitts NB, Rimmer PA. An in vivo comparison of radiographic and directly assessed clinical caries status of posterior approximal surfaces in primary and permanent teeth. Caries Res. 1992;26(2):146-52.

16. Chana P, Orlans MC, O’Toole S, Doméjean S, Movahedi S, Banerjee A. Restorative intervention thresholds and treatment decisions of general dental practitioners in London. Br Dent J. 2019;227(8):72732.

17. Tikhonova S, Girard F, Fontana M. Cariology education in Canadian dental schools: where are we? where do we need to go? J Dent Educ. 2018;82(1):3946.

18. Tikhonova S, Jessani A, Girard F, Macdonald ME, De Souza G, Tam L, et al. The Canadian core cariology curriculum: outcomes of a national symposium. J Dent Educ. 2020:84(11):1245-53.

19. Fontana M, Zero D. Bridging the gap in caries management between research and practice through education: the Indiana University experience. J Dent Educ. 2007;71(5):579-91.

20. McGlone P, Watt R, Sheiham A. Evidence-based dentistry: an overview of the challenges in changing professional practice. Br Dent J. 2001;190(12):636-9.

21. Espelid I, Tveit AB, Mejàre I, Sundberg H, Hallonsten AL. Restorative treatment decisions on occlusal caries in Scandinavia. Acta Odontol Scand.

2001;59(1):21-7.

22. The reference manual of pediatric dentistry: definitions, oral health policies, recommendations, endorsements, resources. Chicago: American Academy of Pediatric Dentistry; 2019.

23. Slayton RL, Urquhart O, Araujo MWB, Fontana M, Guzmán-Armstrong S, Nascimento MM, et al. Evidence-based clinical practice guideline on nonrestorative treatments for carious lesions: a report from the American Dental Association. J Am Dent Assoc. 2018;149(10):837-49.e19.

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NEWS

FAST AND EASY APPLICATION.

Meron Plus QM

Meron Plus QM – The real “Plus” for conventional luting Success CD Meron Plus QM

conditions such as those encountered with short cores. The working time of 2 minutes (from the •New Excellent adhesionfor to the dentalversion structure The material perfect temporary crowns and bridges paste-paste start of mixing) offers sufficient time for the luting • Precise marginal fit of both individual restorations and bridges. At the Success CD quick is PROMEDICA’s composite-based, self- High-quality restorations 5 minutes glass(self-adhesive) ionomer luting cement same time,temporary the products in thewithin Meron Plus range all •Resin-reinforced Secure and bonding curing paste-paste systemInfor quick and chairside a retention time flow of 30properties to 60 seconds in the oral in QuickMix syringe Meron Pluseasy QM, VOCO After boast outstanding without unwanted • Almost immediate removal of excess material production of temporary crowns, bridges, and cavity, the material takes on anmoisture elastic consistency, which is offering a resin-reinforced glass inlays ionomer flowing away and a high tolerance. thanks to optional short-time light polymerisation onlays. removal risking Once deformation. luting cement in a paste-paste version in the facilitates Meron Plus QM without is self-curing. the gelThe phase cures completely withinmaterial a further can 3 minutes and practical QuickMix syringe, naturally with all the material is achieved, the excess be removed then be polished. timesaving and also advantages of the tried-and-tested Meron Plus can simply and cleanly.This In procedure addition, is the curing can economical. products – from self-adhesion to the thin film thus be highly individually controlled when removing the excess. thickness right up to the continuous fluoride Simply cure the excess material for 5-10 seconds and Excellent physicalremove properties and great aesthetic results release. High adhesion values directly.

Source: Prof. Dr. Jürgen Manhart, Munich / Germany As far as the material’s physical properties are concerned, above those of a conventional Success CD convinces with its excellent flexural and glass ionomer luting cement For more information please contact VOCO‘s Business Development in overall strength as well as its capacity to withstand high ensure secure and reliable Middle East/Northern Africa, Mohamad El Fil (+961-3-805758 / m.elfil@voco.com). functional loads. hold even in unfavourable The product’s minimal polymerisation shrinkage results in precisely fitting temporary restorations. Success CD’s high colour stability and brilliant, enamel-like gloss Website : www.voco.dental ensure long-term aesthetic results. Moreover, its natural 25.04.2022 08:45:24 fluorescence and the choice of available shades promote perfect aesthetic results.

VOCO GmbH · Anton-Flettner-Straße 1-3 · 27472 Cuxhaven · Germany · Tel. +49 4721 719-0 · www.voco.dental

VOCO_DentalNewsArab_Jun22_MeronPlusQM_205x275.indd 1

website: www.promedica.de

TRISCAN triScan is an innovative intraoral scanner that cementum, pulp and the center of the tooth that captures extremely detailed images of the hard contains nerves, blood vessels and connective tissue. and soft, or non-calcified, tissues in and around These high realistic impressions help to diagnose and the gums and digitally transfers them to your plan any kind of specialized treatment as implants, computer. bridges, dentures, retainers, and crowns.

• High accuracy and precision TheraBase is a dual-cured, andtreatments fluoride releasing, It Light • Faster and lesscalcium invasive and compact structure of 216X40X36 is radiopaque allowing for effective identificationmm on and self-adhesive base/liner.

Its dual-cure ability ensures the material will • Automatic scanTheraBase clean-up contains MDP, radiographs.

246 g weight chemically bonds to tooth utilizes THERA • Complete and structure, precise and impressions in a cure even in deep restorations where light cannot reach! technology. few minutes.

TheraBase

website: www.bisco.com

The scanner generates a virtual model of the oral cavity that shows perfect details of the enamel, dentin,

Website :

www.trident-dental.com

15 CEREC AI have been installed to make CAD/CAM training a permanent feature from the start.

Dentsply Sirona equips Qatar’s first dental school with cutting-edge training tools to prepare the next generation of dental professionals Press Contact Krystel Winiker Villalobos Corporate Communications Manager Sirona Straße 1 5071 wals bei Salzburg, Austria T: +43 664 60097 612 krystel.winikervillalobos@ dentsplysirona.com

Contact

ker Villalobos Marion Par-Weixlberger ommunications Manager ße 1Vice President Public Relations & Corporate bei Salzburg, Austria Cimmunications 60097 612 Sirona Straße 1 ervillalobos rona.com 5071 Wals bei Salzburg,

Austira

arieTRautenberg +43 (0) 662 2450-588 mbH F +43 (0) 662 2450-540 er Str. 15 marion.parweixlberger@ n, Germany dentsplysirona.com 21829 058 na@edelman.com an.com

Weixlberger ent Public Relations & ommunications ße 1 bei Salzburg, Austria 62 2450-588 58 Dental News 62 2450-540

Qatar University, the country’s primary institution for higher education, is partnering with Dentsply Sirona to equip the university’s brand-new preclinical lab at the newly founded College of Dental Medicine. Dentsply Sirona is providing state-of-the-art simulator workstations, instruments, as well as the latest CEREC and inLxab software systems to prepare students for the digital future of dentistry.

Universities and large clinics around the world have entrusted Dentsply Sirona’s International Special Clinic Solutions (ISCS) division and its comprehensive approach to achieve their specific goals. When Qatar University’s College of Dental Medicine in Doha, envisioned their brand-new preclinical laboratory, they worked with Dentsply Sirona’s team to comprehensively equip it with state-of-the- art technology to prepare students for dentistry’s digital future.

32 Sim Intego workstations plus two additional instructor units now offer the best possible learning environment following the latest technological advancements.

Additionally, 15 CEREC AI units and the inLab system will be used to support future dentists in their training for highly specialized procedures.

“The new College of Dental Medicine at Qatar University sees it as part of its core mission to incorporate digital technologies and the latest advancements into its teaching. Thanks to Dentsply Sirona’s innovative products and team of experts we were able to create a future-proof training environment,” said Dr. Hanin Daas, Director of Dental Laboratories at Qatar University.

Preparing for the future of dentistry on cutting-edge equipment All products installed at the University of Qatar have been designed and produced in Germany using particularly robust and durable materials that are ideal for a Quarter III

Press Release

university setting. The state-of-the-art Sim Intego workstations in the preclinic allow students to train in practice-like conditions. Sim Intego includes key components of treatment centers such as the dentist element so that students already familiarize themselves with the actual treatment process in their preclinical semesters.

Furthermore, the university also opted for the lightweight T1 line instruments series. These easyto-handle instruments help ensure the College of Dental Medicine is able to deliver the best training of correct instrumentation techniques to deliver optimal results.

The International Special Clinic Solutions team selected the ideal product mix for Qatar University to fulfill their plan to make the most modern learning tools available to their students.

During the preclinical training, CEREC and inLab systems will prepare the students for using CAD/ CAM technology in dentistry. Additionally, staff will be supported by a multimedia teaching system designed to enhance communication and to give students the best view of demonstrations at the master workstation. With a one touch button, it is possible to share real-time, highquality images from any device on any screen in the classroom.

Dentsply Sirona is proud to have been selected

by Qatar University to help turn their vision of educating world-class dental professionals and the nation’s first graduates of dental medicine into a reality. In consultations for the preclinic area, the International Special Clinic Solutions team discussed the university’s ideas and goals thoroughly and addressed each individual requirement in detail. The engineering team in Germany then developed a custom-made concept that delivers the required portfolio from start to finish.

The College of Dental Medicine’s preclinical lab educates students in the basics of clinical dentistry before they practice on actual patients.

The new lab provides a technologically advanced environment to train students in digital dentistry thus ensuring that the next generation of dental practitioners are well prepared to meet the demands of the future.

Dentsply Sirona

The state-of-the-art multimedia collaboration system links all workstations. It gives students a great view on individual monitors and facilitates image and video transmission of intraoral scanners,microscopes, and cameras.

The newly founded College of Dental Medicine at Qatar University selected Dentsply Sirona to equip its preclinic area.

About Dentsply Sirona Dentsply Sirona is the world’s largest manufacturer of professional dental products and technologies, with over a century of innovation and service to the dental industry and patients worldwide. Dentsply Sirona develops, manufactures, and markets a comprehensive solution offering including dental and oral health products as well as other consumable medical devices under a strong portfolio of world class brands.Dentsply Sirona’s products provide innovative, high-quality and effective solutions to advance patient care and deliver better and safer dental care.

Dentsply Sirona’s headquarter is located in Charlotte, North Carolina.

The company’s shares are listed in the United States on NASDAQ under the symbol XRAY. Visit www.dentsplysirona.com for more information about Dentsply Sirona and its products.

Innovation

X-VIEW 2D PAN CEPH The 2-in-1 model of the X-VIEW family, is a multifunctional and integrated system that puts the advantages of 2D and cephalometric imaging within the reach of the general dentists, periodontists, orthodontics and other specialists working from medium offices to hospitals and clinics.

X-VIEW 2D PAN CEPH incorporates a high-frequency generator and a noise- and imperfection-free acquisition system, providing high quality clinical images.

CCD-TDI detector X-VIEW 2D offers the inherent advantages of CCD (Charge-coupled devices) to capture panoramic images of the skull and jaw with excellent resolution in less time and lower patient exposure: noiseless charge transfer, high signal-to-noise ratio and the unique features of time-delay integration (TDI): • Capturing clear and bright images with the best possible contrast and uniform density.

• Increased sensitivity for signal detection at lower light levels.

• Larger full-well capacity to provide high dynamic range.

Two detectors for Workflow optimization In addition to the CCD-TDI detector for all 2D programs, X-VIEW 2D PAN CEPH is equipped with a dedicated DR flat panel detector for Ceph images acquisition.

The DR (Digital Radiography) version is the highest quality technology available to obtain sharp images:

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• Better contrast • More details and filtering • No background disturbance • Exposure time: 200-500ms • Reading time: immediate • Detector-PC image transmission: 2sec • Image store after shot: 200 • Calibration Method: easy intuitive and manageable from remote

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Advanced Software Technology MITO is the most advanced software to acquire and manage 2D images, as it can be universally used and integrated to all clinical management software and DICOM network imaging devices, offering a smart and high-performance work environment.

Mito is configurable to meet every need of doctors, radiologist or dental clinics.

X-VIEW X-VIEW

DFO: Dental - Facial – Orthopedics

2DPAN PAN 2D CEPH CEPH

Trident offers, as an optional, this functional tool for orthodontic tracing and cephalometric analysis Just run DFO and set all the points needed to complete your analysis which will be automatically calculated and drawn on the screen.

Quick and easy patient positioning Make difference!

Make a adifference!

Makethat thatchange change Make

X-VIEW 2D PAN CEPH adapts to all size and type of patient, its linear and open design eases the access to wheelchair users

Programs • • • • • • • •

Digital Panel | Single | 200 msExposure of Exposure Digital Flat Flat Panel | Single ShotShot | 200 ms of TimeTime

Adult/Child Standard Panoramic Adult/Child Hemi Panoramic Frontal Dentition TMJ closed/open mouth 2D Sinus LL CEPH 30 x 24 AP CEPH Carpus

Optional: • • • • •

Reduced Dose Improved Orthogonality Right Bitewing Left Bitewing Right and Left Bitewing

Artigiani 4 - Castenedolo, 25014 - Italy Via Via Artigiani 4 - Castenedolo, 25014 BS - BS Italy Tel030 39 030 2732485 | www.trident-dental.com Tel 39 2732485 | www.trident-dental.com

NEWS Success CD The material for perfect temporary crowns and bridges Success CD is PROMEDICA’s composite-based, selfcuring paste-paste system for quick and easy chairside production of temporary crowns, bridges, inlays and onlays.

High-quality temporary restorations within 5 minutes After a retention time of 30 to 60 seconds in the oral cavity, the material takes on an elastic consistency, which facilitates removal without risking deformation. The material cures completely within a further 3 minutes and can then be polished. This procedure is timesaving and thus highly economical.

Excellent physical properties and great aesthetic results As far as the material’s physical properties are concerned, Success CD convinces with its excellent flexural and overall strength as well as its capacity to withstand high functional loads.

The product’s minimal polymerisation shrinkage results in precisely fitting temporary restorations. Success CD’s high colour stability and brilliant, enamel-like gloss ensure long-term aesthetic results. Moreover, its natural fluorescence and the choice of available shades promote perfect aesthetic results.

website: www.promedica.de

TheraBase TheraBase is a dual-cured, calcium and fluoride releasing, self-adhesive base/liner. TheraBase contains MDP, chemically bonds to tooth structure, and utilizes THERA technology.

It is radiopaque allowing for effective identification on radiographs. Its dual-cure ability ensures the material will cure even in deep restorations where light cannot reach!

website: www.bisco.com

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Boost your medical tooth whitening treatments Material-viscosity as key factor for controlled procedures and effective results Patient cases requiring medical tooth whitening protocols are frequently challenging.

Medical whitening procedures are used to treat obvious intense discoloration inside the tooth, e. g. as a result of diseases, drugs, tooth malformations and bleeding after accidents or trauma. These kinds of discolorations typically do not affect the entire arch, but only one or several teeth.

Studies by Prof. Polydorou (Freiburg/Germany) have shown, that it is appropriate in such cases, to use a higher concentration of peroxide. The studies regarding safety aspects show additionally, that these treatments maybe considered to be absolutely safe, as they are executed under the full supervision of the practice team.

In order to achieve the best results, it is vital to have suitable procedures in place, supported by perfectly matching products, thus enabling the clinician to proceed in a controlled, yet effective way. Talking about effectiveness and the highest level of control, the viscosity of the whitening product used plays an important role: It is key for precise application, for reliable handling and consequently for convincing results.

For many years, OpalescenceTM BoostTM with 40% hydrogen peroxide has been the state-of-the-art power whitening solution for bespoke medical inoffice treatments. The whitening gel is suitable for the treatment of one or more teeth, parts of a tooth or for accelerated chairside-whitening techniques. It can also be used on non-vital teeth, including in-office intracoronal whitening.

As part of Ultradent Products’ continuous commitment to research and development, Opalescence Boost has been reformulated in order to further improve its performance, usability, consistency and viscosity. The updated material with its higher viscosity provides for advanced handling properties and a more precise placement. Consequently, the newly formulated gel reliably stays in place during the entire treatment.

The re-designed mixing syringes incorporating a gold element, deliver fresh chemicals for each application. A short treatment time of 2 x 20 minutes is sufficient to achieve excellent whitening results. Opalescence Boost’s new improved viscosity means that it should no longer be applied with Micro 20ga and MicroTM 20ga FXTM Tips.

Ultradent Products’ well-known BlackTM Mini Tips ensure easy expression of the more viscous formula and are therefore perfectly suitable for its accurate placement.

Unlike other in-office whitening products, Opalescence Boost is chemically activated and consequently does not require activation by expensive, hot and uncomfortable lights. Due to its high concentration of 40% hydrogen peroxide, Opalescence Boost is categorized as a medical device product*). Despite its high content of active ingredients, Opalescence Boost is pH neutral. Thus, the tooth structure will not be affected, even when used repeatedly. Opalescence Boost also contains PF (potassium nitrate and fluoride) to strengthen the enamel and to reduce sensitivity. If an activated gel syringe is not completely used, the contents remain active for up to 10 days if stored in a refrigeretor.

Chairside whitening, the fastest, most targeted and controlled method of tooth whitening can be performed effectively, safely and economically with Opalescence Boost in its new formulation. Once the teeth have been whitened, the patients usually show an increased awareness for their general oral health. They demonstrate their appreciation for the treatment by their loyalty to the dental practice and by good oral hygiene. What more could a professional wish for?

website: www.ultradent.com

LEBANESE SOCIETY OF PEDIATRIC DENTISTRY

The LSPD Scientific Meeting 2022 MARCH 31, 2022 LA MARINA-DBAYEH, LEBANON

View More Pictures On facebook.com/dentalnews1

Photo from the Opening Ceremony

We finally are reunited. After two years of stress, of fear and anxiety, we are back to our scientific meetings. For me everything started here, at Saint Joseph university where I was nominated to be a member of the executive board of the Lebanese Society of Pediatric Dentistry and later on vice-president. I take advantage of this occasion to express all my gratitude to my university and especially our Dean, Professor Nada Mchayleh. I also want to thank our chief of department Pr. Jean-Claude Abou Chedid and my great friend Dr. Marlene Khoury for proposing me to be vice president. I’m also thankful to all my friends in the department and all the former presidents that I previously worked with. Bechara we haven’t had the occasion to thank you for your mandate for the positive vibes that were present during those 3 years. Your passion for the society and your never ending efforts during those three years were precious for our society. On behalf of the executive board we thank you and we wish you a future full of success.

We accept the challenge and we are organizing this meeting and we chose this poster to say that despite all the misfortune and malpractice that happened to our beloved country, Beirut will rise from its ashes by walking the stairs step by step to reconstruct itself.

Dr. Sandra Dagher : President of the Lebanese Society Of Pediatric Dentistry

Prof. Ronald Younes, President of the Lebanese Dental Association

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Dr. Sandra Dagher, President of the L ebanese S ociety of P ediatric D entistry

Dr. Bechara Al Asmar

Prof. Samia Abou Jaoudeh

receiving a trophy from

Dr Sandra Dagher

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Prof. Riad Bacho receiving a certificate from Dr. Camille Samneh after his lecture:

Medical emergencies related to conscious sedation

Dr. Daniel Kahale receiving his certificate from Dr. Ahmad Tarabay (right)

Dr. Sami Jade lecturing about Medical emergencies related to daily procedures

Left to right: Drs. SamiJade, Elyse Jade, Georges Abi Hatem, Bourane Ambriss, Samia Abou Jaoudeh

Left to right : Tony Harb, Sami Rifai, Tony Dib, Sandra Dagher, Ronald Younes Michel Salameh, Sami Jade, Camille Samneh

Cake cutting by the LSPD members at the Dbayeh Marina Club

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LEBANESE SOCIETY OF ENDODONTOLOGY

LEBANESE SOCIETY OF ENDODONTOLOGY 2022

The Future is Now

MEET US AT OUR ANNUAL INTERNATIONAL MEETING

JUNE 3-4, 2022 HILTON BEIRUT HABTOOR GRAND HORSH TABET, LEBANON

3-4 June 2022

HILTON BEIRUT HABTOOR GRAND HORSH TABET

View More Pictures On facebook.com/dentalnews1

FOR MORE INFO +961 70 142 438

17TH INTERNATIONAL SCIENTIFIC MEETING www.lse-lebanon.org

Picture from the opening ceremony with a full house attendance On behalf of the Lebanese Society of Endodontology I would like to welcome you to our annual 17th international meeting entitled «The Future is Now» 6, 7 march 2020, in the peak of the pandemic we gathered in our annual meeting and it was the last physical meeting in Lebanon.

In September 2021, we accepted another challenge and raised the bar. The LSE team organized the successful international congress of Asian Pacific Endodontic Confederation APEC that gathered around 48 lecturers and more than 350 participants, online and physical.

This year and in spite that we are in the middle of an economic and political crises in the country, we did not resign and we decided to never lower the level and we organized with the collaboration of the prestigious companies (Zarc, Dentsply, Bondent, FKG, Coltene) this meeting gathering 6 top notch speakers from all over the world.

Roberto Estevez from Spain, John West from the USA , Nuno Pinto from Portugal, James Prichard from the UK, Antonis Chaniotis from Greece and Taha Ozyurek from Turkey…Thank you all for your presence and thanks for sharing your knowledge Thank you Mr. Agustin Sanchez Duran representing Zarc4endo company for your second time sponsoring LSE and thank you for believing in us.

Dentsply Sirona and its dealer Pharmacol

Prof. Ronald Younes, President of the Lebanese Dental Association

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Prof. Edward Rizk, President of the Lebanese Society of Edodontology-LSE

Prof. Carla Zgheib, Scientific committee

Prof. Fadl Khaled, Vice president of the LS

chairman

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LSE Congress 2022 JUNE 3-4, 2022

International companies present by their speakers Bondent, FKG and Coltene and all the local dealers…many thanks to you all for your confidence and strong participation.

Thank you President of the Lebanese Dental Association Professor Ronald Younes for your patronage and your presence.

Thank you to the scientific committee and the continuing education committee for their appreciation and accreditation.

Another thanks to the universities and the deans who gave a day off today giving the opportunity to the students and instructors to attend this high level event.

Not to forget the endodontic community and the endolovers believing in the society and its work. A community that was always present and made the biggest support to us.

Finally…»never change a winning team» Thanks to all new board members who worked hard to make this event successful As we always say our society aims always for the best and tends to reach the moon and if not land among the stars.

Please enjoy this event; the lovely venue, the big exhibition (and of course nice food) and please take advantage of the high level scientific program …welcome to you all.

Prof. Edward Rizk, President of the Lebanese Society of Endodontology - LSE

Drs: Carla Zgheib, Edward Rizk, Marc Kaloustian

ZARC booth at the LSE 2022 meeting

Drs.: Tony Dib, James Prichard, Carla Zgheib, Ghada Bassil at the FKG booth

Prof. Edward Rizk with Prof. James Prichard from the UK

Left to right Drs: Aysar Hijazi, Fadl Khaled, Jamal Honeine, Prof. Essam Osman, Edward Rizk, Ronald Younes, Drs: Ghada Bassil, Tony Harb

Left to right: Tony Dib, Tony Harb, Ronald Younes, Edward Rizk, Ghada Bassil, Amin Zoghby

Dr. Sandra Dagher, Prof. Nada Mchayleh, Dr. Paula Ojeil, Prof. Charbel Allam

Professors: Joe Sabbagh, Edward Rizk, Tony Zeinoun

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‫‪NORTH INTERNATIONAL DENTAL‬‬ ‫‪CONGRESS 2022‬‬ ‫‪BEYOND THE CHALLENGES‬‬ ‫‪JUNE 9 - 10 - 11, 2022‬‬ ‫‪BEIRUT ARAB UNIVERSITY - TRIPOLI CAMPUS‬‬

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‫‪Picture of the lecture hall during the opening ceremony‬‬

‫الموتمر‬ ‫كلمة النقيب الدكتور ناظم ح ّفار في ٔ‬ ‫حضرة راعي مؤتمرنا دولة الرئيس نجيب ميقاتي ممثالً بمعالي وزير السياحة السيد وليد نصّار سعادة النواب والنقباء وضيوفنا النقباء العرب‪ .‬حضرة‬ ‫رئيس جامعة بيروت العربية المستضيفة لهذا المؤتمر ممثالً بنائب رئيس الجامعة وعميد كلية طب األسنان البروفسور عصام عثمان وحضرة عمداء كليات طب‬ ‫األسنان حضرة رئيس البلدية ورئيس غرفة التجارة والصناعة‪ ،‬سماحة المفتي وسيادة المطران ‪ ،‬حضرة رؤساء الروابط والجمعيات الطبية والمنظمات ‪ ،‬ايها‬ ‫الزميالت والزمالء والحضور الكريم ‪.‬‬ ‫يسرنا أن نستقبلكم في مدينة طرابلس التي بالرغم من كل المآسي التي نمر بها ها نحن اليوم هنا ألننا نؤمن بغ ٍد أفضل وألننا نحب الحياة والتحدي ونأمل‬ ‫بتخطي الصعاب‪ .‬ومن هنا جاء عنوان المؤتمر «‪ »Beyond The Challenge‬الذي وراءه حماس كبير من مجلس النقابة واللجنة العلمية برئاسة د‪.‬‬ ‫مكسيم بعيني ولجنة المؤتمر برئاسة د‪ .‬بول نحاس وكل الزمالء المتطوعين الذين عملوا بجد وإخالص وهذا كله إيمانا ً بالنقابة وباإلرتقاء بالمستوى العلمي‬ ‫وكذلك حبا ً بالمساهمة لعودة عجلة الحياة العلمية والسياحية واإلقتصادية لطرابلس والشمال‪.‬‬ ‫على الصعيد النقابي “‪ “We Are Back On Track‬بعد إنقطاع ‪ 5‬سنين عن المؤتمرات ها قد عدنا ‪ ..‬وكذلك مجلة النقابة بعد إنقطاع حوالي ‪ 8‬سنين‬ ‫ها نحن اليوم نطلق عدداً جديداً وبحلّة جديدة ‪ ،‬وشكر كبير لرئيسة التحرير الدكتورة روزي بيطار على المجهود الجبّار ‪.‬‬ ‫وكذلك عودة المحاضرات العلمية وبدأنا تنشيط مركز التعليم المستمر‪.‬‬ ‫وكذلك عملنا على إصدار تعرفة جديدة للحد االدنى لألعمال الطبية برئاسة الدكتور هاني عويضة في هذه الفترة الغير مستقرة من تقلب سعر صرف‬ ‫بتعديل ما على بعض القوانين والمواد بالنظام الداخلي التي مضى عليها سنوات دون تعديل‬ ‫الدوالر لليرة اللبنانية ‪.‬في المستقبل نأمل أن نستطيع أن نقوم‬ ‫ٍ‬ ‫وأصبحت ال تحاكي الزمن الحالي ومنها كيفية التعامل مع وسائل التواصل اإلجتماعي وغيرها من االمور‪.‬‬ ‫كلنا متحمسين لخدمة النقابة ونعمل لتحسين ظروف زمالئنا‪.‬‬ ‫لدينا مشاريع وعسى أن ننجح ويتسأل البعض ما عسانا أن نقدم ‪ ...‬أقول ال نملك عصا سحرية ولكن عسى أن يضيف كل نقيب حجر واحد في بناء هذا‬ ‫الهيكل ويكون له بصمة صغيرة‪.‬‬ ‫في الختام نشكر راعي المؤتمر الرئيس نجيب ميقاتي الذي قدم الكثير لنقابتنا ودائما ً بقربنا‬ ‫وكل التقدير للجامعة برئيس وعميد الكلية وكل الفريق في بيروت وفرع طرابلس وأخص البروفسور خالد بغدادي واألمين العام المساعد السيد محمد‬ ‫حمود وكل الفريق لجهودهم إلنجاح مؤتمرنا وشكرا لكل الحضور‪.‬‬

‫‪Professor Essam Osman, Dean‬‬ ‫‪and vice-president at the‬‬ ‫‪Beirut Arab University‬‬ ‫‪Quarter III‬‬

‫‪Professor Paul Nahas,‬‬ ‫‪president of the organizing‬‬ ‫‪committee‬‬

‫‪Dr. Nazem Haffar, President‬‬ ‫‪of the Lebanese Dental‬‬ ‫‪Association-Tripoli‬‬ ‫‪Dental News‬‬

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Dr. Nazem Haffar, Prof. Essam Osman, H.E. Walid Nassar

Dr. Karim Kabbarah, General secretary LDA Tripoli

Prof Ghassan Bassit receiving his letter of appreciation for his lecture on Modern Implants

Dr Ehab Heikal, President of the Egyptian Dental Association, receiving the Trophy from Dr Nazem Haffar

Inauguration of the exhibition with President.

Dr. Nazem Haffar, H.E. Walid Nassar, Dr. Rahil Doueihy, and President Ronald Younes.

Drs: Joseph Yammine, Joseph Hanna, Tony Frangieh

Dr. Ghassan Bassit, Prof. Amirah El Nour, Dr. Anas Abdo

Left to right: Drs Amin Zoghby, Ronald Younes, Nazem Haffar, Joe Salloum President of the Pharmacy order

Drs.: Yasser AlGendy from Egypt, Milad Dib, Nazem Haffar, Mohamed Dib (president of the Algerian Dental Association).

Presidents of the Arab Dental Societies participating in the Congress: from Sudan, Egypt, Tunisia, Algeria, Jordan, Palestine and Iraq

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THE 11TH AIO/ITALIAN DENTAL ASSOCIATION INTERNATIONAL CONGRESS IN SARDINIA: A SUCCESS STORY DEDICATED TO THE WOMEN IN DENTISTRY JUNE 9-11, 2022 CAGLIARI - SARDINIA - ITALY

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Photo from the Opening Ceremony Five hundred attendees representing the dental team: dentists, dental students, dental hygienists, dental assistants, dental technicians and office personnel.

Almost 200 foreign visitors from all over the world.

Seventy speakers. Fifty guests. One hundred operators representing dental companies. These are the final numbers of the 11th AIO/Italian Dental Association International Congress that took place in Chia, a seaside resort town on the spectacular island of Sardegna, last weekend.

Organized by AIO branch of Cagliari/Oristano, the Congress touched on an exciting and evolving topic: equality between men and women in dentistry.

Today the number of women practicing dentists is steadily increasing. Just two years ago women made up 40% of graduates from dental school. Now, in many countries, women make up from 50% to 70% of the total number of dental students. Dentistry is well on the way to becoming a female dominated profession!

Dr. Ana Paz from Lisbon, Portugal

The AIO International Congress, “Focus on the Gender Shift in Dentistry: A New Perspective or a Future Challenge?” remained true to its theme, exploring this trend on an even playing field equally divided between male and female lectures in their respective specialties.

A panel of top leaders in dentistry gathered to discuss this gender shift during the Inaugural Ceremony that was opened by the President of the FDI World Dental Federation, Imane Ben Yahya with contributions from the founder of the Washington Institute of Dentistry Claudia Cotca and the Canadian endodontist and chairman of the ceremony, Ken Serota.

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Dr. Josette Camilleri and Dr. Audrey Camilleri Quarter III

THE 11TH AIO/ITALIAN DENTAL ASSOCIATION INTERNATIONAL CONGRESS IN SARDINIA: A SUCCESS STORY DEDICATED TO THE WOMEN IN DENTISTRY

National leaders present and who donated important assessments were also Rossella Galisai, President of the AIO Cagliari Oristano branch, the AIO President Fausto Fiorile and the ANDI Vice President Fabio Scaffidi.

Other top international leaders present were the President of the European Regional Organization FDI Simona Dianiskova, the President of the DDS - Digital Dentistry Society Henriette Lerner with the Italian representative Fabrizia Luongo, the president of Hungarian Dentists Katalin Nagy, Hande Sar Sancakli director of Continuing Education for Europe within the Education Committee of the FDI.

of artificial intelligence. A joint session between the AIO and the Italian Association of Conservative Dentistry took place while a course in photography hosted by Louis Hardan (Beirut) and a laser certification course by Milos Miladinov were held.

The 11th AIO International Congress, however, was above all a cultural and scientific event, hosting top speakers Renato Cocconi, Anna Mariniello, Bedros Yavru Sakuk of the Academy of Dentistry International, representative of Italian pedodontics Maurizio Bossi, Ignazio Loi, Mario Semenza, Dirk Duddeck, Marco Ferrari of the Higher Health Council, Kianor Shah and Preetinder Singh of the Global Summit. Ukrainian Helena Chergava, Peruvian Victor Guerrero, Elisabetta Cotti, Chairperson of the Department of Conservative Dentistry and Endodontics at the University of Cagliari School of Dentistry, Giovanni Olivi, Josette Camilleri Denise Pontoriero, Kym Syncuk.

But that is not all. Space was also dedicated to dental students too! The evidenced based poster session was awarded to Mara Pinna, a postgraduate student at the University of Cagliari with her contribution in pathology. Other winners were Alessia Sicignano (Florence) in orthodontics, Raffaele Donati (Florence) in implantology and Michele Serri (Siena) in conservative dentistry.

In parallel, the Italian branch of the Digital Dental Society held their 3rd National Congress with lectures

by Carlo Mangano (University of San Raffaele Milan), Ioana Datcu and Reinhilde Jacobs on the challenges

Drs: Katalin Nagy, Fabrizia Luongo, Ioana Datcu, Ken Serota, Alessandro Cucchi

The plenary session which closed the meeting on Saturday hosted Vincenzo Musella current National Continuing Education Secretary of the AIO, Preetinder Singh, ambassador of the American Academy of Oral Surgery , Californian Emily Letran and Chiara Jasna Niciforovic, with her lecture in communication and ethical marketing.

The congress could not have been complete without the performance of the Mediterranean Trio led by Gavino Murgia, jazz saxophonist with a repertoire that includes deep Sardinian musical roots, an elegant poolside gala dinner and a traditional Sardinian dinner that ended in a farewell party!

We look forward to seeing you next year, June from June 8-10, 2023 for the 12th International Congress.

Have a happy summer!

Drs: Audrey Camilleri, Enrico Lai, Katalin Nagy and Kim Syngcuk

Drs: Katalin Nagy, Helena Cherhava, Ioana Datcu and Henriette Lerner

Dr. Salvatore Scolavino and Dr. Gaetano Paolone

Drs: Preetinder Singh, Ken Serota, Kianor Shah

Drs: Walid Altayeb, Giovanni Olivi, Nasim Chinifrush, Aleksandra Krisay Dumic Dental News

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