Khalid Almas

Abstract:  Osteonecrosis means the process of bone death. Bisphosphonates (BPs) are becoming recognized increasingly as having a significant impact on dental treatments. BPs are the most widely used class of anti‐resorptive drugs. They prevent bone resorption through osteoclast inhibition and are considered the standard of care for the management of metastatic bone disease. BPs are used for the treatment of skeletal disorders such as osteoporosis, hypercalcaemia of malignancy, ostoelytic lesions arising from solid tumours and Paget’s disease, breast cancer or prostate cancer. Jaw necrosis appears to be associated with the intravenous (i.v.) use of BPs. The aim of this review paper is to update the understanding of healthcare professionals to the osteonecrosis of jaws, mechanism of action and classification of BPs, management of the patients with BP‐related osteonecrosis (BRON) of the jaws. An interdisciplinary approach has been emphasized to prevent and manage the condition. Finally, the role of dental practitioners including dental hygienists has been discussed to early diagnose the BRON and improve the quality of life of patients with the condition.

The aim of this study was to assess the antimicrobial activity of eight commercially available mouthrinses and 50% miswak extract against seven microorganisms. Corsodyl, Alprox, Oral‐B advantage, Florosept, Sensodyne, Aquafresh Mint, Betadine and Emoform mouthrinses were used while 50% aqueous extract of miswak (Salvadora persica) was used against Streptococcus faecalis, Streptococcus pyogenis, Streptococcus mutans, Candida albicans, Staphylococcus aureus and Staphylococcus epidermidis. The ditch plate method was used to test the antimicrobial activity. Inhibition zones of microorganisms around ditches were measured in millimetres. Range, mean and standard deviations were used for comparison of antimicrobial activity. Mouthrinses containing chlorhexidine was with maximum antibacterial activity, while cetylpyridinium chloride mouthrinses were with moderate and miswak extract was with low antibacterial activity. Further research is needed for the substantivity of these mouthrinses and further in vivo/in vitro studies are needed using Biofilm model to substantiate present findings. Dental professionals must exercise caution and provide guidance in assisting their patients in making informed choices regarding their use of mouthrinses for clinical efficacy.

OBJECTIVE: Many patients seeking dental care have a significant medical condition that may alter both the course of their oral disease and the treatment provided. The aim of this study was to assess the systemic diseases profile of patients with periodontal diseases for specialized periodontal treatment. METHODS: Seven hundred and forty-three patient9s medical records were screened from the Periodontal Clinics and referred to the College of Dentistry, King Saud University, a teaching hospital in Riyadh, Kingdom of Saudi Arabia for a special care during the period from January 2002 to June 2002. RESULTS: One hundred and sixty-seven were males while 576 were females. The age ranged was from 18-64 years. Approximately 90% of the patients were systemically healthy. The remaining 10% of the patients were with different systemic diseases or sequelae. Diabetes mellitus, hypertension, asthma and rheumatic fever were most commonly present. Thirty-one (4.2%) of the medically compromised were diabetic. Hypertension was reported in 9 (1.2%) patients. Rheumatic fever and asthma were equally present in 7 (0.9%) patients. Periodontal diseases were equally prevalent in both male and female patients. Approximately 50% of the patients had moderate periodontitis while severe periodontitis was common among 9% of the male and female patients. CONCLUSION: Diabetes and heart related conditions were most common among the specialist patients referred for periodontal treatment. The advanced periodontitis was prevalent among 9% of the patients. It is recommended that physicians are become more familiar with the systemic associations to periodontal diseases. The dental practitioners should be well versed in the interplay between oral and systemic disease. More extensive knowledge of oral and physical medicine will be needed in order to provide quality care and appropriate treatment of patients with periodontal diseases suffering with systemic conditions.

OBJECTIVE: The aim of this study was to find out the knowledge and practices of oral hygiene methods among primary and secondary school teachers in Riyadh, Kingdom of Saudi Arabia (KSA). METHODS: The study was carried out using a self-administered questionnaire. Four hundred and seventy teachers, male 236 (50.2%) and female 234 (48.8%) responded with a response rate of 85.5%. The study was conducted during October to December 2001 at primary and secondary schools in Riyadh City, KSA. RESULTS: Almost 86% of male and 90% of female teachers felt that dental caries is due to the wrong method of tooth brushing, while sugar and sugary drinks were considered the main factor by 90% of male and 98% of female teachers. Seventy-five percent of male and 72% of female teachers considered irregular tooth brushing a cause of gums disease with 32% of male and 39% of female teachers not knowing details with regards to microbial relationship of gum disease. Tooth brushing preference was common among 45% male and 49% female teachers due to perceived effect of better cleaning, while almost an equal percentage of male and females (62%) used miswak due to Sunnah. Thirty-three point five percent of female teachers brushed 3 times a day as compared to 19% male teachers. On daily basis brushing 3 times, a day was common among >5000 SR monthly income group. Male teachers preferred horizontal tooth brushing (40%) while female teachers preferred circular tooth brushing (45%). Miswak was more commonly used by male teachers as compared to female teachers. Female school teachers had a higher income as compared to male schoolteachers. Thirty-two percent of females and 28% of male teachers were regular attendees to the dentist. Males were more satisfied by their oral health as compared to female teachers and 56% of male and 63% of female teachers visited the dentist only on having pain (toothache). CONCLUSION: It is concluded that there is much resemblance in knowledge and practice of oral hygiene habits among male and female schoolteachers and there is a need to enhance their knowledge regarding oral health and disease. Both need more awareness regarding oral health promotion to have a positive role in school oral health education for their students in collaboration with oral health care workers.

Periodontal disease and diabetes are two common chronic diseases affecting humans. The aim of this study was to assess the effect of oral hygiene instructions on periodontal disease among type 2 male diabetic Saudi subjects. Sixty subjects completed the study and were divided into three groups of 20: healthy (non-diabetic) with periodontal disease, type 2 diabetic with early or moderate periodontal disease, and type 2 diabetic with advanced periodontitis. The age ranged from 24-64 (42 ± 13.60) years. The subjects were examined at King Saud University, College of Dentistry, Riyadh, Saudi Arabia. Oral hygiene practices and smoking habits were recorded. Oral hygiene instructions given to patients were to use an Oral B medium toothbrush and brush three times daily for 7 days using the by Bass technique for 2 minutes. Fasting blood glucose level (FBGL), gingival crevicular fluid (GCF), community periodontal index of treatment needs (CPITN), and plaque index (Pll) were used to assess patients’ profiles at baseline and at recall visit after 7 days. The results showed there was a significant overall decrease in FBGL, baseline 172.67 mg/dl (±64.69) to recall visit 162.20 (±58.78) P = 0.000, and GCF volume decreased from .4041 µl (±.1260) to .3698 µl (±.1164) P = 0.000. There was a significant reduction in subjects’ CPITN mean scores (from 13.98 (±8.24) to 13.32 (±8.97) P = 0.000), but there was no significant difference in Group 3 with advanced periodontitis, i.e., 22.25 (±1.37) to 22.30 (±1.38). There was more than a 47% reduction in the overall percentage of plaque scores. The decrease ranged from 82.27 (±19.34) to 34.45 (±17.04) at baseline and recall visit respectively. It is concluded oral hygiene instructions (a standardized regimen) has an effect on FBGL, GCF, CPITN, and PlI. It is also concluded CPITN is not very sensitive to assess change in periodontal status over a 7 days period. Further studies are needed among diabetic and healthy subjects with a larger sample size and over a longer period of time. Citation: Almas K, Al-Lazzam S, Al-Quadairi A. The Effect of Oral Hygiene Instructions On Diabetic Type 2 Male Patients With Periodontal Diseases. J Contemp Dent Pract 2003 August;(4)3:040-051.

Esthetics plays an important role in dentistry today. Because of an increased emphasis on beauty and health, cosmetic dentistry has been the thrust to the forefront of many practices. Many health products are used for bleaching teeth, but all side effects are not known. Tooth sensitivity and gingival irritation are the most common side effects, but they are typically mild and transient in nature. The aim of this investigation was to evaluate objectively the effect of 10% carbamide peroxide gel (Opalescence^TM Utradent Inc, USA) on gingival health by measuring changes in Bleeding Index, Plaque Index, and Gingival Index. Eighteen subjects, 11 female and 7 male, age range 15-30 years (mean 24 years), were selected for the study as a convenient sample. Their teeth had either fluorosis, dental stains, smoking, or tetracycline staining. The Opalescence system was used as office monitored, at-home bleaching for three weeks. There was a statistically significant reduction in bleeding on probing (1% - 37%, p < 0.003), Plaque Index (4% - 50%, p < 0.000), and Gingival Index (2.5% - 34%, p < 0.002). Only two subjects reported tooth hypersensitivity, and none of the subjects complained about gingival irritation. There was a positive change in tooth color as far as staining was concerned. Further research including randomized controlled, double blind clinical trials is needed to confirm these findings and to examine other factors related to bleaching of teeth. Citation: Almas K, Al-Harbi M. The Effect of A 10% Carbamide Peroxide Home Bleaching System on the Gingival Health. J Contemp Dent Pract 2003 February;(4)1:032-041.

The aim of the study was to compare the abrasive effect of miswak and toothbrush filaments on enamel tooth surface. Ten maxillary central incisors were obtained from Division of Maxillofacial Surgery, King Saud University, College of Dentistry. Twenty specimen were prepared, they were divided into 4 groups (1) Butler toothbrush; (2) Aquafresh toothbrush; (3) Miswak; (4) Control group. Miswak, Aquafresh 311 and Butler 311 tooth brush were used with light pressure in one direction motion for 60 seconds on enamel surface. The specimens were prepared for Scanning Electron Microscopy (SEM) examination. The middle filament from toothbrushes and miswak were also prepared for SEM. Showed that filaments end-surface texture play a major role in abrasive active activity and enamel tooth surface loss. The Butler 311 toothbrush and miswak showed lesser effect on enamel as compared to Aquafresh 311 toothbrush.

Bacterial plaque is solely responsible for the initiation and progression of periodontal diseases. There are different mechanical and chemical methods available for the maintenance of oral health through plaque control. Toothbrushes and miswak (chewing sticks) are widely used for the mechanical removal of plaque. Chlorhexidine gluconate (CHX) is one of the best-proven anti-plaque agents. The aim of this study was to evaluate the effects of CHX and miswak extract on healthy and periodontally involved human dentin. Sixteen human premolars recently extracted for orthodontic and periodontal reasons were used in the study. Teeth were free from caries, cervical restorations, or erosions. The dentin disc specimens were prepared and half of them were etched with 6% citric acid for 120 sec. Both etched and unetched were further treated with CHX and 50% miswak extract and prepared for Scanning Electron Microscopic (SEM) examination. It was concluded that CHX 0.2% and miswak extract 50% had a similar effect on dentin in the control group. Miswak extract removed more smear layer as compared to CHX. Further research is needed in vivo to compare the effects of CHX and miswak extract on periodontally involved teeth and teeth with dentinal hypersensitivity. Citation: Almas K. The Effect of Salvadora Persica Extract (Miswak) and Chlorhexidine Gluconate on Human Dentin: A SEM Study. J Contemp Dent Pract 2002 August;(3)3: 027-035.

The popularity and availability of chewing sticks (Salvadora persica) in the Asia, Middle East and Africa make them a commonly used oral hygiene tool in those societies. Salvador persica chewing stick called miswak is frequently used in Saudi Arabia. The antimicrobial effects of miswak has been well documented. The aim of this study is to find our the effect of aqueous extracts of miswak on healthy and periodontally involved human dentine with Scanning Electron Microscopy (SEM) in vitro. 25% aqueous extract of freshly prepared miswak solution was used for the study. Twelve human premolars teeth (6 healthy and 6 with periodontal disease) recently extracted for orthodontic and periodontal reasons were used. 24 SEM specimens were prepared and treated with miswak extract with different conditions e.g. soaking and burnishing with miswak extract. Soaking the healthy and periodontally diseased root dentine in miswak extract resulted in partial removal of smear layer and occlusion of dentinal tubules was observed in dentine specimens burnished with miswak solution. Further research is needed to evaluate the effect of aqueous extract of miswak on etched human dentine at higher concentrations.