Eman Bakhurji

Background/Objectives: Accurate selection of stainless steel crown (SSC) size is essential for successful restoration of primary molars. Conventional crown selection relies on a trial-and-error approach, which may increase chair time and reduce clinical efficiency. Preoperative digital radiographic measurements may provide an objective adjunct for predicting SSC size; however, evidence supporting their agreement with clinically selected crown sizes remains limited. This study aimed to evaluate the agreement between preoperative digital radiographic measurements and clinically fitted SSC size in primary molars, and to assess whether this agreement is influenced by dental arch or tooth type. Methods: This retrospective cross-sectional study analyzed archived patient records and preoperative digital radiographs of pediatric patients who received SSCs on primary molars. Mesiodistal tooth dimensions were measured and converted to SSC sizes according to manufacturer guidelines. The clinically fitted and cemented crown size, as recorded in the patient chart, served as the reference standard against which radiographically predicted size was compared. Intra-examiner reliability was assessed using the intraclass correlation coefficient. Associations were analyzed using chi-square tests and binomial logistic regression (p ≤ 0.05). Given repeated teeth within patients, the primary logistic regression model was additionally re-fit using generalized estimating equations (GEEs) with an exchangeable working correlation structure and robust standard errors, and prediction error was further characterized using near-miss accuracy, direction of bias, weighted kappa, and Bland–Altman analysis. Results: A total of 152 primary molars from 71 patients were included. Intra-examiner reliability was excellent (ICC = 0.99). Radiographic prediction agreed with the clinically fitted crown size in 33.6% of cases, and 69.7% of predictions fell within one crown size of the cemented crown. Agreement was significantly higher for mandibular molars than maxillary molars (p = 0.010) and varied by tooth type (p < 0.001). Mandibular molars were more likely to show accurate prediction (OR = 2.52; 95% CI: 1.23–5.17); this association remained statistically significant after accounting for within-patient clustering using GEEs with an exchangeable correlation structure (OR = 2.46; 95% CI: 1.10–5.49; p = 0.029). Maxillary first molars showed a systematic under-prediction of exactly two crown sizes in 97% of cases (mean bias −2.00), identifying a specific, correctable calibration problem. Conclusions: Preoperative digital radiographic measurements show moderate agreement with clinically fitted crown size and may serve as a useful adjunct to clinical judgment for SSC size selection, particularly for mandibular molars. Because the reference standard reflects clinical judgment itself rather than an independent anatomical gold standard, these findings should be interpreted as a concordance analysis, and further prospective work is needed before efficiency benefits can be confirmed.

Aim Exposure injuries pose significant health risks to health care providers. Dentists are considered to be at high risk of occupational exposure, especially needlestick injuries. This study aimed to investigate the frequency of exposure-injuries (EI) and the factors influencing post exposure management in an academic setting in the Eastern Province of Saudi Arabia. Materials and methods This retrospective study extracted information related to exposure injuries reported by dental care providers and staff working in an academic institution between 2016 and 2022. The chi-square test was used to measure the association between the study variables, and the statistical significance (p value) was set at < 0.05. Data were analyzed using the Statistical Package for Social Sciences (SPSS Software Version 23). Results A total of 100 EI were reported over a period of six years. These injuries mainly occurred during afternoon sessions (55%), were significantly more common in females (62.2%, p=0.013) and students (55.6%, p=0.002), and were mainly caused by needle pricks (71.9%, p= 0.016). Immediate post exposure management and serological tests were performed by 85% and 86.6%, respectively, and were implemented significantly more frequently if the incidence occurred in the morning clinical session (p=0.035). Post exposure management was reported by females more than males (p=0.0130). Conclusion Frequency of exposure injuries was high and more common among females and students. Post exposure management was influenced by factors such as sex, cause of injury, and time of occurrence. There is an urgent need for continuous training in the handling of sharps and the implementation of engineering controls.

The aim of this study was to evaluate the shear bond strength and tooth discoloration of resin-modified glass ionomer cement (RMGIC) and high-viscosity glass ionomer cement (HGIC) restorations in primary teeth treated with either nano-silver fluoride (NSF) or silver diamine fluoride (SDF). Sixty-six primary molars with dentin caries were randomly assigned to six groups of 11 teeth each: two NSF-treated groups (one RMGIC, one HGIC) and two SDF-treated groups (one RMGIC, one HGIC). Two additional control groups received direct RMGIC and HGIC restorations, respectively. All samples were tested for tooth discoloration using a spectrophotometer before and after the thermocycling aging process (20,000 cycles). Shear bond strength was compared between the groups. Kruskal–Wallis test with a P-value of < 0.05 was used for statistical significance. The samples treated with SDF and restored with RMGIC exhibited the highest ΔE value (mean ± standard deviation (SD) of 8.27 ± 6.51). In contrast, the samples treated with NSF and restored with RMGIC demonstrated the lowest ΔE value (mean ± SD of 1.45 ± 0.77). No statistically significant differences were found between the groups in the shear bond strength test. NSF provided a better color masking effect compared to SDF when using RMGIC without visible black stains through the restoration. Additionally, neither NSF nor SDF affected the shear bond strength of either type of restoration applied to them. NSF may be preferred over SDF in cases where aesthetics is a priority, with similar bond strength and enhanced color matching.

Aim Exposure injuries pose significant health risks to health care providers. Dentists are considered to be at high risk of occupational exposure, especially needlestick injuries. This study aimed to investigate the prevalence of exposure-injuries (EI) and the factors influencing post exposure management in an academic setting in the Eastern Province of Saudi Arabia. Materials and methods This retrospective study extracted information related to exposure injuries reported by dental care providers and staff working in an academic institution between 2016 and 2022. The chi-square test was used to measure the association between the study variables, and the statistical significance (p value) was set at < 0.05. Data were analyzed using the Statistical Package for Social Sciences (SPSS Software Version 23). Results A total of 100 EI were reported over a period of six years. These injuries mainly occurred during afternoon sessions (55%), were significantly more common in females (62.2%, p=0.013) and students (55.6%, p=0.002), and were mainly caused by needlesticks (71.9 %, p= 0.016). Immediate post exposure management and serological tests were performed by 85% and 86.6%, respectively, and were implemented significantly more frequently if the incidence occurred in the morning clinical session (p=0.035). Post exposure management was reported by females more than males (p=0.0130). Conclusion incidence of exposure injuries was high and more common among females and students. Post exposure management was influenced by factors such as sex, cause of injury, and time of occurrence. There is an urgent need for continuous training in the handling of sharps and the implementation of engineering controls.

Objectives To assess the use of electronic cigarettes among college students, health professionals, and young adults in eastern Saudi Arabia, and the integration of psychosocial and economic factors on its use. Methods An online survey consisting of four sections–demographics, knowledge, use, and factors influencing e-cigarette use–was distributed among a convenience sample of young adults. The survey was distributed via social media platforms using snowball sampling. SPSS was used to analyze the data at a 5% significance level. Results In total, 3017 participants responded to the survey. The majority of the participants were male (63%), had a college degree or higher (65.4%), and were younger than 25 years old (53%). Twenty-two percent of the study sample used e-cigarettes constantly, while 22% used it for the trial. The regression model found that females were more likely to use e-cigarettes than males (OR=1.39), but without significance (95% CI=0.87-2.23). Older participants were significantly more likely to use e-cigarettes than those who were younger than 25 years. Compared to nonsmokers, cigarette smokers and former smokers were significantly more likely to use e-cigarettes. The multidimensional impact of psycho-socio-economics found that economic status was not a significant factor, whereas psychological and social factors were inversely related to the use of e-cigarettes. Conclusion In the presence of all factors, the multidimensional influence of psychosocial factors is either less important or inversely related to e-cigarette use.

Assessing microbial biofilm adhesion to the restorative material's surface is a key factor in determining its success. This study aimed to compare the adhesion of Candida albicans (C. albicans) on stainless steel crowns (SSCs) versus zirconia crowns (ZCs) used for primary molars. This in vitro study involved 20 full-coverage crowns, with 10 SSCs and 10 ZCs. A fungal adhesion assay was performed to evaluate C. albicans adhesion, using colony-forming units (CFU) and cell proliferation assays. The Wilcoxon-Mann-Whitney test was applied to compare the groups, with statistical significance set at 5 %. The study revealed that SSCs had a lower mean CFU value (28.28 ± 4.557 CFU/ml) and cell proliferation rate (49.74 ± 0.4367) compared to the ZC group (30.70 ± 11.0760 CFU/ml and 74.53 ± 0.7014, respectively). However, these differences were not statistically significant. The findings suggest that the selection of crowns for restoring primary molars may not be influenced by C. albicans adhesion.

Motor vehicle crashes (MVCs) are the leading cause of child deaths in the Gulf Cooperation Council. This study aimed to investigate the effect of a social media educational campaign on parents' knowledge of child safety seats. We conducted a pre-post interventional study as an online educational module in Arabic and English. The module link was shared on social media and was accompanied by a pre-post survey that included questions about demographics, knowledge, and practices of car seat use. A total of 303 participants completed the campaign, with 23.8% fathers and 76.2% mothers answered the survey. The majority of participants were from Saudi Arabia (95.7%), while 4.3% were from other Gulf Cooperation Council (GCC) countries. Most parents agreed on the importance of organizing awareness campaigns and having a law to enforce the use of car seats. The pre-survey mean knowledge score was 11.64, which significantly increased to 13.1 in the post-survey (p < 0.001). The intervention of the educational campaign through social media resulted in a significant increase in parents' knowledge and awareness of the importance of using car seats correctly. This study highlights the potential effectiveness of social media campaigns in improving parents' knowledge and awareness of child safety seats.

This retrospective study aimed to investigate the influence of patient behavior toward dental treatment on the presence of adjacent (sound, decayed, or filled) proximal surfaces in the primary molars. The study included a records review of 2226 pediatric patients. Records were eligible if the patients were in primary or mixed dentition, and if they included a complete set of bitewings and periapical intraoral radiographs of all their primary molars. Four calibrated reviewers used intraoral radiographs to record the sound, decayed, and filled proximal distal surfaces of the first primary molars and the mesial surfaces of the second primary molars. Demographical variables were reported from patients’ medical records including gender, age, medical history, nationality, and patient behavior. Patients’ behaviors were evaluated using Frankl’s Behavior Rating Scale. The Pearson correlation was used to test the association between the sound, decayed, and filled distal surfaces of the first primary molars and the mesial surface of the second primary molar. High correlations of ≥0.6 were further tested in simple and multiple linear regression models to test the influence of patients’ behaviors on these correlations after adjusting for demographical factors. All tests were performed at 5% significance level A. A total of 1194 records met the inclusion criteria and were analyzed. There was a high positive correlation between the sound, decayed, and filled distal surfaces of the first primary molar and similar surfaces on the mesial of the second primary molars (0.66, 0.61, and 0.60, respectively). Compared to cooperative patients, the adjusted estimate of the mean decayed mesial surface of the second primary molar increased significantly for non-cooperative patients by 0.1 (95% CI = 0.16–0.53). On the contrary, the adjusted estimate of the mean sound mesial surfaces of the second primary molars decreased significantly by 0.09 for non-cooperative patients, compared to those who were cooperative (95% CI = −0.52–−0.15). Patient cooperation did not significantly influence the mean of the filled mesial surfaces of the second primary molars (adjusted B = 0.01, 95% CI = −0.05–0.09). Educating parents and clinicians about the influence of children’s behaviors on oral health is highly encouraged to improve treatment outcomes and reduce the progression of dental caries. The implementation of specific behavior management techniques is also important to reduce dental fear and anxiety.

Background. Sugar-added diet has been associated with increased risk of developing dental caries. Objective. To investigate the dietary determinants of caries prevalence and experience based on the frequency versus the quantity of consumption among Saudi schoolchildren. Methods. This is a cross-sectional study that invited 12- to 15-year-old intermediate school students (N=3000) in four cities in the Eastern Province of Saudi Arabia. Data collection comprised a pretested questionnaire and clinical examination. Caries was diagnosed based on the World Health Organization (WHO) criteria and was recorded as a decayed, missing, filled tooth (DMFT). The questionnaire included questions regarding the consumption of different quantities and frequencies of multiple sugar-containing food items. Multiple logistic and linear regression models were used to assess the influence of sugar-containing food on the dental caries experience (DMFT) and prevalence of decayed teeth. SPSS version 20.0 was used to analyze the data at 5 significance level. Results. Of 3000 invited students, 2262 participated with a participation rate of 75.4. Our study found that the frequency of soft drink consumption was significantly associated with increased caries prevalence (adjusted OR=1.33, 95 CI 1.071.65) and experience (adjusted B=0.46, 95 CI 0.160.76). The frequency of consumption of fruit juice was statistically significantly associated with increased caries experience (adjusted B=0.48, 95 CI 0.160.79). The interaction terms between the frequency and the quantity of consumption of energy drinks, soft drinks, and sweetened milk were statistically significantly related to caries experience and prevalence. Conclusion. Although the frequency of consumption of sugar-containing drinks was more associated with caries experience and prevalence, the interaction between frequency and quantity was highly related to the prevalence and experience of dental caries.

Examine the effect of dental curing light and laser treatments applied after Silver Diamine Fluoride (SDF) on dentin hardness in carious primary molars. This in-vitro study consisted of 30 extracted primary molars with caries extending into dentin without pulpal involvement. The collected teeth were randomly divided into three groups: group 1: received SDF then Sub-ablative low-energy of Er,Cr:YSGG laser, group 2: received SDF followed by application of curing light for 40 s, group 3: had SDF treatment only. In all groups, 38% Ag (NH3)2F SDF was used. Vickers hardness test was performed on sound dentin below carious lesion. Kruskal–Wallis Test was used to determine the mean difference in dentin hardness of the groups at 5% Significance level using SPSS software. Surface hardness of sound dentin below the carious lesion was statistically significantly higher in the laser + SDF group (891.24 ± 37.33 kgf/mm²) versus the two other groups (Light cure + SDF = 266.65 ± 90.81 kgf/mm² and SDF only = 117.91 ± 19.19 kgf/mm²) with p-value ≤ 0.001. Although Photopolymerization of SDF increases the surface hardness of sound dentin below the carious lesion, applying laser after SDF has the highest surface hardness due to the laser’s sub-ablation of dentin.