Saudi Cultural Missions Theses & Dissertations
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Item Restricted Rapid Review of Interventional Studies to Reduce Inequalities in Caries Among Children(King's College London, 2024-08) Alsindi, Razan Sadaka J; Sabbah, WaelAim: This review aims to assess and synthesize evidence from intervention studies to decrease socioeconomic inequalities regarding dental caries for children. Materials and Methods: A review of the literature up to July 2024 was done to find intervention studies that demonstrated a reduction in socioeconomic inequality in children. The following keywords were used: children, caries, intervention studies, and socioeconomic inequality. Any preventive or health promotion techniques aimed at lowering inequality in dental caries were considered interventions. Any groups that did not receive the intervention or that received an alternative intervention were included in the comparison. We used PubMed, Ovid, and Cochrane as our three databases. All 15 of the identified articles were evaluated for risk of bias using the Cochrane criteria. The rapid review process will be described using the Khangura et al. (2012) to update the findings on interventions to reduce inequalities in dental caries. Results: The 15 identified intervention studies encompassed fluoride varnish applications, health education and promotion initiatives in schools, and the fluoridation of water supplies, due to several methodological limitations. Specifically, some of the studies lacked confirmation of blinding for participants or providers and did not adequately conceal allocation, hence the quality of identified studies is considered moderate. Finally, the use of fluoride in the whole population and target population interventions showed a better impact on inequalities in caries. Conclusion: This review identified a scarcity of studies addressing interventions aimed at reducing socioeconomic inequalities in dental caries among children. Nevertheless, it highlighted that broad population-level interventions, especially community water fluoridation, were more effective and consistently impactful in diminishing these inequalities than targeted measures.29 0Item Restricted Dental Caries in Individuals living with Type 2 Diabetes: Exploring Severity, Risk Factors, and Salivary Metabolic Profiling for Comprehensive Insights(Queen Mary University of London, 2024-03-31) Alkahtani, Ashwaq; Baysan, Aylin; Anderson, PaulDiabetes mellitus is a well-known disease that is associated with several of general and oral health issues. However, evidence related to the association between type 2 diabetes mellitus (T2DM) and dental caries is controversial. Aim This study aimed to investigate the impact of type 2 diabetes mellites (T2DM) on severity of dental caries and evaluate the relative protective and risk factors for the development of dental caries. Material and method Firstly, a laboratory study evaluated the SoproLIFE fluorescence system for detecting dental caries on 56 extracted teeth. Subsequently, a case-control study was conducted with 182 participants, with 91 nondiabetics (ND) and 91 participants. A questionnaire including demographic and oral health and dietary for each participant were recorded. Clinical assessments including dental plaque, periodontal health, dental caries score using ICDAS and root caries, SoproLIFE and dental caries risk assessment using caries management by risk assessment (CAMBRA) were carried out. Unstimulated whole saliva was collected to measure the saliva properties and stimulated saliva for metabolic profiling using 1H-Nuclear Magnetic Resonance Spectroscopy. Results Results from laboratory study showed SoproLIFE had 90% sensitivity and 95.8% specificity for sound-initial caries, 100% sensitivity and 53.8% specificity for dentine caries. The case- control study reported that participants with diabetes showed higher British Asian representation (38%) compared to non-diabetes (12%). 98% of the participants had no dental insurance, with 31.8% on benefits and 39.5% of diabetes participants retired. Diabetes participants had significantly lower juice consumption (34%) compared to non-diabetes (27%). No significant associations were found in oral health behaviours except the presence of removable prosthesis. Significant differences were observed in juice and sweetened juice consumption between diabetes and non-diabetes groups. Saliva pH was slightly low in T2DM (6.65±1.12) vs. ND group (6.88±0.49), but not statistically significant (p=0.065). Saliva buffer capacity showed no significant difference, with values of 7.38 ± 3.2 in T2DM and 7.37±2.83 in ND (p=0.973). Saliva spinnbarkeit was slightly higher in T2DM (4.57±4.34) than ND (3.69±3.6), but not statistically significant (p=0.141). T2DM individuals were more likely to have very low or low saliva flow rates compared to non-diabetic individuals (18% vs. 5.5%, respectively). The plaque index was slightly high in T2DM (p>0.05). Overall ICDAS scores were significantly high with T2DM. ICDAS scores 3 and 6 were significantly high in in T2DM (2.7±2.66, 0.86 ±2.61) compared to ND (2.10±2.00, 0.26±0.96) respectively. SWS 1H-NMR spectroscopy profile for T2DM revealed significant upregulation of organic acid anions, specifically lactate and formate (lactic and formic acids), when compared to the non-diabetic group. Conclusion: The light fluorescence evaluator (SoproLIFE) reported promising performance in distinguishing early enamel carious lesions from sound surfaces in the laboratory study. The case-control study showed the mean age at diagnosis of 43±10 years, a gender disparity with more males (67.7%) in the T2DM group, and a notable representation of Asian British individuals (38.4%). T2DM participants had a significantly high reliance on medications (92.3%) and distinct oral health practices when compared to the non-diabetic group. There were differences in the presence of removable prostheses, as well as juice and sweetened juice consumption between the two groups. In addition, this case-control study revealed differences in severity of dental caries with high moderate and severe lesions in T2DM group. The study also provided valuable insights into metabolic changes in saliva among individuals with diabetes, demonstrated that the organic acid anions lactate and formate were significantly upregulated in the T2DM group. These bacterial catabolites have been previously implicated in the pathogenesis of dental caries. This highlights the significant differences in salivary metabolites between individuals with T2DM and healthy controls.9 0Item Restricted Relationship between Oral health Profile, Service utilization and Locations: Building a Model for School Dental Services(Saudi Digital Library, 2023-11-08) Aqeeli, Amal; Kruger, Estie; Tennant, Marc; Alsharif, AllaAim: This research project aims to provide an update on dental caries profile of 9-to-12-year- old schoolchildren in Al- Madinah, Saudi Arabia (SA); to investigate the factors associated with dental care utilization including sociodemographic characteristics, and oral health needs; to examine regular dental visit and its association with sociodemographic, clinical, and behavioural characteristics; to assess the distribution and accessibility of primary public dental services in Al-Madinah in comparison with that in Jeddah; and to develop a geographic model for school dental services (SDS) in Al-Madinah, SA, geographic information system (GIS)-based on the distribution of child population density. Methods: Data from 1,000 schoolchildren aged 9–12 years old from a cross-sectional oral health survey in Al-Madinah, SA was obtained and analysed. Clinical, sociodemographic and behavioural data were extracted from the survey. Descriptive and inferential statistics were calculated to estimate caries prevalence and severity and their association with sociodemographic factors. A multiple logistic regression model was used to assess the factors influencing dental care use. For geographic analysis, primary public dental services locations; the location of primary public schools and the number of students in each school were mapped using GIS. Analysis of primary public dental services distribution in Al-Madinah compared to Jeddah was conducted. And building a geographic theoretical model for SDS in Al-Madinah, SA was designed. Results: Caries prevalence in primary or permanent teeth was 85.1%, with untreated caries at 76.1%. The mean dmft was 2.66 ± 2.63 while the mean DMFT was 1.43 ± 1.73. Approximately a iii quarter of all participants (23.8%), have never received dental care before while only 9.2% of the sample reported regular dental visits. Pain or trouble with teeth was the most common reason for visiting the dentist (49.4%). The multiple logistic regression model showed that children from low-income families had a reduced likelihood of receiving dental care (OR=0.571, P=0.014). Children who have caries and who reported having toothache in the past 12 months were more likely to visit the dentist (OR=1.599, P=0.028) & (OR=2.188, P>0.001). In addition, regular dental visits were associated with gender (female: OR = 1.715; p = 0.041), high family income (middle income: OR = 0.464; p = 0.024; and low income: OR = 0.517; p = 0.015), and the consumption of sugary food and drinks (almost daily: OR = 0.438; p = 0.017; and several times a week: OR = 0.511; p = 0.050). An uneven distribution of dental services was found, with services concentrated in certain districts in both cities and other districts with far fewer or no dental services. Furthermore, the future locations for SDS were studied: the areas with the higher number of schools; higher number of students; and dense child population as presented in the map suggest the future location of SDS. The total number of dentists required to work in SDS settings was 415 for the first model, and 277 for the second model. Conclusion: Dental caries persists as a public health challenge among schoolchildren in Al- Madinah, SA, with high prevalence and severity among schoolchildren. Dental care utilization is mainly driven by symptomatic dental care and regular dental visits are uncommon behaviour. Establishing SDS is suggested as a solution to this health issue in Al-Madinah and SA in general. A theoretical model was proposed for SDS with the future SDS locations and the number of dentists to hire for the services to meet the child population's oral health needs.17 0