ASSESSMENT OF DENTAL ANXIETY AMONG PATIENTS ATTENDING COLLEGE OF DENTISTRY IN SANA'A, YEMEN [download full text] 10.9 MB
Abstract: Background: The assessment of dental anxiety among patients would provide information on their behavior and aid in planning treatment. The prevalence and factors affecting dental anxiety in new patients visiting a teaching dental clinics in Sana'a University - Yemen, were measured.
Materials and methods: The cross-sectional study utilized a self-reported questionnaire based on Modified Dental Anxiety Scale (MDAS) translated into Arabic. Research was based on interviews with 252 patients, aged 18 years-old and over, attending College of Dentistry’s teaching dental clinics in Sana'a University, Yemen from January to March 2009.
Results: It was realized that 28.17% of the study sample was dentally anxious, according to the MDAS. Dental anxiety in both males and females was significantly different regarding gender as measured by (MDAS). The time elapsed since the onset of initial symptoms was more than 7 (seven) days for 44.44% of the participants. A large proportion of anxious women returned to treatment during the past year. A previous traumatic experience with dental treatment was identified in 46.48% of the dentally anxious patients. No significant relation between level of education or income and dental anxiety was observed.
Conclusions: Assessment of dental fear is an extremely useful tool for the dental practitioner, who can use it to customize behavioral treatment and management for individual patients. Dentally speaking, females seemed to have higher dental anxiety as compared to the males. Previous experience seems to be an important factor contributing to avoidance of dental care.

MULTIDISCIPLINARY APPROACH OF ANTERIOR DENTAL ESTHETICS: A CASE PRESENTATION [download full text] 4.64 MB
Introduction: Bimaxillary dentoalveolar protrusion is one of the most prevalent malocclusion in Asian population [1]. However, for extremely severe cases, orthodontists seem to still have to face the limitation of orthodontic treatment and turn to surgeons for cooperation. In this case, we will see how dramatic changes happened on an adult patient with severe bimaxillary dentoalveolar protrusion malocclusion after the surgical and restorative treatment. In addition one of the most challenging problems in dentistry is the choice of treatment for correction of one or more maxillary incisors that have been malposed or lost as a result of traumatic injuries. The problem of restoring esthetics and function varies significantly according to the age of the patient, the location of the malposed teeth.

PREVALENCE OF DENTAL CARIES IN RELATION TO WATER FLUORIDE LEVEL IN SOME AREAS OF YEMEN REPUBLIC [download full text] 4.29 MB
Abstract: The purpose of this study was to assess the caries prevalence of children living in areas with either above optimal and below optimal 2.03 or 0.25 ppm fluoride level in the drinking water, and to relate caries experience to the concentration of fluoride in the drinking water. Population subjects targeted for this study were boys and girls aged 9-20 years attending public schools. The study population comprised 793 subjects selected from various school and work places in seven towns to represent different geographical areas in Yemen. Mean and median ages of the population were 13.3 and 12 years respectively. The age range of the subjects was 9-20 years. The subjects included 439 (55.4%) boys, and 354 (44.6%) were girls. Caries was recorded according to WHO criteria (WHO, 1987). The criteria for selection was conducted as the following, in each town selected, schools represented different socio-economic classes were clustered for the study. Finally a total of 14 schools were randomly selected from the cluster. In the schools selected classes with children of the concerned age were randomly selected. It was also decided that, drinking water samples from the main water supplies in the community under investigation to be collected for analysis for fluoride content. The prevalence of DMFT in five towns (Ebb. Hajah, Lahaj, Taiz and Al-amannah) was above the 75% of the affected total study subjects. The mean DMFT in these towns was (78%) and ranged from 75% to 95%. The mean DMFT in the rest of the towns (Al-hodydah and Aden) was 64%, and the range was 59% to 69%. The prevalence of dental caries seems to be high in both high and low water fluoride level.

COMPARISON BETWEEN THE EFFICACY OF HERBAL AND CONVENTIONAL DENTIFRICES ON ESTABLISHED GINGIVITIS [download full text] 5.99 MB
Abstract: Aim: To evaluate the effectiveness of antimicrobial dentifrices with herbal extracts for the improvement of oral hygiene and the reduction of gingival inflammation in patients with gingivitis in comparison to conventional toothpaste with no antimicrobial action.
Methods: 48 adult patients (aged 20-40 years old) with chronic marginal gingivitis were randomly divided into three groups. Test group 1 and 2 received herbal extract dentifrices. Test group 3 just used a conventional dentifrice. Values of the Patient Hygiene Performance Index (PHP), Approximal Plaque Index (API), Gingival Index (GI), and Sulcular Bleeding Index (SBI) were assessed at baseline and after 14, 28 and 42 days. Subjects were asked to brush their teeth with the allocated dentifrice, three times a day, for 42 days. Results: Oral hygiene (tooth brushing with dentifrices for 42 days) led to a significant decrease in plaque accumulation on smooth (by 61.2% and 57.2 in herbal test groups 1 and 2, respectively) and approximal (by 57.4 and 52.8% in herbal test groups 1 and 2, respectively) tooth surfaces, reduction of gingival inflammation (by 68.0 and 70.6% in herbal test groups 1 and 2, respectively) and gingival sulcus bleeding (by 79.5 and 81.2% in herbal test groups 1 and 2, respectively). Final indices values in both herbal test groups (T1 and T2) were significantly (P<0.001) lower compared to those at baseline and those after 42 days in the conventional group (T3). Conclusion: Continuous application of herbal tooth paste provided significant improvement of oral hygiene level and periodontal condition in patients with gingivitis.

PREVALENCE AND SEVERITY OF DENTAL FLUOROSIS IN YEMEN [download full text] 7.43 MB
Abstract: The specific objective of this study was to examine if severe dental fluorosis is associated with increased susceptibility of dental caries. The present study is the first to be conducted in Republic of Yemen since the unifications in 1990. Cross-sectional study, which used random sample of subjects aged 9-20 years attending or working in non private schools in seven towns strategically, distributed, and represented most geographical and climatic areas. Subjects investigated were (n = 793), their age mean and median were 13.3 and 12 years respectively. The gender distribution (n = 439; 55.4%) was boys and 354 (44.6%) girls. Dental fluorosis was recorded using the modified Dean’s index. In which the grade questionable fluorosis was omitted. Among the total number of study subjects (n = 793) the prevalence of dental fluorosis was (n = 495; 62.4%). The prevalence of dental caries among boys was (n = 237; 29.9%) and among girls was (n = 258; 32.5%). Younger subjects aged (9-14 years) had more dental fluorosis than older subjects (15-20 years). Whereas the prevalence of dental caries was (n = 596; 75.2%) of these 332 (41.9%) boys and 264 (33.3%) were girls. The prevalence of (DMFT) among younger subjects (9-14 years) was (n = 397; 78.8%) was significantly higher than older subjects (15-20 years) (n = 199; 68.9%). The present study demonstrated high prevalence of dental fluorosis in approximately two third of the Yemeni population. The high fluorosis was particularly observed in southern and central areas of Yemen. It was also positively correlated with high fluoride in communal drinking water and hot climatic areas. The findings of the present study demonstrated that dental fluorosis showed little protection for those with very mild and moderate degrees of fluorosis compared to those without or with mild fluorosis. Dental fluorosis failed to incur protection to those with severe degree of dental fluorosis compared to those without dental fluorosis. This difference between sbujects with severe detnal fluorosis and those without was statistically highly significant (p-value < 0.05).

EVALUATION OF ORTHODONTIC TREATMENT OPTIONS FOR THE IMPACTED MAXILLARY CANINE [download full text] 6.14 MB
Introduction: Maxillary canine impaction has an incidence of 1 in 100 in the general population and has been reported as much higher in an individual orthodontic practice15. Impaction of the upper permanent canine is almost as common as impaction of the third molar. The likelihood of being able to align one of these teeth with the rest of the dentition depends on a number of factors, and several treatment options are available 16.

DENTAL IMPLANT IN PATIENTS WITH TYPE II DIABETES: PLACEMENT TO 5 YEARS [download full text] 3.55 MB
Abstract: Unfortunately recent data about the prevalence of diagnosed diabetes mellitus (DM) mainly type II and it is relation to dental implants in Yemen was not estimated. Several objectives have been considered in this study, 1- to establish a base line data for future research in dental implant in Yemen, 2- to study the rate of success of dental implants for medically compromised patients in Yemen. The present study is the first to be conducted in Republic of Yemen. Diabetes may effect as many as 18% of people over the age of 65, many of whom will be partially or totally edentulous. The disease has far reaching systemic sequelae, including an increased susceptibility to caries and periodontal disease. It is also known to impair healing which increases the risk of tissue necrosis and infection. However improvements in diabetic management have resulted in many patients being well controlled with stability of their blood glucose and metabolic control. These patients have been shown in previous studies to be suited to dental implant surgery, with an acceptable degree of predictability. This study reports retrospectively on the survival of dental implants placed into diabetic patients. 34 females and males patients with 227 implants were followed through to final restoration. Upon uncovering, 214 of the 227 implants were found to have osseointegrated, yielding a 94% success rate. Of the thirteen failed implants 10 were from the immediately loaded group and three from bone grafting group. All other patients don’t lose any implant. Failures occurred either in the maxillary and in the mandibular jaws, and also in the anterior and posterior segments. Five of the 13 surgical failures were located in the posterior mandible, five were in the posterior maxilla, two were in the anterior maxilla, and one was in the anterior mandible. It was established that, diabetes was categorized into uncontrolled diabetes and controlled diabetes. Only the former was identified as a contra-indication to dental implant treatment. It is important to extract a thorough medical history from the patient, who if diabetic, should be able to demonstrate a good level of control of blood glucose levels, with confirmation that they are metabolically stable prior to and at the time of implant surgery. Patients need to be advised of the importance of maintaining their drug regime throughout treatment and they should be routinely prescribed prophylactic antibiotics, using a broad spectrum drug for 10 days. Under these circumstances it can be concluded that the provision of implants in well controlled diabetic patients yields a high success.

INFECTION CONTROL PRACTICES AMONG DENTAL STUDENTS IN SANA'A, YEMEN [download full text] 7.63 MB
Abstract: Purpose: To assess the level of knowledge, attitude, and practice among Yemeni dental students towards standard infection control precautions in Sana'a, Yemen.
Methods: The study sample comprised 179 (40 males and 139 females) junior and senior dental students from a public dental college located in Sana'a city, Yemen. A self applied, closed ended questionnaire (response as ‘yes’ or ‘no’) was used to collect data. The questionnaire consisted of 15 items related to medical history taking, vaccination status, barrier techniques, and infection control practices.
Results: About 98 percent of dental students usually ask their patients about medical history, 65 percent were vaccinated against hepatitis B, 100 percent wear gloves and 99 percent change gloves during treatment and between patients, and 71 percent wear masks and 51 percent change masks during treatment and between patients. Most dental students (85 and 88 percent) reported that they changed extraction instruments and burs between patients respectively. Unfortunately dental students reported that only 64 percent they changed saliva ejectors between patients, and only 36 percent changed handpieces between patients. Approximately 27 percent (49/179) used autoclaves for sterilization, 13 percent (24/179) used plastic bags to wrap sterilized instruments, and only 26 percent (47/179) disinfected impressions before sending them to dental labs. Four percent used rubber dams in the clinics, and 71 percent had special containers for sharps disposal.
Conclusion: The undergraduate students at this dental college in Sana'a exhibited poor infection control practices. These findings show the need to change organizational and administrative procedures to enable dental students to follow a strict infection control protocol.

INFLUENCE OF KHAT CHEWING ON PERIODONTAL TISSUES AND ORAL HYGIENE STATUS AMONG YEMENIS [download full text] 5.22 MB
Abstract: Background: Khat chewing is popular among Yemenis. This study was performed to investigate the effects of Khat chewing on periodontal tissue and oral hygiene status.
Methods: A total of 730 subjects (336 chewers and 394 non-chewers with a mean age of 31.5 ± 0.8 and 29.4 ± 0.9 years, respectively) were involved. Clinical data on periodontal tissues, oral hygiene sta-tus, gingival bleeding, burning sensation in the soft tissues, halitosis, ulcers in the oral cavity, difficulty in opening the mouth and swallowing solid food were collected to evaluate periodontal condition. Lo-gistic regression analysis, student t test and chi-squared test were employed according to which hypo-theses were being tested.
Results: The oral hygiene status of non-chewers was significantly better than that of chewers. The mean oral hygiene index of chewers was 2.12 ± 0.86 while that of non-chewers was 1.54 ± 1.12, the difference being statistically significant (P < 0.001). The incidence of gingival bleeding was signifi-cantly higher in Khat-chewers. About 23% of chewers complained of difficulty in mouth-opening, as compared with only about 1% of non-chewers. Furthermore, 10% of chewers had difficulty in swal-lowing solid food. A burning sensation in the soft tissues was also found in a higher proportion of Khat-chewers. Similarly, ulcers on the oral mucosa were present in about 7% of chewers, as com-pared to 0.5% of non-chewers. Gingival recession was present in about 51% and 26% of chewers and non-chewers, respectively.
Conclusion: There does appear to be a relationship between the effect of chewing khat on peri-odontal tissue and oral hygiene status.
Keywords: Khat; Yemen; Oral hygiene; Chewers; Gingival Hemorrhage.

MUSCULOSKELETAL SYMPTOMS AMONG DENTISTS IN YEMEN [download full text] 5.71 MB
Abstract: The objective of the study was to find out the prevalence and distribution of musculoskeletal symptoms among dentists in Yemen. Furthermore, to find possible correlations between these symptoms and working positions and actions. A questionnaire about musculoskeletal symptoms in different parts of the body was completed by 136 dentists (78 male, 58 female) from the public dental service clinics in Sana'a city in April 2010. Back pain was the most common complaint affecting almost 80% of the study population, followed by neck pain (58.8%) and shoulder pain (47%). The frequency of shoulder pain among female dentists was nearly double that of males (P=0.009). The mean days of neck pain among males was significantly higher as compared to females (P=0.048). The study suggests that musculoskeletal complaints are common among dentists, though they are not of severe nature. To reduce the prevalence and severity of these disorders specific exercises should be performed.
Keywords: Musculoskeletal disorders, Occupational health, Dentists in Yemen, Working positions

REASONS FOR EXTRACTION OF TEETH IN YEMEN [download full text] 4.06 MB
Abstract: Objectives: To investigate reasons for tooth extraction and its association with age and gender in Yemen.
Materials and Methods: A cross sectional survey was conducted. A record of all tooth extractions performed in Sana'a the capital city of Yemen between 2007 and 2009 was logged on specially designed study forms. The patient’s age and gender, number of teeth extracted, and the reason(s) for the extraction were recorded.
Results: A total of 5140 teeth were extracted in 2602 patients, An examination of the different age groups revealed that caries was the most common reason for extraction of teeth among young patients between the age of 16 and 30 years. Beyond 30 years however, the rate of extraction due to periodontal disease markedly increased. Trauma accounted for 4 % of the teeth lost.
Conclusions: The data show that caries is the principal cause for extractions in younger patients, while periodontal disease accounts for the majority of tooth extractions in older patients. Furthermore, this study indicates that more teeth per patient are lost to periodontal disease than for any other reason.
Keywords: Tooth extraction; Caries; Periodontal disease; Tooth loss; Yemen

EPIDEMIOLOGY OF TRAUMATIC INJURIES TO THE PERMANENT INCISORS IN A SCHOOL POPULATION IN SANA’A, YEMEN [download full text] 3.92 MB
Abstract: This cross-sectional survey was carried out to assess epidemiological data concerning dental injuries to the permanent incisors of Yemeni children. It included 612 boys and 563 girls represented a normal ethnic and socioeconomic distribution for the area. The prevalence, relationship to gender, pattern of involvement, degree of injury and the causative factors for traumatized permanent teeth were studied in a school population. The prevalence was found to be 3.8% with a ratio of 1.3 boys to 1 girl. The most prevalent fractures were found from the enamel. Though most of these fractures were aesthetically unsatisfactory, a high proportion of them were not treated. The most common causative factor was minor outdoor accidents. It was concluded that, traumatic dental injury may pose a serious dental public health problem. Great attention should be gain by parents, teachers and the school heath team for the need of early professional attention.