Aims: Surgical management of patients presenting with multiple fractures of the mandible involving condylar segments can be a challenging proposition to the maxillofacial surgeon. These fractures can be double or triple mandibular fractures and may also be in association with panfacial fractures. Even though most authors suggest that the conventional approachof reduction and fixation of the mandibular symphysis/ parasymphysis fractures, prior to addressing the fractured condylar segment is appropriate, there exists another school of thought suggesting that the condylar segment must be reduced and fixed first. This article aims to review the outcomes of surgery when reduction and fixation of the fractured condyle is done prior to other associated mandibular fractures and looks into the various surgical approaches advocated for the same. Materials and Methods: 121 surgically treated patients with multiple (double/ triple) mandibular fractures including a condylar component were reviewed. The preauricular, periangular and the retromandibular (anterior parotid-transmasseteric) approaches were advocated to access the fractured condylar segments. Results: The fractured condyle was the first segment to be addressed during the sequencing of the surgical management, irrespective of the approach used. Good reduction and fixation with limited complications were achieved by addressing the condylar fracture first. Conclusion: Sequencing of multiple mandibular fractures, though the prerogative of the operating surgeon, addressing the condylar segment first, provides the operator with a viable alternative to the conventional technique.

Aims: The aim of the study is to determine the water source used for drinking and cooking purpose by the pediatric population in the United Arab Emirates (UAE). To ascertain the underlying factors influencing the parental choice for selecting tap water or bottled water. The study was also done to evaluate whether demographic factors have an influence on the parental choice of water consumption source.Materials and Methods: A total of 200 parents who had children aged between 3- and 15-year-old were chosen for this randomized cross-sectional study. The parents of the selected children were given a prewritten questionnaire consisting of 12 questions in four different languages. The questionnaires documented sociodemographic characteristics, water consumption practices, and the rationale for choosing bottled water and tap water. The responses were analyzed using descriptive statistics and a Chi-square test for a single proportion. Results: Majority of the parents in this study preferred bottled water to tap water for drinking and cooking purposes. About 84% of the parents opted bottled water for drinking and 57% selected bottled water for cooking at home. The consumption of tap water for drinking purpose from school and home was only 13% and 16%, respectively. Parental educational background and household income did not affect their selected source of water. A Chi-square test of independence conducted to investigate possible association between source of water and its purpose for drinking and cooking revealed that the source of water (tap/bottled water) was dependent on its purpose. Conclusion: A greater percentage of the UAE pediatric population utilized bottled water for drinking at school and home. The perceptions about the quality and safety of tap water had a great effect on the caregiver's choice on children's water consumption habits. The demographic factors such as socioeconomic status and parental education had no influence on the source of water used for drinking purpose.

Aims: The aim of the study is to appraise the awareness levels among dentists of the Kingdom of Saudi Arabia (KSA) regarding oral cancer. Materials and Methods: A survey based on questionnaire was done to evaluate the acquaintance levels regarding oral cancer among the dentists working in the governmental and private dental clinic, Riyadh city, KSA. Results: Majority of the patients were male (57.9%, n = 117), most were working in private clinics (57.4%, n = 116), graduated within 15 years (2003–2018) (89.1%, n = 180), and general practitioners (78.7%, n = 159). The variation between knowledge and age, gender, year of graduation, and specialty (P > 0.05) among dentists was insignificant. Conclusion: For early detection of oral cancers, dentists have a vital role as they are the persons who see and observe oral cavity during routine dental checkups and can help identify suspicious lesions before having any symptoms.

Aims: Hereditary and environmental factors can lead to enamel hypoplasia (EH). This defect can affect the baby teeth (primary) or permanent teeth. The study has been performed to estimate the incidence of the enamel hypoplasia among children between the age group of 8 and 15 years in Al-Anbar Governorate, Iraq and to try to find some solutions to protect the enamel in these ages. Materials and Methods: A total of 2652 pupils were selected from schools of primary and medium. All samples were chosen according to the randomized stratified clustered manner. The pupils' populations were classified into 1–3 groups. In each group, there were 884 pupils (442 males and 442 females) examined. The procedures of diagnosis were in calm status with daylight, using general surgical instruments, for example, disposable mirror, and forceps that have been used to retract the lips and cheeks. Statistical Analysis: The data have been collected were analyzed using the Chi-square statistic test (SPSS version 22 software). Results: The enamel hypoplasia was the most common widespread in both genders, in the boys, it was 122 (9.2%), whereas in the girls, it was 117 (8.82%), and there were no statistically significant P value differences between both genders (P > 0.05). Results also showed that hypoplastic enamel was significantly seen on the maxillary incisors compared with the canines and the premolars. Conclusion: Several factors can cause enamel hypoplasia among children between the age group of 8 and 15 years in Al Anbar Governorate such as nutritional factors, illness, or the range of acquired genetic factors that are eventually lead to esthetics problems and dental hypersensitivity. Accordingly, enamel hypoplasia in teeth can increase the risk of dental caries and tooth wear; therefore, one of the best options was effective preventive care and monitoring are required that is the helping to protect the enamel.

Aims: Arch form is one of the important components that can relapse after orthodontic treatment. The relationship is between arch form and tooth size ratio (TSR) need to be evaluated that could help to determine extraction or nonextraction treatment in malocclusion. The aim of this study was to analyze the correlation of maxillary and mandibular arch forms with TSR in ethnic Javanese Malocclusion Patient at Airlangga University Dental Hospital. Materials and Methods: This study was an observational, analytical study with cross-sectional and total sampling method. The samples consisted of 135 model study were chosen according to the inclusion criteria and distributed into malocclusion Class I, Class II, and Class III Angle's classification. All the samples were analyzed using Bolton's anterior and overall ratio, and the maxillary and mandibular arch forms were detected using mathematical ratio using (canine depth/molar depth (MD))/(canine width [CW]/molar width [MW]). Statistical Analysis: The correlation of maxillary and mandibular arch form with clinically significant TSR using Bolton's analysis is interpreted using Pearson correlation test (P < 0.05). Results: No significant correlation of maxillary and mandibular arch forms with TSR using Bolton's analysis among malocclusion of Angle Class I, Class II, and Class III in ethnic Javanese (P > 0.05) was found. While the anterior TSR in Class I Angle's malocclusion has a significant correlation with inter-CW in mandibular arch (P < 0.05). Conclusions: TSR was not affected by types of arch form either in maxillary or mandibular while the anterior TSR in Class I Angle's malocclusion did.

Aims: Metal-porcelain restoration on esthetic zones often results in an umbrella effect due to metal collar coping on the labiomarginal area. Therefore, metal collarless design on metal-porcelain restoration was indicated, yet it may influence the fracture resistance of the restoration. This study aimed to determine the effect of metal coping designs on the labiomarginal area against fracture resistance of metal-porcelain restoration. Materials and Methods: A total of 24 samples of metal-porcelain restorations from four designs were fabricated and cemented on 24 metal dies. The study was divided into four groups; Group A with metal collar design, Group B with modified metal collar design, Group C with metal collarless design, and Group D with modified metal collarless design. The measurement of fracture resistance was carried out using universal testing machine (Torsee UTM AMU-10, Tokyo, Japan) at a crosshead speed of 0.05 mm/minute. Loading point was applied at an angle of 45° until the porcelain layer fractured. Results: The mean value and standard deviation of fracture resistance are 2237.56 ± 183.83 N in Group A, 1934.34 ± 152.81 N in Group B, 2049.62 ± 162.58 N in Group C, and 2146.15 ± 210.75 N in Group D. Significant influence of fracture resistance on metal-porcelain restorations was found in all experimental groups (P < 0.05), and there were significant differences between Groups A and B and between Groups B and D (P < 0.05). Conclusion: Metal-porcelain restoration with modified metal collarless design can be an alternative restoration on esthetic zone with high fracture resistance and may be able to prevent umbrella effect on the labiomarginal area.

Aim: The aim of the study is to assess the prevalence of malocclusion and orthodontic treatment needs among 12–15-year-old female schoolchildren of Riyadh, Saudi Arabia. Materials and Methods: A cross-sectional descriptive survey was conducted among 500 female students aged 12–15 years. The prevalence of malocclusion and orthodontic treatment needs was assessed using occlusal traits based on the FDI/World Health Organization objective method. General information on demographic data was also recorded. Descriptive statistics was done to check discrepancies and consistencies. Results: Malocclusion and orthodontic treatment need were reported in this study. Twenty-three percent of participants had 2 mm and more diastema. The majority of participants had Class 1 relation with molar, incisor, and canine. Around 18.8% of participants had over 1/3 overlap, 12.9% had anterior open bite, and 11.9% had posterior over bite (unilateral and bilateral). Posterior crossbite on the right and left sides was present in 19.6% and 16.1% of participants, respectively. Scissor bite on the right and left sides was present in 11.5% and 12.8% of participants, respectively. Around 8.4% of participants had maxillary overjet over 4 mm. Reverse overjet was present in 14.8% of participants. Conclusions: There is a prevalence of malocclusion among the age group of 12–15 years in the KSA. This study can be used as a standard to implement school-based oral health awareness programs which are needed in the KSA.

Aims: The survival of oral squamous-cell carcinoma (OSCC) patients remains poor despite recent treatment advances. A sensitive and specific biomarker is important in screening high-risk patients. The present study was undertaken to test a hypothesis whether salivary tumor necrosis factor-alpha (TNF-α) can be used as a biomarker for OSCC. The study aimed to assess salivary TNF-α in OSCC, leukoplakia, and whether it can be used as a biomarker for the early diagnosis of OSCC. The objectives are as follows: (1) To evaluate salivary TNF-α and compare with histological grades of OSCC. (2) To evaluate salivary TNF-α in leukoplakia and compare with different grades of dysplasia. (3) To compare TNF-α levels in the saliva of oral cancer patients with leukoplakia patients and with healthy control group. Materials and Methods: The study was conducted in 90 participants, of which 30 healthy individuals, 30 leukoplakia, and 30 OSCC patients. Whole unstimulated saliva was collected and analyzed using an ELISA test. Results: TNF-α was significantly elevated in leukoplakia, further elevated in OSCC as compared to controls. There was a significant difference in TNF-α between the different histopathological grades of OSCC and leukoplakia (P ≤ 0.01). There were also statistically significant differences in TNF-α level between different clinical stages in OSCC (P ≤ 0.05). ROC curve analysis and area under curve values showed high specificity and sensitivity in differentiating OSCC from leukoplakia and healthy controls. Conclusion: The present study shows that salivary TNF-α can be used as a marker for predicting leukoplakia and oral cancer. The study also showed a significant correlation between clinical staging and histopathological grading of OSCC and TNF-α level.

Aims: Enamel is the hardest tissue in the human body and possessing mechanical properties, such as physiological functions as chewing, while protecting the underlying structure. Fluoride increase and improve one of the mechanical properties which is tooth surface hardness, but the excessive use of fluoride has the risk of fluorosis. Theobromine in cacao rind extract could potentially be used as an alternative herbal ingredient. Theobromine increases tooth enamel surface hardness through interstitial reactions. The aim of this study is to analyze differences in the hardness of the enamel surface by immersing it in extract of cacao rind and fluoride. Materials and Methods: The dental crowns of 27 square-shaped bovine incisors were planted in a round-shaped resin mold and divided into three groups consisting of nine samples. The control group was immersed in artificial saliva, Group I was immersed in artificial saliva with 0.1% of theobromine cacao rind extract, while Group II was immersed in a combination of artificial saliva and 2% sodium fluoride (NaF). The measuring of surface hardness was performed using Wolpert Wilson Vickers Microhardness tester after the sample had been immersed in the incubator for 30 min at 37°C. Results: Those groups immersed in artificial saliva to which 0.1% theobromine cacao rind extract was added yielded the highest surface hardness. The surface hardness of groups immersed in artificial saliva with the addition of 2% NaF was higher than that of the artificial saliva group. Conclusions: There was significant difference in the tooth enamel surface hardness of the groups immersed in cacao rind extract compared with that of the fluoridated groups.

Aims: The objective of this research is to form independent cadres and could provide counseling and training on how to brush full/partial edentulous teeth the right way to the elderly in nursing home. Materials and Methods: This descriptive study was conducted with 12 participants with posttest only group design. Participants are given the theory of toothbrushing method of edentulous teeth, practical demonstration, and evaluation. To measure the knowledge level, there is a posttest and socialization ability test for respondents.Results: The average achievement percentage of respondents about knowledge and application of the elderly toothbrushing method was 96.67%, and the achievement percentage of respondent's success about the socialization ability was 87.66%. Conclusions: Based on empowerment results, most cadres understood about how to brush elderly teeth properly and socialize it to their elderly friends about how to brush their teeth properly.