The appropriate timing for orthodontic intervention has been a subject of debate for a long time, concerning not only the immediate effects but also the long-term benefits of such treatment. This review aimed to find the appropriate treatment timing for the intervention of various orthodontic problems. A literature search was performed in all major databases, including PubMed and Cochrane Library, until February 20, 2023. All observational and experimental studies published in English that compared early versus late orthodontic treatment in different types of orthodontic problems were included. Data selection and charting were undertaken by a single investigator. A total of 32 studies were identified that discussed various aspects of interventions, including Class II and Class III malocclusion, pseudo-Class III malocclusion, anterior and posterior crossbite, extractions, and long-term benefits. Overall, early intervention was not found to be superior in terms of effectiveness, overall duration of appliances, and cost–benefit ratio. Early intervention should be reserved for specific conditions or localized malocclusions that have psycho-social benefits, or to significantly reduce the severity of problems to be dealt with in comprehensive treatment in the permanent dentition.
Background: Intranasal sedation is commonly used in pediatric dentistry to manage dental anxiety and improve patient compliance. This systematic review and meta-analysis aimed to evaluate the recovery time, patient satisfaction, and adverse effects of the intranasal sedatives midazolam, dexmedetomidine, and ketamine in pediatric dental procedures. Methods: A systematic search of PubMed, Scopus, the Web of Science, the Cochrane Library, Embase, and Google Scholar was conducted following the PRISMA 2020 guidelines. Only randomized controlled trials (RCTs) involving intranasal sedation in pediatric patients (≤18 years) were included. The revised Cochrane risk of bias tool (RoB 2) was employed to assess study quality. A meta-analysis using a random-effects model was performed to evaluate the recovery time. Results: Twenty-one RCTs were included in this review. A meta-analysis of seven studies revealed that dexmedetomidine was associated with significantly longer recovery times compared to midazolam and ketamine. Specifically, midazolam demonstrated the shortest recovery time (mean difference: −19.1 min, p < 0.05), followed by ketamine (mean difference: −15.6 min, p < 0.05). A qualitative analysis of adverse effects showed mild to moderate complications, including nasal irritation (midazolam), prolonged sedation (dexmedetomidine), and hypersalivation (ketamine). Patient satisfaction was found to be highest with dexmedetomidine, although midazolam was preferred for its faster onset of sedation. Conclusions: Intranasal sedation in pediatric dentistry is a safe and effective approach, with each agent exhibiting distinct recovery profiles and safety considerations. The findings emphasize the importance of standardized sedation protocols and the need for further research into the long-term outcomes of these sedatives in pediatric populations.
Background/Objectives: Oral hygiene is an essential component of overall health, but is often neglected during hospital stays, particularly among patients who rely on healthcare providers for daily care. Poor oral hygiene may lead to discomfort, infections, and complications such as hospital-acquired pneumonia. The objective of this study was to assess the oral hygiene practices of hospitalized patients in Al-Ahsa, Saudi Arabia. Methods: A hospital-based cross-sectional study was conducted among patients in public and private hospitals. Since no prior studies existed for this population, a pilot study with 60 participants was used to estimate the population proportion for sample size calculation. Based on the pilot findings, a proportion of 80% was assumed, with a 95% confidence level, 5% margin of error, and 80% power. Patients were recruited through non-probability convenience sampling. Data were collected via structured face-to-face interviews and analyzed using SPSS version 27. Descriptive statistics, chi-square tests, and logistic regression were applied, with significance set at 0.05. Results: Regular toothbrushing declined from 69.6% before admission to 29.8% during hospitalization. Only 29.8% of patients received oral hygiene supplies, and 79.2% received no assistance. In-hospital toothbrushing was significantly associated with being female (AOR = 2.52; 95% CI: 1.17–5.43), non-Saudi (AOR = 3.91; 95% CI: 1.22–12.55), and having a Bachelor’s degree or higher (AOR = 5.66; 95% CI: 1.53–20.88). Conclusions: Oral hygiene among hospitalized patients in Al-Ahsa was inadequate, particularly in public hospitals where essential supplies were lacking. Hospitals should adopt clear oral care policies, ensure supply availability, train staff, and integrate dental professionals to improve patient safety and prevent complications.
Background/Objective: This study evaluated the diagnostic performance of vertical growth patterns and mandibular morphology, alongside the anteroposterior dysplasia indicator (APDI), for classifying skeletal malocclusions in a Saudi adult population using cephalometric analysis. Materials and Methods: This retrospective cross-sectional discriminatory performance study analyzed 162 archived lateral cephalometric radiographs of Saudi adults aged 18–44 years. The assessed variables included Frankfort-mandibular plane angle (FMA), gonial angle, ANB angle, and APDI. Statistical analysis involved descriptive statistics, ANOVA with post hoc testing, Pearson correlation, logistic regression, and receiver operating characteristic (ROC) curve analysis. Results: Significant differences among skeletal classes were observed for all evaluated variables (p < 0.05). APDI showed the largest effect size and the highest diagnostic performance, particularly for Class III malocclusion, with excellent discriminatory ability reflected by area under the curve (AUC) values, high sensitivity, and acceptable specificity at optimal cutoff points. FMA showed moderate discriminatory performance, with higher specificity but limited sensitivity, while the gonial angle exhibited comparatively weaker diagnostic performance. In logistic regression analysis, APDI was the only significant independent associated variable of Class II malocclusion. Conclusions: Within the ANB-based classification framework used in this study, APDI showed the highest discriminatory performance for skeletal malocclusion classification, supporting its role as a primary sagittal indicator. FMA contributed adjunctive information on vertical skeletal pattern, while the gonial angle showed limited diagnostic value. Combined assessment of sagittal and vertical parameters may improve cephalometric diagnosis.