BackgroundStudies have found a consistent positive association between maternal smoking and non-syndromic orofacial clefts (NSOFC). However, no comprehensive assessment of the association between NSOFC and passive smoking has been undertaken. This systematic review and meta-analysis explores the relationship between maternal passive smoking and NSOFC, and compares the associations between passive and active smoking.Methods and FindingsSearch strategy, inclusion / exclusion criteria, and data extraction from studies reporting maternal passive smoking and NSOFC was implemented without language restrictions. Risks of bias in the identified studies were assessed and this information was used in sensitivity analyses to explain heterogeneity. Meta-analysis and meta-regression of the extracted data were performed. Egger's test was used to test for small study effects. Fourteen eligible articles were identified. Maternal passive smoking exposure was associated with a twofold increase in risk of NSOFC (odds ratio: 2.11, 95% confidence interval: 1.54–2.89); this was apparent for both cleft lip with and without palate (OR: 2.05, 95% CI: 1.27–3.3) and cleft palate (OR: 2.11, 95% CI: 1.23–3.62). There was substantial heterogeneity between studies. In the studies that provided data enabling crude and adjusted odd ratios to be compared, adjustment for potential confounders attenuated the magnitude of association to about a 1.5-fold increase in risk.ConclusionOverall, maternal passive smoking exposure results in a 1.5 fold increase in risk of NSOFC, similar to the magnitude of risk reported for active smoking, but there is marked heterogeneity between studies. This heterogeneity is not explained by differences in the distribution of cleft types, adjustment for covariates, broad geographic region, or study bias/quality. This thorough meta-analysis provides further evidence to minimize exposure to environmental tobacco smoke in policy making fora and in health promotion initiatives.

Purpose: Silver diamine fluoride (SDF) is an effective caries control agent. The aim of our study was to investigate the parental acceptance of the utilization of SDF on their child’s primary and permanent teeth and to determine the factors that influence their decision-making. Patients and methods: This descriptive cross-sectional study included parents of healthy children aged 12 years and younger and currently receiving dental treatment. The interview questionnaire was conducted and pre-tested for face and content validity. The trained interviewing dentists showed colored pictures of primary and permanent teeth before and after receiving SDF treatment. The statistical significance was set at P <0.05. Results: A total of 104 parents were included in the study. The mean parental rating of treatment acceptability of the staining associated with SDF was 3.9±1.95. The plurality considered the staining caused by SDF treatment strongly not acceptable 46 (43.4%). Parental acceptance of SDF treatment was significantly affected by the location and type of teeth. Parents showed significantly higher acceptance of SDF treatment on their child’s primary compared to permanent teeth and posterior compared to anterior in both dentitions ( P <0.001). In addition, parents of children with a history of uncooperative behavior during previous dental treatment were significantly more accepting of SDF treatment regardless of the type and location of the teeth. Conclusion: Parental acceptance of SDF increased for primary compared to permanent teeth, on anterior compared to posterior teeth in both dentitions and for uncooperative children.

Objectives:To describe the characteristics and prevalence of non-syndromic orofacial clefting (NSOFC) and assess the effects of parental consanguinity on NSOFC phenotypes in the 3 main cities of Saudi Arabia.Methods:All infants (114,035) born at 3 referral centers in Riyadh, and 6 hospitals in Jeddah and Madinah between January 2010 and December 2011 were screened. The NSOFC cases (n=133) were identified and data was collected through clinical examination and records, and information on consanguinity through parent interviews. The diagnosis was confirmed by reviewing medical records and contacting the infants’ pediatricians. Control infants (n=233) matched for gender and born in the same hospitals during the same period, were selected.Results:The prevalence of NSOFC was 1.07/1000 births in Riyadh, and 1.17/1000 births overall; cleft lip (CL) was 0.47/1000 births, cleft lip and palate (CLP) was 0.42/1000 births, and cleft palate (CP) was 0.28/1000 births. Cleft palate was significantly associated with consanguinity (p=0.047, odds ratio: 2.5, 95% confidence interval: 1 to 6.46), particularly for first cousin marriages.Conclusion:The birth prevalence of NSOFC in Riyadh alone, and in the 3 main cities of Saudi Arabia were marginally lower than the mean global prevalence. While birth prevalence for CLP was comparable to global figures, the CL:CLP ratio was high, and only CP was significantly associated with consanguinity.

BackgroundThe aim of this study was to systematically review the literature to determine the sequelae of early extraction of compromised first permanent molars (FPMs) with regard to the skeletal and dental development of 5- to 15-year-old children. Meta-analysis was conducted when applicable.MethodsOur research protocol included a search strategy, inclusion/exclusion criteria, and a data extraction plan. The search engines used were PubMed, Scopus, and Science Direct. Study selection was performed independently by three reviewers. Articles published from 1960 to 2017 were reviewed based on inclusion and exclusion criteria. Meta-analysis was performed to compare space closure between upper and lower arches.ResultsEleven studies fulfilled the inclusion criteria. The consequences were decrease in post extraction space, accelerated development and eruption of second permanents molars (SPMs) and third molars, a decrease in caries and/or fillings on the proximal surfaces of adjacent teeth, lingual tipping and retrusion of incisors, and counter clockwise rotation of the occlusal plane.ConclusionThere were several consequences of early extraction of FPMs, which were related to skeletal and dental development. Our systematic review suggests that comprehensive evaluation of the compromised FPMs should be performed before planning an extraction. The ideal time for FPM extraction is when the SPM is at the early bifurcation stage in order to achieve complete closure of the extraction space by the SPM. Benefits should be weighed over the risks to decrease the risk of unfavorable outcomes as much as possible. However, due to the limited evidence on the outcomes and variables that influence them, high-quality prospective studies are needed.Electronic supplementary materialThe online version of this article (10.1186/s12903-018-0516-4) contains supplementary material, which is available to authorized users.

Early assessment of the oral health status of children has the potential to reduce or even eliminate oral diseases. Parents rarely take their children to dentist early enough to control dental diseases. However, parents contact pediatricians several times even before the child is born and during the child's early life. Accordingly, pediatricians are considered a perfect and reliable source for oral health control and prevention.Aim: To measure the dental knowledge, attitude and behavior (KAB) of pediatricians in the City of Jeddah regarding oral health status and methods for prevention of dental diseases in children. Materials and method: Questionnaires consisting of 40 demographic and KAB's questions were distributed to all pediatricians in Jeddah city (605 pediatricians). The KABs' questions consisted of general dental knowledge, preventive dental measures, timing for referral, diet counseling, parafunctional habits and handling of traumatized teeth. A score was given for each question. Percentages of total scores of KABs were compared.Results: The response rate of pediatricians in Jeddah city (363) was 60%. Their mean age was 39.57 years. Pediatricians' KABs were found to be unsatisfactory. The most important observation was that the concept of oral health prevention was deficient. Pediatricians' awareness of fissure sealants, fluoride, dietary counseling,time of first dental visits and thumb sucking were quite limited. Pediatricians' knowledge was significantly lower than their attitude and behavior's scores. Conclusion: In general, pediatricians' knowledge,attitudes and behavior regarding oral health were not satisfactory.

Zinc oxide eugenol (ZOE) has traditionally been used as a root filling material in primary teeth pulpectomy. Calcium hydroxide and iodoform (Ca(OH)2/iodoform) may have advantages as a root canal filling material to evaluate treatment success of Ca(OH)2/iodoform pulpectomy in primary teeth compared with ZOE based on clinical and radiographical criteria. All human clinical studies reporting clinical and radiographical outcomes of Ca(OH)2/iodoform compared with ZOE in primary teeth pulpectomy were identified in digital bibliographic databases. Two authors independently selected studies and extracted relevant study characteristics. Success of treatment was based on an accomplishment of specific clinical and radiographical criteria. Meta‐analyses were performed to appraise study heterogeneity and aggregated statistics. Out of 5,000 articles identified in initial search, 15 articles met all inclusion criteria, while 10 were included in the meta‐analyses. At 6‐ and 12‐month follow‐up, there were no statistically significant differences in the clinical and radiographical success rates of Ca(OH)2/iodoform and ZOE. However, ZOE was shown to have statistically significant higher success rates at ≥18‐month follow‐up. On the basis of the findings of this systematic review, we recommend that Ca(OH)2/iodoform be utilized for pulpectomy in primary teeth nearing exfoliation; conversely, ZOE should be utilized when exfoliation is not expected to occur soon. Future randomized control clinical trials with a long‐term follow‐up are needed before a reliable conclusion can be drawn as to the best pulpectomy material. The success of pulpectomy in primary teeth depends on selecting the ideal root canal filling material. It is challenging to select the appropriate filling materials for primary teeth. ZOE or ZOE/iodoform combined with Ca(OH)2 appears to be the materials of choice if primary teeth are not nearing exfoliation. More high‐quality randomized control clinical trials with a long‐term follow‐up period are needed before a reliable conclusion can be drawn as to the best pulpectomy material in primary teeth (systematic review registration number: CRD42016037563).

Background This systematic review of the literature was carried out to assess parental acceptance for silver diamine fluoride (SDF) application and esthetic outcome on their children primary dentition and evaluate factors that might influence their acceptance. Methods Our research protocol included a search strategy, inclusion/exclusion criteria, and a data extraction plan. The search engines we used were PubMed, Google Scholar, and Science Direct. Reviewers independently reviewed, determined and carried out quality assessment for included studies using CONSORT (for clinical-trials), and STROBE (for Observational studies). In addition, evidence and recommendation’s strength was conducted using Shekelle et al. system. Subsequently, a meta-analysis was performed to assess the association between parental acceptance for SDF treatment and teeth type, location and child’s cooperation. Results Eight studies fulfilled the inclusion criteria. There were statistically significant differences between parental acceptance for SDF usage on posterior teeth compared to anterior teeth ( P < 0.001, OR: 0.23 and 95% CI: 0.15–0.34) and for SDF usage on anterior teeth of uncooperative compared to cooperative children ( P < 0.001, OR: 0.27 and 95% CI: 0.17–0.44). Additionally, parent’s acceptance rate for SDF application increased after follow-up visits and education. Conclusion Parental acceptance for SDF treatment was significantly related to tooth location, child cooperation and pre-operative instruction.

The eightfold variation in the prevalence of orofacial clefts between highest and lowest prevalence is likely to be due, at least in part, to problems with ascertainment, but there may also be underlying genetic or environmental factors that require further investigation.