Passive smoking in the etiology of non-syndromic orofacial clefts:a systematic review and meta-analysis

Background Studies have found a consistent positive association between maternal smoking and nonsyndromic 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 Findings Search 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. Conclusion Overall, 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.</p

Birth prevalence of non-syndromic orofacial clefts in Saudi Arabia and the effects of parental consanguinity

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

Molecular Screening of <i>VAX1</i> Gene Polymorphisms Uncovered the Genetic Heterogeneity of Non-Syndromic Orofacial Cleft in Saudi Arabian Patients

Objective: Nonsyndromic orofacial cleft (NSOFC) including cleft lip with or without cleft palate (CL±P) and cleft palate (CP) are multifactorial developmental disorders with both genetic and environmental etiological factors. In this study we investigated the association between CL±P and CP, and two polymorphisms previously determined using genome-wide association studies, as well as the association between consanguinity and CL±P and CP. Methods: DNA was extracted from saliva specimens from 171 triads consisting of affected individuals and their parents, as well as 189 control triads (matched for age, gender, and location) that were recruited from 11 referral hospitals in Saudi Arabia. Two polymorphisms, rs4752028 and rs7078160, located in the VAX1 gene were genotyped using real-time polymerase chain reaction. A transmission disequilibrium test was carried out using the Family-Based Association Test and PLINK (genetic tool-set) to measure the parent-of-origin effect. Results: Significant differences were found between affected individuals and the control group. In the case of the rs4752028 risk allele in cleft, the phenotypes were: CL±P (fathers: odds ratio [OR] 2.16 [95% CI 1.38–3.4]; mothers: OR 2.39 [95% CI 1.53–3.71]; and infants: OR 2.77 [95% CI 1.77–4.34]) and CP (fathers: OR 2.24 [95% CI 1.15–4.36] and infants: OR 2.43 [95% CI 1.25–4.7]). For CL±P and the rs7078160 risk allele, the phenotypes were: (fathers: OR 1.7 [95% CI 1.05–2.86]; mothers: OR 2.43 [95% CI 1.49–3.97]; and infants: OR 2.34 [95% CI 1.44–3.81]). In terms of consanguinity, we found significant association between consanguinity and the rs4752028 polymorphism minor allele among CL±P compared with controls (p = 0.001). Conclusion: This is the first study to find a relationship between these two loci on 10q25 (rs4752028 and rs7078160) and NSOFC in a population with high levels of consanguinity

Children's electronic screen time exposure and its relationship to dental anxiety and behavior

الملخص: أهداف البحث: كان الغرض من هذه الدراسة هو تقييم العلاقة بين وقت الشاشة الإلكتروني وقلق وسلوك الأسنان لدى الأطفال الذين تتراوح أعمارهم بين ستة إلى اثني عشر عاما أثناء فحص الأسنان والوقاية وتطبيق الفلوريد الموضعي. طريقة البحث: كانت هذه دراسة مقطعية شملت 402 مريض أسنان أطفال تتراوح أعمارهم بين ستة إلى اثني عشر عاما جاءوا إلى مستشفى جامعة الملك عبد العزيز لطب الأسنان في جدة، المملكة العربية السعودية. تم جمع البيانات من سبتمبر 2020 إلى ديسمبر 2021. تم استخدام الاستبيان الذاتي لجمع البيانات من المريض وولي أمره. كانت تتألف من 8 أسئلة ديموغرافية بالإضافة إلى 13 سؤال متعدد الخيارات فيما يتعلق بوقت شاشة المرضى. تم تقييم القلق عند الأطفال باستخدام مقياس قلق أسنان الأطفال. تم تقييم سلوك الطفل باستخدام مقياس فرانكل للتقييم السلوكي. النتائج: كان معدل استجابة هذه الدراسة 100٪. من بين 402 مشاركا، وجد أن 248 (61.7٪) يعانون من القلق بينما 154 (38.3٪) لم يكونوا كذلك. من بين جميع المشاركين 274 (68.2٪) كانوا متعاونين و 128 (31.8٪) لم يكونوا متعاونين. تم العثور على علاقة ذات دلالة إحصائية بين القلق والمشاكل السلوكية أثناء زيارة الأسنان وإجمالي ساعات تعرض المشاركين للأجهزة الإلكترونية. أظهر الأطفال الذين تعرضوا للإلكترونيات في سن عامين أو قبل ذلك مزيدا من القلق والسلوك غير المتعاون. الاستنتاجات: يمكن أن يرتبط التعرض المبكر للشاشات الإلكترونية، خاصة لأغراض الترفيه والتعرض لفترة أطول بزيادة قلق الأسنان والسلوك غير المتعاون لدى الأطفال الذين تتراوح أعمارهم بين 6-12 عاما. يجب توعية الآباء حول مخاطر السماح لأطفالهم باستخدام الأجهزة الإلكترونية وتشجيعهم على استبدال هذه الأجهزة بأنشطة تتضمن نشاطا بدنيا. Abstract: Objectives: The purpose of this study was to assess the association between electronic screen time and dental anxiety and behaviour among children aged six to twelve years during dental examination, prophylaxis, and topical fluoride application. Material and methods: This was a cross-sectional study which included 402 paediatric dental patients aged six to twelve years who came to King Abdulaziz University Dental Hospital in Jeddah, Saudi Arabia. The data was collected from September 2020 to December 2021. Self-constructed questionnaire was used to collect data from the patient and his/her guardian. It was comprised of eight demographic questions as well as 13 multiple-choice questions regarding the patients' screen time. Child dental anxiety was assessed by using Abeer Children Dental Anxiety Scale (ACDAS). Assessment of child's behaviour was done by using Frankl Behavioural Rating Scale. Results: This study had a response rate of 100%. Out of the 402 participants, 248 (61.7%) were found to have anxiety while 154 (38.3%) were not. Of all participants 274 (68.2%) were cooperative and 128 (31.8%) were not. A Significant relationship between anxiety and behavioural problems during a dental visit and the participant's total exposure hours to electronic devices was found (p < 0.001). Children exposed to electronics at the age of two years or before displayed more anxiety and uncooperative behaviour (p < 0.001). Conclusions: early exposure to electronic screens, especially for entertainment purposes and longer exposure can be associated with increased dental anxiety and uncooperative behaviour in children age 6–12 years. Recommendations: Parents should be educated about the risks of permitting their children to use electronic devices and encouraged to replace such devices with activities that incorporate physical activity

Effect of Environmental Tobacco Smoke on Children’s Anxiety and Behavior in Dental Clinics, Jeddah, Saudi Arabia: A Cross-Sectional Study

Background: Environmental tobacco smoke (ETS) has been linked to behavioral problems, but no study has assessed its relationship with dental anxiety. Therefore, this study&rsquo;s goal is to assess the relation between ETS and both behavioral problems and dental anxiety among children. Methods: The study sample was collected from two centres in Jeddah from October 2019 to January 2020. Inclusion criteria included healthy 5&ndash;16-year-old children having their first dental visit with no emergency complaint. The questionnaire including general information, ETS exposure, the child&rsquo;s anxiety using the Abeer Children Dental Anxiety Scale (ACDAS) and dental behavior using the Frankl Behavioral Rating Scale. Results: Of 500 children, 337 (67.4% response rate) responded to the questionnaire, among whom 201 (59.6%) had been exposed to passive smoking compared to 136 (40.4%) who had not. Exposed children had a statistically significantly greater tendency to develop anxiety (p = 0.002) and demonstrate uncooperative behavior (p = 0.006). Generalized linear mode and binary regression analyses suggested that ETS has a statistically significant effect on children&rsquo;s dental anxiety and behavior (p &lt; 0.05). Conclusions: Children exposed to ETS demonstrated statistically significantly higher anxiety levels and uncooperative behavior in the dental clinic compared to those who were not exposed

Forest plot for meta-analysis showing the crude and reported adjusted OR for the association between maternal passive smoking and NSOFC.

<p>Forest plot for meta-analysis showing the crude and reported adjusted OR for the association between maternal passive smoking and NSOFC.</p

Consequences of early extraction of compromised first permanent molar: a systematic review

Abstract Background The 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. Methods Our 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. Results Eleven 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. Conclusion There 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

Forest plot for meta-analysis of the association between maternal passive smoking and NSOFC according to region.

<p>Forest plot for meta-analysis of the association between maternal passive smoking and NSOFC according to region.</p