ASSESSING SMILE SATISFACTION AND NEEDS OF DENTAL IMPROVEMENT TREATMENTS AMONG DENTISTS, INTERNS, AND STUDENTS IN YEMEN

Ahmed Hasan Ismail Shibam1image, Mohammed Lutf Mohammed Al-Anesi2image, Raad Ghaleb Ghaleb Yahya Al-Salou3image, Sarah Nasser Ali Al-Maznae4image, Fatima Mohammed Abdullah Al-Rohmi5image, Adel Saleh Ali Sulaiman1image, Ammar Qasem Hasan Al-Muntaser1image,

Hassan Abdulwahab Al-Shamahy6image  

1Department of Oral and Maxillofacial Surgery, Faculty of Dentistry, Sana'a University, Republic of Yemen.

2Orthodontics, Pedodontics and Prevention Department Faculty of Dentistry, Sana'a University, Yemen.

3Departement of Basic Sciences, Faculty of Dentistry, Sana’a University, Republic of Yemen.

4Medical Microbiology and Clinical Immunology Department, Faculty of Medicine and Health Sciences, Sana’a University.

5Department of prosthodontics, Faculty of Dentistry, Emirates International University, Yemen.

6Department of Restorative and Esthetic Dentistry, Faculty of Dentistry, Sana’a University, Republic of Yemen.

 

Abstract

Background and aims: Individual differences in how they view beauty may have an impact on their desire for cosmetic procedures. Several studies have compared dentists' perceptions of smile treatments with the general public. However, few studies have compared the perceptions of dental students, interns, and recent dental graduates with those of a similar group of dental professionals. This study aimed to compare how dental students perceive dental smiles and the extent to which they seek dental enhancement treatments.

Methods: This study aims to conduct a cross-sectional study targeting dental students in their final two years, training students, dentists and specialists in Yemen using a written questionnaire sample selected from the Faculty of Dentistry, Sana'a University and selected dental clinics in Sana'a city. The questionnaire was designed and distributed by the researchers. The study involved 329 dental students and dentists, with an average age of 25±4 years. 

Results: The study found that 79.6% of participants were confident about their overall teeth, while 75.7% were confident about their tooth color, size, shape, and alignment. The study found that 40.4% of participants had crowding, 14.3% had gaps, 12.8% had fractures, and 37.1% had dental caries. 16.7% did not have cosmetic restorations, and 9.7% suffered from protruding teeth. 14% experienced a deep bite, while 4.9% experienced an open bite. The study found that 25.8% of participants sought orthodontic treatment, while 35.9% desired other treatments to improve their appearance. The majority (22.5%) preferred teeth whitening, while 39.2% prioritized function, while 53.2% prioritized aesthetics. 

Conclusion: The study reveals that students, trainees, and dentists all respond positively to smile improvement procedures, showing satisfaction with their smiles and understanding the potential negative effects.

Keywords: Cosmetic treatment, dentists' perceptions, smile treatments, dental enhancement treatments.

 

INTRODUCTION

 

The concepts of beauty and dentistry are closely related. According to some theories, a person's appearance leaves a lasting impression1. The appearance of teeth is one of the key elements of facial beauty. The media promotion of the ideal appearance through television series, Snapchat, and Instagram applications has a significant impact on society's awareness of beauty. Therefore, individuals in our culture are increasingly demanding cosmetic care2,3. Patients' dissatisfaction with the appearance of their teeth is one of the most common reasons for seeking dental treatment4,5. People often focus on the lips and teeth of a person speaking because the mouth is located in the centre of the face. Smiling has a special appeal and is also used to express emotions. A relationship has been revealed between emotional steadiness, self-esteem, dominant person-ality traits, and the apparent beauty of a person's smile 3,6. From a dental perspective, tooth color, shape, and position, as well as the quality of restorations and the overall arrangement of teeth, especially the anterior teeth, are key elements that influence the overall appearance of teeth. Additionally, the position of the upper lip, tooth protrusion, and gingival width have been found to influence what is considered a beautiful smile. Even though each feature can be considered individually, to create the ultimate aesthetic impression, they must all cooperate to create a symmetrical and harmonious whole2,3. Individual differences in beauty perception may have an impact on a person's desire for cosmetic procedures. People's perceptions of beauty are greatly influenced by a number of factors, including age, socioeconomic position, gender, ethnicity, marital status, education level, employment, social media, familial influence, and cultural exposure7-10. Numerous studies have been carried out to assess how the general public and dentistry students see dental aesthetics11.

These studies are crucial because they will examine the ways in which individuals, dental professionals, and students perceive dental aesthetics. They will also give dentistry students advice on how to comprehend the aesthetic demands of a patient. Few studies, nonetheless, have been done to evaluate how dentists and students view their own smiles and teeth12-14. Not a single study has been conducted in Yemen, so this study aimed to examine the attitudes and perceptions of dentists and dental student trainees toward smile enhancement treatments. The hypothesis was that, given their dental background, dentists, trainees, and students' perceptions of smile enhancement treatments might change when compared to a similar group from different backgrounds in Yemeni society.

 

METHODS 

 

Study Design: This study is a KAP designed to examine the attitudes and perceptions of dentists and dental student trainees toward smile enhancement treatments.

Study Population: The study included 329 dental students and dentists. 118 (35.9%) were males and 211 (64.1%) were females. The average age of the participants was 25±4 years, and their ages ranged from 20 to 51 years, with the majority being in the 23-25 age group (59.9%).

Data Collection: Data were recorded in structured questionnaire for each participant. 

Statistical Analysis: Software: SPSS (Version 30.0.0) was used for analysis data. For descriptive Statistics was done to summarize demographics and baseline characteristics. 

Ethical Considerations: All participating patients gave informed permission at the start of the trial, which was approved by the Sana'a University Faculty of Dentistry's medical ethical council.

 

RESULTS

 

Table 1 shows the age and gender distribution of the dental students and dentists participating in the study. The study included 329 dental students and dentists. 118 (35.9%) were males and 211 (64.1%) were females. The mean age of the participants was 24.97±4 years, and their ages ranged from 20 to 51 years, with the majority being in the 23-25 age group (59.9%). 

Table 2 shows the distribution of dental students by level. There were 264 students, including 4 students (1.5%) in level 4, 149 students (56.4%) in level 5, and 111 students (42%) in training. 

Table 3 shows the distribution of participating dentists by specialty. There were 65 dentists, including 7 general dentists (10.8%), 18 periodontists (27.7%), 5 orthodontists (7.7%), 17 endodontics (26.2%), 7 surgical dentists (10.8%), 4 operative dentists (6.1%), 3 prosthodontics (6.1%), and 4 pediatric dentists (6.1%). Table 4 shows smile confidence and dental satisfaction among dental student and dentist participants. 262 participants (79.6%) were confident about their overall teeth, 249 (75.7%) were confident about their tooth color, 268 (81.5%) were confident about their tooth size, 272 (82.7%) were confident about their tooth shape, and 225 (68.4%) were confident about their tooth alignment. Table 5 shows the characteristics of the anterior teeth of the dental student and dentist participants. Regarding crowding, 40.4% of the total participants had crowding, with 14.3% in the upper teeth, 20.4% in the lower teeth, and 5.8% on both sides. Regarding interdental spacing, 21.3% of the total participants had gaps, with 12.5% in the upper teeth, 5.2% in the lower teeth, and 3.6% on both sides. Regarding dental fracture, 12.8% of the total participants had a fracture, with 7.6% in the upper teeth, 5.2% in the lower teeth, and 0.0% on both sides. Regarding dental caries, 37.1% of the total participants had caries, with 9.1% in the upper teeth, 13.1% in the lower teeth, and 14.9% on both sides. In the case of no cosmetic restorations, 16.7% of the total participants did not have a cosmetic restoration, with 4.9% in the upper teeth, 6.1% in the lower teeth, and 4.9% on both sides. In the case of protruding teeth, 9.7% of the total participants suffered from protruding teeth, with 6.7% in the upper teeth, 1.5% in the lower teeth, and 1.5% on both sides. In the case of a deep bite, 14% of the total participants suffered from a deep bite. In the case of an open bite, 4.9% of the total participants suffered from an open bite, 7% suffered from inter-dental deviation, 17.02% suffered from midline deviation, and 21.3% suffered from tooth discoloration.

Table 6 shows the satisfaction of dental student and dentist participants with their gums. Regarding gum color, 81.2% of participants expressed confidence in its color, while 259 participants (78.7%) expressed confidence in its shape. 20.4% had black, triangular gums. 16.4% had a gummy smile. Regarding lip line, 86.3% of participants had a natural lip line, while 10.3% had a raised lip line and 2.4% had a lower lip line. 23.1% had hidden teeth when smiling. 

Table 7 shows the frequency of previous anterior tooth treatments among dental student and dentist participants. 25.8% of participants had orthodontic treatment, 7.3% had tooth whitening, 10.5% had crowns, 5.2% had anterior dental implants, 18.2% had root canal treatment, 29.5% had composite fillings, 19.8% had periodontal treatment, 3.3% had orthodontic surgery, and 3.65% had facial defect correction surgery. Table 8 shows the percentage of dental student and dentist participants who desired the following treatments to improve their appearance: 35.9% of participants desired orthodontic treatment, 22.5% teeth whitening, 16.7% crowns/veneers, 4.26% anterior dental implants, 9.7% root canal treatment, 21.6% composite fillings, 22.5% gum treatment, 4.6% orthodontic surgery, and 3.3% surgical correction of a facial defect. When participants were asked which was more important: function or aesthetics, 39.2% responded that function was more important, while 53.2% responded that aesthetics was more important. 

 

DISCUSSION 

 

The way that a grin is seen varies from person to person and is influenced by a number of things. A person's smiling self-perception may be influenced by a variety of characteristics, including media, gender, age, marital status, education level, financial position, influence from friends and family, and employment15-23. Moreover, someone’s smile could be affected by many factors, such as tooth shape, color, size, and position; gingival color, shape, and amount of gingival display, and finally, the lip position6.  In the current study, Table 4 shows smile confidence and dental satisfaction among dental student and dental practitioner participants. 262 participants (79.6%) were confident about their overall teeth, 249 (75.7%) were confident about their tooth color, 268 (81.5%) were confident about their tooth size, 272 (82.7%) were confident about their tooth shape, and 225 (68.4%) were confident about their tooth alignment. All rates were in the range of other studies that have shown higher rates of smile confidence and satisfaction with the teeth they have and express in their smiles7.

The amount of space needed for teeth to be correctly aligned is known as dental crowding. There are two ways to get it: 1) by measuring the space needed and figuring out how much room is available across the tooth width, or 2) by measuring the degree of overlap between the teeth. In current study, with regard to crowding, 40.4% of the total participants had crowding. According to Angle, crowding leads to malocclusion, which is any deviation of the occlusion from the ideal24. On the other hand, the measurement of these conditions must take into account the correlation with aesthetics and the effect on function. Treatment might not be required if the patient finds these characteristics acceptable even if they fit the official diagnosis of malocclusion. It is estimated that about 30% of the population suffers from crowding and malocclusion classified as severe and would certainly benefit from orthodontic treatment25. The reasons for this high rate may be due to active skeletal growth,26 mouth breathing, finger sucking, thumb sucking, pacifier sucking, nail biting, skin eating, pen biting, abnormal posture, swallowing disorders, and other habits that significantly affect facial and dental arch development27. Pacifier sucking habits are also associated with otitis media28,29. Dental caries, apical inflammation, and loss of primary teeth can alter the correct eruption of permanent teeth.

Dental caries affected 37.1% of all individuals in the current investigation (Table 5).  Dental caries in permanent teeth affects over 3.6 billion individuals globally30.  It affects roughly 620 million individuals, or 9% of the population, in their children's teeth31.  Dental caries is less frequent in China32 and more common in South Asian, Middle Eastern, and Latin American nations.  Dental caries is the most prevalent chronic pediatric illness in the United States, occurring at least five times as frequently as asthma33.  It is the most common pathological reason why children lose their teeth34.  Dental caries affects between 29% and 59% of persons over 50. Treating dental caries costs between 5% and 10% of healthcare budgets in industrialized countries and can easily exceed budgets in low-income countries36.

In the current study, in the case of a deep bite, 14% of the total participants suffered from a deep bite. This result is lower than the rate previously reported in different regions of the world, where it has been estimated that approximately 30% of the population suffers from a malocclusion (deep bite) that is classified as severe and would certainly benefit from orthodontic treatment37. The most common corrective treatments are fixed or removable appliances (such as braces), which may or may not require surgical intervention. Currently, there is no strong evidence of the success of the treatment38.  In the current study, 4.9% of participants had an open bite. An open bite is when the upper teeth do not overlap the lower teeth. When this malocclusion occurs in the front teeth, it is known as an anterior open bite. Open bites are difficult to treat due to multifactorial causes, with relapse being a major concern. This is particularly true for anterior open bites39. Therefore, a comprehensive initial assessment is important to obtain a diagnosis and develop an appropriate treatment plan39.  It is important to consider any common risk factors, as this is crucial for a successful outcome without relapse. The treatment approach includes behavioural changes, appliances, and surgery. Adults are treated with a mix of orthognathic surgery, intermaxillary elastics, permanent appliances, and extractions40. Orthodontics is usually utilized to adjust for children's continuous development. When permanent teeth emerge in children with mixed dentition, malocclusion may correct on its own. Additionally, stopping infantile behaviours like thumb, finger, or pacifier sucking may cause malocclusion to go away. Finger and thumb sucking can be prevented with the use of habit-blocking gadgets. For patients who are still developing, functional appliances and headgear are additional therapy alternatives. Our rate is similar to that reported elsewhere41.

In the current study, Table 6 shows the satisfaction of dental students and dentist participants with their gums. Regarding gum color, 81.2% of participants expressed confidence in its color, and 259 participants (78.7%) expressed confidence in its appearance. A gummy smile was found to be an important element rated as attractive by participants. This contradicts a study by Mukhtar et al., in which most participants were dissatisfied with their gums. On the other hand, a gummy smile was accepted by a significant number of people with no dental experience, indicating that treatment planning for a harmonious smile does not require correcting all deviations from aesthetic standards42. Additionally, the results of studies by Osehal et al. and Benzan-Versellino et al. concur, stating that dentists were more critical than people with no dental experience when evaluating gummy smiles43,44.

In the current study, Table 7 shows the frequency of previous anterior tooth treatments among dental students and dental practitioners. 25.8% of participants had orthodontic treatment, 7.3% had teeth whitening, 10.5% had crowns, 5.2% had anterior dental implants, 18.2% had root canal treatment, 29.5% had composite fillings, 19.8% had periodontal treatment, 3.3% had orthodontic surgery, and 3.65% had facial reconstructive surgery. Our rates for all previous treatments in our study were low compared to their desired aesthetic treatments, with 35.9% of participants desiring orthodontic treatment, 22.5% seeking teeth whitening, 16.7% seeking crowns/veneers, 4.26% seeking anterior dental implants, 9.7% seeking root canal treatment, 21.6% seeking composite fillings, 22.5% seeking periodontal treatment, 4.6% seeking orthodontic surgery, and 3.3% seeking surgical correction of a facial defect. When participants were asked which was more important: function or aesthetics, 39.2% responded that function was more important, while 53.2% responded that aesthetics was more important. This result is similar to that reported from Saudi Arabia45, Yemen and Iran46,47 among dental students and dentists.

Limitation of the study

This study was the first in Yemen and the lack of similar studies is the concern of researchers in Yemen with more harmful and severe health problems such as temporomandibular joint dysfunction48-50, jaw surgical site infection51, the anatomical pattern of the mandibular canal course52, interleukin-1 beta levels in the human gingival sulcus53, the effect of dental implants on aerobic bacterial colonization in the oral cavity54, deep malocclusion55, determining the factors and patterns of permanent tooth extraction56, and Porphyromonas gingivalis mouth infections57. Therefore, a broader study should be conducted, using previous research and filling in the gaps in this study. Although the research is conducted in Yemen, it does not explore local cultural elements that may influence people's perceptions of smile aesthetics or dental treatment. Including these factors would have added depth to the research and made the findings more meaningful in context.

 

CONCLUSIONS 

 

Within the study's limitations, it can be concluded that dentists, trainees, and students generally react similarly to smile enhancement treatments and their understanding of the concept. Dentists, students, and trainees appear to be more satisfied with their smiles and have demonstrated an ability to detect and identify adverse effects of smile enhancement procedures.

 

ACKNOWLEDGEMENTS 

 

The authors express their gratitude to Yemen and the Sana'a University Faculty of Dentistry for their cooperative efforts.

 

AUTHOR’S CONTRIBUTIONS

 

Shibam AHI: research, methods, and original draft writing. Al-Anesi MLM: conceptualization. Al-Salou RGGY:  composition, evaluation. Al-Maznae SNA:  formal analysis, data processing. Al-Rohmi FMA: editing, conceptualization. ASA Sulaiman: statistical analysis. AQH Al-Muntaser: editing, review. Al-Shamahy HA: review, data processing. Final manuscript was checked and approved by all authors. 

 

DATA AVAILABILITY

 

Upon request, the accompanying author may furnish the empirical data used to bolster the findings of the study.

 

CONFLICT OF INTEREST 

 

Regarding this project, there are no conflicts of interest.

 

REFERENCES

 

  1. Afroz S, Rathi S, Rajput G, et al. Dental esthetics and its impact on psycho-social well-being and dental self-confidence: A campus based survey of north Indian university students. J Indian Prosthodont Soc 2013; 13(4): 455-60. https://doi.org/10.1007/s13191-012-0247-1 PMID: 24431775
  2. Morley J, Eubank J. Macroesthetic elements of smile design. J Am Dent Assoc 2001; 132(1): 39-45.https://doi.org/10.14219/jada.archive.2001.0023 PMID: 11194397
  1. Tin-Oo MM, Saddki N, Hassan N. Factors influencing patient satisfaction with dental appearance and treatments they desire to improve aesthetics. BMC Oral Health 2011; 11(1): 6. https://doi.org/10.1186/1472-6831-11-6. PMID: 21342536
  2. Febriastuti F. Complex aesthetic treatment on anterior maxillary teeth with malposition. Dent J 2008; 41(4): 179-81. https://doi.org/10.20473/j.djmkg.v41.i4  
  3. Musskopf ML, Rocha JM, Rösing CK. Perception of smile esthetics varies between patients and dental professionals when recession defects are present. Braz Dent J 2013; 24(4): 385-90.https://doi.org/10.1590/0103-6440201302223
  1. Van der Geld P, Oosterveld P, Van Heck G, et al. Smile attractiveness. Angle Orthod 2007; 77(5): 759-65.https://doi.org/10.2319/082606-349
  1. Da Silva GD, De Castilhos ED, Masotti AS, et al. Dental esthetic self-perception of Brazilian dental students. RSBO 2012; 9(4): 375-81.
  2. Geron S, Atalia W. Influence of sex on the perception of oral and smile esthetics with different gingival display and incisal plane inclination. Angle Orthod 2005; 75(5): 778-84. PMID: 16283815
  3. Jørnung J, Fardal. Perceptions of patients’ smiles: A comparison of patients’ and dentists’ opinions. J Am Dent Assoc 2007; 138(12): 1544-53.https://doi.org/10.14219/jada.archive.2007.0103
  1. Kerosuo H, Al Enezi S, Kerosuo E, et al. Association between normative and self-perceived orthodontic treatment need among Arab high school students. Am J Orthod Dentofacial Orthop 2004; 125(3): 373-8.https://doi.org/10.1016/j.ajodo.2003.04.009
  1. Akeel R. Attitudes of Saudi male patients toward the replacement of teeth. J Prosthet Dent 2003; 90(6): 571-7.https://doi.org/10.1016/j.prosdent.2003.09.007. PMID: 14668758
  1. Abidia RF, Azam A, El -Hejazi AA, et al. Female dental student’s perception of their dental aesthetics and desired dental treatment. Eur Sci J 2017; 13(3): 171.https://doi.org/10.19044/esj.2017.v13n3p171 
  1. Al-Zarea BK. Satisfaction with appearance and the desired treatment to improve aesthetics. Int J Dent 2013; 2013: 912368. https://doi.org/10.1155/2013/912368
  2. Subait AA, Ali A, Hammad ZA, et al. Dental aesthetics and attitudes among university students in Saudi Arabia - A cross-sectional study. J Dent and Oral Disord 2016; 2: 1022.
  3. Omar H, Tai YT. Perception of smile esthetics among dental and nondental students. J Educ Ethics Dent 2014; 4(2): 54. https://doi.org/10.4103/0974-7761.148986
  4. Flores-Mir C, Major PW, Salazar FR. Self-perceived orthodontic treatment need evaluated through 3 scales in a university population. J Orthod 2004; 31(4): 329-34.https://doi.org/10.1179/146531204225020644  
  1. Al-Omiri MK, Hammad OA, Lynch E, et al. Impacts of implant treatment on daily living. Int J Oral Maxillofac Implants 2011; 26(4): 877-86. PMID: 21841999
  2. Al-Omiri MK, Abu Hantash RO, Abu Yunis M, et al. Relationship between personality and impacts of implant treatment on daily living. Clin Implant Dent Relat Res 2012; 14(S1): e2-e10. https://doi.org/10.1111/j.1708-8208.2010.00331.x.  PMID: 21414136
  3. Al-Omiri MK, Karasneh J. Relationship between oral health-related quality of life, satisfaction, and personality in patients with prosthetic rehabilitations. J Prosthodont 2010; 19(1): 2-9. https://doi.org/10.1111/j.1532-849X.2009.00518.x. PMID: 19780908
  4. Al-Omiri MK, Lamey PJ, Cooper C, et al. Relationship between personality and satisfaction with the dentition in tooth wear patients. Eur J Prosthodont Restor Dent 2006; 14(4): 179-84. [PMID: 17205954]
  5. Hantash ROA, AL-Omiri MK, Yunis MA, et al. Relationship between impacts of complete denture treatment on daily living, satisfaction and personality profiles. J Contemp Dent Pract 2011; 12(3): 200-7.https://doi.org/10.5005/jp-journals-10024-1035
  1. Karasneh J, Al-Omiri MK, Al-Hamad KQ, et al. Relationship between patients’ oral health-related quality of life, satisfaction with dentition, and personality profiles. J Contemp Dent Pract 2009; 10(6): E049-56.
  2. Nazir R, Mahmood A, Anwar A. Assessment of psycological impact of dental aeshetic and self-perceived orhodonic treatment need in young adults. Pak Oral Dent J 2014; 34(2): 39102901.
  3. Hurt MA. Weedon D. Weedon's skin pathology. 3rd ed. London: Churchill Livingstone Elsevier, 2010. Dermatol Pract Concept 2012; 2 (1): 79–82.https://doi.org/10.5826/dpc.0201a15. PMC 3997252.
  1. Borzabadi-Farahani A. An overview of selected orthodontic treatment needs indices. In Naretto, Silvano (ed.). Princi Contem Orthodontics. Intech Open Ltd 2011; 215–236.https://doi.org/5772/19735
  2. Björk A, Helm S. Prediction of the age of maximum puberal growth in body height(PDF).  Angle Orthodontist 1967; 37 (2): 134–43. PMID 4290545.
  3. Brucker M. Studies on the incidence and cause of dental defects in children: IV. Malocclusion. J Dent Res 1943; 22 (4): 315-321. https://doi.org/10.1177/00220345430220041201
  1. Wellington M, Hall CB. Pacifier as a risk factor for acute otitis media. Pediatrics 2002; 109 (2): 351–2, author reply 353. https://doi.org/1542/peds.109.2.351 PMID 11826228.
  2. Rovers MM, Numans ME, Langenbach E, et al. Is pacifier use a risk factor for acute otitis media? A dynamic cohort study. Family Practice 2008; 25 (4): 233–6.https://doi.org/10.1093/fampra/cmn030  PMID 18562333.
  1.  Oral health. World Health Organi-zation. Archivedfrom the original on 2019-10-17. Retrieved 2025-03-14.
  2. Vos T. Years lived with disability (YLDs) for 1160 sequelae of 289 diseases and injuries 1990–2010: A systematic analysis for the global burden of disease study 2010. The Lancet 2012; 380 (9859): 2163–96.https://doi.org/10.1016/S0140-6736(12)61729-2PMC 6350784. PMID 23245607.
  1. Healthy People: Archived2006-08-13 at the wayback Machine. Html version hosted on healthy People 2010.gov Archived 2017-03-10 at the wayback Machine Page accessed August 13, 2006.
  2. Pinhasi R, Eshed V, von Cramon-Taubadel N. Incongruity between affinity patterns based on mandibular and lower dental dimensions following the transition to agriculture in the Near East, Anatolia and Europe. PLOS ONE 2015; 10 (2): e0117301.  Bibcode: 1017301P. https://doi.org/10.1371/journal.pone.0117301
  3. Frequently asked questions archived 2006-08-16 at the wayback machine, hosted on the American dental hygiene association website. Page accessed August 15, 2006.
  4. Dental cariesarchived 2008-12-07 at the wayback machine, from the disease control priorities project. Page accessed August 15, 2006.
  5. Guideline: Sugars intake for adults and children.  www.who.int. Archivedfrom the original on 2023-06-21. Retrieved 2025-04-14.
  6. De Oliveira K, Nemezio MA, Romualdo PC, et al. Dental flossing and proximal caries in the primary dentition: A systematic review. Oral Health Prev Denti 2017; 15 (5): 427–434.https://doi.org/10.3290/j.ohpd.a38780.  PMID 28785751.
  1. Batista KB, Thiruvenkatachari B, Harrison JE, et al. Orthodontic treatment for prominent upper front teeth (Class II malocclusion) in children and adolescents.  Cochr Database System Rev 2018; 2018 (3): CD003452.https://doi.org/10.1002/14651858.cd003452.pub4
  1. Atsawasuwan P, Hohlt W, Evans CA. Nonsurgical approach to Class I open-bite malocclusion with extrusion mechanics: a 3-year retention case report. Ameri J Orthods Dentofacial Orthope 2015; 147 (4): 499–508.https://doi.org/10.1016/j.ajodo.2014.04.024 PMID 25836010
  1. Cambiano AO, Janson G, Lorenzoni DC. Nonsurgical treatment and stability of an adult with a severe anterior open-bite malocclusion. J Orthodontic Sci 2018; 7: 2.https://doi.org/10.4103/jos.JOS_69_17 PMC 5952238. PMID 29765914.
  1. Borzabadi Farahani A, Olkun HK, Eslamian L, et al. Austral Orthod J 2024; 40: 111–120.https://doi.org/10.2478/aoj-2024-0013
  1. Mokhtar HA, Abuljadayel LW, Al-Ali RM, et al. The perception of smile attractiveness among Saudi population. Clin Cosmet Investig Dent 2015; 7: 17-23.PMID: 25653558
  1. Ousehal L, Aghoutan H, Chemlali S, et al. Perception of altered smile aesthetics among Moroccan professionals and lay people. Saudi Dent J 2016; 28(4): 174-82.https://doi.org/10.1016/j.sdentj.2015.12.004  PMID: 27872548
  1. Pinzan-Vercelino CRM, Costa ACS, Ferreira MC, et al. Comparison of gingival display in smile attractiveness among restorative dentists, orthodontists, prosthodontists, periodontists, and laypeople. J Prosthet Dent 2020; 123(2): 314-21. https://doi.org/10.1016/j.prosdent.2019.03.023    PMID: 31153615
  2. Ansari S, Abdullah Alzahrani A, Said Abomelha A, et al. Influence of social media towards the selection of hollywood smile among the university students in Riyadh City. J Family Med Prim Care 2020; 9(6): 3037-41.
  3. Abbasi MS, Lal A, Das G, et al. Impact of Social Media on Aesthetic Dentistry: General Practitioners' Perspectives. Healthcare 2022; 10(10): 2055.
  4. Al-Anesi MLM, Al-Ghaffari KM, AL-Haddad KA, et al. An In vitro Investigation on the Impact of Sodium Fluoride on the Color Stability of Ceramic Restorations. Int J Orl Health 2024;4(2):1-6.https://doi.org/10.51626/ijoh.2024.04.00041
  1. Sulaiman ASA, Abbas AMA, Majid ALAA, et al. Effects of low-level laser in the treatment of myofascial pain dysfunction temporomandibular joint in sample of Yemeni patient. Universal J Pharma Res 2025; 10(2): 11-18.http://doi.org/10.22270/ujpr.v10i2.1314
  1. Al-Khorasani MAM, Al-Kebsi AM, Al-Hammadi MS, et al. Prevalence of signs of temporomandibular disorders in healthy asymptomatic completely edentulous individuals and the effect of denture on temporomandibular disorders. Universal J Pharm Res 2023; 8(1).https://doi.org/10.22270/ujpr.v8i1.894
  1. Aldeen HMAS, Abbas AK, Al-Kibsi TAM, et al. Oromandibular dystonia: prevalence, clinical and demographic data, therapeutic strategies out-come for hundred patients in Sana’a city, Yemen. Universal J Pharm Res 2023;8 (2): 1-8.https://doi.org/10.22270/ujpr.v8i2.925
  1. Alhadi YAA, Al-Kibsi TAM, Al-Shamahy HA, et al. Surgical site infections: prevalence, associated factors and antimicrobial susceptibility patterns of the bacterial isolates among postoperative patients in Sana’a, Yemen. Universal J Pharm Res 2022; 7(3):1-6.https://doi.org/10.22270/ujpr.v7i3.777
  1. Alhadi YAA, Alasbahi AA, Al-Shamahy HA. Anatomical pattern course of mandibular canal and its foramina location on sample of Yemeni patients using cone beam computed tomography. Universal J Pharm Res 2023; 8(1):35-41. https://doi.org/10.22270/ujpr.v8i1.895
  2. Al-dossary O A, Al-Kholani AIM, AL-Haddad KA, et al. Interleukin-1β levels in the human gingival sulcus: Rates and factors affecting its levels in healthy subjects. Universal J Pharm Res 2022; 7(5):1-6.https://doi.org/10.22270/ujpr.v7i5.838
  1. Al-Hamzi MA, Sharafuddin AH, Al-Shameri BH, et al. The effect of dental implants on aerobic bacteria colonization in the oral cavity and the antibiotic profile of common isolated aerobic bacteria. Universal J Pharm Res 2023; 8(4): 1-6.https://doi.org/10.22270/ujpr.v8i4.969
  2. Alaklany BAGA, FL Almotareb, SHA Albaham, et al. Deep bite malocclusion: Exploration of the skeletal and dental factors. Universal J Pharm Res 2023; vol. 8, no. 2,1-6. https://doi.org/10.22270/ujpr.v8i2.919
  3. Zabara AQ, Al-Kholani AIM, Alrubaidi YA, et al. Resolution of factors and pattern of permanent dental extraction in selected dental clinics in Sana’a city, Yemen. Universal J Pharm Res 2022; 7 (4):1-6.https://doi.org/10.22270/ujpr.v7i4.813.
  1. Al-Deen HMS, Al-Ankoshy AAM, Al-Kibsi TAM, et al. Porphyromonas gingivalis: Biofilm formation, antimicrobial susceptibility of isolates from cases of localized aggressive periodontitis (LAP). Universal J Pharm Res 2021; 6 (4):1-6.https://doi.org/10.22270/ujpr.v6i4.633