Libyan Journal of Dentistry

The Most Promising Alternative to Mercury-containing Dental Restorations

Rawan Albeshti — 2025-01-15

The European Union Environmental Commission report and the United Nation Minamata Convention have legislated for phasing-out of mercury-containing dental materials use (dental amalgams) by 2030.^{1, 2} Several Scandinavian countries have already banned the use of dental amalgams, and this ban is expected to grow to other countries worldwide.^{2, 3} This creates a market gap for materials which can be used as an alternative to dental amalgams.⁴ Varieties of mercury-free dental materials have been clinically approved as posterior restorations; such as (1) resin-based composite materials, and (2) glass-based materials, including glass ionomers and glass hybrids. Using these types of dental materials will decrease the mercury’s risks on human’s health and also contribute significantly in the reduction of the environmental mercury pollution.^{5, 6}

Recently, several clinical approaches to treat dental caries lesions have shifted the focus to preserving tooth structure and use of adhesive materials. Considering this, Minimally Intervention Dentistry (MID) has become a crucial concept which includes three aspects to fulfil the requirement of preventive and restorative dentistry; these are early caries diagnosis, enhance remineralisation and minimal cutting of tooth surfaces.^{7, 8} This approach is identified as an Atraumatic Restorative Treatment (ART). The ART technique was adopted in 1994 by the World Health Organisation (WHO) as an alternative technique for dental caries management in the developed countries either for treating deciduous and/or permanent dentitions.⁹ The high viscous glass ionomer cement (GIC) is approved as an ideal candidate material to be used with ART technique; such as GC Fuji IX^®, Ketac^TM Molar and Glass Carbomer^®.^{10, 11}

One of the main advances in dental materials field is based on the modifications of the GIC chemical compositions, by introducing a bioactive glass in different particle sizes (for promoting remineralising ability) and/or using a highly molecular weight of poly-

acrylic acid (for enhancing matrix strength).¹² When bioactive glass-containing dental materials come into contact with body fluid, will undergo to a sequence of bioactivity reactions; which is summarised into (1) ion exchange, (2) dissolution and (3) precipitation stages, leading to formation of apatite crystals in fractions identical to those of the natural bone and tooth components.¹³ Formation of apatite crystals [hydroxyapatite-Ca₁₀(PO₄)₆OH₂ or fluorapatite-Ca₁₀(PO₄)₆F₂] in the bioactive glass-containing GICs occurs via delivering of calcium (Ca²⁺), phosphate (PO₄³), hydroxyl (OH^-) and/or fluoride (F^-) species at the interfaces between the GIC/tooth surfaces and/or the GIC/oral environment.¹⁴ For this reason, the bioactive glass-containing GICs are considered as the most promising alternative restorative materials for posterior cavities.

A call to reform the Libyan oral health care system

Osama Ahmadi — 2025-01-15

The Libyan healthcare system was once described as one of the best healthcare systems in Africa.¹ A recent study describing the Libyan oral health care system has been published which shows that health care is mainly privatized, and the governmental sector is poorly functioning with limited funding and unclear targets.² It is well known structural determinants of health such as the health system can have a negative impact on the health outcomes. ³ In the case of the Libyan systems, it seems the impact is heavy on preventive dental care which is deterred by limited resources in the governmental sector and payment issues in the private sector. This has been manifested in the high rates of oral disease in Libyan children and adults.^4-10 Furthermore, challenges in the oral health care system include barriers such as time constraints, insufficient incentives, and limited resources that hinder the provision of care.¹¹ However, in Libya, the oral health care system could experience similar or even more severe difficulties due to political instability, inadequate infrastructure, and a lack of trained professionals, which could further aggravate these issues.

There is an urgent need to raise the issue and mobilize actions to reform the oral health care system to meet the needs of the society and avoid further deterioration of health services and creating jobless dentists. Government expenditure on oral health in Libya primarily follows an outdated model that emphasizes diagnosis and treatment of oral and dental diseases, rather than funding programs aimed at preventing these conditions.¹² In 2012, Libya had approximately six dentists per 10,000 people.¹³ Although the numbers of dentists is considered sufficient, large numbers of dental graduates are bombarded into the Libyan oral health care system which reflect improper planning of the dental workforces.¹⁰

The one might say the dental system of Libya was studied in Benghazi as a case,² however, similar situation

applies to the whole country. For example, the dental faculty in Tripoli enrols up to 1,000 new students each

year, and other institutions also admit substantial numbers.¹⁴ This situation places considerable strain on the educational system and could, over time, negatively impact the job market for private dental practitioners.

Children's oral health and parents’ education status in Benghazi, Libya: a cross-sectional study

Rasmia M Huew — 2025-01-15

Aim: The study aims to evaluate the impact of parents’ education on the promotion of child dental care.

Methods: Data were collected via a questionnaire survey among parents who brought their children to the Pediatric Dental Department of the Faculty of Dentistry, University of Benghazi, Libya. The data were logged and analyzed using IBM-SPSS for Windows version 29.0 (SPSS Inc., Chicago, IL). Frequencies and percentages were measured to assess the influence of parental education on the dental knowledge of their children’s oral care.

Results: More than two-thirds (69.2%) of parents sought dental care for their children when they expressed pain. More than half of parents (59%) reported the importance of deciduous teeth and its impact on successor teeth. Only 16% started brushing when the first primary tooth erupted, and 40% of their children brushed at least twice a day. In addition, only 39% of parents knew the correct time of the first permanent molar eruption. The frequency of parents who reported the correct total number of primary teeth, preferred treatment of primary teeth rather than extraction and asked their children to brush once daily increased with increasing the parents' education levels.

Conclusion: The present study displayed that a high parents’ educational level does not directly subscribe to good oral health care for their children. The parents need further attention by presenting more programs dealing with dental health which will be useful in improving their children’s oral health.

Social Media Use and E-Professionalism among Libyan Dental Students at the University of Benghazi

Asma Albaraesi — 2025-01-15

Aim: This study aimed to assess dental students' social media (SM) usage and their perceptions of and attitudes towards e-professionalism.

Materials and methods: This study used a paper-based questionnaire administered to undergraduate dental students (4^th year and interns) at the University of Benghazi, Libya, in 2022. The questionnaire included closed-ended questions to recognize dental students' use of social media platforms, their privacy settings and their perceptions and attitudes towards e-professionalism. The responses were compared according to the study year and whether the participants received professionalism-related training. The chi-square test was used for all comparisons, with the significance level set at p˂0.05.

Results: A total of 364 students were included in the analysis (response rate: 73.5%). Almost all participants used multiple SM platforms. However, the most frequently used platforms were Facebook (84.3%) and Telegram (76.9%). More than half of the respondents (57.5%) considered their online behaviour to be a personal activity that would not affect their job opportunities in the future (71.1%). On the other hand, a considerable proportion of the respondents described posting information about dental patients as unprofessional (70.9%). Overall, a small proportion of participants (6.4%) considered communication with patients on SM unprofessional. Interns, however, were more likely to report this as unprofessional (P = 0.026).

Conclusion: The current study demonstrated the widespread popularity of SM platforms, notably Facebook and Telegram, among dental students at the University of Benghazi. The study also highlights concerns about students’ perceptions of what constitutes unprofessional behaviours when using SM platforms with blurred personal-professional boundaries. The study's findings underscore the necessity of creating guidelines for social media use among Libyan dental students and incorporating e-professionalism into the dental curriculum.

Antibiotic Prescribing Regimen and Resistance Awareness Among Eastern Libyan Dentists

Ranya Al-gadhy — 2025-01-15

Background: The frequent use of antibiotics in dentistry for prophylaxis and treatment has contributed to a significant global public health issue: antibiotic resistance.

Aim: This research aims to evaluate the patterns in the prescription of antibiotics and their prophylactic usage in treating systemic conditions. Additionally, it investigates the awareness as well as adherence to guidelines for antibiotic prescription, as well as the awareness of antibiotic resistance among dentists with advanced degrees and postgraduate (AD) qualifications, and those with bachelor’s Degrees (BD) in the eastern region of Libya.

Materials and Methods: This cross-sectional study employed a questionnaire to gather data from a representative sample of 130 Libyan dentists in the eastern region (including Benghazi, Almarj, Albayda, Derna and Tobruk cities).

Results: Most of the antibiotics prescribed by dentists were amoxicillin with clavulanic acid followed by amoxicillin alone, and both participant groups were adherent to the recommendations for prescribing antibiotics with statistically significant variation between the two groups.

Conclusion: This study revealed a tendency to overprescribe and utilize antibiotics for particular dental diseases. The majority of dentists were aware of resistance to antibiotics and adhering to the antibiotic prescription guidelines, the participants acknowledged the recommended use of antibiotics as a preventive strategy for systemic conditions.

Retrospective Clinicopathological Study of 33 Cases of Pleomorphic Salivary Adenoma Diagnosed in Benghazi

Siraj S. Najem — 2025-01-15

Background: Pleomorphic salivary adenoma (PSA) is the most frequently found neoplastic tumor in major and minor salivary glands. It has a high recurrence rate and there is a possibility for benign PSA to transform into malignant form. No study on clinical and histopathological features of pleomorphic adenoma in Libya was found. occurrence of benign PSA is more common than PSA with malignant foci.

Aim: The present study aimed to retrospectively analyze the clinical and histopathological features of cases diagnosed as pleomorphic adenoma and compare our findings to those of other studies.

Materials and Methods: In this retrospective study, the pleomorphic salivary adenoma cases diagnosed between 1994-2019 in the Department of Oral Pathology, Dental School, University of Benghazi, Libya were retrieved. The diagnosis was confirmed by reevaluation of hematoxylin and eosin-stained slides. Descriptive statistics were used to describe the clinical data of the patient’s demographics and clinical features of the tumor.

Results: It was found that among 33 diagnosed cases of PSA, 11 cases were males and 22 cases were females. The most common age range was 10-29 years (21 cases). The most common intra-oral site was the palate (15 cases) followed by buccal mucosa (6 cases) and submandibular glands and parotid glands were most commonly affected among major salivary glands. Benign pleomorphic adenoma (24 cases) was most common, myoepithelium was reported in 2 cases and malignant foci were reported in 7 cases.

Conclusion: This study revealed that Females were more affected than males. The most common location of pleomorphic adenoma was the palate. The myoepithelioma is a rare.

Oral Health Awareness and Practices among Libyan University Students: Insights into Non-Bacterial Tooth Wear

Karima Alfitory Ahmed — 2025-01-15

Background: Tooth substance loss, when unrelated to bacterial activity, encompasses several conditions such as attrition, abrasion, erosion, and resorption. Each of these forms of tooth wear results from different etiological factors, including mechanical forces, dietary acids, and physiological processes. Despite the significance of these conditions, awareness of non-bacterial causes of tooth wear is limited among the general population, especially young adults. University students, who are exposed to a variety of stressors and lifestyle habits, may be at increased risk for these issues.

Objective: This study investigates the prevalence of non-bacterial tooth substance loss and evaluates the level of awareness among Libyan university students, focusing on factors that contribute to attrition, abrasion, erosion, and resorption.

Methods: A cross-sectional study was conducted using an online Google Forms survey, distributed via social media. A total of 523 responses were collected. The questionnaire gathered demographic data, oral health practices, symptoms of non-bacterial tooth substance loss (NBTLS), and awareness of conditions like attrition, abrasion, erosion, and resorption. Descriptive statistics were used to analyze the data, assessing prevalence and awareness levels. Chi-square tests examined associations between demographic factors, oral health habits, and NBTLS awareness. Statistical significance was set at p < 0.05.

Results: The study involved 523 Libyan university students, revealing a significant age skew towards 21-23 years (56.8%), with a majority female population (69.8%). Most participants were from the Dental field (62.9%). In terms of oral health practices, 38.2% visited the dentist every six months, and 57.9% brushed twice daily. Awareness of non-bacterial tooth loss conditions varied, with 68.9% recognizing abrasion and 54.1% erosion. Notably, 45.5% reported experiencing tooth wear symptoms, and 99.2% showed strong interest in learning about non-bacterial causes of tooth wear, with a binomial test confirming this interest as statistically significant (p < 0.001).

Conclusion: This study underscores a significant awareness of non-bacterial tooth substance loss among Libyan university students, alongside a marked interest in further education on this subject. Despite the generally proactive oral health practices observed, there is variability in awareness of specific conditions such as erosion and resorption. The overwhelmingly high interest in learning about non-bacterial causes of tooth wear, supported by statistical significance, indicates a critical need for enhanced educational initiatives. Targeted interventions are essential to bridge existing knowledge gaps and promote effective preventative strategies within this demographic.