Browsing by Author "El-Halabi, Manal"

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Assessment of the knowledge of United Arab Emirates dentists of Child Maltreatment, protection and safeguarding
(2018-05) El-Halabi, Manal; Kowash, Mawlood B.; Hassan Khamis, Amar; Hussein, Iyad
Aim: Child safeguarding is society’s responsibility. Dentists are uniquely positioned to recognise Child Abuse and Neglect (CAN) in dental practice and the wider society. The United Arab Emirates (UAE) introduced a child protection law in 2016. We aimed to assess the awareness of UAE dentists of child maltreatment, protection and safeguarding. Study Design: A cross-sectional survey. Methods: We surveyed 381 UAE dentists about the knowledge and practice of CAN and safeguarding issues using a self-administered anonymous questionnaire. Statistical analysis was carried out using Chi-square, t-test, ANOVA and Pearson’s correlation test and statistical significance was set as p <0.05. Results: Over 39 % (n=152) of the responders suspected CAN; male dentists suspected more CAN than females (p=0.015). Orthodontists, paediatric dentists (p<0.001) and female dentists (p=0.001) were more knowledgeable about diagnosing CAN. Paediatric dentists attended more CAN-related postgraduate training (p<0.001) than other specialties. Over 90% (n=346) believed that CAN should be addressed, 58.1% (n=224) and 54.1% (n=206) had CAN undergraduate and postgraduate training respectively but 53.5% (n=204) were unaware of local child protection guidelines. Dentists barriers to child protection reporting were; fear of family violence (59.6%, n=227), lack of knowledge of referral process (60.2%, n=228) and lack of diagnosis certainty (54.9%, n=206). UAE dentists qualified in Western and Asian countries had fewer barriers for child protection reporting (p=0.022) than the Arab and Gulf Cooperation Council qualified dentists. Conclusions: A large minority of UAE dentists suspected CAN. Factors influencing child protection reporting were identified. Dentists’ gender, specialty, and country of qualification affected their knowledge of CAN and practice of safeguarding. Child protection training is recommended.
An Audit on the Quality of Intra-Oral Digital Radiographs Taken in a Postgraduate Paediatric Dentistry Setting
(2017-02-01) Salami, Anas A.; El-Halabi, Manal; Hussein, Iyad; Kowash, Mawlood B.
Abstract: Background: Quality assurance (QA) for radiographs sustains accurate diagnostic information while maintaining radiation doses as low as reasonably achievable (ALARA). Aims: To audit the quality of digital intraoral periapical (IOPAs) and bitewings (BWs) radiographs taken in a postgraduate paediatric dentistry setting. Standards: The National Radiological Protection Board (NRPB) guidance describes three grades of radiograph quality. Excellent (Grade 1 >70% of total exposures), diagnostically acceptable (Grade 2 <20%) and unacceptable (Grade 3 <10%). Methodology: A pilot study was performed on 10 IOPAs and 10 BWs. 50 IOPAs and 50 BWs were reviewed in 2 audit cycles with a 6 month interval (total of 200 X-rays). Results: First Cycle: Of 50 IOPAs: 18 (36%) scored Grade 1, 25 (50%) Grade 2 and 7 (14%) Grade 3. Of 50 BWs: 10 (20%) scored Grade 1, 33 (66%) Grade 2 and 7 (14%) Grade 3. Second Cycle: Of 50 IOPAs: 28 (56%) scored Grade 1, 15 (30%) Grade 2 and 7 (14%) Grade 3. Of 50 BWs: 27 (54%) scored Grade 1, 17 (34%) Grade 2 and 6 (12%) Grade 3. Rejection rate of Grade 3 was analysed in both cycles. A clear improvement in radiograph quality was demonstrated between both cycles, but the standard was not met. Action plan and recommendations: Results were disseminated to all staff and recommendations to improve radiograph quality were made to use film holders and paediatric film sizes. Conclusion: Although a significant improvement was observed in the 2nd cycle, the overall standard of radiographs fell short of the guidelines. Thus, the quality of radiographs requires continuous auditing to reach the gold standard. An audit spiral is planned.
Contemporary dental caries management concepts in paediatric dentistry: A survey of awareness and practice of a group of gulf cooperation council dentists.
(2017-03-08) Hussein, Iyad; El-Halabi, Manal; Kowash, Mawlood B.; Hassan Khamis, Amar
Introduction: Debatable clinically relevant child dental caries management concepts exist; restoring a carious primary molar (RCM), the choice of pulpotomy medicament (PM), the “Hall Technique” (HT), and sealing of dental caries (SDC). Our aim was to assess the knowledge and practice of dentists treating children in the Gulf Cooperation Council (GCC) region of the aforementioned contemporary concepts. Methodology: Paediatric Dentists (PDs) and General Dental Practitioners (GDPs) who treated children completed a questionnaire (N=150) covering: RCM choices; choice of PM; knowledge and practice of HT and acceptance of SDC in primary and permanent teeth. Statistical analysis was conducted using Chi-Square test (p<0.05). Results: For RCM: 76% of those surveyed would remove non-pulpal caries in an asymptomatic lower D and restore with composite (33%), glass ionomer or conventional stainless steel crown (SSC) (17.4%), amalgam (7.4%) and zirconia (0.7%). The remaining 24% would seal caries (HT SSC). For PM: 40.7% chose Ferric Sulphate, followed by Formocresol (36.7%), Mineral Trioxide Aggregate (14%) and Calcium hydroxide (8.7%); For HT: 60.6% had knowledge of HT but 81.5% never used it. For SDC: sealing caries in primary & permanent teeth was rejected by 56.6% & 53.1% respectively. GDPs and PDs choices differed significantly with RCM, HT (knowledge and practice) (p=0.007, 0.003 and 0.003 respectively). Conclusion: Overall the surveyed dentists practicing in the GCC disagreed on RCM, PM with reluctance to accept new concepts like the HT and SDC. PDs choices of RCM differed from GDPs, and their awareness of HT and practice of HT were more favourable.
Current Guidelines for the Use of Fluoride in Pediatric Dentistry, A Review
(2014) El-Halabi, Manal
Abstract: Fluoride use as a chemotherapeutic agent for caries prevention has been well researched and documented. The recommendations for the use of fluoride have evolved through the years as a result of many factors. The change in the prevalence of caries and the advent of different fluoride formulations along with the desire to maximize the benefits and minimize the side effects lead many authorities to set guidelines for the use of different formulations of fluoride. This review attempts to summarize the most current evidence-based guidelines of fluoride therapy put forth by various organizations worldwide. The review includes guidelines on community water fluoridation, fluoride supplements, fluoride toothpaste, professionally applied fluorides and fluoride mouth rinses.
Dental Implications of Down Syndrome (DS): Review of the Oral and Dental Characteristics
(2017-05-27) Ghaith, Batool; El-Halabi, Manal; Kowash, Mawlood B.
Abstract: A literature search was conducted to identify the key oral and dental manifestations of DS. These findings are discussed and used to suggest recommendations for treatment planning in DS patients for the practicing dental practitioner and also to help other medical professionals in understanding the oral health status of DS patients and the importance of liaison with dental professionals.
Dentists knowledge of the guidelines of traumatic dental injuries in the United Arab Emirates
(2018-12) El-Halabi, Manal; Hussein, Iyad; Hassan Khamis, Amar; Kowash, Mawlood B.
Aim: This study aimed to assess general dental practitioners’ (GDPs) knowledge within the United Arab Emirates (UAE) regarding the management of traumatic dental injuries (TDIs), and to compare their level of knowledge with that of paediatric dentists (PDs). Methods: Dentists were asked to complete a two-part questionnaire (seven questions covering demographic data and 13 questions about trauma cases scenarios) in electronic and paper format. A total of 296 returned questionnaires were analysed to identify GDPs’ knowledge in managing TDIs, and to compare the score of GDPs’ knowledge with that of PDs’. Results: Out of a total score of 13, the mean knowledge score (MKnS) for GDPs was 4.87±1.82 (only 37.5% of the 13 questions were answered correctly) while the MKnS of paediatric dentists was 5.56±1.47 (with 42.8% correct answers); both scores indicated poor knowledge and the difference was statistically significant (p=0.005). Conclusions: There was poor knowledge of TDIs among the surveyed UAE GDPs as well as the PDs, although PDs scored higher, indicating the need for further training.
Emergency Management of Traumatic Dental Injuries: Knowledge of Dubai School Nurses
(2019-07-15) El-Halabi, Manal; Kowash, Mawlood B.; Hussein, Iyad
Objective: To assess the knowledge of school nurses in Dubai, United Arab Emirates, about the emergency management of Traumatic Dental Injuries (TDIs) at schools. Material and Methods: A cross-sectional questionnaire survey was conducted amongst 68 school nurses (SN) prior to inviting them to an educational workshop on the emergency management of TDIs. The educational workshop covered all the topics in the questionnaire and provided basic necessary information to the SN regarding the emergency management of TDIs. Descriptive statistics were used to describe the characteristics of the sample; the Kolmogorov-Smirnov test was used to test normality for the score of knowledge and Mann-Whitney U test to correlate score of knowledge with different demographical variables (p<0.05). Results: An overall lack of knowledge about the emergency management of TDIs was observed. The overall average for the score of knowledge for all the participants was 10.75 out of a total of 16 correct answers. Female participants had significantly higher scores of knowledge compared to males (p=0.02). None of the other demographic variables were significantly associated with the score of knowledge. Conclusion: More training programs are essential for school nurses to improve their knowledge and awareness for better future handling of traumatic dental injuries.
Hybrid child friendly biological primary molar restorative alternatives to general anaesthesia
(2018-09) Alnuaimi, Eman H; El-Halabi, Manal; Hussein, Iyad
Abstract: Management of early childhood caries, especially in high caries prevalence regions, is challenging, with multiple extractions under general anaesthesia (GA) becoming frequently unavoidable. This paper describes a combination of child-friendly biological methods of caries management that could be utilized by general dental practitioners. The use of interim therapeutic restorations to aid in diagnosis of pulpal status in deeply carious primary molars followed by using multiple Hall technique preformed metal crowns is described through a series of case reports. By the hybrid utilization of these methods with complete avoidance of local anaesthesia, an alternative treatment to dental GA is demonstrated. CPD/Clinical Relevance: To provide a guide for the use of combined biological methods to treat early childhood caries.
Medical and Dental Implications of Autism Spectrum Disorder: A Review
(2017-05-26) El-Halabi, Manal; Kowash, Mawlood B.; Mansoor, Dina
Abstract: Globally 1 in every 68 child is diagnosed with Autism. Autism spectrum disorder (ASD) or Autism is a group of neurodevelopmental disorders, affecting the normal development and functioning of the brain in three core domains; reciprocal social interactions, verbal and non-verbal communication and the presence of restricted or repetitive behaviors. Typically it appears in the first three years of life and affects males four times more than females but females are more likely to show more signs of mental retardation. Other medical problems can co-exist along with Autism such as psychiatric illnesses, epilepsy; sleep disturbances, feeding problems, gastrointestinal problems and voiding problems. Autism cannot be cured, but the earlier the intervention the better the results. Medications, therapies and behavioral interventions can only alleviate Autism related symptoms and cause substantial improvement. Autism characteristics can have an impact on three different perspectives of dental care, which are oral care at home, oral care at the dentist and access to oral care. This paper aims to review and discuss the literature on the general and oral characteristics of children with Autism Spectrum Disorder in order to help the dental practitioners as well as the medical professionals in providing them with better oral and health services.
Medical and Dental Implications of Cerebral Palsy: Part 1 General and Medical Characteristics: A Review
(2017-06-07) Alhashmi, Haifa; Kowash, Mawlood B.; El-Halabi, Manal
Abstract: Cerebral palsy (CP) is a group of neuromuscular disorders that affects the development of movement and posture, causing activity limitations. CP is classified into three main groups: spastic, dyskinetic and ataxic. Population-based studies from around the world report estimates of CP prevalence ranging from 1.5 to more than 4 per 1,000 live births. The commonest cause of CP remains unknown in 50% of the cases; prematurity remains the common asterisk factor. CP children suffer from numerous problems and potential disabilities such as mental retardation, epilepsy, feeding difficulties, and ophthalmologic and hearing impairments. This paper reviews and critically discusses the definition, epidemiology, aetiology, classifications, treatments and associated manifestation and complications of CP.
Medical and Dental Implications of Cerebral Palsy: Part 2: Oral and Dental Characteristics: A Review
(2017-06-07) Alhashmi, Haifa; Kowash, Mawlood B.; El-Halabi, Manal
Abstract: Cerebral palsy (CP) is a group of neuromuscular disorders that affects the development of movement and posture, causing activity limitations. CP is classified into three main groups: spastic, dyskinetic and ataxic. Population-based studies from around the world report estimates of CP prevalence ranging from 1.5 to more than 4 per 1,000 live births. CP children suffer from numerous problems and potential disabilities such as mental retardation, epilepsy, feeding difficulties, and ophthalmologic and hearing impairments. Intra orally, Patients with cerebral palsy are reported to have several oral health problems such as poor oral hygiene, bruxism, drooling, traumatic dental injuries, and malocclusion. A literature search was conducted to identify the key oral and dental manifestations of CP. These findings are discussed and utilized to suggest recommendations for treatment planning in CP patients for the dental practitioner. The findings might also help other medical professionals in understanding the oral health status of CP patients and the importance of liaison with dental professionals.
Medical and Dental Implications of Patients with Beta Thalassaemia Major. Part 2: Orofacial and Dental Characteristics: A Review
(2017-06-20) Al Raeesi, Shaikha; Kowash, Mawlood B.; El-Halabi, Manal
Abstract: Thalassaemia, one of the most common genetic disorders, often causes serious medical, social, and psychological problems. Beta thalassaemia major is a life-threatening disorder that presents with a vast variability in the systemic signs and symptoms. In addition, orofacial and dental tissues are also affected. The common orofacial features among thalassaemic patients include: frontal bossing, skeletal overgrowth with characteristic appearances known as chipmunk faces, upper lip retraction, protrusion of pre maxilla bone associated with alveolar enlargement that causes malocclusion in the dentition with the clinical appearance of protrusion, flaring, spacing of anterior teeth and anterior open bite. The oral mucosa appears pale or a lemon yellow colour due to deposition of bilirubin pigmentation and anaemia. Sometimes the gingival colour tends to be dark, caused by high ferritin level in the blood. Current reports show a significant improvement in thalassaemia major patients’ survival rates. With increased life expectancy, the need for improved oral healthcare is very important to ensure a high quality of life for this patient population. This paper reviews the literatures and discusses briefly the dento-facial manifestations, radiographic features, dental caries, periodontal and soft tissue conditions related to beta thalassaemia major as well as dental management and considerations of thalassaemia patients.
Medical and Dental Implications of Patients with Beta Thalassaemia Major. Part1: General and Medical Characteristics: A Review
(2017-06-12) Al Raeesi, Shaikha; Kowash, Mawlood B.; El-Halabi, Manal
Abstract: Thalassemia is one of the most common inherited haemoglobinopathies characterized by either a partial or a complete suppression in the production of normal haemoglobin as a result of defective synthesis of one or more of the globins chains. Thalassemia is the most widely distributed genetic disorder. Approximately 5 % of the world’s population was found to have a globin variant, with only 1.7 % having an alpha or beta thalassemia trait. The Mediterranean region, the Middle East, the Indian subcontinent and Far East Asia show the highest rates of prevalence of beta thalassemia. Beta thalassemia is considered to be a major public health issue, as well as a life threating condition characterized by severe anaemia, hepatosplenomegaly, growth retardation, endocrine dysfunction, cardiac failure and skeletal changes. Management strategies using blood transfusion and chelation therapy will improve the control of anaemia, suppression of erythropoiesis, and inhibition of gastrointestinal iron absorption of beta thalassaemia major patients. Bone marrow transplant is considered an excellent curative therapy in thalassaemic patients during childhood, which will provide prolonging life expectancy. This paper reviews the literatures and discusses briefly the definition, history, epidemiology, classification, aetiopathogenesis, general manifestation and general management of beta thalassaemia major.
Oral and Dental Considerations in the Management of Leukemic Children
(2014-09) Alnuaimi, Eman H; El-Halabi, Manal; Kowash, Mawlood B.
Abstract: An incidence of overall oral sequelae in leukemic children of 54% has been reported in the literature. Oral complications include mucositis, fungal and viral infections, salivary gland hypofunction, dental caries, and others. Mucositis accounts for the most common complication followed by fungal infections and viral infections. It has also been reported that the quality of life of these children is affected. Dental healthcare professionals play a very important role in assessing the patient’s oral health needs before, during, and after cancer therapy. A multidisciplinary approach between the medical and dental team will help prevent, stabilize, and treat the oral and dental problems at an early stage. This paper reviews briefly the oral health problems in leukemic children as well as dental considerations and recommendations for optimal oral health care.
Oral health challenges facing Dubai children with Autism Spectrum Disorder at home and in accessing oral health care
(2018-06) El-Halabi, Manal; Hassan Khamis, Amar; Kowash, Mawlood B.
Aims: To investigate the challenges faced by Autism Spectrum Disorder (ASD) children and their families in Dubai from three different perspectives of dental care: oral care at home, oral care at the dentist and access to oral care, and to compare the results to their normally developing peers. Methods: A case-control comparative study of 84 ASD and 53 healthy children attending special needs centres and schools in Dubai including siblings of the autistic children. Data collection was by a survey questionnaire completed by parents or guardians. Results: More parents of ASD children compared to parents of healthy children reported difficulties across almost all oral care variables explored. The majority of ASD children’s parents (83.3%) reported that their children need assistance in brushing their teeth compared with 15.4% of the healthy controls (p-value < 0.001). The ASD children’s uncooperative behavior increased during dental visits and significantly more parents (37%) rated their child’s experience as negative compared with 9.5% among the parents of control children (p-value=0.006). The autistic children had visited a dentist mostly for extractions. Conclusion: This study indicates that autistic children in Dubai experience more challenges and barriers to oral care than their typically developing healthy peers.
Oral Health Knowledge, Attitude, and Practices of Sharjah Mothers of Preschool Children, United Arab Emirates
(2017-12-17) Kowash, Mawlood B.; Hussein, Iyad; Hassan Khamis, Amar; El-Halabi, Manal
Objective: The improvement of children’s oral health, a world global health target, is essential to general health and quality of life. Hence, the aim of this study was to assess the knowledge, attitude, and practices of mothers toward their children’s oral health in Sharjah, United Arab Emirates (UAE). Materials and Methods: A cross sectional interview based study was conducted among 383 mothers of preschool children (average age 3.49 [+1.63 years]) attending Sharjah Dental Center, UAE. Statistical analysis was performed using SPSS software for Windows, version 20.0 (SPSS Inc., Chicago, IL, USA). Results: Adequate knowledge was found among 58.2% of mothers, 99% exhibited excellent attitude, and only 20% followed good practices toward their children’s oral health. Poor knowledge and practice of mothers were significantly associated with mothers’ occupation and education. Employed mothers had a significantly higher score of knowledge. Mothers with secondary education and university qualifications had significantly higher scores of practice compared with mothers with primary education. Conclusions: Although mothers had better than average knowledge and excellent attitude toward their children’s oral health issues; most of them carried out improper practices. Mothers’ educational and employment backgrounds were significant influencing factors.
Oral health problems in leukaemic paediatric patients in the United Arab Emirates: A retrospective study
(2018-09) Alnuaimi, Eman H; El-Halabi, Manal; Hassan Khamis, Amar; Kowash, Mawlood
Aim: The aim of this study was to estimate the prevalence of oral health problems in leukaemic paediatric patients in the United Arab Emirates (UAE) and correlate it to the phase of chemotherapy. Materials and Methods: Medical records of 120 paediatric leukaemic patients (age below 15 years) in the UAE were reviewed for the occurrence of oral health problems. Records from the three main hospitals that provide cancer therapy were accessed after obtaining the required permissions. Results: The overall prevalence of oral health problems in leukaemic patients in our study is 60%. The most common oral health problem recorded in the patients’ records was oral mucositis and ulceration (52.4%) followed by dental caries and oral candidiasis accounting for 18.3% and 14.2% respectively. Other oral health problems recorded were gingivitis and gingival bleeding, herpetic gingivostomatitis, poor oral hygiene, and facial palsy. The peak occurrence of most oral problems was during phase IV (maintenance). Oral health problems were more common among patients who received treatment and follow-up locally rather than abroad. Statistics: Collected data were analysed using statistical software International Business Machines (IBM) Statistical Package for Social Sciences (SPSS, version 20, Chicago, SPSS Inc). Descriptive statistics were performed to describe the characteristics of the study population. The association between oral health problems and other risk factors was analysed using the Chi-squared test. A P-value of <0.05 was considered statistically significant. Conclusion: This is the first study to describe oral health problems and its correlation to the phase of chemotherapy in leukaemic paediatric patients in the UAE. Oral health problems as a result of leukaemia and its management are both variable and unavoidable. Therefore, oral and dental care is of critical importance in maintaining the overall wellbeing of the patient before, during, and after treatment. This can be achieved by close liaison between the oncology and dental teams.
Oral Health Status among Children with Cerebral Palsy in Dubai, United Arab Emirates
(2017-11-17) Alhashmi, Haifa; Kowash, Mawlood B.; Hassan Khamis, Amar; El-Halabi, Manal
Objectives: The purpose of this study was to assess the oral health status of children with cerebral palsy (CP) in Dubai, United Arab Emirates (UAE). Materials and Methods: Eighty four CP and 125 healthy children were recruited from special needs centers and private/public schools in Dubai. A dental examination for decayed missing filled teeth in primary dentition (dmft)/Decayed Missing Filled teeth in permanent dentition (DMFT) indices, simplified oral hygiene index, calculus index (CI), and oral debris index was conducted. In addition, assessments of occlusal, dentofacial, soft tissue anomalies and erosion were conducted. Statistical analysis was conducted using SPSS for Windows, version 20.0 (SPSS Inc., Chicago, IL, USA). Results: DMFT/dmft scores were comparable in both groups. CI was significantly higher among children with CP. CP patients had a significantly higher proportion of anterior open bite, anterior spacing, Class II molar Angle malocclusion, trauma, high arched palate, tongue thrust, lymphadenopathy, angular cheilitis, macroglossia, drooling, and erosion as compared to controls. Conclusions: The study highlighted peculiar characteristics and needs for the CP patients in Dubai, UAE.
Oral health status of pre-school children of incarcerated mothers in United Arab Emirates prison nurseries and oral health knowledge and attitudes of their caregivers
(2018-07) Salami, Anas A.; El-Halabi, Manal; Hussein, Iyad; Kowash, Mawlood B.
Aim: To evaluate the oral-health of preschool-children of incarcerated-mothers at nine United Arab Emirates (UAE) prison nurseries and assess the oral-health knowledge and attitudes of the prison nurseries’ caregivers. Study design: Cross sectional comparative study. Methods: A total of 128 and 254 preschool children formed the study and control groups respectively. All were examined clinically for dental caries using the dmft score and oral health and hygiene status indices. Knowledge and attitudes of all caregivers (n = 45) at prison nurseries were assessed using an interview questionnaire. Results: The prevalence of caries was not significantly different between the two groups with 89.9% [mean-dmft 4.97 (± 3.61)] in the study group and 92.1% [mean-dmft 4.48 (± 3.60)] in the controls. Oral-hygiene in the control group was better with 18.2% having good oral-hygiene compared to 6.2% in the study-group. Oral-health knowledge and attitude of the caregivers of prison nurseries were not satisfactory. Conclusions: Despite the non-significant difference in the caries prevalence between the study and control groups, oral hygiene and care level of vulnerable-children of incarcerated-mothers were significantly poorer. Prisons’ caregivers had poor knowledge and attitude of dental health matters.
Oral manifestations and dentofacial anomalies in β-thalassemia major children in Dubai (UAE)
(2018-02) Kowash, Mawlood B.; Hassan Khamis, Amar; El-Halabi, Manal
Aims: The purpose of this study was to identify special oral and dentofacial manifestations of β -thalassemia major ( Β TM) in Emarati children in Dubai (UAE). Materials and methods: A total of 38 (Β TM) and 76 healthy Emirati children were recruited. An oral examination was conducted to determine dmft/DMFT indices, Simplified Oral Hygiene Index, occlusal anomalies, dentofacial, and soft-tissue abnormalities. Results: Β TM children had significantly higher DMFT compared to the healthy controls ( p -value, 0.017). The Met Need Index (MNI) and the Restorative Index (RI) were lower in the Β TM group but without statistical significance. Calculus Index (CI) was found to be significantly higher in Β TM children (p -value, 0.002). The proportion of gingivitis was significantly lower in the Β TM group ( p -value, 0.009). Β TM children had significantly higher proportion of retained primary teeth (p -value, 0.001) and gingival pigmentation compared with healthy controls ( p -value, 0.001). BTM children did not have any statistically significant difference in the Angle molar classification compared to the control. Interestingly, a significantly higher proportion of transverse cross bite was found in the control subjects compared to the BTM group ( p -value, 0.004). Conclusions: Significantly higher DMFT, retained primary teeth, gingival pigmentation, and CI was found in the BTM group compared to the controls while significantly lower gingivitis index and transverse cross bite was seen in the BTM group.