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Article History

Received: 22 January 2023

Revised: 7 March 2023

Accepted: 23 March 2023

First Online: 11 April 2023

Competing interests

: The authors declare no competing interests.

: Ethical approval was obtained from the ethics committee of the Faculty of Dentistry in Damascus University. In addition, a formal permission was obtained from the Ministry of Social Affair and Labor to get access to orphanage and perform the required examinations on children. A written informed consent from the manager of the orphanage and their carers were obtained. This trial was in accordance with the ethical standards of the institutional and national research committee of the study institution and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. It was approved by the Research Ethics Committee of Faculty of Dentistry of Damascus University and was registered at the ISRCTN registry ( ).