Journal of Dental Medicine

Background and Aims: Dental aesthetics has become an important issue in contemporary society. This study was designed to evaluate the patients’ satisfaction with their dental appearance and tendency to improve dental aesthetics.
Materials and Methods: In this descriptive study, a questionnaire with 17 questions was used to collect data from 200 patients referred to the dental school of Isfahan University of Medical Sciences from April-July 2019. A valid and reliable self-administrative questionnaire consisted of questions about the appearance of anterior teeth, receiving cosmetic treatments, and favorite aesthetic dental treatments was designed and used. Data were fed into SPSS22 and analyzed by Mann-Whitney, Kruskal Wallis and Spearman correlation tests (α=0.05).
Results: Among the participants, 27.5% (n=45) were dissatisfied with the appearance of their anterior teeth and the major reason for this dissatisfaction was related to the tooth color (35.8%, n=71). It was also observed that approximately 84% (n=168) of the patients had a history of smile concealment because of their teeth appearance. Among cosmetic dentistry treatments, aesthetic restorations were more commonly used than other treatments (20.5%, n=41). However, the most desired cosmetic treatments were teeth whitening (78.4%, n=156). There was no significant relationship between the satisfaction with the appearance of teeth and interest in the orthodontic treatment with age and education level (P=0.6).
Conclusion: Teeth color was the most important factor determining the degree of satisfaction with the appearance of teeth. Most of subjects desired to receive an aesthetic dental treatment and teeth whitening was the most popular aesthetic dental treatment.

Background and Aims: Studies have shown that dental anxiety may be caused by various factors such as child mood, age, maternal emotional maturity, previous dental anxiety and parenting styles. Therefore, the aim of this study was to investigate the possible relationship between the parenting styles and pediatric dental anxiety and the predictability of this variable through parenting styles.
Materials and Methods: The present study was a cross-sectional correlational study. The study population was children aged 7 to 12 years who had referred to the dental clinics of Tehran in 1400. Sampling from one of the clinics was done randomly. A total of 100 questionnaires of modified child dental anxiety scale and parenting style inventory were given to the children and their parents and 95 of them could have been analyzed. The questionnaires were analyzed using SPSS22 software and Pearson correlation and regression tests.
Results: The results showed that dental anxiety had a negative and significant relationship with authoritative parenting style (r=-0.286, P<0.01) and a positive and significant relationship with authoritarian parenting style (r=0.342, P<0.01). Authoritarian parenting style can be a predictor of dental anxiety.
Conclusion: Knowing the predictors of dental anxiety can help a pediatric dentist analysing who is most prone to dental anxiety. Based on this approach, a relationship based on trust can be established between the dentist and parents to make the necessary recommendations to parents in the office, reduce dental anxiety and improve oral health conditions in children.
 

Background and Aims: The most effective way to maintain and improve oral health is tooth brushing to physically remove dental plaque. In this regard, this study was conducted to compare the efficiency of the usual method of each person in comparison with different methods of brushing to remove dental plaque.
Materials and Methods: This study was conducted in 2020, as a randomized and open clinical trial with 72 non-dental male and female students of Tehran University of Medical Sciences. In this study, the usual method of tooth brushing with Modified Bass and Scrub Horizontal methods after training was evaluated in two random groups with plaque and gingival indices. Plaque index as a percentage and gingival index as a number (numbers between 0-1 mild inflammation, 1.1-2 moderate inflammation, 2-3 severe inflammation) were reported. The results were analyzed using SPSS25 software and paired t-test and variance equality test.
Results: The efficiency of the usual tooth brushing method in comparison with the two Modified Bass and Scrub Horizontal methods using two indicators of dental plaque and gingival indices was not statistically significant (P>0.05). Each method alone after tooth brushing significantly removed dental plaque (P<0.05).
Conclusion: The results of this study showed that the efficiency of the usual method of tooth brushing compared to trained methods in removing dental plaque and reducing gingivitis in short-term evaluation was not statistically significant.
 

Background and Aims: The objective of this study was to evaluate the knowledge, attitude, and practice of ergonomics during dental treatment among students of Urmia university of medical sciences in 2020.
Materials and Methods: In this descriptive-analytical study, self-administered questionnaires were given to 78 dental students of Urmia University in 2020 and the knowledge, attitude, and practice of every participant were evaluated. Demographic data including sex, age, and University grade were recorded as well. Data were analyzed by SPSS software24 with One Way ANOVA and t-test and the significance level of P<0.05.
Results: 78 students (44 males and 34 female) by Mean Age 23.9±2.12 were included in the study. The difference between the attitudes of different age groups was significant (P=0.006). The age group of 20 to 24 years had a more positive attitude than other age groups. However, the results of this study did not show a significant r elationship between the participants' knowledge and practice with their age (P>0.05).
Conclusion: According to this study, the knowledge, attitude and practice of Urmia dental students were in the desired range. 20-24 year students had significantly higher attitude in comparison to others. Therefore, more endeavors should be taken to improve these parameters in ergonomics.

Background and Aims: Dental caries affects the quality of life of children and parents, oral health and overall health which can interfere with the childrens’ daily activities and growth. The purpose of this study was to investigate the relationship between the severity of dental caries and quality of life in pre-school children.
Materials and Methods: This cross-sectional descriptive study was conducted on 145 parents and preschool children aged 2-5 years old referring to Ahvaz dental school and a pediatric dentistry office in Ahvaz city. The convenient sampling method was used and participants were patients referred to the faculty of dentistry and one pediatric dentistry office in Ahvaz. Early Childhood Oral Health Impact Scale (ECOHIS) questionnaire was used to evaluate the oral health related quality of life. The demographic information and dmft index (decayed, missing, and filled teeth) was assessed for children. Statistical analyzes included descriptive statistics, Spearman and Pearson tests.
Results: The mean age of children was 4.12 ± 1.2 years. 72 children (49.65%) were boys and 73 of children (50.34%) were girls. Based on our results the mean ECOHIS score was 39.69 ± 18.95. There was a significant correlation between decreased quality of life and the lower age of the children (P=0.047), less parental education (P=0.018), more dmft score (P=0.000).
Conclusion: It can be concluded that severity of dental caries is effective on children's quality of life. The quality of life of children decreases with the increase in the dmft, lower socio-economic status of parents, and higher age of parents.

Background and Aims: For dental students, communication skills are essential to effectively transfer the necessary information to the patient and meet the patient’s needs and expectations. Therefore, this study was conducted to determine the patient communication skills of dental students at Islamic Azad university of Isfahan in 2021.
Materials and Methods: In the present cross-sectional analytical study, an online standardized questionnaire DCCC (Dental consultation communication checklist) was provided to all clinical dental students applying a census sampling method. In total, from 248 clinical dental students, 230 students participated in the study (response rate=92.7%). The questionnaire included five dimensions of introduction, medical history, clinical examination, closure and patient. In order to determine the patient communication skills, its dimensions, and the association between patient communication skills and students’ demographic characteristics, friedman test, analysis of variance, independent t-test and a linear regression model were used for statistical analysis.
Results: The mean score of total communication skills of the students (117.16±15.6) was above average which was obtained from the maximum score of 155. There was a significant difference between the dimensions of communication skills (P<0.001). The highest scores were assigned to the clinical examination, patient, medical history, introduction and closure, respectively. No significant relationship existed between the score of students' communication skills with gender (P=0.08), age (P=0.17), marital status (P=0.19), and educational background in psychology (P=0.07). No significant relationship revealed between the total score of communication skills (P=0.92) and its dimensions (introduction P=0.79, medical history P=0.90, clinical examination P=0.77, closure P=0.35, and patient P=0.85) with the students’ academic year.
Conclusion: The total score of dental students’ communication skills and all its dimensions was above average. However, students reported poorer performance in dimensions of introduction and closure than the other dimensions. Therefore, it is recommended to design and implement educational interventions specially to improve the dimensions of introduction and closure.

Background and Aims: The 2019 coronavirus pandemic has resulted in a lot of pressure on health systems around the world. The risk of transmission of infection in dentistry is significantly high. The aim of this study was to evaluate Covid-19 protection knowledge and practice of dentists in Isfahan in clinical environment.
Materials and Methods: In this study which was performed in April 2021 by available sampling method, an online questionnaire was used as a data collection tool. Questions included demographic characteristics, knowledge of proper protective protocols, protection protocols taken against Covid-19, and the prevalence of Covid-19 infection. Descriptive and analytical analyzes were performed using SPSS26 software including frequency distribution tables, graphs, independent t-test, and Pearson and Spearman correlation coefficients.
Results: 310 questionnaires were collected with complete answers. 87.4% of dentists had moderate and high knowledge of proper protective protocols against Covid-19. The mean knowledge score had no significant relationship with the demographic characteristics of age (P=0.59), gender (P=0.31 and r=0.05), work experience (P=0.16 and r=0.07) and degree (0.33=P). In the pandemic period, 87% of dentists treated dental emergencies and 40% delayed the dental treatment for patients with high risk of Covid-19. Dentists used personal protective equipment correctly. Among all the included dentists, 75% used high protection masks, 75% used face shields, 67% used hats, and 60% used sterile gowns in all of their treatment activities. The clinical environment was equipped well to prevent spreading of Covid-19. The results showed that 55.8% of the participants had one or more similar signs/symptoms of Covid-19 and 9% had a positive SARS-CoV-2 test during the last months.
Conclusion: The majorities of dentists had enough knowledge of proper protective protocols against Covid-19 and efficiently used all protections while performing dental procedures.
 

Background and Aims: According to the importance of primary stability on dental implant success and osseointegration, we intend to check and compare the stability and crestal bone loss rate between osteotomy technique and conventional implant insertion techniques.
Materials and Methods: In this study, 26 implants in anterior segment of maxilla in 13 patients were evaluated. The implants were TBR system (Toulouse, France) with 3.5 diameter and 10.5-12 mm length. The implant stability level was recorded immediately after surgery and 3 months later with Ostell mentor. The periapical radiography was taken immediately after surgery, 3 and 6 months to assess crestal bone resorption. Paired t-test and Wilcoxon signed Rank test used for data analysis.
Results: There were no statistically differences between the two treatments techniques in terms of stability (P>0.05). The mean crestal resorption was higher for the osteotomy technique 3 months after implant insertion (P<0.001) but there were no significant differences after 6 months (P=0.678).
Conclusion: Within the limitations of the current study, it can be concluded that the osteotomy it can be considered as a treatment technique in insufficient bone width.

Background and Aims: Activity-based costing enumerate every input consumed in treatment. The Covid-19 pandemic changed the dental treatment protocols and the ordinary circumstances of patients. The aim of this study was to calculate and compare the costs of three common dental services in Iran from the viewpoint of the providers and recipients of the services before the Covid-19 pandemic (2019) and during the pandemic (2021).
Materials and Methods: Direct medical and non-medical costs were considered from the service provider's perspective. Direct medical costs, indirect costs, direct non-medical costs, and intangible costs were considered from the recipient's perspective. To calculate the equivalent costs, the base year was considered 2021, and the costs of 2019 were calculated with a discount rate of 16%.
Results: From the service provider's perspective before the pandemic, the cost of dental amalgam restoration was 2,851,235 Rials, root canal treatment was 6,351,580 Rials, and tooth extraction was 1,887,295 Rials. The cost of these services in 2021 was 5,562,150 Rials, 8,070,591 Rials, and 4,865,563 Rials, respectively. From the recipient's perspective, before the pandemic, the cost of tooth restoration was 715,466 Rials, root canal treatment was 2,883,001 Rials, and tooth extraction was 3,267,359 Rials. The cost of the mentioned services in the year 2021 was 1,212,528 Rials, 3,971,640, and 3,680,880 Rials, respectively.
Conclusion: The Covid-19 pandemic has had an effect on increasing the cost of dental services from both the service provider and recipient perspective, but economic volatility has a vital role in increasing the estimated costs in the country. Probably, a part of the increase in costs was due to the role of brokers in providing dental materials and equipment.

Background and Aims: Considering the problems associated with occupational stress and burnout caused by this stress, this study aimed to determine the academic burnout, dental environment stress, and their association among dental students in Isfahan.
Materials and Methods: This analytical cross-sectional study was conducted in 2020, applying a convenient sampling method. Data collected from undergraduate dental students from Isfahan University of Medical Sciences and Azad University of Isfahan using the validated Persian version of BCSQ-12-SS (Burnout Clinical Subtype Questionnaire) including 12 questions and DES (Dental Environment Stress) including 32 questions. Volunteer students filled in the online questionnaires using social media including WhatsApp and Telegram. Data were analyzed using SPSS26, U Mann-Whitney test, Kruskal-Wallis test, Spearman correlation coefficient, and a linear regression model (level of significance P<0.05).
Results: Among 300 participants (response rate=64%), the mean age was 24.25±2.72, and 54.7% were women. The mean score of academic burnout was 2.61±0.66 of the maximum score of 5. Overload was the most effective dimension of academic burnout. The mean score of DES was 2.80±0.51 of the maximum score of 4. Clinical education was the most effective dimension of DES. A direct correlation was observed between the dental environment stress and academic burnout (P<0.001; r=0.33).
Conclusion: The academic burnout among dental students in Isfahan was moderate and dental environment stress was high. Considering the direct association between the stress and burnout, more efforts should be made to reduce dental environment stress especially in the field of clinical education.

Background and Aims: Endocrown is a type of monoblock restoration using the pulp chamber and remaining coronal tooth structure for retention. Advancements in adhesive techniques have breathed fresh spirit into endocrown. Nowadays, there are two approaches for endocrown: conventional approach and  biomimetic approach. This study aimed to review data on the steps and clinical and philosophical points of using these approaches to help dentists’ selection and performance.
Materials and Methods: The review was conducted by reviewing the articles available in PubMed, Scopus, and Google Scholar databases from 1995 to 2022. The keywords used were; Crown, Endodontically-treated teeth, Light-curing of dental adhesive, Onlay, and Post-Core.  
Results: After removing duplicates, titles/abstracts were reviewed. Animal studies, studies without available full text or non-English language studies were excluded from the study. Then, the full texts of the remaining 59 articles were evaluated and 49 articles were eligible for the present study. The articles included clinical trials, in vitro, systematic reviews, and case reports.
Conclusion: Endocrown is a successful alternative to crown, especially in molar teeth. Regardless of the conventional or biomimetic approach, this treatment has a more favorable fracture pattern while preserving the remaining tooth tissue as much as possible.

Background and Aims: Dentists faced the highest risk of infection during the COVID-19 pandemic. Educating competent students is the first task of the dental school to overcome the created problems and thus, it is necessary to recognize the created educational deficiencies. This study aimed to assess the students' perspectives from the Dental School at Tehran University of Medical Sciences during the academic year 2019-2020, concerning the competencies expected to be developed during the clinical phase of the general dentistry curriculum during the COVID-19 pandemic. The findings are intended to inform the formulation of educational strategies in the post-pandemic period to address identified gaps in training.
Materials and Methods: During the academic year 2019-2020, a cross-sectional descriptive study was conducted at the School of Dentistry, Tehran University of Medical Sciences, Iran. The study consisted of three phases: checklist design, psychometrics, and a survey of general dentistry students in their third to sixth year. The checklist design phase involved a team of four individuals, including educational officials from the faculty, academic staff members, and medical education experts. Experts confirmed the content validity of the checklist, while reliability was assessed using the Intraclass Correlation Coefficient (ICC), which indicated favorable validity and reliability. Subsequently, questionnaires formatted as Google Forms and a census approach were distributed to all students enrolled in the general dental course within the clinical section of the School of Dentistry at Tehran University of Medical Sciences. Ultimately, following the data collection process, statistical analysis was conducted utilizing descriptive statistics, including the mean and standard deviation, and the findings were communicated to the group managers.
Results: The assessment of content validity was established at a minimum of 71%, based on the evaluations provided by five experts. Additionally, reliability was measured using an intra-cluster correlation coefficient (ICC) exceeding 0.79, signifying a strong level of both validity and reliability. 122 students (53%) in the clinical stage completed the forms related to the pre-clinical/clinical units passed during the Covid era. Despite having enough training, basics Removable Partial Prosthodontics, Surgery 1, and Restorative 3 courses needed more training. In addition, Basics Removable Partial Prosthodontics, Surgery 1, and Surgery 4 needed the most practical training to acquire the necessary competencies.
Conclusion: The findings of this research indicated that the dental students expressed a desire for increased practice across various levels of pre-clinical and clinical courses. This would suggest that the challenges associated with patient interactions during the COVID-19 pandemic may not be the sole contributing factor. Consequently, alongside the need for educational planning to address the requirements of enrolled students, it appears essential to conduct similar studies in the post-pandemic context. Furthermore, this approach may also prove beneficial in evaluating educational needs for ongoing professional development courses.

Background and Aims: Emotional intelligence helps dental students better manage stress and establish effective communication with patients, while self-efficacy strengthens their confidence in performing clinical tasks and acquiring professional skills. The connection between these two factors leads to improved academic and professional performance. The aim of this study was to examine the relationship between the emotional intelligence, self-efficacy, and academic success among dental students.
Materials and Methods: This cross-sectional study included 55 dental students from Shahid Beheshti University of Medical Sciences - Iran, selected by convenient sampling. To measure academic self-efficacy beliefs, the Sherer questionnaire was used, which consisted of 17 questions with a theoretical score range of 17-85. To measure emotional intelligence, the Bar-On questionnaire was used, consisting of 90 questions with a theoretical score range of 90-450. Academic achievement was assessed using the students' grade point average (GPA). Additionally, gender, living at home or in a dormitory, and parental education levels were considered as background variables. The data were analyzed using descriptive statistics, t-tests, and Pearson correlation coefficient.
Results: Among the 55 students who participated in this study, including 30 women and 25 men, the average emotional intelligence score was 84.85, the average self-efficacy score was 62.02, and the average GPA was 16.42. There was a significant difference in the emotional intelligence scores based on gender and living situation, with male students scoring higher than female students and dormitory residents scoring higher than those living at home (P=0.02). There was no significant difference in the self-efficacy scores and GPA between males and females. Students whose mothers had higher levels of education and those living at home had higher GPAs (P<0.03). No statistically significant relationship was found between the academic success and emotional intelligence or self-efficacy (P>0.05).
Conclusion: The findings suggest that while emotional intelligence and self-efficacy may not directly influence academic success, other factors like living environment and parental education can play a role. Understanding these dynamics can help educators focus on holistic student development, addressing not just academic skills but also personal and social factors that contribute to student performance and well-being.

Background and Aims: The quality of sleep plays a significant role in the academic performance of dental students, especially in the clinical years. Identifying and treating students at risk of sleep disorders can reduce or limit the drop in academic performance. The purpose of this study was to determine the relationship between the sleep quality and educational performance of Rafsanjan dental Student-Iran.
Materials and Methods: The present study was a descriptive-analytical cross-sectional study that was conducted among all dental students in Rafsanjan University of Medical Sciences - Iran. This study was presented to all dental students in Rafsanjan by online questionnaire method on Pressline website. The questionnaire included demographic information and student number along with the Pittsburgh Sleep Quality Standard Questionnaire. The Pittsburgh Questionnaire examines the quality of sleep in the range of 0 to 21. The link of the questionnaire was made available to the students through Telegram, and the GPA of the total students was obtained by using the student number from the Vice-Chancellor of University Education. The data were analyzed with SPSS26 software. First, the data were analyzed with Smironov's kermograph test. The results of this test showed that the data distribution is not normal (P<0.05). Due to the non-normality of the data distribution, non-parametric tests such as K-score, Mann-Whitney, Kruskal-Wallis and Spearman were used.
Results: 151 students participated in the questionnaire of which, 73 were men (48.3%) and 78 were women (51.7%). The mean and standard deviation of the age of the subjects studied was 22.11±2.3 years. The overall average sleep quality score of dental students was equal to 8.13, which according to the questionnaire, students experience poor sleep quality. 86.1% of students had poor sleep quality. Examining the correlation between the sleep quality and academic performance showed that there was no significant relationship between them. Sleep quality had no significant relationship with gender, marital status, place of residence, and entry year (P<0.05).
Conclusion: The results of the present study showed that majority of dental students in Rafsanjan had low sleep quality. Although, there was no relationship between the quality of sleep and academic performance, it seems necessary to pay attention to the sleep status of these students in order to improve their sleep quality, which is an important factor in improving their health by administrators and Rizan health program.