Journal of Dental Medicine

Background and Aims: Dental anxiety and fear can act as a barrier to seek dental care leading to insufficient oral health in people. The aim of this study was to determine the relations between dental fear and anxiety with dental caries status (DMFT) and clinical consequences of untreated dental caries (PUFA) among the adult patients referred to the faculty dental clinic of Tehran University of Medical Sciences.
Materials and Methods: In this cross-sectional study in 2019, the patients above 18 years old were assessed. Two standard questionnaires, Dental Fear Scale (DFS) and Modified Dental Anxiety Scale (MDAS), were used to assess the scores of dental fear, and dental anxiety, respectively. The demographic data of the patients were recorded. Dental caries status and clinical consequences of untreated dental caries, using DMFT and PUFA, respectively, were measured. Pearson correlation coefficients and multiple linear regression model (Backward method) were used for statistical analysis.
Results: Totally, 283 patients with the mean age of 38.6±11.8 years old participated. The mean scores of MDAS, and DFS were 12.04±4.49, and 41.33±16.87, respectively. Educational level (P=0.03, β=-0.14) and marital status (P=0.01, β=0.17) had significant relationships with MDAS scores. Moreover, a significant relationship was found between marital status and DFS scores (P<0.001, β=0.25). Significant correlations were found between dental anxiety level and D (P<0.001, r=0.36) and M components (P=0.02, r=0.14) of DMFT index. Moreover, there was a significant correlation between dental anxiety and U components of PUFA index (P=0.045, r=-0.12). Furthermore, the correlations between dental fear and D and M component of DMFT were significant (P<0.001, r=0.36; P<0.001, r=0.23; respectively).
Conclusion: Dental anxiety and dental fear were infrequent in the studied population; however, significant relationships were found between dental anxiety and dental fear with dental caries indices. Therefore, it was concluded that the more MDAS and DFS scores, the worse dental caries status.

Background and Aims: Supporting the preventive approach is important in training future dentists. The purpose of the present study was to evaluate the knowledge, attitude and practice of senior dental students regarding non-invasive management of dental caries.
Materials and Methods: A cross-sectional study was conducted in 2019 using total sampling method and a valid and reliable questionnaire. Knowledge, attitude and self-reported practice of senior dental students regarding caries risk assessment (CRA) and management of lesions in two paper patients were assessed. The data analysis was performed using SPSS20 and the descriptive and analytical statistics were reported.
Results: In overall, 86 students (response rate=91%) were responded. In the knowledge section, caries history in the previous year, having frequent fermentable carbohydrate, xerostomia, and low socio-economic status were considered by more than half of students as factor for caries risk assessment. More than 90% of students had a positive attitude towards CRA in children. Nearly 50% of students tend to restore enamel lesions in proximal and occlusal surfaces in high-risk scenarios. There was significant association between the OHI instruction and debris index improvement (P=0.04) in the integrated comprehensive care clinic (TUMS). The linear regression analysis showed that there was no significant association between the demographic characteristics, place of education, previous course on the level of knowledge and attitude.
Conclusion: Senior dental students despite their general knowledge and positive attitude toward caries risk assessment, tended to aggressively manage the incipient lesions in the enamel and DEJ. Delivering prevention as integrated in the comprehensive care unit in order to improve oral hygiene status of patients is recommended.

Background and Aims: Different factors play a role in causing tooth decay. Modern dentistry is looking for a way to prevent tooth decay and suggests different ways to increase remineralization. The aim of this study was to evaluate the effect of nanohydroxyapatite toothpaste and mouthwash on remineralization of primary enamel lesions and obstruction of tubules.
Materials and Methods: In this study, 90 human extracted central teeth were used. Artificial decay was induced by placing the specimens for 72 hrs in a demineralization solution in an incubator at 37 °C. Hardness of the specimens was determined by a microhardness test before any surface treatment. The specimens were then divided randomly into 6 groups of 15. For 1-6 groups, the specimens were subjected to a pH cycling for 14 days, which included 3 hrs of demineralization and 21 hrs of remineralization. At the same time, 1-3 groups were in contact with diluted toothpaste in a ratio of 1:3 with deionized water at a rate of 5 ml twice a day for two min. Eac specimen of 4-6 groups was exposed to 5 ml of three types of mouthwashes for one min. Then, the specimens were cut in the buccolingual direction in order to simultaneously evaluate the dentinal tubules and Vickers microhardness test was performed again and the before and after microhardness values were compared. Then, the percentage of deposition on the surface and tubule obstruction were analyzed using SEM (Scanning electron microscope) (P=0.006). Data were analyzed using SPSS24 software bu the descriptive statistics, ANOVA analysis of variance, and multiple Tukey comparisons.
Results: The results of analysis of variance test showed that there was a statistically significant difference in the microhardness changes between study groups (P=0.006). Also, in-group analysis of microhardness changes, there was a significant difference (P<0.0001). Besides, only in the group containing 0.5% nanohydroxyapatite toothpaste, more than 50% tubule deposition and obstraction was observed (P<0.05).
Conclusion: According to the present study, nanohydroxyapatite can be one of the treatment strategies to repair incipient lesions of teeth and the addition of nanohydroxyapatite, preferably to toothpaste, increases the dental microhardness.

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: Achieving non-invasive methods for the proper detection of secondary caries adjacent to dental restorations has a great importance. As alterations in horizontal and vertical angles of X-ray beam would affect the detection of dental caries on radiographs, this study was designed to evaluate the effect of changing the horizontal angle of X- ray on detection of dental caries adjacent to class II amalgam restorations in posterior teeth on periapical radiographs.
Materials and Methods: In this in vitro study, artificial carious lesions were prepared in axial walls of the amalgam restoration cavities in interproximal surfaces of 27 human extracted premolar teeth. Periapical radiographies with different horizontal X- ray angles were obtained, observed, and rated by 5 maxillofacial radiologists for detection of carious lesions. For each observer, the sensitivity, specificity, accuracy, PPV, and NPV of radiographs in the individual horizontal angles were calculated and compared by nonparametric Kruskal Wallis test. Interobserver agreement was assessed by fleiss’ kappa coefficient.
Results: The highest accuracy of periapical radiographs for the detection of secondary caries of mesial dental surfaces was in 5-degree of mesial and distal X- ray angle (86.66%) and for the distal dental surfaces was allocated to 10-degree of distal X- ray angle (85.90%). Also, there was a significant difference in the accuracy between different horizontal angles (mesial and distal 0, 5, 10, 15-degree) (P=0.01). The higher agreement between observers in detecting mesial surface caries was in 10-degree of distal angle (0.86) and in detecting distal caries was in 5-degree of distal angle (0.89).
Conclusion: In the case of doubt in the existence of recurrent caries in the interproximal tooth surface, if the carious lesion is not visible on standard radiographic image with direct angle of X- ray, A 5- 10 degree of x- ray horizontal angle can improve the detection of secondary caries under amalgam restorations in interproximal dental surfaces.

Background and Aims: The status of oral diseases in children with visual impairments is a topic of concern for dental researchers. The aim of this study was to evaluate the rate of dental caries in these children according to the PUFA index.
Materials and Methods: To evaluate the rate of tooth decay, sixty 6-12 year old children with visual impairments were selected by convenience sampling in 2022 in Isfahan-Iran. The examination and pufa/PUFA index (exposed pulp, residual root mucosal ulcers, fistulas, and abscesses) were recorded.  Data were analyzed with Mann-Whitney tests (comparison of pufa/PUFA index according to gender, type of disorder and severity of disorder) and Spear-Man (examining the relationship between pufa/PUFA index and child age).

Results: The means of pufa/PUFA index in primary and permanent dental systشems were 0.89±0.68 and 0.44±0.2, respectively, of which the highest portion was related to the caries with pulp involvement. There was no significant relationship between the pufa and PUFA index according to gender, type of disorder, and severity of visual impairment (P<0.05). Also, only a significant and direct relationship was observed in pufa between the primary tooth system and age (P=0.042).

Conclusion: Untreated caries in children with visual impairment based on the PUFA index in primary and permanent dental systems had a relatively low prevalence. The highest  PUFA index portion was related to the tooth decay with pulpal involvement. Furthermore, untreated caries in primary teeth were increased by increasing the children’s age.

Background and Aims: Dental caries is one of the most prevalent chronic oral diseases worldwide. Timely and accurate diagnosis of dental caries plays a crucial role in preventing lesion progression and reducing complications. This study aimed to systematically review the studies on dental caries detection using machine learning algorithms applied to periapical radiographs.
Materials and Methods: A comprehensive search was conducted in PubMed, Scopus, Web of Science, IEEE Xplore, and Google Scholar databases up to the end of 2024. Inclusion criteria comprised studies using machine learning algorithms for detecting dental caries in periapical or intraoral radiographs. The quality of studies was assessed using the QUADAS-2 tool.
Results: From 825 initial articles, 13 studies met the inclusion criteria. All studies used Convolutional Neural Networks (CNNs) with various architectures including ResNet, VGG, Inception, DenseNet, and YOLO. ResNet-based models and their hybrid variants showed the best performance with diagnostic accuracy ranging from 82% to 98%. Comparison with human experts in 6 studies revealed that deep learning algorithms demonstrated similar or superior performance.
Conclusion: From the results, deep learning especially convolutional neural networks, had significant potential for improving dental caries detection in periapical radiographs. However, challenges such as limited high-quality training data and generalizability issues need further investigation.

Background and Aims: Many oral health problems, including tooth decay mostly begin in childhood. Since decay in pits and fissures accounts for a higher percentage, it is of great importance to expand fissure sealant therapy, raise awareness and parents' attitudes towards preventive methods, especially fluoride and fissure sealant therapy. Therefore, the aim of the present study was to evaluate the awareness of parents of 6-12 year old children in Khorramabad city in Iran about the fissure sealant method for preventing tooth decay.
Materials and Methods: The present study was descriptive-analytical. In this study, 601 parents of 6-12 year old children in Khorramabad schools were evaluated using cluster sampling in the academic year 2021. The designed questionnaire included demographic information and questions that estimated the level of parental awareness about fissure sealants. Then, data were analyzed by the SPSS version 23 software and Pearson correlation, ANOVA, and T-test statistical tests.
Results: The mean age of the participants was 40.54 ± 8.09. 339 of the subjects had a bachelor's degree or higher. 17.3% of parents had a good level of knowledge. In this study, a statistically significant relationship was observed between the knowledge score and the variables of education level (P<0.02), oral hygiene education history (P<0.001), and time of visiting the dentist (P<0.05). However, no significant relationship was observed between the age, parental relationship, and economic status (P>0.05).
Conclusion: The findings of this study showed that the awareness score of most of the individuals participated in the study was low about fissure sealants, especially in the individuals with low level of education or no education. Therefore, more attention and serious attempts should be done to increase the parental awareness in this regard.

This narrative review provides a comprehensive overview of the potential of plant-derived polyphenols in restorative and preventive dentistry. As natural bioactive compounds such as polyphenols reshape the oral microbial ecology by attenuating virulence, inhibiting quorum-sensing communication, disrupting extracellular polymeric substance (EPS) formation, and reducing acidogenicity within dental biofilms. Beyond their antimicrobial effects, polyphenols can protect host tissues, namely, enamel, dentin, and gingiva, by cross-linking collagen fibrils, suppressing matrix metalloproteinase (MMP) activity, and modulating inflammatory pathways. Experimental, in situ, and clinical evidence consistently demonstrated improved bond durability at the dentin–resin interface. The most compelling data support the use of primers containing proanthocyanidins, quercetin, epigallocatechin gallate (EGCG), and resveratrol. In preventive applications, catechin-based varnishes have demonstrated remineralization effects comparable to those of fluoride varnishes. Conversely, pomegranate extract–enriched mouthrinses, in the presence of fluoride, could enhance both anti-demineralization and antibiofilm activity. In the context of implants and dental prostheses, the polyphenol-functionalized coatings, particularly those based on tannic or caffeic acid, would reduce biofilm formation and provide corrosion resistance for metallic surfaces. Nevertheless, several formulation challenges remain, including rapid oxidation, limited solubility, and discoloration, all of which require careful management. Strategies such as dose optimization, solvent selection, covalent stabilization, and microencapsulation are recommended to overcome these limitations. For broader and more effective clinical translation, standardization of multispecies laboratory models and harmonization of clinical endpoints are essential. Furthermore, future longitudinal trials are needed to bridge the gap between laboratory findings and clinical performance. Ultimately, with the design of innovative delivery systems and long-term monitoring of parameters such as restoration survival, secondary caries, periodontal health, and color stability, polyphenols hold promise to define a new generation of antibacterial, biocompatible, and aesthetically stable dental materials.