Journal of Dental Medicine

Background and Aims: Due to the review of general dental courses, it was necessary to assess the students' satisfaction with this curriculum. The aim of this study was the assessment level of students’satisfaction with the new educational curriculum of the Ministry of Health at the department of restorative dentistry of Tehran university of medical sciences in 2019-2020.
Materials and Methods: In this descriptive cross-sectional trial,72 sixth year dental students of Tehran University who passed the restorative dentistry courses based on the new curriculum were studied. A questionnaire was developed and for validity content assessment, it was presented to 5 professors and then revised. For reliability approval of the questionnaire, test-retest approach was used. The questionnaire was given to the 30 students of the main pilot group in one session and two-week later and agreement percentage and Kappa index were calculated.  After conducting the "test" process and re-testing, the "questions" were statistically analyzed using STATA software.
Results: The most level of satisfaction regarding to practicality of subjects was found for fundamental of restorative dentistry including principles of amalgam class I cavity preparations and restorations on the dentic (81.94% and 76.39% acceptable respectively) and the principles of amalgam classII cavity restorations on the dentic (72.22%). The least satisfaction levels were obsereved in the first and second theoretical restorative courses including tooth-colored restorations (47.22%), onlays and inlays (47.22%) and tooth-colored classII cavity preparations and restorations (48.61%). The amount (P-value or error of the first type) was reported in all questions>0.001.
Conclusion: Despite the limitation of this study, final-year dental students’ satisfaction of theoretical restorative dentistry courses was medium, while it was high for the fundamental and practical restorative courses of 2017 educational curriculum.

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: 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: Considering the preventive and therapeutic effects of resin infiltration (RI) and the unknown effect of bleaching on the enamel treated with this method, this in-vitro study aimed to assess the effect of bleaching on color stability of enamel lesions treated with RI.
Materials and Methods: In this in-vitro, experimental study, enamel-dentin samples measuring 5×5×3 mm were prepared on the buccal and lingual surfaces of 30 extracted humans third molars with no caries, cracks or enamel defects by a microtome. The specimens were divided into three groups of 10 specimens: 1) sound enamel (control), 2) demineralized enamel, 3) demineralized enamel plus RI. White spot lesions were artificially created by immersing the samples in hydroxyethyl cellulose demineralizing gel with a pH of 4.5 for 4 days. Next, Icon RI was applied on the samples in group 3. The baseline color of the specimens was measured using a spectrophotometer. Then, 35% hydrogen peroxide was applied on the specimens in three cycles and time interval of 10 min. After the end of the last cycle, the samples were completely washed for 1 min and then, underwent colorimetry again. Data were analyzed using one-way ANOVA.
Results: The results of this study showed that the highest level of color change (ΔE) in the demineralized group was 6.3±2.003, while the least amount of ΔE in the enamel lesion group treated with resin infiltration was 3.54±0.98 and in the control group ΔE was 4.13±1.14. Therefore, there was a significant difference between demineralized and treated by infiltratant groups (P=0.005). However, there was no significant difference between control group and treated with resin infiltration group (P=0.54).
Conclusion: Bleaching induced a less change in the color of the enamel lesions treated by resin infiltration compared with that of the demineralized teeth.
 
 

Background and Aims: The aim of this study was development and validation of a questionnaire measuring the pseudo-scientific unsupported of Iranians’ belief regarding oral health.
Materials and Methods: A list of 169 pseudo-scientific and invalid Iranian beliefs about oral health that was collected in the previous phase of the study were sent to a purposive sample of 13 professors at Mashhad dental school which resulted in extracting 34 beliefs being considered more common among Iranians. A list of 21 pseudo-scientific beliefs was obtained for preparing the questionnaire after receiving the sample opinions of 21 professors of Mashhad dental school about the invalidity and pseudoscientific propositions and their written revision. Finally, the questionnaire was completed by 44 participants to analyze the ease and clarity and to calculate Cronbach's alpha and Kuder Richardson measure as a homogeneity reliability index. It was completed in a group of 15 participants with a time interval of one month for test-retest analysis and consistency reliability evaluation.
Results: A questionnaire consisting of 21 beliefs was developed using four-point, three-point, or two-point Likert scales. The standardized Cronbach's alpha score and Kuder Richardson's measure score were 0.641 and 0.514, respectively, which indicated the moderate to good reliability of the homogeneity. The Interclass Correlation Coefficient (ICC) was calculated as 0.863, representing very good reliability of consistency of the questionnaire. Furthermore, the kappa coefficient of each of the 21 statements had a significant difference with zero (P<0.05) ranging between 0.605 and 1.
Conclusion: The result of the present study is a questionnaire measuring the level of Iranians’ belief in unsupported and invalid statements about oral health. Using this questionnaire would be helpful for dentists and oral health professionals to promote knowledge of Iranians about oral health.

Background and Aims: One of the concerns of dentists is selecting a suitable brand of stainless steel crowns with maximum dimensional adaptation with primary teeth. The aim of this study was to compare the primary molar crown dimensions with that of two brands of stainless steel crowns (SSCs) in a sample of Iranian children.
Materials and Methods:  In this study, 130 eligible children between 3 and 12 years (66 boys, 64 girls) were selected. After recording the demographic information, the mesiodistal, buccolingual and occluso-gingival dimensions of first (D) and second (E) primary molars were measured on dental casts and compared with the dimensions of KTR (MeiMeiMinBenjing, Benjing, China) and Shinghung (Shinhungcompany, Seoul, South Korea) SSCs. Data were assessed using chi-square test and Pearson correlation coefficient. P<0.05 was considered statistically significant.
Results: In this study, the most dimension matching of the teeth with that of SSCs were observed mesiodistally in upper D and lower D, buccolingualy in the upper D and lower D, and occluso-gingivaly in upper D and lower E. The most cases of mismatch in the mesiodistal dimensions of the teeth with that of SSCs were observed in the lower E and upper D. Also, the most cases of mismatch in the buccolingual dimension were found for upper E and lower E.
Conclusion: Both SSCs brands in this study showed significant dimensional adaptation with the primary teeth in Iranian children. The most dimensional adaptation was between KTR SSCs and maxillary primary molars, and between Shinhung SSCs and mandibular primary molars.

Background and Aims: The incisive canal cyst also known as nasopalatine duct cyst (NPDC) is the most common developmental non odontogenic cyst and it is usually asymptomatic with a well corticated round, ovoid or in some cases unique heart shaped radiolucent radiographic finding. Its accurate diagnosis from odontogenic cysts, odontogenic tumor, and benign non-odontogenic tumors using clinical and radiographic findings leads to eradication of pathologic condition with minimum residual defects and patient discomfort. In this case report, the clinical and radiographic findings of a 60-year-old female with the chief complaint of swelling was reviewed. There were typical histologic and radiographic findings related to nasopalatine duct cyst. The surgical management is explained. Follow up visit showed satisfactory healing and no dehiscence. It could be suggested that heart shaped radiographic finding in 3-D reconstructed image in the maxillary midline would be a good predictor for NPDC.

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: Considering the prevalence of periodontal disease in Iranian adults and its impact on general health and the role of medical practitioners, the purpose of the present study was to determine physician’s knowledge and attitude towards periodontal health.
Materials and Methods: A cross-sectional study was conducted in Tehran in 2019 and after getting informed consent, a valid and reliable questionnaire was provided to medical practitioners in a continuing education course. Data were analyzed using the SPSS26 software.
Results: In total 170 subjects (response rate=95%) responded. The mean scores of knowledge and attitude towards periodontal health were 4.1 (maximum score of 6) and 51.9 (maximum score of 65), respectively. Work experience (P=0.022) and period of time after graduation (P=0.007) had a positive and significant relationship with participants' knowledge. Also, gender (P=0.012), work experience (P=0.002), period after graduation (P=0.005) and practitioner’s workplace (P=0.001) were significantly associated with their attitudes. The results showed that women had a better attitude towards prevention of gum disease.
Conclusion: In the present study, medical practitioners’ knowledge was good towards description of healthy periodontium and the first sign of periodontal diseas. Also, their attitudes regarding the importance of oral and dental diseases and its impact on social activities were appropriate. The results of the present study showed more emphasis is needed on delivering relevant dental education in medical curriculum.

Background and Aims: Considering the extensive connections of anatomical components in the head and neck region, it is expected that a change in one of the components of this functional unit will have effects on other parts. The aim of this study was to investigate the effect of correction of class III skeletal relationship with orthognathic surgery on the angles between cervical vertebrae.
Materials and Methods: This descriptive-analytical retrospective study was conducted in 1403 at the orthodontic department of Babol Dental School. 30 patients with class III skeletal malformations in the age group of 18 to 48 years who underwent orthognathic surgery (single jaw or double jaw) and had a good quality lateral cephalometric radiography were randomly selected and available based on entry and exit criteria. Dependent variables including 13 parameters in the cranial (angles of SNA, SNB, ANB and Wits App), cervical (the angle between the OPT and CVT lines with each other and with the true perpendicular line) and craniocervical area (the angle of the OPT and CVT lines with the horizontal planes of the head, including the mandibular and palatal plane) of the head and neck were used to evaluate the angles between the cervical vertebrae. The data were analyzed using SPSS22 software and independent t-test, and in case of non-normality, Will-Coxon test was used.
Results: In this study, a total of 30 samples were examined. None of the measured parameters of the cervical area before and after surgery showed a statistically significant change (P<0.05). By comparing the angles between the cervical vertebrae, the PP/CVT angle in the craniocervical region showed statistically significant changes (P=0.024). The values of PP/OPT, MP/OPT, SN/CVT, and MP/CVT angles increased slightly after surgery, but they were not statistically significant (P≥0.05), which showed a relative increase in the tension of the head on the upper part of the cervical spine.
Conclusion: Changing the position of the jaw following orthognathic surgery could cause head extension, but it had no effect on the position of the first 4 cervical vertebrae.

Background and Aims: Today's working conditions in medical sciences, including dentistry, are changing rapidly. The explosion of scientific information on the one hand and the increase in consumer awareness on the other hand, along with the ever-increasing advances in artificial intelligence and access to the internet and the wide information network, has made health service providers face complex and different conditions. One of the ways to properly respond to the treatment needs of patients is to benefit from the best available evidence and clinical experience and to pay attention to the values and preferences of patients, which is manifested in the form of evidence-based practice. Dentists as members of the group of health service providers, must be familiar with evidence-based dental concepts and procedures and use them in their professional performance. This article discusses the steps of evidence-based dentistry to help empower dentists in the field of clinical decision-making based on the latest research benefiting from the best evidence and improving their clinical practice.
Materials and Methods: To find relevant articles in the field of evidence-based dentistry, PubMed scientific database and Google Scholar search engine were searched from 2000 to 2023 with keywords of Evidence-based dentistry, clinical practice, and decision making. Among the articles searched based on the inclusion and exclusion criteria, 15 articles in English whose main topic was evidence-based dentistry with an educational approach were selected and used to describe evidence-based dentistry and its components.
Conclusion: Due to the complexity of patients' issues and their increasing awareness, it is essential for dentists to possess specialized skills to meet patients' needs in accordance with their expectations and values, while also utilizing research findings.

Background and Aims: Ensuring the long-term stability of orthodontic treatments and preventing tooth relapse remains a significant challenge in orthodontics, often addressed through the extended use of retainers. Given the pivotal role of retainers' physical and mechanical properties in this regard, this study aimed to investigate the tensile strength, flexural strength, and deflection of three distinct types of fixed orthodontic retainers.
Materials and Methods: In this laboratory study, each group comprised 12 samples of twisted, flat, and coaxial retainer wires, each measuring 8 mm in length. These samples were affixed onto the polyethylene blocks using cyanoacrylate adhesive and subsequently subjected to compressive loads using a universal testing machine. The maximum bending strength and deflection rate were recorded from stress-strain diagrams. To evaluate the tensile strength, the identical samples underwent tensile loading. Statistical analysis was performed utilizing SPSS software, employing analysis of variance tests to compare data between groups.
Results: Significant differences were observed in the bending strength (P=0.004), deflection (P<0.001), and tensile strength (P<0.001) among the investigated retainer wires. The flat retainer wire exhibited the highest bending strength, averaging 822.876±136.07 MPa, while the coaxial retainer wire showed the lowest, with an average of 673.65±73.35 MPa. Regarding deflection, the flat retainer wire displayed the highest average at 4.04±0.6 mm, surpassing the other two types of retainers. However, the tensile strength of the twisted retainer wires, averaging 699.7±83.46 MPa, exceeded that of both the flat and coaxial retainer wires.
Conclusion: The flat retainer wires demonstrated the highest bending and deflection strength, while the twisted retainer wires exhibited the highest tensile strength. Overall, the bending strength, deflection, and tensile strength of the 3-strand twisted and flat retainer wires outperformed those of the 5-strand coaxial retainer wires, increased flexural and tensile strengths imply a higher resistance of the wires to the forces induced by harder and more viscous foodstuffs.

Background and aims: Substance abuse is recognized as a serious public health issue. The aim of this study was to comprehensively assess the correlation between the substance use and oral health status  as well as its impact on the quality of life of addicts in a multi-center approach.
Materials and Methods: In this cross- sectional and analytical study in year 2023, individuals with a history of addiction who visited addiction treatment centers in Isfahan province were recruited conveniently and examined through questionnaires (about demographic information, methods of substance use, oral health behaviors, the use of dental services, and perceived oral health) and clinical examinations. The oral health-related quality of life (OHQOL) was assessed using the OHIP-14 questionnaire. Clinical examinations assessed DMFT, gingival index, mucosal lesions, temporomandibular joint disorder, and treatment needs of the individuals. Data were analyzed using ANOVA, t-tests, and linear regression models (α=0.05).
Results: 232 individuals with age of 45 ± 9.9, mostly male (94.8%) and married (68.5%) were recruited. About 50% of individuals never brushed their teeth. A total of 123 individuals (53%) used substances with moderate harm intensity (opium, hashish and cannabis). Pigmentation was the most common oral lesion. The mean DMFT was 19.27 ± 3 and the perceived oral health mean was 4.53 ±2.98 (out of 10). A total of 187 individuals (80.6%) required prosthetic treatment. The mean OHQOL was 15.93 ± 11.6. Functional limitation had the lowest (1.53), and psychological discomfort had the highest score (3.31) among the seven domains of OHQOL. The linear regression model (P<0.001 and R2=24%) found that the use of high-risk psychoactive substances, oral health behaviors, and age contributed to changes in DMFT. The OHIP linear regression model (P<0.001 and R2=36%) revealed that the duration of addiction, perceived oral health, age, self-employment, government jobs, and retirement contributed to changes in OHIP.
Conclusion: Compared to the general population, addicts have poorer oral health behaviors and more oral health problems, which significantly reduce their oral health-related quality of life.

Background and Aims: Oral self-care among health care workers not only increases the oral health of individuals and their patients, but also improves the society's understanding of the prevention methods of oral disease. Therefore, this study aimed to investigate the oral self-care and compare it among dentistry, nursing, and midwifery students.
Materials and Methods: In this cross- sectional study in 2023, the HU-DBI questionnaire (Hiroshima University Dental Behavior Inventory) was applied to compare the oral self-care status among the first and final year students of dentistry, nursing, and midwifery. Volunteer students entered the study by a census sampling method. Data were analyzed using Spearman’s correlation coefficient, Kruskal-Wallis, and Mann-Whitney tests (P<0.05).
Results: In total, 348 students including 67% women participated in the study. No significant differences in the  mean score of oral self-care were found (P=0.676) among the first-year dental students (5.01±1.71), nursing students (4.81 ±1.81), and midwifery students (4.79±1.63). The mean scores of oral self-care among the final-year students in dentistry, nursing, and midwifery were 6.71±1.59, 5.13±1.62, and 5.17±1.61, respectively. Dental students had a significantly higher score of oral self-care (P<0.001).
Conclusion: Oral self-care among medical students in Azad University of Isfahan was average. Although, dental students revealed a higher level of self-care compared to the nursing and midwifery students, more training in this field is necessary.

Background and Aims: Orphaned children are one of vulnerable groups in society. The aim of this study was to compare oral health, treatment needs, and oral health behaviors of orphaned children under the protection of welfare organization with the guardian children.
Materials and Methods: In this historical cohort study, all 7–12-year-old children under the protection of welfare organization in Isfahan were compared with their classmates’ counterparts in 2019. Clinical examination recorded DMFT/dmft, plaque index, and treatment needs. Children were asked about their oral health behaviors including the frequency of tooth brushing, flossing, fluoride toothpaste, and snacking. Mann-Witney U test, Chi-Squared test, and Fisher's exact test served for  analysis (P<0.05).
Results: The mean score of dmft and DMFT among orphaned children were 3.64±2.54 and 2.93±2.54, respectively, which showed no significant differences with comparison group (P>0.05). No significant difference revealed between the two groups in terms of mean number of deciduous teeth in need of treatment (P=0.175). Only the mean number of permanent teeth requiring treatment was higher in orphaned children (2.46) than that of the comparison group (1.28) (P<0.049). Also, the percentage of children with poor plaque index was higher in orphaned children (P=0.009). There was no significant difference between two groups regarding oral health behaviors (P>0.05).
Conclusion: No significant difference existed between orphaned children and their classmates’ counterparts in terms of dental caries index and oral health behaviors. Only plaque index and the number of permanent teeth requiring treatment was higher in orphaned children. Educational interventions are recommended to promote oral hygiene and to facilitate the orphaned children’s access to dental treatment.

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: Achieving reliable tools for accurate shade matching of ceramic samples is of great importance in restorative and aesthetic dentistry. This study aimed to evaluate the accuracy of the Trios5 intraoral scanner in determining the shade of ceramic samples using the Vita Classical Shade Guide (VC).
Materials and Methods: This in-vitro study involved scanning each ceramic sample 15 times by two independent observers using the Trios5 intraoral scanner. The detected shade of each sample was compared with the reference shades of the Vita Classical Shade Guide (VC) and the compatibility of the scanner’s results with the reference shades was assessed. The data were analyzed using SPSS24 software and Pearson correlation and paired t-tests and kappa coefficient at a significance level of 0.05.
Results: The highest accuracy of shade detection in both observers was found for shades A2, A3, A3.5, A4, B1, and C4, each with 100% accuracy. The lowest accuracy for both observers was noted for shade A1, with 0% accuracy. The mean overall accuracy for the first and second observers was 64.99% and 63.75%, respectively, with a total overall accuracy of 64.37%. A statistically significant interobserver agreement was observed (P≤0.005).for all shades except B2 (P=0.299).
Conclusion: The Trios5 intraoral scanner can be considered a useful adjunct tool for ceramic shade determination. However, for clinical applications, it is recommended to use it in conjunction with reference tools and complementary methods such as spectrophotometry or visual assessment by experienced clinicians.

Background and Aims: Dry socket is one of the most common complications following dental surgery. Therefore, effective prevention of dry socket can significantly improve patient recovery after tooth extraction. The aim of this study was to evaluate the effect of tranexamic acid combined with a Gelfoam carrier on the prevention of dry socket following surgical removal of impacted mandibular third molars.
Materials and Methods: This parallel randomized clinical trial was conducted in 2023 on 72 patients (40 in the intervention group and 32 in the control group) at the Department of Oral and Maxillofacial Surgery, Faculty of Dentistry, Islamic Azad University, Tehran Unit. In the intervention group, 250 mg of tranexamic acid powder was placed into the extraction socket and covered with Gelfoam, whereas the control group received sterile gauze only. The diagnosis of dry socket was made 2–3 days postoperatively by an independent surgeon. Statistical analysis was performed using the chi-square test, likelihood ratio, and Fisher’s exact test, with a significance level set at P<0.05.
Results: The incidence of dry socket was 7.5% in the intervention group and 34.4% in the control group. All statistical tests demonstrated a significant reduction in the occurrence of dry socket in the intervention group (P≤0.005). These findings are consistent with the physiological mechanism of tranexamic acid in inhibiting fibrinolysis and stabilizing the blood clot, resulting in a marked reduction compared with the control group.
Conclusion: Topical application of the tranexamic acid in combination with Gelfoam following extraction of impacted third molars is an effective, simple, and cost-effective method for the prevention of dry socket. For broader clinical recommendation, further studies with larger sample sizes, comparisons with existing standard preventive methods, and longer follow-up periods are suggested.