Journal of Dental Medicine

Background and Aims: Interest and satisfaction of students toward their field of study has important role in knowledge promotion, future activities, and also healthcare of country. This study aimed to evaluate the attitude of dental students toward their field of study and also their future career.
Materials and Methods: This cross-sectional descriptive study was based on a standardized researcher designed questionnaire in 2018. Demographic data was collected and questions were based on the attitude of students toward their field of study and their future. ANOVA and Backward stepwise regression methods were used for statistical analysis. Significance level was determined at 0.05.
Results: In this study 62.2% of responders were female and 37.8% were males. Students chose dentistry under the influence of following matters consecutively: high income, recommendation of people around and self-interest. Girls compared to boys, were significantly influenced more by self-interest and also had more interest compared to boys for working in dentistry (P<0.05). Also, most of students were anxious about the increase in the number of dental students.
Conclusion: Students had positive attitude toward their field of study and their future. They were interested in working in this field but factors such as not having enough familiarity toward this field and also an increase in the number of students in recent years created some worries for them.

Background and Aims: Radiography is one of the most important para-clinical methods in diagnosing and selecting treatment in dentistry. Due to the potential dangers of X-rays for patients, the professional responsibility of the dentist requires that unnecessary radiographs to be avoided. The aim of this study was to investigate the awareness of dentists in Zanjan about the principles of radiation protection in 2019.
Materials and Methods: This cross-sectional study was performed on 107 general dentists and specialists working in Zanjan and the questionnaires were distributed among them. The level of awareness of dentists in 27 questions of radiographic prescribing questionnaire was evaluated and in each of the mentioned questions, their gender, age, work experience, participation in retraining, having X-ray machine in the field of dentistry and type of activity were evaluated. Data were analyzed by Chi-square test, Independent T-test, and ANOVA using SPSS software version 22.
Results: The results showed that the level of knowledge of general dentists about the principles of radiation protection (14.35±3.08) was lower than that of specialized dentists (17.19±2.35). Those who participated in retraining workshops (13.85±2.99) had less knowledge than those who did not (15.97±3.97), which was statistically significant (P<0.05); However, there was no significant difference in the dentists' knowledge about the principles of radiation protection based on gender, age, type of activity, having an X-ray machine at the place of treatment, and history of clinical experience (P≥0.05).
Conclusion: Awareness of dentists at various levels was moderate. Therefore, designing and holding more purposeful retraining courses to maintain and improve the level of awareness of dentists according to the guidelines provided by the authorities, still seems to be necessary.

Background and Aims: Information collection about the malocclusion and oral health in blind children is essential to plan for their education in schools. Therefore, this study aimed to evaluate the status of malocclusion and oral health among blind children and teenagers in Mazandaran, Iran.
Materials and Methods: The population of this included 150 blind children and teenagers aged from 10 to 18 years who were referred to the public and private centers cities including Sari, Babol, Freydoonkenar, and Babolsar in Mazandaran, Iran in 2019. Information on maxillary occlusion status, oral hygiene index, and DMFT index was extracted through clinical examination. Data were analyzed using SPSS23 software by ANOVA and Chi-square tests in addition to the descriptive statistics.
Results: The mean DMFT was 10.25 (SD 4.67). Oral hygiene status was good in 16% of participants, moderate in 82%, and poor in 2%. There was no significant difference between girls and boys in terms of oral hygiene status (P=0.5). In all cases, 35.8% had class I malocclusion, 29.8% had class II malocclusion, and 14.6% had class III malocclusion. Class II malocclusion was more common in girls and class I in boys (P=0.01).
Conclusion: Dental caries and occlusal abnormalities were common among blind children and adolescents living in Mazandaran province. Addressing the oral and dental needs of the blind should be a priority for health policymakers in this province in Iran.

Background and Aims: Pulpal exposures originated from the external cervical root resorptions have major effects on the treatment and prognosis. Therefore, the aim of this study was performed to compare the two different imaging systems-digital radiography with PSP (Photostimulable Phosphor) sensor in three horizontal different views and CBCT (cone beam computed tomography) images to assess the pulpal exposure in simulated cavity of external cervical root resorptions that was performed in 1398 in the School of Dentistry of Azad University.
Materials and Methods: 40 intact maxilla anterior teeth with straight roots were included. Teeth were randomly divided to two groups (20 teeth with and 20 without pulpal exposures). Each sample was assessed using PSP digital radiography (in 3 horizontal angles) and CBCT image system, to detect the presence of pulpal exposures. False negative and false positive results in 2 imaging procedures were judged with ratio test.
Results: The results showed in CBCT (P.P.V=85.7%) and (N.P.V=89.5%), and in digital intraoral radiography (P.P.V=80%) and (N.P.V=80%) in proximal defects. Ratio test showed that there were no significant differences in the proximal defects (P<0.4).
Conclusion: The results showed that there were no significant differences in detection of exposure in the proximal surfaces between two imaging systems.

Background and Aims: This study aimed to collect reports and HIS in a web-based system due to the problems of paper recording of student activities in practical courses, as well as the lack of computers in the departments for observing graphs and treatment plans.
Materials and Methods: The initial graphic design of the website was done after the assessment of needs and the necessary planning for designing the website. The main template of the website was designed after consulting with the faculty and the designer company. A combination of HTML, CSS, JQuery, and Java script was used for static coding and what the user sees or interacts with. Then, the basic information entered the website and the content designer put the website in the designed layout. In the end, a sample hosting space was prepared and the website was fully provided to the professors and faculty officials to work with as an administrator and a user. They conveyed all their opinions and the corrections were made based on the feedback given.
Results: The use of the internet and software with a central database played a significant role in monitoring and evaluating the long-term information of the student and the evaluation of the entire department, universities, and patients in each region up to macro-national evaluations. This could give the expansion and advancement of science in addition to the central registration of documents and radiographs, as well as their ease to access.
Conclusion: The designed website was well received among the students and the attending staff. Introducing a web based logbook and HIS system can optimize the clinical teaching. These logbooks could help both students and staff saving time and resources, and to facilitate providing better personalized care for patients.

Conclusion: The trend of publishing scientific articles in Iran in the field of dentistry has been increasing during the selected period. The keywords oral, dental, and pediatric surgery have the most effective and decisive role in the scientific network of dentistry. These keywords provided strong scientific communication amongst the dental scholars in Iran.

Background and Aims: Nowadays, new techniques are used to control dental caries that have the ability to kill cariogenic bacteria. Recently, the addition of antibiotics to glass ionomers has been proposed to reduce the overall number of saliva bacteria. The aim of this study was to compare the antimicrobial effect and compressive strength of resin- modified glass ionomer (RMGI) containing different antibiotics on Streptococcus mutans.
Materials and Methods: A total of 120 specimens were prepared in 3 groups (n=40) including RMGI containing doxycycline with a concentration of 1.5%, RMGI containing a combination of ciprofloxacin, metronidazole and minocycline with a concentration of 1.5%, and RMGI without antibiotics as control group. To measure the antibacterial effect, the disk diffusion method and counting of Streptococcus mutans bacterial colonies were used and then the compressive strength test was performed. Data were collected into SPSS25 and analyzed by ANOVA and Kruskal-Wallis tests and the significance level was considered α=0.05.
Results: The mean number of bacterial colonies in the RMGI group containing doxycycline in all three time intervals 1, 24 hours and 7 days was significantly lower than the specimens in the RMGI group containing the triple antibiotic (P<0.001). The mean compressive strength of the two experimental groups was lower than the control group but was not statistically significant (P=0.326).
Conclusion: The addition of antibiotics at a concentration of 1.5% to RMGI resulted in a favorable antibacterial property with no significantly change in the compressive strength.

Conclusion: The data of this study in proving the anti-biofilm and antibacterial effects of aloe vera extract showed that the expression of the target gene is reduced. It seems that this substance can be used as an alternative to oral hygiene chemicals.

Conclusion: The data of this study in proving the anti-biofilm and antibacterial effects of aloe vera extract showed that the expression of the target gene is reduced. It seems that this substance can be used as an alternative to oral hygiene chemicals.

Conclusion: According to the results of this study, it seems that dentists should pay more attention to the components of emotion regulation and emotions in order to prevent and reduce job burnout.

Conclusion: According to the results of this study and the application of anaerobic conditions, forced anaerobic bacteria can be isolated from clinical specimens of oral infections and by Tetra Arms-PCR no significant relationship between TGF-1β genomic polymorphism and periodontitis was observed. In addition, therer was no significant difference in the frequency of alleles and genotypes between the control and patient groups.

Background and Aims: School teachers have key role in providing the basic health information for their students, and their knowledge, attitude, and practice affect children's oral health through developing of the healthy behaviors. The goal of this study was to evaluate the effectiveness of an oral health education program for primary school teachers on their knowledge, attitude, and practice fields in the framework of oral health promoting schools.
Materials and Methods: This quasi-experimental pre-post study was conducted among five oral health promoting schools in Isfahan city in 2019. A validated and reliable questionnaire including four sections of demographic data, knowledge, attitude, and practice was applied for data collection. The questionnaire contained 24 knowledge, 9 attitudes, and 5 practice questions. It was distributed among 63 enrolled teachers at base line and two months later after two educational-emotional workshops. Before and after data were analyzed by SPSS21 (α=0.05) by related samples Wilcoxon signed rank test and background variables by Kruskall-wallis test.
Results: After the educational intervention, their knowledge score increased significantly from 14.1±3.8 to 18.5±3.7 (P<0.001). About 34% of teachers had a high level of knowledge proficiency at the beginning of the study which eventually rose to 76%. Teachers’ attitude decreased significantly from 34.6±5 to 31.4±4.6 (P<0.001). At the beginning of the study, 89% of them had a positive attitude towards oral health programs which decreased to 84% at the end of the study. In the performance part, 63.5% of the teachers paid attention to the fluoride in their toothpaste which reached 87.3% after the workshop and the teachers' performance score increased from 3.07 to 3.39 after the intervention (P<0.012).
Conclusion: The package of educational intervention for teachers in oral health-promoting schools improved the level of knowledge and practice, but slightly reduced the level of attitude. However, due to the importance of changing attitudes in teachers and the existence of structural and programmatic barriers to integrate the health issues into school education, other models need to be evaluated and compared.

Background and Aims: Survival of periodontal ligament (PDL) cells after avulsion is an important factor in treatment prognosis. Grapefruit Seed Extract (GSE) can be a proper environment for preserving periodontal ligament cells. The objective of this study was to analyze the effect of different concentrations of GSE on the proliferation of fibroblast PDL cells.
Materials and Methods: In this study, the undifferentiated PDL fibroblasts were obtained from two human premolars teeth and cultured in Dulbecco’s modified Eagle’s medium (DMEM). The cultured cells were exposed to different concentrations of GSE. The positive and negative control groups were cultured in fetal bovine serum (FBS) 10% and in a medium without FBS 10%, respectively. The plates were incubated for 1, 6, 12, 24, and 48 hrs. The PDL cell viability was assessed by MTT (3-(4,5-dimethylthiazol-2-yl)-2,5-diphenyltetrazolium bromide) assay. Statistical analysis of data was accomplished using repeated measure ANOVA with Post HOC Tukey, P<0.05 was considered statistically significant.
Results: We found out that among different concentrations of GSE, 1:128 had the most impact on undifferentiated PDL fibroblasts. Although, the cell vitality was higher in the twelfth hour, 1:128 GSE and in the forty-eighth hour, 1:1024 GSE than the positive control group but they were not statistically significant (P>0.05). Furthermore, all the samples were similar to the positive control group in three of the five timeperiods (P>0.05).
Conclusion: GSE was more effective in fewer concentration and longer periods and it had no toxic effect on PDL cells. Therefore, GSE can be considred as a promoting medium in PDL regeneration of avulsed permanent teeth in the future.

Background and Aims: The stress, job satisfaction and depression can affect the performance of dental professionals in various fields. The aim of present study was to examin the level of stress, depression and job satisfaction among different specialized fields of dentistry in Zanjan provinc, Iran.
Materials and Methods: In this cross-sectional study, the depression, anxiety and stress scale questionnaire (DASS-21) and the Herzberg questionnaire were used to assess job satisfaction. The questionnaires were completed on the web, and the relevant link was sent to all specialists in different fields of dentistry in Zanjan province. Finally, 33 people participated in the study. Data were analyzed after appropriate code allocation using independent T-test and U-Mann Whitney tests and SPSS16.
Results: The results showed the mean of stress (24.4), depression (17.48) and anxiety (13.28) among specialists. The mean of stress and anxiety among female dentists was higher than male specialists, but there was no significant difference between these two variables between the two sexes (P>0.05). In terms of job satisfaction, 21.2% were dissatisfied with their job. By gender, 26.6% of female specialists and 16.7% of male specialists were dissatisfied with their jobs.
Conclusion: Despite the general perception that work conditions are suitable for dental specialists, these people suffer from the stresses, anxiety and depression and may not be satisfied with their job. As these conditions can affect the performance of these people in the workplace, it would be necessary to take measures, to identify, and to increase mental health and job satisfaction.

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: 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: 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: Recently, the addition of nanoparticles into the restorative materials and tooth preparation by laser for improving the bond strength have been concidered by researchers. The aim of this study was to investigate the shear bond strength of the bioactive glass ionomer containing titanium particles and a conventional glass ionomer with two surface treatments by Er-YAG laser and conventional methods.
Materials and Methods: In this in-vitro study, 64 sound extracted premolars were collected. For conventional method, the specimens were prepared in such a way that dentin surfaces with a depth of 0.5 millimeter created at distance of 2 mm from the joint of CEJ at the root or crown.  In the laser group, after preparing the teeth, the surface area was prepared by Er-YAG laser. Then, in the middle part of the buccal surface, a cylindrical mold with dimensions of 3.5 mm in diameter and 4 mm in height was placed and for each group was filled with its own glass ionomers. The  specimens  were divided into 8 groups by simple random sampling (n=8): A (laser, conventional glass ionomer, coronal dentin)/ B (laser, glass ionomer containing titanium nanoparticle, coronal dentin)/C (conventional, conventional glass ionomer, coronal dentin)/ D (conventional, glass ionomer containing titanium nanoparticle, coronal dentin)/ E (laser, conventional glass ionomer, root dentin)/ F (laser, glass ionomer containing titanium nanoparticle, root dentin)/ G (conventional, conventional glass ionomer, root dentin)/ H (conventional, glass ionomer containing titanium nanoparticle, coronal dentin). Finally, the shear bong strength by a universal testing machine was measured at a cross-head speed of 1 mm/min. For data analysis, Two-way ANOVA test was used to evaluate the effect of each variable and their interaction on the shear bond strength and Tukey test was used to compare the two groups.
Results: There was significant difference only between groups B with C (P=0.002), E (P=0.007), G (P=0.001) and H (P=0.01). The highest bond strength was found for group B (laser, glass ionomer containing titanium nanoparticle, coronal dentin) and the lowest bond strength for group G (conventional, conventional glass ionomer, root dentin).
Conclusion: All three factors of Er-YAG laser, glass ionomer containing titanium nanoparticle and coronal dentin had a positive effect on the improvement of the bond strength.

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: By using the image processing capability in Cone-Beam Computed Tomography (CBCT), obtained information can be improved. The aim of the present study was to investigate the effect of sharpen image processing filter in determining the external resorption of the root apical region in single-rooted teeth due to the proximity of the impacted tooth using CBCT.
Materials and Methods: In this laboratory study, the lateral surfaces of the apical region of the root of 40 healthy extracted teeth were artificially cut by bur and the teeth were randomly divided into four groups: control, low, moderate, and high resorption. After preparing CBCT of the teeth, the samples were then processed with and without an image sharpening processing filter and examined by two observers. The results of this study were analyzed by SPSS22 and Medcalc Statistical Software version 14. The significance level was considered P≤0.05 for all the statistical tests.
Results: Specificity (100%) and sensitivity (66%>) were either complete or very high for both modes without and with the sharpen filter. The overall accuracy (0.83>) was high in both cases and no significant difference was observed between the two overall accuracies (P>0.05). Statistical analysis of both image observations by two observers showed that the overall sensitivity and accuracy in the medium and high resorption groups was much higher than the low resorption group, but the specificity in all groups was 100%.
Conclusion: The results showed that the images with a sharpening filter did not increase the detection power compared to the unfiltered images. However, as no loss of accuracy was observed with this filter, it could be used as a processing filter.

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.