Journal of Dental Medicine

Background and Aims: Today, academic stress and subsequent test anxiety is one of the most important problems for the last year of high school students. In addition to systemic effects, stress can affect the level of oral health by disrupting oral health behaviors. The aim of this study was to investigate the relationship between stress and variables related to oral health in the final year of high school students prior to University entrance exam.
Materials and Methods: In this descriptive-analytical study, the level of stress and variables related to oral health in 180 students of the final year of high school in Tehran, in three time periods during the academic year 2018-2019, were measured by a questionnaire and one clinical examination. Data were analyzed by Friedman, Bonferroni and Generalized Estimating Equations using SPSS software.
Results: As the exam approaches, some variables related to the oral health, such as toothbrush usage pattern, daily sleep, fast food frequency, and sweet snack consumption, changed (P<0.05). Daily sleep changes were significantly associated with the stress changes (P=0.022). According to the results of the Repeated Measures Analysis, significant changes were observed between the average score of the "Cognitive Error" aspect of three times (P<0.001). Also, according to the results of the Bonferroni Test, significant changes related to the difference in the average score of "cognitive error" 6 months and 3 months before the entrance exam (P<0.001), 6 months and 1 month before the entrance exam (P<0.001), and 3 months and 1 month before the entrance exam (P<0.001) were observed. In all three cases, as the time of the entrance exam approaches, the score of "cognitive error" had decreased significantly. Considering that the lower score in this index indicates a higher level of test anxiety, the closer we get to the entrance exam, the higher the level of test anxiety in the "cognitive error" dimension
Conclusion: The academic stress of the national university entrance exam can affect some oral health variables such as daily sleep, however, it is not related to other variables.

Background and Aims: Selecting the appropriate education evaluation method and the effects of this choice according to different fields of medical sciences, is one of the current priorities of medical education. Therefore, the aim of this study was to design a checklist for evaluating the practical skills of dental students and to get compared with the global ranking method.
Materials and Methods: A checklist was developed for the assessment of clinical skills of the practical pediatric course according to an action research method. 32 students were evaluated by the checklist method and 32 students were evaluated by the conventional global rating method (sampling was based on available sample).  Faculty staff and students’ satisfaction regarding the two methods were reported by a 6-scaled measure and statistically analyzed by Wilcoxon Signed Ranks test. The students' scores by the two methods were subjected to paired t test for comparison.
Results: The students were more satisfied with the checklist method (P=0.003). The faculty staff considered a greater ability of the checklist method to differentiate between the students (P=0.03). However, in terms of ease of use and suitability, most faculty staff preferred the traditional method (P=0.02). In other cases, there were no significant differences in the views of students and faculty staff towards the two methods.
Conclusion: In the present study, both Checklist and global rating methods were valuable for evaluation, although due to the greater satisfaction of students and faculty staff with the developed checklist method, the possibility of identifying the weak points leading to decreased scores and better assessment of capabilities, this checklist can be used for evaluation instead.

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: Atypical facial pain (AFP) is a chronic disease associated with local pain in the craniofacial area. A wide range of treatments including drug therapy, psychiatric methods and open surgery are used for its treatment. Opiorphin is a pentapeptide that can block pain and also has proven antidepressant effects. The aim of this study was conducted to investigate the opiorphin concentration in AFP patients and to compare it with healthy people.
Materials and Methods: This study was performed on 30 AFP patients and 40 healthy individuals. Unstimulated saliva was collected from both groups by spitting method. HAD-A (Hamilton Anxiety Test) and HAD-D (Hamilton Depression Test) questionnaires were completed for all patients and controls. Psychological interview with the patients and psychological analysis were performed to determine anxiety and depression scores. Data analysis was done using SPSS (ver.24) statistical software
Results: The subjects of two groups were homogeneous in terms of age and sex. The mean salivary opiorphin concentrations in the case and control groups were 1.8050±0.2923 and 1.8032±0.3682 ng/ml, respectively. According to the results of t-Test, no significant difference was observed in the mean opiorphin concentration between the AFP group and control group (P=1.000). According to the Pearson's test, no significant relationship was found between the opiorphin levels and the age, sex, and anxiety or depression score in the patient and control groups (P>0.05). Also, there was no remarkable correlation between initial VAS, duration of pain and previous treatments with opiorphin levels in the AFP patients (P>0.05). No significant correlation was found between the opiorphin concentration and menopausal period in the case and control women (P>0.05).
Conclusion: The results showed that most AFP patients had some degree of anxiety and depression. However, salivary opiorphin concentration did not significantly increase in the AFP patients.

Background and Aims: The aim of this study was to investigate the tooth discoloration caused by cold ceramic compared to MTA Angelus in contact with the washing solutions such as sodium hypochlorite (NaOCl) and normal saline.
Materials and Methods: 50 samples of extracted human maxillary anterior teeth were selected. After preparing the access cavity, they were divided into 4 experimental groups and 1 control group (10 in each group). The access cavities of teeth in groups 2 and 4 were rinsed with 5.25% sodium hypochlorite and those in groups 1 and 3 were rinsed with normal saline. Then, after drying, 3 mm thickness of cold ceramic (groups 1 and 2) and MTA Angelus (groups 3 and 4) were placed in the access cavities of the teeth. After setting of the materials, all specimens were restored with a resin modified glass ionomer. Based on the CIE Lab system, each sample’s total color change (∆E) was obtained before, one, and 90 days after application. Data were statistically analyzed using the Wilcoxon test.
Results: According to the results, there was no statistically significant difference in the average tooth discoloration between the groups filled with cold ceramic and in different time periods (P>0.05). While, in the groups filled with MTA Angelus, the difference in the average tooth discoloration in 90 days after application was significantly higher than one day (P<0.05).
Conclusion: The results of this study showed that compared to MTA Angelus, cold ceramic causes less tooth discoloration over time and therefore, it can be suggested as a more suitable alternative endodontic cement than MTA Angelus.

Background and Aims: Artificial intelligence (AI) technology is widely used in dentistry in addition to numerous other sectors that impact human life, including medicine. A dentist can use AI technology to analyze patient data, diagnostic processes, and management activities. This study was conducted in Iran to identify the dental applications of AI and prioritize them.
Materials and Methods: In the winter of 2022, this applied research was carried out in two stages using a mixed method. In the qualitative phase, 570 articles from 2011 to 2022 were identified in the databases of PubMed, Web of Science, Scopus and Google Scholar among the studies in the field of dentistry and related to artificial intelligence technology based on keywords and then the applications of artificial intelligence in dentistry were extracted. In the quantitative phase, the identified applications prioritized by a group of experts comprised 13 University faculty members with related research areas using the best-worst method (BWM).
Results: The factors identified in the first stage of research were classified into six categories: implant and surgery, executive management, disease diagnosis, analysis of images, clinical prediction, and orthodontics. According to the experts’ opinion, it was determined that medical photo analysis had the highest coefficient of importance (0.252) followed by orthodontics (0.234), disease diagnosis (0.151), implantology and surgery (0.143), clinical forecasts (0.127), and executive management (0.093).
Conclusion: Dentists can use the capabilities of artificial intelligence in examining patients' teeth and diagnostic tests in dentistry based on the analysis of patient information. Information technology policymakers with the support and reinforcement of knowledge-based companies active in the field of artificial intelligence and joint investment in the field of medicine can be the basis for progress and the development of this technology in the country and the field of treatment.

Background and Aims: The evaluation of the results of health transformation plan in dentistry, which started in March 2016 with the aim of improving oral and dental health, is extremely important in order to improve planning for future actions. Therefore, the purpose of the present study was to evaluate the effect of the health transformation plan on common oral health indices in Guilan province in Iran.
Materials and Methods: This cross-sectional analytical study was performed using the Health Deputy of Guilan University of Medical Sciences data and results of the general population and housing census of the 2010 and 2015. Data analysis was done using Ordinary Least Squares regression method, considering dependent variables including DMFT, dmft and periodontal disease indices (CPI) and independent variables including gender, education, urban or rural residence, percentage of 13-year-old population, illiteracy rate, fertility rate and being or not in the transformation plan, to investigate the difference between the two groups before and after the implementation of the transformation plan in terms of variables and to examine the relationship between independent and dependent variables. Finally, data were analyzed by STATA SE software version 15.
Results: The health transformation plan did not have a significant relationship with the change of DMFT and CPI 2 to CPI 6 indices, but had succeeded in reducing dmft and CPI1 (P<0.05), which reduction in CPI1 index was not desirable.
Conclusion: It seems that despite the extensive activities of the health transformation plan in dentistry in the field of prevention and treatment, there is still a need for more changes, especially in terms of culture and education. Also, there is need to provide more facilities for access to services by all sections of the society, especially the weak sections for healthcare.

Background and Aims: Pulp necrosis in immature teeth disrupts root development and makes the teeth susceptible to fracture. Regenerative endodontics is a relatively new modality of treatment where the necrotic pulp is replaced with newly formed healthy tissue which has normal functionality. Many clinical reports have demonstrated the potential of this strategy to induce root maturation and apical closure. However, clinical outcomes are patient-dependent and unpredictable. Developing predictable protocols can be achieved through the interplay of three basic elements of tissue engineering, namely, scaffolds, stem cells, and signaling molecules. Furthermore, the clinical success of this treatment is influenced by both the method of preparing the inner space of the root and the type of biomaterial utilized in the coronal part. In this review, we discuss recent advances in tissue engineering-based strategies for regeneration of the pulp/dentine complex along with their advantages and limitations. 

Background and Aims: Journal of Dental Research is among the dentistry journal with the highest impact factor. This study aimed to map the most important topics for journal editors and readers.
Materials and Methods: The world's active research topics in the field of dentistry related to the Journal of Dental Research in the last 5 years were extracted from SciMapper's SciTrends. Also, we clustered the most cited papers in that journal to show the most important research topics for the journal editors and readers.
Results: We identified and mapped 11 active international research areas in the field of dentistry and related to this journal. Among 146 faculty members of the school of dentistry, 12 had at least one article related to the most active research areas in the journal. In this regard, they had similar articles elated to the 7 clusters out of 13, but their articles are mainly related to the clusters 7 and 19. Among the investigated faculty members, nine had directly collaborated with 21 authors of the mapped clusters. Moreover, 12 faculty members could also connect to the 126 authors with articles in that journal through their scientific collaborators.
Conclusion: One way to publish in a top international journal is to know the most active and interesting research areas for the journal editors and readers. About 8% of the school of dentistry faculty members at Tehran University of Medical Sciences had some research related to the Journal of Dental Research.

Background and Aims: Root canal treatment failures are often attributed to incomplete removal of bacteria, particularly Enterococcus faecalis. While, chlorhexidine and sodium hypochlorite serve as conventional treatments. herbal medicine has been today considered as an alternative to synthetic medicine due to its safety. Therefore, the aim of the present study was to compare the antibactrial effect of Scrophularia Striata extract with chlorhexidine and sodium hypochlorite on Enterococcus Faecalis in the tooth root canal. Materials and Methods: In this study, sixty extracted teeth were examined. Following the infection of dental canals with Enterococcus faecalis, materials were tested in 3 groups: 1) chlorhexidine 2% (18 teeth), 2) sodium hypochlorite 2.5% (18 teeth), and 3) Scrophularia striata (at the concentration obtained from MIC, 20%; 18 teeth). Additionally, the positive control and negative control were included (3 teeth in each group). Samples were then cultured on bile esculin agar. After 72 hours, black colonies were eaxamined. Chi-squared test was used to analyze the results. Results: Enterococcus faecalis bacteria grew in 6, 8, and 17 out of the 18 teeth within the sodium hypochlorite, chlorhexidine, and Scrophularia striata extract groups, respectively. Consequently, the bactericidal effects for sodium hypochlorite, chlorhexidine, and Scrophularia striata extract were 66.6%, 55.5%, and 5.55%, respectively.

Conclusion: The antibacterial effect of the Scrophularia striata extract was significantly lower than chlorhexidine and sodium hypochlorite on Enterococcus faecalis in dental canals viewed as a suitable replacement to the already in use synthetic therapeutic irrigants.

Background and Aims: Considering the regulatory role of vitamin D3 in the immune system, this vitamin may be able to prevent autoimmune diseases by modulating the immune system, so this study was conducted with the aim of comparison of the serum level of vitamin D3 in patients with oral lichen planus and healthy persons.
Materials and Methods: In this case-control study, the serum vitamin D3 level of 80 people, including 40 patients referred to Guilan dental school who were suffering from oral lichen planus and 40 healthy individuals referred to the laboratory for routine check-up, after matching for age and gender, was investigated. Data based on the type of variable were analyzed using independent t-tests, Mann-Whitney, Chi-square test, and Fisher's exact test using SPSS26 software at a significance level of 0.05.
Results: In this study, 80 person participated, including 29 women (72.5%) and 11 men (27.5%) in each of two groups of patients with an average age of 52.17 ± 12.12 years and healthy people with an average age of 52.10 ± 12.23 years. The average serum level of vitamin D3 in the control group was significantly higher than the case group (P=0.006). There was no statistically significant relationship between the vitamin D3 serum level and different types of oral lichen planus, gender, duration of disease, and age.
Conclusion: Considering the significant lower mean serum level of vitamin D3 in people with oral lichen planus; vitamin D3 may be effective as a supplement in the healing process of patients' lesions.

Background and Aims: To be successful in root canal therapy, the dentists must be aware of the possible variation in the root canal and should know not only the natural anatomy of the pulp, but also a variety of possible morphologies. Frst of all, the dentists should be familiar with the possible anatomy of the root canal and then with the extraction of organic tissue from pulp chamber and root canal, increasing the chances of treatment success. Therefore, in this study, we decided to investigate the internal anatomy of root canals in the maxillary permanent molar teeth in Khoy city. Materials and Methods: In this in vitro study, 100 extracted human molars in Khoy city in West Azerbaijan province were collected. In all teeth, the access cavities were prepared, then they were decalcified and colored with India ink and evaluated by clearing technique. Data were collected based on Vertucci's classification which entered into SPSS23 software. The descriptive statistics in the form of numbers and percentages in tables and graphs were used to analyze the data. Results: The most common type observed in the mesiobuccal root of the first molars was type IV by 44%, in distobuccal root was type I by 92%, and in palatal root was type I by 94%. Also, in the mesiobuccal root of the second molars, the most common type was type I by 70%, in distobuccal root was type I by 94%, and in palatal root was type I by 96%. Conclusion: The mesiobuccal root of the first molar had the most variation in the internal anatomy. Also, the most common type of Vertucci in the mesiobuccal root of first molar was type IV and in the other roots of the first and second molar teeth was type I.

Background and Aims: Nowadays, the requirement of any policy-making at the national and regional level is to know the level of knowledge of people about oral health and ways to prevent dental caries.  This study examined the habits, actions and economic level of elementary school students in Qazvin city in 2017-2018.  Also, the effects of peer group social network on behaviors related to oral health and obesity was investigated in order to find the way for interventions making it more effective in this social group. Materials and Methods: In this descriptive-analytical study, 145 students participated. They were in the 3nd and 6th grades of elementary school in the academic year of 2017-2018. The questionnaire used in this study had 20 questions and 4 main sections. The main parts of this questionnaire included demographic characteristics, behavior and habits related to oral health, oral health knowledge of students and families, and socio-economic status. Data were collected through clinical examinations and through valid questionnaires and evaluated using SPSS and Excel software. Results: According to the results of Pearson's correlation analysis, a significant correlation was observed between the health knowledge scores of individuals and their friends between both groups of casual and close friends (P<0.01). The correlation between the knowledge of individuals and close friends was significantly stronger (P<0.01). Also, there was a significant relationship between socio-economic status and behaviors related to oral health (P<0.05). There was also a significant positive relationship between the number of times close friends brushing their teeth in a social network (P<0.001). This connection was not observed in the friends’ network. Conclusion: This study determined that close friends can be effective in determining the oral hygiene behaviors of elementary school students.

Background and Aims: Multiple sclerosis (MS) is an autoimmune disease. Oral manifestations in these patients include paralysis or spasm of facial muscles, temporomandibular joint disorders (TMJ), trigeminal neuralgia, dysphagia, or dysarthria. The aim of the study was to investigate the characteristics of orofacial pain in patients with MS.
Materials and Methods: The current cross-sectional study was conducted on 250 patients with a definite diagnosis of MS referred to Iran MS Association and Iran MS Research Center. The patients were in the age group of 17 to 57 years and were selected completely randomly. Data were obtained based on two checklists and clinical examination. Finally, DC/TMD criterion was used to check TMD problems. Then the data was analyzed by SPSS version 26 software and by Fisher's Test.
Results: The prevalence of MS disease was higher in women and the average age of patients was 37 years and the average duration of MS disease among patients was 8 years. The most common pain was related to shooting and shock-like pain with a frequency of 40.4% and the lowest quality was related to dull and diffuse pain with a frequency of 5.3%. In total, 24.5% of patients with buccal-oral pain had TMD, and in this case, the DC/TMD criterion was used.
Conclusion:  Temporomandibular disorders and shooting and shock-like pains are usually observed in a number of patients with MS.  As a result, dentists should be aware of the presence of these pains in the patient, the pain trigger, and the drugs used by the patients, in order to provide medical services and being aware of drug interactions.

Background and Aims: Idiopathic osteosclerosis is an asymptomatic local growth of cortical bone and is discovered incidentally on panoramic radiographs. The purpose of this study is to evaluate the frequency of idiopathic osteosclerosis and its radiographic features in panoramic images of patients referred to the Department of Maxillofacial Radiology, Faculty of Dentistry, Arak University of Medical Sciences (Iran) in 2022-2023.
Materials and Methods: In this cross-sectional study, 460 panoramic images from the radiology department of Arak Faculty of Dentistry were randomly selected and analyzed. The demographic information of patients, frequency of idiopathic osteosclerosis, location, and also its relationship with adjacent teeth in terms of proximity to lamina dura and periodontal ligament and radiographic features in terms of size and morphology were evaluated. The data were analyzed using the SPSS24 software.
Results: Panoramic images of 460 patients (266 men and 194 women) with an average age of 38.12 (11.75) years were evaluated. The frequency of idiopathic osteosclerosis was 6.1% (28 images). 92.9% of the lesions were in the lower jaw and 46.4% of them were near the premolar teeth. In 39.3% of the cases, the lesion was adjacent to the periodontal ligament and laminadora of the tooth. In 3.6% of the cases, it was associated with a small displacement of the adjacent tooth, and 17.9% was associated with tooth root resorption. According to the results, there was no correlation between the incidence of this lesion with age and gender (P>0.05).
Conclusion: According to the findings of this study, the frequency of idiopathic osteosclerosis in the patients referred to Arak dental school was reported as 6.1%. Most of these lesions were observed in the back of the lower jaw and thus, it is important to be able to distinguish this lesion from the radiopaque lesions of the jaw which need treatment.

Background and Aims: Oral health literacy plays an important role in reducing oral health disparities. Evaluation of oral health literacy can be done at individual and population levels. This study was conducted with the aim of investigating oral health literacy among students of Shiraz University of Medical Sciences in 2023. Materials and Methods: This study was descriptive, applied and cross-sectional. The research population included the students of different academic levels of Shiraz University of Medical Sciences, except the final semester students. The sample size was calculated based on the total number of students studying at different levels at Shiraz University of Medical Sciences in the second half of the academic year in 2023 using an appropriate statistical formula. Sampling was done in a stratified-random manner according to faculty, field, and level of education. The oral health literacy of the participants based on education level, age, and gender was measured by the oral health literacy adult questionnaire (OHL Adults Questionnaire: OHL-AQ). Data analysis was done using SPSS 27 software and descriptive statistics (mean, standard deviation, percentage), independent t-test, Kruskal-Wallis, and Tukey test. Results: The findings indicated that the average oral health literacy score of students was 14.75±1.37. Also, there was a statistically significant relationship between the average oral health literacy score of students and the parameters of education level, gender, and age of students (P-value < 0.05). This indictaed that the oral health literacy of students increased in the doctoral level and also with increasing age. In addition, the female students had higher oral health literacy. Conclusion: Based on the results, the oral health literacy among Shiraz medical students was high. People with higher education level and age had higher level of oral and dental health literacy than people with lower education level and age. Oral and dental health literacy level was higher in girls than boys. It can be suggested that a 1) suitable platform be provided in order to improve the level of education of the society, leading to the improvement of the oral health literacy of the people; 2) regular dental examinations in order to increase the oral health literacy of the society is encouraged and promoted, especially in lower year students; and 3) research in effective training in the field of oral health literacy to increase the oral health literacy of people in the society.