Journal of Dental Medicine

Background and Aims: This study aimed to assess the severity of tooth decay and related factors in children 5-7 years old, in 2016, in Tehran.

Materials and Methods: A descriptive and cross-sectional study was performed on 572 children aged 5-7 years old (300 girls and 272 boys) in public schools in Tehran, Iran. Severity of dental caries (number of decayed, missing, filled surfaces) recorded for C, D and E teeth according to WHO criteria. Data analysis was performed by Backward Linear Regression Analyses using SPSS 20 (P≤0.05).

Results: Assessment of dental caries severity according to the number of decayed surfaces showed generally higher figures in upper jaw. The order of average severity of carious teeth was C, E and D from low to high in both jaws. According to the results of Linear Regression Analysis, severity of dental caries was more than other children in boys (OR=1.83, 95%CI: 0.81-2.8), those visited dentist due to dental problems associated with pain (OR=1.17, 95%CI: 0.73-1.6), and those without fluoride therapy (OR=1.64, 95%CI: 0.58-2.6) in C, D and E teeth.

Conclusion: Flow the results, it was concluded that gender, level of mother's education, type of snack consumption, start age of tooth brushing, reason for dental visit and fluoride therapy affected severity of tooth decay.

Background and Aims: Nowadays, oral cancer is considered one of the most important diseases related to oral health. The objective of the present study was to determine the dental students’ knowledge in Isfahan about oral cancer and the comparison of the level of students' knowledge in different years of education.

Materials and Methods: The present study was a cross-sectional-analytical one conducted in 2013. The population of study included the dental students of private and state University of Isfahan which 255 students were randomly selected. The data were collected using questionnaire and were then analyzed using SPSS software program and Kruskal-Wallis and Mann-Whitney.

Results: From private and public dental schools in Isfahan, 56% and 44% of dental students were involved. Regarding performing routine clinical oral examination, 81% of the participants answered positively, which showed no significant difference among the years of education of the participants (P=0.116). Regarding the examination of patients with oral lesions, 46% of them answered positively, which the difference between the years of education was highly significant (P≤0.001).

Conclusion: The findings of the research indicated that the level of knowledge of dental students of Isfahan city regarding the detection of oral lesions was not sufficient. Although, the students did not perform common examinations for exploring oral cancer, they did not have sufficient knowledge regarding some of the risk factors and oral lesions related to cancer. Therefore, it is necessary that a comprehensive curriculum be developed in this regard for their education.

Background and Aims: Cervical tooth hypersensitivity (CTH) is defined as a sharp pain of short term that occurs in dentin exposed to the oral environment. The aim of this study was to evaluate the efficacy of a desensitizing toothpaste containing potassium nitrate (Sensodyne®) for relieving of CTH, when used locally or as tooth paste.

Materials and Methods: 36 patients were enrolled in this study. They were randomly divided into three groups I) Tooth brushing without toothpaste, II) Local application of toothpaste containing potassium nitrate 5%, III) Tooth brushing with toothpaste containing potassium nitrate 5%. Assessment of CTH was done by evaporative (using air and water spray) and cold stimuli at baseline, 1, 3, and six weeks after the treatment. To compare pain changes over time, due to the interaction between the variables of the studied groups and time, one-way ANOVA was used at any time. Due to the difference of variance between groups to compare pairs of groups, Dunnett T3 test was used.

Results: During the study period, no adverse event observed. In all three groups, pain decreased gradually. Local application of toothpaste had the most favorable effect on CTH. Therefore, when compared with that of the first group, the percentage reduction in pain were statistically significant (P=0.03).

Conclusion: Local application of toothpaste containing potassium nitrate as a desensitizing ingredient is a better choice for treatment of CTH than that of application with toothbrush.

Background and Aims: Headache is among the most common complaints in patients suffering from temporomandibular joint disorders (TMD). Thus, it seems that evaluation of patients with headache in terms of temporomandibular joint (TMJ) disorders is necessary. In people with TMD, parafunctional activities play an important etiologic role. Considering the high prevalence of bruxism and TMDs in patients with headache, assessment the accuracy and severity of this association can play a key role in diagnosis and treatment of these two phenomena. The purpose of this study was to investigate the relationship between bruxism, TMD and headache, also assessment the efficacy of TMD conservative therapy with a special approach to self-management in treating patients with headache.
Materials and Methods: Motor searches of Cochrane, Medline and EMbase databases, PubMed, Google Scholar, Uptodate, BMJ clinical Evidence, MD consult and science direct by using of relevant key words were searched for article published between 2000 and 2015. A total of English language abstracts were reviewed, 80 full articles were obtained and among them, 30 relevant articles were reviewed in this study. Because of the high number of studies in this field, we divided the data into four group, bruxism and TMD, TMD and headache, bruxism, TMD and headache, treatment.
Conclusion: Bruxism and temporomandibular disorders are the two main contributing factors in initiation and perpetuation of headache. Treatment of these two phenomena would be effective in the treatment of headache.

Background and Aims: Radiopacity is an essential requirement for all restorative materials. Radiopaque materials allow the dentist to diagnose and assess radiographically the restoration, primary caries, assessment of contours, overhang and secondary caries. The aim of this study was to evaluate the radiopacity of two types of dental bases and liners in comparison whit dental structure using a digital radiography system.
Materials and Methods: Two classes of materials were prepared: 1 mm and 2 mm thickness disks for glass inomer and 1 mm and 0.5 mm thicknesses for dycal. Specimens of enamel and dentine with the same thicknesses were obtained. As a control, an aluminum step wedge was used. Samples were positioned over a phosphor-ray, plate of min ray soredex system, exposed, and the images were analyzed using the contour dent software. ANOVA analysis was used to investigate the significance of differences among the groups. For pairwise comparisons, the Bonferroni test was applied (P<0.005).
Results: 0.5 mm diameter of self-cure and light cure dycal and enamel, presented radio-opacity higher than that of dentine, except for the light cure dycal that had radiopacity lowers than enamel. 1 mm diameter of all the groups presented higher radiopacity than dentin. Light cure and self-cure glass inomer and self-cure dycal presented radiopacity higher than enamel. Enamel showed radipacity higher than light cure dycal in 2 mm diameter self-cure. Light cure glass inomer presented radiopacity higher than that of enamel and dentin.
Conclusion: The increased thickness of the materials evaluated increased their radio-opacity. It was concluded that all the materials had lower radiopaaty than dentin. Only enamel showed higher radiopacity than light-cured dycal.

Background and Aims: For the clinical success of implant-retained prostheses, fitness of matching components and stability of the applied torque to the implant-abutment assembly under dynamic occlusal loading is essential. The aim of this study was to evaluate the torque loss in Co-Cr castable abutments after cyclic loading.
Materials and Methods: 10 castable abutments were cast in Co-Cr alloy with similar size and height. Each specimen was mounted vertically on a separated implant using a 30 Ncm tightening torque. The detorque values of the abutments were evaluated after 10 min. The same tightening torque was applied to the abutments on their corresponding implants and cyclic loading was applied for 500,000 cycles to the implant-abutment assembly. The torque values after cyclic loading were recorded for each specimen. T-test analysis was conducted on scores from the groups.
Resultes: The results of this study showed that the percentage of torque loss in castable abutments was significantly increased after cyclic loading (P<0.001).
Conclusion: Misfit between the castable implant components can cause torque loss before and after cyclic loading. However, it is more appropriate to relate the results of this study to the screw loosening of the above mentioned abutments than judging their clinical performance.

Background and Aims: Making dental prostheses is sensitive and accurate work and requires powerful and skilled hands. Because of this, the dental prosthesis technicians may suffer harmful effects such as stress and fatigue during the course. The aim of this study was to investigate fatigue, stress and job performance and their relationship with some demographic variables in this community.
Materials and Methods: The present study was cross-sectional and done in 2016. The study population was a group of dental prosthesis technicians that had participated in a national congress in Tehran. Sampling was done by census Two standardized questionnaires on the subjects of fatigue and stress which were distributed among 100 female and male participants and sampling was done by census. Then, the obtained data was analyzed using SPSS16 software and applying descriptive statistics, Pearson correlation test, and ANOVA, T-test.
Results: From the 100 samples, there were 16 females and 84 males with mean age 34.71±7.90 and average work experience of 10.82± 9.01 years. 82 percent of the subjects were married and 42 percent of them were smokers. The results showed that 100 percent of dental prostheses technicians were facing with moderate to severe stresses. The stress and fatigue scores in married ones were higher than the single ones. The results showed a significant relationship between smoking, stress, and fatigue scores (P<0.05).
Conclusion: According to the high level of job stress in the dental prostheses technicians, this problem must be considered, minimized, and more attention should be paid to their psychological and emotional problems.

Background and Aims: The dentist's attire and appearance affects his/her relationships with the patients. It is also essential to sync the professional attire in dentistry with the habits and Islamic culture of Islamic Republic of Iran, meet the patients' desires, and pay attention to the infection-control-requirements as well.The objective of the present study was to determine the patients' viewpoints about the professional appearance of the dentists at Tehran University of Medical Sciences, Dental School in 1395-96.
Materials and Methods: In this descriptive cross-sectional study, 103 patients (54 females and 49 males) were studied. (=α0.05 and standard variation=4.5). The questionnaire were included color photographies of a female dentist and a male dentist dressed in different attires. The patients were asked to select the cleanest, and the most trustable, competent, and experienced dentist according to the 4 different attires. The frequencies and percentages of the participants’ answers to the questionaire were descriptively reported.
Results: All patients preferred dentists to use white coat during their treatment. For the male dentists, most patients (45.6%) favored simple hair model. For the female dentists, most patients (35.9%) considered veil as the more acceptable Hejaband, and 54.4% of them preferred light makeup.
Conclusion: All patients preferred their dentists to dress in the professional attire with a white coat. They believed that wearing formal-professional-dressing by the dentists may show them look cleaner, and more trustable, more competent, and experienced.

Background and Aims: Regarding the high prevalence of caries and oral dental diseases, especially in the elderly, and the increasing attention of people to using the concept of quality of life, this study was conducted to determine the relation between oral and dental health and the quality of life in elderly people in Yazd.
Materials and Methods: This cross-sectional study was performed using data from the Yazd Public Health Survey (YAHS) with a sample of 9293 people, in 1393-94. All information was collected from 1907 elderly people aged between 60 to 70 years, including quality of life and oral and dental indexes from the comprehensive questionnaire of YAHS. Data were analyzed by independent t-test and Spearman correlation coefficient using SPSS16 software.
Results: There was a significant relationship between the quality of life and oral hygiene (P<0.01). Also, the score of quality of life and oral health was significantly related to education (P<0.01).
Conclusion: This study showed the positive relation between the oral health the quality of life. In addition, there was a quality of life level in the elderly people with poor oral hygiene.

Background and Aims: All metal components of orthodontic appliances are somewhat corroded in the oral environment due to some changes in chemical, mechanical, thermal, microbiological and enzymatic factors which facilitates ion release. Ionic release can result in a discoloration of the surrounding soft tissue or allergic reactions in sensitive patients or even local pain in the area. In general, ions can cause toxic and biological side effects if their values reach the threshold, so the release of ions from the metal components of orthodontic appliances is important to us. The aim of this review article to determine the rate of orthodontic appliances ion release in different solutions.
Materials and Methods: A review of the literature was carried out in Pubmed, Google Scholare and Web of science database using selected key words (Saliva/ Titanium/Normal Saline/ Ion release Orthodontic appliance/Mouth wash/ Nickel/ Chromium). These searches were limited to the articles published from 2005 to 2018. According to the inclusion and exclusion criteria, 25 articles were obtained.
Results: Because of conflicts in the reported results, it was necessary to synchronize the measurement methods and also to use artificial saliva medium with normal pH as a control to achieve better systematic comparison.
Conclusion: There was significant differences in the ion release between mouthwashes. In all studies, the effect of pH and acidity has been shown to increase the release of these ions. In addition, stainless steel (SS) instruments had the least biocompatibility among all types of alloys evaluated.

Background and Aims: Erosion is the chemical dissolution of a tooth by acid without bacterial involvement. The purpose of the current study was to investigate the effect of resin infiltration (Icon), MI paste plus, and Nd:YAG laser on the enamel microhardness.
Materials and Methods: 40 enamel samples were obtained from the third molar tooth. Primary microhardness was measured in all specimens. Then, erosion was created using hydrochloride acid on the surfaces of enamel and the microhardness values were measured. The samples were randomly divided into four groups. G1: MI paste plus, G2: MI paste plus+ Nd:YA laser, G3: ICON without etching, G4: ICON with etching. Erosion was induced again by hydrochloric acid and then subjected to thermocycling. Finally, the microhardness of the samples was measured. Statistical analysis was performed using SPSS23 software, one-way ANOVA, multiple Tukey and T-test comparisons. P<0.05 was considered as a significant level.
Results: The microhardness increased in the third stage compared to the second stage in all groups, which was statistically significant (P<0.000). Also, the comparison of the increase of microhardness among groups, except second group with the fourth group, was statistically significant.
Conclusion: All the materials used in this study significantly increased the microhardness of the eroded enamel.

Background and Aims: Providing quality services is one of the important goals of the health system. Dental services and treatments are expensive. The aim of this study was to investigate the factors influencing the perceived quality of dental treatment services.
Materials and Methods: This descriptive-cross study conducted in 2 qualitative-quantitative phases. Data were collected using interviews and pairwise comparison matrix with 20 dentists working in NAJA dental clinics who were selected by targeted sampling. The validity and reliability of the interviews were determined by long-term engagement of their peers and negative case analysis. The validity of the pairwise comparison matrix was determined through the incompatibility rate (>0.1). Data were analyzed by coding and effect intensity tests (R+J), descriptive statistic test (mean, standard deviation) using SPSS23, Maxqda and matlab R2017b.
Results: Content analysis of the interview showed that tangible factors, assurance, trust, and empathy are the factors affecting the quality of dental treatment services. In the second phase, data analysis showed that trust and empathy (28.204), assurance (24.356), and tangible factors (17.798) are the most to the least important factors in the quality of dental treatment services (P=0.1).
Conclusion: Trust and empathy were the most important factors in the quality of dental treatment services. Managers of dental clinics and dentist need to improve the quality of dental treatment services by emphasizing respect for patients in accordance with the promise to act in the field of providing treatments to patients.

Background and Aims: Pregnancy is a period with hormonal and psychological changes affecting women’s oral health. The aim of present review study was to evaluate, elaborate and categorize factors affecting oral health status of pregnant women.
Materials and Methods: A literature search with the following keywords: pregnancy, “pregnant women”, “pregnant mothers” and “expectant mothers” , AND dentistry, “dental health” and “oral health” in PubMed and Scopus was performed from 2009 to 2019. Search results included 1435 articles which 467 duplicate studies were excluded. Finally, 30 articles were included in the study. Oral health outcomes were categorized and significant relationships with determinants and risk factors were reported.
Results: Most studies (70%) were performed cross-sectionally. Among the studied outcomes, dental visit, periodontal disease and dental caries were the most common. The most studied independent variables were socioeconomic factors and demographic factors, followed by behavioral and enabling factors. The lowest frequency was related to the systemic factors. Mothers’ education and age were examined more than other variables and in about 40% of studies had significant association with outcomes. Dental counseling was assessed in only 3 studies and in all three studies, the relationship with outcome was significant.
Conclusion: Socioeconomic, demographic and enabling factors could affect the oral health of pregnant women.

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: Knowing the depth and type of the teeth impaction with radiographic approaches can guide the clinicians into selecting the most appropriate treatment and prevent surgical complications. Therefore, the purpose of this article was to evaluate the prevalence of canine and premolar impaction in the digital panoramic view of patients referred to Rasht dental school in 2019.
Materials and Methods: This annalistic-descriptive cross-sectional study comprised patients who attended the Faculty of Dentistry, Rasht, Iran in 2019. Dental records and panoramic radiographs of 500 patients were reviewed retrospectively. Demographic information as well as the type and depth of impaction, involved jaw, and also, the associated pathological lesions were recorded. Data were analyzed with SPSS24 version with significant level of P<0.05.
Results: The findings revealed that among 500 individuals (300 (60%) were females and 200 (40%) were males), 35 individuals (7%) had at least one impacted tooth, 80% of impacted teeth were canines and the others were premolars. The most common impaction type, impaction level, and pathological lesion were mesioangular, B, and carries of the adjacent tooth, respectively. A significant relation was not observed between the type and level of impaction with the involved jaw (P=0.15, P=0.99) and also, the relation between the type of pathological lesion and gender was insignificant (P=0.85).
Conclusion: Functional and esthetic complications of impacted tooth can be prevented or declined by on-time radiographic screening.

Background and Aims: Finishing and polishing of composites is a critical step influencing the clinical service of restorations. The aim of this article was to evaluate and compare the effect of two liquid polishes on the polish retention of two nanocomposites.
Materials and Methods: Eighty standardized disk-shaped specimens (4×2 mm) were prepared from two nanocomposites (n=40), including one nano-filled composite (Filtek Z350 XT-3M ESPE, USA) and one nano-hybrid composite (Aelite Aesthetic Enamel-Bisco, Inc. Schaumburg, USA). The specimens were randomly divided into 4 subgroups (n=10) based on the method of finishing (F) and polishing (P) procedures: M: as control, polymerized under Mylar strip; S: finish and polish with a sequence of Sof-Lex discs (3M ESPE, USA); SP: finish and polish with Sof-Lex discs and use of Permaseal liquid polish (Ultradent products, Inc. USA); SB: finish and polish with Sof-Lex discs and use of Biscover liquid polish (Bisco, Inc. Schaumburg, USA). The specimens were undergone pH cycling and brushing machine and then, the average surface roughness (Ra) and average profile changes along the desired area (Rz) of the specimens were determined with profilometer instrument. Two-way and one-way analysis of variance (ANOVA) was used to compare the mean of surface roughness. Then, Tukey test was used to identify the groups responsible for the difference and t-test was used to compare the mean of surface roughness.
Results: The type of composite and the method of polishing procedure had no effect on the mean Ra (P=0.733) but it had significant effect on Rz1 factor (P=0.025).
Conclusion: Using liquid polish after polishing discs had no effect on the polish retention of nanocomposites.

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: Dry socket is one of the most common post-tooth-extraction complications. The aim of this study was to investigate the relationship between some of the predisposing factors of dry socket and this complication in all maxillary and mandibular molars and evaluation of its incidence. Furthermore, the two jaws were compared.
Materials and Methods: In this descriptive-analytical cross-sectional study, 150 patients were examined in 2020 in the city of Zahedan. A questionnaire consisting of two sections was designed: In the first section age, gender, systemic disease, smoking status, contraceptive pill consumption, and antibiotic consumption were investigated. In the second section, data related to the difficulty of surgery based on the duration of surgery and the number of local anesthetic cartridges that were administered were collected. Then, the collected data were analyzed by Chi-square and Kruskal-Wallis tests.
Results: The incidence of dry socket was 25.3%. The frequency of dry socket was significantly relevant to smoking, oral contraceptive consumption, difficulty of the surgery, and the number of local anesthetic cartridges that were administered (P≤0.05). Age, gender, controlled systemic disorder, and systemic antibiotic usage for two weeks prior to surgery revealed no significant associations with dry socket (P>0.05). Furthermore, the frequency of dry socket in maxillary and mandibular jaws had a significant difference according to smoking status, difficulty of surgery, and number of local anesthetics carpules (P≤0.05).
Conclusion: It is recommended to identify high-risk groups when performing extraction to consider pre-operative and post-operative measures in order to reduce postoperative complications.

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.