Journal of Dental Medicine

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. 

Background and Aims: Dentists are at risk of musculoskeletal disorders due to their job characteristics. The purpose of this study was to compare the posture and musculoskeletal disorders of dentists with high and low work experience.
Materials and Methods: This analytical cross-sectional study research was conducted on 76 dentists in Urmia city. Based on work experience, the samples were divided into two groups: less experienced (less than 15 years) and experienced (15 years and more). The variables of forward head, kyphosis, round shoulder, and musculoskeletal disorders were compared in two groups. Forward head and round shoulder variables were evaluated by photography, kyphosis variable by flexible ruler, and musculoskeletal disorders were evaluated by Nordic questionnaire. Data analysis was done using descriptive statistics and analytical statistics (Kolmogorov-Smirnov test, Leven test, independent t-test and Yeoman-Whitney test).
Results: The independent t-test results showed that the angle of forward head, round shoulder, and kyphosis was higher in the high work-experience group than that of the low work-experience group (P=0.001). In comparing the prevalence of neck disorders, the results were significant such that the experienced group had more neck disorders (P=0.002). However, in examining the difference in the amount of disorders in other parts of the body, the difference between the two groups was not statistically significant (P>0.05).
Conclusion: Experienced dentists had a higher degree of forward head, round shoulder and kyphosis positions. Although, there are musculoskeletal disorders in both groups of dentists with low and high level of experience, neck disorders were more common in high-experienced dentists than that of low-experienced ones.

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: Mandibular third molar is the most common impacted tooth and craniofacial morphology and facial parameters can be appropriate predictors of impaction of this tooth. The aim of this study was to evaluate the relationship between Gonial angle, mandibular plane inclination, and ramus height with the impaction of mandibular third molar.
Materials and Methods: This retrospective descriptive-analytical study was performed by analysis of lateral cephalometric radiographic images of 172 patients in city of Zahedan in 2020. The status of eruption of mandibular third molars was determined by clinical examination and assistance of panoramic radiographic images and samples were categorized into four groups: fully erupted (1), partially impacted (2), impacted (3), partially developed (4). Then, the Gonial angle, mandibular plane, and ramus height were measured on lateral cephalometric images of each group and collected data were analyzed by Chi-square test and analysis of variance (ANOVA).
Results: Among the patients, 68.02% were female and 31.97% were male. The difference between the mean values of Gonial angle of four groups was not statistically significant (P>0.05). In the fourth group, the mean value of mandibular plane inclination was significantly higher (29.74) and the mean value of the ramus height was significantly less (49.21 mm) than other groups.
Conclusion: According to the preformed analysis and obtained results, Gonial angle, mandibular plane, and ramus height were not accurate predictors for the impaction of mandibular third molar and further studies should be undertaken in this filed.

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: Dental caries and periodontal disease are the most common chronic diseases. Health care workers specially “Behvarz” due to their wide range of duties, have the potential role in delivering education and prevention of dental caries. The purpose of the present study was to assess the perspective of “Behvarz” working in health care centers of Kordkooy city regarding oral health.
Materials and Methods: Focus group discussions was conducted with a convenient sample of “Behvarz” working in health centers of Kordkooy city.  Total number of 26 Behvarz with the mean work experience of 13 years took part in the study. After obtaining informed consent, group discussions performed in- person (2 groups of 7 and 2 groups of 6 participants) in health centers considering universal precautions. Two researchers coordinated the discussions. Five questions proposed on dental service utilization and oral health challenges and data collection continued until saturation obtained. The content of the discussion recorded and transcribed verbatim. For content analysis, two raters independently coded the content; sub-themes and themes were then extracted and consensus obtained.
Results: More than half of the participants were 34 years of age and older. Regarding the challenges related to dental care in health centers, the main themes were; resource limitation, workload, lack of awareness of “Behvarz” role, limited access, economic barriers to prevention and care. Regarding the challenges to prevention, the main themes were; poor knowledge of patients, limited oral health related knowledge of “Behvarz”, and human resources. The main suggestions were emphasizing on the role of schools, mothers and patient education.
Conclusion: Our research showed that despite the important role of “Behvarz” in delivering oral health promotion at the population level, this role is neglected and needs further attention.

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.

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.