Journal of Dental Medicine

Background and Aims: Activity-based costing enumerate every input consumed in treatment. The Covid-19 pandemic changed the dental treatment protocols and the ordinary circumstances of patients. The aim of this study was to calculate and compare the costs of three common dental services in Iran from the viewpoint of the providers and recipients of the services before the Covid-19 pandemic (2019) and during the pandemic (2021).
Materials and Methods: Direct medical and non-medical costs were considered from the service provider's perspective. Direct medical costs, indirect costs, direct non-medical costs, and intangible costs were considered from the recipient's perspective. To calculate the equivalent costs, the base year was considered 2021, and the costs of 2019 were calculated with a discount rate of 16%.
Results: From the service provider's perspective before the pandemic, the cost of dental amalgam restoration was 2,851,235 Rials, root canal treatment was 6,351,580 Rials, and tooth extraction was 1,887,295 Rials. The cost of these services in 2021 was 5,562,150 Rials, 8,070,591 Rials, and 4,865,563 Rials, respectively. From the recipient's perspective, before the pandemic, the cost of tooth restoration was 715,466 Rials, root canal treatment was 2,883,001 Rials, and tooth extraction was 3,267,359 Rials. The cost of the mentioned services in the year 2021 was 1,212,528 Rials, 3,971,640, and 3,680,880 Rials, respectively.
Conclusion: The Covid-19 pandemic has had an effect on increasing the cost of dental services from both the service provider and recipient perspective, but economic volatility has a vital role in increasing the estimated costs in the country. Probably, a part of the increase in costs was due to the role of brokers in providing dental materials and equipment.

Background and Aims: With the growth of elderly population, attention to their oral health status has become increasingly important. Most of the available studies have been conducted among dependent elders who usually have different oral health statuses and needs. Therefore, the aim of this study was to determine the oral health status of independent elderly attending municipal public centers and parks in Isfahan in 2020.
Materials and Methods: This is a descriptive-analytical cross-sectional study conducted among 195 elderly people attending Isfahan municipal centers in 2020. The oral health status and the oral health related quality of life (QOL) of elderly were evaluated using Geriatric Oral Health Assessment Index (GOHAI) and clinical examinations. The obtained data were analyzed using descriptive statistics (mean and standard deviation), correlation, independent T-test, Chi-squared and ANOVA using SPSS22 (α=0.05).
Results: 69% of the participants (n=133) were male and the mean age was 68.9± 3.5. Almost 20% of elderly (n=39) did not have any of their natural teeth. 63% (n=123) suffered from at least two chronic diseases and 38.5% (n=75) had a functional occlusion. The mean score of quality of life (QOL) of elderly and their DMFT was 51.7±6.4 and 20.5±6.3, respectively. A significant and negative relationship was found between the DMFT and GOHAI (P<0.001, r=-0.36). QOL scores were significantly higher in participants with dentures than those without dentures (P<0.001). There was a significant relationship between the frequency of brushing and the mean of DMFT (P<0.001). In people who did not brush, the DMFT score was higher than those who brushed at least once a day or even sometimes a week.
Conclusion: The results indicated that the oral health status of elderly was weak and it would reflect the need for more attention to taking more measures to both prevent the oral problems and to promote oral health.

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: Malocclusion in orthodontics is one of the dental and jaw abnormalities that can cause psychosocial and social problems. Personality traits, body image, and self-concept are different in orthodontic applicants due to the different effects of malocclusions on appearance and psychological well-being. The aim of this study was to investigate the personality traits, body image, and self-concept in patients seeking orthodontic treatment in Tabriz-Iran in 1400.
Materials and Methods: The statistical population of the study included all patients requesting orthodontic treatment whom were referred to one of the orthodontic clinics in Tabriz during 1399-1400. This study was performed on 149 patients seeking orthodontic treatment (127 females and 22 males) by Convenience Sampling method. Neo personality traits, the Body Image Concern, and Marsh body self-concept questionnaires were used. SPSS software was used for data analysis.
Results: According to the results, neuroticism, agreement, conscience, extraversion and openness to experience were high in orthodontic patients (P<0.05). The average dissatisfaction with body image was high (P<0.05). Also, the body outside self-concept was low and the self-esteem was high (P<0.05).
Conclusion: Personality factors, body image, and self-concept are three effective psychological characteristics in patients seeking orthodontic treatment. Therefore, the request for orthodontic treatment is largely due to psychological factors such as differences in personality traits, body image, and self-concept.

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: 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: The white color of teeth is one of the most essential factors in smile esthetics. Therefore, various whitening agents such as bleaching mouthwashes have been produced in response to the people’s high demand for having whiter teeth. The present study evaluated the efficacy of three whitening mouthwash products on tooth enamel whiteness.
Materials and Methods: In the present in vitro study, 32 bovine incisors were assigned to four groups in terms of the mouthwash used (n=8): control (C); Xenon Smart White (ZSW), containing pyrophosphate and triphosphate; Signal White Now (SWN), containing Blue Covarine; and Pasta Del Capitano whitening mouthrinse (PCW), containing Plasdone. Colorimetry was carried out using a spectrophotometer at the baseline and 2, 4, 8, and 12 weeks after treatment with mouthwashes. Data were analyzed using CIELab parameters with ANOVA, RM two-way ANOVA, and post hoc Tukey tests (α=0.05).
Results: The results showed that the whiteness created by the SWN mouthwash was clinically visible (ΔE>3.3). However, the functions of all the mouthwashes were statistically similar with no significant differences from the control group (P>0.05).
Conclusion: Although, Blue Covarine-containing mouthwash was somewhat effective in whitening of tooth enamel, none of the mouthwashes had significant efficacy compared to distilled water.

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

Background and Aims: Insufficient adhesion between fiber post and root canal is the main reason for the failure of the restoration and the fiber post surface treatment can imprive the bond strength. Additionally, there is disagreement about the ideal method of preparation to achieve the desired bond. The aim of this study was to compare the effect of two surface treatment methods on push-out bond strength of fiber posts to root canals.
Materials and Methods: In this study, 45 healthy incisor teeth underwent root canal treatment. After preparing the post space, they were divided into 3 groups of 15, based on the surface treatment methods of the fiber post. In the first group as control group, no surface treatment was done on the fiber post. In the second and third groups, sandblasting with Cojet sand particles and 810 nm diode laser were used for surface treatment, respectively. Then, fiber posts were placed in all root channels by a self-adhesive resin cement. Then, the roots were cut in such a way that from each, 3 pieces with a thickness of 1.5 mm were obtained. Finally, the push-out bond strengths were measured using a universal testing machine. Data were analyzed by ANOVA using SPSS software. The level of significance was considered at P<0.05.
Results: The average bond strengths in three groups were as follows: control group, 2.877 ±1.430, sandblast group 6.318±3.444, and laser 4.224 ±1.890 MPa ± SD. The difference in the bond strength between the sandblast group and the control group was significant (P=0.001). However, the average of the bond strength of laser group was not significantly different from the control group. (P=0.03).
Conclusion: The findings of this study showed that unlike diode laser radiation, the use of Cojet sand particles for sandblasting the fiber post surfaces significanlty improved the bond strength.

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: The bond strength of direct composite restoration to the caries affected dentin is a challenging issue. Preparation of dentin with an antibacterial agent is a method for creating durable bonded restorations. The aim of this study was to investigate the effect of curcumin photosensitizer on the bond strength of a universal adhesive to the caries-affected dentin (CAD).
Materials and Methods: In this experimental in vitro study, forty-four decayed human molar teeth were selected. After removing the surface enamel and dentin by a water-cooled saw, the decayed mid-coronal dentin was stained with a caries detection solution. The green and soft infected dentin was removed and CAD and hard and healthy surrounding dentin were left. Then, the remaining dentin surfaces were treated by 600 grit silicon carbide papers and polished. The specimens were divided into two groups (n=22): dentin pretreatment group by curcumin and control with no dentin pretreatment group by curcumin.  Each group was divided into two subgroups based on the method of application of All-Bond Universal adhesive (Bisco, USA) (etch and rinseand self-etching methods). After placing the Aelite All Purpose Body (Bisco, USA) composite, all  specimens  were placed in a universal testing machine for microshear bond strength (µSBS) test. The failure mode of the isolated surfaces was evaluated under a stereomicroscope. Two-way ANOVA analysis was used for statistical analysis.
Results: Based on the obtained results, intervention with the adhesive application method and surface pretreatment with curcumin had no significant effect on the bond strength. Also, there was no significant difference in the bond strength of the curcumin group in both etch and rinse and self-etching methods (SE=56.3±27.11 MPa; ER=52.4±84.11 MPa) (P=0.847). In the curcumin-free group, there was no significant difference between the two different adhesive application methods (P=0.187).
Conclusion: The results obtained in the present study showed that the pretreatment of dentin affected by caries with light-sensitive curcumin and also use of a universal adhesive by either self-etching or self-etchinf methodshad no influence on the microshear bond strength of the composite restoration.

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: Temporomandibular disorders refer to a set of musculoskeletal problems that affect the temporomandibular joint, masticatory muscles, and surrounding anatomical structures. These disorders are associated with symptoms such as pain, click, asymmetry, or reduced maximum opening. The etiology of many temporomandibular disorders is complex, for this reason the initial treatments must be reversible and non-invasive. The use of occlusal splints is effective in reducing symptoms, and therefore, it is recommended in early and even long-term treatment of these disorders. These appliances play major role in developing conditions such as stabilizing joint position, creating favorable occlusal conditions that lead to normal muscle function, and protecting teeth and supporting structures against dental wear. The purpose of this article was to present a comprehensive review of occlusal splints in Persian language. Materials and Methods: A search on Pubmed and Google scholar databases was done and the keywords "occlusal splints" and "temporomandibular disorders" were used. The inclusion criterion was articles published in English in the field of the types of occlusal splint between 1980 and 2020. Conclusion:  In this review, the occlusal splints and their applications have been introduced.The success or failure of treatment with occlusal splints depends on various factors such as the correct selection of patients, the process of manufacturing, occlusal adjustment of splints, and the patients’ cooperation.

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.