Journal of Dental Medicine

Background and Aims: Most children get a lot of anxiety while they visit a dentist. The most important factor in the child's fear at the beginning of treatment is the syringe and needle. Ways to cope with this anxiety include behavioural control techniques such as mental regeneration, distraction, and induction. The purpose of this study was to compare the pain and anxiety in children when using a syringe and toy- shape syringe needle. This study was the first study that used a toy-shape needle cover.
Materials and Methods: This clinical trial study was conducted on 20 children age from 5 to 8 years. More than half of them were anxious with Cfss-Ds (Dental Subscale of the Children's Fear Survey Schedule) and FIS
(Facial Image Scale) anxiety diagnostic tests, and the rest of them were not anxious. Patients were randomly divided into two groups. The first group received local anesthesia with conventional syringe and the second group, by syringe with toy shape needle cover. Following, the first group received local anesthesia by syringe with toy shape needle cover, and the second group, by a conventional syringe. Heart rate measuring and pain evaluating test was performed. Analysis of heart rate and anxiety data was performed by non-parametric wilcoxonsianed Ranks T-test (P-value was considered significant at 0.001).
Results: The mean amount of pain measured after using a syringe with a toy shape needle cover and using conventional syringe had a significant difference of 5.20% between the two groups. The pain was reduced in children who received local anesthesia by syringe with toy shape needle cover (P<0.001).
Conclusion: The physical appearance of the injection device plays an important role in reducing the anxiety and pain of injection in the children.

Background and Aims: Today, smoking is recognized as a major health problem and an impediment to development in many developing countries. This is the reason of early deaths and disabilities which leads to death of about 4 million people around the globe annually. This study aimed at assessing the awareness and attitude among the students last years dental at Yazd Shahid Sadooghi Medical School in providing consultation for giving up smoking.
Materials and Methods: This study was a descriptive sectional study that evaluated the awareness and attitudes of students last years dental at school of dentistry. Data was collected through standard questionnaires and were analyzed by T test and Pierson correlation coefficient in SPSS18 software.
Results: A total of 110 students participated in this study. Awareness mean's score of female students was 18.38 and male students 17.66. The attitude mean's score of female students was 31.06 and the male students was 32.45. Based on the correlation coefficient of awareness with age (0.112), with the semester (-0.001) and with a GPA (0.76), it was concluded that awareness with increasing age and GPA increased, and with increasing semester decreases. Also, based on the correlation coefficient of attitude with age (0.013), with the academic semester (0.018) and with a GPA (0.008), it was concluded that attitude with increasing age, semester, and GPA was improved.
Conclusion: Despite the relatively good attitude of dental students about smoking cessation counseling, their awareness was poor. Therefore, the need to revise the education programs and steps in the field of training are required.

Background and aims: Solubility is an important property of luting cements in determining clinical durability. The aim of this study was to compare the solubility of Panavia, Calibra and Maxcem resin cements with that of GC Fuji PLUS resin modified glass ionomer cement in three different pH values.
Materials and Methods: A total of 96 specimens were prepared (8mm diameter, 4mm thickness) according to manufacturer instructions. After setting, they were desiccated and weighed. The specimens were kept immersed in distilled water and lactic acid solution (pH values of 3 and 5) for 30 days and then removed and weighed again. Data were statistically analyzed by SPSS18 using two-way ANOVA with P≤0.05 set as the level of significance.
Results: The results of this study showed no significant difference between three pH values (P=0.08). The Calibra resin cement had the lowest value of solubility in distilled water and both pH of lactic acid. GC Fuji PLUS resin modified glass ionomer cement had the highest value of solubility in lactic acid and the Maxcem resin cement had the highest value of solubility in water.
Conclusion: The solubility characteristics of resin modified glass ionomer and three different resin cements were significantly affected by their composition and the storage condition.

Background and Aims: One of the most important determinants of health is Oral Health Literacy (OHL). The aim of this study was to investigate the OHL among nomadic population in Kouhrang city as pristine society.
Materials and Methods: This was a  cross -sectional descriptive study among 200 nomadic population aged 18-60 years of Kouhrang city in 2018. Data were collected using a questionnaire and face-to-face interview, sampling method was performed by randomized cluster. The questionnaire consisted of 17 questions in 4 sections of reading comprehension, listening, perception of number, and decision making. According to the number of questions, the questionnaire score was formed 0 to 17 and the nomadic populations were categorized into three groups with inadequate OHL (0-9), borderline OHL (10-11), and adequate OHL (912-17).
Results: The mean and standard deviation of the participants in this study was 35.49±12.00. The results showed that 7.00% of participants had sufficient OHL (12-17), 21.51% borderline (10-11), and 71.50% had inadequate OHL
(0-9). The mean and standard deviation of OHL score in general was 7.65±2.80, and the mean DMFT index was 8.03±5.64 (P<0.001).
Conclusion: The results of this study showed that the OHL score in the nomadic population was low, and also the mean DMFT index was very high. It is necessary to pay attention to the timely prevention and treatment of the teeth, as well as serious attention to the health education in this population.

Background and Aims: The bleaching agents can lead to color and translucency changes in composite resins. Due to the increasing use of the nano composites and the silorane-based composites, this study aimed at examining the color and translucency changes of these restorations after bleaching agents.
Materials and Methods: In this experimental - laboratory study, 198 composite discs were divided into three groups of 66 specimens using three types of composite: the microhybrid composite Z250, the nanohybrid composite Z350 and the silorane-based composite P90. After acid etching, half of the specimens in each group were covered by a resin rebounding agent. Then, the color and translucency assessment was done by reflectance spectrophotometer, using CIE LAB system. Each group was divided into three subgroups of bleaching agents: the 40% hydrogen peroxide and 20% carbamide peroxide bleaching agents and the control group. After applying bleaching agents, the final color and translucency changes were assessed. Data were analyzed using Mann Whitney and Kruskal Wallis tests.
Results: The effect of composite and bleaching agent type and bonding agent were significant (P<0.001). The color changes in the microhybrid composite were higher than nanohybrid and silorane-based composites (P<0.001) (∆E>3.3). Also, the color changes by 20% carbamide peroxide were higher than that of hydrogen peroxide and control groups (P<0.001). The results of translucency changes were generally consistent with color-change measurements (∆E>3.3).
Conclusion: According to the present study, the most color changes appeared in the microhybrid composite and by 20% carbamide peroxide bleaching agent. Rebound samples were generally less affected by bleaching agents. The least color and translucency changes were related to nanohybrid composites.

Background and Aims: Various methods to induce anesthesia have been investigated in situations where the primary inferior alveolar nerve block (IANB) injections fail. The aim of this study was to compare the effect of synergic effects of anesthetic injection of prilocaine supplemental with that of lidocaine anesthesia in teeth with irreversible pulpitis.
Materials and Methods: This study was a parallel-controlled clinical trial on 58 patients with one mandibular molar tooth having irreversible pulpitis. The first anesthesia was injected with an inferior alveolar block with 2% lidocaine anesthesia. Patients who failed pulpal anesthesia were randomly divided into two groups; case and control groups. In the case group, IANB was injected with 3% prilocaine, and in the control group with 2% lidocaine anesthesia. Anesthesia after the second injection was evaluated by three methods of numerical evaluation of the patient's response to Electric Pulp Tester (EPT), the severity of the patient's response to the cold test, and the extent of pain during the onset of access cavity latency on the Visual Analog Scale (VAS). Statistical analysis was performed using T-test and Mann-Whitney tests.
Results: There was no significant difference between the two groups in terms of depth of anesthesia (P>0.05).
Conclusion: The results of this study showed that there was no difference between 2% lidocaine and 3% prilocaine in the depth of supplemental IANB anesthesia after failure of first IANB in mandibular molar teeth with irreversible pulpitis.
 

Background and Aims: Oral squamous cell carcinoma (OSCC) is one of the most prevalent oral cancers with increased risk in individuals younger than 40 years especially in developed countries. There are many evidences that people who have plenty of fruits and vegetables in their diets tend to have lower risk of cancer. In this study, we evaluated the anticancer effect of four medicinal plants of Otostegia Persica, Otostegia Michauxii, Otostegia Aucheri, and Hibiscus Sabdariffa on OSCC cell lines.
Materials and Methods: In this study, methanolic & dichloromethane extracts of the above medicinal plants were used in order to evaluate their effect on oral squamous cell carcinoma cell line in different concentrations and after 24 , 48 and 72 hrs by MTT assay test. Finally, the appropriate concentration for repeating the test were chosen.
Results: In this study, the mean amounts of IC50 for O. persica and O. Aucheri were less than the two other herbs and the least and most amount of IC50 were related to the dicloromethanolic extract of O. persica after 72 hrs and the water extract of H. sabdariffa after 24 hrs, respectively.
Conclusion: It was concluded that all of the plants evaluated especially O.Persica and O.Aucheri had anticancer properties and dichloromethalonic extracts of these plant were more effective than that of methanolic extract.

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: The inferior alveolar nerve block (IANB) is the most frequently used technique for mandibular anesthesia. Due to the many factors which can cause its failure, the aim of this study was to evaluate the efficacy of experience and knowledge in the success rate of IANB technique.
Materials and Methods: : In this study, 115 students of Shiraz Dental school were participated in two groups. One group contained 53 novice students and another group 62 students with one year experience in IANB injection. Each student accomplished injection once and then success or failure of the injection was examined. In order to evaluate the students’ knowledge, each student was asked to fill out a questioner including 6 questions related to the instruction of the injection. Data were then collected, coded, and analyzed by SPSS18 using Chi square with a significant level of 0.05.
Results: The rates of knowledge in novice and experienced group were 71.6% and 86.3%, respectively. The success rates of IANB were 47.1% in novice group and 64.3% in experienced group. The success rates of IANB and knowledge were significantly higher in the experienced group compared with the novice group. (P=0.02 and P=0.01, respectively) There was no significant difference between male and female (P=0.06).
Conclusion: The results showed that knowledge and experience could play an important role in the success rate of IANB technique.

Background and Aims: Immediate implant placement following tooth extraction is a treatment with many advantages. Alveolar bone preservation after immediate implant, need minimum of 2 mm thickness in buccal bone plate. The aim of this study was to evaluate the thickness of buccal cortical bone of maxillary premolars by Cone Beam Computational Tomography (CBCT) technique.
Materials and Methods: In this descriptive epidemiological study, Cone Beam Computed Tomography image was obtained from 29 patients (male and female) referred to the radiology department of Jundi Shapoor dental school of Ahvaz from 1393 (Mehr) to 1394 (Shahrivar) for implant insertion insertion. The thickness of buccal cortical bone was measured in 3 and 5 mm apical to the CEJ and root apex, perpendicular to the longitudinal axis. All the measurements were done by two oral and maxillofacial radiologists, separately. Data were analyzed by SPSS22 software, using descriptive statistics, and T-test.
Results: The thickness of buccal cortical bone in second premolar was significantly more than 1 mm (P=0.001), but in first premolar, the thickness was close to 1 mm with a non-significant difference (P=0.29).
Conclusion: The results of this study showed that immediate implant insertion could be done in the maxillary second premolar area with more predictability compared to the first premolar area.

Background and Aims: Elastomeric chains are known as a current device with the purpose of dental movement in orthodontic treatments. The aim of this study was to compare the elastomeric behavior and force degradation rate between different elastomeric chains existing in Iran in different time durations.
Materials and Methods: 11 different elastomeric chains used in this study were: Class One, ASTAR, G&H, TSNPT, MIB (French and Chinese type), Ultra Chain and both American, Ortho Technology (simple and memory type). All chains were stretched upon to exert 150 g force and then force degradation rate in 6 time duration
(1, 3, 24 hours and 3, 7, 21 days) and modulus of elasticity (MOE) in 2 time duration (start and 21 days) were investigated. All Data were analyzed statistically by ANOVA, Tukey, Games-Howel tests.
Results: All chains up to the 21th day showed a significant decrease in MOE except for the G&H, ClassOne, simple orthotechnology and a significant force degradation except for the American (memory type). The most significant force degradation rate was in ASTAR gray (P<0.05) and the least in MIB (French), Ultra Chain, and American (P<0.05).
Conclusion: All chains showed significant time-dependent force degradation (mostly in the first day). Only, this rate was not significant in any time duration for the American (memory). In all groups, the most force degradation rate belonged to ASTAR gray and the least to Ultra Chain, MIB (French) and American after 21th day.

Background and Aims: Pre-cancerous lesions of the oral mucosa as important malformation need acceptable knowledge of dentists. The purpose of this study was to determine the knowledge of Isfahan city general dentists about pre-cancerous lesions of oral cavity.
Materials and Methods: This descriptive cross-sectional study based on validated questioner form was performed in 115 general dentists in Isfahan City in 2019, associated with sex and year of graduation from general dentistry course. The mean score was in the range from 0 to14. Data were recorded in Microsoft Excel and then analyzed by SPSS. In order to compare quantitative variables, independent T–Test, One-Way ANOVA and Mann-Whitney was used. P≤0.05 was considered as significant.
Results: The mean age in the participants of: lower than 5 years, between 5-10 years, and more than 10 years of graduation were 28.6±4.9, 30.6±4.0 and 47.9±10 years old, respectively. In total population, the mean score of knowledge was 5.97±2.79. There was not any significant difference between the mean score of knowledge in women when compared to men (5.96±2.99 versus 5.98±2.6; P=0.58). The mean knowledge score in the participants of: lower than 5 years, between 5-10 years, and more than 10 years, of graduation were as follow: 7.8±2.2 versus 5.8±2.9 versus 4.4±2.1, correspondingly (P≤0.05).
Conclusion: For the early diagnosis of pre-cancerous lesions of the oral cavity, retraining program based on oral cavity pathology courses is recommended for the dentists in Isfahan city.

Background and Aims: Enoxolon is a natural licorice and its formula is similar to cortisone. The aim of this double blind randomized match control clinical trial, was to analyze the effect of Arthrodont toothpaste containing 1% Enoxolone on dental plaque, gingival inflammation, and bleeding indices.
Materials and Methods: 40 patients who had gingivitis were selected. They were instructed to brush their teeth twice daily for three minutes then massage the gums with pastes for one minute and then wash their mouths. The patients were divided into two groups: The Arthrodont toothpaste containing Enoxolon, was given to the study group and the Crest toothpaste free of Enoxolon, was given to the control group. At the beginning of the study and after 21 days, plaque, gingival, and bleeding indices were measured. The statistical analyses were done by Paird T test, T test and nonparametrical analysis of Wilcoxon and Mann-Whitney.
Results: In both groups, the three indices decreased significantly. Comparing between the two groups, the gingival and bleeding indices had significantly decreased in the study group (Arthrodont toothpaste) compared to the control group (Crest toothpaste). However, no significance difference in the plaque index between the two groups was found (P=0.143).
Conclusion: The results of this clinical study showed that Enoxolon had anti-inflammatory effect on gingivitis.

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

Background and Aims: Adding nanoparticles to dental composite resins, could reduce bacterial adhesion and secondary caries. Thermocycling can resemble in-vitro conditions to the oral environment. The aim of this study was to determine the effect of thermocycling on the microleakage of a mixture of copper oxide nanoparticles and flowable composite.
Materials and Methods: In this in-vitro study, 88 premolar teeth were divided into eight groups based on the application of copper oxide nanoparticles with concentrations of 0.1% and 0.3% w/w and thermocycling by 0, 1000, 5000 and 15,000 cycles. The occlusal grooves of the teeth were sealed with the mixture of flowable composite and copper oxide nanoparticles, and the teeth were thermocycled. Next, the teeth were immersed in methylene blue 2% solution for 24 hrs and were cut and the microleakage was evaluated by a stereomicroscope (hp/USA). Data were analyzed using Kruskal-Wallis and Mann-Whitney tests at the significance level of 0.05.
Results: In the groups with 0.1 % copper oxide nanoparticles, the mean microleakage increased significantly with increasing the number of thermocycling rounds (P=0.032). The difference in the microleakage between the groups exposed to 0 and 15,000 termocycling was significant (P=0.019). However, thermocycling had no significant effect on the microleakage of groups with concentration of 0.3% (P=0.780). The specimens subjected to the 0, 1000, 5000 and 15000 thermocycling in two concentrations of copper oxide nanoparticles showed no significant difference in the microleakage.
Conclusion: In groups containing copper oxide nanoparticles with a concentration of 0.1%, the microleakage increased by increasing the number of thermocycling up to 15,000 cycles compared to the control group. However, this did not have significant effect for the concentration of 0.3% copper oxide nanoparticles.

Background and Aims: With increasing age and inability to maintain good oral hygiene, the chances of tooth loss increase and the need for dental implants will increase in the future. It also increases the risk of developing peripheral implants, especially at older ages in the failure of implant treatments. Recently, the high prevalence of cardiovascular disease and peri-implantitis in the elderly has been reported. The aim of this study was to investigate the effect of cardiovascular disease on the peri-implantitis in people with failed dental implants.
Materials and Methods: In this retrospective study, the files of patients referred to Shahid Montazeri Dental Clinic from 2009 to 2018 whose their failed implants were extracted, were collected. There were a total of 793 people with failed dental implants. The variables of this study were demographic information including age and sex, health status in terms of cardiovascular disease and peri-implantitis, which were identified and then statistically analyzed by examining the files of patients with these two variables. Data were statistically analyzed by SPSS25 statistical software and Chi-square was used to determine the effective variables.
Results: A total of 793 patients had failed dental implants, including 368 women (46.4%) and 425 men (53.6%) with an average age of 50.79 years. 42 patients (5.3%) had heart disease and 44 (5.5%) had peri-implantitis. According to the Chi-squared test, the significance level was less than 0.05 (P=0.011).
Conclusion: The results of this study showed that the cardiovascular disease and peri-implantitis were significantly related.

Background and Aims: A significant percentage of children with dental caries require, hospital dentistry and their parents do not have much information in this regard. The aim of this study was to determine the knowledge, attitude and practice of pediatricians in hospital dentistry in Isfahan Province.
Materials and Methods: This cross-sectional study was performed on 100 pediatricians working in Isfahan. The self-administered questionnaire included demographics of doctors and 19 questions for assessing the knowledge, attitude and practice of pediatric practitioners about hospital dentistry under general anesthesia. Raw data were analyzed by Chi-square test using SPSS software version 23.
Results: 100 pediatricians with an average age of 44.1±5.7 years (57% male) completed the questionnaire. 53% of the pediatricians had a high level of awareness about hospital dentistry and 42% about its related guides. 66% practitioners had a favorable attitude toward general anesthesia and costs, while 71% considered the parents' awareness were poor about hospital dentistry. Only 43% of pediatricians performed oral examinations in their daily visits, and 17% had a referral for hospital dentistry. Male pediatricians aged from 35 to 45 had a higher level of knowledge about hospital dentistry. The attitude and practice of pediatricians did not have a significant relationship with their age. Meanwhile, male pediatricians had better performance in oral and dental examination and referral for hospital dentistry (P=0.15).
Conclusion: From the results of this study, there is a need for a serious improvement in the level of knowledge, attitude, and practice of pediatricians in the field of hospital dentistry.

Conclusion: The high prevalence of TMD and related factors, such as a history of jaw dislocation, posterior edentulousness, earache, and clenching, requires attention to be identified and treat these problems.

Conclusion: Powerful authoritarin and authoritative parenting practices have a clear impact on the oral health status of children. Therefore, parenting paratices can be considered as one of the main factors affecting the oral health of children.

Background and Aims: Supporting the preventive approach is important in training future dentists. The purpose of the present study was to evaluate the knowledge, attitude and practice of senior dental students regarding non-invasive management of dental caries.
Materials and Methods: A cross-sectional study was conducted in 2019 using total sampling method and a valid and reliable questionnaire. Knowledge, attitude and self-reported practice of senior dental students regarding caries risk assessment (CRA) and management of lesions in two paper patients were assessed. The data analysis was performed using SPSS20 and the descriptive and analytical statistics were reported.
Results: In overall, 86 students (response rate=91%) were responded. In the knowledge section, caries history in the previous year, having frequent fermentable carbohydrate, xerostomia, and low socio-economic status were considered by more than half of students as factor for caries risk assessment. More than 90% of students had a positive attitude towards CRA in children. Nearly 50% of students tend to restore enamel lesions in proximal and occlusal surfaces in high-risk scenarios. There was significant association between the OHI instruction and debris index improvement (P=0.04) in the integrated comprehensive care clinic (TUMS). The linear regression analysis showed that there was no significant association between the demographic characteristics, place of education, previous course on the level of knowledge and attitude.
Conclusion: Senior dental students despite their general knowledge and positive attitude toward caries risk assessment, tended to aggressively manage the incipient lesions in the enamel and DEJ. Delivering prevention as integrated in the comprehensive care unit in order to improve oral hygiene status of patients is recommended.