Journal of Dental Medicine

Background and Aims: The surgical removal of mandibular third molar is frequently accompanied by significant postsurgical complications, and different protocols have been described to decrease such complications. The aim of this study was to compare the postoperative complications of mandibular impacted third molar removal with two conventional rotary and piezoelectric methods.
Materials and Methods: In this study 27 patients with bilateral mandibular impacted third molars were selected. The patients’ teeth were extracted by the piezoelectric method on a random side and the opposite tooth was extracted by conventional rotary technique. On operation and post operation days, edema, pain, and mouth opening were assessed. The duration of each operation was also measured. Data were analyzed by Mann-Whitney test and independent t-test.
Results: The mean duration of operation in the rotary group was less than that of the piezoelectric group, which was statistically significant (P=0.001). Pain was significantly higher in the rotary group on days 0 to 5 (P<0.05). Whereas, difference in pain on day 6 was not statistically significant (P=0.067). There was no significant difference between the two groups in each day after surgery regarding mouth opening (P>0.05). Edema was significantly higher in the rotary group on the first, third, and fifth days after surgery (P<0.05). Also, edema was higher in the rotary group on the seventh day after surgery, but not statistically significant (P=0.076).
Conclusion: According to the results of the present study, it can be concluded that pain and swelling in patients after impacted tooth surgery using time consuming piezoelectric technique can be reduced.

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: Dentists faced the highest risk of infection during the COVID-19 pandemic. Educating competent students is the first task of the dental school to overcome the created problems and thus, it is necessary to recognize the created educational deficiencies. This study aimed to assess the students' perspectives from the Dental School at Tehran University of Medical Sciences during the academic year 2019-2020, concerning the competencies expected to be developed during the clinical phase of the general dentistry curriculum during the COVID-19 pandemic. The findings are intended to inform the formulation of educational strategies in the post-pandemic period to address identified gaps in training.
Materials and Methods: During the academic year 2019-2020, a cross-sectional descriptive study was conducted at the School of Dentistry, Tehran University of Medical Sciences, Iran. The study consisted of three phases: checklist design, psychometrics, and a survey of general dentistry students in their third to sixth year. The checklist design phase involved a team of four individuals, including educational officials from the faculty, academic staff members, and medical education experts. Experts confirmed the content validity of the checklist, while reliability was assessed using the Intraclass Correlation Coefficient (ICC), which indicated favorable validity and reliability. Subsequently, questionnaires formatted as Google Forms and a census approach were distributed to all students enrolled in the general dental course within the clinical section of the School of Dentistry at Tehran University of Medical Sciences. Ultimately, following the data collection process, statistical analysis was conducted utilizing descriptive statistics, including the mean and standard deviation, and the findings were communicated to the group managers.
Results: The assessment of content validity was established at a minimum of 71%, based on the evaluations provided by five experts. Additionally, reliability was measured using an intra-cluster correlation coefficient (ICC) exceeding 0.79, signifying a strong level of both validity and reliability. 122 students (53%) in the clinical stage completed the forms related to the pre-clinical/clinical units passed during the Covid era. Despite having enough training, basics Removable Partial Prosthodontics, Surgery 1, and Restorative 3 courses needed more training. In addition, Basics Removable Partial Prosthodontics, Surgery 1, and Surgery 4 needed the most practical training to acquire the necessary competencies.
Conclusion: The findings of this research indicated that the dental students expressed a desire for increased practice across various levels of pre-clinical and clinical courses. This would suggest that the challenges associated with patient interactions during the COVID-19 pandemic may not be the sole contributing factor. Consequently, alongside the need for educational planning to address the requirements of enrolled students, it appears essential to conduct similar studies in the post-pandemic context. Furthermore, this approach may also prove beneficial in evaluating educational needs for ongoing professional development courses.

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.

Background and Aims: The quality of sleep plays a significant role in the academic performance of dental students, especially in the clinical years. Identifying and treating students at risk of sleep disorders can reduce or limit the drop in academic performance. The purpose of this study was to determine the relationship between the sleep quality and educational performance of Rafsanjan dental Student-Iran.
Materials and Methods: The present study was a descriptive-analytical cross-sectional study that was conducted among all dental students in Rafsanjan University of Medical Sciences - Iran. This study was presented to all dental students in Rafsanjan by online questionnaire method on Pressline website. The questionnaire included demographic information and student number along with the Pittsburgh Sleep Quality Standard Questionnaire. The Pittsburgh Questionnaire examines the quality of sleep in the range of 0 to 21. The link of the questionnaire was made available to the students through Telegram, and the GPA of the total students was obtained by using the student number from the Vice-Chancellor of University Education. The data were analyzed with SPSS26 software. First, the data were analyzed with Smironov's kermograph test. The results of this test showed that the data distribution is not normal (P<0.05). Due to the non-normality of the data distribution, non-parametric tests such as K-score, Mann-Whitney, Kruskal-Wallis and Spearman were used.
Results: 151 students participated in the questionnaire of which, 73 were men (48.3%) and 78 were women (51.7%). The mean and standard deviation of the age of the subjects studied was 22.11±2.3 years. The overall average sleep quality score of dental students was equal to 8.13, which according to the questionnaire, students experience poor sleep quality. 86.1% of students had poor sleep quality. Examining the correlation between the sleep quality and academic performance showed that there was no significant relationship between them. Sleep quality had no significant relationship with gender, marital status, place of residence, and entry year (P<0.05).
Conclusion: The results of the present study showed that majority of dental students in Rafsanjan had low sleep quality. Although, there was no relationship between the quality of sleep and academic performance, it seems necessary to pay attention to the sleep status of these students in order to improve their sleep quality, which is an important factor in improving their health by administrators and Rizan health program.

Background and Aims: Educational planning is one of the main areas of education and training, which plays an essential role in the optimal training of human resources. The aim of this study was to compare the educational program (curriculum) of general dentistry in Iran with that of several prestigious dental schools in the Middle East countries.
Materials and Methods: This is a descriptive comparative study using the dental education curricula of six prominent countries in the Middle East in the field of dental sciences. Their selection was based on similarities and common cultural, economic and social characteristics. After collecting the selected curriculums, four steps including description, interpretation, juxtaposition and comparison were done. Tables were drawn based on goals such as the number of years of education, mission, general goals, and the role of graduates in the medical system of that country.
Results: The educational curriculum of the countries reviewed in the Middle East have many similarities in terms of the number of years of study in the field of dentistry, the general mission and goals, and the role of students in the medical system of that country. The main differences were in the number and type of teaching units in the curriculum of this countries. The method of teaching and the distribution of topics in the curricula of the countries differentiated them from each other. According to the results of this study, the curriculum of the countries of Iran, Saudi Arabia and the UAE were the most similar among the countries of the Middle East. The teaching method and distribution of topics in the curricula of countries distinguished them from each other.
Conclusion: Countries that are based on Russian language education have a shorter number of years of education and are similar to Russia. However, countries with an American educational base such as Saudi Arabia, the United Arab Emirates, and even Iran have a longer academic years and more general similarities in educational content.

Background and Aims: Sleep quality may be a predictive factor for temporomandibular disorders (TMD) compared to other risk factors. Patients with TMD may experience quality-of-life problems such as sleep disorders and orofacial pain. Timely diagnosis of TMD can halt its progression in the initial stages and reduce its severity. This study aimed to investigate the frequency and severity of temporomandibular joint disorders and their co-occurrence with sleep quality among dental students in Yazd in 2023.
Materials and Methods: This descriptive study was conducted among 211 students at the Yazd Dental School. The Fonseca and PSQI questionnaires were used to determine the severity of TMD and sleep quality, respectively. Clinical examination was conducted to assess the symptoms of TMD. Additionally, demographic information such as gender, marital status, and place of residence was recorded. The data were analyzed using chi-square and t-tests.
Results: The final analysis was performed on 211 individuals, comprising 118 males (56%) and 93 females (44%). Among all the participants, 204 individuals (83.88%) had at least one symptom of TMD.  The participants' most prevalent symptoms were jaw sounds, midline deviation, pain, and mouth opening limitation. There was no significant difference in the frequency of TMD symptoms, jaw sounds, jaw deviation, and limitation in opening, based on gender. Similarly, the prevalence and severity of TMD and their symptoms showed no significant association with residence or marital status (P>0.05). Although, a correlation was observed between the poor sleep quality and the severity of TMD, no association was found between the presence of TMD symptoms and poor sleep quality (P>0.05).
Conclusion: While, the frequency of TMD symptoms did not differ significantly between genders, the severity of TMD and jaw pain was significantly higher among female students. Individuals with poor sleep quality exhibited significantly higher severe degree of TMD.

Background and Aims: Musculoskeletal disorders are the most common and costly occupational injuries, and dentists are more prone to musculoskeletal problems than other medical professionals. This study aimed to investigate the effect of a course of corrective exercises on the alignment of the thoracic spine and balance in female dentists with increased kyphosis.
Materials and Methods: This research was a quasi-experimental study with a pre-test/post-test design, conducted in the field. Thirty female dentists from Amol and Babol cities (Iran) with increased kyphosis were selected using purposive sampling. The patients were randomly assigned into two groups: control (n=15) and intervention (n=15). In the pre-test, the thoracic curvature angle, static balance, and dynamic balance were assessed using a flexible ruler, the stork balance test, and the Y balance dynamic test, respectively. Then, the intervention group were assigned to perform the exercises for six weeks, while the control group only engaged in daily activities. After completing the exercises, the post-test was conducted. Paired t-tests and analysis of covariance were used to compare intra-group and inter-group differences.
Results: The statistical analysis  showed a significant difference between the two groups in the thoracic curvature angle (P=0.001), static balance (P=0.001), and dynamic balance (P=0.001). The intervention group demonstrated significant improvement in these parameters compared to the control group.

Conclusion: Based on the results of this study, it is recommended that corrective exercises under the supervision of a specialist be included in the weekly exercise program of female dentists with increased kyphosis.

 This article presents a challenging case of a 64-year-old man with episodic fever, urticarial rash, and arthralgia, prompting a detailed diagnostic process. Despite initial considerations of adult-onset Still's disease, the atypical symptoms led to further investigations, revealing a periapical abscess through a dental examination. The patient's symptoms significantly improved following dental intervention, challenging the initial diagnostic inclination towards a rheumatological disorder. This case underscores the importance of thorough physical examinations and interdisciplinary collaboration in reaching accurate diagnoses. The ultimate diagnosis of systemic presentation due to an occult dental abscess, highlights the need for a comprehensive approach to medical evaluations, considering various clinical aspects and avoiding diagnostics biases. This case study serves as a reminder of the evolving landscape of medical diagnostics and the continued significance of holistic patient assessments and physical examination as valuable practicing skills.

Background and aims: Dental anxiety is one of the most common barriers to utilizing oral health services. It can lead to delayed dental visits, treatment avoidance, and worsening of oral health problems. This study aimed to assess the level of dental anxiety among patients visiting general dental clinics in Babol, Iran.
Materials and Methods: This descriptive-analytical cross-sectional study was conducted in 2020 on 400 patients over the age of 18 who attended private general dental practices in Babol and were selected through convenience sampling. Data were collected using the Persian version of the standard Dental Anxiety Inventory (DAI), consisting of 36 items rated on a five-point Likert scale (score range:
36-180), the validity and reliability of which have been confirmed in previous studies. Data were analyzed using independent samples t-test and analysis of variance (ANOVA) in SPSS, with a significance level set at 0.05.
Results: The mean age of participants was 31.61  ± 9.03 years, and 61.8% were female. The mean dental anxiety score was 129.52 ± 31.04 out of 180, indicating a relatively high level of anxiety among the participants. Dental anxiety was significantly higher in female (P=0.002) and single participants (P=0.007), while no significant differences were observed based on the age, occupation, education level, or number of previous dental visits (P>0.05).
Conclusion: The findings indicated a high level of dental anxiety among patients attending general dental clinics in Babol. It is recommended that educational, psychological, and communication-based interventions be implemented in dental settings to help the reduction of anxiety and improvement of patient care.

Background and Aims: Student perspectives play a crucial role in evaluating educational systems. This study assessed the self-efficacy of dental students at Yazd Dental School in diagnosing and managing oral and maxillofacial pathological lesions.
Materials and Methods: This cross-sectional study was conducted among dental students from semesters 6 to 12. A total of 250 self-efficacy questionnaires, designed to evaluate students' abilities in lesion management, were distributed. The questionnaire covered biopsy procedures, differential diagnosis, and treatment planning. Data were collected using structured self-reporting methods and analyzed through SPSS version 16, employing descriptive and inferential statistics, including chi-square tests. The semester progression, gender, age, academic performance, and marital status were examined for their impact on self-efficacy. According to the mean and standard deviation obtained in this study, the scores were divided qualitatively.
Results: The response rate of the questionnaire was 91.6%. The average self-efficacy score was 80.30±14.72 (out of 150), indicating a moderate level of confidence. Performing biopsies had the lowest self-efficacy, while diagnosing and managing oral ulcers had the highest. Higher-semester students showed significantly greater self-efficacy (P=0.018), whereas variations based on gender, age, academic performance, and marital status were not statistically significant (P>0.05). Increased exposure to the clinical cases and theoretical knowledge contributed to a growth in self-efficacy over time.
Conclusion: Overall, the students demonstrated moderate self-efficacy in lesion management. Higher-semester students benefited from accumulated experience, though specific areas, such as biopsy procedures and lesion diagnosis, which require further emphasis. Future strategies should enhance teaching methods, clinical practice opportunities, and assessment approaches to prepare students for the practical challenges they will face.

Background and aims: Dental procedures carry a significant risk of transmitting viral and bacterial infections to both patients and healthcare personnel. Patients' awareness of infection control principles can play a crucial role in improving the safety of the clinical environment and promoting public health. This study aimed to assess the level of patients’ awareness regarding infection control principles in dental treatments.
Materials and Methods: This descriptive-analytical cross-sectional study was conducted in 2022 on 390 patients attending the Dental School Clinic of Babol University of Medical Sciences, Iran. Data were collected using a validated questionnaire consisting of 24 items related to infection control. Each correct answer was awarded one point. The total score and awareness level of participants were analyzed based on the gender, age group, educational level, and number of dental visits using independent samples t-test, chi-square test, and ANOVA in SPSS, with a significance level set at 0.05.
Results: The mean age of patients was 33.89 ± 13.24 years and 62.8% were female. The mean awareness score was 18.37 ± 3.21. A total of 76.4% of participants demonstrated a good level of awareness. The awareness mean score was higher in female than male patients (P=0.006). A statistically significant difference was observed in mean awareness scores educational level (P<0.001) and age group (P=0.01). However, no significant difference was found based on the number of dental visits (P=0.867).
Conclusion: Although, the overall level of patient awareness regarding infection control principles was acceptable, gaps remain in certain areas. The implementation of targeted educational programs is recommended to enhance patients’ awareness and to promote infection control practices in dental treatment settings.

Background and Aims: Musculoskeletal disorders (MSDs) are among the most common occupational health problems faced by dentists. Given their impact on dentists’ health and performance, the present study aimed to investigate the prevalence of MSDs among general and specialist dentists practicing in Babol, Iran.
Materials and Methods: In this cross-sectional study, the standardized Nordic questionnaire, consisting of general and specific sections, was distributed in person among dentists practicing in Babol, based on data obtained from the local Medical Council. Distribution was carried out after a telephone invitation and confirmation of willingness to participate. The questionnaire included items regarding pain and discomfort in different body regions such as the neck, shoulders, and lower back. The frequency of participants with MSDs was assessed based on gender, right/left handedness, specialty, playing sports, and participating in a specific sport. The mean age, weight, height, body mass index, weekly working hours, and work experience of dentists with and without MSDs were also compared. Data were analyzed using SPSS software version 22, employing independent t-tests, Chi-square tests, and Fisher’s exact test, with a significance level set at 0.05.
Results: Of the 182 dentists approached, 17 declined participation and 5 met the exclusion criteria. A total of 160 dentists (mean work experience: 15.65 ±9.26 years) were included in the study; of these, 100 (62.5%) were male, 95 (59.4%) were general practitioners, and 65 (40.6%) were specialists. The overall prevalence of MSDs in this population was reported to be 90%. The most commonly affected region was the neck (76.4%), while the least affected was the ankle (3%). A statistically significant association was found between engaging in a specific type of regular physical activity and a reduced incidence of MSDs (P<0.001). No significant associations were observed with other variables such as gender, handedness, specialty, or field of specialization (P>0.05). Furthermore, no significant differences were found in the mean height, weight, body mass index, weekly working hours, or years of experience between dentists with and without MSDs (P>0.05).
Conclusion: Musculoskeletal disorders are highly prevalent among dentists in Babol. Given this high prevalence, the development and implementation of educational programs on ergonomics, along with recommendations for targeted physical activity appear to be essential.