Prevalence and causes of self-medication for oral health problems: a systematic review and meta-analysis.

INTRODUCTION: Self-medication, particularly for oral and dental health problems, stands as a significant health and social concern. Therefore, the current systematic review and meta-analysis study was conducted to evaluate the prevalence and underlying causes of self-medication for oral and dental health problems. METHOD: Articles published until August 30, 2023, were searched in Scopus, PubMed, and Web of Science databases. A manual search was also done in Google Scholar, references, citations, and Gray literature. The screening of articles was done independently by two members of the research team. The quality of reporting in the articles was evaluated using the JBI Critical Appraisal Checklist For Analytical Cross-Sectional Studies. Meta-analysis was performed using the fixed effects model in Stata software (StataCorp, version 16). RESULTS: The results of 37 studies involving 12,110 participants with a mean age of 32 years and 48% male were analyzed. Most of the studies were conducted in low- and middle-income countries. The overall prevalence of self-medication was estimated at 59% [95%CI: 55-63%], with 58% [95% CI: 53-63%] among dental patients, and 60% [95% CI: 52-67%] in the general public. Analgesics (60%) and antibiotics (19%) were the most commonly used drug categories. In terms of the mean proportion, having previous experience, unbearable pain, and lack of time had the highest percentages, and in terms of the number of repetitions among the reviewed articles, economic problems, lack of time, and limited access were the most repeated reasons. The most significant related factors in self-treatment were female gender, higher education, and occupation. Pharmacies were the primary source of self-treatment medications. CONCLUSION: The results showed a very high prevalence of self-medication for oral health problems, necessitating prompt and effective interventions. It is recommended to focus on regulating the consumption of analgesics and antibiotics, addressing financial issues, and overseeing the pharmacy operations.

The relationship between oxidative stress markers and temporomandibular disorders: A systematic review and meta-analysis.

Background: Oxidative stress has a role in many pathologic conditions, including oral diseases and temporomandibular joint disorders (TMDs) pathophysiology. This study compared the selected oxidative biomarkers' levels in TMD patients and healthy controls in a systematic review and meta-analysis. Materials and Methods: Medline/PubMed, Scopus, Web of Science, Google Scholar, and Embase were systematically searched for English articles up to October 2022 using MeSH and free keywords. Joanna Briggs Institute checklist was used to assess the risk of bias. Differences between biomarker levels in TMD patients were compared to the control group. Results: Ten case-control studies were included based on inclusion and exclusion criteria with a total of 659 patients: 314 with TMD and 345 healthy controls. The studies investigated 15 markers, including total oxidant status (TOS), total antioxidant status, and malondialdehyde (MDA). There was a significant difference in the salivary MDA of patients with TMD in comparison with healthy people; standard mean difference = 3.22 (95% confidence interval [CI]: 0.28-6.16); I 2 = 96.0%). The Antioxidant status in serum was significantly lower in patients with TMD in comparison with healthy people; weighted mean difference = -0.52 (95% CI: -0.90 to -0.14; I 2 = 97.0%). The result of TOS was inconclusive. Conclusion: Salivary MDA and serum total antioxidative status measurements may be used as a biomarker for diagnosing TMD. Due to the lack of sufficient evidence, it is not possible to express a definite relation between the amount and type of marker and TMD diagnosis, which suggests that more case-control studies with larger sample sizes are required.

Effect of probiotics on pain and ulceration in patients undergoing fixed orthodontic treatment.

Background: Ulcers caused by mucosal irritation of fixed orthodontic appliances remain an unsolved problem, and more research is needed to improve the pain caused by orthodontic appliances to provide more comfortable treatment for these patients. This study investigated the effect of probiotic Lactogum on pain and ulceration in patients undergoing fixed orthodontic treatment. Methods: In this study, 64 patients over 12 years of age and candidates for fixed orthotic treatment were divided into case and control groups (n=32). The control group received orthodontic waxes, and the case group received the same orthodontic waxes and "Lactogum" probiotic lozenges from the beginning of the treatment. The number of ulcers, the amount of pain, and the location of the ulcer were recorded and compared between the two groups. An independent-sample t-test was used to compare the pain level and number of ulcers between the two groups. A significance level of 0.05 was considered for all tests. SPSS 17 was used for data analysis. Results: The mean number of ulcers in the case group was significantly lower than the control group (P<0.001). The mean pain in the case group was significantly lower than in the control group (P<0.001). The most frequent location of ulcers was the buccal mucosa, followed by the labial mucosa. Conclusion: Lactogum probiotic lozenges can reduce traumatic oral ulcers and pain levels in patients undergoing fixed orthodontic treatment. However, larger clinical trials are encouraged to confirm these findings.

Comparison of autologous platelet concentrates and topical steroids on oral lichen planus: a systematic review and meta-analysis.

BACKGROUND: Oral lichen planus is a chronic and potentially malignant disorder of oral mucosa. Corticosteroids are used as first-line therapy for oral lichen planus patients; however, they have many side effects. Platelet concentrates (platelet-rich plasma and platelet-rich fibrin) are autologous bioactive materials. This systematic review investigated the effects of autologous platelet concentrates compared to topical steroids in treating symptomatic oral lichen planus patients. MATERIALS AND METHODS: A systematic literature search was performed in PubMed, Web of Science, Scopus, Embase, and Cochrane for randomized controlled trials. Preferred Reporting Items for Systematic Reviews and meta-analysis guidelines were observed for article selection. For the pooling of studies, meta-analysis using Standardized Mean Differences by random effects model was carried out to estimate summary effect sizes for the treatment of oral lichen planus. RESULTS: A total of six studies, incorporating 109 oral lichen planus patients, were involved. Both treatment modalities showed a statistically significant improvement in the outcome parameters (lesion size, pain score, Thongprasom score) from the baseline to the end of treatment and further to the follow-up visits. There was no significant difference in the pooled estimate SMD of pain decline in patients of the two groups (SMD = 0.17 (95% CI: -0.47 to 0.81); I2 = 63.6%). The SMD of Thongprasom score in patients receiving autologous platelet concentrates was lower than the corticosteroid groups, with no significant effect size (SMD= -2.88 (95% CI: -5.51 to -0.25); I2 = 91.7%). Therefore, there was no statistically significant difference between the autologous platelet concentrates and topical steroids regarding pain and clinical score. CONCLUSION: Autologous platelet concentrates, and topical steroids decreased the size of lesions, Thongprasom scale, and pain in oral lichen planus patients, but the difference between the two treatments was not statistically significant. Thus, autologous platelet concentrates could be considered as an alternative treatment to topical steroids.

Evaluation of the Relationship between Sublingual Varices and Hypertension.

Objectives: Sublingual varices are characterized by abnormally dilated veins. Some systemic conditions such as cardiovascular disease have been suggested to be associated with sublingual varices. Due to the convenience in examining the sublingual area, the present study aimed to assess the relationship between sublingual varices and hypertension. Materials and Methods: In this descriptive-analytic study, 500 patients were categorized into two groups: those with sublingual varices and those without. Two oral medicine specialists assessed the lesions, and the blood pressure of all patients was measured while they were in a relaxed sitting position. Age and gender data were recorded for all participants. Statistical analysis included t-test, chi-square, and logistic regression, with significance set at P<0.05. Results: The frequency of sublingual varices was 21.8%. Mean systolic blood pressure was 139.68±19.01mmHg in patients with sublingual varices and 118.09±13.78mmHg in patients without the lesions (P=0.561). Mean diastolic blood pressure was 100.45±17.81mmHg and 80.31±12.08mmHg in patients with and without sublingual varices, respectively (P<0.001). Smoking was significantly more prevalent among patients who had the lesions (P<0.05). Gender (P=0.686) and age (P=0.875) showed no significant relationship with sublingual varices, while smoking and blood pressure levels were significantly associated with these varices (P<0.001). Conclusion: It is advisable to monitor and manage blood pressure in patients with sublingual varices who may not be aware of their blood pressure status. Our results showed that smoking could be one of the predictive factors for sublingual varices.

The Effect of Direct Observation of Procedural Skills on Learning and Satisfaction of Students in Community Dentistry Course.

Introduction: Direct Observation of Practical Skills (DOPS) tests is a valuable method for clinical assessment. This study aimed to implement the DOPS test to assess the procedural skills of community dentistry courses and its effects on mastery learning and satisfaction of professors and students at Tabriz faculty of dentistry in 2021-2022. Methods: In a quasi-experimental study, 60 dentistry students of a class were assigned into two study (n=30) and control (n=30) groups by Permuted block randomization. In the case group, the skills were related to Fluoride therapy, fissure sealant therapy, and health education evaluated by DOPS. In the control group, these skills were evaluated by traditional evaluation methods. Each test was repeated three times. Finally, the satisfaction of students in the case group was assessed by a questionnaire. The chi-square test was used to compare qualitative variables. Repeated measure ANOVA test was used to compare the mean scores in three stages and two groups. P value less than 0.05 was considered significant. Data were analyzed using SPSS 16 software. Results: A significant difference in the mean score of Fluoride therapy, pit and fissure sealant therapy, and health education was seen between the case and control groups (P<0.001). Also a significant increase in these skills in the third stage of assessment in the case group was observed (P<0.001). The professors and students' satisfaction was considerably high on the DOPS test. Conclusion: The DOPS method had more impact on Fluoride therapy, pit and fissure sealant therapy, and health education's learning process in dentistry students than the conventional evaluation. The professors and students' satisfaction level was high regarding DOPS. The advantages of the DOPS method are student-centeredness, objectivity, and appropriate feedback.

Exploring the experiences of dentistry students of Tabriz University of Medical Sciences of academic motivation: a content analysis study.

BACKGROUND: Students' academic motivation is crucial to their academic performance, success, and future career performance. Understanding the experiences of students regarding academic motivation can help address this issue. This qualitative study aimed to explore the experiences of dentistry students of Tabriz University of Medical Sciences regarding academic motivation. METHODS: This qualitative content analysis study collected data through semi-structured individual interviews with open-ended questions. The collected data were then organized into codes, subcategories, categories, and themes. Extensive interviews, meetings, and active engagement with the participants were conducted to ensure the strength of the data collected. RESULTS: The results of this study yielded 20 subclasses and 11 classes. These codes, categories, and sub-categories were summarized into seven themes: self-efficacy, outcome expectations, outcome expectancies, emotional coping, self-regulation, situational perception, and environment. CONCLUSION: This study showed that various concepts, from personal processes to environmental and social processes, play a role in students' academic motivation. This study's findings can contribute to developing more effective interventions to improve the motivation level of dentistry students.

Relationship between sublingual varices and hypertension: a systematic review and meta-analysis.

BACKGROUND: Previous research has investigated the connection between sublingual varices (SV) and cardiovascular disease, aging, and smoking. However, it is still unclear whether arterial hypertension affects the presence of SV. This meta-analysis aimed to investigate the relationship between hypertension and the presence of SV. METHODS: The literature search was performed using PubMed, Web of Science, Scopus, Google Scholar, and Embase for cross-sectional studies until July 2023. PRISMA guidelines were used for article selection. A meta-analysis using standardized mean differences by a random effects model was conducted to pool studies. RESULTS: A total of 568 articles were retrieved, of which twelve were included in the meta-analysis. Cumulatively, 2543 samples in the case group (1185 with hypertension) and 3897 samples (821 with hypertension) were studied in the control group. Using the random effects model, the pooled odds ratio (OR) revealed a significant association between hypertension and sublingual varices (OR = 2.66; 95% CI: 1.69-4.18). CONCLUSION: The meta-analysis showed a significant and positive association between sublingual varices and hypertension. SV's presence could be used by dentists as a non-invasive indicator of hypertension screening.

Effects of topical fluoride treatment on the bond strength of pit and fissure sealants: A systematic review.

Background: This systematic review aimed to evaluate the available scientific evidence concerning the effects of topical fluoride treatment on the bond strength of pit and fissure sealants. Prevention of dental caries is one of the crucial issues in pediatric dentistry. Pit and fissure sealant and fluoride therapies are two caries prevention procedures that may be performed in one session. However, fluoride therapy may affect the bond strength of pit and fissure sealants. Methods: An electronic search for in vitro studies published in English and Persian on topical fluoride therapy and the bond strength of pit and fissure sealants was performed via PubMed/ Medline, Web of Science, Google Scholar, Embase, and Scopus databases until May 2022. The articles were independently reviewed for quality by two reviewers. Textual data were analyzed manually, and the bond strength of sealants placed after fluoride application was compared with control groups. Results: A total of 8482 articles were initially identified and reviewed by two independent reviewers, and 13 were selected for full-text evaluation. Finally, six articles were included in the systematic review. A total of 250 teeth were studied, 148 of which were in the case group (fluoride group) and 102 in the control group. Tensile and shear bond strengths were compared between groups in the studies. Conclusion: In the studies in which the tooth surfaces were washed after applying fluoride, there was no change in the fissure sealant bond strength. However, in studies in which fluoride was not washed, the bond strength decreased significantly, independent of the fluoride type.

Association between 5-Hydroxytryptamine Receptor 2A Gene (rs6313 and rs4941573) Polymorphism and Sleep Bruxism: A Meta-analysis.

Genetic factors may influence sleep bruxism's pathogenesis. Even though the association between the, 5-hydroxytryptamine 2A (5-HTR2A) serotonin receptor gene polymorphism and sleep bruxism has been investigated, inconsistent findings have been discovered. As a result, meta-analysis was performed to gather complete results on this topic. PubMed, Web of Science, Embase, and Scopus databases were searched for all papers containing English abstracts until April 2022. Medical Subject Heading (MESH) terms plus unrestricted keywords were used in the searches. The Cochrane test and the I 2 statistic were used to determine the heterogeneity percentage in numerous researches. Comprehensive Meta-analysis v.2.0 software was used to conduct the analyses. Five properly fitting papers were chosen for meta-analysis from the 39 articles acquired during the initial search. The meta-analysis revealed that the 5-HTR2A polymorphism has no link with sleep bruxism susceptibility across the models studied (P-Value > 0.05). The combined odds ratio analysis revealed no statistically significant association between the 5-HTR2A gene polymorphism with sleep bruxism. Nonetheless, these findings require confirmation through researches with large sample sizes. Identifying genetic markers for sleep bruxism may help clarify and expand our current knowledge of bruxism physiopathology.

Effect of Pilocarpine Mouthwash on Salivary Flow Rate in Patients with Xerostomia: A Systematic Review and Meta-Analysis.

Statement of the Problem: Xerostomia is a subjective sensation of dry mouth considered as a complex state affecting multiple oral functions. Pilocarpine may be a useful medication for the treatment of xerostomia, but its side effects limit its use under certain conditions. Recent studies have focused on the pilocarpine mouthwash as an alternative. Purpose: We have undertaken this study to review the latest available scientific evidence systematically, concerning the effects of pilocarpine mouthwash on salivary flow rate in patients with xerostomia. Materials and Method: An electronic search for randomized controlled trials published in English until September 2021 related to pilocarpine mouthwash and salivary flow rate in patients with dry mouth was performed in PubMed/Medline, Web of Science, Google Scholar, Embase, and Scopus. A random-effects meta-analysis was conducted to evaluate the relationship between the groups. Results: Two papers with 86 patients were selected for the final review based on strict eligibility criteria. According to the results of the meta-analysis, the mean visual analogue scale in the patient treated with pilocarpine mouthwash was 0.88 unit lower than that of the control group in the fourth week follow; however, it was not statistically significant (pooled mean difference=-0.88, 95% CI = (-2.72; 0.95), p= 0.34). Conclusion: It seems that the use of pilocarpine mouthwash can increase the salivary flow rates; however, no optimal dose and application regimen can currently be suggested due to the high heterogeneity of the data. Regarding the relief of the symptoms using pilocarpine mouthwash, the existing evidence does not support its effectiveness.

Effect of at-home and in-office bleaching on microleakage of class V composite resin restorations using different types of universal adhesives: An in vitro study.

Background: When bleaching agents contact dental structures, they act on restorative materials and adhesive interfaces. This study investigated the effect of "at-home" and "in-office" bleaching on the microleakage of composite resin restorations performed with different universal adhesives in self-etch and etch-and-rinse modes. Methods: Class V cavities were prepared in 132 premolars. The samples were divided into four groups (n=33). All Bond Universal adhesive was used in the first and second groups, and G-Premio Bond adhesive was used in the third and fourth groups. The total-etch mode was used in the first and third groups, and the self-etch mode was used in the second and fourth groups. The samples were divided into three subgroups (n=11). In the first subgroup, home bleaching was used, and in the second subgroup, office bleaching was used. In the third subgroup, bleaching was not performed. The specimens were examined under a stereomicroscope for microleakage. Ordinal regression analysis was applied (P<0.05). Results: The adhesive type, application method, and margin type significantly affected microleakage (P<0.05). The amount of microleakage in All Bond Universal adhesive was significantly higher than in G-Premio Bond adhesive. The chance of microleakage in the self-etch mode was almost twice as high as in the etch-and-rinse mode. The bleaching method did not significantly affect microleakage (P>0.05). Conclusion: Based on the results of the microleakage test, bleaching after composite resin restorations did not significantly affect the microleakage of Class V restorations.

Effect of zinc supplementation as an adjuvant to corticosteroid treatment in patients with oral lichen planus: A systematic review.

Background: Oral lichen planus (OLP) and one of its main presentations, desquamative gingivitis, are common diseases with no definite treatment. Zinc deficiency has a critical role in the pathogenesis of oral mucosal diseases. The current study systematically reviewed the effect of zinc in addition to topical corticosteroids in the treatment of OLP. Methods: English articles in PubMed, Web of Sciences, Embase, and Scopus were searched until August 2022. The differences in symptoms were analyzed, including pain, burning sensation, and lesion sizes in patients with lichen planus receiving zinc supplementation as an adjuvant to corticosteroid treatment. Results: A total of 148 articles related to the searched keywords were found. Eventually, two clinical trials were selected. The total population of studied individuals included 60 patients. Due to the high heterogeneity between the studies, meta-analysis was not possible. Administering zinc, in addition to corticosteroids, did not improve the symptoms compared to corticosteroid monotherapy. Conclusion: Considering the limited number of studies and lack of sufficient evidence, it is not currently possible to reach a definite conclusion regarding the effects of zinc on OLP.

Management of iatrogenic chloroform mucosal burn in the palate: a case report.

Chloroform is used widely in endodontic treatments for solving gutta-percha points, but it can have destructive effects if it comes in to contact with oral mucosa. This article presents a case of necrotic ulcer of palatal and buccal mucosa due to injudicious use of chloroform in endodontic treatment, which has caused severe destruction in maxilla. A conservative treatment method of repeated curettage and irrigation was used and although the lesion healed completely, it had major effects on the patient's quality of life including loss of two teeth. It is important that dentist be aware of the devastating effects of imprudent application of various chemicals used in dentistry. The conservative treatment used for this case can be helpful option for similar cases.

The comparison of calcium hydroxide, curcumin, and Aloe vera antibacterial effects on 6-week-old Enterococcus faecalis biofilm as an intracanal medicament: An in vitro study.

Background: This study aimed to compare the antibacterial effects of calcium hydroxide, curcumin, and Aloe vera as an intracanal medicament on 6-week-old Enterococcus faecalis biofilm. Materials and Methods: In this in vitro study, the solution containing E. faecalis ATCC® 29212™ was inserted into the canals of 72 single-rooted teeth to produce biofilm. The samples were divided into four groups, and the antibacterial agent as an intracanal drug was used for 1 week. Calcium hydroxide, curcumin, and A. vera were used as intracanal medicaments in three groups, respectively, and the fourth group was irrigated with normal saline. The collected debris was cultured by spread plate method for the bacterial count by colony count machine, and the number of bacteria in each sample per ml was reported in colony-forming unit per ml (CFU/ml). The data were analyzed using SPSS software. KruskalWallis and MannWhitney U-tests were used for comparison of CFU/ml between the study groups. P <0.05 was considered significant. Results: The mean CFU/ml in the groups of calcium hydroxide, curcumin, and A. vera were 749.44, 630.55, and 1529.16, respectively. Compared with the control group, curcumin, calcium hydroxide, and A. vera showed 99.5%, 99.41%, and 98.79% antimicrobial effects, respectively. All three groups were significantly effective than the control group (P = 0.023, P = 0.023, and P = 0.024, respectively) but were not significantly different from each other (P = 0.057). Conclusion: All three groups showed significant antibacterial activity compared to the control group, curcumin had the most significant effect, followed by calcium hydroxide and A. vera. Therefore, herbal materials can be considered safe alternatives to synthetic medicaments for intracanal usage.

Push-out Bond Strength of Fiber Posts to Intraradicular Dentin Using Multimode Adhesive System.

INTRODUCTION: Because there is little information about bond strength of fiber posts cemented with a universal adhesive system (UAS) with different resin cements, the aim of this study was to compare the effect of different bonding strategies in the application of UASs on push-out bond strength of fiber posts to intraradicular dentin. METHODS: Seventy-two single-rooted teeth were randomly divided into 6 groups: self-adhesive resin cement (SAC), dual-cure resin cement (DCC), UAS in the etch-and-rinse (E&R) mode and SAC (E&R + SAC), UAS in the self-etch (SE) mode and SAC (SE + SAC), UAS in the E&R mode and DCC (E&R + DCC), and UAS in the SE mode and DCC (SE + DCC). The push-out test was conducted at a crosshead speed of 0.5 mm/min. Data were analyzed with 2-way analysis of variance (P < .05). RESULTS: Bond strength was significantly influenced by the adhesive strategies (P < .001). However, post space region did not have a significant effect on bond strength (P > .05). CONCLUSIONS: ClearfilSA Luting SAC (Kuraray Noritake Dental Inc, New York, NY) cannot be used alone for fiber post adhesion; it needs an adhesive. Universal adhesive in the SE mode is suggested. When UAS is used for luting fiber posts, the type of cement does not have any effect on bond strength.