The effect of hydroalcoholic extract of Psidium guajava L. on experimentally induced oral mucosal wound in rat.

BACKGROUND: The aim of this study was to evaluate the biological effects of hydroalcoholic extract of Psidium guajava L leaves and phenytoin as a standard agent on the induced oral mucosal wound. METHODS: Hundred seventy Sprague Dawley rats were grouped in 5 clusters randomly. Oral mucosal wounds were induced in all rats except for the control group. Phenytoin and guajava leaf extract were used as a mouthwash. Twelve rats from the 5 groups were euthanized on day 7th and 10th, and 10 rats from each group were sacrificed on the 14th day. Interleukin-6 and total antioxidant capacity were determined in the serum. The tissues were evaluated for pathological and stereological assessments. Phytochemical analyses were performed on the hydroalcoholic extract of Psidium guajava L to determine the antioxidant potency. RESULTS: Total phenolic content test and DPPH analysis demonstrated the high potential of antioxidant capacity of Psidium guajava L. Decreasing IL-6 and increasing TAC were seen in the guajava hydroalcoholic extract and phenytoin groups. The difference of IL-6 between the wound treated guajava group and the wounded group was significant. The wound treated guajava group and wound treated phenytoin group on the 14th day increased the number of fibroblast cells and volume density of sub-mucosae effectively to the same thickness to be considered as a healed sub-mucosae layer. The volume density of the epithelium changes showed statistically significant different responses based on gender. CONCLUSION: In conclusion, hydroalcoholic extract of Psidium guajava L leaves might exert theraputic effects on oral mucositis.

The Effect of an Educational Intervention on Oral Health Literacy, Knowledge, and Behavior in Iranian Adolescents: A Theory-Based Randomized Controlled Trial.

Introduction: Oral health is one of the most important issues in public health. Most educational interventions, as the primary prevention strategy, are focused on increasing information and knowledge and are not usually effective. Therefore, the present study is aimed at determining the effect of theory-based education on oral health behavior and its psychological determinants including dental health literacy. Method: This randomized controlled educational trial was conducted in two girls' high schools that were selected by multistage cluster sampling and were divided into an intervention and a control group. Literacy, knowledge, oral health behavior, dental plaque index, and constructs of the protection motivation theory were evaluated before and one month after four training sessions. Finally, the data were entered into the SPSS 19 software and were analyzed using the chi-square test, independent t-test, and Mann-Whitney test at the significant level of 0.05. Result: Before the intervention, there was no significant difference between the intervention and control groups regarding the mean scores of knowledge, behavior, and oral health literacy; plaque index; and protection motivation theory constructs. After the educational intervention, however, the means of these variables were significantly improved in the intervention group compared to the controls (p < 0.05). Conclusion: The study findings were in favor of the effectiveness of the theory-based educational intervention in improving the knowledge, literacy, and behavior related to oral health. Yet, further research is suggested to determine the effectiveness of such an intervention in male students as well as in populations with different socioeconomic and cultural statuses.

The Effect of Toothpastes Containing Natural Ingredients Such As Theobromine and Caffeine on Enamel Microhardness: An In Vitro Study.

The current study aimed to investigate the effect of biocompatible kinds of toothpastes containing natural ingredients such as theobromine and caffeine on the enamel microhardness after demineralization. 72 maxillary premolar teeth extracted for orthodontic purposes were used in this study. Primary enamel surface microhardness examinations were performed using a Digital Micro Vickers Hardness Tester following the Knoop technique (50 g load for 15 s with three indentations at various points). The specimens were immersed in lactic acid (pH = 5.4) for 7 days, washed with distilled water, dried, and then retested for microhardness. According to the type of toothpaste used for brushing, all specimens were categorized as follows: Group 1, Theodent classic® toothpaste (theobromine); Group 2, Power Energy toothpaste (caffeine); Group 3, Colgate toothpaste (fluoride); and Group 4, distilled water as the negative control. The specimens were retested for enamel microhardness after brushing 2 times a day for one month. After brushing with different types of toothpaste, for all experiment groups, the increase in microhardness values in the demineralized enamel surfaces was significant and there were significant differences between them (p value <0.05). The fluoride group had the highest microhardness and had a significant difference with the caffeine and distilled water groups, but there was no significant difference with the theobromine group (p value <0.05). In the theobromine group, the hardness was considerably higher than in the caffeine and distilled water groups. There was no significant difference between the caffeine and distilled water groups. Theobromine toothpaste had the same remineralization effect as that of fluoride toothpaste, while caffeine toothpaste had no positive effect on the remineralization process.

The efficacy of administrating a sweet-tasting solution for reducing the pain related to dental injections in children: A randomized controlled trial.

BACKGROUND: Anaesthetic injections are an unpleasant experience for children in the dental office. Oral intake of sweet substances by newborns has been shown to be effective in reducing pain. AIM: The purpose of this study was to determine whether a prior administration of a sweet-tasting solution has an effect on dental injection pain. DESIGN: A total of 56 healthy children needing bilateral maxillary primary canine extraction were included in this split-mouth randomized clinical trial. In the test side, dental injection (local infiltration) was applied after the patient received a sweet-tasting solution, while in the control side sterile water was administered. The patients' demographic characteristics, body mass index (BMI), and sweet taste preference were recorded. Pain perception during injection was measured using visual analogue scale (VAS) and sound, eye, body movement (SEM). RESULTS: Mean VAS (28.30 ± 6.43) and SEM (2.14 ± 0.78) in the test side were lower than the control side (45.80 ± 7.17 and 2.95 ± 1.00). It was shown that higher BMI was associated with reduction in the analgesic effect, while the individual's tendency to sweetness increased pain reduction. CONCLUSIONS: Sweet taste administration before dental injections in children helps to control the associated pain. This effect is influenced by the individual's sweet taste tendency and BMI.

The effects of lavender aromatherapy on stress and pain perception in children during dental treatment: A randomized clinical trial.

BACKGROUND AND PURPOSE: Reducing dental anxiety is a major aspect of childmanagement in dental visits. This crossover randomized clinical trial was designed to determine the effect of lavender aromatherapy on anxiety level during dental treatment and pain perception during dental injection in children. MATERIALS AND METHODS: Twenty-four children aged 7-9 years received restorative treatment with lavender aromatherapy in the intervention session and without aroma in the control session. Salivary cortisol and pulse rate were measured to evaluate child's anxiety level and the Face Rating Scale (FRS) was used for assessing the pain perception during injection in both visits. RESULTS: The treatment effect on salivary cortisol, pulse rate, and FRS score was -8.01 ± 0.92 nmol/l, -11.17 ± 1.28 (in minutes), and -2.00 ± 0.41 respectively, which was statistically significant (P < 0.001). CONCLUSION: Lavender aromatherapy can decrease dental anxiety and experienced pain in dental setting.

Caries Color, Extent, and Preoperative Pain as Predictors of Pulp Status in Primary Teeth.

AIM: This study aimed to assess the relationship between preoperative pain status, caries extent, and caries color and the ability to achieve hemostasis at the canal orifices during pulp therapy access in primary teeth. STUDY DESIGN: Eighty primary molar teeth with extremely deep caries extending to the pulp (based on bitewing radiography) were investigated in 66 children. The teeth with clear radiographic and clinical signs indicating the involvement of the radicular pulp were excluded. The history of preoperative pain status, the color of dental caries by visual inspection, and the extent of caries lesion measured in bitewing radiographs were recorded. After preparing the access cavities, the hemostasis achievement at the canal orifices was assessed and considered as the final factor in determining the type of treatment (pulpotomy or pulpectomy). The data were analyzed using Fisher's exact test, the independent t-test, and Cohen's unweighted kappa statistic. P<0.05 was considered statistically significant. RESULTS: Hemostasis was achieved in 78.1% of the teeth with black dental caries, whereas in most of the teeth with light brown dental caries (64.3%), hemostasis was not achieved (p=0.015). The extent of dental caries in the teeth needing pulpotomy was statistically significantly lower than that of those needing pulpectomy (p=0.024). Mesial side dental caries was more related to the irreversible pulpitis compared to the distal one (p=0.01). In 78.1% of the teeth without pain, hemostasis was achieved, and in most of the teeth with nocturnal pain (64.3%), hemostasis did not occur (p=0.034). CONCLUSION: The caries color, caries extent, and preoperative pain have the potential to be used as clinical diagnostic tools to determine the pulpal status in primary teeth.

Prediction of dental arch width increase in the early mixed dentition using craniofacial parameters.

BACKGROUND: The dimensions of the dental arch have considerable impact on treatment planning. Since the dental arch development has a relationship with the craniofacial growth, we designed a cohort study to find a regression model for predicting the mandibular arch width increase using craniofacial parameters. METHODS: A total of 148 children, all in early mixed dentition, were selected randomly from primary schools by cluster sampling. Craniofacial anthropometric parameters were measured by a caliper bow and intercanine and intermolar widths were assessed on each subject's dental casts by a digital caliper at baseline and after 12 months. Data were analyzed with SPSS v. 15. Student's t-test and linear regression test were applied separately for girls and boys. RESULTS: Out of 153 children, 148 returned for one-year follow-up meeting the inclusion criteria. The results of regression analysis showed a significant inverse correlation between intercanine width and facial index. The bigonial dimension showed a high correlation with both the intermolar width and the intercanine width increase. CONCLUSIONS: We found that the arch width increase in the early mixed dentition could be predicted precisely based on certain craniofacial parameters.

Prediction of the occurrence and severity of mandibular incisor crowding in the early mixed dentition using craniofacial parameters.

INTRODUCTION: With the recent interest in esthetics at an early age, prediction of mandibular incisor crowding is of significant importance. Since dental arch development is related to craniofacial growth, we conducted a cohort study to find a regression model for mandibular incisor crowding based on various craniofacial parameters in children. METHODS: A total of 250 children, all in the early mixed dentition, were selected randomly by cluster sampling from primary schools. Craniofacial parameters were measured by a caliper bow, and intercanine widths were measured on dental casts. After a 12-month follow-up period, mandibular incisor crowding and intercanine width were assessed on each subject's dental cast. Discriminant and multiple regression analyses were performed separately for boys and girls. RESULTS: Of 250 children, 148 returned for the 1-year follow-up and met the inclusion criteria. Regression analyses of patients with normal occlusion showed a statistically significant correlation between anterior dental crowding and facial height and bigonial width in both sexes. A significant inverse correlation was found between initial intercanine width and incisor crowding in girls. Furthermore, using the aforementioned parameters, the occurrence of mandibular incisor crowding could be predicted with an accuracy of 92.6%. CONCLUSIONS: We found that the occurrence and severity of mandibular incisor crowding in the early mixed dentition can be predicted accurately based on certain craniofacial parameters.

Pain Perception Due to Dental Injection by Smartject: Split Mouth Design Study.

STATEMENT OF THE PROBLEM: Dental injection is one of the most fearful procedures in dental setting, especially for children. Many researchers have attempted to find a painless method. As computer controlled local anesthesia delivery system devices (CCLADs) allow the speed rate and pressure of injection solution to be controlled, they may cause less pain during injection in comparison to the conventional method. PURPOSE: The aim of this study was to compare pain perception in dental injection by Smartject with conventional technique. MATERIALS AND METHOD: The present study was a randomized single-blind crossover clinical trial. The participants consisted of 50 healthy volunteer dental students. They received a topical anesthetic agent plus injection in maxillary premolar buccal mucosa via conventional technique on one side (control) and a topical anesthetics agent plus injection in maxillary premolar buccal mucosa by Smartject on the other side (experimental). The first injection method was chosen based on block randomization table. A blind person recorded the subjects' pain perception of injection based on the visual analogue scale (VAS) in the two groups. Repeated measure test, independent Student t-test and Student paired t- test were used. Statistical significance was defined at p< 0.05. RESULTS: There was statistically significant difference in VAS score between Smartject and the conventional technique. The mean of VAS scores for Smartject and the conventional technique were 14.5±7.4 and 24±12.1, respectively. CONCLUSION: It is suggested, needle penetration is not the main reason of pain during injection. Inconsistent fluid pressure created by injected anesthetic solution on nerve fibers is more impressive in pain development. Hence, Smartject as a CCLAD can be considered as an appropriate device for dental injection.

Bilateral Supernumerary Deciduous Maxillary Lateral Incisors with Fusion: Report of a Rare Case.

Dental anomaly in number, size and shape might be due to excessive activation of dental lamina during the morpho-differentiation stage. Fusion is one of the most unusual and rare anomalies of shape of the teeth. It frequently involves the supernumerary teeth resulting in a challenging differential diagnosis with gemination. Dental anomalies may result in different problems such as delayed eruption and crowding; thus, early diagnosis is required for effective intervention and proper in-time treatment. The case reported here is a 4-year-old girl with bilateral supernumerary primary maxillary lateral incisors associated with fusion between primary maxillary left lateral incisor and supernumerary lateral tooth.

How Do Children Behave Regarding Their Birth Order in Dental Setting?

STATEMENT OF THE PROBLEM: Prediction of child cooperation level in dental setting is an important issue for a dentist to select the proper behavior management method. Many psychological studies have emphasized the effect of birth order on patient behavior and personality; however, only a few researches evaluated the effect of birth order on child's behavior in dental setting. PURPOSE: This study was designed to evaluate the influence of children ordinal position on their behavior in dental setting. MATERIALS AND METHOD: A total of 158 children with at least one primary mandibular molar needing class I restoration were selected. Children were classified based on the ordinal position; first, middle, or last child as well as single child. A blinded examiner recorded the pain perception of children during injection based on Visual Analogue Scale (VAS) and Sound, Eye and Movement (SEM) scale. To assess the child's anxiety, the questionnaire known as "Dental Subscale of the Children's Fear Survey Schedule" (CFSS-DS) was employed. RESULTS: The results showed that single children were significantly less cooperative and more anxious than the other children (p<0.001). The middle children were significantly more cooperative in comparison with the other child's position (p< 0.001). CONCLUSION: Single child may behave less cooperatively in dental setting. The order of child birth must also be considered in prediction of child's behavior for behavioral management.

Clinical Success Rate of Compomer and Amalgam Class II Restorations in First Primary Molars: A Two-year Study.

Background and aims. The majority of failures in Class II amalgam restorations occur in the first primary molar teeth; in addition, use of compomer instead of amalgam for primary molar teeth restorations is a matter of concern. The aim ofthe present study was to compare the success rate of Class II compomer and amalgam restorations in the first primary molars. Materials and methods. A total of 17 amalgams and 17 compomer restorations were placed in 17 children based on a split-mouth design. Restorations were assessed at 12- and 24-month intervals for marginal integrity, the anatomic form and recurrent caries. Data were analyzed with SPSS 11. Chi-squared test was applied for the analysis. Statistical significance was set at P<0.05. Results. A total 34 restorations of 28 restorations (14 pairs) of the total restorations still survived after 24 months. Compomerrestorations showed significantly better results in marginal integrity. Recurrent caries was significantly lower incompomer restorations compared to amalgam restorations. Cumulative success rate at 24-month interval was significantlyhigher in compomer restorations compared to amalgam restorations. There was no statistically significant difference inanatomic form between the two materials. Conclusion. Compomer appears to be a suitable alternative to amalgam for Class II restorations in the first primary mo-lars.

Evaluating of life quality in patients with acne vulgaris using generic and specific questionnaires.

Background. Acne vulgaris is a common skin disease that can adversely affect the quality of life of patients. Objective. The aim of this study was to determine the quality of life in patients with acne vulgaris. Methods. This study was carried out on 70 patients with acne vulgaris (28 males, 42 females). All the patients filled out two Persian versions of questionnaires: short form 36 (SF-36) and Dermatology Life Quality Index (DLQI). The obtained data were analyzed by using SPSS software (version 17). Results. The scores for physical functioning, social functioning, and bodily pain domains in patients were over 70%, but the scores for role physical, general health, vitality, role emotional, and mental health in patients were under 70%. Scores on the DLQI in patients with acne vulgaris ranged from 0 to 22 (mean ± SD, 8.18 ± 4.83). After comparing mean score of DLQI with respect to gender and age, it was found that the difference between the two groups was not statistically significant. Conclusion. Acne vulgaris has a significant effect on the quality of life. There was not any significant gender or age related difference in QOL.

MSX1 mutation in witkop syndrome; a case report.

The Witkop syndrome is a rare autosomal dominant disorder characterized by the absence of several teeth and abnormalities of the nails. This is the first report of a rare genetic tooth and nail syndrome diagnosed in a 2.5-year-old boy with early exfoliation of the primary canine, absence of the primary incisors, and nail dysplasia. A homozygous mutation was identified in 3'-UTR of MSX1 gene in the proband. The parents of the patient had no dental and nail anomalies.

Effect of pre-cooling injection site on pain perception in pediatric dentistry: "A randomized clinical trial".

BACKGROUND: Injection of local anesthesia is one of the most important reasons for development of avoidance behavior in children. Efforts have been performed to decrease pain perception of injection. The present research evaluated the effect of cooling the injection site on pain perception before infiltration of local anesthetics. MATERIALS AND METHODS: A prospective single-blind crossover clinical trial was used to investigate pain perception in 50 healthy pediatric patients who needed bilateral buccal infiltration of local anesthetics for dental treatment. They received a topical anesthetic agent (Benzocaine) on one side (control) for 1 min and topical anesthetic agent plus one minute of ice pack on the other side (trial) prior to the injection. A dentist blind to the study assessed the patients' reaction during injection. Wilcoxon and Mann-Whitney U tests were used for statistical analysis. Statistical significance was defined at P < 0.05. RESULTS: The means of sound, eye, and motor scales (SEM) were 4.06 ± 1.32 and 5.44 ± 1.79 for the study and control groups, respectively. The means of visual analogue scales (VAS) for the study and control groups were 42.20 ± 12.70 and 58.40 ± 16.83, respectively; with statistically significant differences between the two groups (P < 0.05). CONCLUSION: Cooling the injection site before infiltration of local anesthetics in the buccal mucosa for 1 min, reduced pain perceived by pediatric patients.