Comparison of two histopathologic methods for evaluating subcutaneous reaction to mineral trioxide aggregate.

OBJECTIVES: One of the most important factors for suitable materials for pulp therapy is biocompatibility. Two histopathologic methods of Cox and Federation Dentaire International (FDI) were used to evaluate inflammation. In Cox method, density of inflammatory cells, tissue reactions like fibrosis, vascular responses like congestion and fibrin extravasation have been used to evaluate inflammatory reactions. The aim of this study was to compare the accuracy of pathologists' interpretations using two different methods. STUDY DESIGN: Three pathologists observed the degree of inflammation in 225 histopathologic sections. These sections showed inflammation in subcutaneous connective tissue of rats adjacent to polyethylene tubes, filled with white or gray mineral trioxide aggregate. Empty tubes served as controls. Samples were harvested after 7-, 15-, 30-, 60-, and 90-days. All pathologists examined the sections under a light microscope (Carl Zeiss, Oberkochen, Germany) at ×400 magnifications. Chi-Square test was used to evaluate the difference between inflammation grades when one pathologist used two methods. Cohen's Kappa value was used to measure agreement of three pathologists to recognize the degrees of inflammations when using one of the methods. RESULTS: There were no significant differences between the two methods when one of the pathologist used these methods to report the degree of inflammation (p=0.054). However, two other pathologists reported significant differences between two methods (p=0.005, p=0.001). In the FDI method, there was an acceptable agreement between first and second, and first and third pathologist in terms of the degree of inflammation, and intermediate agreement existed between the second and third pathologist. With the Cox method, no agreement among the pathologists could be found. CONCLUSION: The results of three pathologists in terms of rating inflammation with the FDI method showed better agreement than with the Cox method. Therefore, FDI method is more reliable than the Cox method to evaluate inflammation.

Microleakage comparison of glass-ionomer and white mineral trioxide aggregate used as a coronal barrier in nonvital bleaching.

OBJECTIVES: There is some evidence that the pH at the root surface is reduced by intracoronal placement of bleaching pastes, which is known to enhance osteoclastic activity. Therefore, it is recommended that a protective barrier be used over the canal filling to prevent leakage of bleaching agents. Glass-ionomer (GI) is commonly used as a coronal barrier before nonvital bleaching. Because mineral trioxide aggregate (MTA) creates high alkalinity after mixing with water, using MTA as a protective barrier over the canal filling may not only prevent leakage of bleaching agents and microorganisms, but may prevent cervical resorption. The aim of this study was to evaluate sealing ability of white mineral trioxide aggregate (WMTA) as a coronal barrier before nonvital bleaching. STUDY DESIGN: Root canals of one hundred thirty human maxillary incisors were instrumented and filled with gutta-percha without sealer. Gutta-percha was removed up to 3 mm below the cementoenamel junction (CEJ). The teeth were randomly divided into six experimental groups of 20 teeth each and two control groups of 5. In three experimental groups, WMTA was packed into the canal to the level of CEJ. In the remaining experimental groups, glass-ionomer (GI) was used as a coronal barrier. After a 24-hour incubation period, one of the following three bleaching agents was placed in the access cavity of each of the WMTA or GI groups. These three bleaching agents were 30% hydrogen peroxide, sodium perborate mixed with 30% hydrogen peroxide, and sodium perborate mixed with distilled water. The bleaching agents were replaced every 3 days for three times. In the positive controls, no coronal barrier was used. In the negative controls, all the tooth surfaces were covered by two layers of nail varnish. Microleakage was evaluated using protein leakage test. Statistical analyses were performed with the Kruskal-Wallis and Mann-Whitney tests. RESULTS: The experimental groups showed minimum leakage which was not significantly more than tha in the negative controls. There was no statistically significant difference in leakage between the experimental groups (p<0.05). CONCLUSIONS: This study indicated that different bleaching agents have no effect on sealing ability of WMTA.

Effect of alkaline ph on sealing ability of white mineral trioxide aggregate.

OBJECTIVES: The aim of this study was to evaluate microleakage of white mineral trioxide aggregate (WMTA) after its exposure to a range of alkaline environments during hydration. STUDY DESIGN: Seventy single-rooted teeth were divided into 4 experimental and 2 control groups. All the teeth were instrumented, and their apices were resected. Root-end cavities were filled with WMTA in the experimental groups. In the control groups, root-end cavities were not filled. Root-end fillings were exposed to alkaline environments with pH values of 7.4, 8.4, 9.4, or 10.4 for 3 days. Microleakage was evaluated by bovine serum albumin. Evaluations were carried out at 24-hour intervals for 80 days. Data were analyzed by one-way analysis of variance and a post hoc Tukey test at the 0.05 level of confidence. RESULTS: The number of days (mean ± standard deviation) needed for color change at pH values of 7.4, 8.4, 9.4, and 10.4 were 78.53 ± 5.68, 80.00 ± 0.00, 68.93 ± 19.00, and 34.46 ± 12.73, respectively. The time needed for leakage to occur was significantly shorter in samples stored at a pH value of 10.4 (P<0.001). CONCLUSIONS: Within the limits of this study, it can be concluded that pH values greater than 9.4 may jeopardize the sealing ability of WMTA during hydration.

The Viewpoints of Last-Year Dentistry Students of Shahid Beheshti University on the Application of Lasers as an Independent Credit in the Education of General Dentistry.

Introduction: Enhancing students' pragmatic skills as an enabling means brings about changes in their curriculum, which should be reconciled with the students' educational needs. Thus, this study seeks to examine the viewpoints of last-year dentistry students on the need for the instruction of laser application as an independent credit in the general dentistry curriculum. The findings of this study can help determine the educational priorities of students while providing and compiling their curriculum. Methods: This descriptive study was done on 91 last-year dentistry students of Shahid Beheshti University in a full census manner. The data collection tool was a fieldwork questionnaire, the validity and reliability of which were evaluated. To report the findings, frequency distribution, frequency percentage, and average tableaux were utilized. Results: Amongst the 91 participants, regarding the average figures of value assignment from 1 to 10 to respond to questions, the highest value was assigned to learning the side effects of lasers (7.99 ± 0.01) and the lowest value was assigned to learning about the history of lasers and light physics (4.53 ± 0.47). Conclusion: The findings indicate that students have a positive attitude toward the incorporation of an independent laser credit in their curriculum and thus the necessity of incorporating this credit in their curriculum can be posed.

Comparing Vitamin D Serum Levels in Patients with Oral Lichen Planus and Healthy Subjects.

STATEMENT OF THE PROBLEM: Lichen planus disease is a chronic inflammatory lesion without a known etiology. Recent studies have indicated the role of vitamin D on immune system and proposed its anti-inflammatory effects. PURPOSE: This study aimed to compare vitamin D serum levels in patients with oral lichen planus and healthy subjects. MATERIALS AND METHOD: In this case‒control study, 18 patients suffering from oral lichen planus referred to the Department of Oral Medicine, Tabriz Faculty of Dentistry were chosen as the case group and 18 healthy people were chosen as the control group. A 5-mL blood sample was taken from all subjects and the subjects' vitamin D serum levels were assessed with a vitamin D total (25-hydroxy vitamin D) kit by employing the electrochemiluminescence technique. The results were analyzed and compared by using SPSS17 statistic software. p< 0.05 was considered statistically significant. RESULTS: The mean vitamin D level in serum of patients with oral lichen planus was 30.7±20.38ng/ml and in healthy subjects was 36.45± 15.33ng/ml, the difference was not statistically significant (p= 0.346). CONCLUSION: The difference between the level of vitamin D in the serum of patients suffering from oral lichen planus and healthy individuals was not significant.

Diagnostic and prognostic relevance of salivary microRNA-21, -125a, -31 and -200a levels in patients with oral lichen planus - a short report.

BACKGROUND: Oral lichen planus (OLP), a relatively common chronic inflammatory disease of the oral mucosa, is considered to be a premalignant disorder of the oral cavity. Previously, several biomarkers have been tested for their diagnostic potential. Here, we aimed to investigate the diagnostic potential of four miRNAs, miR-21, -125a, -31 and -200a, known to be involved in oral squamous cell carcinoma (OSCC) development, in the saliva of OLP patients as also their putative relation to OSCC development in these patients. MATERIALS AND METHODS: Saliva samples from 30 patients with OLP were collected, 15 of whom were diagnosed with dysplasia upon histopathologic examination. In addition, 15 saliva samples from patients with OSCC and 15 saliva samples from healthy donors were collected. After RNA extraction, the respective miRNA levels were assessed by quantitative RT-PCR. RESULTS: We found that the miR-21 levels were significantly increased in saliva samples derived from patients with OLP, dysplastic OLP and OSCC, compared to those from healthy controls (p = 0.012, p = 0.0017 and p < 0.0001, respectively). Conversely, significant decreases in miR-125a levels were found in the OLP, dysplastic OLP and OSCC samples, compared to those from healthy controls (p < 0.0014, p < 0.0001 and p < 0.0001, respectively). In addition, significant increases in miR-31 levels were found in samples derived from dysplastic OLP and OSCC patients, but not in those from nondysplastic OLP patients, compared to those in healthy controls (p = 0.01 and p = 0.004, respectively). Finally, we found that the miR-200a levels were significantly decreased only in samples derived from OSCC patients (p < 0.0001). CONCLUSIONS: From our data we conclude that increased miR-21 levels in conjunction with decreased miR-125a levels in saliva of OLP patients may be indicative for a poor prognosis. Conversely, we conclude that lack of significant alterations in miR-31 and miR-200a levels in saliva of OLP patients may be indicative for absence of malignant transformation.

Frequency of Head and Neck Squamous Cell Carcinomas and Related Variables in Southern Iran (Ahvaz City): 10-Year Retrospective Study

Objective: Squamous cell carcinoma (SCC) is a life threatening lesion but there has been only limited research about its frequency in Iran. The aim of this study was to evaluate the frequency of squamous cell carcinoma of the head and neck in the records of the pathology department of Imam Khomeini hospital in Ahvaz between 2005 and 2015. Methods: The retrospective and cross-sectional study was conducted using 55,708 medical records of cancer throughout the body, accumulated in the pathology department of Imam Khomeini in Ahvaz in the designated period. Information about age, gender, site of involvement, histological characteristics, status of lymph node metastasis, smoking habit, family history, job and education level was extracted and data were analyzed with the Chi-square test with SPSS version 22. Result: Of the total of 55,708 records, 582 patients (1.04%) had head and neck squamous cell carcinomas. The male to female ratio was 2.85. The frequencies in the head, mouth and neck were 28.7%, 22% and 49.3% respectively. Significant relationships between being male and location (neck) (p = 0.002), age (60 to 80 years old) and being a farmer (p = 0.001) was observed. The most important correlated risk factors were: smoking, sunlight exposure, rural residence, job and education level. Conclusion: Head and neck squamous cell carcinomas were found to account for 1.04% of all cancers in Ahvaz, one of the southern provinces of Iran.

Extramedullary Plasmacytoma of the Oral Cavity in a Young Man: a Case Report.

Extramedullary plasmacytomas are rare solitary soft tissue tumors that arise from proliferations of malignant transformed monoclonal plasma cells and can be diagnosed through biopsy and histopathologic examination. These lesions are closely associated with multiple myelomas, which should be ruled out in all these cases by necessary laboratory and radiographic examinations. A 25-year-old man was referred to our clinic with a rapidly-growing painless lesion measuring about 2.5×3×3 cm in the palatal side of the left maxillary second and third molar teeth. A diagnosis of solitary plasmacytoma was made on the basis of clinical, radiographic, and histopathological findings. Early diagnosis of extramedullary plasmacytomas is of great importance. Radiotherapy is the common modality of treatment with or without adjuvant chemotherapy. Progression to multiple myeloma is possible; thus, close follow-up of the patient is essential after completion of the therapeutic procedure.

A comparison of the effect of triamcinolone ointment and mouthwash with or without zinc on the healing process of aphthous stomatitis lesions.

Background. Recurrent aphthous stomatitis (RAS) is one of the most common ulcerative diseases of the oral mucosa. Definitive etiology of RAS has not been conclusively established. There is no certain treatment for aphthous stomatitis but some drugs such as steroids are commonly used for the treatment of RAS. Regarding the effect of zinc on the healing process of epithelial layer and cell division, in this research the effect of triamcinolone (with orabase) in combination with a zinc-containing mouthwash and triamcinolone alone on the healing process of RAS lesions was assessed. Methods. The present study consisted of 20 patients diagnosed with RAS. The patients were instructed to rinse the mouth-wash or placebo three times a day and triamcinolone ointment twice a day for two weeks. The largest dimension of the ulcer was measured by a digital caliper and the severity of pain was assessed by visual analogue scale (VAS). Number, size, duration, ulcer-free period and pain of the lesions were evaluated twice a week for twomonths. Data were analyzed by SPSS 16 using Mann-Whitney U test and t-test. Results . A decrease was seen in the mean pain severity score (P = 0.631) and the size of the lesions but it was not statistically significant (P = 0.739). Also the difference between the number of lesions (P = 0.739), duration and ulcer-free period (P = 0.873) were not statistically significant. Conclusion. Zinc mouthwash seems to be as effective on wound healing process as typical treatment modalities for RAS.

Expedited removal of pyogenic granuloma by diode laser in a pediatric patient.

INTRODUCTION: Pyogenic granuloma (PG) is one of the inflammatory hyperplasia seen in the oral cavity. It is a reactional response to minor trauma or chronic irritation. The most common treatment of PG is surgical excision but alternative approaches such as laser excision have also been proposed especially for pediatric patients. CASE REPORT: Herein, we present a case of gingival pyogenic granuloma in a 6-year-old patient. The lesion was excised successfully with diode laser as a conservative and non-stressful method in a pediatric patient. RESULTS AND CONCLUSION: The use of laser as modern medicine offers a new tool for treatment of oral lesions as comfortable as possible in pediatric patients, which results in less stress and fear in children.

Relationship between Lichen Planus and Helicobacter pylori Infection.

BACKGROUND AND AIMS: Lichen planus (LP) is a relatively common, chronic dermato-mucosal disease that often affects the oral mucosa. Among bacterial infections affecting LP, Helicobacter pylori has recently been proposed as an important etiologic factor. The present study was designed to evaluate the association of LP and H. pylori infection. MATERIALS AND METHODS: This study included 30 patients with skin LP, 30 patients with oral LP and 30 healthy individuals without LP as control group. Patients and control group were selected from those referred to a dental and a dermatology clinic. Urea breathing test (UBT) was performed for all subjects. Descriptive statistic (frequency and percentage) were applied and chi-square test was employed to compare mean differences, using SPSS 13.0 computer software. RESULTS: UBT test were positive in 24 patients (80%) in oral LP group, 22 patients (73.3%) in skin LP group, and 20 individuals (66.7%) in the control group. No significant differences were found in the positive test results between the three groups (P = 0.50). CONCLUSION: In this study, no significant association was found between LP and H. Pylori infection.

Treatment of desquamative gingivitis with free gingival graft: a case report.

Recalcitrant gingival erythematous lichen planus lesions comprise a considerable therapeutic problem. This case of chronic desquamative gingivitis in a 25-year-old woman with erosive oral lichen planus was treated with topical and systemic corti-costeroid administration, followed by placement of a free gingival graft on right upper quadrant. Although recurrence of the lesions was observed following both treatment modalities, free gingival graft despite being an aggressive therapy, proved more effective and with fewer side effects compared with topical or systemic steroid therapy, and seems to be a promising treatment modality with the benefit of more stable results, among others.

Central giant cell granuloma of the posterior maxilla: a case report.

Central giant cell granuloma (CGCG), formerly called giant cell reparative granuloma, is a non-neoplastic proliferative lesion of unknown etiol-ogy. It occurs most commonly in the mandible. The case reported here resembled a wide variety of conditions that led to a misdiagnosis both on clinical and radiographic examinations but was histopathologically diagnosed as CGCG. We describe a case of CGCG arising from the poste-rior maxilla to highlight the importance of histo-pathology in the diagnosis of this enigmatic le-sion.