Cleaning efficacy of various root canal irrigants in primary teeth: a scanning electron microscopic study.

Root canal irrigation plays an important role in debridement and disinfection of the root canal system. The present study aimed to evaluate the efficacy of 17% ethylenediaminetetraacetic acid (EDTA), 2% iodine-potassium iodide (IKI), and 1% and 3% concentrations of sodium hypochlorite (NaOCl) for root canal irrigation in the anterior primary teeth. A total of 60 anterior primary teeth were selected and assigned to 1 of 4 irrigation groups (n = 15): 1, 17% EDTA; 2, 3% NaOCl; 3, 2% IKI; and 4, 1% NaOCl. The root canals in all groups were subsequently irrigated with normal saline following a 30-minute incubation period. The prepared specimens were cut longitudinally and imaged using scanning electron microscopy to evaluate the cleaning efficacy in the coronal, middle, and apical thirds. Data were analyzed using descriptive statistics as well as nonparametric Kruskal-Wallis and Mann-Whitney U tests. Group 2 (3% NaOCl) showed the greatest efficacy for cleaning the entire root canal (P < 0.01). Analysis of the different parts of the root canal revealed that group 2 also demonstrated the greatest efficacy in achieving a clean apical portion (P < 0.01). According to the results of the present study, 3% NaOCl offered a better performance in irrigating the root canals of primary teeth.

Effects of the Consumption of Probiotic Yogurt Containing Bifidobacterium lactis Bb12 on the Levels of Streptococcus mutans and Lactobacilli in Saliva of Students with Initial Stages of Dental Caries: A Double-Blind Randomized Controlled Trial.

Dental caries, caused by oral microbiota, is one of the most common human diseases. The present study aimed to investigate the effect of consumption of probiotic yogurt containing Bifidobacterium lactis Bb12 on salivary Streptococcus mutans and lactobacilli in students with initial stages of dental caries. In this double-blind randomized placebo-controlled clinical trial, 66 students (18-30 years) with initial stages of dental caries were selected and randomly assigned into 2 groups: the intervention group received 300 g/day of probiotic yogurt and the control group received 300 g/day of conventional yogurt for 2 weeks. An unstimulated fasting saliva sample was collected pre- and post-intervention. Bacterial counting was performed for salivary S. mutans and lactobacilli. A significant reduction in salivary S. mutans and lactobacillus counts was observed in the intervention group compared to their baseline and compared to the control group. In conclusion, it is suggested that the consumption of probiotic yogurt containing B. lactis Bb12 may modify the oral biofilm.

Anticaries Activity of Curcumin on Decay Process in Human Tooth Enamel Samples (In Vitro Study).

BACKGROUND: Dental caries is a big public health problem which is prevalent in the highest degree worldwide, especially in lower socioeconomic levels. This study aims to investigate the anti-caries effects of Curcumin in Turmeric on the caries model of enamel under laboratory conditions. METHODS: In order to make a reliable model of caries, a Streptococcus mutans (ATCC 3568) bacterium was used. The biofilm was created on enamel slabs in 5 days. There were 5 groups of slabs. In order to create Cariogenic conditions, the slabs were exposed to Sucrose 10% three times a day and then, it was exposed to different concentrations of Curcumin (5, 10, 20 mg/ml). The slabs of one group were exposed to the normal saline after the exposure to Sucrose and called positive caries control group; and the other group was exposed to normal saline in each time of exposure which was called negative caries control groups. Environment PH was measured by PH meter two times in a day. After the laboratory phase, the slabs were washed and dried and Vickers hardness test was used to determine the superficial hardness and then the decrease rate of superficial hardness (SHL%) was measured by the approved formula. SPSS version 20 was used to analyse the data. Then, to analyse the data, One-way ANOVA with 95% confidence, Kolmogorov - Smirnov, and Tukey test was used. RESULTS: The present study showed that Curcumin can have anti caries effect at the most level even in the least level of concentration used in this study (5 mg/ml). With regard to changes in PH of environment, we can declare that Curcumin results in reducing the dental caries by restraining the bacterial activity. CONCLUSIONS: Regarding that these results were received in laboratory conditions, further studies are needed.

Four-level evaluation of health promotion intervention for preventing early childhood caries: a randomized controlled trial.

BACKGROUND: Early childhood caries (ECC) is the most common dental disease among children, which can affect children's primary teeth during their teething. This study evaluates an intervention for preventing early childhood caries in a pediatric population in Ahvaz, Iran. METHOD: The population of this study (IRCT2017070210804N10) consists of 104 women with 12 to 36 months of age without dental caries referred to a health care center in Ahvaz, Iran. The children were randomly assigned to either an experimental or control group in equal numbers. First, the demographic information of participants was collected through a questionnaire containing components of perceived threat, health literacy, and oral health behaviors using a valid and reliable questionnaire. The ECC status of the children was established by a dentist. Control group received "standard well baby care". The experimental group received standard well baby care in addition to educational interventions, including lecture and group discussion. After 6 months, the participant completed the questionnaire for the second time, and the children's teeth were reexamined. Data were analyzed using SPSS version 15 at a significance level of p < 0.05. RESULTS: The mean ages of women and children were 31 ± 6.68 years and 18 ± 7.21 months, respectively. Before the intervention, no significant difference was documented between the groups for the study variables, p > 0.05. However, after the intervention, a significant difference was observed between the perceived threats (41.15 ± 4.46 in the experimental group and 38.26 ± 4.21 in the control group, p = 0.001), health literacy (20.98 ± 2.15 in the experimental group and 19.76 ± 2.70 in the control group, p = 0.01), oral health behaviors (7.75 ± 2.30 in the experimental group and 6.15 ± 2.65 in the control group, p = 0.01), and the incidence of ECC (13% in the experimental group and 35% in the control group, p = 0.001). CONCLUSION: This intervention had positive effects on the perceived threat, health literacy, and health behaviors; and the intervention could reduce the incidence of ECC. The finding of this study provided a suggestion for evidence-based decision-making processes regarding ECCs prevention programs. TRIAL REGISTRATION: IRCT2017070210804N10 (retrospectively registered).

Effects of Chitosan as a Novel Obturation Material for Pulpectomized Teeth on Periapical Inflammation, Periodontal Ligament Widening, and Hard Tissue Resorption: A Preliminary Exploratory Study on Dogs.

Objectives: This preliminary animal study was conducted to assess the effects of chitosan as a novel obturation material for pulpectomized teeth on periapical inflammation, periodontal ligament (PDL) widening, and hard tissue resorption. Materials and Methods: Forty premolar root canals in two mature dogs were obturated with zinc oxide eugenol (ZOE) and an experimental 3% chitosan paste (n=20 in each group). The teeth were then restored with amalgam. After 28 days, the dogs were sacrificed, and histopathological assessment was performed. The amount of resorbed obturation material, degree of inflammatory response, degree of PDL widening, and the number of bone/cementum/dentin resorption defects were recorded under ×40 and ×200 magnifications. Data were analyzed using the Mann-Whitney U test, one-sample Wilcoxon signed-rank test, and Fisher's exact test (α=0.05). Results: Bone, cementum, and dentin resorption were seen in 6, 10, and 1 chitosan-obturated canals and 14, 15, and 0 ZOE-obturated canals, respectively. Only the bone resorption defects were significantly fewer in the chitosan group (P=0.026). Mild, moderate, and severe inflammation were observed in 17, 3, and 0 chitosan-obturated canals, and 7, 9, and 4 ZOE-filled canals, respectively (P=0.004). Mild, moderate, and severe PDL widening were seen around 15, 5, and 0 chitosan-filled canals and 7, 12, and 1 ZOE-filled canals, respectively (P=0.025). Conclusion: The 3% chitosan was superior to ZOE in terms of causing less inflammation and PDL widening. It also decreased bone resorption and acted similar to ZOE in terms of dentin and cementum resorption.

Evaluation and comparison of mineral trioxide aggregate and cold ceramic in primary tooth pulpotomy: Clinical and radiographic study.

Aim: In recent years, many studies have been conducted on different materials for covering the pulp in pulpotomy. Recently, some materials such as Coldceram have been introduced that have the ability to regenerate the pulp. In this study, our aim was to compare the clinical and radiographic success of the pulpotomy of milk molars using MTA and Coldceram over 3-, 6-, and 9-month follow-ups. Methods: In this clinical trial, 42 children aged 4-9 years old who fulfilled the inclusion criteria of the study were selected. Finally, pulpotomy was conducted on 42 teeth using MTA and another 42 teeth using Coldceram in these children. Simultaneously, all teeth were permanently repaired using glass ionomer and metal veneers in the same treatment session. Then, clinical and radiographic evaluation was conducted in 3-, 6-, and 9-month follow-up periods. Results: None of the teeth showed clinical symptoms at the specified 3-, 6-, and 9-month follow-up times, and clinical success was 100% in both groups. In radiographic evaluation, the numbers of successful treatments were 42/42 (100%) and 41/42 (97%) for the teeth treated with MTA and Coldceram, respectively. Conclusion: According to this research, both materials were proven to have a 100% clinical success rate, but in the radiographic evaluation, MTA attained a higher success rate compared with Coldceram; however, this difference was not statistically significant (P = 0.36). It is recommended to consider longer follow-ups and larger sample sizes in future studies.

Oral health status among orphan and non-orphan children in Mashhad: a case-control study.

Developing and modifying the policies of orphanages requires the availability of accurate information. This study aimed to compare caries and oral hygiene status among orphan and non-orphan children. This descriptive cross-sectional study took place in governmental orphanages and schools of both genders in Mashhad, Iran. The prevalence of caries was assessed using the Decayed, Missing and Filled Tooth (DMFT) index, and oral health status was assessed using the Oral Hygiene Index - Simplified (OHI-S). The results were statistically analyzed using a t-test and Chi-Square test. The mean DMFT was 3.36 in orphans and 2.10 in non-orphan children, which was not statistically significant (p=0.6). The mean dmft was 9.01 in the orphan group and 5.26 in the non-orphan group, which was statistically significant (p=0.003). The average OHI-S index was 2.30 in the group of orphan children and 1.05 in the non-orphan children, presenting a statistically significant difference (p=0.00). The prevalence of caries, especially in deciduous teeth, was high among orphan children. The oral health status of these children was worse than that of children living at home. Consequently, there is a need for proper planning to promote the oral health of children living in orphanages.

Effect of postbiotic-toothpaste on salivary levels of IgA in 6- to 12-year-old children: Study protocol for a randomized triple-blind placebo-controlled trial.

Background: Children in mixed dentition are highly at risk for dental caries, which is a major health issue worldwide. Despite their effect in controlling dental caries, using probiotics can be challenging. Therefore, it has been advised to use their inanimate forms, called postbiotics. We hypothesize that postbiotics can enhance the oral immunity. Methods: The aim of this triple-blind, randomized, placebo-controlled trial is to investigate the effect of postbiotic-toothpaste (Bifidobacterium animalis subsp. animalis) on salivary levels of Immunoglobulin A (IgA) and pH in children. Using comparing two means formula to calculate the sample size, for this trial 80 healthy 6- to 12-year-old children during mixed dentition with no cavitated dental caries will be selected by convenience sampling method and randomly allocated to two groups, postbiotic-toothpaste or placebo-toothpaste. Saliva samples will be gathered at baseline and four weeks after the intervention. The level of salivary IgA will be determined by ELISA and salivary pH will be measured using a pH meter. Data will be compared within and between groups using independent t-test and paired t-test, in case of normality, with a p < 0.05 as statistically significant. Discussion: If postbiotics-toothpaste prove to be effective in improving the oral immunity, they can be used to prevent dental caries and other oral diseases. The result of this study can help researchers who are working on the immunomodulatory effects of postbiotics in children. Trial registration number: Iranian Registry of Clinical Trials (IRCT), IRCT20191016045128N2. Registered on 7 March 2022.

Comparison of the effect of fluoride gel and two toothpastes with different materials on remineralization of initial carious lesions in primary teeth.

INTRODUCTION: Various types of toothpastes are claimed to be able to improve initial enamel caries. This study compared the effect of fluoride gel and two toothpastes on remineralization of initial caries lesions in primary teeth. MATERIALS AND METHODS: A total of sixty-four sound extracted primary canine were immersed in demineralizing solution at 37°C for 96 h to produce artificial caries in vitro. Enamel pieces (3 × 3 × 5 mm) were prepared from each tooth and mounted in self cure acrylic blocks. The specimens were randomly assigned to four groups (n = 16) based on treatment agent (fluoride gel, Chitodent toothpaste, ReminPro toothpaste, no treatment as control) and underwent a pH cycling model for 10 days. Vickers microhardness (VH) was measured before and after treatment. Data was analyzed using analysis of variance and paired t-test by SPSS 18 (P < 0.05). RESULTS: No significant difference was found in VH between groups at baseline (fluoride group: 265.9 ± 44.8, Chitodent group: 282.6 ± 34.6, ReminPro group: 266.5 ± 26.6, control: 272.7 ± 32.5; P = 0.516). Microhardness significantly increased after exposure to ReminPro toothpaste (VH change: 24.1%, P < 0.001) and fluoride gel (VH change: 10.9%, P = 0.046), but no significant changes were observed in Chitodent (VH change: 2.8%, P = 0.635) and control (VH change: - 2.2%, P = 0.181) groups. CONCLUSION: ReminPro toothpaste might be effective in remineralizing initial carious lesions of primary teeth.

Effects of three commercial toothpastes incorporating "chitosan, casein phosphopeptide-amorphous calcium phosphate, sodium monofluorophosphate, and sodium fluoride" on remineralization of incipient enamel caries in the primary dentition: A preliminary in vitro study.

BACKGROUND: Given the importance of primary dental caries, assessment of new preventive/therapeutic materials is necessary. In light of the scarcity of such studies on the role of new agents in primary dentition, this study assessed the efficacy of three commercial toothpastes with different ingredients on remineralization of early caries in the primary dentition. MATERIALS AND METHODS: Thirty-nine intact primary canines were used in this in vitro experimental study. The baseline microhardness of enamel was measured. Particular demineralizer was used for 96 h and then secondary microhardness was measured. Then, samples were divided into three groups treated by toothpastes with sodium fluoride, chitosan, and casein phosphopeptide-amorphous calcium phosphate and sodium monofluorophosphate (CPP-ACP+SMFP). Each group was incubated and pH-cycled. Subsequently, they were demineralized and remineralized using toothpastes. Eventually, tertiary microhardness was measured. Percent of enamel microhardness recovery (EMHR%) and efficacy of toothpastes in remineralization were established. Data were analyzed using paired t-test, repeated-measures test, Kruskal-Wallis, and Mann-Whitney U-test (α = 0.05, 0.017). RESULTS: Demineralization significantly reduced microhardness from 316.2 to 248.5 Vickers hardness number (VHN) (P = 0.000). All toothpastes succeeded to remineralize the enamel significantly (P = 0.000). The efficacies of toothpastes differed significantly (P < 0.05). Mean EMHR percentages of toothpastes incorporating NaF, chitosan, and CPP-ACP+SMFP were 75.1%, 52.5%, and 55.8%, respectively. The highest increases in enamel microhardness were observed after using NaF-containing toothpaste (~53 VHN) which was significantly superior to other toothpastes (P ≤ 0.001). However, there was no statistically significant difference between EMHR percentages of toothpastes including chitosan and CPP-ACP+SMFP (P = 0.739). CONCLUSION: Although all three toothpastes could increase the microhardness of primary enamel, NaF toothpaste was superior to others. Toothpastes having chitosan and CPP-ACP+SMFP acted rather similarly.

Investigating The Antimicrobial Activity Of Different Root Canal Filling Pastes In Deciduous Teeth.

BACKGROUND: The antiseptic property of root canal filling materials is very important for the removal of residual pathogens from root canals. The aim of the current study was to investigate the antimicrobial activity of mineral trioxide aggregate (MTA), calcium hydroxide (CH), Metapex, zinc oxide eugenol (ZOE), and CEM-cement. MATERIALS AND METHODS: Four standard bacterial strains including Staphylococcus aureus (ATCC 6538), Enterococcus faecalis (ATCC 29212), Pseudomonas aeruginosa (ATCC 27853), and Bacillus subtilis (ATCC 6633) and Candida albicans (ATCC 10231) were used. On five plates containing Brain Heart Infusion (BHI) agar, five cavities were made. Then, the plates were cultured by 0.1 mL of bacterial suspension with a concentration of 0.5 McFarland. Afterwards, the cavities were filled with the tested materials and were incubated at 37 °C for 24, 48, and 72 hrs. Diameters of microbial inhibition zones were then measured. RESULTS: The highest mean diameter of growth inhibition zones was observed around ZOE and then CH and CEM-cement. According to the Kruskal-Wallis test, there was a significant difference among the tested groups (P<0.041). CONCLUSION: Considering antimicrobial activity, CH was an acceptable alternative to ZOE.

Volumetric Assessment of Root Canal Obturation Using 3% Nano-Chitosan versus Zinc Oxide Eugenol (ZOE) and Iodoform-Calcium Hydroxide (Metapex), in Primary Root Canals Shaped with Rotary versus Manual Methods: A Preliminary In-Vitro Spiral CT Study.

OBJECTIVES: In this study, chitosan was introduced and used as a substitute for pulpectomy obturation against conventional materials: zinc oxide eugenol (ZOE) and iodoform-calcium hydroxide (Ca(OH)2). Efficacies of rotary versus manual instrumentations were also compared. MATERIALS AND METHODS: This preliminary study was performed on 152 intact nonresorbed root canals of primary molars divided into rotary (n=78) versus hand-instrumentation (n=74) and into ZOE (n=53), iodoform-Ca(OH)2 (n=50), and 3% nano-chitosan (n=49). Canals were cleaned/shaped using hand or rotary files. Canal spaces were measured using spiral computed tomography and obturated using the three materials. The percentages of obturation volume (POV) were estimated. Rotary and manual instrumentations were compared in terms of canal spaces before and after obturation. Three obturation materials were also compared regarding canal spaces after obturation (α=0.05). RESULTS: Average POVs of materials were 96.54% (ZOE), 97.87% (Metapex), and 74.74% (nano-chitosan; P=0.000). POV of chitosan differed from the other two (P<0.001) but the other two were similar (P=0.896). Average POVs were 91.46% (manual) and 88.51% (rotary); the difference was not significant (P=0.322). Preobturation spaces of canals for different methods were 3.89 mm 3 (manual) and 3.26 mm 3 (rotary); the difference was significant (P=0.013). Two-way ANCOVA showed a significant effect of materials (P<0.001) but not root length (P=0.585) or shaping methods (P=0.362) on POVs. CONCLUSION: Nano-chitosan showed a considerable success rate but it still needs reformulation as it was weaker than the extremely successful commercial competitors. Rotary instrumentation can provide results similar to hand-filing in terms of POV although it might yield smaller canals.

Effects of Restoring the Primary Dentition with Stainless-Steel Crowns on Children's Salivary Nickel and Chromium Levels, and the Associations with Saliva pH: a Preliminary Before-After Clinical Trial.

Nickel and chromium existing in stainless-steel crowns (SSCs, used in pediatric dentistry) might be cytotoxic and allergenic. However, no in vivo studies have examined their salivary levels in children using SSCs, or in young children without SSCs. Also, the effect of acidity on metal ion release has not yet been evaluated in any previous in vivo studies in the whole literature. Therefore, this preliminary before-after clinical trial was conducted. Salivary nickel/chromium levels of 30 children before and after 2 months of placement of SSCs were measured using atomic absorption spectrophotometry. Salivary pH was measured with a digital pH meter. The effects of treatment, pH, number of SSCs, gender, and age on salivary ions were analyzed statistically (α = 0.05, ß = 0.15). Salivary nickel concentrations increased from 4.9010 ± 4.7390 to 5.6320 ± 4.7210 µg/L (P = 0.000, paired t test). Chromium increased from 0.3273 ± 0.5214 to 0.4199 ± 0.6404 µg/L (P = 0.016). Saliva pH increased from 6.81 ± 0.52 to 7.04 ± 0.47 (P = 0.000). Ion levels were not correlated with pH (P > 0.14), except chromium in the follow-up (rho = - 0.435, P = 0.016). Nickel increase (but not chromium increase) was correlated with pH increase (rho = 0.367, P = 0.046). Age was only correlated with baseline chromium (rho = 0.373, P = 0.042). Being male was associated with baseline/follow-up nickel levels (P ≤ 0.030). SSC number was not correlated with ions or pH (P > 0.36). It was shown for the first time that SSCs might increase salivary nickel and chromium concentrations and reduce saliva acidity. Nickel increase might be in line with pH elevation. The raised pH might be associated with reduced chromium release. Boys might have higher nickel levels than might girls, with or without SSCs.

Evaluation of nickel releasing from stainless steel crowns regarding to "trimming": An in vitro study.

CONTEXT: Stainless steel crowns (SSCs) are the most durable and effective restorations for the primary teeth. Allergy to nickel as major components is common. AIMS: The purpose of this study is to evaluate the effect of pH, time, oral temperature, and SSCs trimming on the nickel releasing. SETTINGS AND DESIGN: This in vitro study was done on 18 same size crowns. SUBJECTS AND METHODS: Group A (without trim 0 and Group B (with trim) were immersed in 5 ml artificial saliva. The amount of nickel releasing in each 18 subgroup composed from 3 pH (3.5, 5, and 6.75) and 3 temperatures (27°C, 37°C, and 47°C) in 3 times (1, 7, and 21 days), was measured by Atomic Absorption Spectrophotometer. STATISTICAL ANALYSIS: Data were analyzed by SPSS software (SPSS 20, IBM, Armonk, NY, USA) and use of t-test, Duncan, and Tukey's test for analysis of variances. Results were reported with 95% confidence. RESULTS: The amount of nickel releasing reduced with crown trimming, significantly (P = 0.0001). A significant difference was observed in the amount of released nickel in temperature 47°C in comparison with 37°C (P = 0.0001); this measurement was not significant between 47°C and 27°C (P = 0.442). There was no significant difference between concentration of released nickel in 3 pH conditions and also in 3-time situations. The concentration of nickel was lower in trimmed group in comparison to intact group (P = 0.0001). CONCLUSIONS: The concentration of released nickel decreased with trimming of margins and increased when temperature increased. Time and pH had no significant effect on released nickel.

Antibacterial Effects of Chitosan, Formocresol and CMCP as Pulpectomy Medicament on Enterococcus faecalis, Staphylococcus aureus and Streptococcus mutans.

INTRODUCTION: During pulpectomy of primary teeth, cytotoxic medicaments such as formocresol or camphor mono-chlorophenol (CMCP) are used as medicaments. For the first time it is theorized that chitosan can substitute these traditional materials used in pulpectomy of infectious primary teeth. METHODS AND MATERIALS: This preliminary in vitro study consisted of two separate phases (n=75), each of which assessed the antibacterial effects of chitosan versus formocresol and CMCP and positive/negative controls (n=15) on three bacteria types [Enterococcus faecalis, Staphylococcus aureus, Streptococcus mutans, (n=5 per subgroup)]. Phases 1 and 2 concerned respectively with 1- and 7-day effects of these materials. Bacteria were cultured and injected into sterilized canals and colonies were counted. Medicaments were applied and colonies were re-counted after 1 day of treatment (phase 1). Specimens were re-sterilized and re-randomized, and used for phase 2, in which the same procedures were performed for a 7-day period. Effects of agents on bacteria were analyzed statistically (Kruskal-Wallis α=0.05 and Mann-Whitney α=0.017). RESULTS: Treatments reduced bacterial count either after 1 or 7 days (P=0.000). Their effects on different bacteria types were not significant either after 1 or 7 days (P>0.48). Antibacterial efficacies of treatments (indicated by colony reduction) were significantly different, after 7 days (P=0.045). Antibacterial efficacy of chitosan was similar to that of formocresol or CMCP, in both phases [either after 1 or 7 days of treatment (P>0.017). Formocresol and CMCP had similar efficacies in either phase (P>0.017). CONCLUSIONS: This preliminary study confirmed the appropriate antibacterial efficacy of chitosan as a medicament in pulpectomy of infectious primary teeth.

Effects of Pretreatment Exposure to Dental Practice Using a Smartphone Dental Simulation Game on Children's Pain and Anxiety: A Preliminary Double-Blind Randomized Clinical Trial.

OBJECTIVES: Studies on modeling a pre-exposure technique for the prevention of anxiety in children are rare, and there is no study on interactive modeling using computer games. We assessed the effect of playing a dental simulation game before operation on pain and anxiety in 4- to 7-year-old children during their first dental treatment session. MATERIALS AND METHODS: In this double-blind randomized clinical trial, 50 children needing unilateral pulpotomy and placement of stainless-steel crowns (SSC) on mandibular primary first molars were enrolled and randomly divided into experimental (a simulation game) and control (no intervention) groups. The experimental group played the game twice a day for two weeks before the scheduled visit. At the dental session, their pre- and post-operative pains were recorded using the Wong-Baker Facial Rating Scale (W-BFRS). Also, heart rate (HR; as an indicator of anxiety) was measured using a finger pulse oximeter at six treatment stages: (1) baseline (at the initial session, two weeks before treatment) and (2-6) during different stages of treatment. Effects of playing the simulation on pain and HR were analyzed using t-test and repeated-measures two-way analysis of covariance (ANCOVA). RESULTS: Game playing significantly reduced the HR (P=0.031). The interaction of playing with the treatment period was also significant (P=0.004). When the groups were compared in each of the six time points, the experimental group showed reduced HR during anesthetic injection and cavity preparation using a high-speed handpiece (P<0.003). CONCLUSIONS: Based on the results, playing certain dental simulation games before the first dental visit might reduce the anxiety felt during anesthetic injections and drilling.

Knowledge, attitudes, and practices regarding the oral health of children: a cross-sectional study among iranian parents

Parents are responsible for their children's health care, and their oral health-related knowledge, attitude, and habits can affect their children's oral health. Aim: The objective of this study was to evaluate parents' knowledge, attitudes, and practices regarding their children's oral health. Methods: In this study, a sample of 398 parents of 4- to 6-year-old children completed a self-designed questionnaire. The parents' oral health-related knowledge, attitudes, and practices were assessed. Children's oral health was evaluated using decayed, missing, and filled tooth index (dmft). Data were analyzed using the SPSS version 23.0 with a p < 0.05 as statistically significant. Categorical data were reported as frequency (%), and continuous data were reported as mean ± SD. Moreover, Spearman's correlation, multiple regression, Mann-Whitney test, Kruskal Wallis test, and Kolmogorov-Smirnov test were used. Results: Most of the parents had a satisfactory level of knowledge and positive attitudes regarding their children's oral health. The knowledge and attitude scores were higher among parents with higher education (p<0.001), and the knowledge score was higher among mothers (p=0.004). Also, the attitude score was correlated with the number of decayed, missed, and filled teeth of children (p=0.01, p=0.04, and p=0.007, respectively). However, there was no significant relationship between dmft and the parents' knowledge, attitudes, and practices using multiple regression. The mean dmft of children was 6.86 ± 3.56, and most of the parents had poor oral health-related practices. Conclusion: The parents' level of knowledge and attitudes were satisfactory, but they had poor oral health practices. Moreover, there was no significant relationship between children's oral health and their parents' level of knowledge, attitudes, and practices. Educating programs and strategies are needed to enhance parents' oral health-related attitudes and knowledge and, more importantly, change their oral health practices

Comparative evaluation of shear bond strength of metallic brackets bonded with two different bonding agents under dry conditions and with saliva contamination.

BACKGROUND: This study compared the shear bond strength of metallic brackets bonded with Single Bond and Assure bonding agents under dry and saliva-contamination conditions. METHODS: Sixty sound premolar teeth were selected, and stainless-steel brackets were bonded on enamel surfaces with Single Bond and Assure bonding agents under dry condition or with saliva contamination. Shear bond strength values of brackets were measured in a universal testing machine. The adhesive remnant index scores were determined after debonding of the brackets under a stereomicroscope. One-way analysis of variance (ANOVA) was used to analyze bond strength. Two-by-two comparisons were made with post hoc Tukey tests (p<0.001). Frequencies of adhesive remnant index scores were analyzed by Kruskal-Wallis test. RESULTS: Bond strength values of brackets to tooth structure were 9.29±8.56 MPa and 21.25±8.93 MPa with the use of Assure resin bonding agent under saliva-contamination and dry conditions, respectively. These values were 10.13±6.69 MPa and 14.09±6.6 MPa, respectively, under the same conditions with the use of Single Bond adhesive. Contamination with saliva resulted in a significant decrease in the bond strength of brackets to tooth structure with the application of Assure adhesive resin (p<0.001). There were no significant differences in the adhesive remnant index scores between the study groups. CONCLUSION: Application of Single Bond and Assure bonding agents resulted in adequate bond strength of brackets to tooth structures. Contamination with saliva significantly decreased the bond strength of Assure bonding agent compared with dry conditions.