Design, Implementation, and Evaluation of Educational Program in Oral Health for Midwives and Other Antenatal Care Providers in Iran.

Background: Maintaining oral health during pregnancy has been considered an essential public health issue worldwide. One of the various preventive strategies is to train antenatal care providers to guide pregnant women. This study aimed to design, implement, and evaluate an educational program's effect on the oral health-related knowledge, attitudes, and practice of antenatal care providers in Iran. Materials and Methods: All of the antenatal care providers working at Isfahan health centers were invited for this study in April 2019. A total of 340 volunteers (120 midwives and 220 others) finally participated in this interventional study with a pre-test-post-test design. A questionnaire was developed to assess the participants' knowledge, attitudes, and practice before and after the intervention. A lecture-based educational session containing similar issues asked in the questionnaire was held for all the participants. The participant's total knowledge scores before and after the intervention, and their attitudes and practice were evaluated and compared through paired t-test. Results: The participants' mean total knowledge scores before and after the intervention were 42.87 and 52.25, respectively. The paired t-test revealed a statistically significant difference between pre- and post-intervention scores (p < 0.001). The frequency of participants' answers to attitude and practice questions was also determined. Conclusions: Improving oral health-related knowledge of antenatal care providers can be achieved through a single educational session designed by accurately assessing their needs. The participants' attitudes revealed barriers to seeking dental care by pregnant women; however, the participants' oral health-related practice was acceptable.

Rotary versus Manual Instrumentation for Root Canal Preparation in Primary Teeth: A Systematic Review and Meta-Analysis of Clinical Trials.

Objectives: The aim of this systematic review was to assess the scientific evidence on the effect of rotary versus manual instrumentation for root canal preparation in primary teeth. Materials and Methods: Search terms were selected based on Medical Subject Headings (MeSH) and non-MeSH terms. Electronic database search of English published literature was performed in March 2020 within the following databases: Scopus, Cochrane, PubMed, and Embase. The risk of bias of selected studies was assessed by means of Cochrane collaboration tool. The heterogeneity level among the included studies was measured by I 2 index. For statistical analysis of instrumentation time, standard mean difference (SMD) of continuous data was analyzed with 95% confidence intervals (95% CIs) using the fixed-effects model. A random-effects model was used for analysis of odds ratio (OR) to assess the probability of optimal fill, underfill, and overfill obturations. Forest plots were applied to show the results and to estimate the effectiveness of rotary instrumentation. Results: Seven articles were selected for this review. The SMD in rotary techniques was 1.79 min less than manual techniques (95% CI: -2.56--1.03 min) and had a significant P = 0.001. The OR of optimum quality was calculated to be 3.53 (95% CI: 1.79-6.97) in the rotary technique at P = 0.254. Conclusions: Within the limitations of this review, it can be asserted that rotary files decrease the instrumentation time and increase the rates of optimally filled canals in primary teeth. However, these files do not decrease the risk of underfilling and overfilling compared to manual files.

Immunogenicity and Safety of Three WHO Prequalified (DTwP -HB-Hib) Pentavalent Combination Vaccines Administered As Per Iranian National Immunization Plan in Iranian Infants: A Randomized, Phase III Study.

BACKGROUND: The pentavalent vaccine Pentavac was officially introduced in the Iranian National Immunization Plan in November, 2014. OBJECTIVE: To compare the immunogenicity and safety of Pentavac vaccine (Serum Institute of India Ltd.) with two other pentavalent vaccines available in Iran, i.e., Pentabio (PT Bio Farma (Persero)) and Shan 5 (Shantha Biotechnics Ltd.). DESIGN: Randomized, phase III study. PARTICIPANTS: 900 infants attending the study sites to receive the vaccine at 2, 4, and 6 months of age. INTERVENTION: Infants were randomly assigned to one of the Pentavac, Pentabio, and Shan 5 vaccine groups. OUTCOMES: The antibody titers were measured against five antigens, diphtheria, tetanus, pertussis, Haemophilus influenzae B, and hepatitis B before receiving the first dose and one month after the last dose. The adverse events following vaccination after each dose were recorded in the adverse events diary. RESULTS: All vaccines showed similar immunogenicity against four of the five antigens except pertussis. While vaccination with Shan 5 resulted in the highest immunogenicity against pertussis, Pentabio was significantly lower than the other two vaccines (P<0.001). The incidence of local adverse events significantly differed among the three vaccine brands (P<0.001), but the incidence of most of the evaluated systemic adverse events was similar (P>0.05). CONCLUSIONS: Pentavac and Shan 5 had similar immunogenicity, the former having better immunogenicity against pertussis than Pentabio. Pentavac and Pentabio had a comparable safety profile.

EFFECT OF PRE-COOLING ON PAIN ASSOCIATED WITH DENTAL INJECTIONS IN CHILDREN: A SYSTEMATIC REVIEW.

OBJECTIVES: Several methods, including cooling of the injection site, have been proposed for pain control during the dental local anesthetic injection. This systematic review aimed to evaluate the scientific evidence on the precooling of the injection site to reduce pediatric dental injection pain. DATA SOURCES: The search terms were selected according to the Medical Subject Headings and non-Medical Subject Headings. The main keywords included dental injection, cooling, pain, and children. Potentially eligible studies involved the subjective or objective pain evaluation in children receiving any dental injection. Risk of bias assessment was carried out using the Cochrane risk of bias tool. An electronic search was carried out for published studies in the English language up to March 2020 on Scopus, Cochrane, and PubMed databases. Of 761 articles retrieved initially, 14 were eligible to be included in the systematic review, of which 6 articles were excluded. Regarding the type of intervention, 6 articles used cooling agents in the intervention group, and 2 studies used the Buzzy device (a combination of cold and vibratory stimuli). All studies included in the systematic review except one considered that the use of intra- or extra-oral cooling could reduce pain during anesthesia injections in children significantly. CONCLUSION: Overall, the evidence presented in this review was limited and had low quality. It may be concluded that application of cold agents before dental anesthesia can be more helpful than the traditional dental injection in reducing pain in children. Besides, the use of the Buzzy device showed promising results, as shown by 2 studies.

Impact of Motivational Interviewing on Parental Risk-Related Behaviors and Knowledge of Early Childhood Caries: A Systematic Review.

BACKGROUND: Behavior is important in dental disease etiology, so behavioral interventions are needed for prevention and treatment. Motivational interviewing (MI) has been proposed as a potentially useful behavioral intervention for prevention of early childhood caries. METHODS: Studies have evaluated the effectiveness of MI on reduction of the risk-related behaviors for early childhood caries (ECC) compared to dental health education (DHE) The aim of this systematic review was to assess the scientific evidence on MI applied to change parental risk-related behaviors. The potentially eligible studies involved the assessment of caries-related behaviors in caregivers receiving MI. Electronic search of English published literature was performed in February 2020 in the Scopus, Cochrane, PubMed, and Embase databases. Assessment of risk of bias was done by the Cochrane risk of bias tool. RESULTS: Of 329 articles retrieved initially, seven were eligible for inclusion in this review. Four studies evaluated the behavior of tooth brushing and four studies assessed the cariogenic feeding practice, while only one study investigated the behavior of checking teeth for pre-cavities. Moreover, two studies examined dental attendance for varnish fluoride use and oral health-related knowledge. It was not possible to perform a meta-analysis. CONCLUSIONS: Generally, results support the application of MI to improve the "dental attendance behavior for fluoride use" and participants' knowledge. However, the results were inconclusive for other behaviors. We need further and better designed interventions to completely evaluate the impact of MI on specific ECC-related behaviors.

Anesthetic Efficacy of Lidocaine/Ketorolac in Inferior Alveolar Nerve Block in Patients with Irreversible Pulpitis: A Randomized Clinical Trial.

OBJECTIVE: The purpose of this randomized, double-blind study was to evaluate the anesthetic efficacy of lidocaine-ketorolac administration by Inferior Alveolar Nerve Block (IANB) in patients with irreversible pulpitis. METHODS: Eighty-eight adult patients received a combination of either one cartridge of '2% lidocaine with 1: 80.000 epinephrine' (Li) plus one cartridge of a mixture of 0.8 mL of the same solution and 1mL ketorolac tromethamine (KT)(30 mg/mL), or one cartridge of Li solution plus one cartridge of a mixture of the same solution and saline. Endodontic access was prepared after fifteen minutes. Anesthetic success was defined as no or mild pain [less than 54 mm on the Heft-Parker visual analog scale (HP-VAS)] during access cavity preparation and initial file insertion. Chi-square test was used for data analysis, and the level of significance was set at 0.05 (P=0.05). RESULTS: Results showed that the success rates were 34.1% and 27.3% for Li-KT and Li-Saline groups, respectively, with no significant difference between the two groups (P=0.48). However, significant decrease of baseline mean VAS pain score of the participants in both groups was found during access cavity preparation or initial file insertion (P<0.05). CONCLUSION: Mixed Li-KT solution did not increase the success rate of IANB injection significantly.

Impact of motivational interviewing on early childhood caries: A systematic review and meta-analysis.

BACKGROUND: The authors aimed to assess the scientific evidence on motivational interviewing for the clinical reduction of early childhood caries compared with traditional dental health education. METHODS: Search terms were selected on the basis of Medical Subject Headings and non-Medical Subject Headings terms. The main key words were motivational interviewing, early childhood caries, and education. Potentially eligible studies involved the clinical assessment of caries rate in children whose parents or caregivers received motivational interviewing as an intervention. The authors assessed the risk of bias using the Cochrane risk-of-bias tool. In March 2019, the authors performed an electronic database search of literature published in English within the following databases: Scopus, Cochrane, PubMed, and Embase. RESULTS: Of 329 articles retrieved initially, 14 were eligible for inclusion in the systematic review and 3 articles contributed to the meta-analysis. For statistical analysis, the mean difference of continuous data was analyzed at a 95% confidence interval using the random-effects model. CONCLUSIONS: Overall, the evidence presented in this review was limited. Although the results of the meta-analysis showed that motivational interviewing is as effective as dental health education in controlling early childhood caries, we need more and better designed and reported interventions to assess its impact on early childhood caries accurately.

In vitro evaluation of dentin tubule occlusion by three bioactive materials: A scanning electron microscopic study.

BACKGROUND: Dentin hypersensitivity (DH) is a common problem characterized by a short, sharp pain. Reduction of dentin permeability by occluding dentin tubules is considered as a method for treating DH. Many substances are available to decrease hypersensitivity. The aim of this study is to evaluate the ability of three different remineralizing agents for occluding dentinal tubules in comparison with positive and negative controls. MATERIALS AND METHODS: In this in vitro scanning electron microscopic (SEM) study, 75 extracted premolars were cut into crown and root fragments with a bur and divided into five groups: group 1: Sodium fluoride 5% varnish was applied (positive control), Group 2: No treatment (negative control), Group 3: Treated with Remin Pro (contains hydroxyapatite and fluoride), Group 4: Treated with MI paste (contains casein phosphopeptide-amorphous calcium phosphate [CPP-ACP]) and Group 5: Treated with GC tooth mousse (contains CPP-ACP). SEM images were obtained and mean tubular diameter was measured in each group. One-way ANOVA and Duncan's tests were used for statistical analysis. A significant level of α = 0.05 was set for comparison between the groups. RESULTS: Statistically significant difference was observed between Group 2 (negative control) and other four groups (P < 0.05). There was no significant difference between Groups 1, 3, 4, and 5 (P > 0.05). CONCLUSION: Under the limitations of the present in vitro study, it can be concluded that the application of a CPP-ACP paste as well as a paste which contains fluoride is effective on reduction of dentin permeability.

Efficacy of the Resin Infiltration Technique in Preventing Initial Caries Progression: A Systematic Review and Meta-Analysis.

Purpose: The resin infiltration technique, used as a microinvasive treatment for initial caries, seals white spot lesions on the tooth surface. The purpose of this systematic review was to perform a review on the effectiveness of resin infiltration in preventing initial caries progression. Methods: This review was conducted according to Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRIMSA) guidelines. The searched databases included Embase, Scopus, Cochrane, and PubMed, and no filters were applied other than the English language. The heterogeneity level among the included studies was measured by I2, Tau2, and Q indices using CMA (version 2) software. A forest plot was applied to show the results and to estimate the effectiveness of resin infiltration technique. Results: Eight articles were selected forthe quantitative analysis of data and preparation of evidence table. Results of the meta-analysis of all studies showed a risk ratio of 0.374 (95 percent confidence interval equals 0.291 to 0.480) which revealed that resin infiltration significantly reduced the risk of caries progression compared with the control groups (P<0.001). Conclusions: Within the limitations of this review, it can be asserted that the resin infiltration technique is effective in preventing initial caries progression in primary and permanent teeth.

Comparison of Oral Melatonin and Midazolam as Premedication in Children Undergoing General Anesthesia for Dental Treatment.

BACKGROUND: Dental anxiety is prevalent in children. This condition may cause uncooperative behavior and need a treatment under general anesthesia. The perioperative period, especially for children, is a stressing event. Premedication is commonly used to reduce perioperative anxiety and facilitate the induction of anesthesia. METHODS: 132 children candidates for dental treatment under GA were enrolled in this study and randomly divided into 3 groups. Oral melatonin, midazolam, and normal saline were administered as premedication. Patient's sedation score before GA, the ease of intravenous line establishment, patient's need for painkillers, and duration of recovery were evaluated and compared. RESULTS: Regarding the sedation score and response to IV access establishment, comparisons showed statistically significant differences between melatonin and midazolam groups (P < 0.05) as well as between midazolam and placebo groups (P < 0.001). The difference between melatonin and placebo groups was not significant (P > 0.05). The need for painkiller administration was statistically different between midazolam and placebo, melatonin and placebo, and midazolam and melatonin groups (P < 0.05). A statistically significant difference was also found between melatonin and midazolam as well as between melatonin and placebo groups (P < 0.05) with regard to the recovery duration while no significant difference was observed between midazolam and placebo groups (P > 0.05). CONCLUSION: Midazolam is superior to melatonin for premedication regarding the patients' sedation score before anesthesia and the ease of IV access establishment. Premedication with midazolam decreases the need for painkillers and increases the rate of recovery in children undergoing GA for dental treatment.

Accuracy of Digital Bitewing Radiography versus Different Views of Digital Panoramic Radiography for Detection of Proximal Caries.

OBJECTIVES: Dental caries are common and have a high incidence among populations. Radiographs are essential for detecting proximal caries. The best technique should be recognized for accurate detection of caries. The aim of this study was to compare the accuracy of detection of proximal caries using intraoral bitewing, extraoral bitewing, improved interproximal panoramic, improved orthogonality panoramic and conventional panoramic radiographs. MATERIALS AND METHODS: In this descriptive cross sectional study, 100 extracted human teeth with and without proximal caries were used. Intra and extraoral radiographs were taken. Images were evaluated and scored by two observers. Scores were compared with the histological gold standard. The diagnostic accuracy of radiographs was assessed by means of receiver operating characteristic (ROC) curve analysis (P<0.05). RESULTS: Microscopic evaluation of proximal surfaces revealed that 54.8% of the surfaces were sound and 45.2% were carious (with different depths). The differences in the area under the ROC curve (Az value) among the five techniques were not statistically significant. CONCLUSION: Improved interproximal panoramic and extraoral bitewing radiographs were superior to conventional panoramic radiography for detection of proximal caries ex vivo and should be considered for patients with contraindications for intraoral radiographs.

Effect of dentin conditioning on bond strength of fiber posts and dentin morphology: a review.

PURPOSE: Post and core systems are commonly used to restore endodontically treated teeth. A durable bond between fiber posts and dentin contributes to the success of the restorative treatment. Different irrigants are used during post space preparation and various studies have investigated the effects of these chemical agents on bond strength and dentin morphology. METHODS: The MEDLINE-PubMed, Cochrane, and SCOPUS databases were searched for appropriate papers addressing the effects of irrigants on bonding of fiber posts to dentin and on dentin morphology. Databases were searched from 2002 through 2012. The search was performed using a variety of keywords including fiber posts, bond strength, post space preparation, post space irrigation, and smear layer removal. RESULTS: Using multiple key words and different strategies, 68 publications were initially screened. The abstracts of these 68 publications were scanned for relevance, and 50 full-text articles were selected and read in detail. Thirty publications which discussed the effect of various intracanal irrigants on bond strengths of fiber posts and dentin morphology were incorporated in this review. Following review of all relevant papers, it can be concluded that bond strengths of fiber posts to radicular dentin can be affected by the irrigants used and that various irrigants affect different types of resin cements differently.