Clinical, radiological, and histological correlation in diagnosis of pulpitis.

Background: To establish an endodontic diagnosis, a clinician should consider a variety of factors. Various studies have failed to demonstrate a strong correlation between histological findings with clinical and radiographic assessments. This study sought to evaluate the histopathological features of reversible and irreversible pulpitis diseases and their correlation with clinical diagnosis in extracted human molar teeth. Materials and Methods: In this experimental ex vivo study, 75 molars with caries and three intact molars were used. According to the radiographic findings and clinical criteria and the need for root canal therapy, samples were categorized as having normal/reversible pulpitis and irreversible pulpitis. Immediately after extraction, an exposure was made at 2 mm below the cementoenamel junction. Formalin-fixed specimens were decalcified, sectioned and stained with hematoxylin and eosin for histological examinations using light microscopy. Variables including the type and severity of the inflammation, hyperemia, necrosis, fibrosis and the existence of an odontoblastic layer and dentin bridge were evaluated. The Fisher's exact test and the Chi-squared test were used for statistical analysis. P <0.05 was considered as significant. Results: Acute inflammation, hyperemia and pulp exposure were significantly more common among subjects with irreversible pulpitis (P < 0/005). However, fibrosis was significantly higher in the reversible group (P < 0/005). There were no statistically significant differences between the groups regarding the other variables. Conclusion: Some discrepancies between clinical, radiographic and histological findings were observed in our experimental study. Indeed, effective clinical practice requires consideration of all discrepancies found.

Knowledge and Practice of Kerman Dentists about Infection Control in Digital Radiography.

Statement of the Problem: Infection control is essential for a safe clinical environment during patients' treatment in dentistry. Transmission of the infection can occur due to contact with patients' saliva and blood in radiology clinics. Purpose: The purpose of this study was to investigate the knowledge and practice of dentists in Kerman about infection control in digital radiology. Materials and Method: This cross-sectional study was conducted on 162 dentists who worked either in private office or clinic or both. The samples were selected through simple sampling method. Data were collected through demographic data, and valid and reliable questionnaire consisted of 7 questions about knowledge and 12 questions about practice on infection control in digital radiology. Data were analyzed in SPSS 26 software using T, ANOVA, and linear regression tests. The p value was considered at 0.05% significant level. Results: 86(53.1%) of participants were men and 76 (46.9%) were female. The mean age of participants and work experience were 36.32±8.88 and 11.03±8.53 years, respectively. The mean and standard deviation of knowledge, practice, and total were 5.20±1.26, 7.98±2.00, and 13.22±2.72, respectively. There was a positive significant correlation between knowledge with age of participants (p= 0.009). There was also a direct significant correlation between knowledge and practice with work experience (p= 0.045 and p= 0.01 respectively). Conclusion: Knowledge and practice of dentists in Kerman about infection control in digital radiology were good and medium respectively. However, there was a direct significant correlation between knowledge and practice of dentists. Knowledge and practice scores in dentists who worked in private office were significantly better than those who worked only in clinics.

Antimicrobial Activity of Methanolic Extracts of Myrtus Communis L. and Eucalyptus Galbie and their Combination with Calcium Hydroxide Powder against Enterococcus Faecalis.

STATEMENT OF THE PROBLEM: The goal of endodontic therapy is the reduction or elimination of microorganisms from the root canal system. The use of intracanal medicament between treatment appointments is recommended in order to eliminate any remainang microorganisms in the pulp space. PURPOSE: The aim of the present study was to investigate the antimicrobial activity of methanolic extracts of Myrtus communis L. and Eucalyptus galbie, their combination with calcium hydroxide powder; combination of calcium hydroxide powder with water, and ready-to-use calcium hydroxide paste with iodoform; against Enterococcus faecalis. MATERIALS AND METHOD: In this experimental study, after gathering the plants, their methanolic extracts were obtained by masceration method. The diameters of inhibition zone of all mentioned materials were determined by agar diffusion test. Minimum inhibitory concentration (MIC), minimum bactericidal concentration (MBC); and anti biofilm effect of the materials that showed antibacterial effect in agar diffusion test, were then evaluated by tube dilution test, and microtiter plate assay followed by colorimetric crystal violet methods, respectively. RESULTS: After 48 hours, both herbal extracts showed antimicrobial effect. However, combination of calcium hydroxide with extracts produced no zone of inhibition. The mean inhibition zone of Eucalyptus extract was more than that of Myrtus. However, the results of ANOVA test, showed that there was no significant difference between the antibacterial effect of Eucalyptus galbie, Myrtus communis L. and positive control (Cefoxitin) (p Value= 0.987). The MIC for both extracts were 12.5 mg/ml. MBC evaluation of the two methanolic extracts showed no bactericidal effect on Enterococcus faecalis. Based on ELISA analysis, biofilm formation in response to different sub-MIC concentrations of both extracts was scored as weak to moderate. CONCLUSION: The methanolic extracts of Eucalyptus galbie and Myrtus communis L. in combination with calcium hydroxide powder were not able to eliminate Enterococcus faecalis within 48 hours.

Pulp Stones, Prevalence and Distribution in an Iranian Population.

AIM: This study determined the prevalence and distribution of pulp stones in the permanent dentition of an adult population using their periapical radiographs. MATERIALS AND METHODS: The study followed a cross-sectional design. A total of 800 periapical radiographs collected from 412 patients attending dental clinics in Kerman, Islamic Republic of Iran, were examined using magnification. RESULTS: Pulp stones were present in 9.6% of all permanent teeth examined, being most common in maxillary first and second molars, followed by mandibular first and second molars. They were present in 31.5% of all adult patients, with a significantly increased prevalence in females compared with males (40.5 vs 23.9%, chi-squared test p < 0.001). There was also an increased prevalence with age. CONCLUSION: Based on the results of this study, clinicians should expect to encounter pulp stones most commonly in the pulp chambers of maxillary first and second molars, particularly in older female patients. CLINICAL SIGNIFICANCE: Pulp stones depending on their size and location can pose challenges to endodontic treatment. They obstruct access to the canal orifices and thus complicate endodontic treatment. Knowing where and when pulp stones are likely to occur improves the quality of root canal treatments.

Effect of chronic stress on capsaicin-induced dental nociception in a model of pulpitis in rats.

OBJECTIVE: Chronic stress can alter nociceptive sensitivity. However, the effect of stress exposure on dental nociception has been less addressed. Therefore, the present study investigated the effects of chronic exposures to some social and psychological stresses on pulpal nociceptive responses. DESIGN: The stress groups were constructed as follows: forced swimming (n=6), restraint (n=6), and mild (n=10) and severe (n=15) crowding stresses. Rats were subjected to stress for 1h per day for a week. At the end of the stress session, pulp irritation was induced by intradental application of capsaicin (100µg). There were another capsaicin or capsaicin plus stress training groups that received articaine 5min before the administration of capsaicin. Nociceptive responses were recorded for 40min. The time (ins) of continuous shaking of the lower jaw and excessive grooming and rubbing of the mouth near the procedure site was measured as nociceptive behaviors. Data was analyzed using one-way analysis of variance (ANOVA) followed by post hoc Tukey's test. RESULTS: Significant nociceptive responses were evoked by the administration of capsaicin. Exposures to forced swimming (p<0.01), restraint (p<0.001), and both mild and severe crowding stresses (p<0.05) exaggerated capsaicin-induced nociceptive reaction. There was, however, no significant difference in nociceptive reaction time between the different stress groups. Articaine buccal infiltration attenuated nociceptive time in capsaicin and capsaicin plus stress training groups (p<0.001). CONCLUSIONS: The current data support the association between chronic stress exposures and nociceptive behavior following intradental capsaicin administration.

Radix Entomolaris in the Mandibular Molar Teeth of an Iranian Population.

Purpose. Supernumerary roots in permanent mandibular molar teeth make endodontic treatment more complicated. The aim of this study was to determine the prevalence of Radix Entomolaris (RE) in permanent mandibular first and second molars in the population of Kerman, in the southeast of Iran. Materials and Methods. From a collection of 500 mandibular first and second molar teeth extracted over 2015-2016 at dental clinics in Kerman, teeth were scored for an additional distolingual root, and the average root length and root morphology of this extra root were determined using the De Moor classification scheme. Results. In this population, RE occurred in 6% of mandibular first molars (4% with a straight apex (Type I) and 2% with buccal apical curvature (Type III)). In all cases, RE was the shortest root, with an average root length of 18.37 mm. RE occurred in only 0.8% of mandibular second molars, with an average root length of 18.0 mm. All mandibular second molars with RE were of Type III. Fisher's exact test showed that the difference in frequency between first and second molars was statistically significant (two-sided P = 0.002). Conclusion. Radix Entomolaris occurs more frequently in mandibular first molars than in mandibular second molars in this sample of 500 mandibular molars. The reported rate of 6% in first molars is expected to be higher than reported rates in European or Caucasian populations where the prevalence is typically less than 2%.

Noxious Stimulation of the Rat Tooth Pulp May Impair Learning and Memory Through the Induction of Hippocampal Apoptosis.

AIMS: To determine whether noxious stimulation of the rat tooth pulp induces learning and memory impairment through the induction of apoptosis in the hippocampus. METHODS: Thirty-five adult rats were divided randomly into five groups (each n=7) as follows: control, sham-operated, sham-vehicle, capsaicin-treated, and capsaicin plus ibuprofen-treated group. After preparing dental cavities via cutting 2 mm of the distal extremities of the mandibular incisors, polyethylene crowns were placed on the teeth. Based on the study groups, different injections were administered into the cavities. Nociceptive scores for each block were obtained by measuring the number of seconds that the animal spent rubbing and flicking the lower jaw. After recording the nociceptive behaviors, spatial learning and memory were assessed by using the Morris Water Maze (MWM) test. The hippocampal levels of Bcl-2, Bax, and caspase-3 protein were determined by immunoblotting. Statistical analyses were performed using one- or two-way analysis of variance. RESULTS: Noxious pulp stimulation induced by intradental application of capsaicin significantly increased time and traveled distance in the MWM test. Capsaicin stimulation of the pulp also significantly increased the Bax:Bcl-2 ratio and activated caspase-3 in the hippocampus (P<.01), which was inhibited by ibuprofen pretreatment (P<.05). CONCLUSION: Memory and learning impairment induced by noxious stimulation of the rat tooth pulp may be correlated with activation of apoptotic pathways in the hippocampus.

Preferred materials and methods employed for endodontic treatment by Iranian general practitioners.

INTRODUCTION: The aim of this study was to gather information on the materials and methods employed in root canal treatment (RCT) by general dental practitioners (GDPs) in Iran. METHODS AND MATERIALS: A questionnaire was distributed among 450 dentists who attended the 53(th) Iranian Dental Association congress. Participants were asked to consider demographic variables and answer the questions regarding the materials and methods commonly used in RCT. Descriptive statistics were given as absolute frequencies and valid percentages. The chi-square test was used to investigate the influence of gender and the years of professional activity for the employed materials and techniques. RESULTS: The response rate was 84.88%. The results showed that 61.5% of the participants did not perform pulp sensitivity tests prior to RCT. Less than half of the general dental practitioners (47.4%) said that they would trace a sinus tract before starting the treatment. Nearly 16% of practitioners preferred the rubber dam isolation method. Over 36% of the practitioners reported using formocresol for pulpotomy. The combined approach of working length (WL) radiographs and electronic apex locators was used by 35.2% of the practitioners. Most of the respondents used K-file hand instruments for canal preparation and the technique of choice was step-back (43.5%), while 40.1% of respondents used NiTi rotary files, mostly ProTaper and RaCe. The most widely used irrigant was normal saline (61.8%). Calcium hydroxide was the most commonly used inter appointment medicament (84.6%). The most popular obturation technique was cold lateral condensation (81.7%) with 51% using zinc oxide-eugenol-based sealers. CONCLUSIONS: The majority of Iranian GDPs who participated in the present survey do not comply with quality guidelines of endodontic treatment.

General Dental Practitioners' Concept towards Using Radiography and Apex-Locators in Endodontics.

INTRODUCTION: Despite being the gold standard as well as a routine technique in endodontics, radiographic working length (WL) determination owns many drawbacks. Electronic apex-locators (EALs) are recommended to complement radiographies. The aim of this study was to evaluate the perceptions of Iranian general dental practitioners (GDPs) towards using radiography and EAL. METHODS AND MATERIALS: Three hundred and ninety one GDPs attending the 53(th) Iranian Dental Association Congress completed a questionnaire focusing on the use of radiography and EALs during the various stages of root canal treatment. The data was analyzed with the chi-square test with the level of significance set at 0.05. The results were then calculated as frequencies and percentages. RESULTS: More than half of the GDPs reported using radiographs as the sole method for WL determination. A total of 30.4% of the practitioners were using the combined approach during root canal therapy of a single-rooted tooth, while 38.9% used this method in multi-rooted teeth. Approximately half of the respondents would not order follow-up radiographies after root canal treatment. CONCLUSION: Radiography continues to be the most common method for WL determination in Iran.

Evaluation of horizontal magnification on panoramic images.

AIMS: This study evaluated the horizontal magnification of images taken from adults and pediatrics with PM 2002 CC Planmeca analogue machine. MATERIALS AND METHODS: A series of 120 panoramic radiographs were obtained of 60 adults and 60 pediatrics. For all patients, negative impressions were used to make positive casts of the teeth. A caliper was used to measure the maximum mesiodistal length of the buccal surface of all teeth except canines on both casts and radiographs. The horizontal magnification factor was calculated for incisor, premolar, and molar regions by dividing the values obtained from the casts by the values obtained from the radiographs. STATISTICAL ANALYSIS: Independent t-test and one-way analysis of variance (ANOVA) were used. RESULTS: The results indicated that with regard to adults, maxillary and mandibular incisor regions, unlike the other two sessions, didn't show significant difference of the mean magnification of horizontal dimension (P = 0.5). In pediatrics, the comparison between mean magnification factors of all subgroups showed significant difference (P < 0.0001). Despite the adults' radiographs, the results of pediatrics' radiographs showed significantly higher magnification than the index listed by the manufacturer of the radiographic machine used. CONCLUSION: The present study results point to the fact that PM 2002 CC Proline panoramic machine makes possible precise measurements on radiographs of adults' jaws in the horizontal dimension.

Root and canal morphology of mandibular third molars in an Iranian population.

BACKGROUND AND AIMS: A through knowledge of the root canal morphology is required for successful endodontic ther-apy. The aim of this study was to investigate the root and canal morphology of mandibular third molars in Kerman, a prov-ince in southeast of Iran. MATERIALS AND METHODS: One-hundred-fifty extracted mandibular third molars were collected randomly from different dental clinics in Kerman. The root canal anatomy and morphology of each tooth was carefully studied using a clearing tech-nique. Root number and morphology, number of canals per root, root canal configuration according to Vertucci classifica-tion, and incidence of dilacerated roots and C-shaped canals in mandibular third molars were evaluated under stereomicro-scope with ×2 to ×3 magnifications. RESULTS: From the total of 150 mandibular third molars studied, 21% had one root. The majority of teeth (73%) had two roots. 5.5% of the teeth had three roots. The incidence of C-shaped canal was 3.5% in this study and 8% of the teeth had at least one dilacerated root. CONCLUSION: Although root canal anatomy and morphology of mandibular third molars is very variable having two roots seems to be the normal anatomy for these teeth.

Cytotoxic chemotherapy tooth ache following chemotherapy: a rare case report.

Currently, localized pulpalgia is listed as a rare manifestation of chemotherapy treatments in patients with malignant tumors. The neuropathy originated from neurotoxicity of anticancer drugs is usually described as a diffuse jaw pain or numbness in orofacial structures. This article reports localized tooth pain as a possible outcome of administrating high dosage chemotherapy drugs particularly in the last cycles of application.

A digital stereomicroscopic study of the furcation wall thickness of mesiobuccal roots of maxillary first and second molars.

INTRODUCTION: This study aimed to compare the thickness of the mesiobuccal furcal canal walls of first and second maxillary molars. MATERIALS AND METHODS: This study was performed on total of 30 first and second extracted molar teeth (15 each). The mesiobuccal roots of each tooth were separated at the cement-enamel junction (CEJ) level and embedded in acrylic resin. The embedded roots were cut horizontally at two and four mm below the CEJ using a 0.20 mm blade (overall three sections CEJ, two and four mm below). Next, photographs of all the horizontal sections were taken using a digital stereomicroscope with identical magnifications (×20). Using the photographs, two independent observers measured and recorded the minimal thickness from the canal wall of the first mesiobuccal (MB1) and the second mesiobuccal (MB2) canals to the furcation area. Data analysis was performed by repeating the measurement Analysis of Variance. The analysis was completed by making paired comparisons using the Bonferroni alpha adjustment method. Statistical significance was set at P<0.05. RESULTS: In maxillary first molars, the mean (±SD) thickness of the canal furcal wall MB1 in three sections were significantly higher than thickness of the canal furcal wall in MB2 (P<0.05). However there was no statistical difference between the mean (±SD) thickness of the canal furcal wall in the three sections (CEJ, 2 and 4 mm below) of maxillary second molars MB1 and MB2 canals. CONCLUSION: Only the maxillary first molars demonstrated significantly lower furcal canal wall thickness (FCWT) values in the MB2 canals. Maxillary second molars MB canals did not demonstrate statistical difference in FCWT values.

Qualitative assessment of the dental health services provided at a dental school in Kerman, Iran.

Increasing the quality of the services provided in a Dental School can raise the satisfaction level of patients and consequently increase the level of their oral health. This study was conducted to evaluate the quality of dental care and services provided to patients referred to a Dental School in Kerman, Iran. In this qualitative study, face-to-face, in-depth interviews were conducted with 41 participants [25 patients (P), 5 nurses (N), 6 dental academic staff (AS), and 5 dental students (S)]. Then, the interviews were transcribed and analyzed, using content analysis of data. Data analysis in qualitative research involves breaking down the data and searching for codes and categories that are then reassembled to form themes. Both positive and negative themes emerged. Positive themes included: good infection control, service accessibility, patient appointments and visits were not assigned on merit, precise examinations, and comprehensive treatment plans. Negative themes included: long wait time, lack of options to pass waiting time, such as newspapers and television, an insufficient number of nurses, and not enough professors for supervision. In addition, the results of this study show that the patients and dental staff have high expectations in relation to dental services, and that implementation of these expectations would increase the overall satisfaction with and the quality of the level of services. Finally, some recommendations for improving services in the Kerman Dental School were given to the managing team of the Dental School.

Qualitative assessment of the dental health services provided at a dental school in Kerman, Iran

Increasing the quality of the services provided in a Dental School can raise the satisfaction level of patients and consequently increase the level of their oral health. This study was conducted to evaluate the quality of dental care and services provided to patients referred to a Dental School in Kerman, Iran. In this qualitative study, face-to-face, in-depth interviews were conducted with 41 participants #&091;25 patients (P), 5 nurses (N), 6 dental academic staff (AS), and 5 dental students (S)#&093;. Then, the interviews were transcribed and analyzed, using content analysis of data. Data analysis in qualitative research involves breaking down the data and searching for codes and categories that are then reassembled to form themes. Both positive and negative themes emerged. Positive themes included: good infection control, service accessibility, patient appointments and visits were not assigned on merit, precise examinations, and comprehensive treatment plans. Negative themes included: long wait time, lack of options to pass waiting time, such as newspapers and television, an insufficient number of nurses, and not enough professors for supervision. In addition, the results of this study show that the patients and dental staff have high expectations in relation to dental services, and that implementation of these expectations would increase the overall satisfaction with and the quality of the level of services. Finally, some recommendations for improving services in the Kerman Dental School were given to the managing team of the Dental School.

Ex-vivo evaluation of x-ray horizontal angle for separating the canals of four-canal first mandibular molars.

INTRODUCTION: A variety of mesial and distal projections have been suggested for separating the canals in a multi-canaled root. But there is no general agreement on the best angulation for each tooth. The purpose of this study was to evaluate the X-ray horizontal angle for separating the canals of four-canal first mandibular molars. MATERIALS AND METHODS: Forty four-canaled mandibular molars were selected. After preparation of coronal access cavities, files were inserted into the root canals and the specimens were radiographed at 10, 15, 20, 25 degrees mesial and distal horizontal angulations. Apices and canals were evaluated. Chi-square test was used for statistical analysis. RESULTS: Although 10° and 15° mesial and distal angulations were best for the most obvious apices manifestation (P<0.001), it was found that 20° mesial angulation is significantly better than the other cone angulations (P<0.001) for separating the root canals. CONCLUSION: 20° mesial angulation improved detection of both the canals and canal terminus visibility.