Dental Caries among the Elderly in Iran: A Meta-analysis.

Background: The prevalence of dental caries among the elderly is high worldwide, and dental caries cause the major burden of oral diseases. This meta-analysis aimed to determine the dental caries experience among the elderly in Iran. Methods: A systematic review of the published and grey literature on Iranians aged 65 years or older was performed. Six international and local databases provided the most comprehensive population-based studies. National oral health surveys and national disease and health surveys were considered other primary data sources. The quality of remained studies was assessed by a modified tool designed based on the STROBE statement checklist to evaluate the cross-sectional studies. R Version 3.6.0 was used for statistical analysis. Heterogeneity was assessed using Cochran's Q and F statistics. Subgroup analysis was performed to detect the source of heterogeneity. Funnel plots and Egger's regression intercept test were used to assess publication bias and selective reporting. Results: Overall, 3099 sources were found. After excluding ineligible studies, 46 data points with 10411 people ≥65 years were included in the meta-analysis. The mean pooled decayed, missing, and filled teeth (DMFT) among older people was 26.84 (range, 26.41-27.28). The DMFT was 26.78 (range, 26.12-27.43) in women and 26.91 (range, 26.32-27.50) in men. The mean number of decayed teeth was 1.48 (range, 1.32-1.65). The mean pooled missing teeth was 24.83 (range, 24.20-25.46), and the mean pooled filled teeth was 0.14 (range, 0.12-0.17). The majority (92%) of the DMFT was related to missing teeth. Conclusion: Iranian elderly have almost 5 sound teeth in their mouth on average. The Iranian oral health policymakers should address this considerable burden of dental caries in designing and implementing better oral health policies for the population, especially older Iranian adults.

Global, regional, and national burden and quality of care index (QCI) of oral disorders: a systematic analysis of the global burden of disease study 1990-2017.

BACKGROUND: Oral disorders are still a major global public health challenge, considering their perpetuating and chronic nature. Currently, there is no direct index to measure the quality of care on a population scale. Hence, we aim to propose a new index to measure the quality of care for oral disorders worldwide. METHODS: We generated our database using the data from the Global Burden of Disease (GBD) study 2017. Among different variables such as prevalence, incidence, years lived with disability, and disability-adjusted life years, we utilised principal component analysis (PCA) to determine the component that bears the greatest proportion of information to generate the novel quality of care index (QCI) for oral disorders. RESULTS: Global QCI for oral disorders gradually increased from 1990 to 2017 (from 70.5 to 74.6). No significant gender disparity was observed during this period, and the gender disparity ratio (GDR) was considered optimal in 1990 and 2017. Between 1990 and 2017, the age-standardised QCI for all oral disorders increased in all the SDI regions. The highest QCI for all oral disorders in 2017 belonged to high-middle SDI countries (=80.24), and the lowest YLDs rate was seen in the low SDI quintile. In 1990, the quality of care in European, Central Asian, and Central and South American countries was in the lowest quintiles, whereas the North American, East Asian, Middle Eastern, and some African countries had the highest quality of dental care. Maynmar (=100), Uganda (=92.5), Taiwan (=92.0), China (=92.5), and the United States (=89.2) were the five countries with the highest age-standardised QCI. Nicaragua (=41.3), Belgium (=40.2), Venezuela (=38.4), Sierra Leone (=30.5), and the Gambia (=30.3) were the five countries with the least age-standardised QCI values. CONCLUSION: The quality of care for all oral disorders showed an increasing trend on a global scale from 1990 to 2017. However, the QCI distribution was not homogenous among various regions. To prevent the exacerbation of imminent disparities in this regard, better attention to total tooth loss in high-income countries and prioritising primary healthcare provision in low-income countries are recommended for oral disorders.

National and Subnational Trend of Dental Caries of Permanent Teeth in Iran, 1990-2017.

OBJECTIVE: There are currently no integrated data on the trend of dental caries amongst distinct age groups in Iran. We aimed to assess the national and subnational trend of dental caries of permanent teeth in Iran from 1990 to 2017. METHODS: A literature search about dental caries and the decayed-missing-filled teeth index (DMFT) was performed in PubMed, Web of Science, Scopus, and 3 national databases (in Persian). All eligible national oral health surveys in these 28 years were included. We categorised and aggregated the DMFT values and their components based on age (5-year-based groups from 5 to 9 to 60+ years), sex, year, and province. The data for missing spots were estimated using the spatiotemporal Bayesian hierarchical model. We used the bootstrap method in multilevel models to predict the uncertainty interval (UI) of the modelled results. RESULTS: Nationally, the all-ages mean DMFT increased by nearly 58.0% (6.8 [95% UI, 4.1-10.5] in 1990 to 10.8 [95% UI, 7.5-14.5] in 2017). Decayed teeth (DT) and missing teeth (MT) rose by 84.5% and 31.6% during this period, respectively. Filled teeth (FT) showed almost a 2.6-fold increase in the same period from 0.6 (95% UI, 0.01-1.6) in 1990 to 1.7 (95% UI, 0.6-2.8) in 2017. The proportion of DT and FT continuously increased in both sexes. In 2017, the highest DT, MT, and FT were estimated in the 25-29 (4.9 [95% UI, 2.5-7.2]), 60+ (21.5 [95% UI, 17.5-25.4]), and 35-39 (2.6 [95% UI, 1.3-4.0]) year age groups. CONCLUSIONS: Caries of permanent dentition levies a growing burden on the Iranian population. Considering the continuous increase in caries during the 1990-2017 period, Iranian policymakers should pay heed to these findings and react more proactively to mitigate this perpetuating issue. Implementing nationwide interventions such as sugar consumption management should be encouraged to achieve sustainable outcomes in this regards.

Development and initial validation of the Comprehensive Geriatric Oral Health Assessment Tool.

OBJECTIVES: Improving the oral health of the elderly is crucial to improving their general health and quality of life. To reach this goal, it is necessary to start with a comprehensive oral health assessment and a detailed treatment plan. The aim of this study was, therefore, to develop a comprehensive Oral Health Assessment Tool for the geriatric population. MATERIAL AND METHODS: Following a panel of experts' consultation, a clinical form and a self-assessment questionnaire were developed, encompassing eight domains: dental caries, periodontal diseases, partial and complete edentulism, oral soft tissue lesions, occlusion, xerostomia, temporomandibular joints, and oral or oral prostheses hygiene. Subsequently, a pilot study was conducted to appraise the clinical form and questionnaire involving 84 residents of an Iranian nursing home. After securing ethics approval, both the qualitative and quantitative aspects of the self-assessment questions' validity and reliability were assessed, and specificity and sensitivity were calculated. RESULTS: The mean age of the participants was 69.8 (±4.1) years, and 86% had less than 12 years of education. The questions regarding the number of remaining teeth and the number of decayed teeth had the highest sensitivity (97% and 88%), respectively. Questions regarding the presence of periodontitis and gingivitis had the highest specificity (both 100%). CONCLUSIONS: A Comprehensive Geriatric Oral Health Assessment Tool has been developed and its validity and reliability evaluated in a pilot study. It should now be further evaluated in larger studies.

Trends in dental caries of deciduous teeth in Iran: a systematic analysis of the national and sub-national data from 1990 to 2017.

BACKGROUND: Dental caries is the most prevalent child affliction in the world and can be reduced through effective preventive interventions. To plan cost-effective interventions, clear and integrated data are needed. This study has been designed to overcome the lack of national trend in deciduous dental caries in Iran. OBJECTIVE: To estimate the dental caries trend in deciduous teeth in the Iranian population at different ages from 1990 to 2017. METHODS: From 1990 to 2017 a literature search about dmf and its components (decayed, missed, and filled tooth, abbreviated as dt, mt, and ft) as well as dental caries was done in the Iranian population in three English (PubMed, Web of Science, and Scopus) and three national databases (in Persian). All eligible national oral health surveys in these 28 years were included. National dmft data were categorised based on age (1-4, 5-9, and 10-14), sex, province and year. The final trends were estimated using an age-spatio-temporal hierarchical model. We used the bootstrap method in multilevel models to predict the uncertainty interval (UI) of the modelled results. Finally, the estimations of dmft, dt, mt, and ft with a 95% UI were reported from 1990 to 2017. RESULTS: Almost 22% of the Iranian deciduous teeth were involved with dental caries in 1990 [dmft = 4.37; (95% UI 2.23, 6.62)] which more than 83% of it was dt [3.64 (1.53, 5.88)] and less than 7% was ft [0.30 (0.06, 0.65)]. During 1990-2017, dmft increased by more than 15% [in 2017, dmft = 5.03 (2.82, 7.29)]. The highest increase was seen in dt which was more than 17% [in 2017, dt = 4.27 (1.96, 6.57)]. CONCLUSION: Increasing dental caries among Iranian children over 28 years shows that oral health policies in Iran need critical evaluation. We need cost-effective nationwide interventions (e.g., supervised tooth brushing and improving dietary habits) and training well-experienced intermediate manpower (e.g., dental hygienists) to reduce dental caries.

Experiences from the management of COVID-19 pandemic in a nursing home in Iran (March-April, 2020).

As the first outbreak of COVID-19 in Wuhan, China, the elder population and those with comorbidities were at higher risk of COVID-19 infection. The mortality rate was also higher in this population. Hence, the management and prevention of this novel disease in nursing homes was of utmost importance. The health management team in Kahrizak Charity Foundation (KCF), a nursing home in Iran with more than 1400 elder or comorbid resident, have tackled the COVID-19 outbreak with a novel approach towards this problem. This commentary aims at sharing the insights and lessons learned in the management of COVID-19 in KCF. Supplementary Information: The online version contains supplementary material available at 10.1007/s40200-022-01005-3.

Global, regional, and national burden and quality of care index (QCI) of lip and oral cavity cancer: a systematic analysis of the Global Burden of Disease Study 1990-2017.

BACKGROUND: To measure the quality of care for lip and oral cavity cancer worldwide using the data from the Global Burden of Disease (GBD) Study 2017. METHODS: After devising four main indices of quality of care for lip and oral cavity cancer using GBD 2017 study's measures, including prevalence, incidence, years of life lost, years lived with disability, and disability-adjusted life years, we utilised principal component analysis (PCA) to determine a component that bears the most proportion of info among the others. This component of the PCA was considered as the Quality-of-Care Index (QCI) for lip and oral cavity cancer. The QCI score was then reported in both men and women worldwide and different countries based on the socio-demographic index (SDI) and World Bank classifications. RESULTS: Between 1990 and 2017, care quality continuously increased globally (from 53.7 to 59.6). In 1990, QCI was higher for men (53.5 for men compared with 50.8 for women), and in 2017 QCI increased for both men and women, albeit a slightly higher rise for women (57.2 for men compared with 59.9 for women). During the same period, age-standardised QCI for lip and oral cavity cancer increased in all regions (classified by SDI and World Bank). Globally, the highest QCI scores were observed in the elderly age group, whereas the least were in the adult age group. Five countries with the least amount of QCIs were all African. In contrast, North American countries, West European countries and Australia had the highest indices. CONCLUSION: The quality of care for lip and oral cavity cancer showed a rise from 1990 to 2017, a promising outcome that supports patient-oriented and preventive treatment policies previously advised in the literature. However, not all countries enjoyed such an increase in the QCI to the same extent. This alarming finding could imply a necessary need for better access to high-quality treatments for lip and oral cavity cancer, especially in central African countries and Afghanistan. More policies with a preventive approach and paying more heed to the early diagnosis, broad insurance coverage, and effective screening programs are recommended worldwide. More focus should also be given to the adulthood age group as they had the least QCI scores globally.

Association between tooth impaction and odontogenic lesions: A matched case-control study.

Background: Impacted tooth is common in dental practice. Dentists usually remove them if they are associated with any pathologic sign or symptom. The challenge is whether to extract the asymptomatic tooth or not. This study was conducted to determine the association between developmental odontogenic cysts and tumors and impacted and unerupted teeth, if left untreated. Methods: In this matched case-control study, 262 participants were recruited in case and control groups to evaluate the association between the presence of odontogenic cyst and tumors and unerupted and impacted teeth in patient records in the School of Dentistry, Shahid Beheshti University of Medical Sciences during 2000-2002. The controls referred to a dental radiology center for routine OPG. We also recorded the data on age, gender, the involved jaw, and type of lesion. All patients' records were reviewed by the research director and an oral pathologist separately. The variables that were matched as confounders were age, gender, and the site of the involved jaw. Results: Results of conditional logistic regression analysis showed that the presence of odontogenic lesions was associated with impacted teeth (OR = 6.9), and not associated with the involved jaw and unerupted teeth. Conclusion: Impacted teeth could be considered as a potential risk factor for the presence of odontogenic lesions.

Effect of single injection of platelet-rich plasma in comparison with corticosteroid on knee osteoarthritis: a double-blind randomized clinical trial.

BACKGROUND: Evidence on the effect of platelet-rich plasma (PRP) in treating osteoarthritis (OA) is insufficient. Therefore, the present study compares the effects of a one-time injection of PRP and corticosteroid (CS). METHODS: In the present randomized double blind clinical trial, the participants who suffered from knee osteoarthritis (Grades II/III), were randomly divided into two groups: intra articular injection of PRP and CS. Knee injury and osteoarthritis outcome score (KOOS), the 20-Meter-Walk Test (20MW), active and passive ranges of motions (ROM), flexion contracture, and pain intensity based on Visual Analog Scale (VAS) were assessed before, 2-months, and 6-months after interventions. RESULTS: Forty-one participants (48 knees) were involved in the research (66.7% women; average age of 61.1±7.0 years old). Compared to the group treated with corticosteroid, pain relief (df: 6, 35; F=11.0; P=0.007), symptom free (df:6, 35; F=23.0; P<0.001), activities of daily living (ADL) (df:6, 35; F=10.7; P=0.005) and quality of life (df:6, 35; F=5.2; P=0.02) in the RPR group were significantly higher, but sporting ability was not different between the two groups (df: 6, 35; F=0.6; P=0.55). PRP was significantly more helpful for relieving patients' pain (VAS) compared to corticosteroids (df: 6, 35; F=32.0; P=0.001). It is also notable that using PRP was more helpful in improving the 20MW test than corticosteroid treatment (df: 6, 35; F=7.4; P=0.04) but none of the treatments had any impact on active flexion ROM، passive flexion ROM and flexion contracture (P>0.05). CONCLUSIONS: Our study demonstrated that one shot of PRP injection, decreased joint pain more and longer-term, alleviated the symptoms, and enhanced the activity of daily living and quality of life in short-term duration in comparison with CS.

Burden of Oral Diseases in Iran, 1990-2010: Findings from the Global Burden of Disease Study 2010.

BACKGROUND: Oral diseases, as a group of chronic diseases, are among the major public health problems that lead to disability throughout the world. The major part of burden of oral diseases is caused by dental caries, periodontal diseases, edentulism, mouth cancer, cleft lip, and cleft palate. The aim of the present paper is to report the global results for the burden of oral disease in Iran from 1990 to 2010, derived from GBD study 2010 by sex and age. METHODS: The Global Burden of Disease Study 2010 (GBD 2010) was a systematic effort with a common framework to estimate disability adjusted life years (DALYs) for diseases in different parts of the world. Years of life lost due to premature mortality (YLLs) were assessed based on cause-of-death estimates and by means of a cause of death ensemble model (CODEm). Years of life lost due to disability (YLDs) were computed by multiplying the prevalence, the disability weight for a sequel, and the duration of symptoms. A systematic review of published and unpublished data was conducted to estimate disease distribution using a Bayesian meta-regression method (DisMod-MR). Disability weights were measured by collecting data from population-based surveys. In this paper, we describe the results of GBD 2010 regarding oral diseases in Iran, critique the results, and provide some recommendations. RESULTS: Between 1990 and 2010 in Iran, an increase occurred in DALYs at all ages, attributed to dental caries (from 37,230 to 56,521) as well as periodontal diseases (from 21,482 to 43,308), and a decrease was found for edentulism (from 53,134 to 47,960). DALYs at all ages attributed to mouth cancer increased (from 5,597 to 7,771), while a decline was noted for cleft lip and cleft palate (from 6,157 to 5,034). The age-standardized DALY rates per 100,000 population did not considerably change for dental caries and periodontal diseases, while edentulism showed a reduction. The corresponding DALY rate due to mouth cancer decreased, while it remained almost unchanged for cleft lip and cleft palate over this period. DALY rates per 100,000 population due to dental caries and edentulism were higher among Iranian women than for Iranian men at all ages, while Iranian men suffered from a higher burden of periodontal disease, mouth cancer, cleft lip, and cleft palate. The most significant burden due to dental caries and periodontal diseases was found in Iranians aged 15-49 and 50-69 years, respectively and edentulism and mouth cancer led to the highest burden in Iranians older than 70 years of age. The highest burden caused by cleft lip and cleft palate occurred in children younger than 5 years old. CONCLUSION: The findings address the challenging changes in oral diseases and difficulties in responding to the urgent oral health needs in Iran. The burden of oral diseases should be considered as a priority in Iran. A need also exists to pay more attention to the oral health policies and principles of preventive oral care. Global analyses of disease burdens provide a useful framework to guide a suitable policy in response to disease changes. In fact, strong national and sub-national analyses will be required to provide more effective public health strategies.

National and sub-national trend of prevalence and burden of dementia in Iran, from 1990 to 2013; study protocol.

BACKGROUND: Dementia is a disabling syndrome, which generally affects aged population more than any other age groups. This syndrome has a growing prevalence and incidence worldwide. The prevalence and burden of this group of diseases in Iran have not been estimated in a community-based study yet. This paper aims to explain the systematic approach, data sources, research methodology, and statistical analysis that will be used to quantify the prevalence and burden of dementia at national and sub-national levels. METHODS: This is the protocol of a secondary data study that explains the design and method of conducting the study. We will use several sources of data that will include a systematic review of articles and gray literature which have reported the prevalence or incidence of dementia and its uncertainty at national and sub-national levels in Iran, in addition to data about dementia-specific drug sales per each year at provincial levels, as well as data extracted from 23 million health insurance prescriptions over 8 years and some data from medical documents of Iranian Alzheimer's Association members. The technical groups of National and Sub-national Burden of Disease will collect some covariate data, such as age and sex structure of population, urbanization status, mean years of schooling, plasma cholesterol, fasting plasma glucose, and systolic and diastolic blood pressure at provincial levels which will be used in our models. Two statistical models, namely spatio-temporal and hierarchical autoregressive models, will be used for interpolation and extrapolation of missing data. CONCLUSION: It seems that the study of national and sub-national burden of dementia could provide more accurate estimation of prevalence and burden of dementia in Iran with an acceptable level of uncertainty than the previous studies.

National and sub-national burden of oral diseases in Iran: 1990 - 2013, study protocol.

BACKGROUND: Non-communicable chronic diseases are the greatest preventable cause of death. One of the most prevalent groups of chronic diseases, are oro-facial diseases. The major burden of oral diseases is caused by dental caries, periodontal diseases, tooth loss, oral cancer and oral clefts. The aim of the study is to present data collection and methodology processes for estimating the prevalence of the mentioned oral diseases and their attributed burden at national and sub-national levels in Iran, from 1990 to 2013. METHODS: Systematic review of published literature will be conducted, as well as using unpublished and grey literature. Three international databases (PubMed, ISI and Scopus) and three local databases (IranMedex, SID and Irandoc) will be used to provide the most comprehensive epidemiologic data bank. The study will be included if it is population-based and has reported diseases data. The target population is representative healthy Iranian population. A comprehensive assessment form in Epi-Info 7 will be designed to assess the quality of selected articles. Other main sources of data are National Oral Health surveys, "National Health Survey", in addition to "Death Registry System" and "Cancer Registry System". Two statistical models, Spatio-temporal Bayesian hierarchical and Bayesian multilevel auto-regressive, will be applied to overcome the problem of data gaps in provinces, and in some age or sex groups or in urban and rural areas. CONCLUSION: A national and sub-national oral diseases burden study needs a standardized protocol for systematic review, quality assessment of data, data extraction strategy, and an appropriate statistical analysis method.

Epidemiology of open-globe injuries in Iran: analysis of 2,340 cases in 5 years (report no. 1).

PURPOSE: To review characteristics of open-globe injuries presented to Farabi Eye Hospital, a large referral center for serious ocular injury in the capital city of Iran. PATIENTS AND METHODS: A retrospective review of 2,340 open-globe injury patients during a 5-year period was performed. Data about any patient that was diagnosed as open-globe injury were collected from medical records. RESULTS: Of 2,340 patients, 1,904 (81.4%) were men. Mean age was 22.44 +/- 16.65 years (range, 4 months to 90 years). Seventy-five percent of cases were younger than 30 years, with a peak of 5 years. There were 561 patients who had an intraocular foreign body (24.7%). In patients younger than 16 years, a knife was the most prevalent cause (22%); in patients younger than 7 years, knives accounted for 33.6% of trauma etiology; and in patients more than 16 years, a projectile metallic foreign body was the most common cause, accounting for 27% of open-globe injuries. Endophthalmitis developed in 5.1% (117 cases). Factors that had a positive association with severity of ocular injury were visual acuity lower than 20/200 at admission, endophthalmitis, double perforation, and laceration length. According to Ocular Trauma Scoring, there was better visual prognosis in younger age groups, male sex, and intraocular foreign body groups. The rate of enucleation or evisceration was 5.3% (126 cases). We had a low sympathetic ophthalmia rate of 0.08%. CONCLUSION: The most prevalent trauma etiology is a projectile metallic foreign body in adults and a knife injury in children. Compared with other previous epidemiologic studies, we had younger patients, lower enucleations, and sympathetic ophthalmia.

The histological and clinical effects of 630 nanometer and 860 nanometer low-level laser on rabbits' ear punch holes.

Low-level laser therapy (LLLT) studies on the musculoskeletal and cartilage tissues of rabbits have reported conflicting results. We aimed to investigate the effects of 630 nm and 860 nm low-level laser on injured rabbit cartilage. After punching 5 mm holes in both ears of ten rabbits, we grouped the rabbits randomly. The punched holes of the laser-treated group were irradiated with 630 nm and 860 nm diode laser on days 3-5 and then every other day until day 20. In both laser and control groups, the hole diameters were measured weekly. Histological evaluation was carried out on day 30. The inter-group difference in hole diameters was not significant. Mann-Whitney U tests showed significant inter-group differences in histological variables related to chondrocyte production and organization, growth rate, granulation tissue and pseudocarcinomatosis. LLLT improved cartilage formation and reduced inflammation and formation of granulation tissue. More accurate results on its healing effects warrant studies with larger sample sizes.

Injection drug use in Rural Iran: integrating HIV prevention into iran's rural primary health care system.

Major opium trafficking routes traverse rural Iran, but patterns of drug use and HIV infection in these areas are unknown. In 2004, Iran's Ministry of Health integrated substance use treatment and HIV prevention into the rural primary health care system. Active opium or heroin users (N = 478) were enrolled in a rural clinic. Participants received counseling for abstinence from substances, or daily needle exchange and condoms. On enrollment, 108 (23%) reported injecting; of these, 79 (73%) reported sharing needles. Of 65 participants tested for HIV, 46 (72%) tested positive. Participants who received daily needle exchange/condoms stayed in the program longer than those who did not (AOR 2.08, 95% CI 1.1-3.88). This project demonstrates that HIV risks exist in rural Iran and suggests the innovative use of Iran's rural health care system to extend prevention and treatment services to these populations.

Factors influencing success rate of leukocyte immunization and anti-paternal antibodies in spontaneous recurrent miscarriage.

PROBLEM: Paternal leukocyte immunotherapy has been used as treatment for spontaneous recurrent miscarriage; however, controversies have raged against the factors influencing its success. METHODS: Five hundred and forty-nine women with three or more unexplained pregnancy losses were offered immunization. Two weeks after the second immunization, serum was tested for anti-paternal cytotoxic antibody (APCA) by cross matching and if revealed positive she was advised pregnancy. Meanwhile, decision trees have been developed by Waikato Environment for Knowledge Analysis package to predict factors influencing APCA production and pregnancy. RESULTS: Of 549 subjects, 93 (16.9%) revealed to have positive APCA, among whom 49(52.7%) had clinically successful pregnancy (> or =28 weeks). Patient's age, consanguinity between couples and previous history of surgery, and infectious, endocrine, immunologic, uterine and cervix disorders were inversely associated with APCA production and clinically successful pregnancy, whilst, number of children was a potent positive predictor. CONCLUSION: Leukocyte immunization could be borne in mind as a therapeutic approach in selected subjects. Younger females with negative past medical history who are not frequent aborters are more likely to take benefit from this therapeutic approach if they do not have any familial relationship with their spouse.