Investigating the biocompatibility, flexural strength, and surface roughness of denture base resin containing copper oxide nanoparticles: An in vitro study.

Aim: This study aimed to evaluate the biocompatibility, flexural strength, and surface roughness of polymethyl methacrylate (PMMA) containing Copper Oxide Nanoparticles (CuO NPs) at different concentrations. Methods: 25 heat-polymerized PMMA wax patterns fabricated in 5 groups containing 0.5, 5, 50, and 500 µg/ml CuO NPs and nanoparticle (NP)-free PMMA discs were prepared. 5 growth mediums (DMEM with 10% FBS and 1% penicillin-streptomycin) without disks were also incubated similarly to serve as the control groups. The cytotoxicity of the discs was measured by the 3-(4,5-dimethylthiazol-2-yl)-2,5-diphenyl-2H-tetrazolium bromide (MTT) assay on cultured Human Gingival Fibroblasts. The number of 1.3 × 104 cells were seeded in each well of 96-well plates (5 wells for the extract of each specimen). Days 1, 3, 5, and 7 were the intervals that the culture media were in direct contact with the PMMA discs for either 24 or 72 h. After that, a total of 40 specimens with 65 × 10 × 2.5 mm dimensions were prepared in five groups (n = 8). The specimens were subjected to a rugosimeter for the evaluation of surface roughness. The flexural strength test was performed using a universal testing machine. Microscopic evaluation was performed for the dispersion of the NPs. Non-parametric Kruskal-Wallis test and parametric one-way ANOVA test were used for data analysis. Results: The samples containing 500 µg/ml NPs showed the lowest percentage of cell viability at all incubation periods, while the highest cell viability was observed in NP-free PMMA 24 h after the seventh day of incubation. NPs at 50 and 500 µg/ml concentrations showed strongly significant differences in cytotoxicity compared to the 0 concentration and the control group (p < 0.001). Although all the samples demonstrated an increasing pattern of cell viability on the third, fifth, and seventh days, the percentage of cell viability was significantly lower after 72 h than after 24 h in all incubation periods (p < 0.001). NPs significantly increased flexural strength (p = 0.005) but did not affect the surface roughness of the PMMA discs (p = 0.396). Significance: The CuO NPs were cytotoxic only when applied in high concentrations, but presented a descending trend over time. No cytotoxic effect was observed in the experimental groups after seven days of incubation. Furthermore, CuO NPs increased flexural strength, but the surface roughness of the PMMA discs was not affected.

Attitude of dental students toward evidence-based dentistry in Iran: A systematic review.

Background: Dentistry practice has become more complex and challenging in the recent years. The clinical decision-making process has experienced many problems due to changing socioeconomic patterns, knowledgeable patients, rapid technological advances, and information explosion. The present study reviewed the status of the attitude toward evidence-based dentistry (EBD) among dental students of Iran Universities. The effect of the educational intervention was also assessed. Materials and Methods: This systematic review was conducted according to the Preferred Reporting Items for Systematic review and Meta-Analysis checklist. Search strategy was developed by Medical Subject Headings terms and keywords surfing electronic available databases including Medline/PubMed and Google Scholar and local databases such as Scientific Information Database (SID) and Magiran. Two reviewers read the abstracts of all eligible papers and excluded the duplicates. They extracted the information of the full-text of the studies included in the review and assessed the quality by Joanna Briggs Institute critical appraisal checklist. Results: Ten studies including 8 cross-sectional and 2 interventional studies met the criteria. The assessment of the attitude of 937 dental students from a different region of the country toward EBD showed moderate to acceptable status using 3 different tools. In regard to educational interventions, 2 studies were successful to improve their attitude. Conclusion: Although the researchers presented good scores on the attitude questionnaires, the quality of the study tools, the eligible criteria for recruiting the participants and the method of evaluating the construct of attitude should be investigated in future studies.

Oral Pemphigus Vulgaris Treatment with Corticosteroids and Azathioprine: A Long-Term Study in Shiraz, Iran.

Background: Treating oral mucosal lesions of Pemphigus Vulgaris (PV) disease is usually challenging for clinicians. We studied the treatment outcomes of the oral PV patients referred to the Oral Medicine Department of Shiraz University of Medical Sciences from 2004 to 2018. Methods: The medical records of 54 oral PV patients with histopathological confirmation who were treated by a single protocol were studied. The protocol consisted of initial treatment with 1 mg/kg/day of oral prednisolone for all patients. After 4-6 weeks, all patients were prescribed 40 mg of prednisolone. If lesion recovery was not observed or new lesions had developed, adjuvant therapy (maximum dose of 200 mg per day of Azathioprine (AZA)) was initiated anytime during the treatment. The oral prednisolone dosage was gradually tapered to 5 mg/alternate day in 9 months. Results: 47 patients were included in the study. 34.04% were male and 65.96% were female with a mean age of 41.83 ± 12.520. The mean follow-up period was 50.806 ± 44.417 months (over 4 years). The severity of oral involvement was mild in 21.27%, moderate in 36.17%, and severe in 42.6%. During treatment, all patients except one experienced complete remission. The mean time to achieve complete remission was 150.39 ± 224.075 days. Most of the patients experienced relapse due to self-discontinuation of treatment. 55% had complete remission and 43% were in partial remission at the last follow-up session. In 65.96% of patients, treatment-associated side effects were observed. The patients treated with prednisolone alone had significantly more side effects than those using AZA as an adjuvant (80% vs 50%, respectively; P=0.030). The mean duration of follow-ups was longer for patients with side effects (P < 0.01). Topical corticosteroids were used for all patients sometime during the treatment. No deaths were recorded. Conclusion: Prescribing low-dose prednisolone and adding AZA in nonresponding cases has good clinical outcomes for the treatment of oral lesions of PV. Adjuvant therapy can avoid the increase in corticosteroid dosage and side effects. The treatment method described in this study can be a helpful guide for clinicians, especially when other immunosuppressive drugs are not available.

Salivary IGF-1 and Alkaline Phosphatase-Based Modeling for Skeletal Maturity Prediction in Orthodontic Patients.

RESULTS: A strong positive correlation was found between CA and cervical stages (r = 0.836, P < 0.001). Based on the regression model analysis, the model which combined IGF-1, ALP, and CA provided the best prediction at P < 0.001 with McFadden's pseudo R 2 value of 0.552 for cervical stage prediction and 0.646 for growth phase prediction. In particular, its predictive ability for the prepubertal, pubertal, and postpubertal growth phases was 95%, 80%, and 90%, respectively. CONCLUSIONS: A new model with the combination of salivary IGF-1 and ALP with CA can be used as a less invasive method to determine the cervical stage and also growth phase with high predictive ability in healthy subjects.

Spatial Evaluation of Oral Lichen Planus Patients Referred to Shiraz Dental School, Iran: a Medical Geography Approach.

Statement of the Problem: Oral lichen planus (OLP) is an important inflammatory disease concerning its tendency to malignancy. The etiopathogenesis of this disease is still unknown. Medical geography uses geographic techniques to study factors related to location that cause uneven distribution of disease. Purpose: This study was conducted to map OLP in patients referred to Shiraz Dental School with medical geography techniques and investigate any possible relationship between the number of dentists and health-centers in different regions of Fars province with the number of referrals. Materials and Method: In this cross-sectional study, we evaluated the records of OLP patients referred to Shiraz Dental School from 2007 to 2018. Age, sex, place of residence, occupation, level of education, location of involvement, duration, and cutaneous involvement were recorded. The number of dentists and healthcare centers was obtained from the statistical records of Fars province. A Geographic Information System was used for the assessment of the spatial distribution of OLP. Ordinary least squares (OLS) and geographically weighted regression (GWR) indices were used for evaluating the relationship between the number of dentists and health centers with the number of referrals. Results: From 1006 records, 457 were studied, from which 71% were female (age range of 41-60). The regression coefficient was 0.937 for the number of dentists in each county compared to OLP referrals indicating a strong relationship. The regression coefficient was 0.983 for the number of health-centers. According to GWR analyses in Shiraz neighboring counties like Marvdasht, Sepidan, and Sarvestan, there is a positive relationship between the number of dentists and OLP patients. Conclusion: The results revealed that dentists and health care centers had a good cognition of referring patients with OLP (as a premalignant lesion) for definite diagnosis in Fars counties. But both groups need more education in this matter. Moreover, referrals from settlements near Shiraz were more common because of their easier access.

Comparative study of serum zinc concentration in recurrent herpes labialis patients and healthy individuals.

BACKGROUND: Recurrent herpes labialis (RHL) is a common recurrent infective vesiculoulcerative disease. Topical and systemic administration of Zinc compounds has been indicated to have preventive and therapeutic effects. The purpose of this study was to evaluate the serum level of zinc in the patients with RHL and healthy individuals and also to investigate the correlation of this level with various parameters of the patient and disease course. METHODS: This cross-sectional study was performed on 43 patients with a history of recurrent herpers labialis and 42 subjects without any previous experience of the lesion. Blood samples were taken, and serum zinc level was measured using colorimetry (spectrophotometry) method. Chi-Square test was used to compare the qualitative relationships, and for comparing the quantitative relationships, independent T-test was used. To observe the relationship of quantitative factors including serum zinc level, the number of relapses, and recovery rates, correlation test was taken. RESULTS: The results show that, serum zinc level has no significant difference between healthy subjects and the patients (p > 0.05). Also, zinc level was not related to age and sex factors and frequency of relapse (p > 0.05). However surprisingly, there was a significant relationship between zinc level and recovery period in the RHL patients. The lower the serum zinc level, the higher the duration of recovery (p = 0.009). CONCLUSION: The results of this study indicate that, zinc deficiency can be considered as a risk factor for increasing the duration of herpes labialis lesions. Therefore, the evaluation of serum zinc level in the subjects with RHL and subsequent administration of zinc are recommended in these kind of patients.

Interleukin-27 gene variant rs153109 is associated with enhanced cytokine serum levels and susceptibility to Behçet's disease in the Iranian population.

Behcet's disease (BD) is a systemic vasculitis, characterized by recurrent oral aphthous, genital ulcers, ocular lesions, and other organ involvement. Interleukin (IL)-27 with its pro- and anti-inflammatory effects might be an important effective cytokine in this disease. The aim of this study was to investigate the association of IL-27 serum concentration and a single-nucleotide polymorphism (SNP) rs153109 (-964 A > G) with the risk and clinical features of the patients with BD. IL-27 Genotyping was performed using polymerase chain reaction-restriction fragment length polymorphism (PCR-RFLP) and the IL-27 serum levels were measured using enzyme-linked immunosorbent assay (ELISA). It is shown that AG, GG, and AG + GG genotypes, as well as G allele of rs153109, can significantly increase the risk of BD in total and in male individuals. Significantly higher frequencies of AG and GG genotypes and G allele were observed in total and male patients with an active form of BD. AG and GG genotypes were associated with joint (p = 0.046) and vascular (p = 0.02) involvement. The frequency of the G allele was higher in all patients, as well as in female patients with vascular involvement (p = 0.02). Serum cytokine analysis indicated an increased level of IL-27 in BD patients compared to healthy subjects (p = 0.038). Additionally, a higher level of IL-27 was detected in patients carrying the rs153109 GG genotype (p = 0.04) and those with renal (p = 0.009) and skin (p = 0.05) involvement. In conclusion, this study underscores the involvement of IL-27 rs153109 variants and increased serum level in BD susceptibility and pathogenesis.

Oral Health-Related Quality of Life in Chronic Liver Failure Patients Measured by OHIP-14 and GOHAI.

BACKGROUND: Oro-dental diseases are prevalent in chronic liver failure (CLF) patients. The aim of this study was to evaluate the quality of life associated with oral health in candidates for liver transplant surgery. MATERIALS AND METHODS: The demographic information of 105 end-stage liver cirrhotic patients was collected. All patients were ordered a panoramic view for pretransplant dental evaluation. The DMFT (decayed-missing-filled tooth) index was calculated for dental examination. The model for end-stage liver disease (MELD) was used for the severity of liver disease. The OHIP-14 (Oral Health Impact Profile) questionnaire and GOHAI (Geriatric Oral Health Assessment Index) questionnaire were applied to evaluate the impact of oral disease on the quality of life. RESULTS: A total of 79 patients thoroughly completed the questionnaires; 79.7% were male, 32.9% were over 50, and 25.3% were less than 30 years old. Further, 12.7% smoked, 2.5% were illiterate, 64.6% had not finished school, and 10.1% had university degrees. Almost half of the cirrhotic patients were suffering from the disease for more than 3 years. Most complaints reported by the patients as "very often" were becoming self-conscious (13.9%) and being uncomfortable when eating any foods (13.9%) followed by feeling tense (12.8%). There was no significant difference between gender, smoking, age, and MELD score based on quality of life (OHIP and GOHAI) (P > 0.05). The level of education (P = 0.020), duration of disease (P = 0.017), and DMFT index (P = 0.039) had a significant impact on oral health-related quality of life in CLF patients. An inverse relationship was seen between the DMFT index and the quality of life. CONCLUSION: Oral health has a high impact on the quality of life of cirrhotic patients. The psychological dimension of oral health is the most debilitating factor affecting the quality of life. This shows the importance of professional oral care, oral health, and self-care education in this group of patients.

Multiplex polymerase chain reaction for detection of bacteremia during dental extraction.

AIM: Incidence of transient bacteremia following dental extractions ranges 30%-70% among adults and 58%-100% in children. This study aims to assess the multiplex polymerase chain reaction (PCR) technique in detection of transient bacteremia during dental extraction. METHODS: Twenty volunteers for dental extraction entered the study. Blood samples were taken at baseline and 30 seconds and 15 minutes after extraction. Five types of bacteria were selected, namely Streptococcus mutans, S. salivarius, S. sanguinis, Enterococcus faecalis and Lactobacillus. Blood samples were evaluated by microbial culture and multiplex PCR. RESULTS: Blood culture showed rates of 0%, 80% and 25% for bacteremia before, during and after dental extraction, respectively. A significant difference was observed between baseline and during extraction. Using PCR, bacteremia was deemed 20%, 100% and 30% before, during and after extraction, respectively, and a significant difference was witnessed between the baseline and during extraction. The highest incidence was at the 30-second mark after extraction, and the most prevalent type of bacteria was S. mutans. CONCLUSIONS: Multiplex PCR can be used to determine bacterial diversity with high accuracy during occurrence of bacteremia. Therefore, in cases where positive blood cultures only indicate the presence of one species, we recommend the use of this method to detect more diverse bacteria types.

CD73 a novel marker for the diagnosis of benign and malignant salivary gland tumors.

BACKGROUND: Ecto-5'-nucleotidase (CD73) plays an important role in the development of several types of cancer; however, its prognostic significance in salivary gland tumors remains unknown. The current study was conducted to investigate the expression of CD73 in such tumors. MATERIAL AND METHODS: In this retrospective study, immunohistochemical expression of CD73 was evaluated in 25 pleomorphic adenomas, 20 mucoepidermoid carcinomas and 20 adenoid cystic carcinomas using the Envision technique. Labeling indices of CD73 expression were calculated and compared between lesions. RESULTS: Immunohistochemical analysis demonstrated that the CD73 expression was significantly higher in salivary gland tumors than in normal salivary gland tissue (p<0.001). CD73 expression was significantly higher in mucoepidermoid carcinoma and adenoid cystic carcinoma compared to pleomorphic adenoma p<0.001). In addition, the expression of CD73 was significantly higher in lymph node metastasizing cancers compared to non-metastasizing malignancies (P<0.001). In contrast, there was no significant association between CD73 expression and other clinicopathological variables such as age, gender, tumor size and distant metastasis (P>0.05). CONCLUSIONS: The findings suggest that CD73 can be an independent and useful biomarker for predicting the clinical behavior of salivary gland tumors. Key words:Ecto-5'-nucleotidase, immunohistochemistry, salivary gland tumors.

Knowledge and attitude of general dentists regarding common emergencies in dental offices: A cross-sectional study in Shiraz, Iran.

BACKGROUND: Medical emergencies are likely to occur in dental offices due to the use of anesthetics, anxiety, and systemic complications of the patient. Since such emergencies are life threatening in many cases, preparedness of the dentist is highly required. AIMS: This study was carried out to evaluate the dentists' knowledge and attitude regarding diagnosis and treatment of medical emergencies in dental offices in Shiraz, Iran. METHODS: This cross-sectional study was performed on 150 general dentists in Shiraz with at least 5 years since graduation in 2015. They were asked to complete a validated questionnaire including the dentists' demographic information and inquiries about their performance and knowledge in emergency situations. STATISTICAL ANALYSIS USED: Independent t-test, one-way ANOVA, and Pearson's correlation coefficient were used in this study. RESULTS: According to the inclusion criteria, 105 dentists participated in the study. The mean knowledge and attitude of the dentists was estimated 4.98 (±1.50) out of 10. No significant correlation was detected between age, sex, number of patients per day, and working hours with the knowledge of managing an emergency situation (P > 0.05). Out of the number of studied dentists, 49% had attended training workshops and 90% called for re-attending a workshop. The knowledge score of those who had participated in workshops was significantly higher than those who had not (P = 0.016). CONCLUSION: The results of this study revealed that the dentists' knowledge about emergency situations was average while the knowledge was higher in those who had attended emergency workshops. Thus, retraining courses and workshops must be considered more often for graduated dentists.

Osteoporosis and Jaw Abnormalities in Panoramic Radiography of Chronic Liver Failure Patients.

INTRODUCTION: Patients with chronic liver failure (CLF) are faced with many complications, because this organ is involved in various metabolic activities. Hepatic osteodystrophy is one of the major health issues encountered by this group of patients. The current study evaluated osteoporosis and bone changes in oral panoramic radiographies of cirrhotic patients. MATERIALS AND METHODS: In this study, 138 panoramic views of CLF patients, candidates for liver transplant (65 females, 73 males, aged 19-68 years) referred to Shiraz University Dental Clinic (Shiraz, Iran) for pretransplant oral examination, were evaluated. Also 138 healthy individuals (69 females, 69 males, aged 18-70 years) referred to the same clinic were examined. Abnormalities such as osteoporosis, pathologic radiolucencies, pathologic calcifications, tonsilloliths, condylar degeneration, and other findings in the alveolar bones were recorded. RESULTS: Osteoporosis was a common finding in CLF patients (p<0.001), and the probability of detecting low bone density in the panoramic view was 20.37 times higher among patients than healthy subjects. The probability of detecting pathologic jaw radiolucencies was 8.92 times higher in the case group than in the controls (p<0.001). Other bone abnormalities such as condylar degeneration and idiopathic osteosclerosis were also more prevalent in CLF patients compared to healthy subjects (p<0.001). CONCLUSION: Cirrhotic patients are prone to osteoporosis of the alveolar bones. Also, pathologic jaw radiolucencies as a result of oral infections are more prevalent in this group of patients. Routine oral panoramic views are acceptable and cost-effective radiographies for use in detecting such abnormalities in the alveolar bones as well as overall dental health. These findings also support the importance of dental health examinations prior to liver transplantation to reduce the risk of organ rejection.

Antifungal Activity of Xylitol against Candida albicans: An in vitro Study.

AIM: The most common fungal infection among human population is candidiasis, the etiology of which is mostly Candida albicans. As a result of a disrupted balance of the normal flora or a compromised immune system, Candida species can become pathogenic. Various in vitro surveys have shown that glucose intake is a promoter of C. albicans growth, whereas in vivo studies have found that xylitol can decrease the risk of candidiasis and angular cheilitis. Hence, we aimed to evaluate for the first time the inhibitory effects of xylitol on C. albicans by assessing its minimum inhibitory concentration (MIC) and minimum fungicidal concentration (MFC). MATERIALS AND METHODS: The standard strain of C. albicans was acquired. The fungi were incubated in supplemented brain-heart infusion broth for 48 hours at 37°C. The MIC was measured according to the Clinical and Laboratory Standards Institute (CLSI) M100-S24 standard. Microdilution method was applied using 360-uL sterilized polystyrene flat-bottomed 96-well plates. The antimicrobial effects were examined by the microbroth dilution method according to the CLSI M100-S24 standard. RESULTS: The MIC of xylitol for C. albicans was found to be 20 × 104 µg/mL. Furthermore, the concentration of 40 × 104 µg/mL with a decrease of 99.95% in the colony-forming units (CFUs) of the microorganism was found to be the MFC of xylitol for C. albicans. CONCLUSION: According to the results of this survey, xylitol has considerable antimicrobial effects. Hence, this substance can be used as an effective element in gums, toothpastes, and antimicrobial mouthwashes, especially in patients with candidiasis. CLINICAL SIGNIFICANCE: By knowing the MIC and MFC of xylitol, this substance can be effectively used in products aimed to cure this fungal infection.

Clinical Evaluation of High and Low-Level Laser Treatment (CO2vsInGaAlP Diode Laser) for Recurrent Aphthous Stomatitis.

STATEMENT OF THE PROBLEM: Recurrent aphthous stomatitis (RAS) is one of the most common lesions in the oral cavity. Due to its multifactorial nature, there is no definitive treatment for RAS. Laser therapy is one of the suggested treatments to reduce patient's discomfort. PURPOSE: The purpose of the present clinical trial is to assess the effect of low and high level laser therapy on pain control and wound healing of RAS. MATERIALS AND METHOD: Thirty six patients with minor RAS were divided into three groups. Group 1 (n=14) received CO2 laser, group 2 (n=12) were treated with InGaAlP Diode laser and group 3 (n=10) received sham laser as placebo. All patients were evaluated daily up to 15 days after receiving one session of laser therapy. Pain severity before and after treatment, wound healing, patient's satisfaction, and functional disturbance before and after treatment were recorded for each patient. RESULTS: According to statistical analysis, pain reduction after treatment in group 1 was 7.00±2.41, in group 2 was 2.08±2.31, and in group 3 was 1.40±1.77. In addition, a significant difference was observed in the reduction of functional complications in CO2 laser treated patients compared to the other two groups. CONCLUSION: High-level laser treatment showed analgesic effects on RAS, but no healing was observed. Low-level laser therapy demonstrated no positive effect on recurrent aphthous ulcers.

Evaluation of the Effect of Two Different Systemic Doses of Viola Odorata on Prevention of Induced Tongue Dysplasia in Rats.

STATEMENT OF THE PROBLEM: Oral cancer is among the ten most common cancers worldwide. It affects the life quality of patients in many ways. PURPOSE: The aim of this study was to compare the effects of two different systemic doses of Viola Odorata syrup on the prevention of 4-Nitroquinoline-1-oxide (4-NQO) induced tongue dysplasia in rats. MATERIALS AND METHOD: Forty-eight male Wistar rats were divided into four groups of A, B, C and D. Group A served as the control group. The rats in groups B to D received 30 ppm of 4-NQO in drinking water for 12 weeks. Additionally, the rats in groups B and C received Viola Odorata syrup at doses of 15 and 5 ml/kg, respectively, 3 times a week. Body weights were measured three times a week. At the end, the rats were euthanized and the tongue was removed. Histological evaluations for carcinogenesis were carried out under a light microscope. RESULTS: The mean body weight of the rats in groups B, C, and D were lower than that in group A (p< 0.01). After 12 weeks of treatment, microscopically no histological changes of the tongue base epithelia were observed in the control group. The rats in group B did not show severe dysplastic changes; only mild to moderate histological changes including hyperplasia and hyperkeratosis were evident. These incidences were significantly more apparent in groups C with moderate to severe changes (p< 0.05) and group D with severe dysplastic changes (p< 0.01). Almost all rats in group D had hyperplasia and manifested all of the stages of dysplasia. CONCLUSION: Viola Odorata extract has dose-dependent inhibitory effects on the development of tongue induced dysplasia.