Comparison of pulse oximeter, cold test, and electric pulp test for assessment of pulp vitality in permanent immature teeth.

INTRODUCTION: Pulp sensitivity tests are commonly used for assessment of pulp vitality. However, indirect assessment of pulp vitality by evaluation of nerve response and subjective nature are the main limitations of these tests. Pulse oximetry is used for assessment of blood oxygen saturation in medicine, and its efficacy for assessment of pulp vitality needs to be evaluated.

COMPARATIVE EFFICACY OF 1% CURCUMIN NANOMICELLE GEL AND 2% CURCUMIN GEL FOR TREATMENT OF RECURRENT APHTHOUS STOMATITIS: A DOUBLE-BLIND RANDOMIZED CLINICAL TRIAL.

OBJECTIVE: Recurrent aphthous stomatitis (RAS) is a highly prevalent painful inflammatory condition. Curcumin is currently used as a medicinal herb with optimal anti-inflammatory properties for many inflammatory conditions. However, due to its low water solubility and consequently low bioavailability, its nanoparticulate formulation has been considered for use. This study aimed to compare the efficacy of topical application of 1% curcumin nanomicelle gel and 2% curcumin gel for treatment of RAS. METHODS: This double-blind randomized clinical trial evaluated 48 RAS patients. The patients randomly received 1% curcumin nanomicelle gel or 2% curcumin gel, and were asked to apply it 3 times/day for 1 week. The severity of pain was measured using a visual analog scale (VAS), and the size of lesions (in millimeters) was measured by a periodontal probe before (baseline), and at 4, and 7 days after treatment. Data were analyzed by repeated measures ANOVA. RESULTS: No significant difference was noted in the pain score (P = .160) or size of lesions (P = .432) between the 2 groups at baseline. At 7 days, the pain score and size of lesions significantly decreased in both groups (P < .05). The reduction in pain score and lesion size was significantly greater in the curcumin nanomicelle gel group at both 4 and 7 days (P < .05). Also, the efficacy index (EI) was higher in curcumin nanomicelle gel group. CONCLUSIONS: The 1% curcumin nanomicelle gel can be effectively used to enhance the healing of RAS.

In vitro antibacterial effect of Pimpinella anisum essential oil on Enterococcus faecalis, Lactobacillus casei, Actinomyces naeslundii, and Aggregatibacter actinomycetemcomitans.

INTRODUCTION: Pimpinellaanisum is a medicinal plant with antimicrobial, antifungal, and anti-oxidative properties. Limited studies have assessed the antibacterial properties of Pimpinellaanisum on oral and dental pathogens.

Radiographic Position of Impacted Mandibular Third Molars and Their Association with Pathological Conditions.

OBJECTIVES: This study aimed to assess the radiographic position of impacted mandibular third molars (IMTMs) and their association with pathological conditions. MATERIALS AND METHODS: The impaction depth, relationship with ramus, and angulation of 1600 IMTMs and their association with 2nd molar distal caries and root resorption, pathological conditions, and proximity to the mandibular canal were evaluated on panoramic radiographs. The IMTM position was determined based on the depth of impaction according to the Pell and Gregory classification, relationship with ramus according to the Pell and Gregory classification, and angulation according to the Winter's classification. The classical and Bayesian logistic regressions were applied to analyze the effect of IMTM position on the associated complications using the odds ratio (OR) and 95% confidence interval (credible interval for Bayesian models). Two-tailed P value < 0.05 was considered statistically significant. RESULTS: Of 1600 IMTMs evaluated in this study, 195 (12.2%), 252 (15.8%), and 119 (7.4%) had caused second molar distal caries, second molar root resorption, and pathological lesions, respectively, and 872 (54.5%) had contact with the mandibular canal. Impaction angulation was a risk factor for second molar distal caries (maximum OR = 5.01, 95% CI: 3.12-8.18). Changed angulation and greater impaction depth were the risk factors for second molar root resorption (minimum OR = 1.64, 95% CI: 0.58-4.02). Decreased distance between the ramus and distal side of the second molar was a risk factor for associated pathological lesions (minimum OR = 2.73, 95% CI: 1.79-4.25). Mesioangular and horizontal angulations and greater impaction depth were the risk factors for contact with the mandibular canal (maximum OR = 3.44, 95% CI: 2.6-4.57 and minimum OR = 1.3, 95% CI: 094-1.8). CONCLUSIONS: The frequency of complications associated with IMTMs was low, but considerable. The occurrence of these conditions might be affected by the impaction position. Thus, regular follow-ups are recommended in order to be able to surgically intervene when the first signs of pathologies arise.

Role of Serum Uric Acid as a Protective Biomarker in Patients with Different Histopathological Grades of Oral Squamous Cell Carcinoma: a Case-Control Study.

The antioxidant properties of uric acid may have a protective effect against the formation of oxygen radicals and subsequently against carcinogenicity. The present study aimed at evaluating the serum level of uric acid in patients with oral squamous cell carcinoma (OSCC) with different histopathological grades. In this descriptive-analytical, case-control study, patients with OSCC and healthy controls were selected and matched regarding age and gender. The serum samples were collected from patients (before radiotherapy and chemotherapy) and controls, and their serum uric acid levels were measured enzymatically. Data were analyzed using independent t-test and ANOVA at 0.05 level of significance. The mean serum uric acid level in OSCC patients (4.2 ± 1.5 mg/dL) and healthy controls (4.38 ± 1.22 mg/dL) was not significantly different (P = 0.377). No significant association was noted between the histopathological grade of OSCC and mean serum uric acid (P = 0.781). The serum uric acid level had a direct significant correlation with age in OSCC patients (P < 0.001). The results of this study did not support the role of uric acid as a protective biomarker in OSCC. Further prospective studies are recommended to better elucidate the role of uric acid in the etiology of OSCC.

Secretor Status of ABO Antigens in Saliva of a Defined Group of Iranian Patients with Pemphigus Vulgaris: A Case-Control Study.

INTRODUCTION: Pemphigus is a chronic inflammatory and autoimmune disease which can cause blisters and mucocutaneous erosions. ABO secretor refers to those who secrete ABO blood group antigens based on their blood type in body fluids such as saliva, sweat, tears, semen, and serum. Previous studies showed that nonsecretor people are more prone to certain autoimmune diseases. AIM: The aim of this study was to determine the ABO secretor status in the saliva of patients with pemphigus vulgaris. MATERIALS AND METHODS: This case-control study was conducted on 35 patients with pemphigus vulgaris and 35 healthy controls. The two groups were matched for age and gender. Pemphigus vulgaris diagnosis was confirmed by histopathology and direct immunofluorescence microscopy. ABO blood grouping was done, and 5 ml of unstimulated saliva was collected to determine secretor status. Secretors were recognized from nonsecretors by the Wiener agglutination inhibition test. Results were extracted by using statistical chi-square and Fisher's exact tests. RESULTS: 16 male and 19 female patients aged 49.43 ± .12.37 years were compared with 16 male and 19 female controls aged 46.43 ± 11.88 years. The most frequent blood group among case and control groups was O (54.3% and 60%, respectively). There was no significant difference in blood groups (P=0.73). 90% of the samples were ABO secretors. The patient group included 31 (88.6%) and the control group included 32 (91.4%) ABO secretors; there was no significant difference between the two groups (P=1.000). CONCLUSION: In this study, we observed that the people with nonsecretor status in comparison with the people with secretor status are not more susceptible to develop pemphigus vulgaris.

Combination Therapy with 1% Nanocurcumin Gel and 0.1% Triamcinolone Acetonide Mouth Rinse for Oral Lichen Planus: A Randomized Double-Blind Placebo Controlled Clinical Trial.

OBJECTIVES: This study aimed to evaluate the efficacy of a combination of 1% nanocurcumin gel with 0.1% triamcinolone acetonide mouth rinse for oral lichen planus (OLP). MATERIALS AND METHODS: This double-blind randomized clinical trial was conducted on 31 patients with erosive or ulcerative OLP. All patients received 0.1% triamcinolone mouth rinse and were then randomly divided into two groups for combination therapy with (I) %1 nanocurcumin gel or (II) placebo gel. The reticular-erosive-ulcerative (REU) score was calculated at baseline and at two and four weeks after the intervention. The changes in the mean REU score and the efficacy index were calculated to determine the level of improvement after two and four weeks. Data were analyzed using independent t-test, repeated measures ANCOVA, Mann-Whitney test, and chi-square test. P < 0.05 was considered statistically significant. RESULTS: There were 14 patients in the nanocurcumin and 17 patients in the placebo group. A significantly higher decrease in the mean REU score was observed in the nanocurcumin compared with the placebo group (P < 0.001). The efficacy index was significantly higher in the nanocurcumin group (P < 0.001). CONCLUSION: Application of 1% nanocurcumin in combination with 0.1% triamcinolone acetonide can serve as an effective treatment strategy to enhance the level of improvement of lesions compared with the use of triamcinolone acetonide alone.

Mandibular Metastasis of Silent Papillary Thyroid Carcinoma: A Rare Case Report with Review of the Literature.

Metastasis to the jaws is a rare event; however, it has great importance because it may be the only symptom of an undiagnosed underlying malignancy. Papillary thyroid carcinoma, the commonest histopathologic variant of thyroid cancer, has minimal potential for distant metastasis, and most reported metastatic thyroid carcinomas of the oral cavity have been follicular thyroid carcinoma. The aim of this article is to present a rare case of metastatic papillary thyroid carcinoma, which presented itself as a painless expansion in the anterior region of the mandible in a 56-year-old female, and to review previously published cases of this type of cancer. Reporting rare cases such as this one, together with reviewing previous reports of related rare diseases, will expand the body of knowledge about these uncommon lesions.

Effect of 810 nm diode laser on physiologic gingival pigmentation.

BACKGROUND AND AIMS: Physiologic gingival pigmentation (PGP) is the most common type of gingival pigmentation causing esthetic concerns particularly in gummy smile patients. Laser therapy is an effective and noninvasive treatment modality for such patients. This study aimed to evaluate the efficacy of diode laser for treatment of PGP. SUBJECTS AND METHODS: This quasi-experimental study (one-group pretest-post-test design) was conducted on 20 patients complaining of gingival melanin pigmentation. The gingiva of the anterior segment of the arch was ablated with 810 nm diode laser until the entire visible pigmentation was removed. Clinical observations for the intensity of pigmentation were made at baseline, one month and three months, postoperatively. Data were analyzed using SPSS and Friedman test. RESULTS: Preoperatively, the mean score of gingival melanin pigmentation in the maxilla and mandible was 2.95. At one month postoperatively, the mean scores of the maxilla and mandible were 1.53 and 1.55, respectively. After three months, the mean rank of scores of the maxilla and mandible was 1.53 and 1.50, respectively. The difference between the pre- and postoperative mean scores was statistically significant (P < 0.001). CONCLUSION: Diode laser therapy is an effective and minimally invasive modality for gingival depigmentation. But further investigations with long-term follow ups are warranted in this respect.

Orofacial manifestations of adverse drug reactions: a review study.

BACKGROUND: Adverse reaction to medication is common and may have a variety of clinical manifestations in the oral cavity. The present review paper aimed to describe adverse drug reactions (ADRs) which might be encountered by dental practitioners in every discipline. METHODS: In this narrative review article, the specialized databases such as PubMed, PubMed Central, MEDLINE, EBSCO, Science Direct, Scopus, and reference books from the years 2000-2016 were used to find relevant documents by using MeSH terms: Adverse Drug Reaction, Drug induced, Medication Related, Mouth, Oral Manifestation, Tooth, Hard Tissue, Soft Tissue. RESULTS: The data were categorized in 4 groups as follows: saliva and salivary glands involvement, soft tissue (mucosal) involvement, hard tissue involvement, and non specific conditions (taste disorders, halitosis, neuropathies, movement disturbances, and infection). Most articles were about the adverse effect of drugs on the function of salivary glands, which often cause a decrease in saliva secretion. Other reactions were less common; meanwhile, the side effect of bisphosphonate was increasing in the alveolar bone, because of its unlimited prescription. CONCLUSION: Oral health care providers should be familiar with such events, as they will be confronted with them in their practice.

Gingival depigmentation by Er,Cr:YSGG laser and diode laser: a split mouth, clinical trial study.

BACKGROUND AND AIMS: The Aim of this study was to evaluate the effectiveness of Diode laser and Er,Cr:YSGG laser ablation on the treatment of physiologic gingival melanin hyperpigmentation. MATERIALS AND METHODS: This research design was split mouth, double blind, and clinical trial. The power of the diode laser was set at 1 W, fiber 320 µ, irradiation mode: continuous-wave with treatment mode of contact tip and Er,Cr:YSGG laser (2780 nm) was set at 100 MJ, frequency of 15 Hz, total power of 1.75 W, 10% water and 20% air. Bleeding, pain, healing, Dummett oral pigmentation index (DOPI) and Hedin melanin score changes and repigmentation were assessed. Patients were followed for 6 months. RESULTS: A total number of 14 patients were involved in this study. There were statistically significant differences in reduction of DOPI and Hedin melanin score in each treatment groups separately while diode laser group had better results (P < 0.0001). There was no statistically significant difference between groups in terms of repigmentation. There was more pain in diode laser group (P < 0.0001) and there was more bleeding in Er,Cr:YSGG laser group (P = 0.0156). Gingival healing was more in Er,Cr:YSGG laser group (P < 0.0001). CONCLUSION: Diode laser had more efficiency for reduction of DOPI and Hedin melanin index scores.

Can Salivary Acetylcholinesterase be a Diagnostic Biomarker for Alzheimer?

INTRODUCTION: The loss of brain cholinergic activity is a key phenomenon in the biochemistry of Alzheimer's Disease (AD). Due to the specific biosynthesis of Acetylcholinesterase (AChE) of cholinergic neurons, the enzyme has been proposed as a potential biochemical marker of cholinergic activity. AChE is expressed not only in the Central Nervous System (CNS), Peripheral Nervous System (PNS) and muscles, but also on the surface of blood cells and saliva. AIM: This study aimed to measure salivary AChE activity in AD and to determine the feasibility of creating a simple laboratory test for diagnosing such patients. MATERIALS AND METHODS: In this cross-sectional study, the recorded data were obtained from 15 Alzheimer's patients on memantine therapy and 15 healthy subjects. Unstimulated whole saliva samples were collected from the participants and salivary levels of AChE activity were determined by using the Ellman colorimetric method. The Mann Whitney U test was used to compare the average (median) of AChE activity between AD and controls. In order to adjust for possible confounding factors, partial correlation coefficient and multivariate linear regressions were used. RESULTS: Although the average of AChE activity in the saliva of people with AD was lower compared to the control group, we found no statistically significant differences using Mann Whitney U test (138 in control group vs. 175 in Alzheimer's patients, p value=0.25). Additionally, no significant differences were observed in the activity of this enzyme in both sexes or with increased age or duration of the disease. After adjusting for age and gender, there was no association between AChE activity and AD (regression coefficient ß=0.08; p value= 0.67). CONCLUSION: Saliva AChE activity was not significantly associated with AD. This study might help in introduce a new diagnostic aid for AD or monitor patients with AD.

Frequency of craniofacial pain in patients with ischemic heart disease.

BACKGROUND: Referred craniofacial pain of cardiac origin might be the only symptom of ischemic heart accidents. This study aimed to determine the frequency of craniofacial pain in patients with ischemic heart disease. MATERIAL AND METHODS: This cross-sectional study was accomplished on 296 patients who met the criteria of having ischemic heart disease. Data regarding demographics, medical history and referred craniofacial pain were recorded in data forms. In addition, patients underwent oral examination to preclude any source of dental origin. Chi-square test, Student's t-test and backward regression model were used to analyze the data by means of SPSS software version 21. P<0.05 was considered significant. RESULTS: A total of 296 patients were studied comprising of 211 men (71%) and 85 women (29%) with the mean age of 55.8. Craniofacial pain was experienced by 53 patients out of 296, 35 (66%) of whom were male and 18 (34%) were female. None of the patients experienced craniofacial pain solely. The most common sites of craniofacial pain were occipital and posterior neck (52.8%), head (43.3%), throat and anterior neck (41.5%) respectively. We found no relationship between craniofacial pain of cardiac origin with age, diabetes, hypertension, and family history. On the other hand, there was a significant relationship between hyperlipidemia and smoking with craniofacial pain of cardiac origin. CONCLUSIONS: Radiating pain to face and head can be expected quite commonly during a cardiac ischemic event. Dental practitioners should be thoroughly aware of this symptomatology to prevent misdirected dental treatment and delay of medical care. Key words:Craniofacial pain, ischemic heart disease, myocardial infarction, angina pectoris, referred pain.

Evaluation of Root Canal Morphology of Mandibular First and Second Premolars Using Cone Beam Computed Tomography in a Defined Group of Dental Patients in Iran.

BACKGROUND: Successful dental root canal treatments require a complete knowledge of dental anatomy and root canal morphology. MATERIALS AND METHODS: One hundred and forty-five cone beam computed tomography (CBCT) images were used to assess the anatomy and morphology of mandibular premolars based on Vertucci's classifications in a defined group of dental patients in Iran. The number of roots and root canals, root canal morphology, root and canal shape (curvature), existence of C-shaped canal, and influence of sex on each of these were evaluated. A chi-squared test was used for statistical analysis. RESULTS: The mandibular first and second premolars had a single root in 95.97% and 100% cases, respectively. In the mandibular first premolars, 62.2% were of type I, 0.8% type II, 10.9% type III, 0.8% type IV, 20.3% type V, 4.2% type VI, and 0.8% type VII; in the second premolars, 78% of canals were of type I, 3% type II, 11% type III, 7% type V, and 1% type VI. C-shaped canals did not exist in either of the premolars. The most prevalent root and canal shape was straight. The most prevalent root curvature was a distal curvature in both premolars (71.4% and 74% of first and second premolars, resp.). The most prevalent canal curvature was lingual and buccal for the first premolars (7.6% each) and distal for the second premolars (11%). No significant difference was found between men and women in nearly all of the above (P > 0.05). CONCLUSION: The results suggest that there is a need to conduct further evaluations on finding root and canal variations among more populations to gain better knowledge prior to root canal treatment.

Assessment of Uric Acid Level in the Saliva of Patients with Oral Lichen Planus.

OBJECTIVE: The aim of this study was to evaluate the level of uric acid (UA) in saliva, which is considered to be an antioxidant defense biomarker against oxidative stress in patients with oral lichen planus (OLP). SUBJECTS AND METHODS: In this case-control study, 25 OLP patients were included. The reticular form of OLP was verified by a clinical examination with Wickham striae, and other types (erosive, atrophic, ulcerative) were confirmed by histopathological assessment. Thirty healthy individuals matched for age and gender were selected as the control group. In both groups, the Navazesh technique was used to collect the unstimulated saliva. Then, the amount of UA was measured using a Cobas Mira autoanalyzer with a wavelength of 546 nm. The Student t test was used to analyze the data assuming a significance level at <0.05. RESULTS: Of the 25 patients, the most common type of OLP was erosive (n = 11, 44%), and the most common site of OLP was seen as bilateral in the buccal mucosa (n = 12, 48%). The mean level of salivary UA was significantly lower in the patients with OLP (2.10 ± 0.19 mg/dL) in comparison with the control group (4.80 ± 0.29 mg/dL; p < 0.001). CONCLUSION: In this study, OLP was associated with a decrease in UA levels in the saliva. Salivary UA as a biomarker could be used for monitoring and treating OLP.

Bimaxillary Aneurismal Bone Cyst in Patient with End Stage Renal Disease and Hyperparathyroidism: A Rare Case Report and Review of the Literature.

Aneurismal bone cyst (ABC) is a rare bony lesion occurring predominantly in long bones. Its jaws' involvement is uncommon and the simultaneous involvement of both jaws is very rare. This report is about a 27-year-old female experiencing renal failure with ABC involving her maxilla and mandible. The progressive lesion was treated surgically and there was no recurrence after 18 months of follow-up.

Risk factors in patients with oral pemphigus vulgaris: a case-control study.

Pemphigus vulgaris (PV) is considered a chronic disease with a potentially fatal outcome. Studies have suggested that environmental factors and personal habits play an important role in the pathogenesis of PV, but more studies are required to elaborate their connection to the disease. The goal of this multicenter case-control study was to determine some of the environmental factors related to PV. Cases (n = 99) were patients with PV, and controls (n = 198) were individuals who did not have PV. Data about demographics, history, clinical findings, occupational exposures to pesticides, smoking status, number of births (parity), herpes simplex virus (HSV) infection, and fast food consumption were collected using a structured questionnaire. Chi-square and logistic regression analyses were used for data analysis. Univariate logistic regression analysis indicated that the statistically significant factors related to PV were infection with HSV in recent weeks (odds ratio [OR], 3.35; 95% confidence interval [CI], 1.75-6.43), parity (OR, 0.50; 95% CI, 0.39-0.63), and lack of occupational exposure to pesticides (OR, 0.36; 95% CI, 0.21-0.60). Multivariate analysis revealed that significant factors were cessation of smoking (adjusted odds ratio [AOR], 4.36; 95% CI, 1.50-12.66), HSV infection (AOR, 2.91; 95% CI, 1.47-5.75), and lack of occupational exposure to pesticides (AOR, 0.35; 95% CI, 0.20-0.63). The findings indicated that cessation of smoking and HSV infection in recent weeks are risk factors for PV, while lack of occupational exposure to pesticides and increasing parity (a greater number of births) are protective factors against PV.

Evaluation of Salivary Secretor Status of Blood Group Antigens in Patients with Oral Lichen Planus.

OBJECTIVE: To investigate the relationship between secretion or nonsecretion of blood group antigens into the saliva and oral lichen planus (OLP). SUBJECTS AND METHODS: In this study, 30 patients (women: 22, men: 8) with OLP were examined as the case group and 30 subjects without OLP matched for age and gender as the control group. Diagnosis of OLP was confirmed by clinical and histopathological examinations according to WHO criteria. The control group was randomly selected from healthy individuals without pathological oral changes seeking dental treatment. In both groups, blood group type was determined by hemagglutination, and unstimulated saliva was collected using the Navazesh technique. Establishment of salivary secretor status was carried out using the Wiener agglutination test. The data were analyzed using a Χ2 test, Fisher's exact test, and logistic regression. RESULTS: The patients with OLP (cases), including 22 (36.7%) women and 8 (13.3%) men with a mean age of 51 ± 14.16 years, were compared with healthy subjects (controls), comprised of 25 (41.7%) women and 5 (8.3%) men with a mean age of 50.7 ± 13.56 years. A large majority of the people examined in both groups were secretors of blood group A. On the other hand, most OLP patients were blood group B. In the case group, 25 subjects (84.4%) were secretors and 5 (16.6%) were nonsecretors. In the control group, 24 subjects (80.0%) were secretors and 6 (20.0%) were nonsecretors. There was no significant difference between the case and control groups for secretor status (p = 0.73). CONCLUSION: The present study did not indicate a significant difference in salivary secretor status between OLP patients compared to controls.

Lasers in esthetic treatment of gingival melanin hyperpigmentation: a review article.

The health and suitability of mouth components play an important role towards defining facial attractiveness. An important component of the oral cavity is the color of the gingival tissue. Gingival melanin hyperpigmentation is caused by several reasons and affects people across ethnicity, race, age, and both gender. Lasers are presently being used for gingival melanin depigmentation. In this article, we reviewed studies on laser parameters, duration of gingival healing, pain perception during and after the operation, scores used for the evaluation of gingival melanin hyperpigmentation, follow-up period, treatment results, and recurrence reports. We conclude that laser ablation for gingival depigmentation is one of the most pleasant, reliable, acceptable, and impressive techniques available for treating gingival melanin hyperpigmentation.

Frequency of Iatrogenic Errors through Root Canal Treatment Procedure in 1335 Charts of Dental Patients.

BACKGROUND: Endodontic procedures such as root canal treatment would be at the risk of failure like other medical interventions due to any unsuitable conditions. This has a causative effect in making the procedure more complicated to resulting in weak prognosis finally. Technical errors such as ledge, perforation, obstruction, broken instrument, etc. make infection control too hard or impossible. The aims of this study are common errors frequency and types of root canal treatments focusing on defined groups of dental students in Qazvin, Iran. MATERIALS AND METHODS: All the errors were divided into three major kinds of: (1) During providing access cavity, (2) cleaning and preparation and (3) canal obturation. RESULTS: A total number of 1335 charts of the cases were studied in the field of root canal treatment. The whole number of charts, which reported errors was 880 (66%) while 455 (34%) error-free ones. The most frequent error in upper incisors was void with the rate of 50.9%, followed by overfilling (apical perforation) in 18.2%. The same errors were also most common for lower incisors in addition to imperfect cleaning. CONCLUSIONS: The current study identified the least mistakes through the process of providing access cavity and instrumentation phase comparing obturation phase, which had the most frequent errors including void, overfilling and imperfect cleaning.