Postoperative pain of single-visit endodontic treatment with gutta-percha versus MTA filling: a randomized superiority trial.

BACKGROUND: Postoperative pain has remained a challenge for clinicians. This randomized superiority trial compared the levels of postoperative pain following the use of gutta-percha (GP) and sealer or mineral trioxide aggregate (MTA) as root canal filling materials in teeth with asymptomatic apical periodontitis. METHODS: A total of 119 patients were initially evaluated in this two-arm, parallel-group, single-blind, superiority randomized trial. The inclusion criteria were participants aged 18-65 years with single-canal premolars diagnosed with asymptomatic apical periodontitis. The participants were finally divided into two groups using the permuted block randomization method. In the GP group (N = 46), the cleaned and shaped root canals were filled with gutta-percha and AH Plus sealer, while in the MTA group (N = 48), the cleaned and shaped root canals were filled with an MTA apical filling and a coronal gutta-percha and sealer. Patient pain level was measured 6, 12, 24, 48, and 72 h postoperatively using a 10-point visual analog scale (VAS). The data were analyzed by the chi-square, independent t, Friedman, and Mann-Whitney U tests. RESULTS: The mean of VAS scores decreased significantly over time in both groups (P < 0.001). The mean VAS scores were significantly lower in the MTA filling group than in the other group (P < 0.05). Female patients reported higher VAS scores at 6- and 12-hour periods in both groups (P < 0.05). CONCLUSION: MTA as a root canal filling material might be a valuable option for clinicians due to its low postoperative pain. TRIAL REGISTRATION: The trial protocol was registered at the Registry of Clinical Trials (IRCT20191104045331N1).

Effect of premedication on the success of inferior alveolar nerve block in patients diagnosed with irreversible pulpitis: An umbrella review.

Successful management of pain during endodontic treatment is essential for both patients and dentists. Achieving adequate pulp anesthesia in mandibular molars is a significant concern for patients with irreversible pulpitis during endodontic treatment. The increased sensitization of nociceptors due to inflammation decreases the success of inferior alveolar nerve block (IANB). The main focus is on reducing inflammation before delivery of local anesthesia to increase the success of anesthetic drugs. This umbrella review aimed to revise, qualify and summarize the existing body of evidence on the effect of premedication on IANB in patients with irreversible pulpitis. A literature search was conducted using electronic databases (PubMed, Scopus, the Web of Science, and the Cochrane Library) with no date restriction until September 2021 to identify the relevant studies. All the cross-references of the selected studies and grey literature were also screened. Four systematic reviews assessing the effect of premedication on the success of IANB were selected. A conclusion was drawn that premedication with >400 mg of ibuprofen can positively affect the success of IANB.

Histological evaluation of ProRoot mineral trioxide aggregate and Cold ceramic as root-end filling materials in animal models.

Background: This study aimed to evaluate the reaction of the periapical tissue to Cold ceramic and mineral trioxide aggregate (MTA) following periapical endodontic surgery. Materials and Methods: In this experimental study, a total of 12 mandibular first, second, and third premolars of two male dogs were selected. All procedures were performed under general anesthesia. The access cavities were prepared, and the length of canals was determined. Root canal treatment was performed. A week later, periradicular surgery was performed. After osteotomy, 3 mm of the root end was cut. Then, a 3-mm cavity was created by an ultrasonic. The teeth were randomly divided into two groups (n = 12). The root-end cavities were filled with MTA in the first group and with Cold ceramic in the second group. After 4 months, the animals were scarified. Histological evaluation of the periapical tissues was performed. Data were analyzed using SPSS 22 and Chi-square test and P = 0.05. Results: The findings showed 87.5% and 58.3% cementum formation in MTA and Cold ceramic groups, respectively, indicating a significant difference (P < 0.001). In addition, the results showed 91.7% and 83.3% bone formation in MTA and Cold ceramic groups, respectively, but the difference was not statistically significant (P = 0.6). Furthermore, the findings revealed 87.5% and 58.3% periodontal ligament (PDL) formation in MTA and Cold ceramic groups, respectively (P = 0.05). Conclusion: Cold ceramic was able to induce the regeneration of cementum, bone, and PDL; hence, it can be considered as a biocompatible root-end filling material in endodontic surgery.

The effect of micro-osteoperforation on root resorption, pulp vitality, and biological changes of teeth subjected to orthodontic tooth movement: A systematic review study.

Background: These days minimally invasive micro-osteoperforation (MOPs) has accelerated orthodontic tooth movement (OTM). However, there are some conflicting reports about their various impacts; hence, the present systematic review study aimed to evaluate the effect of MOP on root resorption, pulp vitality, and the biological changes of teeth subjected to OTM. Materials and Methods: Search in electronic databases of English literature including PubMed, Scopus, Web of sciences, Cochrane, and Google scholar as well as a manual search was performed from 2013 to 2022. Most of the studies included in this article were randomized controlled trials. Results: From the total number of 321 found articles, 31 duplicated and 268 irrelevant articles were excluded regarding the defined inclusion and exclusion criteria. Consequently, 22 articles were subjected to the quality assessment process, and finally, 18 articles were selected for the review phase. Root resorption during tooth movement using the MOP approach was reported only in one study. Besides, except for two animal studies, all of the relevant included articles showed that MOPs significantly increased the expression of some inflammatory biomarkers known to recruit osteoclast precursors and increase the number of osteoclast cells. On the other hand, two animal studies showed no differences in osteoclast counts by using MOPs in comparison to their control groups, which was consequently the result of biologic variability between animal and human and also probably the small sample sizes of these two studies. Conclusion: In this systematic review, according to the adverse effects of MOP on root resorption, one study showed higher levels of root resorption among patients undergoing MOP. However, this outcome was due to the different methods used to evaluate the effect of MOPs on root resorption. Moreover, a high certainty of evidence supports that MOP causes biological changes and an elevation in cytokines, chemokines, and other biomarkers that stimulates osteoclasts differentiation which in turn accelerate OTM. There was no change in pulp vitality status based on available evidence.

MicroRNAs-mediated regulation of the differentiation of dental pulp-derived mesenchymal stem cells: a systematic review and bioinformatic analysis.

BACKGROUND: Human dental pulp-derived mesenchymal stem cells (hDP-MSCs), which include human dental pulp stem cells (hDPSCs) and stem cells from human exfoliated deciduous teeth (SHEDs), are promising cell sources for regenerative therapies. Nevertheless, a lack of knowledge relating to the mechanisms regulating their differentiation has limited their clinical application. microRNAs (miRNAs) are important regulatory molecules in cellular processes including cell differentiation. This systematic review aims to provide a panel of miRNAs that regulate the differentiation of hDP-MSCs including hDPSCs and SHEDs. Additionally, bioinformatic analyses were conducted to discover target genes, signaling pathways and gene ontologies associated with the identified miRNAs. METHODS: A literature search was performed in MEDLINE (via PubMed), Web of Science, Scopus, Embase and Cochrane Library. Experimental studies assessing the promotive/suppressive effect of miRNAs on the differentiation of hDP-MSCs and studies evaluating changes to the expression of miRNAs during the differentiation of hDP-MSCs were included. miRNAs involved in odontogenic/osteogenic differentiation were then included in a bioinformatic analysis. A miRNA-mRNA network was constructed, and Gene Ontology and Kyoto Encyclopedia of Genes and Genomes (KEGG) pathway analyses were performed. A protein-protein interaction (PPI) network was also constructed. RESULTS: Of 766 initially identified records through database searching, 42 and 36 studies were included in qualitative synthesis and bioinformatic analyses, respectively. Thirteen miRNAs promoted and 17 suppressed odontogenic/osteogenic differentiation of hDP-MSCs. hsa-miR-140-5p, hsa-miR-218 and hsa-miR-143 were more frequently reported suppressing the odontogenic/osteogenic differentiation of hDP-MSCs. hsa-miR-221 and hsa-miR-124 promoted and hsa-miR-140-5p inhibited neuronal differentiation, hsa-miR-26a-5p promoted and hsa-miR-424 suppressed angiogenic differentiation, and hsa-miR-135 and hsa-miR-143 inhibited differentiation within myogenic lineages. A miRNA-mRNA network including 1890 nodes and 2171 edges was constructed. KEGG pathway analysis revealed MAPK, PI3K-Akt and FoxO as key signaling pathways involved in the odontogenic/osteogenic differentiation of hDP-MSCs. CONCLUSIONS: The findings of this systematic review support the potential application of the specific miRNAs to regulate the directed differentiation of hDP-MSCs in the field of regenerative therapies.

Antioxidant Materials in Oral and Maxillofacial Tissue Regeneration: A Narrative Review of the Literature.

Oral and maxillofacial tissue defects caused by trauma, tumor reactions, congenital anomalies, ischemic diseases, infectious diseases, surgical resection, and odontogenic cysts present a formidable challenge for reconstruction. Tissue regeneration using functional biomaterials and cell therapy strategies has raised great concerns in the treatment of damaged tissue during the past few decades. However, during biomaterials implantation and cell transplantation, the production of excessive reactive oxygen species (ROS) may hinder tissue repair as it commonly causes severe tissue injuries leading to the cell damage. These products exist in form of oxidant molecules such as hydrogen peroxide, superoxide ions, hydroxyl radicals, and nitrogen oxide. These days, many scientists have focused on the application of ROS-scavenging components in the body during the tissue regeneration process. One of these scavenging components is antioxidants, which are beneficial materials for the treatment of damaged tissues and keeping tissues safe against free radicals. Antioxidants are divided into natural and synthetic sources. In the current review article, different antioxidant sources and their mechanism of action are discussed. The applications of antioxidants in the regeneration of oral and maxillofacial tissues, including hard tissues of cranial, alveolar bone, dental tissue, oral soft tissue (dental pulp, periodontal soft tissue), facial nerve, and cartilage tissues, are also highlighted in the following parts.

Antibacterial effect of nano-chlorhexidine on Enterococcus faecalis biofilm in root canal system: An in vitro study.

Background: A new method to improve the properties of the materials is nano-encapsulation, which improves the biological properties, antibacterial activity along with reduction of toxicity. Due to the spread of nano-knowledge, the present study was performed to evaluate the antibacterial effect of nano-chlorhexidine (CHX) on Enterococcus faecalis biofilm in the root canal system. Materials and Methods: In this in vitro experimental study, 55 matured single-root mandibular premolars were decoronated and the canals were prepared by single length method up to #F3 ProTaper Universal system. Five teeth were selected as negative control. Then, the teeth were randomly divided into three experimental groups (n = 15) and a positive control group (n = 5). The experimental groups were irrigated with 2% nano- CHX gel, 2% CHX solution, and 5.25% sodium hypochlorite (NaOCl), respectively. Finally, the number of colonies was counted. Kruskal-Wallis test was used to compare the number of colonies among groups. The level of significance was set at P < 0.05. Results: The mean number of colonies in the groups of nano-CHX, NaOCl, CHX, and positive control were obtained as 17.73 ± 18.69, 35.53 ± 36.42, 38.8 ± 31.8, and 96.8 ± 22.52, respectively. There was a significant decrease in the number of colonies in all the experimental groups compared to the control group (P < 0.05). However, difference in the number of colonies among these three groups was not significant (P > 0.05). Conclusion: The use of nano-CHX in removing E. faecalis biofilm from root canal is as effective as the use of CHX and NaOCl.

In Vitro Diagnostic Accuracy and Agreement of Dental Microscope and Cone-Beam Computed Tomography in Comparison with Microcomputed Tomography for Detection of the Second Mesiobuccal Canal of Maxillary First Molars.

Objectives: The percentage of failure of endodontically treated maxillary molars is relatively high; one main reason is that the second mesiobuccal canal (MB2) is missing. Some techniques have been proposed for detection of the MB2. This study was aimed at assessing the diagnostic accuracy and agreement of the dental microscope and cone-beam computed tomography (CBCT) in comparison with microcomputed tomography (micro-CT) for detection of the MB2 of maxillary first molars in vitro. Materials and Methods: This in vitro, experimental study evaluated 71 permanent maxillary first molars that were stored in 100% humidity at room temperature. The teeth were mounted in 9 silicone dental arches to the level of their cementoenamel junction (8 teeth in each arch). The blocks underwent CBCT in a XG3D scanner. Access cavity was then prepared, and the teeth were inspected by a surgical microscope for negotiation of the MB2. Also, micro-CT images were obtained from the teeth to serve as the gold standard. CBCT and micro-CT images were observed by two examiners twice with a 2-week interval. Results: The frequency of the MB2 detected by dental microscope was significantly lower than micro-CT (P < 0.001) and CBCT (P = 0.008); no significant difference existed between micro-CT and CBCT in this respect. The sensitivity, specificity, positive predictive value, and negative predictive value of CBCT for detection of MB2 were 92.6%, 100%, 100%, and 81%, respectively. Conclusion: CBCT is superior to the dental microscope for detection of the MB2 of maxillary first molars and can be used for this purpose in the clinical setting with adequate accuracy.

Effect of Duration of Root Canal Infection on the Ability of Dentin-Pulp Complex Regeneration of Immature Permanent Teeth: An Animal Study.

INTRODUCTION: Persistent infection is always considered the most important reason for the failure of dentin-pulp complex regeneration. The present study aimed to evaluate the effect of the duration of root canal infection (from 1-12 weeks) on the ability of dentin-pulp complex regeneration. METHODS: In this animal study, 64 roots of immature premolar teeth of 4 dogs were randomly divided into the following groups: the positive control group, 8 root canals treated with the regenerative endodontic procedure (REP); the negative control group, 12 infected root canals; the intervention groups, 36 root canals infected with supragingival plaque (1, 3, 6, and 12 weeks) and treated with REP; and an additional positive control group, 8 normal roots. After 3 months, the teeth were investigated by radiographic images and immunohistochemical staining (CD31, CD34, and S100 markers). In addition, DSPP gene expression was assessed using a real-time polymerase chain reaction technique. RESULTS: Based on radiologic evaluation among the intervention groups, the highest root canal development (length and width) occurred in the intervention group of 1 week, and the lowest radiologic results were in the intervention groups of 6 and 12 weeks (1-way analysis of variance, P-value < .05). There was a significant difference between the groups in terms of CD31, CD34, S100, and DSPP expression percentage (1-way analysis of variance, P-value < .05); the highest and lowest expression percentages belonged to the 1- and 12-week groups, respectively, among the intervention groups. CONCLUSIONS: This study demonstrated that long root canal infection decreased the ability of the body to regenerate the dentin-pulp complex.

Anaesthetic efficacy of incorporating different additives into lidocaine for the inferior alveolar nerve block: A systematic review with meta-analysis and trial sequential analysis.

BACKGROUND: Incorporating an additive into lidocaine is a method to enhance the efficacy of the inferior alveolar nerve block (IANB) in mandibular posterior teeth. OBJECTIVES: To assess the efficacy of incorporating additives into lidocaine in the success rate of IANB for teeth with the diagnosis of normal pulp (NP) or symptomatic irreversible pulpitis (SIP). METHODS: Randomized controlled trials (RCTs) assessing the incorporation of additives into lidocaine on the pulpal anaesthesia success rate of mandibular posterior teeth were searched in PubMed, Scopus, Web of Science, Ovid, EBSCO, Embase, and Cochrane databases up to 1 December 2021. The risk of bias (RoB) was assessed by the Cochrane Risk of Bias Tool. A random-effects model was employed to calculate the pooled risk ratio (RR) with a 95% confidence interval (CI), using STATA 16. The trial sequential analysis (TSA) was applied to calculate the required information size (RIS). The Grading of Recommendations, Assessment, Development and Evaluations (GRADE) approach was used to assess the certainty of the evidence. RESULTS: Of 6966 records retrieved initially, 14 trials (8 for NP and 6 for SIP groups) were included in qualitative and quantitative syntheses. All trials were categorized as low and unclear RoB for NP and SIP groups, respectively. In the NP group, with 307 participants, no significant effect was observed for additives incorporated into lidocaine (RR: 0.84; 95% CI: 0.53-1.32; I2  = 98%). Subgroup analysis revealed that adding mannitol led to a higher success rate (RR = 1.24; 95% CI: 1.15-1.34; I2  = 7.16%). In the SIP group, with 434 participants, no significant effect was shown when the additives were incorporated (RR = 1.22; 95% CI: 0.98-1.52; I2  = 0%). Likewise, in subgroup analysis, incorporating mannitol or sodium bicarbonate demonstrated no significant effect (RR = 1.76; 95% CI: 0.93-3.32; I2  = 18.41% and RR = 1.06; 95% CI: 0.65-1.72; I2  = 53.5%, respectively). DISCUSSION: TSA revealed that the outcome was "inconclusive" for each group. The certainty of the evidence was graded as "very low" and "low" for NP and SIP groups, respectively. CONCLUSIONS: The very low to low certainty of evidence indicated that incorporating additives into lidocaine did not increase the efficacy of IANB and supplemental injections are still necessary to help practitioners achieve painless dentistry. REGISTRATION: PROSPERO database (CRD42020132585).

Anesthetic Success Rate of Inferior Alveolar Nerve Block for Mandibular Molars with Symptomatic Irreversible Pulpitis in Women Taking Antidepressants.

Introduction: This study sought to evaluate the success rate of inferior alveolar nerve block (IANB) during the endodontic management of mandibular molars with symptomatic irreversible pulpitis in women taking selective serotonin reuptake inhibitor (SSRI) antidepressants. Materials and Methods: Ninety adult female patients over 18 years of age who were diagnosed with symptomatic irreversible pulpitis of a mandibular molar were recruited in this study. The patients were equally assigned to SSRI user group (including citalopram, escitalopram, fluoxetine, fluvoxamine, paroxetine, and sertraline), who had taken an SSRI, and non-SSRI user group, who had not taken any SSRIs at all. All patients in both groups received 3.6 mL of 2% lidocaine with 1:80,000 epinephrine using conventional IANB injection. Access cavity was prepared 15 min after the injection. Lip numbness was necessary for all patients. Success was determined as no or mild pain upon access cavity preparation and/or instrumentation based on the Heft-Parker visual analog scale recordings. Data were analyzed using the chi-square test Mann-Whitney U test, and t-test. Results: The success rate was 55.6% for SSRI users and 44.4% for non-SSRI users, and no statistically significant difference was observed between the two groups (x 2=1.1, P=0.292). Conclusions: Based on the results of this study, taking SSRI antidepressants could not affect the anesthetic success rate of IANB for mandibular molars with symptomatic irreversible pulpitis in women.

Isolation and Differentiation of Adipose-Derived Stem Cells into Odontoblast-Like Cells: A Preliminary In Vitro Study.

OBJECTIVE: The aim of present study was to isolate and differentiate human adipose-derived stem cells (ASCs) into odontoblast-like cells. MATERIALS AND METHODS: In this experimental study, human adipose tissues were taken from the buccal fat pad of three individuals (mean age: 24.6 ± 2.1 years). The tissues were transferred to a laboratory in a sterile culture medium, divided into small pieces and digested by collagenase I (2 mg/mL, 60-90 minutes). ASCs were isolated by passing the cell suspension through cell strainers (70 and 40 µm), followed by incubation at 37ºC and 5% CO2 in Dulbecco's modified eagle medium (DMEM) supplemented with fetal bovine serum (FBS 5%) and penicillin/streptomycin (P/S). After three passages, the ASCs were harvested. Subsequently, flow cytometry and reverse transcriptase polymerase chain reaction (RT-PCR) were used to detect expression levels of NANOG and OCT4 to evaluate stemness. Then, a differentiation medium that included high-glucose DMEM supplemented with 10% FBS, dexamethasone (10 nM), sodium ß-glycerophosphate (5 mM) and ascorbic acid (100 µM) was added. The cells were cultivated for four weeks, and the odontogenic medium was changed every two days. Cell differentiation was evaluated with Alizarin red staining and expressions of collagen I (COL1A1), dentin sialophosphoprotein (DSPP) and dentin matrix protein-1 (DMP1). RESULTS: The ASCs were effectively and easily isolated. They were negative for CD45 and positive for the CD105 and CD73 markers. The ASCs expressed OCT4 and NANOG. Differentiated cells highly expressed DSPP, COL1A1 and DMP1. Alizarin red staining revealed a positive reaction for calcium deposition. CONCLUSION: ASCs were isolated successfully in high numbers from the buccal fat pad of human volunteers and were differentiated into odontoblast-like cells. These ASCs could be considered a new source of cells for use in regenerative endodontic treatments.

Antibacterial Activity of Curcumin Against Periodontal Pathogens: A Systematic Review.

Periodontitis is a chronic inflammatory disease characterized by destruction of the supporting structures of teeth caused by development of dental plaques and accumulation of microorganism around the gingival tissue. Curcumin has been shown to improve clinical parameters in periodontal diseases. However, the efficacy of curcumin in the elimination of periodontal pathogens is not clearly defined. The purpose of this study was to carry out a systematic review of the antibacterial activity of curcumin against periodontal pathogens. An electronic literature search in Medline, Scopus, Science Direct, Web of Science, Cochrane library, and Google scholar was performed up to February 29, 2020, to identify studies assessing the antibacterial activity of curcumin against periodontal pathogens. From 1238 publications, three clinical trials and five in vitro studies met the eligibility criteria. All three clinical studies reported improvement in restoring gingival health in clinical and microbiological parameters, following adjunctive use of curcumin for treatment of periodontitis. All five in vitro studies showed that curcumin could inhibit the growth of bacterial strains. Three of the five in vitro studies evaluated the effect of curcumin on mixed biofilm of periopathogens, which showed a significant inhibitory effect of curcumin on periodontal biofilms. This systematic review found that curcumin has antibacterial activity against periopathogens. The anti-biofilm activity of curcumin is reported as one of the mechanisms for this phenomenon. Curcumin could improve the clinical parameters of periodontal tissue not only by inhibition of the pathogens but also by modulating the host response.

Meta-Analysis of Correlations between Altmetric Attention Score and Citations in Health Sciences.

INTRODUCTION: In recent years, several controversial reports of the correlation between altmetric score and citations have been published (range: -0.2 to 0.8). We conducted a meta-analysis to provide an in-depth statistical analysis of the correlation between altmetric score and number of citations in the field of health sciences. METHODS: Three online databases (Web of Science, Scopus, and PubMed) were systematically searched, without language restrictions, from the earliest publication date available through February 29, 2020, using the keywords "altmetric," "citation," and "correlation." Grey literature was also searched via WorldCat, Open Grey, and Google Scholar (first 100 hits only). All studies in the field of health sciences that reported on this correlation were included. Effect sizes were calculated using Fisher's z transformation of correlations. Subgroup analyses based on citation source and sampling methods were performed. RESULTS: From 27 included articles, 8 articles comprise several independent studies. The total sample size was 9,943 articles comprised of 35 studies. The overall pooled effect size was 0.19 (95% confidence interval 0.13 to 0.26). Bivariate partial prediction of interaction between effect size, citation source, and sampling method showed a greater effect size with Web of Science compared with Scopus and Dimensions. Egger's regression showed a marginally nonsignificant publication bias (p = 0.055), and trim-and-fill analysis estimated one missing study in this meta-analysis. CONCLUSION: In health sciences, currently altmetric score has a positive but weak correlation with number of citations (pooled correlation = 0.19, 95% C.I 0.12 to 0.25). We emphasize on future examinations to assess changes of correlation pattern between altmetric score and citations over time.

The Effects of Nutraceuticals and Bioactive Natural Compounds on Chronic Periodontitis: A Clinical Review.

The paper aims to review the current clinical evidence of various herbal agents as an adjunct treatment in the management of chronic periodontitis patients. Gingivitis and periodontitis are two common infectious inflammatory diseases of the supporting tissues of the teeth and have a multifactorial etiology. An important concern about chronic periodontitis is its association with certain systemic disease. New treatment strategies for controlling the adverse effects of chronic periodontitis have been extensively assessed and practiced in sub-clinical and clinical studies. It has been shown that the phytochemical agents have various therapeutic properties such as anti-inflammatory and antibacterial effects which can be beneficial for the treatment of periodontitis. The findings of this review support the adjunctive use of herbal agents in the management of chronic periodontitis. Heterogeneity and limited data may reduce the impact of these conclusions. Future long-term randomized controlled trials evaluating the clinical efficacy of adjunctive herbal therapy to scaling and root planing are needed.

The Effect of Adding Clonidine to Articaine and Epinephrine on Post-treatment Pain: A Randomized Clinical Trial Study.

Introduction: Articaine is reported to have a fast onset and a short-acting pulpal anesthesia in inferior alveolar nerve blocks. Clonidine is an α 2-adrenoceptor agonist and is used as an adjunct to enhance the anesthetic efficacy and induce greater analgesia. In an attempt to search for more effective ways to achieve profound analgesia after root canal treatment, this randomized clinical trial assessed the efficacy of clonidine added to articaine/epinephrine solution on post-operative pain relief after root canal treatment in mandibular molars with irreversible pulpitis. Materials and Methods: Our randomized clinical trial study enrolled one hundred patients with symptomatic irreversible pulpitis in mandibular molars. They were divided into two groups, each group received either 0.2 mL 150 µg/mL clonidine or distilled water added to 1.8 mL of 4% articaine with 1:100,000 epinephrine cartridge. The alveolar nerve block in the two groups was administered by the same clinician and the subject's pain scores were recorded at 6, 12, 24, 48 and 72 h post-operatively using a Heft-Parker visual analog scale. Data were analyzed using t, chi-square and repeated-measures ANOVA statistical tests. Results: The mean pain scores for clonidine group were significantly lower than control at all the time intervals after treatment (P<0.05). We did not notice any clinical and there were no complaints from the patients either. Conclusion: Based on this randomized clinical trial study the addition of clonidine to the articaine/epinephrine solution using an inferior alveolar nerve block during root canal treatment in mandibular molars with irreversible pulpitis may be effective in reducing post-operative pain.

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

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

The impact of pregnancy on women's oral health-related quality of life: a qualitative investigation.

BACKGROUND: Complex psychological and physiological changes occur in women's body during pregnancy. These changes affect both oral health status and oral health-related quality of life (OHRQoL). In almost all of the previous cross-sectional design studies on pregnant women, generic OHRQoL instruments have been used to measure OHRQoL. While such instruments may be reliable, they may not be appropriate to evaluate the OHRQoL in special populations like pregnant women. The purpose of this study was to investigate the self-perceived factors affecting the OHRQoL among pregnant women. METHODS: In this qualitative descriptive study, twenty- seven pregnant women were recruited from four healthcare centers located in Isfahan city, Iran. The interpretative phenomenological analysis was used to collect and analyze the data. Four criteria of credibility, dependability, transferability, and confirmability were implemented through established procedures to confirm the study rigor. RESULTS: Three major themes and six sub-themes capturing the impacts of pregnancy on women's OHRQoL were identified. They covered all areas of life, including daily life, psychological well-being, social life, physical impact, and also barriers to utilization of dental care services. Some new domains such as "dentists' refusal to treat pregnant women", "negative feelings about pregnancy" and "concerns about fetal health" were found as important factors which could influence the OHRQoL during pregnancy. CONCLUSION: The findings help to better understand the oral health issues impacting women during pregnancy and to achieve person-centered care and improved oral health outcomes in pregnant women. The conceptual framework created based on the results of this study may help health care workers and policy makers for improving the health of pregnant women.

Natural and herbal compounds targeting breast cancer, a review based on cancer stem cells.

Cancer stem cells (CSCs) are known as the major reason for therapy resistance. Recently, natural herbal compounds are suggested to have a significant role in inhibiting the breast cancer stem cells (BCSCs). The aim of this study was to explore the effective natural herbal compounds against BCSCs.This review article was designed based on the BCSCs, mechanisms of therapy resistance and natural herbal compounds effective to inhibit their activity. Therefore, Science direct, PubMed and Scopus databases were explored and related original articles were investigated from 2010 to 2019. BCSCs use different mechanisms including special membrane transporters, anti-apoptotic, pro-survival, and self-renewal- related signaling pathways. Natural herbal compounds could disturb these mechanisms, therefore may inhibit or eradicate the BCSCs. Studies show that a broad range of plants, either as a food or medicine, contain anti-cancer agents that phenolic components and their different derivatives share a large quantity. Natural herbal compounds play a pivotal role in the eradication of BCSCs, through the inhibition of biological activities and induction of apoptosis. Although it is necessary to conduct more clinical investigation.

Association between periodontal disease and non-apnea sleep disorder: a systematic review.

OBJECTIVES: Inflammation is an integral part of the pathogenesis of periodontitis and sleep disorders. The aim of the present study was to review systematically the current evidence relating to the association between periodontal diseases and non-apnea sleep disorder. MATERIALS AND METHODS: Systematic searches were performed in MEDLINE, PsycINFO, Cochrane library, Web of Science, and Scopus without any limitation. Following preliminary screening, the quality of the remaining selected papers was appraised using the Newcastle-Ottawa Scale. Due to substantial heterogeneity among the selected articles, main outcomes were reported in a qualitative manner. RESULTS: Following screening and evaluation, a final set of 13 studies was selected for inclusion. These studies examined the association between periodontal disease and short sleep duration, long sleep duration, poor sleep quality, or non-specific sleep disorders. The majority (N = 12/13) reported an association or trend between one type of sleep abnormality and periodontal or gingival parameters. CONCLUSION: Despite the respective limitations of the articles included in this systematic review, an association between periodontal diseases and sleep disturbances was apparent. CLINICAL RELEVANCE: Adequate management of periodontal disease requires that a patient's lifestyle factors be taken into consideration in treatment planning. One such factor is sleep initiation and maintenance. An obvious association between sleep disturbances and periodontitis exists. Sleep disorders may induce systemic inflammation, which, in turn, could influence the development of periodontitis.