Common risk factors of dry socket (alveolitis osteitis) following dental extraction: A brief narrative review.

Dry socket is a common complication of dental extraction, especially extraction of third molars. Knowledge of the frequent risk factors of alveolitis osteitis is useful in determining high-risk patients, treatment planning, and preparing the patients mentally. The aim of this narrative review was to summarize the common risk factors of dry socket. Unlike surgery difficulty, surgeon's experience, oral contraception use, and oral hygiene which showed stronger evidence, the influences of age, gender, and smoking were rather inconclusive. The case of female or oral contraceptive effect might relate mainly to estrogen levels (when it comes to dry socket) which can differ considerably from case to case. Many risk factors might be actually a combination of various independent variables, which should be targeted instead, in more comprehensive designs.

Diagnostic value of cone beam computed tomography and panoramic radiography in predicting mandibular nerve exposure during third molar surgery.

The aim of this study was to evaluate the diagnostic accuracies of cone beam computed tomography (CBCT) and panoramic techniques in predicting inferior alveolar nerve (IAN) exposure. The sample size was determined based on a pilot study. This prospective clinical series study included 59 third molar extraction sites with any of seven previously suggested panoramic signs of IAN exposure. The diagnosis of nerve exposure was done on panoramic and CBCT images. Molars were extracted and nerve exposure was evaluated clinically. Sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) of CBCT method, and sensitivity and PPV of panoramic method were estimated). The panoramic and CBCT methods correctly classified 67.7% and 93.3%, respectively, of 60 cases. This difference was statistically significant (χ2=13.333, P=0.000). The sensitivity, specificity, PPV, and NPV for CBCT were 97.4%, 85.7%, 92.7%, and 94.7%, respectively. The sensitivity and PPV of panoramic radiography were 67.8% and 97.6%, respectively. The signs with the highest sensitivity were interruption of the mandibular canal border and abrupt canal narrowing. None of the Pell and Gregory criteria, molar angulations, or three-dimensional canal-apex relationships was significantly associated with clinically confirmed IAN exposure. Panoramic radiography may miss about one-third of exposure cases, but a positive panoramic diagnosis is most likely to be a real exposure and should be taken seriously.

Meta-Analysis of Observational Studies on the Most Commonly Missing Permanent Dentition (Excluding the Third Molars) in Non-Syndromic Dental Patients or Randomly-Selected Subjects, and the Factors Affecting the Observed Rates.

PURPOSE: The aim of this study was to summarize the literature on the most frequently missing permanent teeth excluding the third molars. STUDY DESIGN: A search was conducted to find all the available literature (in various scientific and general databases) regarding the most commonly missing teeth with respect to ethnicity and time, as well as factors biasing this outcome. Quality assessment was done to exclude studies with inconsistent information, poor designs, or data pertaining to syndromic cases or the third molars. The role of biasing factors was as well quantitatively assessed using statistical analyses [Q-test, Egger regression, Spearman correlation coefficient, multiple linear regression, Welch t-test] (α=0.05). RESULTS: A total of 81 reports was included. The meta-sample was heterogeneous (P=0.000, Q-test). No significant publication bias was detected (P>0.1, Egger regression). The mandibular second premolar was reported as the most commonly missing tooth in most studies, followed by the maxillary lateral (the most commonly missing in the rest). In terms of the missing share of each tooth percent of all missing teeth, the mandibular second premolar and incisors are more likely to be absent, followed by the maxillary second premolar and lateral. The absence of different teeth can be affected by the ethnicity, sample types (epidemiological or dental patients), sample sizes (only in the case of bimaxillary second premolars), and the minimum ages of pooled subjects (only in the case of the maxillary lateral and the mandibular second premolar). CONCLUSIONS: Since enrolling younger patients can bias the results, older patients should be sampled.

Risk factors influencing dentists' hepatitis B-related knowledge and attitudes and their willingness to treat hepatitis B positive patients.

This study assessed factors that could predict dentists' knowledge, attitudes and behaviour towards hepatitis B virus (HBV). A total of 300 dentists in Tehran, Islamic Republic of Iran were surveyed and their demographic, educational and office characteristics were analysed in relation to their scores on knowledge about HBV, self-reported attitudes towards treating people infected with HBV and actual behaviour towards treating simulated HBV-positive patients. Having a Master's degree, faculty membership, taking ≥ 3 continuing education courses, wearing eye-shields, spending more time on preparing dental units and higher self-confidence about knowledge predicted better knowledge. A positive attitude was associated with having attended more courses and working in group practice. The number of courses and a shorter dental unit preparation time positively affected dentists' behaviour.

Chlorhexidine gel and less difficult surgeries might reduce post-operative pain, controlling for dry socket, infection and analgesic consumption: a split-mouth controlled randomised clinical trial.

Reports on post-surgical pain are a few, controversial and flawed (by statistics and analgesic consumption). Besides, it is not known if chlorhexidine can reduce post-extraction pain adjusting for its effect on prevention of infection and dry socket (DS). We assessed these. A total of 90 impacted mandibular third molars of 45 patients were extracted. Intra-alveolar 0·2% chlorhexidine gel was applied in a split-mouth randomised design to one-half of the sockets. None of the included patients took antibiotics or analgesics afterwards. In the first and third post-operative days, DS formation and pain levels were recorded. Predictive roles of the risk factors were analysed using fixed-effects (classic) and multilevel (mixed-model) multiple linear regressions (α = 0·05, ß≤0·1). In the first day, pain levels were 5·56 ± 1·53 and 4·78 ± 1·43 (out of 10), respectively. These reduced to 3·22 ± 1·41 and 2·16 ± 1·40. Pain was more intense on the control sides [both P values = 0·000 (paired t-test)]. Chlorhexidine had a significant pain-alleviating effect (P = 0·0001), excluding its effect on DS and infection. More difficult surgeries (P = 0·0201) and dry sockets were more painful (P = 0·0000). Age had a marginally significant negative role (P = 0·0994). Gender and smoking had no significant impact [P ≥ 0·7 (regression)]. The pattern of pain reduction differed between dry sockets and healthy sockets [P = 0·0102 (anova)]. Chlorhexidine can reduce pain, regardless of its infection-/DS-preventive effects. Simpler surgeries and sockets not affected by alveolar osteitis are less painful. Smoking and gender less likely affect pain. The role of age was not conclusive and needs future studies.

Tehran dentists' knowledge and attitudes towards hepatitis B and their willingness to treat simulated hepatitis B positive patients.

The dental profession has a high risk of hepatitis B virus (HBV) contamination and can play a crucial role in controlling HBV cross-contamination. In this cross-sectional study we used unique methods to assess Tehran dentists' knowledge, attitude and behaviour regarding HBV. Two simulated HBV-positive patients visited 300 general/specialist dentists in their offices and recorded dentists' willingness to treat them. Later, the dentists were interviewed regarding their knowledge about hepatitis B and attitude to HBV-positive patients. The mean knowledge score of dentists was 14.3 (SD 6.9) out of 44 and the mean attitude score was 20.0 (SD 3.6) out of 39. A majority of dentists (55.6%) were willing to treat a patient with HBV, unconditionally or with conditions. Some individual attitude items correlated with knowledge items concerning transmission of the virus and its prevention. Dentists' willingness to treat patients did not correlate with knowledge or attitude, except for the attitude item on concern about becoming infected.

Tehran dentists' knowledge and attitudes towards hepatitis B and their willingness to treat simulated hepatitis B positive patients

The dental profession has a high risk of hepatitis B virus [HBV] contamination and can play a crucial role in controlling HBV cross-contamination. In this cross-sectional study we used unique methods to assess Tehran dentists’ knowledge,attitude and behaviour regarding HBV. Two simulated HBV-positive patients visited 300 general/specialist dentists in their offices and recorded dentists’ willingness to treat them.Later, the dentists were interviewed regarding their knowledge about hepatitis B and attitude to HBV-positive patients. The mean knowledge score of dentists was 14.3 [SD 6.9] out of 44 and the mean attitude score was 20.0 [SD 3.6] out of 39. A majority of dentists [55.6%] were willing to treat a patient with HBV, unconditionally or with conditions. Some individual attitude items correlated with knowledge items concerning transmission of the virus and its prevention. Dentists’ willingness to treat patients did not correlate with knowledge or attitude, except for the attitude item on concern about becoming infected

La profession dentaire est à haut risque de contamination par le virus de l'hépatite B et peut jouer un rôle crucial dans la lutte contre la contamination croisée par ce virus. Dans cette présente étude transversale, des méthodes uniques ont été adoptée pour évaluer les connaissances,les attitudes et les comportements des dentistes de Téhéran vis-à-vis du virus de l'hépatite B. Deux patients déclarant une infection fictive par le virus de l'hépatite B ont rendu visite à 300 dentistes spécialistes ou généralistes sur leur lieu d'exercice et ont pris note de leur disposition à les traiter.Dans un deuxième temps, les dentistes ont été interrogés sur leurs connaissances en matière d'hépatite B et leur attitude vis-à-vis des patients infectés par le virus. Le score moyen des dentistes pour les connaissances était de 14,3 [ET 6,9] sur 44 tandis que le score moyen pour l'attitude était de 20,0 [ET 3,6] sur 39. La majorité des dentistes [55,6 %] étaient disposés à traiter un patient infecté par le virus de l'hépatite B, avec ou sans conditions. Certains items concernant l'attitude individuelle étaient corrélés aux items concernant les connaissances relatives la transmission du virus et sa prévention. La disposition des dentistes à traiter des patients infectés n'était pas corrélée aux connaissances ni à l'attitude, à l'exception de l'item concernant l'attitude relative à la crainte de contracter l'infection

Tehran dentists' self-reported knowledge and attitudes towards HIV/AIDS and observed willingness to treat simulated HIV-positive patients.

Dentists' self-reported attitudes towards patients with HIV/AIDS might not reflect their actual behaviour. In this study 2 observers posed as HIV-positive patients and directly evaluated the behaviour of 300 dentists in Tehran, Islamic Republic of Iran. Two months later another observer interviewed the same dentists at their offices regarding AIDS-related knowledge and self-reported attitudes. Only 14.9% of dentists agreed to treat the simulated HIV-positive patients, 78.5% referred and 6.6% rejected them. Older age, longer work experience, graduation from a non-Iranian university and not having additional degrees were significantly related to adverse behaviours. Mean scores were 8.3 (SD 9.7) (out of 18) for knowledge and 17.5 (SD 7.1) (out of 39) for attitude. There were no significant correlations between dentists' knowledge and attitude or between knowledge and behaviour, but there was a weak positive correlation between self-reported attitude and observed behaviour.

Accuracy of shade matching performed by colour blind and normal dental students using 3D Master and Vita Lumin shade guides.

The purpose of this study was to investigate whether 3D Master or VitaLumin shade guides could improve colour selection in individuals with normal and defective colour vision. First, colour perception of 260 dental students was evaluated. Afterwards, 9 colour blind and 9 matched normal subjects tried to detect colours of 10 randomly selected tabs from each kit and the correct/false answers were counted. Of the colour-defective subjects, 47.8% and 33.3% correctly detected the shade using 3D Master and VitaLumin, respectively. These statistics were 62.2% and 42.2% in normal subjects. In normal participants, but not in colour blind ones, 3D Master significantly improved shade matching accuracy compared to VitaLumin.

Tehran dentists' self-reported knowledge and attitudes towards HIV/AIDS and observed willingness to treat simulated HIV-positive patients

Dentists' self-reported attitudes towards patients with HIV/AIDS might not reflect their actual behaviour. In this study 2 observers posed as HIV-positive patients and directly evaluated the behaviour of 300 dentists in Tehran, Islamic Republic of Iran. Two months later another observer interviewed the same dentists at their offices regarding AIDS-related knowledge and self-reported attitudes. Only 14.9% of dentists agreed to treat the simulated HIV-positive patients, 78.5% referred and 6.6% rejected them. Older age, longer work experience, graduation from a non-Iranian university and not having additional degrees were significantly related to adverse behaviours. Mean scores were 8.3 [SD 9.7] [out of 18] for knowledge and 17.5 [SD 7.1] [out of 39] for attitude. There were no significant correlations between dentists' knowledge and attitude or between knowledge and behaviour, but there was a weak positive correlation between self-reported attitude and observed behaviour

An in vitro assessment of the effects of three surface treatments on repair bond strength of aged composites.

OBJECTIVE: This study evaluated the effectiveness of three surface treatments on repair shear bond strength (SBS) of aged composites. METHODS: A total of 120 cylindrical samples made of a micro-hybrid composite (Clearfil AP-X) were randomly assigned to one control and three experimental groups (n=30) after water storage (3 weeks). All experimental groups included surface roughening with diamond burs. Subsequent treatments were provided as follows: group 1 - only (self-etching) bonding; group 2 - silane and bonding; and group 3 - phosphoric acid etching, silane, and bonding. The composites were repaired with the same brand and were aged (water storage [48 hours] and thermocycling [2000 cycles]). Each group was divided into two subgroups (each, n=15): new - water storage at 37°C for one week; old - water storage for six months. The SBS was tested. The fracture mode was assessed under 40× magnification. RESULTS: Mean SBS values (MPa) for the study subgroups were as follows: control (new: 3.38 ± 1.6; old: 1 ± 0.76), group 1 (new: 27.3 ± 1.8; old: 25.7 ± 1.9), group 2 (new: 59.1 ± 7.9; old: 50.8 ± 4.6), and group 3 (new: 48.5 ± 8.6; old: 39 ± 3.5). Significant influence of the conditioning method and the duration of water storage was observed (p<0.01 [two-way analysis of variance {ANOVA}]). The SBS of all groups were significantly different (all p values <0.01 [Tukey]). Longer water storage time significantly reduced repair bond strength in all experimental groups (p<0.01). Although the control group and group 1 showed approximately 100% and 75% adhesive failures, respectively, groups 2 and 3, respectively, demonstrated about 75% mixed and cohesive failures. Weibull analysis showed that groups 2 and 1 had the lowest and highest probabilities of failure among the experimental groups, respectively. CONCLUSION: All experimental groups produced acceptable SBS levels; however, use of silane and bonding systems showed the most superior results. Acid etching reduced the SBS.

Developing an automatic lateral cephalometric landmark identification program and evaluating its performance.

PURPOSE: To evaluate the accuracy of detecting cephalometric landmarks automatically by computer. MATERIALS AND METHODS: Digital image processing algorithms (edge-based and morphological) in addition to mathematical algorithms (knowledge-based) were used to develop a program for the identification of 15 lateral cephalometric landmarks on digital cephalograms. RESULTS: The automatic landmark identification system was clinically acceptable (p > 0.05 comparing with 2-mm error range) for five landmarks. CONCLUSION: The automatic landmark identification is accurate for only some landmarks. Additional studies may be necessary to improve this method.