Oral Health Status and Salivary Properties among Children before and after Tonsillectomy.

Objectives: Enlarged adenoids can lead to obstruction of the nasopharyngeal airway and subsequent oral respiration. Oral breathing can cause dry mouth, dehydration in gingival tissue, and resistance to plaque accumulation. This study aimed to evaluate the impact of tonsillectomy on oral health status, salivary pH and flow rate, and common complications caused by tonsillar hypertrophy in children. Materials and Methods: An analytical before-and-after study was conducted on 60 children aged 5-12 years who required tonsillectomy. We gathered data through a questionnaire and collected unstimulated saliva using the spitting method for five minutes. Salivary pH was measured by a pH meter and its volume was determined with a calibrated test tube. The plaque index, bleeding index and modified gingival index were determined using a disclosing tablet, Williams' probe and observational examination, respectively. All measurements were repeated one month after tonsillectomy. Paired t-test was used for data analysis. Results: We found a significant increase in mean pH and salivary flow rate after tonsillectomy and observed a decrease in oral health indices among the children one month after surgery. Over half of the children who reported complications such as dry mouth, itchy nose and throat, snoring, night sweats, and sleep disturbances experienced complete recovery after tonsillectomy. Conclusion: Based on the results obtained in the present study, children with enlarged adenoids showed significant improvements in salivary pH, salivary flow rate, and oral health indices, one month after tonsillectomy.

Assessment of Clinical Reasoning and Diagnostic Thinking among Dental Students.

Introduction: This study aimed to investigate dental students' clinical reasoning and diagnostic thinking ability by key feature test and "diagnostic thinking inventory" questionnaire. Methods: The present study was a descriptive cross-sectional study. The participants consisted of 61 senior dental students. Clinical reasoning and diagnostic thinking were assessed by key feature tests and the "diagnostic thinking inventory" "DTI" questionnaire, respectively. The "diagnostic thinking inventory" was developed by Bordage et al. in France and consisted of 41 questions on a 6-point Likert scale. The satisfaction of students was assessed through a 10-item questionnaire. Data were analyzed using SPSS 19 with descriptive tests (mean, SD, and percentage), student independent T-test, and Pearson correlation. The significance level was determined at p < 0.05. Results: The mean scores of the key feature test were 56.55 ± 7.80. Diagnostic thinking scores of learners were reported in diagnostic thinking 136.47 ± 16.45, flexibility in thinking 72.22 ± 11.15, and structure of memory 64.24 ± 7.84. The difference in students' scores in flexibility in thinking was significantly higher among male students than female students. (p-value = 0.04). The students' satisfaction scores were 3.53 ± 0.52, which showed relative satisfaction. Conclusion: The participants' clinical reasoning and diagnostic thinking skills were reported at a low level. This issue emphasizes the need for training to enhance diagnostic thinking and clinical reasoning in dental education. Formative evaluation and reform of the educational programs of this course should be considered.

Evaluation of root surface roughness produced by hand instruments and ultrasonic scalers: An in vivo study.

Background. The aim of periodontal treatment is to remove bacterial plaque and dental calculus by hand and power-driven instruments. However, the comparison of the effectiveness of these instruments has always been controversial. Therefore, this in vivo study investigated and compared the effects of hand and ultrasonic piezoelectric instruments on the roughness of dental surfaces under an atomic force microscope (AFM). Methods. In this study, 35 periodontally hopeless teeth were selected and randomly divided into four groups (n=7). The control group consisted of teeth that had to be extracted for orthodontic or prosthetic treatment (n=7). In group one, scaling and root planing were performed using hand instruments. In other groups, scaling and root planing were performed using piezoelectric ultrasonic instruments with low to high power, respectively. Then the scaled teeth were extracted for analysis under an atomic force microscope. Results. This study showed that root roughness significantly differed between different experimental groups (P<0.027). The root roughness (Rq) in the SRP2 group significantly differed from the control group (P<0.05), while no significant differences were observed between the other groups. Furthermore, the least roughness was observed in the SRP3 group, with the highest roughness in the SRP2 group. Conclusion. Within the limitation of this study, there were no significant differences in surface roughness between different powers of the ultrasonic device.

Assessment of dental residents' professionalism through Professionalism Mini-Evaluation Exercise (P-MEX).

PURPOSE/OBJECTIVES: The aim of the study was to assess the professional behavior of dental residents through Professionalism Mini-Evaluation Exercise (P-MEX). METHODS: This was a descriptive-analytical study. Content validity of P-MEX form was investigated for use in the context of dentistry. A total of 24-item version of P-MEX consisted of doctor-patient relationship skills (n = 7), reflective skills (n = 5), time management (n = 3), and interprofessional relationship skills (n = 9) was used in the present study. Residents in different dental specialties (n = 56) were evaluated by trained raters (448 times). Data were analyzed by descriptive (mean, SD) and analytical tests (Pearson, ANOVA, and post hoc test (Bonferroni)). RESULTS: Validity of P-MEX was approved in the field of dentistry. The mean score of professional behavior in residents were reported 2.79 ± 0.24, with minimum and maximum scores of 2.17 and 3.62, respectively. The residents' professional behavior in the domain of reflective skills and doctor-patient relationship skills were lower than the other domains. CONCLUSION(S): The results showed that the scores of professional behavior among dental residents were classified in the below expectation level and their scores have followed a downward trend from the second year. Therefore, planning for training and continuous assessment of professional behavior among residents in the faculty of dentistry should be considered.

Characteristic Factors Affecting Oral Pigmentation in Passive Smoker Children.

STATEMENT OF THE PROBLEM: Smoking affects not only smokers themselves, but also the people around them. 700 million children are exposed to second hand tobacco worldwide. One of the adverse effects of being a passive smoker is oral pigmentation. PURPOSE: This study was conducted to evaluate the association between smoking of a parent at home and oral pigmentation in children, and the characteristic factors affecting that. MATERIALS AND METHOD: In this retrospective cohort study, 140 healthy children aged 4 to 10 (mean age= 6.68±1.60), 70 with smoker parent and 70 without smoker parents, were examined for oral pigmentation. Environmental factors were evaluated by asking the parents to fill a questionnaire. Data were analyzed using Chi-square test, Fisher's exact test, Logistic regression, and Spearman scale. RESULTS: There was a meaningful relationship between having a smoker parent and oral pigmentation (p= 0.0001). Spearman's correlation showed parents' duration of cigarette smoking and the number of cigarettes per day could meaningfully affect the severity of oral pigmentation (R=0.329). The study did not find a statistical relationship between oral pigmentation in passive smoking and gender or house area. CONCLUSION: Children exposed to secondhand tobacco are at more risk for oral pigmentation. Its severity depends on duration of cigarette smoking and the number of cigarettes per day.

Awareness of the effect of fluctuations in female sex hormone levels on periodontal health among obstetricians.

Background: Changes in women's hormonal levels in different periods of their lives, such as puberty, menses, pregnancy, menopause and oral contraceptive use, affect periodontal health. Periodontal status has been associated with adverse pregnancy outcomes. Subsequently, it is important for obstetricians to be aware of the effects of hormones on women's oral health. The current study assessed obstetricians' awareness about the effect of female sex hormones on periodontium in Yazd in 2016. Methods: A cross-sectional study was conducted using a self-administered, structured questionnaire. Prior to the study, a questionnaire was pre-tested and validated (ICC=0.89). The questionnaire was randomly distributed among 40 obstetricians in Yazd. Data were analyzed with chi-squared test, t-test and ANOVA and Spearman's correlation coefficient, using SPSS 18. Results: There were no significant relationships between awareness level and the age (P=-0.252), years of practice and experience (P=-0.030) or practicing in public medical centers (P=0.121). Conclusion: As women have special periodontal health care considerations due to fluctuations in the levels of their sex hormones, this study suggests that promotion of oral health awareness among obstetricians is necessary to improve women's overall health, especially during pregnancy.

Effect of non-surgical periodontal treatment on clinical signs of rheumatoid arthritis.

Background: Several studies have shown the association between periodontitis and rheumatoid arthritis (RA) and some similarities in the pathogenesis of these two diseases but clinical trials which have evaluated the effect of periodontal therapy on clinical signs of active RA are scarce, particularly in Iran. The aim of this study was to evaluate the effect of non-surgical periodontal treatment on the improvement of clinical signs of patients with RA. Methods: Fifty-six patients with active RA and generalized moderate-to-severe chronic periodontitis were selected and divided into case (periodontal treatment) and control (without periodontal treatment) groups. Periodontal parameters and RA disease activity scores (DAS28 index) were compared at 6- and 12-week intervals. Results: In the case group, a significant reduction in all the periodontal indices was observed 6 weeks after treatment. At the 12-week evaluation, periodontal indices showed a significant reduction in comparison with baseline and a little increase in comparison with 6-week interval. Six weeks after treatment, DAS28 decreased significantly in the case group (P<0.05). DAS28 also decreased at 12-week interval but its reduction was not significant in comparison with 6-week interval. DAS28 in the case group at 12-week interval was significantly less than that in the control group (P<0.05). Conclusion: Since periodontal care as a part of treatment protocol in RA patients can be effective in improving clinical signs, the recall intervals are better to be 3 months or shorter.

The Effect of Brushing with a Soft Toothbrush and Distilled Water on the Incidence of Ventilator-Associated Pneumonia in the Intensive Care Unit.

BACKGROUND: Ventilator-associated pneumonia (VAP) is a common nosocomial infection, which results in longer hospitalization, increased treatment costs, and higher mortality rates. One major cause of VAP is colonization and microaspiration of oropharyngeal secretions following the formation of dental plaque, which is due to poor oral hygiene and failure to mechanically remove these microorganisms from the teeth. This study was conducted to determine the effect of brushing teeth with distilled water on the incidence of VAP in patients admitted to intensive care unit (ICU). MATERIALS AND METHODS: In this randomized clinical trial, 168 intubated patients, who had at least 20 teeth were randomly assigned to two groups. In the experimental group, the patients' teeth were brushed twice a day with a children's toothbrush and distilled water in addition to the routine oral care. The clinical pulmonary infection score (CPIS) was used to diagnose VAP. The data were analyzed using SPSS version 16 software. RESULTS: A total of 38.6% of the patients in each group developed VAP. There was a significant difference in incidence of VAP on day five between the two groups (P<0.05). The incidence of VAP had a significant relationship with smoking (P<0.001), underlying diseases (P<0.001), duration of hospitalization (P=0.002), and age (P<0.001). Enterobacter was the most common microorganism identified in both groups. CONCLUSION: According to our results, tooth brushing twice daily with distilled water reduced the incidence of VAP in patients admitted to the ICU. Therefore, it is recommended that nurses caring for ventilator-dependent patients brush the patients' teeth with distilled water as a part of their routine oral care.

Effect of 1% Phenytoin Muco-Adhesive Paste on Improvement of Periodontal Status in Patients with Chronic Periodontitis: A Randomized Blinded Controlled Clinical Study.

STATEMENT OF THE PROBLEM: Phenytoin (PHT) has been known to promote wound healing in some medical conditions owing to its proliferative as well as anti-inflammatory effects. Yet, its application in oral lesions was less investigated. PURPOSE: The aim of this study was to evaluate changes in periodontal indices following the topical use of phenytoin in chronic periodontitis. MATERIALS AND METHOD: In this doubled-blind, randomized, split-mouth controlled clinical study, 20 patients with moderate to severe chronic periodontitis referred to Periodontology Department of Shahid Sadoughi Medical University of Yazd in 2014 were selected consecutively. After initial therapy (scaling and root planning and oral hygiene instructions), periodontal indices including bleeding on probing (BOP), periodontal pocket depth (PPD) and modified gingival index (MGI) were recorded. Gingival facial surface of two posterior sextants with at least two teeth with similar conditions, were selected randomly. Then one surface received PHT paste whereas the other side had placebo as control. Patients were received the mucoadhesive pastes under strict control by an examiner, twice a day for a week. Periodontal indices were measured 3 weeks after treatment. Data was analyzed with t-test and paired t-test by using SPSS 21 software. RESULTS: It was observed that periodontal pocket depth was significantly more decreased in phenytoin side in comparison with placebo one (p< 0.05). In addition, inflammatory indices including bleeding on probing and modified gingival index declined more in the phenytoin group (p= 0.001 and p< 0.05 respectively). CONCLUSION: These encouraging results support the use of 1% phenytoin mucoadhesive paste as an adjunctive in periodontal treatment.

The Effect of Nonsurgical Periodontal Therapy on Trichomonas Tenax and Entamoeba Gingivalis in Patients with Chronic Periodontitis.

STATEMENT OF THE PROBLEM: Trichomonas tenax and Entamoeba gingivalis are commensal protozoa which inhabit the human oral cavity. These parasites are found in patients with poor oral hygiene and might be a reason for progressive periodontal diseases. PURPOSE: The aim of this study was to evaluate the effect of nonsurgical periodontal treatment on the frequency of these protozoa in saliva and plaque samples. MATERIALS AND METHOD: In this clinical trial, samples of saliva and dental plaque were collected from 46 patients with moderate to severe chronic periodontitis before and after periodontal therapy. The samples were assessed for the frequency of parasites. RESULTS: The frequency of Entamoeba gingivalis was reduced in saliva (p= 0.007) and plaque (p= 0.027) three weeks after the treatment. Likewise, the frequency of Trichomonas tenax reduced in saliva (p= 0.030); however, the decrease was not significant in plaque (p= 0.913). Trichomonas tenax frequency in dental plaque directly related to the severity of periodontitis (r= 0.565, p≤ 0.000). In contrast, the number of Entamoeba gingivalis in both saliva (r= -0.405, p≤ 0.005) and plaque (r= -0.304, p= 0.040) was inversely related with the severity of the periodontal disease. CONCLUSION: Nonsurgical periodontal treatment could reduce the number of Trichomonas Tenax and Entamoeba gingivalis in the oral environment of patients with chronic periodontitis.

CPITN changes during pregnancy and maternal demographic factors 'impact on periodontal health.

BACKGROUND: There have been speculations about the effects of hormonal changes and socio-demographic factors on periodontal health during pregnancy. OBJECTIVE: According to the lack of sufficient epidemiologic information about the periodontal status of pregnant women in Yazd, this study was accomplished to determine the changes of Community Periodontal Index for Treatment Needs (CPITN) during pregnancy and evaluating the possible relationship between this index and demographic characteristics of the mothers. MATERIALS AND METHODS: This was a longitudinal descriptive study. The samples included 115 pregnant women who were referred to health centers of Yazd, Iran. The mothers' data were obtained from a questionnaire consisted of 3 parts: consent paper, demographic data and CPITN records. Examination was performed with dental unit light, flat dental mirror and WHO's scaled probe. RESULTS: In the beginning of the study, 60.1% of checked sextants had healthy gingival status. 25.9% had code1 and 14% had code 2. Code 3 and 4 were not seen in any sextants. There was a significant relationship between lower CPITN and higher maternal education, occupation and more frequencies of tooth-brushing but there was not a relationship between CPITN and mother's age and number of pregnancies. CPITN had a significant relationship with increasing of the gestational age. CONCLUSION: There might be a relationship between increasing the month of pregnancy and more periodontal treatment needs. CPITN Increasing during pregnancy shows the importance of periodontal cares during this period.