Comparison of histologic and radiographic changes of sockets grafted with LPRF and sockets without intervention after tooth extraction.

OBJECTIVES: After tooth extraction, marked resorption occurs in extraction socket walls, leading to functional and esthetic problems in that area. One of the methods introduced to reduce this resorption is the use of platelet derivatives. This study aimed to evaluate the effects of leukocyte and platelet-rich fibrin (L-PRF) on the changes following tooth extraction. MATERIALS AND METHODS: The participants were 24 patients who needed to replace at least one single-rooted tooth with an implant. They were randomly divided into test and control groups. After the tooth extraction, the sockets in the test group received LPRF clots, while in the control group, the sockets were left free of any interventions. CBCT scans were obtained from the extraction site both immediately after the tooth extraction and 8 weeks later. The histologic biopsy was also obtained while the implant site was being prepared 8 weeks after the extraction. RESULTS: The average vertical bone loss in the buccal crest was not significantly different between the two groups (1.67 ± 1.67 in the test group and 2.3 ± 1.36 in the control group; mean difference = - 0.36, 95% CI: - 1.65-0.93, p-value = 0.57). Nor was the difference in resorption of the palatal wall (mean difference = - 0.19, 95% CI: - 1.51.12, p-value = 0.76). The mean ridge width resorption in 25% of the coronal aspect of sockets was also measured in the test (1.30 ± 0.66) and control group (0.58 ± 0.95) (mean difference = 0.73, 95% CI: 0.03-1.42, p-value = 0.04). The new bone formation in histologic view was not statistically different between groups (p-value = 0.15). CONCLUSION: The LPRF neither reduces the rate of ridge resorption in vertical or horizontal dimensions of extraction sockets nor induces more new bone formation. CLINICAL RELEVANCE: This study helps dentists choose the appropriate material for ridge preservation.

Impact of smartphone application usage by mothers in improving oral health and its determinants in early childhood: a randomised controlled trial in a paediatric dental setting.

PURPOSE: Integration of smartphones has overcome barriers in traditional education; this trial aimed at exploring this ubiquitous platform in oral health education. A smartphone application promoting preschooler's oral health was designed and its effectiveness was compared with that of common oral health education delivered in paediatric dental settings. METHODS: This controlled clinical trial was performed on preschooler-mother dyads referring to the clinic of Tehran School of Dentistry in 2019-2020. Initially, the dyads were randomly partitioned to application intervention or common training groups. The mothers answered an interviewer-administered questionnaire on paediatric dentistry knowledge, attitude and practice regarding children's oral health; modified plaque index (m-PI) and modified gingival index (m-GI) of children were measured. Subsequently, the smartphone application was installed for application intervention group and an educational pamphlet and verbal explanations were given to common training group. In 1-month and 3-month follow-ups, the questionnaires and clinical measurement were re-done. A generalized estimating equation (GEE) was used to investigate the effect of training methods. RESULTS: Among the participants 51 dyad attended baseline and follow-up assessments. The preschoolers mean age was 4.6 ± 1.2 years and 54.4% were girls. Both trainings improved mothers' knowledge and practice regarding children's oral health and reduced children's m-PI and m-GI (p < 0.050). The 3-month follow-up revealed a better m-GI in application intervention group (p < 0.001). CONCLUSIONS: Considering the greater improvement of paediatric gingival status in the application intervention group, it appears that smartphone applications may provide a promising tool for more prolonged impacts in children oral health care. TRIAL REGISTRATION: IRCT, IRCT20131102015238N3. Registered 28 July 2019 https://en.irct.ir/trial/40933.

Effect of visual distraction on children's anxiety during dental treatment: a crossover randomized clinical trial.

AIM: This was to evaluate the effect of visual distraction on anxiety of children during dental treatment. MATERIALS AND METHODS: This randomized, crossover clinical trial study was conducted on 28 children (aged 4-5 years) randomly divided into two groups of 14 each. Group 1, treatment procedure in the first visit was completed while the patients were watching a cartoon as a visual distraction tool, at the second visit, the procedure was carried out with conventional tell-show-do. Group 2, had visual distraction in their second visit and conventional tell-show-do during the first visit. Treatment procedures were similar in both groups during two sessions. The anxiety level was determined using Venham picture test and pulse rate (PR) at the beginning and the end of each appointment. Patient behaviour was also scored using Frankl behaviour rating scale (FBRS). RESULTS: Self-reported dental anxiety was reduced significantly by visual distraction (p-value < 0.001) compared to conventional tell-show-do, but it did not change FBRS scores significantly (p-value = 0.24). CONCLUSION: Use of visual distraction improves self-reported anxiety and decreases PR of children but does not change their behaviour.

Dental pain and its determinants in an adult population in Tehran, Iran, Urban HEART-2.

OBJECTIVE: To assess the prevalence of dental pain in the past year among adults in Tehran-Iran, and its determinants. BASIC RESEARCH DESIGN: Cross-sectional population study. PARTICIPANTS: A sample of 20,322 adults (18-64 years old). METHODS: A questionnaire survey was conducted across the 22 districts using the multi-stage random sampling method. Data were analysed applying the complex samples method. Multiple logistic regression analysis was used to adjust the effects of other variables on the outcome variable as dental pain in the past year. RESULTS: Overall, 19,645 individuals with a mean age of 39.9 (SD=12.5) years responded. Dental pain in the past year was reported by about one sixth (14%) of subjects and associated with being widowed/divorced (OR 1.45, 95%CI 1.07-1.97, p=0.016), married (OR 1.24, 95%CI 1.04-1.47, p=0.016), Azari minority (OR 1.2, 95%CI 1.05-1.37, p=0.009) and having dental visit in the past year (OR 2.6, 95%CI 2.29-2.95,p⟨0.001). Older subjects (OR 0.76, 95%CI 0.59-0.97, p= 0.029), those with a high economic status (OR 0.84, 95%CI 0.72-0.98, p=0.03), good (OR 0.75, 95%CI 0.58-0.96, p=0.023) or moderate oral health behaviour (OR 0.79, 95%CI 0.62-0.99, p=0.042), and good self-perceived oral health (OR 0.52, 95%CI 0.45-0.61, pp⟨0.001) were less likely to report dental pain. CONCLUSIONS: Dental pain in the past year was associated with being married/widowed, being a minority, and visiting a dentist in the past year. Older subjects and those with a high socio-economic status, good/moderate oral health behaviour, and good self-perceived oral health were less likely to report dental pain.

The comparative study of antifungal activity of Syzygium aromaticum, Punica granatum and nystatin on Candida albicans; an in vitro study.

AIM: Candida species are opportunistic fungi, among which, Candida albicans is the most important species responsible for infections in immunocompromised patients with invasive fungal disease. Resistance of Candida species to antifungal drugs has led scientists to pay more attention to traditional medicine herbs. Due to the limitations in the treatment of fungal diseases such as shortages, high prices, antifungal side effects and drug resistance or reduced susceptibility to fungal drugs we decided to study the antifungal effects of herbal extracts of Syzygium aromaticum and Punica granatum. METHODS: Twenty-one isolates of oral C. albicans in patients with denture stomatitis referred to prosthesis department, Dental faculty of Tehran University of Medical Sciences were prepared and cultured. Plant extracts were prepared from the herbs market. Tests on patient samples and standard strains 5027ATCC (PTCC10231) yeast C. albicans were performed via well diffusion method. In addition, nystatin and methanol were used as positive and negative control, respectively. Finally, the antifungal effect of extracts using Statistical Repeated measurement ANOVA test was investigated. RESULTS: Both S. aromaticum and P. granatum showed noticeable antifungal activity in well method. Syzygium aromaticum showed better anti candida activity than nystatin (P<0.001). CONCLUSION: Due to increasing problems with fungal diseases, these findings suggest that the plant extracts of S. aromaticum and P. granatum showed good antifungal effects (P-value<0.001). S. aromaticum (inhibition zone diameter: 29.62) showed better antifungal effects than nystatin (inhibition zone diameter: 28.48).

The efficacy of selenium in prevention of oral mucositis in patients undergoing hematopoietic SCT: a randomized clinical trial.

Oral mucositis (OM) is a complication of high-dose chemotherapy (HDC) followed by hematopoietic SCT (HSCT) with few effective treatments. Selenium has a cytoprotective role via the glutathione peroxidase (Glu.Px) enzyme and prevents chemotherapy-induced toxicities. We performed a double-blind, randomized, placebo-controlled study to evaluate the efficacy of selenium on the prevention of OM in 77 patients with leukemia, undergoing allogeneic HSCT. Thirty-seven patients received oral selenium tablets (200 mcg twice daily) from the starting day of HDC to 14 days after transplantation. OM was evaluated daily for 21 days after transplantation according to World Health Organization oral toxicity scale. The incidence of severe OM (grades 3-4) was significantly lower in the selenium group (10.8% vs 35.1%, P<0.05). We noted that the duration of objective OM (grades 2-4), excluding patient's self-declaration (grade 1), was significantly shorter in the selenium group (3.6±1.84 vs 5.3±2.2 days, P=0.014). Significant elevations in serum selenium level and plasma Glu.Px activity were observed 7 and 14 days after transplantation compared with baseline in the selenium group. We conclude that selenium can reduce the duration and severity of OM after HDC. Clinicaltrial.org ID: NCT01432873.

Malaria Status in Economic Cooperation Countries; Achievement and Gaps toward United Nations Millennium Development Goals.

BACKGROUND: Evaluating the malaria status of the Economic Cooperation Organization (ECO) member countries relation to goal 6 of 3rd Millennium Development Goals (MDGs) which includes have halted by 2015 and begun to reverse the incidence of malaria. METHODS: By 2009, we reviewed the MDGs reports, extracted the data from surveillance system, published, and unpublished data. The main stakeholders, from both governmental and international organizations in the country have been visited and interviewed by the research team as part of the data validation process. RESULTS: The malaria incidence is very heterogeneous among ECO countries, which differ less than 200 cases in total country in Kazakhstan, Kyrgyzstan, Turkey, Turkmenistan, Uzbekistan, and Azerbaijan to 82,564 cases (2,428/100,000) in Afghanistan and 59,284 cases (881/100,000) in Pakistan and about 18/100,000 in Iran in 2008. Malaria has been a major public health problem in Pakistan and Afghanistan and will continue to pose serious threat to millions of people due to poor environmental and socioeconomic conditions conducive to the spread of disease. The main malaria endemic areas of Iran are in southeastern part of the country; consist of less developed provinces that are bordered in the east by Afghanistan and Pakistan. There are little valid information about proportion of population in malaria-risk areas using effective malaria prevention and treatment measures indicators. CONCLUSION: All ECO countries could achieve MDGs malaria indicators by 2015 except Pakistan and Afghanistan, unless preparing urgent intervention programs to fulfill the goals.

Evaluation of an interferon-gamma release assay in young contacts of active tuberculosis cases.

In a cross-sectional study in a hospital in Tehran in 2006-08 the QuantiFERON-TB interferon-gamma release assay (QTB) was compared with the tuberculin skin test (TST) in 59 young people (aged < 20 years) with close contact with immunocompetent cases of proven pulmonary tuberculosis. After 1 year follow-up 10 subjects had progressed to tuberculosis disease and received treatment; TSTwas positive in 30% and QTB in 100%. Of the 49 non-progressive subjects, TST was positive in 10.4% and QTB in 16.3%. The agreement between TST and QTB assay in non-progressive subjects was poor (K = 0.43). False positive and false negative rates for TST were 40.0% and 9.3% respectively; positive and predictive values were 60.0% and 90.7%. We suggest adding the interferon assay to the skin test in the decision to perform chest X-ray or to start chemoprophylaxis at least in younger subjects (aged < 20 years).

Evaluation of an interferon-gamma release assay in young contacts of active tuberculosis cases

In a cross-sectional study in a hospital in Tehran in 2006-08 the QuantiFERON[Registered]-TB interferon-gamma release assay [QTB] was compared with the tuberculin skin test [TST] in 59 young people [aged<20 years] with close contact with immunocompetent cases of proven pulmonary tuberculosis. After 1 year follow-up 10 subjects had progressed to tuberculosis disease and received treatment; TST was positive in 30% and QTB in 100%. Of the 49 non-progressive subjects, TST was positive in 10.4% and QTB in 16.3%. The agreement between TST and QTB assay in non-progressive subjects was poor [Kappa=0.43]. False positive and false negative rates for TST were 40.0% and 9.3% respectively; positive and predictive values were 60.0% and 90.7%. We suggest adding the interferon assay to the skin test in the decision to perform chest X-ray or to start chemoprophylaxis at least in younger subjects [aged<20 years]

Evaluation of nutritional status in patients undergoing hematopoietic SCT.

The aims of this study were to establish the nutritional status of patients during hematopoietic SCT (HSCT) and to determine if body mass index (BMI) is a valid indicator of nutritional status in this population when compared with nitrogen balance (NB). In total, 50 patients were enrolled (mean age: 25.7+/-9.0 years). Patients (14%) were underweight (BMI<18.5 kg/m(2)), 58% in a normal BMI (between 18.5 and 24.9 kg/m(2)) and 28% were overweight or obese (BMI >or= 25 kg/m(2)). NB dropped after transplantation and increased from days +5 to +20 after transplantation (P=0.006). There was a significant negative relationship between patients' BMI and time to engraftment (r=-0.45, P=0.001). Engraftment of underweight patients was 3.0 days (P=0.002) and 4.0 days (P<0.001) later than in normal and overweight or obese patients, respectively. There was no significant correlation between NB before transplantation and time to engraftment (r=-0.22, P=0.16). The results of this study demonstrate that patients undergoing HSCT may have suboptimal nutritional status and that pre-HSCT-BMI rather than NB may have a greater correlation in HSCT patients with the time of engraftment. Therefore, it may be useful to consider patient's BMI before transplantation for earlier engraftment time.

Fludarabine and busulfan as a myeloablative conditioning regimen for allogeneic stem cell transplantation in high- and standard-risk leukemic patients.

Busulfan and cyclophosphamide (BuCy) are currently the most widely used myeloablative regimen to treat malignancies with allogeneic stem cell transplantation. Fludarabine has considerable efficacy in both immunosuppression and tumor cells killing with a minimal extramedullary toxicity. We evaluated the efficacy of 40 mg/m(2) fludarabine i.v. for 5 days and busulfan 4 mg/kg/day p.o. for 4 days as myeloablative conditioning regimen in 70 patients (median age 24 years) with acute leukemia or chronic phase of myelogenous leukemia. They all had human leukocyte antigen-matched sibling donors. The patients received 10 mug/kg granulocyte colony stimulating factor (GCSF), 24 h after stem cell infusion until engraftment occurred. Graft-versus-host disease (GVHD) prophylaxis included 3 mg/kg cyclosporine-A i.v. from day -2 to +6 followed by 12 mg/kg p.o. until day +60. The median time of neutrophil recovery (>0.5 x 109/l) and platelet recovery (>20 x 109/l) were 10 and 12 days, respectively. Mucositis (93%) and hepatic toxicity (16%) resolved with conservative therapy. The incidence of acute GVHD grade I-II and III-IV were 38.6 and 15.7% respectively. Overall survival and disease-free survival were 71 and 64% respectively with 17 months median follow-up for surviving patients. We conclude that FluBu may be used as a substitute for BuCy with almost the same efficacy and with a lower transplant adverse effect but to increase anti-leukemic effects, especially in acute lymphoblastic leukemia patients, it needs some modifications.

Esophageal exfoliative cytology samplers. A comparison of three types.

OBJECTIVE: To compare three types of esophageal exfoliative cytology samplers in terms of patient acceptability, ease of use, final destination of the sampler tip in the gastrointestinal tract and cellular yield. STUDY DESIGN: A controlled, single-blind, cross-over study was undertaken to compare the balloon, sponge and sponge-mesh samplers in healthy volunteers. After completing the three procedures in random order, participants were asked about their preferred method. Ease of use was defined as the technician's ability to perform the intubation successfully. Final destination of the samplers was assessed fluoroscopically. Cytopathologists determined the cellular yield of each sampler using the Bethesda System. RESULTS: Sixty-two volunteers participated. The two encapsulated samplers were significantly preferred over the balloon (P < .0001). There was no significant difference in ease of use, final destination or cellular yield of the three techniques. All three samplers were successfully intubated on the first attempt and retrieved adequate numbers of squamous and glandular cells in > 78% of cases. CONCLUSION: All three samplers obtained satisfactory yields of squamous and glandular cells, but the encapsulated samplers were more patient acceptable. The sponge-mesh sampler may be the least complicated sampler for field screening use. Larger-scale studies will be required to test the accuracy of these three samplers for detecting esophageal dysplasia and carcinoma.

In vitro activity of cefixime versus ceftizoxime against Salmonella typhi.

Emergence of multi-resistant strains of Salmonella typhi is a major problem in treatment of typhoid fever and requires an excessive hospitalization period. Therefore, the present study was carried out to estimate the degree of the resistance of S. typhi strains to various antibiotics such as cefixime. Fifty two strains of Salmonella typhi isolated from patients with typhoid fever and their sensitivity to various antibiotics was determined. MICs of cefixime and chloramphenicol were also determined according to comitee de l'antibiogramme français. Results indicated that 41.9%, 33.9%, 38.7%, 58.1% and 1.6% of isolated strains were resistant to chloramphenicol, co-trimoxazole, ampicillin, tetracycline and gentamycin respectively. About one third (33.9%) of strains showed multiple resistance to the first four mentioned antibiotics. All strains were susceptible to ceftizoxime and cefixime (MICs 1 and less than 1 mcg/ml). It could be concluded that cefixime due to its effectiveness, oral administration and shorter courses of treatment could be the therapy of choice in cases of typhoid fever caused by multiple resistant strains especially when we have a shortage of hospital beds.