bahareh tahani

“Complex problems require complex solutions” 1 and the population's oral health is a typical –and still unresolved- complex problem. There are some reasons why oral diseases are considered as a major and complex global public health problem. Over three billion people in the world suffer from these diseases 2, and their economic burden on individuals and societies is considerable 3, but the current treatment-oriented (rather than preventive) 4 high-technology approach has proved inefficient and has failed to address the underlying causes of these diseases as well as the existing inequalities in oral health. Even the most cited proposed models applied to understand the determinants of oral health are mostly linear and do not adequately consider the interaction of behavioral, psychological, sociological and structural factors. Thus, a fundamentally different approach is required for a ‘radical action’, i.e., a system change to reduce the burden of oral diseases. 5 In this commentary, we introduce “system thinking” (ST) as the required approach to address this hugely complex problem. We will start with a brief introduction to the definition and characteristics of ST. Then, we discuss how this approach might help policy makers to develop new and effective solutions for some specific problems in the dental public health domain. System thinking could be considered as an initiative or approach aimed at examining how things interact with each other within their respective contexts as a whole entity. 6 This approach has been emerged in the public health literature with impressive growth in the recent years and its implications in solving public health problems ranging from obesity to tobacco have been discussed. Public health interventions usually deal with complex issues that are multifactorial and multilevel. The recognition of such complexity has encouraged public health practitioners and researchers to experiment with systems sciences techniques to shift their focus from individual behavior changes to societal, environmental and policy interventions. 7 Thoughtful engagement with complexity, including capturing and understanding nonlinear cause and effect relationships, differing time scales, identification and management of unintended consequences, and transdisciplinary thinking can be regarded as the key strengths of systems approaches that could be adopted to solve public health problems. 8 Different theories and methods in ST have been designed to aid the analysis and address complex public health problems for which simple blueprint approaches have limited success. 9 Some tools are developed to facilitate reaching a common understanding of an issue, thus prompting further inquiry and action among a group of people. For example, “systems archetypes”, including causal loop diagrams (CLD), can help teams to understand the generic patterns of interaction that can be applicable to their “story”, rather than using the pre-existing templates. 10 CLD has the potential to promote our understanding of the broader political, institutional, and cultural contexts. It could be helpful in improving the currently accepted causality models in dentistry, which have commonly categorized determinants as structural, intermediate and proximal ones, with direct, linear and mostly unidirectional relations. 2 For example, understanding the current visible trend toward cosmetic dentistry in many high-income and even middle-income countries could be seen as a typical case that requires a system-thinking approach. Reduction of the trend to only a moral or financial issue is clearly insufficient. The interaction of a series of cultural, structural, economic and psychological causes could explain over-utilization or over-provision of aesthetic dental services. However, even when analyzing the commercial determinants of dental diseases, as an emerging approach in dental public health, its interactions seem to follow the same causality approach. Therefore, a system science approach might be helpful in identifying how unhealthy commodity industries market their products, gain control over policy, and legitimize their increasing presence in public health. Thus, identification of the connection circles for dental disease causes that would otherwise be missed in more individualized behavior approaches could be achieved by using such qualitative-quantitative methods as CLDs. One of the concerns of health planners has been the inquiry that whether interventions shown to be effective in a research setting would be simply replicated at the large scale or in the real world. The concept of “Effectiveness Decay” contributes the ‘effective coverage’ of an intervention to contextual and operational determinants. The process of using or utilizing an intervention begins with the questions asking whether patients access care and whether and how services are administered, received and adhered to. 11 Therefore, based on this concept, the real effectiveness of a community-based intervention might differ from the expected efficacy illustrated in small-scale research settings. For example, in the field of dental public health, based on a Cochrane systematic review of Fluoride Varnish (FV) application in ideal settings for clinical trials, it is suggested that this intervention can reduce the worsening of caries in the primary dentition with a prevention fraction of 37%. However, applying FV in wider public health programs has shown a modest and nonsignificant anti-caries effect. 12 The potential area for case loss in these interventions, or ‘node’, as a function of many concurrent forces between actors, context and structure of health systems might be discovered. 13 While effectiveness decay models highlight areas of deficiency requiring targeted attention, they do not reveal the underlying causes of such a decay. There are a number of other tools including network mapping, social network analyses and process mapping that are used to map out events or show how things are connected. Thus, it is possible to examine critical processes that are associated with the potential supply and demand-side determinants underlying the nodes indicated in the effectiveness decay models. 11 Application of ST in designing and evaluating the system-wide upstream policies seems to be another enormously important but overlooked issue. To design system-wide policies, the emphasis would be on some kind of multi-disciplinary and multi-stakeholder involvement. It is recommended that for a collective brainstorming on the possibly system-wide effects of the proposed upstream policies, the representative of each relevant sub-system (considering the relationships and dynamics among these sub-systems) is required. 14 The current unacceptable state of global oral health is rooted not only in external factors as competing disease priorities or scarcity of resources, but also in the inadequate coalescence among oral health actors and their disconnection with the wider global health mainstream. Therefore, to improve the populations' oral health, it is highly recommended that upstream policy interventions, such as legislation, regulation and fiscal change, focus more on the involvement of stakeholders from private and public sectors in oral health and other NCDs systems, industry, non-health sectors such as education councils, mass media, etc. We then need to focus on maximizing the synergy of efforts. Involvement of a wide range of stakeholders is crucial in conceptualizing the pathway of dynamic interactions in sub-systems or building blocks of the oral health system. Furthermore, system thinking can be beneficial for designing the methods to evaluate the implemented system-wide interventions. The emphasis in this approach is mainly upon incorporating plausibility designs such as “interrupted time-series”, which use mixed methods to provide estimates of adequacy, processes, contexts, effects and economic analyses of the interventions. They could complement and upgrade the traditional evaluation methods commonly used in health systems, i.e., probability designs such as randomized controlled trials with high internal validity but insufficient in evaluating system-wide interventions. Finally, it is worth mentioning that while the dental public health could benefit from system thinking approach to solve its special problems, the application of the such approach is emerging slowly in the oral health sector and mostly limited to the behavioral and psychological acculturation of dental habits such as tooth brushing. 15 The use of systems science within DPH is crucial to understanding and promoting good oral health for all, as well as to better understanding the complexity associated with the systems.

Orthodontic patients are prone to dental and periodontal diseases due to difficulties maintaining oral hygiene, causing increased plaque accumulation. Although synthetic mouthwashes such as Chlorhexidine are effective, they can lead to undesirable side effects. Therefore, it is essential to explore the benefits and usage of herbal mouthwashes like Persica. The prominent purpose of this study is to assess the influences of Persica mouthwash on the oral health of orthodontic patients and to evaluate its impact on appliances used for orthodontic treatments.

For this review, we searched PubMed, Scopus, Magiran, Irandoc, and Google Scholar databases without applying any time limits. Relevant keywords, such as orthodontic, mouthwash, mouth rinse, Salvadora Persica, and their Persian counterparts, were utilized to find laboratory or clinical studies related to the subject. Finally, among the 694 articles found, 22 articles related to the inclusion and exclusion criteria were selected and included in the study. Ten clinical studies and 12 laboratory studies were designed and implemented. Findings in the subgroups of the effect of Persica mouthwash on oral and periodontal health indicators in orthodontic appliance patients, the antimicrobial properties of this mouthwash in orthodontic patients, and its impact on the biomechanical and biochemical characteristics of orthodontic appliances were investigated.

In most studies, the effect of Persica on reducing Streptococcus mutans colonization was equal to that of chlorhexidine. Also, Persica mouthwashes were as effective as chlorhexidine in improving plaque index and gingivitis in most studies. The effect of Persica mouthwash on the biomechanical and biochemical properties of appliances was reported to be similar to or better than other commercial mouthwashes in some studies. Natural mouthwashes such as Persica had more adverse effects on the acrylic resin surface of removable orthodontic appliances than chlorhexidine. Compared to chlorhexidine, the mouthwash containing Persica was similar to chlorhexidine, with a better release of nickel and chromium ions.

Due to its suitable antibacterial properties and the effect it has on improving oral health indicators, gums, and periodontal tissue, along with the usual oral and dental hygiene methods such as toothbrush and dental floss, Persica can have an acceptable effectiveness in improving oral health in orthodontic patients and a suitable alternative to artificial mouthwashes in these patients. However, to prove this issue, more studies with larger sample sizes and longer duration are needed.

The aim of this study was to assess the tobacco use pattern among senior dental students and their practice and attitude toward the provision of cessation counselling.

This descriptive-sectional study was conducted among the senior dental students of Isfahan during 2023 based on the census sampling method. A self-administrated questionnaire was developed and validated using quantitative methods (CVI, CVR). The final questionnaire included 22 questions regarding the pattern of smoking and tobacco use and the following of 5A protocol among dental students and 5 questions to assess their attitude. Data was analyzed using SPSS.v27 and logistic regression and chi-squared tests (α=0.05).

Among 154 participants (response rate =77%), the most common substance consumed was cigarettes with a prevalence of 35.1% and 13% were regular smokers. The prevalence of consumption in men was twice that of women (Odds=2.01, 95% CI=1.01-3). Also, the history of smoking in the family was a significant predictor of smoking in the future (Odds=2.6 (,95% CI=1.3-5.5). In this study, no significant relationship was found between smoking history and student performance in protocol 5A. Among the items related to attitude, smoking history had a significant effect only on the student's belief that smoking is a personal decision (P Value=0.02).

 This study showed that the prevalence of smoking among dental students in Isfahan is relatively similar to the general population and most students have poor performance and knowledge in smoking cessation counseling, which affects their attitude towards smoking cessation.

Dental diseases affect children’s performance at schools and their future success in life. It has been reported that children with dental problems are 12 times more likely to miss school or experience activity restriction than their healthy peers, that might threaten their emotional and social well-being. 1. Dental caries is still a common problem in Iran. According to the last national survey, only 26% of 12-year-old students and 0.5 % of 15-year-old students were caries-free. 2 Schools provide an effective and ideal platform for improving the oral health of children and adolescents. Since oral health behaviors, beliefs, and attitudes are shaped during childhood; oral health messages can be reinforced throughout the school years. In addition, schools can provide supportive measures to promote oral health, including policies and programs to increase school safety to reduce facial and dental trauma, to improve student healthy nutrition patterns, to educate them about their oral health, and to identify children in need of dental treatment at early stages and refer them to receive timely treatments. Schools also have plenty of opportunities to communicate with families and increase their awareness toward the oral health of children. 3 Therefore, schools can be considered a special place to implement oral health promotion programs. The experience of running "Oral Health-Promoting Schools" in different parts of the world testifies to this claim. 4, 5. Key steps recommended by the WHO to consider in this protocol include establishing or involving a school health team and a community advisory committee, conducting a situational analysis, obtaining political, parental, and community commitments, establishing supportive school health policies, and setting goals and objectives. 6. Although some health issues are considered in the primary schools in Iran, there is not an established comprehensive plan for oral health promotion. On the other hand, by overcoming the health-oriented approach at the policy making levels of Ministry of Health and Medical Education, dental schools have carried a strong potential for improving public oral health. The Department of Community Dental Health in dental schools of Iran is responsible for teaching the oral health promotion concepts, strategies, and programs and creating the necessary attitude and awareness among dental students to empower them in providing preventive services. Therefore, there is a good opportunity in the general dental practitioner curriculum to teach students how to use their potential in line with targeted population oral health promotion. In a pilot program designed, implemented and evaluated at the Isfahan University of Medical Sciences during Sept 2018- June 2021, coordinated efforts were initiated to integrate the dental education curriculum headlines and the recommended principles of “oral health promoting (OHP) schools”.7 In this program, in coordination with the Province Education Council and the Vice Chancellery of Province Health, dental students -as part of their dental public courses- were to attend some selected primary schools, where they had the responsibility for oral health screening of the schoolchildren, determining their preventive and restorative needed care, and referring them to receive the proper care. Also, they were to provide face-to-face education in small groups using flipcharts and big-size demonstration toothbrush and dental arches, disclosing tablets (Svenska Dentorama, Sweden), dental floss, disposable mirrors, soft toothbrush and fluoridated paste and supervised toothbrushing in the schools’ yards. In addition, dental students were asked to educate parents in two-day workshops organized by the school administrators. Two printed worksheets were also designed, published and distributed in the selected schools to reinforce and remind the headings taught by dental students. As part of the dental public health practical courses, schoolchildren were invited to dental school clinics, where fissure sealant treatment and fluoride varnish therapy were provided to them free of charge by dental students. The final part of this integrated program was the provision of primary and secondary preventive care to schoolchildren using portable dental equipment placed in the schools. All of the provided educations and cares were under the supervision of the Dental Public Health Department professors. The evaluation phase indicated the effectiveness of this model in terms of knowledge and practice improvement among schoolchildren, their parents, and teachers, and in increasing the coverage of professional preventive care and simultaneously, the effective community-based training of dental students. 8 This model of OHP schools would be a good opportunity to both promote the oral health of schoolchildren at a critical age that permanent teeth and oral health behaviors are shaped and also to utilize the potentials of dental schools to provide oral hygiene instructions and working in community-based fields. This project might also improve and strengthen the interdisciplinary cooperation between the health sector and educational council which could be a good example of advocacy in health system. In addition, this project could increase the awareness of supportive members (teachers and parents) about the importance of OH. Therefore, it worth planning to implement this model by other dental schools at least in Iran. Considering the number of dental schools in the country and current dental students (about 2000), this model can benefit both the schoolchildren in deprived schools and also university students.

Dental schools are responsible for providing high-quality and inexpensive need-based oral health services. The aim of this study was to investigate the barriers associated with receiving dental healthcare services in Isfahan Dental School from the patients' perspective.

Methods and Materials: 

This qualitative research which was conducted from January-October 2022, and included patients who referred to the Oral Medicine Department of Isfahan Dental School in 2019, but did not receive any treatment during the follow-up period until 2021. Participants were recruited through a purposive sampling approach. Semi-structured telephone-based interviews were conducted. The interviews were audio-recorded and carefully transcribed and then each transcript was saved and imported in to MAXQDA software. Truth value, consistency, confirmability, and applicability criteria were assessed to affirm the credibility of data. Obtained data were then encoded using a content analysis approach.

A total of 25 patients were interviewed. Five emergent themes and 15 sub-themes were identified: 1) availability (subthemes: not proving care to specific cases and not providing the course in that semester); 2) personal reasons (fear, time restrictions, trust issues); 3) quality (dissatisfaction with the dental treatment and care provider); 4) ability to pay (high tariffs and other financial problems); 5) accessibility (difficulties in scheduling an appointment, long distance, unnecessary bureaucracy, being overly crowded, student-related factors and time-consuming process)

Patients mentioned a wide range of barriers to receiving timely and required dental treatments in this dental school. These factors included personal reasons, those related to the care delivery system such as accessibility and quality, and some related to the provision-setting, i.e. the dental school. These insights can help the dental faculty address the obstacles associated with patient admission and referrals in order to enhance patients’ experience of receiving dental care in dental schools and increase their overall satisfaction.

The study aimed to investigate oral health status and its relationship with oral health‑related quality of life in the elderly in Isfahan, Iran, in 2022.

This cross‑sectional study was conducted in Isfahan, with 460 elderly participants. During interviews with the participants, their demographic information, their medical and dental history, oral health‑related behaviors, self‑perceived oral health, and clinical examinations were collected, and the Geriatric Oral Health Assessment Index (GOHAI) was completed. The final conclusions were made using the Generalized Linear Model (GLM) test.

The mean (sd) scores were 45.05 (8.62) for GOHAI, 5.44 (2.96) for self‑perceived oral health, and 18.11 (5.76) for DMFT (Decayed, Missing and Filled teeth). Moreover, the number of remaining teeth on average was 11.78 (11.89), 39.56% of the participants did not brush their teeth, 40% of the elderly had complete dentures, and 27.17% had dental insurance. After adjusting and modifying the variables, the GLM test revealed that strong predictors for higher GOHAI scores were the higher levels of education (p ˂ .001), the higher frequency of remaining teeth (p = 0.002), more pleasant self‑perceived oral health (p ˂ .001), and dental insurance (p = 0.04).

According to the findings, the elderly’s oral health‑related quality of life in Isfahan was low, which was caused by the following factors: edentulism, few numbers of remaining teeth, high DMFT score, elderly’ non‑adjustment with dentures and their low quality, inappropriate oral health‑related behaviors, lack of complementary insurance for dentistry, and non‑using dental services, and low levels of education.

One of the most important consequences of the rapid growth of urbanization has been the unequal distribution of urban service specially health care services and escalation of social inequality of citizens. Therefore, this study was aimed to analyze the spatial distribution of dental centers in Isfahan from the perspective of spatial equity.

This analytical cross-sectional study was conducted in 2023 in Isfahan city. The required data including the population of the fifteen districts of Isfahan city, the data of the geographic municipal areas and the dental centers of Isfahan city were put into Excell. The population data were gathered from the statistical yearbook of population and housing. The dentists’ data were gathered from the Medical Council. Addresses of the dental centers were fed into the Google earth and were found on the traffic map of Isfahan. Using the Arc GIS 10.8 software and based on the Geographic Information System concepts, the spatial justice was analyzed. Moran's autocorrelation index was used to determine the distribution pattern (cluster, scattered, random). Hot spot analysis and nearest neighbor distance (centers in this radius would have more access) were used. Access ratios were analyzed using the ratio of population to the distance of each parcel to the dental centers and then were categorized as privileged to, semi and unprivileged.

Z-score of Moran test was more than the expected score of 2.58 at 0.01 level of significant, indicating the cluster pattern of dental settings distribution in Isfahan. Moran's index (0.076) was much more than the expected equity coefficient (-0.000055), indicating again the cluster pattern of distribution which was not favorable in terms of spatial justice. The nearest neighbor distance analysis indicated that by moving from the center of the city to the outskirts of the city, access to dental centers decreased. Access analysis determined that privilege areas of the city were located mostly in central municipal areas and about 60% of these areas were limited to three municipal regions. Also, about 63% of the city area were categorized as unprivileged.

Distribution of dental centers in the city of Isfahan is not an equal distribution and the dental settings are mostly concentrated in the central areas of the city, not necessarily in high populated areas. There, this pattern necessitates the proper planning to establish dental settings in deprived and high-populated parts of the city.

Diagnosis of oral cancer in the early stages is the most effective tool to improve survival and reduce complications caused by the disease. The aim of this study was investigating the dental patients’ knowledge of oral cancer in Isfahan.

This descriptive cross‑sectional study was performed on 334 patients referred to dental centers in Isfahan, Shahinshahr, Najafabad, Khomeini Shahr, Harand, and Zarrinshahr cities. Data were collected by a researcher‑made 25‑item questionnaire. Data analysis was carried out by SPSS (version 26) software using the independent t‑test, one‑way analysis of variance, and Pearson correlation coefficient (P < 0.05).

The patients’ mean score of knowledge was 49.3 ± 21.4 in Isfahan city and 53.1 ± 18.4 in the other cities of Isfahan province. There was no significant difference between knowledge of oral cancer and gender, marital status, and residence, but there was a significant difference between employment status and knowledge (P = 0.03). The mean score of knowledge was significantly higher in patients who had a history of oral cancer in relatives than in other patients (P = 0.03). Virtual networks (Telegram, WhatsApp, and Instagram), journals, and books were the most common sources for patients about oral cancers.

Dental patients’ knowledge of oral cancer in Isfahan province and its cities was moderate, so it is necessary to increase their level of knowledge through more education.

 According to the importance of the patient-mix in creating adequate clinical skills and experience for students, the aim of this study was to assess the periodontal needs of patients referred to the periodontics department of Isfahan dental school and compare them with the formulated curriculum for the students to determine if the number of required and performed treatments meets the curriculum.

Methods and Materials: 

In this cross-sectional study all the available files in the archive of the periodontics department during 2016-2017 were included. The information about the needs of the patients referred to the department (patient-mix) Was compared with the number of dental students multiplied by the educational requirements in each semester of practical course 2-4.

 In periodontics course 2 most of the provided care was adequate comparing with the proposed requirement. In clinical course 3, 4 some provided cares including scaling and root planning, oral health education, charting and intra oral examination were adequate. In course 3, surgery assistance by the students was lower than the requirement. Reviewing the files of course 4 also demonstrated that surgical procedures performed by the students including crown-lengthening, flap surgery, curettage, gingivectomy and also surgery assistance were much lower than the proposed curriculum.

 It appears that there might be a gap in students' training in the fields of periodontal surgeries. This lack might be due to the insufficient number of referring patients and the combination of the patient-mix. Therefore, considering outreach programs can efficiently increase the number and variety of patients and the patient-mix.

 The practice scheme of dentists during the coronavirus disease 19 (COVID-19) pandemic changed markedly around the world. The impacts of these changes on the economic concerns of dentists and the oral health of their patients have been the focus of some recent studies. This study aimed to assess probable alterations in the practice and patient mix of general dentists (GDs) and dental specialists in Isfahan, Iran during the COVID-19 outbreak.

 This analytic cross-sectional study was performed among dentists during the COVID-19 pandemic (April-June 2021). A specific self-administrated questionnaire was designed, the validity and reliability of which were verified by calculating the content validity index and intra-class coefficients (test-re-test techniques), respectively. The questionnaire had 21 items in four sections, including demographic and work characteristics, probable changes in the practice scheme, composition of patients, and the type of the provided treatments. The collected data were analyzed using the SPSS software, descriptive and analytical analysis, including t-test, Chi-square, and ANOVA (α= 0.05).

 Overall, 152 general (response rate= 88%) and 171 specialist dentists were recruited, of whom 206 (63.8%) were males. In addition, 74% of the dentists, especially prosthodontists and restorative specialists, reduced the number of patients per working day (P<0.001). Further, 68.5% reported a decrease in the number of their elderly patients. Based on the results, 77% of the dentists reported an increase in tooth decay and hopeless teeth. Although extraction, emergency treatments, and extensive restorations were increased, prophylactic treatments and follow-ups represented a decline. The highest concern was reported to be about family health (7 out of 10). Finally, prosthodontists, endodontists, and surgery specialists reported the least use of these facilities (P<0.001).

 An increase in the number of hopeless and decayed teeth, as well as an increase in emergency treatments (pain and abscesses) and a decrease in preventive care, confirms an untoward change in the dental practice pattern during the pandemic.

Bakground:

 Considering the role of fear and anxiety management in the success of treatment and the need for dentists to be familiar with anxiety control protocols, we assessed the level of dentists' exposure to patients with dental fear and anxiety and measured the use of anxiety management techniques in this shudy.

 This cross-sectional study was carried out on 360 dentists working in Isfahan City, Iran, in 2020. A 20-item researcher-made questionnaire was designed and validated. The first part of this questionnaire collected information about demographic characteristics, including age, gender, graduation year, and working hours per day and week. The second part included questions to assess dentists’ knowledge in identifying patients with dental anxiety and their management method, the frequency of their exposure to anxious patients in different age groups, and the frequency of using behavioral and pharmacological techniques to manage anxiety. The validity of the questionnaire was measured by calculating the content validity index and its reliability through test-re-test. The questionnaire was prepared electronically and distributed in dentists’ virtual groups. Data were analyzed by SPSS 22. Comparisons between dentists' performance and demographic indicators, such as work experience, gender, and age groups were calculated using Chi-square and correlation coefficients (α=0. 05).

 Out of 360 distributed questionnaires, 311 were filled out (response rate of 86%). The frequency of male dentists was 49. 8% (n=155), and the mean work experience was 10. 3±9. 3 (1-38 years). Overall, the mean of dentists' exposure to patients with dental anxiety was 27. 1±11. 23%. The frequency of using different anxiety control techniques was 82. 9% for Tell-Show-Do, 71. 6% for distraction, and 22. 5% for cognitive-behavioral techniques. The use of cognitive-behavioral methods in the control of dental anxiety showed a significant relationship with gender (P<0. 001). It was also found that medication administration was lower in women dentists (P<0. 001). Regarding the ability to control patients with dental anxiety, appreciably 80% of dentists with more than 20 years of experience reported their ability as very or relatively well.

 Despite the exposure of dentists to anxious patients in different age groups, their knowledge to manage them seems insufficient. They rarely used cognitive-behavioral techniques and muscle relaxation to manage anxious patients. The application of nitrous oxide, sedatives, and hypnotherapy was not very frequent. Therefore, the consideration of educational courses for dentists to identify and manage anxious patients for successful treatment and improve their health seems necessary.

Since general dentists (GDs) usually act as the primary referral source for the patients in need of orthodontic treatments, having the proper knowledge and understanding of the accurate diagnosis of clinical situations is very important. The aim of this study was to assess GDs about the identification of orthodontic treatment needs and their referral practices.

This descriptive and analytical cross‑sectional study was carried out in Iran 2020. A questionnaire consisting of three main parts was designed and distributed electronically among GDs. The first section included 11 image and scenario‑based questions meant to assess the ability of GDs to correctly diagnose the orthodontic treatment needs of the patients. The next two parts were to assess the dentists’ knowledge of the necessity of referral to an orthodontist with 11 questions, and the proper timing of orthodontic treatments with 8 questions. Data were analyzed using SPSS 26, by conducting Mann–Whitney, Kruskal–Wallis, and correlation tests α = 0.05.

Among 384 participated dentists, 50.3% (193) were female. The mean score of knowledge was 17.3 ± 3.5 out of 30. The highest percentage of good knowledge (70% of range) was related to the diagnosis of orthodontic problems, while the lowest one belonged to the referring pattern. There was a weak positive correlation between the working experience and the proper timing of referral (R = 0.15, P = 0.004 (. Kruskal–Wallis test also showed a significant difference between the total knowledge scores (P = 0.04) and the knowledge of the proper timing of treatment (P = 0.04) based on the age groups of participants. Eighty‑seven percentage (n = 334) reported that they would refer the patients in need of orthodontic treatment.

The knowledge level of orthodontic treatment needs among GDs was moderate, thus emphasizing the importance of planning more educational courses for them to improve their knowledge, thus reducing the possible detriments of postponed or inaccurate treatments.

The oral health of pregnant women affects the health of mother and child as much as the public health affects the health of people in a community. Dental treatment during this period should be performed in such a way that it has no side effects on the fetus. This study aimed to evaluate the knowledge and practice of general dentists and dental interns in Isfahan about dental measures in pregnancy period.

In this study, a total of 232 general dentists and dental interns were investigated in Isfahan using a self-made questionnaire containing 26 questions (20 knowledge questions and 6 performance questions) about the measures necessary to employ during pregnancy. Then the validity and reliability of the questionnaire were calculated. The data were statistically analyzed using SPSS software version 22 and performing T-test and ANOVA test. Significant level for all calculations was set at 0.05.

According to the study result, the total knowledge score was 13.2±3/5. The question about "prescribing the required drugs" had a significant correlation with university of study (P=0.047) and type of employment (P=0.047). The question "if the pregnant woman had pyogenic granuloma (pregnancy tumor), what will you do?" had a significant correlation with gender (P=0.042).

The overall score of the dentist's knowledges of the necessary measures during pregnancy was 13.2±3.5 which was fairly acceptable; however, it was recommended that further studies should be carried out in order to eliminate the possible risks posed by dentists to dental treatments of these patients.

The average knowledge score of dentists with less than 5 years of experience was 14.18, and the average knowledge score of dentists with more than 5 years of experience was 13.42, which highlighted the need for offering refresher courses for dentists.

The oral health of pregnant women affects the health of mother and child as much as the public health affects the health of people in a community. Dental treatment during this period should be performed in such a way that it has no side effects on the fetus. This study aimed to evaluate the knowledge and practice of general dentists and dental interns in Isfahan about dental measures in pregnancy period.

 In this study, a total of 232 general dentists and dental interns were investigated in Isfahan using a self-made questionnaire containing 26 questions (20 knowledge questions and 6 performance questions) about the measures necessary to employ during pregnancy. Then the validity and reliability of the questionnaire were calculated. The data were statistically analyzed using SPSS software version 22 and performing T-test and ANOVA test. Significant level for all calculations was set at 0.05.

According to the study result, the total knowledge score was 13.2±3/5. The question about "prescribing the required drugs" had a significant correlation with university of study (P=0.047) and type of employment (P=0.047). The question "if the pregnant woman had pyogenic granuloma (pregnancy tumor), what will you do?" had a significant correlation with gender (P=0.042).

The overall score of the dentist's knowledges of the necessary measures during pregnancy was 13.2±3.5 which was fairly acceptable; however, it was recommended that further studies should be carried out in order to eliminate the possible risks posed by dentists to dental treatments of these patients.

 The average knowledge score of dentists with less than 5 years of experience was 14.18, and the average knowledge score of dentists with more than 5 years of experience was 13.42, which highlighted the need for offering refresher courses for dentists.

Schools are ideal setting for children’s oral health‑promoting programs. It is an integrated model for oral health‑promoting schools (OHPS) with the capacities of dental school’s curriculum and dental students as workforces. In this protocol, the principle of planning and implementation of the oral health program is described.

Based on the PRECEDE‑Policy, Regulatory, and Organizational Constructs in Educational and Environmental Development (PROCEED) planning model, a framework for determining the potential predisposing, reinforcing, and enabling factors that could be intervening was diagnosed. To adapt the phases of the planning model for integration of the “OHPS” principles and the dental students’ curriculum, the following steps are supposed to be considered: Phases 1–5 which are to assess the baseline data will include the assessment of children oral health status and parents and teachers’ knowledge, attitude, and performance. Phase 6 or implementation phase will be allocated to oral health education interventions for students, parents, and teachers, professional screening, prevention, and referral. Phase 7 or the process assessment phase will be to record the number of screened students, the amount of fissure sealant and fluoride provision, and percentage of trained parents and teachers. Phase 8 or the impact assessment phase will assess the students’ improvement in knowledge and practice, decayed, missing, and filled teeth scores, teachers and mothers’ oral health attitudes and behaviors, and brushing and flossing behaviors. At the last, cost analysis of the program and long‑term monitoring of the interventions is suggested.

In case that the effectiveness of this model is proven, it can be implemented by other dental schools for the primary schools in their regions. Considering the number and distribution of dental schools in the country, this model is executable as targeted population oral health promotion approach in 6–12‑year‑old schoolchildren.

 With the growth of elderly population, attention to their oral health status has become increasingly important. Most of the available studies have been conducted among dependent elders who usually have different oral health statuses and needs. Therefore, the aim of this study was to determine the oral health status of independent elderly attending municipal public centers and parks in Isfahan in 2020.

 This is a descriptive-analytical cross-sectional study conducted among 195 elderly people attending Isfahan municipal centers in 2020. The oral health status and the oral health related quality of life (QOL) of elderly were evaluated using Geriatric Oral Health Assessment Index (GOHAI) and clinical examinations. The obtained data were analyzed using descriptive statistics (mean and standard deviation), correlation, independent T-test, Chi-squared and ANOVA using SPSS22 (α=0.05).

 69% of the participants (n=133) were male and the mean age was 68.9± 3.5. Almost 20% of elderly (n=39) did not have any of their natural teeth. 63% (n=123) suffered from at least two chronic diseases and 38.5% (n=75) had a functional occlusion. The mean score of quality of life (QOL) of elderly and their DMFT was 51.7±6.4 and 20.5±6.3, respectively. A significant and negative relationship was found between the DMFT and GOHAI (P<0.001, r=-0.36). QOL scores were significantly higher in participants with dentures than those without dentures (P<0.001). There was a significant relationship between the frequency of brushing and the mean of DMFT (P<0.001). In people who did not brush, the DMFT score was higher than those who brushed at least once a day or even sometimes a week.

 The results indicated that the oral health status of elderly was weak and it would reflect the need for more attention to taking more measures to both prevent the oral problems and to promote oral health.

Clinical and pathologic features of oral and maxillofacial malignant lesions are very important and useful in diagnostic and therapeutic planning. The aim of this study was to determine and compare the clinicopathologic features of different types of oral and maxillofacial cancers in Cancer Registry System at Isfahan-Iran.

In this cross-sectional descriptive analytic study, required data (tumor type, tumor location, age, sex, and grade of malignancy) of 1081 patients from Isfahan Cancer Registry collected.

In this study, the mean age of the patients was 59.9±18.5years old. Most of the patients were male (56.43%). In this study, squamous cell carcinoma was the most common malignancy (61.9%) followed by non-Hodgkin's lymphoma (7%). The most common site was tongue (38.7%) and then the nasopharynx (13%). Also nasopharynx tumors in men were more common than women (P <0.001).

Squamous cell carcinoma, as the most common oral and maxillofacial cancer, requires considerable attention and rapid and appropriate diagnosis and treatment. Knowing the clinical and pathological features of this cancer and risk factors can improve the prognosis of patients.

The purpose of this study was to investigate the quality of life (QOL) score based onstress scale, the relationship between the two and their influencing factors in medical and dental students of Isfahan University of Medical Sciences.

This cross sectional study was carried out on 235 dental students and 488 medicalstudents between April-June 2020. In this study 24 items of physical quality, psychological quality, social quality, environmental quality and 2 general health items related to quality of life and 14 items related to stress level were assessed using the electronic questionnaire ofWHOQOL-BREF. The collected data was fed into SPSS and analyzed by ANOVA, T-test, correlation coefficients and linear regression test (α = 0.05).

The mean for total quality of life was 78.5 ± 14.1 (26-120) and 27.6 ± 7.2 (10-56), respectively. In both professions, the relationship between QOL and total stress showed a significant and inverse relationship (p value < 0.001, r = -0.78). In dental students, four domains and the total score were significantly higher and stress levels were significantly lower compared to medical students. In both professions, women had significantly higher levels of stress than men (p value = 0.03). Based on academic year, in medical students mean for total QOL scores (p value = 0.04), physical (p value < 0.001) and emotional quality (p value = 0.07) were significantly different and while the academic year increased, the QOL scores decreased.

There is a significant and inverse relationship between QOL and stress level. The level of stress in females is higher than in males and also in medical students than in dental students. The score of quality of life and academic year were inversely correlated.

Given the importance of evaluation and the need to use the appropriate instrumentation to evaluate the educational courses, the aim of this study was to revises the course evaluation forms of dental school regarding the nature of this field.

This quantitative-qualitative study was conducted in the academic years 2019-2020 in the school of dentistry of Isfahan University of Medical Sciences. Four evaluation forms of theoretical, practical, clinical, and workshop courses were distributed among the faculty members of the school. After completing by 48 members of the panel, the collected data were analyzed using mean, mode, and CVI (Content Validity Index) calculation. In the second round of Delphi, with the formation of a virtual group and the invitation of the faculty members of the panel, the items with lower median and CVI scores were discussed and the proposed revisions were undertaken.

Most changes were made to the practical training forms. The forms of theoretical courses were classified in four areas including planning, content and resources, course presentation as well as evaluation with 18 items. Clinical and practical forms were categorized into four areas of planning, learning methods, facilities and space, evaluation and outcomes. For clinical and practical forms, 16 and 12 questions were finally developed. Evaluation forms of workshop courses were developed and approved by panel members based on the available workshop forms in the Educational Development Center without any additional revision.

The evaluation forms previously used in the dental school had content and writing problems which were revised based on the consensus opinion of faculty members.

Dental students’confidence is a crucial factor affecting the success of endodontic teaching. The aim of this study was to determine the dental students’confidence level in performing endodontic treatment.

A total of 150 dental students of Isfahan University of Medical Sciences participated in this descriptive study by census sampling. A self-administered questionnaire, including demographic data, endodontic experience, confidence in performing different stages of endodontic treatment, and suggestions for improving the quality of endodontic training, was distributed among the fourth to sixth year students. Data were analyzed with SPSS version 20.0 (IBM Corp., Armonk, New York, USA), using ttest, ANOVA, and linear regression analysis (a=0.05).

The response rate was approximately 88%, and the highest and lowest confidence scores (standard deviation) were reported for establishing proper communication with patients with 4.0 (34.67) and finding all root canals with 3.0 (23.88). The confidence score of male students was significantly higher than female students (P<0.05). There was no significant association between the total score of confidence and difficulty level of the first endodontic treatment and educational level (P>0.05). The multiple linear regression showed a significant correlation between the difficulty level of the first endodontic treatment and confidence (b=−2.1, P=0.02, 95% CI: −3.9–−0.2).

Given the low confidence level of students in some skills, the following are suggested to be taught practically and theoretically. Female students should be provided with a technique to improve confidence. Moreover, the first tooth for endodontic treatment should be selected more thoughtfully.

The purpose of this study was conducted to evaluate the knowledge, attitude, and practice of intensive care unit (ICU) nurses about oral and dental care in hospitalized patients.

In this descriptive‑analytic study, the statistical population included 214 nurses working in the ICU of the affiliated hospitals of Isfahan University in 1394. The level of knowledge, attitude, and practice of ICU nurses was assessed using questionnaires whose justifiability and stability were verified at the beginning of the study with a pilot study. Data were entered into SPSS software and tested by t‑test, Spearman, one‑way variance, and least significant difference test. The significance level was < 0.05.

The data of this study showed that the score of knowledge and performance in male nurses was significantly different from female nurses. There was a significant relationship between nurse’s education and their knowledge score (P < 0.001). Furthermore, the performance score of nurses working in different parts was different too (P < 0.001).

The findings showed that the knowledge and performance of female nurses about oral care were higher than men, but the attitude of the two sexes is almost the same. Nurses with lower educational degree had less knowledge, but their attitude and performance did not differ. The performance score of nurses working in ICU was different, but they had similar knowledge and attitudes.

The sense of coherence (SOC) is defined as a personal orientation to life. People with higher SOC are better at dealing with stressful situations, psychological stress, and problems and are more able to manage them, leading to better general health. The purpose of this study was to evaluate the effect of SOC on the oral health status of people in different age groups. A systematic search up to May 2019 was carried out in PubMed,Scopus, Psycho info, and Persian sources. Studies were included if they evaluated the relationship between SOC and oral health behaviors (OHBs) or oral health status including dental caries. The Newcastle‑Ottawa checklist was used to appraise the selected articles and meta‑analysis of included studies were performed using Comprehensive Meta‑Analysis software. Value of P < 0.05 was considered to be statistically significant. Odds ratio (OR) was used to measure effect size with 95% confidence interval (CI). The random‑effects model was chosen in the presence of heterogenicity. I2 index and Q index were used to measure the heterogeneity present between the studies. Fifteen articles received the minimum score of criticism. In general, SOC could significantly affect the oral health and OHBs of adults independently of the underlying factors. There was a significant relationship between SOC and tooth decay in adolescents, but this association was poor after adjusting for the underlying factors. In children, only one article revealed an association with OHBs. Meta‑analysis revealed that SOC was significantly associated with the caries rate (OR = 0.78, CI 95% = 0.9–0.67, P = 0.001) and tooth brushing frequency (OR = 1.22, CI 95% = 1.1–1.31 and P < 0.001). Sense of coherence appears to be one of the effective factors in predicting oral health behaviors and ultimately oral health, especially in adults. The number of articles available for children and adolescents was not sufficient in this regard.

Recently, therapeutic decision-making in oncology is changed to a big challenge for both patients and involved oncologists due to an increase in available treatment modalities with a variety of benefits or adverse effects.

The current study aimed at comparing the perception of treatment priorities regarding lengthening of survival time or maintenance of the quality of life (QoL) among patients with cancer by health care professionals (HCPs).

The current cross-sectional study was conducted on patients with cancer, their relatives, and healthcare professionals in the referral cancer center of Omid affiliated to Isfahan University of Medical Sciences. To identify treatment choices, priority, and related variables influencing their opinions, all participants were interviewed using a standard and valid questionnaire in Persian. The collected data were analyzed using the SPSS software version 20, and the P-value less than 0.05 was considered statistically significant.

A total of 299 participants, including 100 patients, 109 relatives, and 90 HCPs (74.2% nurses, 20.2% physicians, 5.6% others) participated in the study. The priority of treatment between survival time (66.1% for relatives vs. 47.9% for patients and 21.3% for HCP) and QoL (33.9% vs.52.1% and 78.7%) was significantly different between the three groups (P < 0.001). Most of the HCPs, patients, and their relatives believed that the physician is the only person who should accept the responsibility of treatment choices and process (98.9% vs. 100% and 98%, respectively; P = 0.002).

Among the Iranian population, both the length of life and QoL were valuable; however, it was observed that patients with cancer and HCPs preferred mostly to expand the QoL, while the length of life was more valuable for relatives. Also, all patients, their relatives, and HCPs preferred to choose the physicians as the decision-makers. The results of the study can be helpful in choosing treatment regimens and designing clinical trials.

Dental aesthetics has become an important issue in contemporary society. This study was designed to evaluate the patients’ satisfaction with their dental appearance and tendency to improve dental aesthetics.

In this descriptive study, a questionnaire with 17 questions was used to collect data from 200 patients referred to the dental school of Isfahan University of Medical Sciences from April-July 2019. A valid and reliable self-administrative questionnaire consisted of questions about the appearance of anterior teeth, receiving cosmetic treatments, and favorite aesthetic dental treatments was designed and used. Data were fed into SPSS22 and analyzed by Mann-Whitney, Kruskal Wallis and Spearman correlation tests (α=0.05).

Among the participants, 27.5% (n=45) were dissatisfied with the appearance of their anterior teeth and the major reason for this dissatisfaction was related to the tooth color (35.8%, n=71). It was also observed that approximately 84% (n=168) of the patients had a history of smile concealment because of their teeth appearance. Among cosmetic dentistry treatments, aesthetic restorations were more commonly used than other treatments (20.5%, n=41). However, the most desired cosmetic treatments were teeth whitening (78.4%, n=156). There was no significant relationship between the satisfaction with the appearance of teeth and interest in the orthodontic treatment with age and education level (P=0.6).

Teeth color was the most important factor determining the degree of satisfaction with the appearance of teeth. Most of subjects desired to receive an aesthetic dental treatment and teeth whitening was the most popular aesthetic dental treatment.

School teachers have key role in providing the basic health information for their students, and their knowledge, attitude, and practice affect children's oral health through developing of the healthy behaviors. The goal of this study was to evaluate the effectiveness of an oral health education program for primary school teachers on their knowledge, attitude, and practice fields in the framework of oral health promoting schools.

This quasi-experimental pre-post study was conducted among five oral health promoting schools in Isfahan city in 2019. A validated and reliable questionnaire including four sections of demographic data, knowledge, attitude, and practice was applied for data collection. The questionnaire contained 24 knowledge, 9 attitudes, and 5 practice questions. It was distributed among 63 enrolled teachers at base line and two months later after two educational-emotional workshops. Before and after data were analyzed by SPSS21 (α=0.05) by related samples Wilcoxon signed rank test and background variables by Kruskall-wallis test.

After the educational intervention, their knowledge score increased significantly from 14.1±3.8 to 18.5±3.7 (P<0.001). About 34% of teachers had a high level of knowledge proficiency at the beginning of the study which eventually rose to 76%. Teachers’ attitude decreased significantly from 34.6±5 to 31.4±4.6 (P<0.001). At the beginning of the study, 89% of them had a positive attitude towards oral health programs which decreased to 84% at the end of the study. In the performance part, 63.5% of the teachers paid attention to the fluoride in their toothpaste which reached 87.3% after the workshop and the teachers' performance score increased from 3.07 to 3.39 after the intervention (P<0.012).

The package of educational intervention for teachers in oral health-promoting schools improved the level of knowledge and practice, but slightly reduced the level of attitude. However, due to the importance of changing attitudes in teachers and the existence of structural and programmatic barriers to integrate the health issues into school education, other models need to be evaluated and compared.