مجله دانشکده دندانپزشکی مشهد
سال چهل و هشتم شماره 2 (پیاپی 129، تابستان 1403)

Periodontal inflammatory disease is one of the most common chronic inflammatory diseases that can affect individuals of any age. The results of some studies have shown that both type 1 (T1DM) and type 2 diabetes may be associated with an increased risk of periodontal inflammation. Inflammatory status and vitamin D deficiency create a suitable environment for the progression of chronic diseases such as diabetes and periodontitis in children. This study aimed to investigate the association between vitamin D levels and gingivitis in children with T1DM.

This case-control study was conducted in the city of Ilam to examine the association between 25-hydroxyvitamin D (25(OH)D) levels and gingivitis in 148 children with T1DM. The case-control group was randomly selected from all children aged 6 - 12 years. Participants were classified into two groups, healthy and T1DM, based on the presence of gingivitis. Fasting blood sugar, calcium, and serum 25(OH)D levels were assessed in this study.

The results of the Mann–Whitney showed that 25(OH)D levels were significantly lower in the group with gingivitis (20/72±12/77) compared to the group without gingivitis (29/57±10/72) (p<0.05). In addition, there was no statistically significant difference in the level of 25(OH)D according to gender between the group with gingivitis and the group without gingivitis (p=0.673 and p=0.350). Also, the results of the chi-square test showed that there was no significant difference between the two groups with gingivitis and those without gingivitis in terms of gender and age distribution. (p>0.05)

The results of this study show that vitamin D deficiency is an effective factor in high gingivitis in children with T1DM. Timely monitoring of the level of this vitamin in patients with gingivitis is essential.

Educating oral healthcare providers can lead to oral health promotion in certain groups of the society. The aim of this study was to evaluate how educational intervention would affect the ability of oral healthcare providers in correctly referring target group patients.

Methods and Materials: 

Through this quasi-experimental interventional study, a total of 100 oral health target group patients, including children under the age of 12 and pregnant women, were examined in terms of oral health.  Patients were first examined by a dental student and then by an oral healthcare provider in different healthcare centers of Zahedan city. After the first examination, a two-hour theoretical and practical training course was conducted for healthcare providers. One week after training, new patients were examined using the same examination protocol. Finally, the rate of "correct referrals" and "incorrect referrals" by the healthcare providers were recorded before and after the educational intervention. Data were analyzed and compared by SPSS19 software.

The frequency of correct referral of children after the intervention was significantly higher compared to before intervention (54% versus 74%). The frequency of correct referral of pregnant women also significantly increased following receiving education (44% versus 80%). Although there was no agreement between the oral healthcare providers and the dentists regarding the referral of target group patients prior to the intervention; however, the agreement rate after the intervention was statistically significant (0.120 versus 0.600).

Training oral healthcare providers had a significant effect on increasing their ability in appropriate referral of oral health target group patients.

Prescribing Chlorhexidine mouthwash is currently considered the standard anti-plaque treatment. One of the active antimicrobial compounds in the Iranian shallot extract is a flavonoid called Shalomin II. The purpose of this study was to compare the antibacterial effect of Shalomine II and Chlorhexidine on Lactobacillus acidophilus and Streptococcus mutans bacteria in human saliva.

Methods and Materials:

 In this in-vivo study, about 300 grams of white shallots were collected from Zagros Mountains. Then the aqueous extract was mixed with ethyl acetate (Razi, Iran) at a ratio of 50:50 and mixed for 10 minutes. Microbial resistance and antimicrobial sensitivity of microorganisms were determined using E-test. The bacteria investigated in this study were Lactobacillus acidophilus and Streptococcus mutans. A combination of 0.5% Shalomin II and 2 % chlorhexidine was prepared and diluted at eight different concentrations. The different mixtures were then cultured on the bacteria plate. This experiment was repeated three times. Then the plates were incubated at 37°C for 24 hours and examined for halo radius size. The location of the closed region indicated the minimum inhibitory concentration (MIC).

The MIC values associated with chlorhexidine against Streptococcus mutans and Lactobacillus acidophilus strains was 0.31 mg/mL and 0.16 mg/mL, respectively, and the MIC associated with Shalomin II against Streptococcus mutans and Lactobacillus acidophilus was 1.95 mg/ml. This difference was statistically significant (p=0.002). It was also found that the antibacterial effect of chlorhexidine was greater against Lactobacillus acidophilus compared to Streptococcus mutans.

Shalomin II had antimicrobial effects against both bacterial strains, and displayed a relatively similar inhibitory effect on Lactobacillus acidophilus and Streptococcus mutans. However, its inhibitory effect was not as strong as 0.2% chlorhexidine.

Nasal sputum deviation is the most common anatomical variation of the sinonasal region and can increase the possibility of sinusitis, headache, facial pain, nasal breathing and nasal obstruction. The present study examined the frequency of nasal sputum deviation (NSD) types and opacification of paranasal sinuses and their relationship with gender and age using cone beam computed tomography (CBCT).

Methods and Materials: 

The present descriptive study was conducted on 387 samples from CBCT scans of paranasal sinuses. Deviation of the nasal septum was evaluated based on the Mladina’s classification, and opacification of the paranasal sinuses were evaluated based on the Lund-Mackay scoring system. Cuts greater than 2 mm to increase the thickness of the mucosa were selected as an abnormal condition. After collecting the data, they were analyzed by SPSS software. The significance level was considered 0/05.

387 cases were examined, and NSD was observed in 61.8 percentages of samples. Type 1 of NSD was the most common, followed by type 5. In this study, 59.1 percentages of women and 66.9 percentages of men had NSD (p=0.15). Opacification of paranasal sinuses was found in 63.6 percentages of cases. When the left and right sinuses were considered separately, the maxillary and anterior ethmoid sinuses were most frequently affected. A significant relationship was found between the frequency of nasal septum deviation and opacification of paranasal sinuses and different age groups, and the highest rate was seen in people over 42 years old.

In this study, the frequency of NSD and opacification of paranasal sinuses showed no significant difference between genders. A relationship was found between the frequency of NSD, opacification of paranasal sinuses, and age groups. CBCT is the preferred imaging modality for evaluating NSD and paranasal sinuses.

Complete denture reconstruction is one of the most common prosthetic approaches for restoring both function and esthetics in edentulous patients. The aim of this study was to compare the eating habits of patients with complete dentures and individuals with a healthy dentition.

Methods and Materials: 

In this descriptive-cross-sectional study, participants were recruited from patients referring to Sari School of Dentistry (Tooba Clinic) from January 2014 to June 2019. Patients were to be within the age range of 40-80 years old. Participants were divided into two equal groups; those with a healthy dentition had at least 24 healthy teeth and denture wearers had used their complete denture for 3-5 years. Participants were asked to complete a questionnaire regarding their anthropometric indices and 24-hour dietary recall. The obtained data were analyzed through SPSS version 16 software. A significance level of less than %5 was considered.

A total of 100 patients (n=50 per group) participated in this study. The two groups did not show significant differences in anthropometric indices, and only in the edentulous group, a significant difference was observed between male and females in hip circumference index (P = 0.03). Based on the food recall analysis, there was no significant difference in the intake of calories, macronutrients and micronutrients between the two groups, but according to the food pyramid, dentate people consumed a greater variety of  different food groups in their daily diet. 

Patients with complete dentures had a significantly lower daily intake of Zinc micronutrient compared to individuals with a natural dentition. Therefore, it is better to pay more attention to receiving necessary nutrients through their daily diet in the patients suing complete dentures.

The sphenoid sinus is a common area for performing paranasal surgeries. This sinus and its adjacent vital structures show anatomical variation. awareness of existence of these variations can affect the complications of functional endoscopic sinus surgery.

Methods & Materials: 

120 maxillofacial CBCT images belonging to 57 women (47.5%) and 63 men (52.5%) with an average age of 39.00±13.84 years were analyzed using Romexis viewer 3.8.0 software. For each sample, the following variables were evaluated and compared in two different sexes and ages: Posterior extension of sphenoid sinus pneumatization in relation to the sella turcica, Extension of pneumatization to the clinoid and pterygoid process and whether it is unilateral or bilateral, The presence or absence of protrusion, dehiscence or septa connected to the nerve in the case of the optic canal (OC), vidian canal (VC) and foramen rotundum (FR) and its unilateral or bilateral presence,The presence or absence of a protrusion, dehiscence or septa connected to the carotid canal (CC) and its unilateral or bilateral presence One-way ANOVA, independent t-test, chi-square, and Fisher's exact tests were used for statistical analysis.

The most common pattern of sphenoid sinus pneumatization in relation to the sella turcica was post-sellar (69.1%) pattern.There was a significant relationship between the pattern of sphenoid sinus pneumatization in relation to sella turcica and protrusion/dehiscence/septa connected to CC (P=0.001, 0.032, 0.027) and VC(P=0.023) dehiscence. Pneumatization of the clinoid process was also significantly related to OC, FR and CC protrusion (P<0.05). Pneumatization of pterygoid process and greater wings of sphenoid had a significant relationship with protrusion of VC, FR and protrusion/dehiscence/septa connected to CC (P<0.05). The pattern of sphenoid sinus pneumatization was independent of gender.

The higher prevalence of high-risk anatomical variations in the population of northeastern Iran, indicate a high risk of serious complications in this area.

The presence of the maxillary midline diastema (MMD) is a common aesthetic concern in young children.  The type of the maxillary labial frenum can contribute to the development of MMD. The purpose of this study was to investigate the prevalence and of different types of maxillary labial frenum and MMD in children with primary dentition.

Methods and Materials:

 This cross-sectional descriptive study included children whom were recruited from kindergartens of Sari and Neka cities. Children were examined under sufficient light and in an upright position using a tongue depressor. If present, the MMD was measured and recorded in mm. The maxillary labial frena were categorized based on their connection (papillary, mucosal and gingival) as well as morphology (nodular, simple, and bilateral). Chi-square test, independent T-test and ANOVA were used for statistical analysis. Data analysis was done using SPSS version 25 software. P-value less than 0.05 was considered statistically significant.

A total of 342 children, comprising 186 boys and 156 girls participated in this study. The prevalence of papillary, mucosal and gingival frenum attachments was 16.9%, 26.9% and 56.2%, respectively.  The prevalence of all types of attachments increased with age and was greater among boys compared to girls. This was while the gingival and mucosal connection was less common in 4-year-old children than in 3-year-old children, but this rate increased in 5- and 6-year-old children. All these differences were proven to be statistically significant (P = 0.001).

Simple maxillary labial frenum was the most common type. Increasing age caused an increase in the prevalence of simple, bilateral, and nodular maxillary labial frenum in children. Gingival attachment was the most common type. Moreover, the prevalence of all three types of maxillary labial frenum attachment was higher in boys than in girls.

Pain is common after impacted third molar surgery, and lack of information about the surgical procedure can cause anxiety in patients. Therefore, the aim of this study was to evaluate the effectiveness of providing an education pamphlet in controlling postoperative pain and surgery-related anxiety.

Methods and Materials:

 Participants were selected from patients admitting to the oral and maxillofacial department of Shiraz dental School from January 2023-2024. Patients were scheduled for third molar surgery. Subjects were randomly allocated to two equal groups. In the pamphlet group, subjects were provided with a booklet containing information regarding the surgical procedure, possible complications and post-operative instructions. While in the other group, the surgeon explained the required information for the patient after the surgery was over. Post-operative pain was evaluated using visual analogue scale (VAS), immediately after surgery and one week later. Spielberger State-Trait Anxiety Inventory (STAI-S) was completed prior to the intervention and immediately after surgery. Data were analyzed by T-test, Chi-square, Fisher exact, Wilcoxon and Mann-Whitney test. The significance level was 0.05.

A total of 70 subjects, comprising 38 male and 32 females, completed the study. The average age of patients in the pamphlet and verbal groups were 29.68 ± 8.96 and 29.94±6.68 years, respectively. The level of pre-intervention anxiety was not significantly different between the two groups. However, there was a statistically significant difference between the groups in terms of post-operative anxiety levels (P=0.001). In the pamphlet group, the anxiety level before the intervention and after surgery was significantly different. However, in the verbal group, the pre- and post-intervention anxiety levels were not significantly different. The two groups had no significant difference regarding post-operative pain values.

Providing patients with a written set of explanations and instructions in the form of an education pamphlet, prior to undergoing third molar surgery, can reduce their anxiety.

Imaging advancements such as introduction of cone-beam computed tomography (CBCT) provides the possibility of viewing the tooth in different planes and as a result, a more detailed examination of the internal anatomy of the tooth and intra-operative mishaps. The aim of this study was to evaluate the prevalence of technical errors and periapical radiolucencies in endodontically treated teeth by means of CBCT images.

Methods and Materials:

 A number of 235 CBCT images were obtained from Iranian patients (93 males; 142 females;mean age = 45.36 years). A total of 737 teeth (1141 root canals) were examined for periapical radiolucency, coronal restoration, and endodontic treatment quality (length of obturation, homogeneity of obturation, and presence of technical errors). Prevalence and correlation between tooth group, age and gender distribution were analyzed statistically with chi-square test. The level of significance was considered as 0.05.

Overall, 623 root canals (44.1%) contained technical errors. A number of 291 case for underfilling (20.6%), 120 missed canal (8.5%), 99 overfilling (7%) and 82 non-homogenous obturation (5.8%) were the most prevalent errors, respectively. Maxillary molars showed the highest number of errors (P-value=0.001). 45.1% of root canals had periapical radiolucencies. Maxillary molars were also associated with the most periapical radiolucencies. 62 teeth lacked proper restoration. Perforation, root resorption, root fracture and deviation were observed in less than 2% of root canals.

Endodontic errors and accidents are relatively common in endodontically treated teeth. The prevalence of periapical radiolucencies increases when endodontic errors and procedural accidents are present. Underfilling, missed canal, overfilling and non-homogenous obturation were the most prevalent errors found. Maxillary molars were mostly associated with these errors and accidents.

Lymphangioma is a type of benign hamartomatous tumor in the lymphatic network, which is considered as a developmental vascular malformation that can be combined with hemangioma. The onset of lymphangiomas is either at the time of birth or up to 2 years old and rarely occurs in the adulthood. Lymphangiomas have a significant prevalence in the head and neck region. But oral cavity involvement is rare. In the oral cavity, the tongue is a common site of involvement, which may be seen individually or as a diffuse swelling. Clinically, lymphangiomas are painless soft swelling lesions with slow growth. The treatment of lymphangioma depends on its type, size and the involvement of the anatomical structures of the surrounding tissues. Recurrence is also common due to the nature of infiltration.

Case report: 

This study reports a case of coincidence of unilateral large lingual lymphangioma and geographic tongue in a 21-year-old man in the oral cavity.

Lymphangiomas are benign lymphatic malformations and can cause problems for the patient with irritations in the oral cavity. Therefore, doctors and dentists should have knowledge for early diagnosis and then appropriate referral and treatment for these patients