مجله دانشکده دندانپزشکی مشهد
سال سی و هشتم شماره 1 (پیاپی 88، بهار 1393)

Ever-increasing motor vehicle usage and other unpredictable incidents have increased the risk of injury due to trauma. The maxillofacial fractures cause growth defect in some bones and face deformities which may affect people’s life permanently. The aim of this study was to evaluate the incidence, etiology, gender and age of patients with maxillofacial fractures through conventional radiography during two years. In this descriptive study, routine radiographs of 127 patients with maxillofacial trauma referring to radiology department of Mashhad Dental School were evaluated during two years (2008-2010). The number, etiology, type and anatomic site of the fracture as well as gender, age and educational level of the patients were recorded. The data were analyzed using SPSS 15. A total of 93 out of 127 patients had maxillofacial fractures. The patients with fracture had the age range of 2 to 82 years, including 75 males (mean age 25.83±13.8) and 18 females mean age 20.33±10.7). More fractures were observed in men (80.6%) than women (19.4%). Mandible bone was the most frequent site of fracture (35.5%) in both genders, followed by dentoalveolar fracture (31.2%) and Mandible bone + dentoalveolar fracture (21.5%). Furthermore, the main cause of fractures was vehicle accident (55.9%) followed by falling (26.9%) and assault (10.8%). Multiple fractures occurred 2.7 times more than single fractures. Most fractures occurred in patients with low educational status. In the present study, fractures were more common in men. The mandible bone was the most prevalent site of fracture. The main cause of fractures was motor vehicle accidents. As the fractures occur more commonly in young adults, improving people’s awareness regarding principal safety measures and personal protection is recommended.

Nowadays management of children's dental fear has attracted much more interest. This study was designed to find out the impact of out-patient and in-patient with general anesthesia procedures on the fear level alterations in children. In this cross sectional-descriptive study, two groups of 50 participants (3-6 year old) were selected. The patients in the first group were treated in outpatient service while the other group received the treatment in inpatient service under general anesthesia. The parents were asked to fill out the CFSS-DS (Children’s Fear Survey Schedule-Dental Subscale) questionnaire, before and after the procedure to assess the fear level of their children. The data were analyzed by independent t-test, paired t-test and chi-square test using SPSS 16 (α=0.05). In the outpatient group, mean fear scores, before and after the procedure were 26.3±19.2 and 28.4±24.4 respectively. The difference was not significant. In inpatient treated group with general anesthesia, mean fear scores, were 37.9±24.8 and 40.6±28.7 before and after the procedure, respectively. The difference was not significant. The fear scores in outpatient group were significantly lower than those of the inpatient group, both before and after the procedure (P

Oral lichen planus (OLP) is suggested as a lesion capable of transforming to oral squamous cell carcinoma (OSCC). However malignancy potential of the lesion and its relationship to OSCC is a matter of controversy. Since uncontrolled cell proliferation is an indicator of malignant transformation, the aim of this study was to compare cyclin D1 expression in OLP and OSCC lesions. In this descriptive-analytical study, cyclin D1 expression among 3 groups of epithelial hyperplasia, OLP and OSCC each having 21 samples was investigated using immunohistochemistry staining through quantitative and semi-quantitative methods. One-way ANOVA, Kruskal Wallis, Mann-Withney and Chi-square were used for statistical analysis. Quantitatively, cyclin D1 expression for epithelial hyperplasia, OLP and OSCC were 13.69±6.00%, 28.38±3.53% and 66.94%±14.49%, respectively. Semi- quantitatively, number of stained cells for epithelial hyperplasia and OLP were less than 35% while for OSCC it was more than 35%. Through quantitative and Semi- quantitative comparison, cyclin D1 expression among the three studied groups overally and either bilaterally was significantly different (P<0.05). The results showed that cell proliferation of OLP significantly was less than that of OSCC suggesting that is no relationship between the two although pre-malignancyability of OLP is not exactly ruled out. It seems that increasing cell proliferation might be related to malignancy transformation of OLP; therefore, continuous follow-up of the lesion is necessary.

Mandibular symphysis and parasymphysis fractures are common fractures following mandibular trauma. The success of open or closed reduction treatment depends on the type of fracture, the experience of the surgeon, the facilities available, and the medical conditions of the patient. Each treatment has its own complications. The purpose of this study was to examine the side effects and the complications following open reduction treatment in mandibular symphsis and parasymphysis fractures. In this retrospective study, conducted at Shahid Kamyab Educational-Treatment Center in Mashhad, 208 patients suffering from symphysis and parasymphysis fracture who had undergone treatment with internal fixation were studied. The patients were also subjected to a follow-up period of 8 weeks and the subsequent complications from their treatment were recorded. Chi-square and Fisher’s Exact tests were used for statistical analysis (α=0.05). The results of study showed that the complications arising from open reduction treatment in mandibular symphysis fracture were at an acceptable level and the risk of complications was reduced if treatment started not later than ten days after fracture. In order to reduce the risk of complications after open reduction treatment in mandibular fracture, the open reduction surgery should be started as soon as possible.

Formocresol has been used for primary molar pulpotomy in the past but numerous alternatives have been introduced because of its disadvantages. One of these substitutes is hypochlorite sodium (Naocl) which has shown satisfactory results in spite of few studies on it. The aim of this study was to compare clinical and radiographic success rates pulpotomy treatment in primary molars using 5% sodium hypochlorite versus ferric sulfate (FS) 15.5%. In this study, pulpotomies were performed in mandibular second primary molars in 60 teeth which had sufficient indications for pulpotomy. In each Patient, one tooth was randomized into FS pulpotomy group and one tooth in Naocl group. The teeth were pulpotomised and treated with FS or Naocl. Fallowing treatment, the pulp chamber was Filled with zinc oxide eugenol (ZnOE) and restored with a stainless steel crown. Clinical and radiographic outcomes were recorded at 6 and 12 months. Outcomes were evaluated with Fishers exact test. Both groups (FS as control group and Naocl as experimental group demonstrated 100% clinical success rates at 6 months. But at 12 months clinical success rate for Naocl was 100% compared with 93.3% for FS (P=0.22). Radiographic success rates for Naocl and FS were 96.7% and 100% respectively at 6 months (P=0.5) and 93.7% and 97.3% at 12 months (P=0.5). No significant differences were found in the radiographic and clinical outcomes between the two groups at 6 and 12 months. Naocl demonstrated clinical and radiographic success rate comparable to FS in primary molar pulpotomy.

The purpose of this study was to evaluate the expression of Interleukin-1 beta (IL1β), Tumor necrosis factor alpha (TNF-α) and Myeloperoxidase (MPO) in diabetic rats after pulp capping with Mineral Trioxide Aggregate (MTA) and a new endodontic Calcium Enriched Mixture (CEM) cement. To examine the effect of MTA or CEM, on diabetic dental pulp, animal model of Streptozotocin (STZ)-induced diabetic rats (intraperitoneal (IP) injection of STZ (65mg/kg) were used. Thirty four rats were divided into two diabetic and healthy groups. After exposing the pulp of the first maxillary molar, either MTA or CEM were used as pulp cap agent, cavities were sealed with resin modified glass ionomer cement. After thirty days, the rats were sacrificed. Chi-square, Pearson and two-way ANOVA tests were used for statistical analysis (α=0.05). There was no significant difference in the amount of IL-1β, TNF-α and MPO between healthy and diabetic rats in MTA group (P=0.827, P=0.948, P=0.365). In CEM group, no difference in the amount of IL-1β and TNF-α between healthy and diabetic rats was detected (P=0.652, P=0.932). But there was a significant difference in the amount of MPO between healthy and diabetic rats in the CEM group (P=0.033). There was no significant difference between diabetic and healthy rats in the amount of IL1β, TNF-α in both MTA and CEM groups while the amount of MPO showed a significant difference in rats treated with CEM.

The purpose of this study was to evaluate the deviation of root canal path in endodontically treated teeth by Mashhad dental students from April 2012 till April 2013. A total of 400 records from 895 dental patient records archived in dental school endodontic department between April 2012 and April 2013 were evaluated by two endodontic staffs. The radiographs were then examined for existence of ledge and deviation of apical foramen using a lens with magnification of X2 and an X-ray viewer. Finally, the results were analyzed using SPSS (SPSS Inc., Chicago, IL, USA) and chi-square test (α=0.05). Ledge was observed in 25.1% of maxillary and 23.3% of mandibullar teeth that the difference was not statistically significant (P=0.674). Also there was no difference in the distribution of ledge among anterior, premolar, and molar teeth (P=0.996). Apical foramen deviation was seen in 12.6% of maxillary and 23.8% of mandibullar teeth and the difference was significant (P=0.003). This finding was significantly greater in molar teeth (29%) compared to 7.3% in anterior teeth and 9.6% in premolars (P=0.000). Apical foramen deviation was significantly greater in teeth treated by 5th year student (P=0.019). The canal deviation rate in teeth treated by dental students was 42.3%. By increasing the practice of root canal treatment by dental students on extracted teeth and greater emphasis on crown down and modified passive step back filing methods, this rate could be minimized.

In recent years, clinical expertise has been mixed with research evidence in order to increase the quality of treatments. Learning evidence based dentistry (EBD) is important because of difficulties in finding the evidence based sources in huge amount of articles, books. This article was carried out to show the amount of knowledge and usage of EBD at Mashhad dental school, postgraduate students. Ninety nine post graduate students participated in this cross sectional study conducted at Mashhad dental school, in 2012. The data were collected by questionnaires and analysed by SPSS version 11.5. Ninety Six percent of postgraduate students believed that using EBD would bring better results in treating patients, while only 5 percent of them use EBD in clinic as a usual trend. Despite postgraduate students’ positive attitude toward EBD and access to the internet, they have little knowledge about special evidence based web sites and references. Maybe this is due to they have not spent special courses. Because of the importance of this concept in clinical decisions and the need for educational programs (curriculum) should be corrected and modified.

The results of studies on the dental students’ perceived motivation toward their career choice have been used in planning social, educational, professional, medical, and economic issues associated with this career. The purpose of this study was to investigate the reasons and motivations of first and final grade dental students towards their career choices. Seventy five dental students at first (40 students) and sixth grades (35 students) from Mashhad dental school participated in this cross sectional study. A self administered questionnaire consisting of student's personal information and their motivations for choosing dentistry were distributed among the students. Statistical examination was done using SPSS software (Version 11.5). Chi-square and Mann-Whitney tests were used for performing statistical analysis (α=0.05). The results show that the most frequent reasons for choosing dentistry were economic factors, social status and job security, and proper and flexible working time. Females, attention due to the lower risk for life-threatening complications in dental practice were significantly higher than males (P= 0.001). Shifting perspectives of sixth year dental students toward dentistry compared to first-year students were more frequent (P=0.031). This change in perspective in the sixth-year students had a more negative trend. Economical factors and professional factors had the most influence on selecting dentistry by students. It is definite that these kinds of factors in dentistry could have negative effects on dental graduates, future career.

The aim of this case report was to show how acommon oral condition, such as recurrent aphthous stomatitis, could be the only clinical sign leading to early diagnosis of celiac disease. Case Report: A recurrent oral ulcer was detected by a physician during examination of a 23-year-old young woman complaining of severe weakness and inability to intake foods orally. The patient was visited in oral medicine department and a major aphtous ulcer was diagnosed by an oral medicine specialist. An interesting finding was presence of gastrointestinal manifestations which exacerbated with oral ulcers. The patient was evaluated by gastroenterologist and diagnosis of celiac disease was established by laboratory findings and small intestine biopsy which showed a strong atrophy of the intestinal villi which confirmed diagnosis of celiac disease. After six months on a gluten-free diet, no evidence of oral ulcers was found. At the time of submission of this paper, the patient was in a good health status. Oral medicine specialist has a fundamental role in diagnosing syndromes associated with apthous ulcers. Appropriate referral by other health care providers can help in early diagnosis and prevent long term complications of celiac disease. However, the importance of investigating systemic anomalies in cases with aphtous ulcers should be emphasized.