The Experiences of Medical and Dental Personnel Regarding Informing their Patients about the Diagnosis of Head and Neck Cancer

Introduction: One of the main challenges regarding the patients with cancer, is to inform them about their disease. The aim of this study was to evaluate outlooks and experiences of medical and dental staff experts in Kerman, Iran, regarding the method of informing the diagnosis of head and neck (HN) cancer to patients and their relatives. Method: In this qualitative study, the data were obtained through deep interviews, and focus group discussions. The target groups were faculty members of the departments of oral medicine, oral and maxillo-facial surgery, and oncology, nurses of the departments of oral diseases and oncology, and postgraduate students of the department of oral medicine in Kerman university of Medical Sciences, Kerman, Iran (25 individuals). Aim-based sampling was carried out and continued till the saturation of data. The data were analyzed using content analysis method. Results: Two major classifications were derived. “Truth-telling improving factors” of them, “giving the patients an opportunity for decision making for treatment plan” was the most important factor; and “truth-telling avoiding factors” of them, "close relatives insist to avoid telling the truth to the patients” was the most important factor. Conclusion: In spite of the fact that most of the interviewees believed in telling the truth to the patients, practitioners should consider several factors such as patient's family preference, as well as patients’ anxiety and physical and psychological conditions. It would be reasonable if health care workers train to deal with the patients having cancer. Keywords: Medicine, Dentistry, Head and neck cancer, Qualitative researc

Oral health related quality of life in patients with diabetes mellitus type 2 in the year 2012

BACKGROUND AND AIM: The aim of this study was investigation of oral and dental side effects of diabetes mellitus (DM) on oral health-related quality of life (OHQoL) in patients with DM type 2. METHODS: In this descriptive, analytic study 121 patients were participated by consecutive method based on the type of diabetes and the age. After the subjects received adequate explanations about the necessity of carrying out such a study, a questionnaire was handed into each patient who gave their consent to take part in the study. Oral lesions consisted of ulcers, erythema, leukoplakia, erythroplakia, candidiasis, angular cheilitis, median rhomboid glossitis, and denture stomatitis based on oral examination. The OHQoL were surveyed by oral health impact profile (OHIP-14) questionnaire. Data were analyzed by Pearson’s correlation test, T-test, and χ2 by SPSS software. RESULTS: A total of 121 patients with diabetes were evaluated in this study [31 males (25.6%) and 90 females (74.4%)]. In this study, there was no significant correlation between OHQoL and decayed, missing, and filled teeth (DMFT), periodontal disease index (PDI). OHQoL was associated with higher ages and higher levels of blood sugar (P = 0.002, P = 0.016). The average of OHIP score significantly was increased by xerostomia experience (P = 0.010). CONCLUSION: In this survey, the influence of oral manifestation on OHQoL was low. Xerostomia was the most important symptom in diabetic patients that causes decreasing OHQoL. Age and blood sugar had more influence on this matter as well. KEYWORDS: Diabetes Mellitus; Oral Manifestation; Oral Health Related Quality of Lif

Influence of menstrual cycle and salivary ß-estradiol on volatile sulfur compound

BACKGROUND: ß -estradiol is a steroid sex hormone that plays important role in oral physiology. The aim of this study was to determin the association of the menstrual cycle and salivary ß-estradiol with the production of volatile sulfur compounds (VSC). METHODS: In this cross-sectional study, twenty female dental students in good oral and general health were recruited for evaluation of VSC, salivary flow, ß-estradiol concentration, oral dryness feeling and dysmenorrhea. Data were analyzed by marginal homogeneity test and xtgee model. RESULTS: The only covariates that significantly related to VSC were being at the follicular phase (B = -0.21, P = 0.02), being at the pre-menstrual phase (B = -0.25, P = 0.01), stressfulness (B = 0.02, P = 0.01) and oral dryness feeling (B = 0.34, P = 0.02). Salivary ß-estradiol was at the level of 59.7 31.2 in those having halitosis (VSC ≥ 75) while in the others (VSC < 75) it was about 40.8 18.0 (P < 0.009). This difference was not statistically significant in multivariate analysis. CONCLUSIONS: The menstrual cycle, stress and oral dryness were the most important determinants of halitosis. The salivary ß-estradiol level could not explain such relationship as its effect was eliminated considering the other factors. KEY WORDS: Halitosis, menstrual cycle, ß-estradiol, volatile sulfur compound

Prevalence of Toothache and Associated Factors: A Population-Based Study in Southeast Iran

Introduction: This study was carried out to estimate toothache prevalence among adult residents in Kerman. Materials and Methods: This cross-sectional, population-based study was conducted among individuals aged over 18 years (n=1800). The relevant data on the prevalence of toothache and associated factors were collected by interviewing the individuals in their homes and filling out a questionnaire designed by the examiners. Prevalence of toothache and associated factors that patients recalled previous to their interview were analyzed by chi-square test and multivariate logistic regression analysis. Results: Nine hundred ninety-one individuals (55.1%) reported toothache during the 6 months before the interview. The participants who flossed daily, had regular dental visits, and had higher education showed a significantly lower prevalence of toothache (P&lt;0.05), whereas regular tooth brushing and economic level of residency had no significant effect on the prevalence of toothache. Individuals between the ages of 26 and 45 [odds ratio (OR)=2.0], with a family size of more than 4 (OR=1.5), not using dental floss (OR=1.5), or having a mental or psychological illness (OR=1.5) were more likely to have a history of toothache. Conclusion: High prevalence of toothache (more than half) among residents of Kerman shows a serious and major public health problem. Toothache prevalence in middle aged adults, lower education, bigger family size, lower dental hygiene habit and/or those having mental or psychological illness were more common in the city of Kerman

The Frequency of Medically Compromised Patients in Endodontic Offices in Iran

Introduction: As the result of epidemiological transition and aging of Iranian population, the frequencies of systemic diseases among patients in of need endodontic treatment has increased, especially within developed cities. However, there have been no concise reports of systemic diseases in Iranian patients. Based on this need, the present investigation was conducted to assess the frequency of systemic disease among patients referred to endodontic private practice in three main cities in Iran. Materials and Methods: In a retrospective study, the frequency of systematic diseases were abstracted from the health records of patients who were referred to three private practices limited to endodontics in Kerman, Mashhad, and Tehran between 1994 to 2011. Results: Overall, 15,413 records of patients were assessed. The patterns of systematic diseases among endodontic patients in these three cities were different. The overall frequency of systemic disease in Kerman was significantly higher than two other cities (Kerman: 55.03%, Mashhad: 24.32%, Tehran: 22.16%; P&lt;0.001). The most commonly occurring diseases were cardiac disease, hypertension, allergy and neurological disorders. Conclusion: Since the number of endodontic patients with systematic diseases is considerably significant and varied, special training and educations for treatment of medically compromised patient should be considered at both post- and undergraduate training

Oropharyngeal candidiasis and resistance to antifungal drugs in patients receiving radiation for head and neck cancer

BACKGROUND: Oropharyngeal candidiasis is a common infection in patient receiving radiotherapy for head and neck cancer. Accurate and rapid identification of candida species is very important in clinical laboratory, because the incidence of candidiasis continues to rise after radiotherapy. The genus Candida has about 154 species that show different level of resistance to antifungal drugs and have high degree of phenotypic similarity. The aim of this study was to investigate oral yeast colonization and infection and resistance to antifungal drugs in these patients. METHODS: Thirty patients receiving a 6-week course of radiation therapy for treatment of head and neck cancer at the Oncology Unit in Shafa Hospital, in 2008, were enrolled in the study. Specimens from patients were cultured weekly for Candida. All isolates were plated on CHROM agar and RPMI-based medium. They were subcultured and submitted for antifungal susceptibility testing (nystatin, fluconazole, clotrimazole and ketoconazole) and molecular typing. RESULTS: Infection (clinical and microbiological evidence) occurred in 50% of the patients and Candida colonization (only microbiological evidence) occurred in 70% of subjects in the first week. Candida albicans alone was isolated in 94.9% of patient visits with positive cultures. Candida tropicalis was isolated from 5.1% of patient visits with positive cultures. All isolates were susceptible to nystatin, but did not respond to the other antifungal drugs CONCLUSIONS: The irradiation-induced changes of the intraoral environment such as xerostomia lead to increased intraoral colonization by Candida species. All yeast isolates were susceptible to nystatin. Thus prophylactic therapy with nystatin should be considered for these patients. KEY WORDS: Oropharyngeal candidiasis, radiation, colonization, antifungal drugs, cance

Evaluation of Skills and Use of Computer and Internet among Professors, Postgraduate and Undergraduate Students in Kerman, Iran

Background & Objective: In the 21 century using computers and the internet are necessary. Computers and internet provide professors and students with the possibility of accessing scientific information very quickly. The aim of this study was the evaluation of skills and use of computer and internet among professors, and postgraduate and undergraduate students in Kerman University of Medical Sciences, School of Dentistry. Methods: In this cross-sectional and descriptive-analytic study a questionnaire was given to 51 professors, 42 postgraduate and 241 undergraduate dental students of Kerman University of Medical Sciences. After completing the questionnaires, data were analyzed using chi-square test. Results: Statistical analysis showed that the rate of access to computers at home and universities among professors, and post- and undergraduate students was 88.2%, 84.7%, 85.4%, respectively. 98% of professors, 95% of postgraduates, and 94% of undergraduate students use the internet. The most rate of computer use was 0.5-2 hours during the day. 87.4% of professors, 71.4% of postgraduates, and 71% of undergraduate students do not need education for using the internet. Professors and assistants use of computers for academic activities was higher than students. Conclusion: Skills and use rate of computers and internet was higher in professors in comparison with other groups and there were no statistically significant difference between men and women in three groups. Keywords Dentistry Internet Compute

Oral Health Determinants among Opium Users in Kerman, Iran

Background: Promoting oral health is a complicated issue among drug abusers and opium is the most frequent drug abused in Iran. This study aims to find the oral health determinants of opium users in Kerman, Iran.Methods: This cross-sectional study was a part of the second phase of Kerman coronary artery disease risk factors study (KERCADRS, 2014-2018). In this survey, the data of 1140 opium users were analyzed. The information about using a toothbrush, dental floss, number of dental visits at last year, age of first use of opium, duration, and opium consumption frequency was recorded. The total number of decayed, missing, and filled teeth (DMFT) index and Community Periodontal Index (CPI) was recorded by an oral examination. Poisson and logistic regressions analyses were used for assessing the relationship among variables.Findings: The mean age of participants was 52 ± 12 years. 74.4% were men and 24.6% were women. The average DMFT index was 15.7 ± 7.6 and the prevalence of a healthy CPI score was 18.5%. Educational level (P < 0.001), brushing (P < 0.001), flossing (P < 0.001), dental visit (P < 0.001), first age of using opium (P < 0.001), frequency of consumption (P < 0.001), and age (P < 0.001) were associated with DMFT index. Only using floss (P < 0.001), dental visit [odds ratio (OR) = 1.80, P = 0.030], frequency of consumption (OR = 2.92, P < 0.001), and age (P = 0.001) were associated with CPI score.Conclusion: The frequency of opium consumption has the same effect on caries incidence as oral hygiene habits. Moreover, using dental floss has a more significant effect on the periodontal health of participants

Retrospective Study of Oral Lichen Planus and Oral Lichenoid Lesions: Clinical Profile and Malignant Transformation

Statement of the Problem: Oral lichen planus (OLP) and other oral lichenoid lesions (OLL) are reported to have the potential of malignant transformation and dysplastic changes, turning into oral squamous cell carcinoma (SCC). While the world health organization (WHO) has classified OLP as a precancerous lesion of the oral cavity, there is still much debate among researchers about its risks and malignancy potential.  Purpose: The present study aimed to determine malignant transformation in OLP and OLL and understand related risk factors. Materials and Method: This retrospective study was performed on 356 patients of the Oral Medicine Department of Dental School of Kerman Medical University from 1998 to 2020. All patients’ records were gathered. In addition, patients were followed up routinely. Second biopsy was taken as needed. The samples, previously taken from the patients, were re-evaluated according to WHO histopathologic criteria for diagnosing OLP, OLL, dysplasia, and SCC by an experienced pathologist and compared with first reports. Results: Dysplastic changes were observed in 6.2% of the patients. In more than half of the patients, dysplastic changes were present right from the start and 2.20% of the patients had experienced dysplastic changes averagely within 2.05 years of the onset of lesions. Multiple logistic regression showed that the risk of dysplasia increases with aging (p= 0.013), smoking (p= 0.0001), and thyroid disorders (p= 0.008). Conclusion: Given the rather high prevalence of oral lichen planus and lichenoid lesions, further research appears to be needed to determine the etiology of these lesions, malignant transformations, and the factors affecting this probability. Considering the findings, it is imperative to meticulously record the information of all patients with oral lichen planus and lichenoid lesions in the initial examinations as well as close follow-ups and employ diagnostic tools such as toluidine blue staining or even repeat biopsy when necessary

Comparison the Pain Relief of Amitriptyline Mouthwash with Benzydamine in Oral Mucositis

Statement of the Problem: A significant proportion of patients undergoing chemotherapy or radiotherapy suffer from mucositis. The first symptom of oral mucositis is pain. Severe pain, burning sensation, and discomfort in the oral cavity make it difficult to continue treatment and even continue living in these patients. Purpose: The aim of this study was to evaluate and compare the effect of amitriptyline mouthwash (in two forms of simple and niosomal) as a local anesthetic agent with benzydamine HCl mouthwash in oral mucositis after radiotherapy or chemotherapy. Materials and Method: This double-blind study was performed on 60 patients with oral mucositis caused by radiotherapy and chemotherapy. The severity of mucositis was determined based on patient judgment; then dental examination was performed and recorded in a checklist. Three groups were assigned based on using either benzydamine HCL, amitriptyline, or niosomal form of amitriptyline. Pain and burning sensation were evaluated with VAS at different time intervals: before use and one, five, ten, and thirty minutes and one hour after using mouthwash. T-test was used to compare the intensity of pain between the two groups. ANOVA and Tukey test were used to compare the intensity of pain between groups. Results: Statistical analyses showed the maximum reduction in pain intensity at two different time intervals (p= 0.04). Ten minutes after the use of niosomal form of amitriptyline, a 95% decrease in pain was observed. A 99% reduction in pain occurred after the use of simple form of amitriptyline (p= 0.04). Conclusion: Use of amitriptyline mouthwash had local anesthetic effects in oral mucositis without systemic side effects. Decrease in the severity of pain with the use of amitriptyline mouthwash was more than that of benzydamine HCL mouthwash