Evaluation of the Levels of Evidence in Three Clinical Chapters in Five Editions of the Textbook Pathways of the Pulp

Introduction: The levels of evidence (LOE) of dental education texts is critical from the educational point of view. The present study aimed to evaluate the levels of evidence of references used in three clinical chapters in the textbook Pathways of the Pulp. Material & Method: The references of three clinical chapters in the text book Pathways of the Pulp were assessed in five of its editions. The levels of evidence were ranked according to study type and the Oxford scale from 0 to 5. The chi-square test was used to compare the level of evidence between different editions of the "Retreatment," "Trauma," and "Surgery" chapters. Results: A total of 3656 references were reviewed and analyzed from the "Trauma" (928 references), "Re-treatment" (1906 references), and "Surgery" (822 references) chapters in the 1998, 2002, 2006, 2011, and 2016 editions. The percentage of the LOE 0 (no evidence) was high (>60%) in all three chapters in all editions (P<0.001). The levels of evidence had the same distribution in all editions (P=0.871). The LOE of the "Re-treatment" (P=0.044) and "Surgery" (P<0.001) chapters changed in some editions. Conclusion: The majority of references in the three clinical chapters of the book are low-level evidence. Encouragement policies for researchers to conduct studies with high LOE are necessary

Comparative Outcomes of Pulpotomy in Mature Molars with Irreversible Pulpitis: A Non-Randomized Trial Evaluating Calcified and Non-Calcified Pulp Chambers

Introduction: This non-randomized clinical trial investigated the outcomes of full pulpotomy in adult molars with irreversible pulpitis, comparing those with calcified and non-calcified pulp chambers over 6 and 12 months. Materials and Methods: A total of 101 adult permanent molars with irreversible pulpitis, in individuals over 12 years old, were categorized based on pulp chamber calcification observed in radiographic images by two endodontists. Subsequently, full pulpotomy procedures were performed, achieving hemostasis, and applying a 2 mm layer of calcium-enriched mixture (CEM) cement as a pulp covering agent. After 48 hours, the setting of the CEM cement was verified, followed by the application of a layer of resin-modified glass-ionomer. The tooth was then restored using amalgam. Clinical and radiographic evaluations were conducted at 6-month and 1-year follow-ups by blinded endodontists. Success rates were compared using Fisher's exact test and logistic regression tests with a significance level of 0.05. Results: Among the 97 patients with 6-month and 1-year follow-ups, all achieved clinical success. Radiographic success rates were 99% at 6 months and 96.9% at 1 year, regardless of pulp calcification. In the 6-month follow-up, success rates were 98.07% for non-calcified pulp chambers and 100% for calcified pulp chambers. At the 1-year follow-up, success rates were 96.1% and 97.8%, respectively. Statistical analysis showed no significant difference in radiographic success rate between the two groups at both follow-ups (P>0.05). Conclusions: Full pulpotomy using CEM cement is a successful treatment for adult permanent teeth with calcified and non-calcified pulp chambers presenting signs and symptoms of irreversible pulpitis up to a 1-year follow-up. This study provides compelling evidence that vital pulp therapy can be effectively employed in the pulpotomy of calcified teeth, at least in the short term

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

Comparative Efficacy of Analgesics for Pain Relief in Patients with Symptomatic Irreversible Pulpitis Prior to Emergency Endodontic Treatment: A Randomized Controlled Trial

Introduction This study aimed to compare the efficacy of ibuprofen, Novafen, mefenamic acid (MA), and celecoxib for pain relief in patients with symptomatic irreversible pulpitis prior to emergency endodontic treatment. Materials and Methods: This clinical trial was conducted on 120 patients with moderate to severe pain due to symptomatic irreversible pulpitis seeking emergency endodontic treatment. The patients were randomly divided into 4 groups to receive Novafen, MA, Celecoxib, and ibuprofen. The pain score of patients was measured before and 1 hour after analgesic intake using a visual analog scale (VAS). The success of analgesic treatment was analyzed by the binary logistic regression model. Results: A total of 117 patients including 76 females and 41 males with a mean age of 30.29 years completed the study and were statistically analyzed. Ibuprofen had the highest analgesic efficacy followed by Novafen, and caused a significantly greater reduction in pain score compared with MA and celecoxib [OR (Ibuprofen vs MA)=1.28, OR (Ibuprofen vs Celecoxib)=3.74, OR (Novafen vs MA)=2.94, OR (Novafen vs Celecoxib)=2.94, P&lt;0.05]. Ibuprofen and Novafen had no significant difference in analgesic efficacy (P&gt;0.05). Baseline pain score was a predictive factor for the success of analgesics (P&lt;0.05). The success of analgesic treatment decreased by 0.68 times with each unit increase in pain score (P&lt;0.05). Gender and age of patients had no significant effect on success of analgesics (P&gt;0.05). Conclusion: Both ibuprofen and Novafen can serve as the analgesics of choice for pain relief in patients with symptomatic irreversible pulpitis with moderate to severe pain when emergency endodontic treatment cannot be immediately performed

Determinants of oral-health-related quality of life among adult people in Iran

Background: Oral health-related quality of life (OHRQoL) assesses the subjective perception of oral health and its impact on the quality of life. The aim of this study is to measure the OHRQoL and its determinants among adult people living in Kerman, Iran. Materials and Methods: In this cross-sectional study, a total of 5657 adult people (18–64 years) residing in the Kerman district, both in the rural and urban areas, were enrolled in the study between September 2014 and April 2018. The Oral Health Impact Profile (OHIP-14) and the oral health indices, such as the total decayed, missing, filled teeth (DMFT), community periodontal index (CPI), gingival index (GI), and xerostomia, were measured by an experienced dentist. The demographic variables of gender, age, educational status, and marital status were also recorded. The impact of the studied variables on OHRQoL was evaluated with multiple logistic regression. Results: Participants were 2239 (39.58%) men, and average age was 45.39. The mean scores for OHRQoL, DMFT, CPI and GI were respectively: 24.07 (7.76), 10.7 (6.86), 0.76 (0.96), 0.63 (0.8). The frequency of people with xerostomia was 37.4. 301 (53.3%) of people had poor quality of life related to oral health. In multivariable analysis, there was a statistically significant increase in OHRQoL with an increase in the DMFT (P < 0.001), xerostomia (P < 0.001), CPI, (P < 0.001). Men had a significantly higher OHIP score than women (P < 0.001). Conclusion: According to the results of this study, DMFT, xerostomia, and CPI scores are strongly related to OHIP scores. In addition, between CPI and GI scores, the CPI score is the better predictor

The Validity and Reliability of the Persian Version of the Xerostomia Inventory Questionnaire

Statement of the Problem: Reduced saliva production or changes in the quality of saliva are major causes of xerostomia as a perceptual disease.Purpose: This study aimed to measure validity and reliability of the Persian version of the xerostomia inventory (XI) questionnaire.Materials and Method: This cross-sectional study was performed in Kerman in 2021. The sample size for this study was 100 people. To test the discriminant validity of XI, 50 healthy people (control group) and 50 people undergoing or recovering from laryngeal radiation (xerostomia group) were chosen. Cronbach's alpha coefficient was used to determine internal consistency, and the intra-cluster correlation (ICC) coefficient was used to determine test-retest reliability after two weeks. To evaluate the concurrent validity, the relationship between the total score of the questionnaire and the golden question, which was defined as “How often do you have dry mouth?” was measured.Results: Cronbach's alpha and ICC coefficient for the total XI score were 0.84 and 0.95, respectively. The mean ages of patients in the radiotherapy group and the healthy participants were 59±7.5 and 41.1±6.6 years, respectively. Participants who were having or had had laryngeal radiotherapy had a significantly higher mean total XI score than healthy individuals (p< 0.001).Conclusion: The Persian version of the Xerostomia Inventory is a valid and reliable tool for assessing xerostomia

a-Pinene influence on pulpal pain-induced learning and memory impairment in rats via modulation of the GABAA receptor

Background: This study investigated the effect of central administration of a-pinene and the interaction of a-pinene with GABAA receptor on pulpal nociception-induced changes in learning and memory performances in rats. Materials and Methods: Sixty-six adult male Wistar rats were used. Pulpal nociception was induced by intradental application of capsaicin (100 µg/rat). a-pinene (0.1, 0.2, and 0.4 µg/rat) was injected centrally 10 min before the administration of capsaicin. In addition, a-pinene (0.4 µg/rat) was co-injected with bicuculline (0.5 µg/rat). Spatial and passive avoidance learning and memory were assessed using Morris water maze (MWM) and shuttle box tasks, respectively. Results: Experimental results of the MWM test showed that capsaicin increases escape latency and distance traveled to the hidden platform (P < 0.01). The effect was prohibited by a-pinene at the dose of 0.4 µg/rat. Moreover, capsaicin-treated animals spent less time in the target zone than capsaicin + a-pinene (0.4 µg/rat)-treated rats (P < 0.05). In the shuttle box test, a-pinene (0.2 µg and 0.4 µg) prevented an increased number of acquisition trials and time spent in the dark chamber induced by capsaicin, whereas it increased step-through latency (P < 0.01). However, the effects of a-pinene (0.4 µg/rat) in both tests were prohibited by bicuculline (0.5 µg/rat). Conclusion: The data showed that central administration of a-pinene might reduce pulpalgia-induced learning and memory impairment, at least partially, via modulation of GABA A receptors