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Introduction: Vesiculobullous disorders are a group of autoimmune diseases manifesting as chronic ulcers in the oral cavity. Ocular involvement may accompany oral ulcers and cause various problems for patients. This review summarizes the data regarding ocular involvement in patients with oral vesiculobullous. Methods: Web of Science, Scopus, PubMed/MEDLINE, and Embase electronic databases were searched according to related keywords. Finally, 58 articles were included, all of which were case reports or series. Characteristics such as the age and sex of patients, location and type of oral lesion, type of ophthalmic injury, the interval between oral and ocular lesion, and treatment of oral and ocular disorders were summarized in tables. Results: Eye involvement was 1.6 times more prevalent in women, and most patients were between 30 and 60 years old (67.4 %). Pemphigus vulgaris accounted for almost half of the cases (48.4 %), though lichen planus is more prevalent in the general population. The most frequently affected oral site was the buccal mucosa (17.5 %), and oral ulcers usually presented as erythema, erosion, or inflammation (22.7 %). Conjunctivitis was the most common type of eye involvement (18.4 %), and ophthalmic lesions regularly appeared 12–60 months after the development of oral lesions (30.1 %). Blindness was reported in only one case. Corticosteroids and immunosuppressives were the most frequent oral and ocular lesion therapies. Conclusion: Considering the serious burdens of any ocular injury, monitoring the ocular health of patients with oral vesiculobullous diseases is highly recommended in high-risk cases, especially middle-aged women with oral pemphigus vulgaris.

Abstract Background Human saliva as a bodily fluid—similar to blood—is utilized for diagnostic purposes. Unlike blood sampling, collecting saliva is non-invasive, inexpensive, and readily accessible. There are no previously published systematic reviews regarding different collection, transportation, preparation, and storage methods for human saliva. Design This study has been prepared and organized according to the preferred reporting items for systematic reviews and meta-analyses (PRISMA) 2020 guidelines. This systematic review has been registered at PROSPERO (Registration ID: CRD42023415384). The study question according to the PICO format was as followed: Comparison of the performance (C) of different saliva sampling, handling, transportation, and storage techniques and methods (I) assessed for analyzing stimulated or unstimulated human saliva (P and O). An electronic search was executed in Scopus, Google Scholar, and PubMed. Results Twenty-three descriptive human clinical studies published between 1995 and 2022 were included. Eight categories of salivary features and biomarkers were investigated (i.e., salivary flow rate, total saliva quantity, total protein, cortisol, testosterone, DNA quality and quantity, pH and buffering pH). Twenty-two saliva sampling methods/devices were utilized. Passive drooling, Salivette®, and spitting were the most utilized methods. Sampling times with optimum capabilities for cortisol, iodine, and oral cancer metabolites are suggested to be 7:30 AM to 9:00 AM, 10:30 AM to 11:00 AM, and 14:00 PM to 20:00 PM, respectively. There were 6 storage methods. Centrifuging samples and storing them at -70 °C to -80 °C was the most utilized storage method. For DNA quantity and quality, analyzing samples immediately after collection without centrifuging or storage, outperformed centrifuging samples and storing them at -70 °C to -80 °C. Non-coated Salivette® was the most successful method/device for analyzing salivary flow rate. Conclusion It is highly suggested that scientists take aid from the reported categorized outcomes, and design their study questions based on the current voids for each method/device.

Introduction: A sialolith is a salivary stone usually presenting with swelling and pain in the affected salivary gland, most commonly the submandibular gland. There have been speculations about the association between this condition and other systemic diseases, especially those forming stones, such as nephrolithiasis and cholelithiasis. This systematic review and meta-analysis aimed to summarize the studies assessing the relationship between cholelithiasis and sialolithiasis. Methods: PubMed/MEDLINE, Scopus, Web of Science, and Embase electronic databases were searched according to the keywords related to both disorders without any publication date or language restriction. Case-control and cohort studies evaluating the relationship between salivary and biliary stones were considered eligible. Quality assessment was performed following Newcastle-Ottawa Scale (NOS) for quality assessment of case-control studies. All meta and statistical analyses were performed with Comprehensive Meta-Analysis software. Results: Two studies fully complied with the defined eligibility criteria and were included, both of which were case-control studies using national-scale databases. In both surveys, the prevalence of previous gallstones in patients with sialolithiasis was compared to that of a control group. Though one of the studies found that there is no relationship between sialolithiasis and cholelithiasis, the meta-analysis revealed that previous cholelithiasis is significantly more prevalent among patients with sialolithiasis (P = 0.000), with an odds ratio of 2.04. Conclusion: It seems that cholelithiasis is significantly associated with an increase in salivary stone formation. Therefore, a thorough salivary examination in all patients declaring current or past cholelithiasis is recommended. However, more studies, especially prospective cohorts, are needed to make firmer conclusions.

Abstract The present work demonstrates the results of a 3D numerical analysis of heat transfer and fluid flow through a fabricated aluminium wire filament, bonded mesh deployed as a regenerator surface in the Stirling engine. Here, two inline regenerator models with the same mass but different geometry were simulated by computational fluid dynamics (CFD) and finite element method (FEM). The results show that the temperature efficiency of both inline with non‐uniform and uniform wire diameters is almost equal. However, the non‐uniform diameter model is shorter and reaches the maximum thermal efficiency faster in reduced length

Purpose This review investigated medical students’ satisfaction level with e-learning during the coronavirus disease 2019 (COVID-19) pandemic and its related factors. Methods A comprehensive systematic search was performed of international literature databases, including Scopus, PubMed, Web of Science, and Persian databases such as Iranmedex and Scientific Information Database using keywords extracted from Medical Subject Headings such as “Distance learning,” “Distance education,” “Online learning,” “Online education,” and “COVID-19” from the earliest date to July 10, 2022. The quality of the studies included in this review was evaluated using the appraisal tool for cross-sectional studies (AXIS tool). Results A total of 15,473 medical science students were enrolled in 24 studies. The level of satisfaction with e-learning during the COVID-19 pandemic among medical science students was 51.8%. Factors such as age, gender, clinical year, experience with e-learning before COVID-19, level of study, adaptation content of course materials, interactivity, understanding of the content, active participation of the instructor in the discussion, multimedia use in teaching sessions, adequate time dedicated to the e-learning, stress perception, and convenience had significant relationships with the satisfaction of medical students with e-learning during the COVID-19 pandemic. Conclusion Therefore, due to the inevitability of online education and e-learning, it is suggested that educational managers and policymakers choose the best online education method for medical students by examining various studies in this field to increase their satisfaction with e-learning.

Abstract Through radiographic evaluation to discover the location of a displaced implant, it was revealed that the implant had migrated to the middle meatus of the nasal cavity. The patient had no signs or symptoms, and no inflammation was observed radiographically. The implant was removed under endoscopy through the nostril.

Abstract Background Bone volume plays a pivotal role in the success of dental implant treatment. Autogenous bone grafts should be harvested from reliable sites in the maxillofacial region. This study sought to assess the quantity and quality of bone in the mandibular symphysis for autogenous bone graft harvesting using cone-beam computed tomography (CBCT). Methods This cross-sectional study evaluated the CBCT scans of 78 adults presenting to three oral and maxillofacial radiology centers. The vertical (VD) and horizontal (HD) alveolar bone dimensions, cortical thickness (CT), and cancellous to cortical bone ratio (C/C) were measured in the interforaminal region of the mandible at the sites of central incisor to first premolar teeth. The interforaminal distance (ID) and the anterior loop length were also measured. Nonparametric statistical tests were used to analyze the data with respect to sex, age, and tooth position. Results The median VD, HD, and CT of the symphysis were 20.21 (3.26), 4.13 (0.37), and 2.25 (0.23) mm, respectively. The median C/C was 1.51 (0.11). The median ID was 52.24 (8.24) mm, and the median anterior loop length was 1.82 (1.06) mm. Significant differences were observed in all parameters among different teeth. Most of the measured parameters were greater in males compared with females. There were significant differences in ID, VD, and CT between different age groups. Conclusions The quantity and quality of the available bone in the mandibular symphysis for bone graft harvesting vary by gender, age, and harvesting site, necessitating careful preoperative evaluation.

Nurses, as front-line care providers, strive to offer adequate care to their clients. They have acquired valuable experiences during the COVID-19 pandemic that enhance the nursing profession. This study aimed to explore nurses' caring experiences in the COVID-19 pandemic. This is a qualitative meta-aggregative systematic review. Electronic databases (Google Scholar, PubMed, Web of Science, CINHAL) in English were searched to find out the meaningful subjective data on the COVID-19 pandemic. The inclusion criteria were studies published in English related to nurses' caring experiences in the COVID-19 pandemic. Seventeen qualitative studies with several approaches were included. Three key themes were identified from the studies: Weaknesses and strengths of nursing at the beginning of the pandemic, Nursing beyond challenges related to the pandemic, and Family and career challenges.Nurses face different challenges in caring for patients with COVID-19 that benefit the health and nursing professions. Governments, policymakers, and managers have to support nurses during and after the pandemic. Without enough support, nurses are likely to experience significant psychological issues that can lead to burnout and frustration.

Heat regenerators are mainly used in industry to return heat to the thermodynamic cycles and prevent heat loss. This could increase the efficiency of the cycle and reduce environmental damage. In this study, two heat regenerator staggered and in-line stacked plain-weave screen under some constraints such as same mass, same porosity of packed bed, and same heat transfer surface area to volume ratio was investigated by computational fluid dynamics method. In other words, the only difference between the regenerators was in the arrangement of the wires. The results show that the in-line regenerator not only increases the average efficiency up to 3.6% but also achieves a 36 Pa average lower pressure drop. However, the in-line model reaches the maximum thermal efficiency faster in reduced length< 11 and the staggered model reaches the maximum thermal efficiency faster in 11

BACKGROUND: The number of older adults with bipolar disorder is increasing and medication non-adherence is a major problem that negatively impacts the course of bipolar disorder. This study aimed to determine the effect of a comprehensive individual motivational-educational program on medication adherence in elderly patients with bipolar disorder. MATERIALS AND METHOD: An experimental study with pretest-posttest repeated measures with a control group was conducted on two groups of 62 elderly people with bipolar disorders hospitalized at Ibn Sina Hospital in Mashhad, Northeast Iran, 2019. For the elderly in the intervention group, a comprehensive motivational-educational program was administered for one month (four 30–45 minute sessions), and for the elderly in the control group, routine clinical care was performed. Medication adherence in both elderly groups was measured before, immediately after, one and two months after the intervention. Data were analyzed by SPSS statistical software (version 16) using descriptive statistics and independent t-test, Mann-Whitney, paired t-test, repeated measures analysis of variance (ANOVA), and Chi-square tests. RESULTS: The mean age of elderlies in the intervention and control groups were 69.03 ± 5.75 and 68.50 ± 6.73 years, respectively. Regardless of the groups to which the patients were assigned, a significant difference in medication adherence scores was observed during the study period (time effect; P < 0.001). Also, the medication adherence score was significantly lower in the intervention group, compared to the control group (group effect; P < 0.001). Also, there was a group time interaction between the medication adherence score and the time of evaluation (P < 0.001). CONCLUSION: The results of the present study confirm the positive effect of a comprehensive educational-motivational program on improving medication adherence in elderly patients with bipolar disorder.

Background and purpose: The antimicrobial effect of phenytoin on ulcers has been addressed in few studies. The aim of this study was to determine the antimicrobial effect of phenytoin on common contaminating microorganisms of oral cavity ulcers in vitro. Materials and methods: Three standard microbial species including Staphylococcus aureus, Actinomyces naeslundii, and Candida albicans were prepared. Twenty four-hour cultures of the species was accomplished on BHI Agar medium at 37°C in aerobic situation in an incubator. After 24 hour, 0.5 McFarland concentration were prepared from microorganism colonies. Meadow cultivation of microorganisms was done in plates containing BHI Agar medium. In each plate 4 wells were created for 4 concentrations of phenytoin (0.5, 1, 3, and 5%). Then one drop of each phenytoin solution was poured in the wells in certain concentrations. For each microorganism species, one well containing 0.2% chlorhexidine was prepared as positive control. The plates were placed in incubator and after 24 hour, diameter of non-growth halo around all wells was measured in all plates using a caliper. These steps were repeated three times to ensure the accuracy of process and results. Results: Diameters of non-growth halo around colonies of Staphylococcus aureus, Actinomyces naeslundii, and Candida albicans were 0 millimeter in all four concentrations of phenytoin. Conclusion: Phenytoin was found to have no antimicrobial effect on common contaminating microorganisms of oral cavity ulcers in vitro.

Smokers are at a higher risk of laryngeal cancer, which is a type of head and neck cancer in which cancer cells proliferate and can metastasize to other tissues after a tumor has formed. Cigarette smoke greatly reduces the inhaled air quality and can also lead to laryngeal cancer. In this study, the upper airway of a 70-year-old smoker with laryngeal cancer was reconstructed by taking a CT scan using Mimics software. To solve the governing equations, computational fluid dynamics (CFD) with a pressure base approach was used with the help of Ansys 2021 R1 software. As a result, the maximum turbulence intensity occurred in the larynx. At 13 L/min, 55 L/min, and 100 L/min, the maximum turbulence intensity was 1.1, 3.5, and 6.1, respectively. The turbulence intensity in the respiratory system is crucial because it demonstrates the ability to transfer energy. The maximum wall shear stress (WSS) also occurred in the larynx. At 13 L/min, 55 L/min, and 100 L/min, the maximum WSS was 0.62 Pa, 5.4 Pa, and 12.4 Pa, respectively. The WSS index cannot be calculated in vivo and should be calculated in vitro. Excessive WSS in the epiglottis is inappropriate and can lead to an airway obstruction. Furthermore, real mathematical modeling outcomes provide an approach for future prevention, treatment, and management planning by forecasting the zones prone to an acceleration of disease progression. In this regard, accurate computational modeling leads to pre-visualization in surgical planning to define the best reformative techniques to determine the most probable patient condition consequences.

BACKGROUND: One of the most important steps in increasing the nurses' professional competence and consequently improving the quality of nursing care is to evaluate nurses' clinical competency and then take effective actions to enhance it. This study aimed at exploring the clinical competence of Iranian nurses and factors related to it. MATERIALS AND METHODS: In this systematic review and meta-analysis, PubMed, Scopus, Web of Science, Scientific Information Database, and Iranmedex databases and Google Scholar search engine were searched to February 14, 2020. RESULTS: After screening, a total of 25 articles were included. In general, the level of clinical competence of Iranian nurses was at a desirable level. After meta-analysis of the mean score of nurses' clinical competence, the combined mean was 161.13 (95% confidence interval [CI]: 137.78–184.48; P < 0.001; I2 = 99.8%; P value for heterogeneity = P < 0.001) by the Competency Inventory for Registered Nurses (CIRN) questionnaire. The summarized mean of clinical competency measured by the Nurse Competence Scale (NCS) questionnaire was 70.75 (95% CI: 60.80–80.70; P < 0.001; I2 = 99.9%; P value for heterogeneity = P < 0.001). Factors affecting nurses' clinical competence were age ≥33 years, nursing work experience ≥9 years, and a master's degree in nursing. However, the clinical competence of nurses had a significant negative relationship with job stress. CONCLUSION: The level of clinical competence of Iranian nurses was desirable. Studies that used the CIRN, reported the highest and lowest clinical competence in clinical care and professional development dimensions, respectively. Studies that used the NCS, reported the highest and lowest clinical competence in dimensions of work role and ensuring quality, respectively.

Background: During the first experiences of clinical treatment, dental students face various challenges. The purpose of the study is to standardize the questionnaire as a suitable tool for quantitative and qualitative evaluation of psychosocial impact, stress levels, and learning effect of dental students during the transition from preclinical to clinical education in Persian. Materials and Methods: In this cross-sectional study a questionnaire including three areas of psychosocial impact, perceived stress, and learning effect was systematically translated. In the group of experts, face validity was examined. Then, the content validity ratio (CVR) and the content validity index (CVI) were determined. The reliability of the questionnaire was determined by the test–retest method and the Cohen's Kappa coefficient. In a cross-sectional study, the psychosocial impact, stress levels, and learning effect of all students newly admitted to the endodontic, prosthetics, periodontics, and restorative dentistry departments of Shahid Beheshti Dental School (128 people) were measured. Mann–Whitney and Spearman–Rho were used for statistical analysis (P = 0.05). Results: During the CVR and CVI evaluation, 12 statements were removed from the questionnaire, and one statement was changed. All valid statements of the questionnaire were considered reliable. The initial questionnaire was finally developed in the form of 27 items. Interest in clinical treatment and collaboration between students and faculty had the greatest psychosocial effects. The highest level of stress among students was seen in the endodontic ward (mean = 3.8). The greatest effect of learning was seen in different sections in infection control (mean >4). Conclusion: This study provided a standardized tool in Persian to evaluate the psychosocial impacts, perceived stress, and learning effect of dental students during the transition to clinical education and focused on the first clinical treatment experiences. One important psychosocial factor was collegiality between teachers and students. The ability to communicate well with the patient is thought to reduce stress.

Introduction: One of the main factors influencing students’ learning is learning style that tends to be flexible thus facilitating the learning process by adapting to a given teaching method. The aim of this study was to identify the learning styles of dental students at Shahid Beheshti University of Medical Sciences. Methods: The population of this descriptive, cross-sectional study included all junior and senior dental students at International Branch of Shahid Beheshti University of Medical Sciences during 2016-17. Subjects were selected by means of complete enumeration sampling and standard VARK questionnaire (version 7.8) was used to collect data. Data were analyzed using descriptive and inferential statistics. Results: Of the 93 students, 72% were female and 28% were male. Their average age was 25.09 years and their mean GPA of their previous semester was 15.5. The results showed that 86% of the students used a single style with auditory style as the dominant style. Kinesthetic and auditory styles were the most frequent styles among the male and female students respectively. Double style technique was the most frequent multiple learning style. Moreover, no significant relationship was found between demographic variables (p≤0.05). Conclusion: It is recommended to determine students’ learning styles in the freshman year and especially after finishing the basic sciences course. This will help teachers adapt their teaching styles to students’ learning styles which in turn will improve the effectiveness of training courses.

Introduction: This study is aimed to assess the prevalence and characteristics of head and neck lymphoma in a defined group of an Iranian population. Materials and Methods: In this retrospective study, 126,450 biopsy reports from two referral Pathology Departments, (Tehran, the capital of Iran) were evaluated. In cases with head and neck lymphoma, other variables such as age, sex, specific location of lesions, and histopathological findings were recorded. Descriptive statistics were used to measure the prevalence and characteristics of head and neck lymphoma by means of SPSS soft ware, version 18. Results: In total, 513 (0.4%) cases had head and neck lymphoma (46.9% male, 27.1% female) with a mean age of 46±6.2. Of the total lesions, 200 (0.15%) were Hodgkin lymphoma and 313 (0.25%) were non-Hodgkin lymphoma. Nodular sclerosis was the most common (62.5%) histopathological subtype among Hodgkin lymphoma. In non-Hodgkin lymphoma, diffuse large B-cell lymphoma (62.3%) had the highest frequency. In Hodgkin disease, classic Hodgkin lymphocytic rich, mixed cellularity, and lymphocyte depletion were only seen in the neck compartment. Bone involvement was only found in Hodgkin nodular lymphocytic predominant variation. In non-Hodgkin lymphoma, the tongue, palate, and vestibular mucosa were affected only by diffuse large B-cell lymphoma. Jaw bones were only involved with diffuse large B-cell lymphoma compared to other bony structures. T-cell lymphoma and mucosal associated lymphoid tissue lymphoma were also found. Conclusion: Diffuse large B-cell lymphoma is the most common subtype of non-Hodgkin lymphoma especially in the tongue, palate, vestibular mucosa, and jaw bones.

Context: The differences in frequency of cancer among the less developed and the more developed regions continue to remain as an important problem for service planning and international action against cancers of the head and the neck. Aim: This study compares distribution of cancers of the head and the neck between two similar-sized populations from the west of Iran and Western Australia. Setting and Design: In this retrospective study, de-identified data were collected for a 10-year period from patients diagnosed with head and the neck cancers. Materials and Methods: Data were obtained from the Western Australia Cancer Registries and from major hospitals in the west of Iran. Age at diagnosis, sex, and site code were included in the data sheet. Descriptive analysis was used to describe the basic features, means (±standard deviation) were reported, and tests of significance were used as appropriate. Results: In Iran, cancer of the lip, followed by cancer of the major salivary gland, and cancer of the tongue were the three most frequent types of cancers, whereas in Australia, the most frequent types of cancer were cancer of the lip followed by cancers of the tongue and the tonsil. Distribution of malignancy by site among the patients belonging to different ages indicated that cancer of the lip was the most frequent cancer in both Iran and Australia, except among the patients belonging to the age group of 60–74 years in Iran, where cancer of the major salivary gland had the highest frequency. Both men and women were susceptible for cancers of the head and the neck in the age range of 60–74 years in Iran, whereas in Australia, it was more frequent among men belonging to the age range of 45–59 years and in women above the age of 75 years. Conclusion: This preliminary study defined differences in orofacial malignancy between Iran and Australia. Further studies in countries with different socioeconomic status are recommended.

Introduction: Lasers are used in various disciplines in dentistry such as restorative dentistry, endodontics, periodontics, pedodontics, and oral and maxillofacial surgery. Despite many advantages of dental lasers, this method might have some adverse effects. The aim of this review article is to debate about the impacts of lasers on orodental tissues. Methods: An electronic search was accomplished using specialized databases such as Google Scholar, PubMed, PubMed Central, Science Direct, and Scopus to find relevant studies by using keywords such as “laser”, “dentistry”, “adverse effect”, and “side effect”. Results: Several adverse effects of laser were identified such as impacts on dental pulp, effects on tooth surface, subcutaneous and submucosal effects, histopathological changes, and infection transmission due to laser smoke. During dental procedures, necrosis of the pulp, periodontal ligament and odontoblasts, cemental lysis, bone resorption, hypo/hyperpigmentation, burns, itching, and scarring might occur. In addition, laser can weaken the dentin by inducing surface cracks. Restorative procedures by laser might increase microleakage and decrease shear bond strength, as well as microhardness of tooth walls. Meanwhile, laser surgery might cause emphysema after abscess incision and drainage, frenectomy, flap elevation, and gingivoplasty. Conclusion: Practitioners should be very cautious in treatment planning and case selection during laser-based therapeutic procedures.

Introduction: Periodontal disease is a chronic immune inflammatory response associated with both the genetic makeup and the environmental influence. The aim of this study was to determine the association of different types of blood group with periodontal disease in a defined group of Iranian patients. Materials and Methods: One hundred and forty-six persons participated in this case-control study in Shahid Beheshti University of Medical Sciences Dental School, International Branch, Tehran, Iran. The patients were divided into three groups including periodontally healthy, gingivitis, and periodontitis according to approved criteria. Patients′ blood groups were determined, and the relationship between periodontal status and ABO antigens was assessed. Data was analyzed on the basis of analysis of variance (ANOVA), Chi-square test, and logistic regression. Results: Logistic regression showed that people with blood group B (compared to blood group O) was at 3.94 times greater risk for developing gingivitis. On the other hand, there was no relationship between periodontitis and ABO blood groups, sex, and types of Rh factor. It was noted that 1 year of aging is associated with a 5% rise in likelihood of periodontitis. Conclusions: People with blood group B are at a greater risk to develop gingivitis, whereas periodontitis did not show any relationship with blood groups.

Background: Labor is a stressful situation that may have an adverse impact. Aromatherapy is a method to control anxiety and stress of women. This study was conducted to investigate the effect of aromatherapy using essential oil of orange on women's anxiety during labor. Materials and Methods: In this clinical trial study, 100 women during labor were randomly assigned to two groups: intervention group and control group. The women in the intervention group were exposed to orange essential oil, but the women in the control group were exposed to distilled water. The women's anxiety was assessed using the Spielberger inventory. Moreover, physiological parameters such as systolic and diastolic blood pressure, respiration and pulse rates were assessed in all the women before and 20 min after the intervention. The data were analyzed by Chi-square, Wilcoxon, paired t-test, and Mann–Whitney U test. Data were evaluated with the SPSS 16 program. The significance level of P < 0.05 was considered. Results: The level of anxiety of women in both intervention (P = 0.03) and control (P = 0.003) groups reduced after the intervention. However, the reduction was more in the intervention group (difference in anxiety scores after the intervention in comparison to before intervention = −3.08) in comparison to the control group (score = −1.14). No significant change was found in the physiological parameters of women in the intervention group after the intervention. Conclusions: Aromatherapy is a noninvasive and effective method to help women overcome their anxiety during labor. Orange scent can be useful in childbirth units to help women who are experiencing stress in labor.

Abstract Hypercementosis is identified by an excessive, non-neoplastic deposition of radicular cementum and is mostly presented as a solitary lesion or in rare cases as a multiple type. It usually occurs in the premolar and molar region of mandible with no sex predilection. In this paper, we reported a 57-year-old female patient with multiple radiopaque lesions affecting right maxillary second premolar and molar teeth. The periapical and orthopantomograph radiographs showed club shaped roots surrounded by a normal periodontal ligament space and lamina dura. Her right maxillary teeth were free of caries and dental restorations and electric pulp test revealed that all of them had vital pulp. Finally, based on clinical and radiographic findings, the diagnosis of multiple hypercementosis was carried out. In conclusion, hypercementosis, although rare, should be considered in differential diagnosis of multiple separate radiopacities in the jaws.

Introduction: Epulis fissuratum is a tumor-like hyperplasia developing in association with an ill-fitting denture. Case Report: We report a 73-year-old female with epulis fissuratum in the soft palate as a very rare clinical location. She presented with the chief complaint of an abnormal growth along the posterior border of her ill-fitting upper complete denture as well as pain and discomfort during mastication. Intraoral examination revealed a polypoid fibrous mass, soft in consistency and smooth in texture. On history and clinical examination, a provisional diagnosis of denture-induced hyperplasia was made. The patient was prescribed topical anti-fungal medications for 10 days. Then, the lesion was excised surgically. Discussion: Histopathological examination revealed hyperplastic epithelium as well as a fibrous connective tissue with moderate inflammation which confirmed the clinical diagnosis. Although rare, epulis fissuratum can happen along the posterior portion of the upper denture and should be considered in intraoral examination.

Death was the most important side effect of anaesthesia in dentistry. In this article we reviewed more than 20 studies with adequate data focusing on death associated with dental procedures since 1955 and found 218 deaths out of 71,435,282 patients (3 deaths per 1,000,000 persons) with the mortality rate of 1:327,684. In addition, mortality rate per million has dropped to half (6.2 per 1,000,000 vs. 3 per 1,000,000) since 1955 till the last report in 2012 without any sex predilection. In children, most cases died in the age of two to five years. Hypoxia was the most common cause of death, and cardiovascular, respiratory, and endocrine disorders, hepatic cirrhosis, septicaemia, and bacterial endocarditis were the most frequent underlying systemic disease in deceased patients. Although rare death following general anaesthesia in dentistry, is a critical side effect mostly seen in patients with compromised health condition. Therefore, appropriate case selection in regard with patients’ general health status as well as standard technical and equipment conditions are mandatory to diminish the risk of death during dental anaesthesia.

Oral mucositis is an inflammatory mucosal destruction as a result of chemotherapy and/or radiation therapy, which in severe cases can impair patients’ quality of life. Moreover, mucosal infection and/or systemic involvement due to compromised immunity leads to delay or discontinuation of the treatment. Many strategies and agents have been suggested for the management of this condition. Because of their lower side effects compared to chemical drugs, general interest in evaluating therapeutic effects of herbs has been increased intensively. Herbal plants apply their effect through different mechanisms of action: antioxidant, analgesic, anti-inflammatory, antifungal, antiseptic, and anticarcinogenic activity. Recently, various natural agents in plants have been noticed in mucositis, which may improve the symptoms through different interventions. The purpose of this review is to focus on the preventive or therapeutic use of herbal medicine to alleviate oral mucositis.

Diagnosis of peripheral oral exophytic lesions might be quite challenging. This review article aimed to introduce a decision tree for oral exophytic lesions according to their clinical features. General search engines and specialized databases including PubMed, PubMed Central, Medline Plus, EBSCO, Science Direct, Scopus, Embase, and authenticated textbooks were used to find relevant topics by means of keywords such as “oral soft tissue lesion,” “oral tumor like lesion,” “oral mucosal enlargement,” and “oral exophytic lesion.” Related English-language articles published since 1988 to 2016 in both medical and dental journals were appraised. Upon compilation of data, peripheral oral exophytic lesions were categorized into two major groups according to their surface texture: smooth (mesenchymal or nonsquamous epithelium-originated) and rough (squamous epithelium-originated). Lesions with smooth surface were also categorized into three subgroups according to their general frequency: reactive hyperplastic lesions/inflammatory hyperplasia, salivary gland lesions (nonneoplastic and neoplastic), and mesenchymal lesions (benign and malignant neoplasms). In addition, lesions with rough surface were summarized in six more common lesions. In total, 29 entities were organized in the form of a decision tree in order to help clinicians establish a logical diagnosis by a stepwise progression method.

Introduction: The loss of brain cholinergic activity is a key phenomenon in the biochemistry of Alzheimer's Disease (AD). Due to the specific biosynthesis of Acetylcholinesterase (AChE) of cholinergic neurons, the enzyme has been proposed as a potential biochemical marker of cholinergic activity. AChE is expressed not only in the Central Nervous System (CNS), Peripheral Nervous System (PNS) and muscles, but also on the surface of blood cells and saliva. Aim: This study aimed to measure salivary AChE activity in AD and to determine the feasibility of creating a simple laboratory test for diagnosing such patients. Materials and Methods: In this cross-sectional study, the recorded data were obtained from 15 Alzheimer’s patients on memantine therapy and 15 healthy subjects. Unstimulated whole saliva samples were collected from the participants and salivary levels of AChE activity were determined by using the Ellman colorimetric method. The Mann Whitney U test was used to compare the average (median) of AChE activity between AD and controls. In order to adjust for possible confounding factors, partial correlation coefficient and multivariate linear regressions were used. Results: Although the average of AChE activity in the saliva of people with AD was lower compared to the control group, we found no statistically significant differences using Mann Whitney U test (138 in control group vs. 175 in Alzheimer's patients, p value=0.25). Additionally, no significant differences were observed in the activity of this enzyme in both sexes or with increased age or duration of the disease. After adjusting for age and gender, there was no association between AChE activity and AD (regression coefficient β=0.08; p value= 0.67). Conclusion: Saliva AChE activity was not significantly associated with AD. This study might help in introduce a new diagnostic aid for AD or monitor patients with AD.

Background: Apart from the crucial role of micronutrients like copper, iron, and zinc in the functions of body enzymes, it seems that changes in the serum levels of these biomarkers may play a role in the pathogenesis of oral cancer. The aim of this study was to measure the serum levels of ferritin, copper, and zinc in patients with oral malignancies. Methods: Sixty consecutive patients with oral cancer, together with 66 age- and sex-matched controls were enrolled in this cross-sectional study. The serum levels of ferritin, copper, and zinc were measured in both patients and healthy individuals. Data were statistically analyzed by Student's t-test and Mann-Whitney U test. Results: In patients with oral cancer, the serum levels of ferritin, copper, and zinc were 267.41 ± 249.45, 209.85 ± 160.28, and 113.51 ± 52.30 mg/dl, respectively. In the control group, the serum levels of ferritin, copper, and zinc were reported to be 106.13 ± 72.96, 114.20 ± 38.69, and 64.57 ± 31.54 mg/dl, respectively. The mean serum values of ferritin, copper, and zinc in cancerous patients were significantly higher than in controls (p < 0.001). Conclusions: The serum levels of ferritin, copper, and zinc in oral cancer patients were significantly higher than in control group subjects.

Salivary mucocele is a common lesion derived from minor salivary glands with various surgical or non-surgical treatment modalities. To evaluate the effect of a highly potent corticosteroid (dexamethasone) in the management of salivary mucocele, we performed intralesional injection of dexamethasone in nine patients with labial mucocele. Complete healing of lesions observed in seven of nine patients, and size reduction in two of them. No local scarring or deformity of the lower lip occurred in any of the patients. One patient reported local discomfort at the site of injection. Intralesional injection of dexamethasone is a potentially curative method in the treatment of mucocele.

Introduction: Ameloblastic fibro-odontoma is a rare, benign, asymptomatic tumor. The term ameloblastic fibro-odontoma was first used by Hooker in 1967 as a separate lesion from ameloblastic odontoma. Case Report: This case report describes an eleven years old female with large ameloblastic fibro-odontoma in the right maxillary sinus. Conclusion: There is a low potential for recurrence after complete Enucleation of ameloblastic fibro-odontoma, but due to the risk of ameloblastic sarcoma after recurrence, the surgery should be perfect along with a careful follow up.

Cancer of the oral cavity accounts for approximately 3% of all malignancies diagnosed annually in 270,000 patients worldwide. Oral cancer is the 12th most common cancer in women and the 6th in men. Many oral squamous cell carcinomas develop from potentially malignant disorders (PMDs). Lack of awareness about the signs and symptoms of oral PMDs in the general population and even healthcare providers is believed to be responsible for the diagnostic delay of these entities. The aim of this article is to update and improve the knowledge of healthcare providers about oral PMDs.

Diagnosis of oral white lesions might be quite challenging. This review article aimed to introduce a decision tree for oral white lesions according to their clinical features. General search engines and specialized databases including PubMed, PubMed Central, EBSCO, Science Direct, Scopus, Embase, and authenticated textbooks were used to find relevant topics by means of MeSH keywords such as “mouth disease„, “oral keratosis„, “oral leukokeratosis„, and “oral leukoplakia„. Related English-language articles published since 2000 to 2017, including reviews, meta-analyses, and original papers (randomized or nonrandomized clinical trials; prospective or retrospective cohort studies), case reports, and case series about oral diseases were appraised. Upon compilation of data, oral white lesions were categorized into two major groups according to their nature of development: Congenital or acquired lesions and four subgroups: Lesions which can be scraped off or not and lesions with the special pattern or not. In total, more than 20 entities were organized in the form of a decision tree in order to help clinicians establish a logical diagnosis by a stepwise progression method.

Introduction: Burning mouth syndrome (BMS) is defined as burning and pain in the oral mucosa usually without any clinical and laboratory findings. It has a negative effect on patients' quality of life and can be a significant health problem. The aim of this study was to identify major risk factors associated with BMS in menopausal and non-menopausal women at dental clinics of Gorgan, Iran. Methods: This cross-sectional study was performed on 450 elderly female patients attending Gorgan dental clinics, Iran. Questionnaires were completed for all the patients by the examiner. For those with burning mouth, intraoral examination was performed to make sure of lacking any clinical pathoses. In addition to descriptive statistics, t-student, Chi-square, Fisher exact test, Mann-Whitney U tests, and Logistic Regression were used for data analysis. Results: In total, 13.8% of patients (n=62) suffered from BMS. Level of education (OR=4.67) and menopause (OR=4.45) were found to be a as predictors of increased prevalence of BMS in women of 30 to 60 years of age. According to Logistic Regression analysis, educational level, menstrual status, antidepressants, and systemic disease were significantly related to BMS. Conclusion: The prevalence of BMS among women in Gorgan (Iran) was relatively high, and the major risk factors were high level of education and menopause.

Introduction: The incidence of anterior Stafne bone cyst (lingual mandibular bone defect, static bone cyst, latent bone cyst, developmental submandibular gland defect of the mandible) has been estimated to between 0.009% and 0.3%. It is characterized by a round or ovoid, well-defined border, unilocular radiolucency. Most of anterior Stafne bone defects were located between the cuspid and the first molar, but a few cases have been reported in the incisor area. Case Report: We present a 48-year-old man with anterior Stafne bone defect in the incisor area diagnosed by using cone-beam computed tomography (CBCT). Discussion: CBCT can be a confirmatory imaging technique to detect anterior mandibular bony configurations such as Stafne bone cavity with the lingual cortical plate being spared.

Introduction: Pleomorphic adenoma of the upper lip is a rare entity and its diagnosis requires a high index of suspicion. The aim of this study was to review the reported cases of pleomorphic adenoma (PA) of the upper lip. Methods: This study was performed on the basis of the clinical features of 10 well-documented reported cases of the upper lip pleomorphic adenomas from 1990 to 2012 which have been indexed in the PubMed. The search strategy based on MeSH keywords included "salivary gland tumor", "salivary gland cancer", "pleomorphic adenoma", and "mixed tumor". In the clinical records the following data have been considered: Age, sex, clinical view, complaint time, site, size, texture, pathological view, treatment, recurrence rate, symptom and follow-up period. Results: Of the 11 reported cases of PA, 7 (63.7%) were female and 4 (36.3%) were male, with age ranging from 12 to 65 years. 50% of the patients were between 35 and 55 years of age. Only 3 (27.2%) of cases were younger than 20. The main clinical presentation of lesion in all cases was a submucosal nodule. There was a large interval between the first symptoms and diagnosis. The size of the lesions were between 1 and 3 cm. Involvement of the right half of the upper lip was more common than the left side. 63.6% of the lesions showed a firm consistency and bone formation was seen in one (9.09%) case. The follow-up period ranged from 5 to 48 months. There was no evidence of recurrence in any of the reported cases. Conclusion: Although rare, pleomorphic adenoma should be considered as a differential diagnosis for the swellings in the upper lip. PA has a potential for malignant transformation. Therefore this entity should be evaluated carefully by all clinicians.

Background: Diagnosis of external root resorption (ERR) cavities may be challenging, especially when no clinical signs are seen. Therefore, the aim of this study was to compare the efficacy of conventional intraoral film radiography, charge-coupled device (CCD) detector, photostimulable phosphor plate (PSP) detector, and cone beam computed tomography (CBCT) for the detection of ERR. Methods: The study sample comprised 54 maxillary first premolars. Cavities were created by using a low-speed handpiece with round diamond burs of 1 mm in diameter. Digital and conventional radiographs were taken from each tooth. Three observers examined all images for the presence of resorption cavities. Data were statistically analyzed with the χ2 test. The reliability and degrees of agreement were also determined by the mean of Cohen's Kappa analysis. Results: The differences between the imaging methods in correct detection of root resorption for all sizes were not significant. For locations of root resorption, significant differences were found between CBCT and other methods in the apical regions. Conclusions: CBCT was only useful for detection of cavities located in the apical one-third of the root, compared to other digital or conventional methods.

Introduction: Salivary calcium and phosphate levels might have a relationship with dental caries severity. Evaluation of different indexes such as alkaline phosphatase, which increases salivary phosphate levels, and hydroxyapatite ion activity, which reflects salivary calcium and phosphate levels, might help determine the risk of dental caries. The aim of the present study was to compare salivary alkaline phosphatase activity and hydroxyapatite ion activity index in 6‒12-year-old children with different rates of dental caries. Materials and methods: In this descriptive-analytical study the teeth were examined in 152 children, aged 6‒12, by a dentist and were placed into three experimental groups according to the dental caries severity as follows: group 1: severe dental caries (DMFT ≥ 6); group 2: moderate dental caries rate (1 < DMFT < 6); and group 3: mild dental caries rate (DMFT ≤ 1). After collection of saliva, salivary alkaline phosphatase levels and hydroxyapatite ion activity were measured for each sample. Data was analyzed using one-way ANOVA and a post hoc Tukey test (α = 0.05). Results: The means and standard deviations of alkaline phosphatase levels in groups 1 to 3 were 5.39 ± 2.96, 5.71 ± 3.68 and 5.83 ± 4.53 unit/dL, respectively. Hydroxyapatite ion activity rates were 25.80 ± 0.70, 28.28 ± 0.76 and 28.50 ± 0.56 in groups 1 to 3, respectively. The results of one-way ANOVA showed no significant differences between the experimental groups in alkaline phosphatase levels (p value = 0.830) and hydroxyapatite ion activity (p value = 0.065).Conclusion: According to the finding of the present study, alkaline phosphatase level and hydroxyapatite ion activity have no effect on tooth caries severity in 6‒12-year-old children. Future studies are recommended. Key words: Alkaline phosphatase, Dental caries, Saliva

Diagnosis of oral ulcerative lesions might be quite challenging. This narrative review article aims to introduce an updated decision tree for diagnosing oral ulcerative lesions on the basis of their diagnostic features. Various general search engines and specialized databases including PubMed, PubMed Central, Medline Plus, EBSCO, Science Direct, Scopus, Embase, and authenticated textbooks were used to find relevant topics by means of MeSH keywords such as “oral ulcer,” “stomatitis,” and “mouth diseases.” Thereafter, English-language articles published since 1983 to 2015 in both medical and dental journals including reviews, meta-analyses, original papers, and case reports were appraised. Upon compilation of the relevant data, oral ulcerative lesions were categorized into three major groups: acute, chronic, and recurrent ulcers and into five subgroups: solitary acute, multiple acute, solitary chronic, multiple chronic, and solitary/multiple recurrent, based on the number and duration of lesions. In total, 29 entities were organized in the form of a decision tree in order to help clinicians establish a logical diagnosis by stepwise progression.

Background & Objective: Oral health problems of chronic renal failure patients can compromise systemic health. The purpose of this study was to investigate the dental and periodontal status of patients on regular hemodialysis (HD) maintenance therapy and the effect of duration of HD on oral health. Methods & Materials: In this historical cohort study 65 HD patients and 65 healthy people were collected as case and control groups. Decayed (D), Missed (M) and Filled (F) teeth, DMFT Index, Plaque Index (PI), Gingival Index (GI) ,and Probing depth (PD) were examined and compared between case and control groups. Also, HD patients were divided into two subgroups based on duration of hemodialysis: 1: three and less than three years and 2: more than three years). In this study all variables were examined and compared between these subgroups. T-test and chi-square and SPSS software were used for statistical analysis. Results: Except M and DMFT index, significant differences were found in other indices between case and control groups (P

Introduction: Atypical odontalgia (AO) is a subgroup of persistent idiopathic facial pain. We introduced a combination therapy of fluoxetine and clonazepam to treat AO. Case Report: A 30-year-old female with the chief complaint of severe pain (#8 based on Visual Analogue Scale( VAS)) in the site of extracted tooth #3 since 2 months ago was referred to the Department of Oral Medicine. The pain was of sharp quality continuing all day long and radiated to cervical muscles, forehead, and mandible of the ipsilateral side and contra lateral structures. The patient was treated with fluoxetine 20 mg/d and clonazepam 0.5 mg/d. The pain intensity was reported almost #0 when the patient was re evaluated 1 month after the first visit. An 8-month follow up revealed no sign of pain and discomfort on the affected site. Discussion: Combination therapy with clonazepam and fluoxetine has a positive effect in the treatment of AO.

Introduction: Salivary mucocele is a common benign lesion of the oral cavity, usually presented as a single bluish lesion caused by trauma to the minor salivary gland ducts. We aimed to describe a new combination therapy (micromarsupialization plus intralesional corticosteroid injection) to treat a large mucocele on the lower lip. Case Report: We administered three intralesional dexamethasone (8 mg/2 ml) shots along with standard silk sutures in one-week intervals on a large labial mucocele (primary size: 3.5 cm Χ 1.5 cm) of a 26-year-old man over a three-week duration. Complete healing was obtained three weeks after treatment. A six-month follow-up revealed no signs of recurrence or complications. Discussion: Combination of intralesional dexamethasone and micromarsupialization leads to complete healing of a large lower lip mucocele, and can be considered as an alternative therapeutic method to conventional surgery.

Introduction: Myofascial Pain Dysfunction Syndrome (MPDS) is one of the most important causes of the orofacial pain. The main purpose of this study was to evaluate 40 related variables in this regard. Materials and Methods: Thirty nine patients with MPDS were evaluated in this study. Different factors including age, gender, occupation, marital status, sensitivity of masticatory muscles, maximum opening of the mouth, deviation, deflection, involvement of temporomandibular joint, habit, parafunction, malocclusion, neck pain, headache, earache and history of jaw involvement, etc were analyzed in this evaluation. Results: In our study, 39 patients (32 females and 7 males), 20-40 years old, with the average age of 35 ± 13.32 years were studied. 51% were housewives and 74.4% were married. The most common involvements were Clicking (74.4%), pain in temporomandibular joint (54%), headache (46.2%), earache (41%), neck-pain (35.9%), trouble in the mouth opening (71.8%), malocclusion Class I (74.4%), cross bite and deep bite (25%), clenching (64.1%) and involvement of masseter and lateral pterygoid muscle (84%). Conclusion: Since MPDS consists of variable symptoms, it might be very difficult to provide any definite diagnosis and treatment. Therefore the more the specialists extend their knowledge and information about this disorder, the more they will make the best decision in this regard.

Introduction: Painful dysfunction syndrome of masticatory muscles is one of the most important causes of pain in orofacial region. Therefore, the aim of this study was to evaluate the prevalency of 40 variables related to this disorder. Materials and Methods: A total 39 patients (32 females, 7 males) with painful dysfunction syndrome of masticatory muscles were studied. Patients were evaluated for prevalence of age, sex, job, marriage status, masticatory muscles tenderness, maximum mouth opening, deviation, deflection, temporomandibular joint involvement, habits, parafunctions, mall occlusions, neck pain, headache, ear pain and previous history of jaw involvement. Results: Mean age of patients was 35±13.32 years old and most common range of age was 20-40, 51% were house wife and 74.4% were married. Other variables included: Clicking (74.4%), temporomandibular joint pain (54%), headache (46.2%), ear pain (41%), neck pain (35.9%), limitation of maximum opening (71.8%), class I mall occlusion (74.4%), cross bite and deep bite (25.6%), deviation (7.7%), deflection (41%), bruxism (56.4%), clenching (64.1%) Masseter and external petrygoid (85%) muscles of masticatoty muscles had higher involvement. Conclusion: Because of painful dysfunction syndrome of masticatory muscles has variable signs and symptoms, diagnosis and treatment planning may be very difficult, Therefore having more information about this disorder can help physicians to make best decisions.

Context: Cancer is a major cause of death in children under 15 years of age. Aims: This study aimed to evaluate relationship between demographics and dental status in a defined group of Iranian paediatric patients undergoing cancer therapy. Settings and Design: This cross-sectional study was accomplished on 161 subjects age ranging 8-12 years. There were 76 cancerous patients hospitalized at Mahak Hospital (one of the major children’s cancer centers in Tehran) as the study group and 85 healthy children attending at Dental School, International Branch of Shahid Beheshti University of Medical Sciences, Tehran, Iran from 2012 to 2013. Materials and Methods: Demographics were gathered by using data-form. Oral examination and DMFT Index were used to describe teeth status in all teeth and in the first permanent molars. According to Becker’s definition, “D” stands for untreated decayed teeth, “M” indicates missing teeth, and “F” shows Filled teeth. It is noteworthy that full coverage crowns are considered as “F” in this Index. Statistical Analysis: Chi-square, Mann-Whitney U, Student’s t-tests and Logistic Regression were used for data analysis. Results: The most frequent type of cancer was acute lymphoblastic/lymphocytic leukemia (33.3%). Patients were significantly shorter than controls (p=0.03), and their fathers and mothers were of lower educational achievement (p=0.01, p= 0.001). Although DMFT of all dentition showed significantly higher score in cancerous children (p=0.001), DMFT of four first permanent molars (left, right, upper, and lower) was borderline significantly higher in patients (p= 0.06). Moreover, frequency of cancer was borderline significantly higher in children with lower birth order (p= 0.05). According to Logistic Regression, in as much as patients grew elder 1 year, DMFT index increased 1.5 units. Conclusion: Patients under cancer therapy were shorter than healthy ones, and their parents were of lower educational levels. In addition, their teeth status was poorer than controls.