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BACKGROUND: Toothbrushing twice daily is a recommended component of oral self-care soon after the eruption of primary dentition. Aim. This study aims to investigate oral hygiene and frequency of oral cleaning in children up to 3 years, in relation to mother-related factors. DESIGN: A cross-sectional study of 504 children aged 12-36 months in Tehran, Iran was implemented. Mothers answered questions about their own oral self-care and their activity in their children's oral hygiene. The child's oral hygiene was assessed on the basis of visible dental plaque on the labial surfaces of the upper central incisors. Data analysis included chi-square test, analysis of variance (anova) and logistic regression. RESULTS: Twice daily oral cleaning was reported for 5% of all children and once daily cleaning for 19% of the 12- to 15-month-old children, 18% of the 16- to 23-month-old children, and 48% of the 24- to 36-month-old children. Of the mothers, 59% stated that they lacked the skill to clean their children's teeth. Dental plaque was observed in 65-76% of the children. Clean teeth were more likely (OR = 1.7, 95% CI 1.3-2.3) in children of mothers who themselves have a higher toothbrushing frequency. CONCLUSIONS: To improve oral hygiene in early childhood, more emphasis should be placed on mothers' own toothbrushing and their skills in their children's oral cleaning. [ABSTRACT FROM AUTHOR]

Background: Senior dental students are more aware of the harmful effects of cariogenic snacks and are expected to better watch their diet compared with freshmen dental students. This study aimed to compare the frequency of consumption of cariogenic snacks by senior and freshmen dental students of Tehran city and the related factors., Methods: This cross-sectional study evaluated the senior and freshmen dental students attending dental schools in Tehran in 2018, who were selected by census sampling. A cariogenic snack record form was used to collect information regarding the frequency of consumption of cariogenic snacks both prospectively (within the upcoming week) and retrospectively (previous 24 hours). We also collected information on the demographic characteristics of the participants. The plaque-producing and decay-producing potential of the diet (PAP) index was calculated for each dental student. Data were analysed by the backward regression model using SPSS., Results: A total of 294 dental students with a mean age of 22±2.85 years participated in this study. The mean PAP score was 76.48±49.91 for the freshmen and 89.87±49.41 for the senior dental students with a significant difference between them (p=0.023). Older dental students (p=0.008) and those not living with their parents (p=0.001) acquired a higher PAP score., Conclusion: The mean PAP score of freshmen and senior dental students in Tehran was slightly higher than the optimal level. So the instructional techniques of dental curricula are better to be revised to improve the performance of dental students to cut down the consumption of cariogenic snacks., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2024. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)

Background: The technological advancements of the past few decades in various aspects that are directly or indirectly related to health, along with the emphasis on public health in societal development, have improved the quality of life. However, the occurrence of pandemics and crises underscores how various aspects of individual life can be impacted. The financial consequences resulting from the COVID-19 pandemic have particularly affected the field of dentistry and public oral health. This study aims to investigate the financial effects of the COVID-19 virus on dentistry through a scoping review., Methods: A comprehensive literature search was conducted across four databases (Medline through PubMed, Embase, Scopus, and Cochrane Central) using keywords such as COVID-19 and its equivalents, dentistry, oral health, dental education, dental services, dental clinics, financial impact, financial opportunities and economic impact. Articles addressing the financial impact of COVID-19 on dentistry and oral health were then screened and reviewed., Results: Out of 1015 articles related to COVID-19 and dentistry, 84 were focused on the financial impact of COVID-19 on dentistry. The majority of these articles originated from the United States, Brazil, and Saudi Arabia, with a prevalence of cross-sectional and review articles. The review categorized the articles into two main themes: financial problems and proposed solutions. Moreover, the following themes were extracted: the effects of practice closure on dentists and staff, increased treatment costs and impacts on oral health, personal protective equipment and unforeseen costs, psychological effects of financial issues, and financial challenges within the dental education system., Conclusions: While many high-income countries seem able to mitigate COVID-19-induced financial problems, the economic effects on dentistry might persist despite the pandemic's end. These financial challenges have spurred new opportunities and infrastructure development but can pose significant risks to community oral health. This study aimed to highlight these problems and propose solutions, contributing to efforts to improve the oral health of communities globally. Further research is needed to understand long-term impacts., (© 2024. The Author(s).)

Objectives: This study evaluated the effect of a flipped oral health educational program for primary healthcare providers (PHCPs) on their knowledge, attitude, and practice. Materials and Methods: This field trial was conducted on PHCPs (N=118; 61 cases and 57 controls) in District Health Centers (DHCs) of Tehran, Iran in 2012. The participants filled out a self-report questionnaire with questions on knowledge (N=34), attitude (N=8), and oral health practice (N=14). The intervention included an educational booklet delivered to the staff followed by a brief educational session using the flipped approach and a reminder pamphlet after 1 month. After 4 months, the questionnaire was completed again by the participants. Statistical analysis included paired sample t-test, ANCOVA, and linear and logistic regression. Results: Most participants were females (N=114), and the mean age was 37±8 years. The scores of the three domains of knowledge and also the total knowledge score, the attitude score, and the practice score significantly improved in the intervention group compared to the control group (P<0.001). Knowledge about the oral health of children (P=0.001) and the total knowledge score (P<0.05) significantly increased in the control group, but the increase in other domains was not statistically significant (P>0.05). Conclusion: The oral health knowledge of PHCPs was insufficient, and their practice and attitude were not desirable. The oral health educational program with the flipped approach had a positive impact on the PHCPs' knowledge, attitude and practice, and may be utilized in the academic curriculum or continuing medical education (CME) courses., Competing Interests: None declared., (Copyright © 2024 The Authors. Published by Tehran University of Medical Sciences.)

Objectives: Pregnancy can lead to oral health issues, yet many women remain unaware of the potential negative impact on their pregnancy. This study aimed to assess the dental and periodontal health of pregnant women in Tehran, Iran, and identify its associated factors. Materials and Methods: A cross-sectional study was conducted with 221 pregnant women attending 12 randomly selected public health centers in Tehran, Iran. A self-administered questionnaire gathered data on background characteristics, oral health knowledge, and self-reported health. Periodontal status, oral hygiene, and dental health were assessed using bleeding on probing (BOP), simplified oral health (OHI-S), and decayed-missing-filled teeth (DMFT) indices. Statistical analysis included simple and multiple linear regression (P<0.05). Results: The participants' ages ranged from 18 to 42 years (mean: 27.9 years, SD: 5.5). On average, participants scored 4.1 out of 11 (SD: 1.7) for general oral health knowledge and 1.62 out of 4 (SD: 0.9) for knowledge about oral health during pregnancy. The mean DMFT was 8.28 (SD: 5.7), with 65.6% of women having fair oral hygiene according to the OHI-S. Participants reporting poor general health had more debris (B: 0.276, P=0.043), while those with higher general oral health knowledge had fewer missing teeth (B: -0.183, P=0.048). Conclusion: Despite partial free oral health care provided to pregnant women in Iran, the dental and periodontal conditions of the participants were unsatisfactory. Implementing motivational educational programs within the primary health care system could be instrumental in improving the oral health of pregnant mothers., Competing Interests: None declared., (Copyright © 2024 The Authors. Published by Tehran University of Medical Sciences.)

Aim: According to the World Health Organization (WHO), early childhood caries (ECC) is still considered a major global health problem despite the general improvement in oral health practice. This study aimed to assess ECC's prevalence, severity, and key social and behavioral determinants in Iranian children 1-5- years of age., Method: This cross-sectional study recruited Iranian 1-5-year-olds with a three-stage stratified clustered sampling method. After providing consent, parents were interviewed using a validated questionnaire, including questions on child characteristics and behavioral factors. Each child underwent a dental examination by one of four trained and calibrated dentists. Associations between key covariates of interest and primary outcome measures were assessed by multivariable logistic regression modeling and multivariate generalized negative binomial regression modeling after weightings were applied. Statistical analysis was performed using SPSS V25 and Stata V14.2 software packages. A p-value ≤ 0.05 was considered significant., Results: The mean age of 909 participants was 41.1±1.2 months, 48.6% were male, and 38.1% lived in rural areas. The overall prevalence of ECC was 53.2% and mean dmft score was 2.7± 0.3. Key determinants associated with ECC included living rurally (p = 0.009, OR = 2.13), consuming sweet drinks, sugary snacks, or both [p-value = 0.02 (OR = 2.53), and p-value<0.001 (OR = 4.96), respectively], and visible plaque (p<0.001, OR = 3.41). Covariates associated with dmft scores included residing in rural regions (p = 0.02, IRR = 1.31), having both sugary snacks and sweet drinks (p = 0.02, IRR = 1.85) compared to those had none, and visible dental plaque (p<0.001, IRR = 2.06)., Conclusions: The prevalence of dental caries in children is high in Iran. The increase of ECC prevalence and severity from toddlers to preschoolers emphasizes on the critical importance of early interventions in toddlers. Improving access to care for rural children is essential along with the need to change dietary and self-care behaviors through multilevel efforts., Competing Interests: The authors have declared that no competing interests exist., (Copyright: © 2023 Javadzadeh et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.)

Background: Child neglect is a public health, human rights, and social problem, with potentially devastating and costly consequences. The aim of this study was to: (1) summarize the oral health profile of children across the globe; (2) provide a brief overview of legal instruments that can offer children protection from dental neglect; and (3) discuss the effectiveness of these legal instruments., Methods: We summarized and highlighted the caries profile and status of implementation of legislation on child dental neglect for 26 countries representing the World Health Organization regions: five countries in Africa (Nigeria, South Africa, Sudan, Tanzania, Zimbabwe), eight in the Americas (Argentina, Brazil, Canada, Chile, Mexico, Peru, Unites States of America, Uruguay), six in the Eastern Mediterranean (Egypt, Iran, Libya, Jordan, Qatar, Saudi Arabia), four in Europe (Italy, Latvia, Serbia, United Kingdom), two in South-East Asia (India and Indonesia) and one country (China) with its special administrative region (Hong Kong) in the Western Pacific., Results: Twenty-five of the 26 countries have legal instruments to address child neglect. Only two (8.0%) of these 25 countries had specific legal instruments on child dental neglect. Although child neglect laws can be interpreted to establish a case of child dental neglect, the latter may be difficult to establish in countries where governments have not addressed barriers that limit children's access to oral healthcare. Where there are specific legal instruments to address child dental neglect, a supportive social ecosystem has also been built to facilitate children's access to oral healthcare. A supportive legal environment, however, does not seem to confer extra protection against risks for untreated dental caries., Conclusions: The institution of specific country-level legislation on child dental neglect may not significantly reduce the national prevalence of untreated caries in children. It, however, increases the prospect for building a social ecosystem that may reduce the risk of untreated caries at the individual level. Social ecosystems to mitigate child dental neglect can be built when there is specific legislation against child dental neglect. It may be more effective to combine public health and human rights-based approaches, inclusive of an efficient criminal justice system to deal with child dental neglect., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (© 2023 Foláyan, Ramos-Gomez, Fatusi, Nabil, Lyimo, Minja, Masumo, Mohamed, Potgieter, Matanhire, Maposa, Akino, Adeniyi, Mohebbi, Ellakany, Chen, Amalia, Iandolo, Peedikayil, Aravind, Al-Batayneh, Khader, Al-Maweri, Sabbah, Abeldaño Zuñiga, Vukovic, Jovanovic, Jafar, Maldupa, Arheiam, Mendes, Uribe, López Jordi, Villena, Sam-Agudu and El Tantawi.)

Introduction: Dentists by their professional knowledge of prevention have a key role in providing a positive role model for oral health-promoting behaviours. We aimed to investigate the health behaviour of Iranian senior dental students in terms of oral self-care and tobacco use during a 10-year period to assess their preparedness to act as role models for health-promoting behaviours., Materials and Methods: The study was performed in six dental schools selected through stratified cluster random sampling to have a representative sample of all dental schools in Iran. Data were collected in four occasions in 2005, 2008, 2011 and 2015. Senior dental students (N = 1188) were invited to voluntarily complete a self-administered anonymous questionnaire about their oral self-care and tobacco use. Recommended tooth-brushing habit (RTH) was defined as at least twice a day brushing with fluoridated toothpaste. Three separate questions about cigarette, pipe and waterpipe use were applied to assess the students' reported use of tobacco., Results: The response rate was 81%. Female students reported more frequently RTH than males (p < .001). The reported RTH was more prevalent among nonsmokers. In 2005, 2008, 2011 and 2015, 22.5%, 26%, 28.5% and 24.6% of the students reported smoking, respectively. The trend of reported smoking had the least variation among female students. This was true also for male students regarding RTH., Conclusion: The status and trend of oral self-care and tobacco use among Iranian dental students call for more emphasis on adopting health-promoting behaviours during dental education., (© 2022 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.)

Aim: The objective of this scoping review is to present current evidence regarding the association between early childhood caries (ECC) and maternal-related gender inequality., Methods: Two independent reviewers performed a comprehensive literature search using three databases: EMBASE, PubMed, and Web of Science. Literature published in English from 2012 to 2022 was included in the search and was restricted to only primary research by using the following key terms: "dental caries", "tooth decay", "gender", "sex", "preschool", "toddler," and "infant". The included studies were limited to those reporting an association between ECC and maternal aspects related to gender inequality. Titles and abstracts were screened, and irrelevant publications were excluded. The full text of the remaining papers was retrieved and used to perform the review. The critical appraisal of selected studies was guided by the Joanna Briggs Institute (JBI) Critical Appraisal Tools., Results: Among 1,103 studies from the three databases, 425 articles were identified based on publication years between 2012 and 2022. After full-text screening, five articles were included in the qualitative analysis for this review. No published study was found regarding a direct association between ECC and maternal gender inequality at the level of individuals. Five included studies reported on the association between ECC and potential maternal-gender-related inequality factors, including the mother's education level (n = 4), employment status (n = 1), and age (n = 1). Regarding the quality of the included studies, out of five, two studies met all JBI criteria, while three partially met the criteria., Conclusions: Based on the findings of this scoping review, evidence demonstrating an association between gender inequality and ECC is currently limited., (© 2023. The Author(s).)

Objectives: Oral health literacy (OHL) is an interplay of cultural, social and individual factors and plays an effective role in public health promotion. This study aimed to assess OHL and its socioeconomic and demographic determinants among young couples. Materials and Methods: This analytical cross-sectional study was conducted on 828 adults between 15 to 35 years in 2018 in Zanjan city. Data regarding their OHL were collected by using a 17-item Oral Health Literacy-Adult Questionnaire (OHL-AQ) that was filled out by a combination of self-report and interview. OHL was categorized as adequate, marginal, and inadequate. The effects of age and gender as demographic variables, and floor area per person as a proxy of financial status on OHL were also assessed. Data were analyzed using the linear and multinomial logistic regression models. Results: The mean OHL score was 7.86±3.83 out of 17 in equal number of males and females. Only 21% of the couples had adequate OHL. The socioeconomic, but not demographic variables had significant correlations with the qualitative and quantitative variables of OHL even after controlling for the effect of confounders. A correlation was particularly found between inadequate OHL and years of education [odds ratio:6.00; 95% CI: 3.86-9.28); P<0.001]. Conclusion: Socioeconomic factors had independent correlations with inadequate OHL. Participants with higher levels of education, those living in urban areas, and individuals with better financial status had higher levels of OHL and lower odds of inadequate OHL., Competing Interests: None declared., (Copyright © 2023 The Authors. Published by Tehran University of Medical Sciences.)

Background: The risk of SARS-COV-2 transmission is relatively high during dental procedures. A study was conducted to investigate the effects of mouthwashes on SARS-COV-2 viral load reduction in the oral cavity., Methods: A systematic search was performed in PubMed, EMBASE, Scopus, Web of Science, and Cochrane library for relevant studies up to 20 July, 2022. Randomized and non-randomized clinical trial and quasi-experimental studies evaluating patients with Covid-19 infection (patients) who used mouthwashes (intervention) compared to the same patients before using the mouthwash (comparison) for reducing the SARS-COV-2 load or increasing the cycle threshold (Ct) value (outcome) were searched according to PICO components. Three independent reviewers conducted literature screening and data extraction. The Modified Downs and Black checklist was used for quality assessment. A meta-analysis was performed with a random effects model in the Revman 5.4.1software using the mean difference (MD) of cycle threshold (Ct) values., Results: Of 1653 articles, 9 with a high methodological quality were included. A meta-analysis indicated that 1% Povidone-iodine (PVP-I) was an effective mouthwash for reducing the SARS-COV-2 viral load [MD 3.61 (95% confidence interval 1.03, 6.19)]. Cetylpyridinium chloride (CPC) [MD 0.61 (95% confidence interval -1.03, 2.25)] and Chlorhexidine gluconate (CHX) [MD -0.04 95% confidence interval (-1.20, 1.12)] were not effective against SARS-COV-2., Conclusion: Using mouthwashes containing PVP-I may be recommended for reducing the SARS-COV-2 viral load in the oral cavity of patients before and during dental procedures, while the evidence is not sufficient for such effects for CPC and CHX-containing mouthwashes., (© 2023. The Author(s).)

Aim: The COVID-19 pandemic has accelerated teledentistry research with great interest reflected in the increasing number of publications. In many countries, teledentistry programs were established although not much is known about the extent of incorporating teledentistry into practice and healthcare systems. This study aimed to report on policies and strategies related to teledentistry practice as well as barriers and facilitators for this implementation in 19 countries., Methods: Data were presented per country about information and communication technology (ICT) infrastructure, income level, policies for health information system (HIS), eHealth and telemedicine. Researchers were selected based on their previous publications in teledentistry and were invited to report on the situation in their respective countries including Bosnia and Herzegovina, Canada, Chile, China, Egypt, Finland, France, Hong Kong SAR, Iran, Italy, Libya, Mexico, New Zealand, Nigeria, Qatar, Saudi Arabia, South Africa, United Kingdom, Zimbabwe., Results: Ten (52.6%) countries were high income, 11 (57.9%) had eHealth policies, 7 (36.8%) had HIS policies and 5 (26.3%) had telehealth policies. Six (31.6%) countries had policies or strategies for teledentistry and no teledentistry programs were reported in two countries. Teledentistry programs were incorporated into the healthcare systems at national ( n  = 5), intermediate (provincial) ( n  = 4) and local ( n  = 8) levels. These programs were established in three countries, piloted in 5 countries and informal in 9 countries., Conclusion: Despite the growth in teledentistry research during the COVID-19 pandemic, the use of teledentistry in daily clinical practice is still limited in most countries. Few countries have instituted teledentistry programs at national level. Laws, funding schemes and training are needed to support the incorporation of teledentistry into healthcare systems to institutionalize the practice of teledentistry. Mapping teledentistry practices in other countries and extending services to under-covered populations increases the benefit of teledentistry., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (© 2023 El Tantawi, Lam, Giraudeau, Virtanen, Matanhire, Chifamba, Sabbah, Gomaa, Al-Maweri, Uribe, Mohebbi, Hasmun, Guan, Polonowita, Khan, Pisano, Ellakany, Baraka, Ali, Orellana Centeno, Pavlic and Folayan.)

Background: Some studies suggest a higher effectiveness of motivational interviewing compared to common oral health instruction in healthy individuals. As regards to higher prevalence of dental diseases like early childhood caries, oral mucositis, and gingivitis are reported for leukemic children, the present study aims to compare the effectiveness of educating mothers through MI with the common instruction (CI) for the oral health of children with leukemia under six years old., Method: This quasi-experimental study was designed in Tehran University of Medical Sciences, School of Dentistry and conducted on 61 mothers with leukemic children under age six hospitalized in Mahak Hospital and Rehabilitation Complex which is a Pediatric Cancer Research and Hospital Center, in 2021. Mother and child pairs were allocated to MI or CI (using pamphlets) groups. Data was collected using a questionnaire of mothers' knowledge, attitude, motivation, and practice concerning oral health care in leukemic children. The children underwent clinical examination to assess plaque index before and three months after the intervention. The data were analyzed using SPSS version 25 (IBM, Armonk, NY, USA) by ANCOVA test., Results: The preschoolers mean ages were 4.23 ± 1.41 and 4.32 ± 1.33 (ranged from 2 to 6 years old) in the MI and CI group, respectively. There were 16 girls (53.3%) and 14 boys (46.7%) in the MI group, and 15 girls (48.4%) and 16 boys (51.6%) in the CI group. Significant differences were observed in the amount of plaque index between the MI group and the CI group (0.20 ± 0.04, p-value < 0.001). A significant increase was observed in the mean of changes in scores of knowledge, attitude, motivation, mother's practice concerning child's oral health, mother's practice concerning personal oral health in the MI group (p-value < 0.001)., Conclusions: Considering that instruction using MI showed to be effective in improving oral health adherence in mothers and reducing plaque in children with Leukemia, it may be recommended as a promising method to promote the oral health of such susceptible children in places that they are constantly present for treatment., Trial Registration: The study was registered in the Iranian Registry of Clinical Trials (IRCT) on 11.03.2021 (code: IRCT20131102015238N5)., (© 2023. The Author(s).)

Purpose: We compared the effect of an educational pamphlet and a mobile application regarding prevention and emergency management of sport-related traumatic dental injuries (TDIs) on knowledge and self-reported preventive practice of 11-17-year-old Karate and Taekwondo athletes., Methods: Participants were invited through an online link published by the Public Relations of the corresponding federations. They completed an anonymous questionnaire consisting of demographics, self-reported experience of TDIs, knowledge of emergency management of TDIs, self-reported preventive practice of TDIs, and the reason for not using mouthguard. The respondents were randomly allocated to pamphlet or mobile application group with the same content. Three months after the intervention, the questionnaire was completed by the athletes again. Repeated measures ANOVA and a linear regression model served for statistical analysis., Results: In pamphlet group, 51 athletes and in mobile application group 57 athletes completed both baseline and follow-up questionnaires. At baseline, the mean score was 1.98 ± 1.20 and 1.82 ± 1.24 (out of 7) for the knowledge and 3.70 ± 1.64 and 3.33 ± 1.95 (out of 7) for practice in the pamphlet and application group, respectively. In 3-month follow-up, the mean score of knowledge and self-reported practice was significantly higher compared to baseline in both groups (p < 0.001) with no statistically significant difference between the two groups (p = 0.83 and p = 0.58, respectively). Most of the athletes were very satisfied or satisfied with both types of the educational intervention., Conclusion: Both pamphlet and mobile application seem to be useful to improve awareness and practice regarding TDI prevention in adolescent athletes., (© 2023. The Author(s), under exclusive licence to European Academy of Paediatric Dentistry.)

Objectives: This study aimed to evaluate the effect of an educational intervention on oral health-related knowledge, attitude, and practice of medical students. Materials and Methods: This study was performed on the fifth-year medical students attending an elective oral health course at the Faculty of Dentistry of Tehran University (intervention group) and 25 other students attending another elective course (control group) in 2018. A 2-week internship program including 6 sessions of a workshop program plus 2 days of school field and 2 days of attending dental departments was designed for the intervention group. Before and after the intervention, students completed a questionnaire and their simplified debris index was calculated. Statistical analysis was performed using SPSS version 24 by paired-sample t-test and general linear regression. Results: The mean age of the participants was 24.84±1.31 years in the intervention group and 23.64±1.28 years in the control group. There were 14 (56%) males in the intervention group and 16 (64%) males in the control group. At baseline, the mean knowledge, attitude and practice scores of the control and intervention groups were 26.28, 14.20 and 10.88, and 27.84, 15.80, and 9.36, respectively. After the intervention, the knowledge, attitude, debris index and willingness to adhere to oral health measures significantly improved (P<0.05). Conclusion: Oral health-related knowledge, attitude and practice of medical students were not desirable at baseline. The present study showed that even a short-term intervention in this field was effective to improve the oral health concepts in this group., (Copyright © 2022 The Authors. Published by Tehran University of Medical Sciences.)

Purpose: Integration of smartphones has overcome barriers in traditional education; this trial aimed at exploring this ubiquitous platform in oral health education. A smartphone application promoting preschooler's oral health was designed and its effectiveness was compared with that of common oral health education delivered in paediatric dental settings., Methods: This controlled clinical trial was performed on preschooler-mother dyads referring to the clinic of Tehran School of Dentistry in 2019-2020. Initially, the dyads were randomly partitioned to application intervention or common training groups. The mothers answered an interviewer-administered questionnaire on paediatric dentistry knowledge, attitude and practice regarding children's oral health; modified plaque index (m-PI) and modified gingival index (m-GI) of children were measured. Subsequently, the smartphone application was installed for application intervention group and an educational pamphlet and verbal explanations were given to common training group. In 1-month and 3-month follow-ups, the questionnaires and clinical measurement were re-done. A generalized estimating equation (GEE) was used to investigate the effect of training methods., Results: Among the participants 51 dyad attended baseline and follow-up assessments. The preschoolers mean age was 4.6 ± 1.2 years and 54.4% were girls. Both trainings improved mothers' knowledge and practice regarding children's oral health and reduced children's m-PI and m-GI (p < 0.050). The 3-month follow-up revealed a better m-GI in application intervention group (p < 0.001)., Conclusions: Considering the greater improvement of paediatric gingival status in the application intervention group, it appears that smartphone applications may provide a promising tool for more prolonged impacts in children oral health care., Trial Registration: IRCT, IRCT20131102015238N3. Registered 28 July 2019 https://en.irct.ir/trial/40933., (© 2022. The Author(s), under exclusive licence to European Academy of Paediatric Dentistry.)

Background: Coronavirus disease 2019 (COVID-19) has placed a significant psychological burden on the healthcare personnel. Dental academics play a crucial role in the promotion of public oral health and the education of dental students., Objectives: The aim of the study was to assess COVID-19-related concerns, stress and behavior changes in Iranian dental academics, determine the associated factors, and assess the potential gender differences., Material and Methods: In this cross-sectional study, we shared a researcher-developed questionnaire with Iranian dental academics through social media and e-mail. The questionnaire contained 4 sections: Background (8 items and additional 6 knowledge questions); Concerns (18 items); Stress (based on the 15-item Impact of Event Scale (IES)); and Behavior Change (5 items). We divided the concerns by means of the principal component analysis (PCA) into 3 various components of the fear of infection, concerns over professional responsibilities and concerns over restrictions. The backward stepwise multilevel linear and logistic regression analyses served to discover the association of other factors with stress and behavior changes., Results: Out of 274 respondents, 66% were female, and 78% were 45 years old or younger. Approximately half of the respondents demonstrated moderate to severe stress and the median (Me) for behavior change was 46.5 out of 50. The greatest concern expressed by the participants referred to the fear of becoming infected by their patients and spreading the virus to their loved ones. Being female, living with parents and not having any administrative role, along with greater fear of infection, concerns over restrictions and academic experience were associated with higher levels of COVID-19-related stress. Being female and having an administrative role, along with greater fear of infection and knowledge, and more daily patient visits were associated with desirable COVID-19-related behavior changes., Conclusions: The COVID-19 pandemic has significantly affected dental academics' psychological state, leading to various levels of concern, stress and behavior change. Supportive and educational programs must target those with high fear and stress levels to prevent undesirable behaviors.

Objectives: For decades, the white coat has been the uniform of medical professionals. Recently, medical professionals show interest to use alternatives. We aimed to evaluate the perspectives and preferences of children and their parents regarding dentists' attire and gender. Materials and Methods: This cross-sectional study was performed on 4-to 6-year-olds and their parents referred to dental clinics of Tehran School of Dentistry in 2018. Parents completed a questionnaire on demographics and dental fear, and both parents and children were asked about their preferences regarding the gender of dentist and the color of the dentist's attire. Statistical analysis was performed by the logistic regression model. Results: Totally, 148 children (mean age of 5.42±0.71 years, 48% girls) and their parents participated in the study. Most of the participants (81.2% of the children and 68.0% of the parents) preferred colored coats compared with white coat. More than half of the parents preferred a female dentist for their children (56.5%) while most children preferred a male dentist (54.8%). Boys preferred a male dentist as well (P=0.01). The children were reluctant to go for a dental visit and preferred to be visited by a dentist of the same gender as themselves (P=0.041). Conclusion: Wearing colored coats by dentists and giving a chance to choose the gender of dentist in polyclinics may increase the children's cooperation in pediatric settings., (Copyright © 2022 The Authors. Published by Tehran University of Medical Sciences.)

Aims: This study aimed to evaluate the oral health status of individuals with obsessive-compulsive disorder (OCD)., Methods: Ninety-two participants, aged 18 years and older from which 46 had OCD symptoms, were included in this comparative cross-sectional study. Data on age, sex, smoking habit, educational level, and potential mediators including brushing frequency (BF) and brushing duration (BD) were collected. Clinical examinations determined outcome measures including decayed-missing-filled teeth (DMFT), presence of root caries (PoRC), gingival recession (GR), plaque index (PI), and papillary bleeding index (PBI). Pathway analysis was used for data analysis., Results: Individuals with OCD had significantly lower DMFT (p < .01), higher BF (p = .01), and lower PI (p = .01); however, there were no significant differences regarding BD, GR, PBI, and PoRC (p > .05). While BD did not have a mediating role, BF mediated the effect of OCD on DMFT (B = -0.31, CI = -0.60 to -0.06) and PI (B = -0.15, CI = -0.36 to -0.03). Males had less PI (B = -1.03, CI = -1.81 to -0.24) and PBI (B = -1.14, CI = -2.09 to 0.20) than females. Except for OCD and sex, other predictors were not significant., Conclusions: Individuals with OCD had lower caries experience and similar gingival health compared to controls. Part of the impact of OCD was mediated through brushing habits., (© 2021 Special Care Dentistry Association and Wiley Periodicals LLC.)

Background: A new corona virus called COVID-19 and its epidemic has affected health care systems in many ways. There have also been significant changes in dental education. The present study summarizes the findings about dental education resulting from a scoping review of COVID-19 and dentistry., Methods: First, a comprehensive search of five databases (Google Scholar, Medline through PubMed, Embase, Scopus, and Cochrane Central) was conducted with the keywords: COVID-19 and its equivalent terms, dentistry, education, oral, students, curriculum, and academics. Articles related to oral health and COVID-19 were searched. Then articles on the subject of dental education were screened and reviewed., Results: Of the 1389 articles investigating COVID-19 and dentistry, 135 articles were related to dental education and its relationship with COVID-19. The most articles in this field were from the United States, India, and Saudi Arabia. Most of the articles were cross-sectional and then review articles. Based on the review the articles were divided into two main categories of changes and concerns, and opportunities and solutions. Moreover, the following themes were extracted: teaching-learning quality and methods, study career and how students are prepared, infection control policies, theses, exams and assessments, financial and economic security, students and staff's mental health, school's policies and curricula, knowledge of students and staff about COVID-19., Conclusions: Dental education now faces big challenges, some of which have never been experienced before. On the other hand, the epidemic has created opportunities for dental education as well. Most of these challenges and opportunities are the same around the world, and the findings of the present study can be a good help to overcome the challenges ahead as well as a good reference to find the right questions to be answered in future studies., (© 2021. The Author(s).)

This analytical cross-sectional study aimed to assess the correlation of oral health literacy (OHL) and oral health status and behavior in participants of a pre-marriage counseling program. Also, it aimed to determine the target population's OHL needs to design necessary interventions. A total of 828 couples with a mean age of 24.22 years participating in a pre-marriage counseling program were evaluated. Data were collected using the oral health literacy-adult questionnaire (OHL-AQ). Clinical oral examinations were performed to measure the gingival index (GI), plaque index (PI), and DMFT. The mean OHL score of the couples was 7.86±3.83 out of 17; while, the mean DMFT score was 6.30±5.73. After controlling for the confounders, OHL had a significant correlation with the frequency of dental visits, and smoking status, and inverse correlation with the number of decayed teeth and missing teeth, and PI, and GI (p<0.05). The current results highlight the necessity of OHL interventions to fill the existing gaps. This is an unmet need of the couples, and such interventions are required to promote their own oral health as well as the oral health of their future children., Competing Interests: The authors have declared that no competing interests exist.

Background: Increased engagement of adolescents in martial arts exposes them to a relatively high risk of experiencing orofacial injuries. We evaluated self-reported experience of orofacial injuries, preventive practice, and knowledge of management of sport-related orofacial injuries and related factors in adolescent Karate and Taekwondo athletes in Iran., Methods: This cross-sectional study was conducted on Iranian martial arts athletes including Karate and Taekwondo aged 11-17-year-old in 2020 via an online questionnaire. The anonymous self-administrated questionnaire had four parts: background (age, gender, duration of sports activity, training sessions per week, and previous education on orofacial injury); self-reported experience of orofacial injury; preventive practice including mouthguard and helmet use; and knowledge of emergency management of orofacial injuries. Preventive practice and knowledge scores were calculated by summing up the scores of corresponding questions (possibly range 0-7). A linear regression model and the Pearson correlation served for statistical analysis., Results: Totally, 295 athletes with a mean age of 14.56 ± 1.91 years participated in the study. A quarter (n = 74, 25.1%) of athletes stated that they had received training on prevention of orofacial injuries. Only 3.7% (n = 11) of the participants reported the use of custom-made mouthguards, and 62% (n = 183) reported a positive history of orofacial injuries. A significant relationship existed between self-reported orofacial injury and age (β = - 0.32, p < 0.001), hours of training per week (β = 0.12, p = 0.037), type of sport (β = 0.11, p = 0.049), and previous training on orofacial injuries (β = - 0.14, p = 0.010). No difference existed in the history of orofacial injury between females (n = 114) and males (n = 69) (p = 0.374). The mean score of self-reported preventive practice and knowledge of management of orofacial injuries was 3.53 ± 1.82 (out of 7) and 1.67 ± 1.10 (out of 7), respectively. Age (β = 0.19, p = 0.002) and history of orofacial injury (β = - 0.15, p = 0.010) were associated with the score of self-reported preventive practice. Female athletes (β = 0.11, p = 0.048) and athletes who exercised more per week (β = 0.15, p = 0.012) had significantly more knowledge on management of orofacial injuries., Conclusion: Adolescent athletes had relatively undesirable preventive practices and a distinct lack of knowledge. The high occurrence of self-reported orofacial injuries indicates the importance of more education and stricter rules for the athlete population., (© 2021. The Author(s).)

Background: Universal health care (UHC) may assist families whose children are most prone to early childhood caries (ECC) in accessing dental treatment and prevention. The purpose of this study was to determine the association between UHC, health expenditure and the global prevalence of ECC., Methods: Health expenditure as percentage of gross domestic product, UHC service coverage index, and the percentage of 3-5-year-old children with ECC were compared among countries with various income levels using one-way analysis of variance (ANOVA). Three linear regression models were developed, and each was adjusted for the country income level with the prevalence of ECC in 3-5-year-old children being the dependent variable. In model 1, UHC service coverage index was the independent variable whereas in model 2, the independent variable was the health expenditure as percentage of GDP. Model 3 included both independent variables together. Regression coefficients (B), 95% confidence intervals (CIs), P values, and partial eta squared (ƞ 2 ) as measure of effect size were calculated., Results: Linear regression including both independent factors revealed that health expenditure as percentage of GDP (P < 0.0001) was significantly associated with the percentage of ECC in 3-5-year-old children while UHC service coverage index was not significantly associated with the prevalence of ECC (P = 0.05). Every 1% increase in GDP allocated to health expenditure was associated with a 3.7% lower percentage of children with ECC (B = - 3.71, 95% CI: - 5.51, - 1.91). UHC service coverage index was not associated with the percentage of children with ECC (B = 0.61, 95% CI: - 0.01, 1.23). The impact of health expenditure on the prevalence of ECC was stronger than that of UHC coverage on the prevalence of ECC (ƞ 2  = 0.18 vs. 0.05)., Conclusions: Higher expenditure on health care may be associated with lower prevalence of ECC and may be a more viable approach to reducing early childhood oral health disparities than UHC alone. The findings suggest that currently, UHC is weakly associated with lower global prevalence of ECC.

Dental academic institutions are affected by COVID-19. We assessed the perceived COVID-19 preparedness of these institutions and the characteristics of institutions with greater perceived preparedness. An international cross-sectional survey of dental academics was conducted from March to August 2020 to assess academics' and institutional attributes, perceived preparedness, and availability of infection prevention and control (IPC) equipment. Principal component analysis (PCA) identified perceived preparedness components. Multilevel linear regression analysis assessed the association between perceived preparedness and fixed effect factors (academics' and institutions' attributes) with countries as random effect variable. Of the 1820 dental academics from 28 countries, 78.4% worked in public institutions and 75.2% reported temporary closure. PCA showed five components: clinic apparel, measures before and after patient care, institutional policies, and availability of IPC equipment. Significantly less perceived preparedness was reported in lower-middle income (LMICs) (B = -1.31, p = 0.006) and upper-middle income (UMICs) (B = -0.98, p = 0.02) countries than in high-income countries (HICs), in teaching only (B = -0.55, p < 0.0001) and in research only (B = -1.22, p = 0.003) than teaching and research institutions and in institutions receiving ≤100 patients daily than those receiving >100 patients (B = -0.38, p < 0.0001). More perceived preparedness was reported by academics with administrative roles (B = 0.59, p < 0.0001). Academics from low-income countries (LICs) and LMICs reported less availability of clinic apparel, IPC equipment, measures before patient care, and institutional policies but more measures during patient care. There was greater perceived preparedness in HICs and institutions with greater involvement in teaching, research, and patient care.

Background: Motivation triggers all human activities including learning and lack of career motivation can lead to decreased efficiency. This study assessed the association between academic burnout and career choice motivation in senior dental students., Methods: This cross-sectional study was performed on senior dental students of all four dental schools in Tehran in 2017. Dental students voluntarily filled out a 33-item questionnaire that comprised three sections. The first section included the Burnout Clinical Subtype Questionnaire (BCSQ-SS) with 12 questions addressing academic burnout. The second section consisted of 8 questions about career choice motivation, and the third section concentrated on 13 questions dealing with demographics. The individual scores of each section and the total scores were reported. The factor analysis of 8 questions about dental career choice motivation yielded 3 factors of social status and security, altruism, and others' advice motivations. The data were analyzed using regression test., Results: Totally, 131 students filled out the questionnaire (response rate = 86%). The total score of academic burnout was 38.89% ± 1.13%. The highest and the lowest burnout scores belonged to the domains of "overload" (46.69%± 1.46%) and "neglect" (31.98%± 1.32%), respectively. The most and the least frequently mentioned source of motivation for choosing dentistry were high income and failing to enter other fields, respectively. The burnout score was higher in students with altruism motivations (P = 0.007) and lower in students with others' advice motivations (P = 0.004). The burnout score was higher in students with inadequate or moderate financial support from the family and lower in students whose mothers' educational level was high-school diploma or lower., Conclusion: Senior dental students in Tehran encountered different levels of academic burnout. In the present study, low financial support and altruism as career choice motivations were associated with higher level of academic burnout.

Background: This study aimed to design a gamified smartphone application (app) and assess its efficacy for education of mothers regarding oral healthcare of their children., Methods: In this pretest-posttest controlled clinical trial, a simple app and a gamified version of it were designed to enhance the oral health knowledge and practice of mothers. The app contains information about early childhood caries, health diet, sugars, baby-oral hygiene, fluoride effect, fluoride toothpaste, tooth-brushing training video and regular dental visits. The opinion of experts and 3 mothers were obtained and both apps were revised accordingly. The intervention was implemented on mothers of preschoolers referring to the specialty dental clinic of Tehran School of Dentistry in 2019. The mothers were randomly allocated to the simple app or gamified app group. Before the intervention, all mothers filled out a questionnaire regarding oral health knowledge and practice, and their demographics were collected. The plaque index (PI) of children was also measured. The mothers filled out the same questionnaire 1 month after the intervention, and the PI of children was measured again. Paired t test and linear regression model were used for statistical analysis of the data., Results: Totally, 58 mother and child pairs entered the study; 40% of children were boys. The mean age of children was 4.7 ± 1.2 years. The mean knowledge score of mothers in the pretest was 10.5 and 11.3 in simple app and gamified app group, respectively, which changed to 13.1 and 14.3, respectively in the posttest. The mean practice score of mothers was 4.4 and 4.8 in simple app and gamified app groups, respectively in the pretest, which changed to 8.5 and 8, respectively in the posttest. The mean dental plaque index of children in the pretest was 0.8 and 1 in simple app and gamified app groups, respectively, which changed to 0.5 and 0.5, respectively in the posttest. Children had better Plaque control in gamified app group (P < 0.05)., Conclusion: After 1 month, both apps effectively improved the oral-health knowledge and practice of mothers while oral hygiene as a result of plaque control was superior in children of mothers using the gamified app. Trial registration IRCT, IRCT20131102015238N2. Registered 24 February 2019-Retrospectively registered, https://fa.irct.ir/trial/36600 .

Objectives: This study evaluated the effect of two educational interventions on knowledge and self-reported practice of mothers of 8-year-old children regarding emergency management of traumatic dental injuries (TDIs)., Materials and Methods: Six public elementary schools (girls and boys) in Tehran were randomly selected. The mothers of 8-year-old students at each school were randomly assigned to three groups: intervention by poster, intervention by pamphlet, and control. An anonymous valid and reliable questionnaire, including demographics, previous experience on TDIs, mothers' knowledge, and self-reported practice about emergency management of TDIs was provided to the mothers. After collecting the questionnaires, educational interventions by poster and pamphlet with similar contents regarding step-by-step emergency management of TDIs were performed for the target groups. Three months after the interventions, the same questionnaire was completed by the mothers. The results of pre-test and post-test were compared., Results: Totally, 201 mothers participated in this study. The mean knowledge score significantly increased in the pamphlet group (P<0.05) after the intervention, while this change was not significant in the poster and control groups (P>0.05). The mean knowledge score was significantly higher in the pamphlet than the poster group (P=0.009). The mean self-reported practice score significantly increased after the intervention in both intervention groups (P<0.05) but not in the control group. There was no significant difference in the mean self-reported practice score between the two intervention groups (P>0.05)., Conclusion: Both pamphlet and poster were equally effective in improving the self-reported practice of mothers regarding TDIs, which highlights the significance of educating mothers., Competing Interests: CONFLICT OF INTEREST STATEMENT None declared., (Copyright © 2020 The Authors. Published by Tehran University of Medical Sciences.)

Background: COVID-19 is a global pandemic affecting all aspects of life in all countries. We assessed COVID-19 knowledge and associated factors among dental academics in 26 countries., Methods: We invited dental academics to participate in a cross-sectional, multi-country, online survey from March to April 2020. The survey collected data on knowledge of COVID-19 regarding the mode of transmission, symptoms, diagnosis, treatment, protection, and dental treatment precautions as well as participants' background variables. Multilevel linear models were used to assess the association between dental academics' knowledge of COVID-19 and individual level (personal and professional) and country-level (number of COVID-19 cases/ million population) factors accounting for random variation among countries., Results: Two thousand forty-five academics participated in the survey (response rate 14.3%, with 54.7% female and 67% younger than 46 years of age). The mean (SD) knowledge percent score was 73.2 (11.2) %, and the score of knowledge of symptoms was significantly lower than the score of knowledge of diagnostic methods (53.1 and 85.4%, P <  0.0001). Knowledge score was significantly higher among those living with a partner/spouse than among those living alone (regression coefficient (B) = 0.48); higher among those with PhD degrees than among those with Bachelor of Dental Science degrees (B = 0.48); higher among those seeing 21 to 30 patients daily than among those seeing no patients (B = 0.65); and higher among those from countries with a higher number of COVID-19 cases/million population (B = 0.0007)., Conclusions: Dental academics had poorer knowledge of COVID-19 symptoms than of COVID-19 diagnostic methods. Living arrangements, academic degrees, patient load, and magnitude of the epidemic in the country were associated with COVD-19 knowledge among dental academics. Training of dental academics on COVID-19 can be designed using these findings to recruit those with the greatest need.

Objective: COVID-19 pandemic led to major life changes. We assessed the psychological impact of COVID-19 on dental academics globally and on changes in their behaviors., Methods: We invited dental academics to complete a cross-sectional, online survey from March to May 2020. The survey was based on the Theory of Planned Behavior (TPB). The survey collected data on participants' stress levels (using the Impact of Event Scale), attitude (fears, and worries because of COVID-19 extracted by Principal Component Analysis (PCA), perceived control (resulting from training on public health emergencies), norms (country-level COVID-19 fatality rate), and personal and professional backgrounds. We used multilevel regression models to assess the association between the study outcome variables (frequent handwashing and avoidance of crowded places) and explanatory variables (stress, attitude, perceived control and norms)., Results: 1862 academics from 28 countries participated in the survey (response rate = 11.3%). Of those, 53.4% were female, 32.9% were <46 years old and 9.9% had severe stress. PCA extracted three main factors: fear of infection, worries because of professional responsibilities, and worries because of restricted mobility. These factors had significant dose-dependent association with stress and were significantly associated with more frequent handwashing by dental academics (B = 0.56, 0.33, and 0.34) and avoiding crowded places (B = 0.55, 0.30, and 0.28). Low country fatality rates were significantly associated with more handwashing (B = -2.82) and avoiding crowded places (B = -6.61). Training on public health emergencies was not significantly associated with behavior change (B = -0.01 and -0.11)., Conclusions: COVID-19 had a considerable psychological impact on dental academics. There was a direct, dose-dependent association between change in behaviors and worries but no association between these changes and training on public health emergencies. More change in behaviors was associated with lower country COVID-19 fatality rates. Fears and stresses were associated with greater adoption of preventive measures against the pandemic., Competing Interests: The authors have declared that no competing interests exist.

Background: Increasing the proportion of caries-free children following the WHO's global target has led to more desirable welfare and a higher level of quality of life for children. In the present study, we aimed to evaluate the factors contributing to a caries-free condition in preschool children as a basic action towards the global goals of children's oral health., Methods: This was a case-control study evaluating the protective factors contributing to dental caries free in 4-6-year-old children in Tehran/Iran in 2017. 500 preschool children and their mothers were selected from 22 randomly selected preschools and were enrolled in the study. The participants were divided into two case (caries-free) and control (with dental caries) groups. The data were collected using two data gathering tools; the child oral examination form and the mother's valid questionnaire. The latter included three domains; socio-demographic factors, behavioral oral health measures, and feeding practices and dietary habits. The criteria for caries detection were cavities in the enamel and dentine. A logistic regression model was applied to identify caries-free protective factors (P < 0.05)., Results: Among 230 caries-free and 270 non-caries-free children who participated in the study, boys were more caries-free (P = 0.001). The protective factors against dental caries that were identified in the study were dental check-up as the cause of dental visit, being the first child in the family, the fewer sessions night feeding of the child's, family's house ownership, and parent's university education (P < 0.05)., Conclusions: Dental health can be achieved by considering protective factors like the regular dental check-up and socio-economic factors. Communities are invited to pay close attention to these important protective factors as far as they can increase the proportion of caries-free among preschool children especially in countries with developing oral health care systems.

Background: This study assessed the direct, indirect and total effect of distal - political - risk indicators (affecting populations), and proximal risk indicators (affecting women) on the global prevalence of early childhood caries (ECC) in 3-5 year old children., Methods: Data on global ECC prevalence were obtained from a prior study. Data for distal risk indicators (voice and accountability; political stability/absence of terrorism; control of corruption) were obtained from the World Bank Governance indicators, 2016. Data for proximal risk indicators (women's opportunity for leadership; percentage of female legislators, top officials and managers; basic employability status of women; ability of women to afford time off work to care for newborns; gross national income (GNI) per capita for females) were derived from the Human Development Index, 2016. Associations between variables were assessed with path analysis., Results: Voice and accountability (β = - 0.60) and GNI per capita for females (β = - 0.33) were directly associated with a lower ECC prevalence. Political stability/absence of terrorism (β =0.40) and higher percentage of female legislators, senior officials and managers (β = 0.18) were directly associated with a higher ECC prevalence. Control of corruption (β = - 0.23) was indirectly associated with a lower ECC prevalence. Voice and accountability (β = 0.12) was indirectly associated with a higher ECC prevalence. Overall, voice and accountability (β = - 0.49), political stability/absence of terrorism (β = 0.34) and higher female GNI (β = - 0.33) had the greatest effects on ECC prevalence., Conclusion: Distal risk indicators may have a stronger impact on ECC prevalence than do proximal risk indicators.. Approaches to control ECC may need to include political reforms.

Aim: This study was conducted to evaluate the impact of health promotion interventions on early childhood caries prevention in 2-5 year-olds receiving dental treatment under general anesthesia. Materials and Methods: Thirty-seven mother-child couples presenting to the clinic of the Dental School of Tehran University of Medical Sciences for treatment under general anesthesia were randomly divided to two groups: 19 couples in the pamphlet and fluoride varnish four times a year, and 18 couples in the pamphlet plus six phone call reminders and fluoride varnish four times a year. A standard questionnaire on demographics and children oral health-related practice of parents was completed by respondents. On children's oral examination, the Simplified Oral Hygiene Index (OHI-S), dmft, and the presence of new white spot lesions (WS) were recorded in both phases. At the final stage, Early Childhood Oral Health Impact Scale (ECOHIS) was completed by parents. The length of follow-up was 24 months. Results: In both groups, there was an increase in the number of mothers who knew how to brush their children's teeth as well as the number of mothers who brushed their children's teeth ( P < 0.05). In the reminder group, an improvement occurred in the mothers' perception of their perceived ability to make their children brush their teeth twice a day ( P = 0.03). Clinical examination revealed a significant decrease in the OHI-S (from 1.9 ± 0.8 to 1.15 ± 0.5) and the number of WS (from 8.5 ± 5.5 to 0.08 ± 0.5) in both groups on the follow-up visit. The mean dmft was 11.0 ± 4.0 with a mean d component of 10.56 ± 4 at the baseline, which decreased significantly to 1.44 ± 1.96 after dental treatment. No significant increase was seen in new caries in the intervention groups. There was no significant difference in the ECOHIS score between the two groups. Conclusion: The similar impact of both interventions suggests the possibility of applying the simpler one, i.e., the educational pamphlet, fluoride varnish and frequent follow-ups. However, in the reminder group, the mothers' perception of their perceived ability to make children brush their teeth twice a day was improved., (Copyright © 2020 Razeghi, Amiri, Mohebbi and Kharazifard.)

Background: Continuing education aims at assisting physicians to maintain competency and expose them to emerging issues in their field. Over the last decade, approaches to the delivery of educational content have changed dramatically as medical education at all levels is now benefitting from the use of web-based content and applications for mobile devices. The aim of the present study is to investigate through a randomized trial the effectiveness of a smart phone application to increase public health service physicians' (PHS physicians) knowledge regarding pediatric oral health care., Method: Five of all seven DHCs (District Health Center) in Tehran, which were under the supervision of Tehran University of Medical Sciences and Iran University of Medical Sciences, were selected for our study. Physicians of one DHC had participated in a pilot study. All PHS physicians in the other four centers were invited to the current study on a voluntary basis (n = 107). They completed a self-administered questionnaire regarding their knowledge, attitudes, practice in pediatric dentistry, and background. PHS physicians were assigned randomly to intervention and control groups; those in the intervention group, received a newly designed evidence-based smartphone application, and those in the control group received a booklet, a CME seminar, and a pamphlet. A post-intervention survey was administered 4 months later and t-test and repeated measures ANCOVA (Analysis of Covariance) were performed to measure the difference in the PHS physicians' knowledge, attitude and practice., Results: In both groups, the mean knowledge scores were significantly higher (p-Value < 0.001) in post-intervention data compared to those at baseline. Similar results existed in attitude and practice scores. Although the scores in knowledge in the intervention group indicating potentially greater improvement when compared to those of the control group, the differences between the two groups were not statistically significant (dif: 0.84, 95% CI - 0.35 to 2.02)., Conclusion: In the light of the limitations of the present study, smart phone applications could improve knowledge, attitude and practice in physicians although this method was not superior to the conventional method of CME., Trial Registration: Our clinical trial had been registered in Iranian Registry of Clinical Trials (registration code: IRCT2016091029765N1).

Background: Burnout Clinical Subtype Questionnaire (BCSQ-12-SS) is a short valid questionnaire for assessment of burnout in students. The aim of the present study was to evaluate the psychometric properties of Persian-translated version of the BCSQ-12-SS and assess the burn out clinical subtypes and their correlates in dental students., Methods: In this psychometry study, the BCSQ-12-SS questionnaire in domains of overload (4 questions), lack of development (4 questions), and neglect (4 questions) was translated to Persian and back-translated. Six experts determined the content and face validity of the Persian version. The questionnaire was then piloted on 167 dental students of Tehran University of Medical Sciences in 2016. Data were analyzed using Exploratory Factor Analysis (EFA) and Confirmatory Factor Analysis (CFA) for construct validity and Linear Regression modeling in IBM SPSS and AMOS SPSS. To assess reliability, the questionnaire was filled out by 15 students twice and Kappa coefficient and Composite Reliability (CR) were calculated., Results: Content validity Ratio (CVR) and Content Validity Index (CVI) values and Cronbach's alphas were all over 0.8. Kappa coefficient ranged from 65 to 82.5%. The average burnout score was 29.6 out of maximum score of 60. There were no significant differences in burnout scores across the different semesters (8,10 and 12). Financial support by the family significantly affected the total score of burnout and lack of development. In addition, gender, mother's education, residential status of student, preparing for post graduate exam and financial support by the family affected the overload., Conclusion: The BCSQ-12-SS has good psychometric properties and therefore can be used to assess burnout in IRANIAN dental students. The BCSQ-12-SS may provide an opportunity to identify individuals at risk for burn out and provide counseling to assist in dental student development.

Aim: To assess dental fear and its determinants in 7-11-year-old children., Methods: In this cross-sectional (descriptive-analytical) study, the standard Persian version of the Children's Fear Survey Schedule-Dental Subscale (CFSS-DS) questionnaire was completed by 240 parent-child (children aged 7-11 years) pairs referred to dental clinics in Tehran city, Iran. Background characteristics were also inquired., Results: An equal number of boys and girls participated in the study. The mean score of fear among the children was 21.66 ± 8.33. The causes of fear among the children were, first, injection, and then, seeing the dentist's drill, choking feeling, and finally, filling the tooth. There was a significant correlation between the scores of children's dental fear and their experience of meeting with the dentist (p = 0.001). The result of the regression test showed that the age of the children (p = 0.022) and high levels of dental fear among their fathers (p < 0.001) was related to high levels of dental fear among the children., Conclusions: The present children revealed a moderate level of dental fear. Taking children's age into account in behavioural management and challenging father's fear seemed to play a key role to reduce the child's fear and prevent its long-term consequences.

Background: The present study evaluated the effect of two educational interventions on the knowledge and self-reported practice of primary school teachers regarding emergency management of traumatic dental injuries (TDIs)., Methods: All primary school teachers (n = 664) of Arak, Iran were asked to participate in the study. Based on geographic regions, all participants were enrolled in two groups: educational leaflet and oral presentation. At baseline, teachers in both groups were asked to complete an anonymous self-administrated questionnaire consisting of demographics, eight questions on knowledge, and four paper cases on self-reported practice about TDIs. After collecting the questionnaires, interventions, including an oral presentation and an educational leaflet whose contents were prepared based on the most recent scientific evidence, were implemented. One and six months after the interventions, the questionnaire was completed by the teachers again. Repeated measures ANOVA and a linear regression model were used for statistical analysis., Results: Two hundred and ninety-two teachers participated in all stages of the study (response rate = 64.5%). In one-month follow-up, in both groups, the mean score of knowledge was significantly higher compared to baseline and six-month scores (P < 0.001 and P < 0.001, respectively). Moreover, in six-month follow-up, the mean score of knowledge was higher compared to baseline (P < 0.001) in both intervention groups. No statistically significant difference existed in the mean score of knowledge in three evaluations between two groups (P < 0.05). In one-month follow-up, the mean score of self-reported practice was significantly higher compared to baseline and six-month scores in both interventional groups (P < 0.001 and P < 0.001, respectively). There was no significant difference in the mean score of self-reported practice between the one-month and six-month follow-up (P = 0.53). There was no statistical significant difference in the mean score of self-reported practice in three evaluation phases between two groups (P < 0.05). No significant relationship was observed between the difference in knowledge and self-reported practice scores and demographic factors., Conclusions: Both educational interventions regarding emergency management of TDIs-educational leaflet and oral presentation- were effective in increasing knowledge and self-reported practice of teachers in the short-term follow-up. In long-term evaluation, educational leaflet resulted in more positive changes in teachers' knowledge compared to their self-reported practice.

Background: In addition to numerous general health problems, drug dependents manifest various oral health disorders. Our aim was to investigate the oral health status and its determinants among in-treatment opiate dependents., Methods: As part of a comprehensive cross-sectional survey on opiate dependents admitted to methadone maintenance centers in Tehran, Iran, we conducted a clinical study in two centers from different socioeconomic areas. A trained dentist conducted face to face interviews and clinical oral examinations based on World Health Organization (WHO) criteria for Decayed, Missing, Filled Teeth (DMFT) index and Community Periodontal Index (CPI) on volunteer patients. Student's t-test, Mann-Whitney U, Kruskal Wallis, and Chi 2 tests, in addition to linear and logistic regression models served for statistical analysis (p < 0.05)., Results: A total of 217 patients (98% men), with a mean age of 43.6 years (SD 12.3) participated in the study. Opium was the main drug of abuse reported by 70% of the participants followed by crystalline heroin (22%). Of the participants, 24.4% were totally edentulous. The mean DMFT score of participants was 20.3 (SD 7.8). Missing teeth comprised the main part of the index followed by decayed and filled teeth. Older patients (p < 0.001) and the patients with a lower socioeconomic status (p = 0.01) had higher DMFT scores. None of the dentate patients had a healthy periodontium. Maximum CPI mostly consisted of shallow pockets (66%) followed by calculus in 15%, deep pockets in 11%, and bleeding in 8% of the participants. Older participants (p = 0.02) and those who started drug abuse at a younger age (p = 0.01) were more likely to develop periodontal pockets., Conclusions: Opiate dependents had a poor oral health status in terms of the dentition status and periodontal health. Missing teeth comprised the main part of their dental caries history and none had a healthy periodontium. Oral health care should be integrated into the package of general health services available in treatment centers.

Background: Family physicians are in frequent contact with patients, and their contribution to oral health promotion programs could be utilized more effectively. We implemented an oral health care (OHC) educational seminar for physicians and evaluated its impact on their knowledge retention in OHC., Methods: We conducted an educational trial for primary care physicians (n = 106) working in Public Health Centers in Tehran city. We launched a self-administered questionnaire about pediatric dentistry, general dental, and dentistry-related medical knowledge and backgrounds. Physicians in intervention group A (n = 38) received an educational intervention (Booklet, Continuous Medical Education (CME), and Pamphlet), and those in group B (n = 32) received only an OHC pamphlet. Group C (n = 36) served as the control. A post-intervention survey followed four months later to measure the difference in the physicians' knowledge; the Chi-square test, ANOVA and linear regression analysis served for statistical analysis., Results: The intervention significantly increased the physicians' oral health knowledge scores in all three domains and their total knowledge score (p <  0.001). Those physicians who had lower knowledge scores at the baseline showed a higher increase in their post-intervention knowledge. The models showed no associations between the background variables and the knowledge change., Conclusion: The primary care physicians' OHC knowledge improved considerably after an educational seminar with a reminder. These findings suggest that OHC topics should be included in physicians' CME programs or in their curriculum to promote oral health, especially among non-privileged populations.

Background: Pregnant women are vulnerable to a wide range of oral health conditions that could be harmful to their own health and future child. Despite the usefulness of regular dental service utilization in prevention and early detection of oral diseases, it is notably low among pregnant women. In this qualitative study, we aimed to explore barriers and facilitators influencing pregnant women's dental service utilization., Methods: Using a triangulation approach, we included pregnant women (n = 22) from two public health centers, midwives (n = 8) and dentists (n = 12) from 12 other public centers in Tehran (Iran). Data was gathered through face-to-face semi-structured interviewing and focus group discussion methods. The analysis of qualitative data was performed using conventional content analysis with MAXQDA10 software., Results: Reported barriers of dental service utilization among pregnant women were categorized under emerging themes: Lack of knowledge and misbelief, cost of dental care, physiological changes, fear and other psychological conditions, time constraint, dentists' unwillingness to accept pregnant women treatment, cultural taboos and lack of interprofessional collaboration. Solutions proposed by dentists, midwives and pregnant women to improve dental care utilization during pregnancy were categorized under three themes: Provision of knowledge, financial support and establishing supportive policies., Conclusions: Understanding perceived barriers of dental service utilization during pregnancy can serve as baseline information for planning and formulating appropriate oral health education, financial support, and legislations tailored for lower income pregnant women, midwives and dentists in countries with developing oral health care system.

Purpose: The mandible is an essential esthetic and functional component of the lower third of the face and its reconstruction has always been a challenge, especially after severe post-traumatic injuries. The purpose of the present report was to introduce a new approach of mandibular reconstruction in a patient who had lost the entire mandible except for the rami after being severely injured in a blast., Materials and Methods: A new approach using a titanium mandibular rami implant technique was applied using computer-aided 3-dimensional virtual planning and rapid prototyping technology. A prosthetic component was supported by the mandibular implant, which achieved occlusion and dedicated function for the patient., Results: This method offered precise adaptation of the implant and prosthesis and an easier surgical procedure, providing a shortened operation time, no donor site morbidity, and more predictable outcomes., Conclusion: This new technique allows reconstruction of large-scale mandibular defects that is not possible by conventional surgical methods., (Copyright © 2017 American Association of Oral and Maxillofacial Surgeons. Published by Elsevier Inc. All rights reserved.)

Purpose: This study aimed to compare the effectiveness of alveolar cleft repair using iliac bone and freeze-dried bone allograft (FDBA) in the presence of plasma rich in growth factors (PRGF)., Materials and Methods: Patients with unilateral alveolar cleft (n = 32) were randomly allocated to either the iliac plus PRGF group or the FDBA plus PRGF group. CBCT images were obtained before and 6 months after the surgery to assess the regenerated bone volume. Paired t-tests and two-way analysis of variance (ANOVA) were applied to analyze the data using SPSS 16.0 software., Results: The patients' mean age was 15 ± 5.7 years (range = 8-27). In the iliac plus PRGF group, the mean volume of cleft before the surgery and the mean regenerated bone volume 6 months after were 1.67 ± 0.66 and 1.14 ± 0.47 cm 3 , respectively. The corresponding values were 1.5 ± 0.54 and 0.72 ± 0.23 cm 3 in the FDBA plus PRGF group. The remaining bone to cleft volume ratio was not associated with grafting time (secondary or tertiary) and the original cleft volume. Iliac bone reinforced with PRGF was more successful than FDBA plus PRGF in repairing alveolar cleft (p = 0.007)., Conclusion: Due to the poor performance of the allograft, autografts should still be preferred in spite of possible donor site morbidity., (Copyright © 2017 European Association for Cranio-Maxillo-Facial Surgery. Published by Elsevier Ltd. All rights reserved.)

Objectives: Fluoride varnish application is an effective way to prevent caries in children. We aimed to educate preschool children's mothers on how to apply fluoride varnish and compare their performance with dental students and to assess their self-reported competency six months later., Materials and Methods: Eighty-eight 4-6-year-old children presenting to toy houses of six randomly selected health centers in a non-affluent district of Tehran in 2014 were divided into two groups to receive fluoride varnish by their mothers and students. Mothers and senior dental students participated in a session consisting of lecture, discussion, and demonstration of fluoride varnish application for a child. Then, in three centers, mothers and in others, students applied fluoride varnish for preschoolers and their performance was evaluated. Six months later, mothers were asked to apply fluoride varnish again. Mann-Whitney U test, t-test, one-way ANOVA and logistic regression model were used for statistical analyses., Results: The mean performance score was 9.74±0.22 (out of 10) for mothers and 9.71±0.15 for students (P=0.89). After six months, the mean performance score was 9.58 for mothers, which was not significantly different from that in the first session. The age and educational level of mothers were conversely correlated to their performance (P<0.05). Of mothers, 96% believed that they were competent to repeat fluoride varnish application for their children., Conclusions: Mothers' high performance score and the point that the majority of them felt competent to apply varnish for their children casts light on their potential key role in oral health promotion.

Objectives: To evaluate the association between dental service utilization and mental health in an adult population in the context of the socioeconomic status of the participants., Subjects and Methods: Multi-stage cluster random sampling was performed in Tehran, Iran, in 2011. Data were collected on dental service utilization, barriers of dental visit, self-perceived oral health, mental health, age, gender, education, and wealth status. The complex sample analysis method in SPSS and the survey data analysis menu in STATA were employed for statistical evaluation., Results: Of 20,320 participants, 25-36% suffered from disorders in at least one of the domains of somatization, anxiety, social dysfunction, and depression. Only 56% of the participants visited a dentist at least once during the last year. The main barriers to a dental visit were "no perceived need" and "high costs." Females, the richest participants, subjects aged 25-64-year-old, and those with poor self-perceived oral health, mental health disorders, and higher education had more visits. The participants who perceived the need but did not visit a dentist due to some reasons mostly comprised females, those aged 25-44-year-old, those with a poor perceived oral health, disordered people in all domains of mental health, and poorer participants., Conclusion: Dental service utilization was influenced by socioeconomic factors and the mental health status of the adult population after controlling for multiple confounders. Reducing financial hardship and providing health education on the importance of preventive visits may decrease barriers to regular visits in countries with developing oral health systems.

Introduction: Studies in several countries have shown that dental students need an improved educational programme concerning management of disabled patients. We aimed to study the effect of providing a course entitled 'Oral health care of disabled patients' on knowledge and attitudes of senior dental students at Tehran University., Materials and Methods: A total number of 70 students (n=70) were asked to fill in a questionnaire regarding their background, knowledge and attitudes, before and after the programme. The intervention group of 36 students (n=36) received a four-session course consisting of lectures, group discussion, screening and fluoride varnish provision for disabled patients. Statistical analysis was performed using the Mann-Whitney U-test, the chi-square test and linear regression modelling., Results: Amongst all the participants, 36% had previously treated a disabled patient and 58% believed that merely specialists should treat disabled patients. Twenty-seven percentage of participants believed that hospital is the only proper facility for treating disabled patients. A considerable improvement in both knowledge and attitudes of students was observed following the intervention (P<0.05)., Conclusions: Our findings indicate that a short-term training programme on oral health care has an immense impact on students' adherence to treating disabled patients. These results provide evidence to support the necessity of enrichment of the dental curriculum regarding oral health care for disabled patients., (© 2014 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.)