Journal of Dental School

Introduction: Intraosseous pathological lesions of the jaw include a wide range of benign to aggressive or malignant lesions with different clinical and histopathological characteristics and require various treatments. This study was designed to assess the frequency and characteristics of primary jaw lesions in a defined group of an Iranian population.

Materials and Methods: In this retrospective study, 6676 biopsy reports from the Oral and Maxillofacial Pathology Department, Shahid Beheshti University of Medical Sciences, were assessed. In cases with primary jaw lesions, other variables such as age, gender, location of lesions, and microscopic diagnosis were recorded. The lesions were categorized into “benign /malignant” and “inflammatory” /“non-inflammatory” groups. Chi-square, Kruskal-Wallis, Fisher exact, and T-test were used for statistical analysis.

Results: In total, 395 (5.91%) cases had a primary osseous lesion (63.70% female, 36.29% male) with a mean age of 32.37±16.94. About 74% of the lesions were found in the mandible with posterior predilection. Fibro-osseous lesions (27.03%), Central Giant Cell Granuloma (22.57%), and Osteomyelitis (9.18%) were the most common histopathologic diagnosis. The most common malignant tumor was Osteosarcoma (8.61%). Of the total lesions, 10.2% were inflammatory lesions.  The most common lesions in children and adolescents were fibro-osseous lesions (24.7%), central giant cell granuloma (24.7%), and simple bone cysts (18.8%).

Conclusion: Fibro-osseous lesions and central giant cell granuloma were the most common primary osseous lesions of the jaw in older adults and children with a female predilection. Malignancies included about 9% of all lesions. This study provides a large collection of demographic and microscopic data on primary osseous lesions that will help in accurate diagnosis and appropriate treatment of these lesions.

Objectives Studies have shown the high prevalence of dental caries, negligence of oral health, and unmet dental care needs among children with hearing impairment compared to their healthy peers. This study was conducted to determine the barriers to oral health of children with hearing impairment from the perspective of their mothers.

Methods In this qualitative study, semi-structured interviews were conducted with 19 mothers based on purposive sampling in order to investigate the factors affecting compliance with oral health. Interviews were recorded, handwritten, coded and classified; and for content analysis, Graneheim and Lundman's qualitative approach was used.

Results As a result of the data analysis, the three main themes of “the effects of general health status, the effects of instruction and learning, and problems in receiving dental health care services” were identified as barriers to good oral health. Moreover,  nine sub-themes of “inadequate education regarding oral health, parental insufficient supervision, shortages in dentistry service delivery systems, obstacles hindering mother from pursuing services, lack of guidelines for offering free periodical dental examinations for children with special needs, the impact of improper nutritional habits on oral health, children’s mental problems, unfavorable oral health conditions, and  the impact of oral health on the child’s general health" were obtained.

Conclusion Inadequate education in the field of oral health and difficulties in receiving dental services were identified as the most important factors affecting oral health in children with hearing impairment from their mothers' perspective.

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Objectives Tooth agenesis or hypodontia is a major problem that may occur in any person in any area of the mouth. However, it is of greater significance in patients with cleft lip and palate (CLP) because of their susceptibility to various problems. This study aimed to investigate the prevalence of tooth agenesis in both jaws among patients with CLP.

Methods In this descriptive analytical study, a total of 150 unilateral CLP and 30 bilateral CLP patients (age range, 4-19 years) were randomly selected, and their panoramic radiographs were examined. The collected data were analyzed using Chi-square test, Mann-Whitney test, Fisher’s exact test, and logistic regression analysis.

Results:The results of Chi-square test revealed that the prevalence of tooth agenesis was significantly higher in unilateral CLP patients compared to their bilateral CLP counterparts (P=0.039). The maxillary lateral incisors (26%), followed by right maxillary first premolars (20%), accounted for the highest number of hypodontia. The results of Mann-Whitney test did not indicate any significant differences in the number of hypodontia between unilateral and bilateral CLP patients (P=0.158).

Conclusion The frequency of tooth agenesis in the evaluated CLP population of Isfahan (Isfahan Province, Iran) was similar to that of other populations around the world. According to the present findings, unilateral CLP was more frequent than bilateral CLP, and left-sided CLP was more frequent than right-sided CLP and bilateral CLP.

Objectives This study aimed to assess the knowledge and attitude of mothers of elementary school children toward pediatric dental care in Iran.

Method A cross-sectional study was conducted on mothers of 254 elementary school children between the ages of 6 and 12 years residing in Qom City, Iran, in 2021. Data collection was performed using a standard questionnaire with confirmed validity and reliability for the Iranian population, which was distributed to mothers online. Data were analyzed using ANOVA and t-test..

Results The response rate was 30.97%. The mean age of mothers was 35.88±6.62 years. The majority of them had a Bachelor's degree, while 21% had a high school diploma or lower degree, and 79% had a degree higher than a high school diploma. The mean knowledge score of mothers was 31.71±4.17 out of 40, and their mean attitude score was 24.19±4.20 out of 30. Among the children, 35.7% were girls, and 64.3% were boys. About 26.8% reported brushing their teeth more than once a day, while 73.2% reported toothbrushing once a day or less. Mothers' age showed no significant correlation with their knowledge (P=0.691) or attitude (P=0.155). Similarly, their educational level showed no significant correlation with their knowledge (P=0.355) or attitude (P=0.155).

Conclusion The mothers of elementary school children assessed in this study demonstrated a relatively high level of knowledge and attitude toward pediatric dental care. Additionally, mothers' educational level had a significant correlation with the frequency of toothbrushing reported by their children.

Objectives Communication skills are key element of dental practice. In this study, we aimed to evaluate the effects of a communication skill training course on the verbal, listening, and feedback skills of dental students.

Methods A total of 42 (20 males and 22 females) third-year dental students of the School of Dentistry of Shahid Beheshti University of Medical Sciences (Tehran, Iran) were enrolled in this study and asked to complete the Burton GE questionnaire before and after the clinical communication skill training course. The students were instructed through lectures, case-based scenarios, and group discussions. The questionnaire consisted of 18 questions in three dimensions of listening, verbal, and feedback skills, with each area including six questions. The reliability coefficient was determined by measuring Cronbach’s alpha coefficient. The validity of the questionnaire was also investigated in this study. The collected data were analyzed using paired t-test.

Results The mean total score of the students increased from 17.07 to 22.17 for the verbal skills, from 11.80 to 15.21 for the listening skills, and from 16.55 to 21.76 for the feedback skills. There were significant improvements in the students’ verbal (P<0.001), listening (P<0.001), and feedback skills (P<0.001) after their participation in the communication skill training course. No sex predilection was observed in the baseline and final results.

Conclusion communication skill training courses could have remarkable effects on the  improvement of verbal, listening, and feedback skills of dental students.

Objectives Oral lichen planus (OLP) is a chronic mucocutaneous disease, involving the skin and mucous membranes. Although the pathogenesis of OLP is not fully understood, the immune system, genetic and environmental factors, medications, and infections may play an important role in OLP. The level of matrix metalloproteinases (MMPs) is known to increase in pathological conditions, such as squamous cell carcinoma (SCC), as well as inflammatory conditions, such as OLP. If pain and soreness are present, topical corticosteroids (CSs) are the first-line treatment for these patients. This study aimed to evaluate the level of MMP-9 in individuals with OLP before and after treatment with triamcinolone 0.2% mouthwash.

Method This study was conducted on 18 patients with erosive-atrophic OLP. First, 5 mL of unstimulated saliva was collected, and then, triamcinolone 0.2% mouthwash was prescribed to all the patients. After treatment and healing of the lesions, a sample was collected again from the participants. The MMP-9 concentration was quantified in all the samples using an ELISA kit.

Results The mean age of the participants, including five males and 13 females, was 45.7 years in this study. Before treatment, the mean MMP-9 concentration was 1.599 ng/mL, with a standard deviation (SD) of 1.074, while the mean (±SD) level of MMP-9 was 0.933 ng/mL (0.649) after treatment. The mean reduction was estimated at 0.666, with SD of 1.056 (P=0.016).

Conclusion The MMP-9 level was significantly lower after treatment compared to the pretreatment stage. Based on the results, topical CSs, such as triamcinolone, can decrease the level of MMP-9, as a reliable biomarker of OLP severity; therefore, they can diminish inflammation and prevent the dysplastic progression of the disease.

Objectives Orthokeratinized odontogenic cysts (OOCs) are relatively uncommon odontogenic cysts, lined by an orthokeratinized epithelium. These cysts show different clinical behaviors from the more common odontogenic keratocysts (OKCs), and it is important to distinguish these two types of cysts. Commonly, OOCs manifest as well-defined, unilocular, radiolucent lesions, with a high frequency in the mandibular region. In this case report, we aimed to describe a large maxillary OOC with prominent tooth displacement.

Case The patient was a 14-year-old boy with significant painless swelling in the upper jaw. The panoramic radiograph revealed a well-defined, unilocular radiolucent area from midline to the first right maxillary molar with prominent tooth displacement. The lesion was completely excised under local anesthesia. The histopathological sections demonstrated a cystic lesion lined by an orthokeratinized stratified squamous epithelium with a prominent granular cell layer.

Conclusion Based on the present results, OOCs can be large in size and may be characterized by ballooning expansion and tooth displacement. Therefore, knowledge of the clinical and radiographic features of these uncommon odontogenic cysts can facilitate an accurate diagnosis.

Objectives Intrusive luxation is a severe type of dentoalveolar injury, which causes damage to the pulp and supporting tissues of a tooth, as the tooth is apically dislocated into the alveolar process.

Case This report describes a case of re-eruption of an intruded immature severely ankylosed upper permanent central incisor. A seven-year-old boy was referred to the pediatric dental clinic three months after a traumatic injury. Clinical and radiographic examinations revealed intrusive luxation of the immature left upper permanent central incisor. In the first visit, initial bracketing was performed, and the left central incisor was engaged. In the second visit (after four weeks), the tooth showed no movement and produced a metallic sound in percussion. The tooth was consequently luxated and engaged again with a heavier force and followed-up monthly.

Conclusion It re-erupted completely, and the follow-up periapical radiographs showed that root formation continued, and the root apex was approximately closed.