Barriers to the Accessibility of Emergency Pediatric Dental Care Services during the COVID-19 Pandemic: A Qualitative Study in Mashhad, Iran.

Objectives: The aim of this study was to investigate barriers to the accessibility of emergency pediatric dental care services during the coronavirus disease 2019 (COVID-19) pandemic from the viewpoint of parents in Mashhad, Iran. Materials and Methods: A qualitative study was conducted on a purposive sample of parents seeking emergency dental care for their children during the COVID-19 pandemic. Data were collected through semi-structured face-to-face interviews. The participants were asked, "Were there any barriers encountered when seeking emergency dental care for your child during the COVID-19 pandemic?". If any barrier was faced, the parents were asked to explain about it. All interviews were recorded and transcribed verbatim. The thematic content analysis of the transcripts began after the first interview, and the interviews and analysis process continued until data saturation was achieved. Results: In total, 26 parents were interviewed. The thematic content analysis of the transcripts led to the recognition of three main categories of barriers: "fear of COVID-19", "financial constraints", and "dentists' less occupational activity". "fear of COVID-19" had two subcategories: "fear of contracting COVID-19" and "fear of transmitting COVID-19 to others". "financial constraints" also had two subcategories: "increased costs" and "decreased income". Conclusion: From the viewpoint of parents seeking emergency dental care for their children in Mashhad, Iran, there were various barriers to the accessibility of emergency pediatric dental care services during the COVID-19 pandemic. The barriers were not limited to the fear of COVID-19 and were partly outside the control of dentists and parents.

Reducing pain and discomfort associated with rubber dam clamp placement in children and adolescents: a systematic review and meta-analysis of effectiveness.

BACKGROUND: The application of rubber dams is a widely accepted method of tooth isolation in dental practice. Placement of the rubber dam clamp might be associated with levels of pain and discomfort, especially in younger patients. The purpose of the present systematic review is to evaluate the efficacy of the methods for reducing pain and discomfort associated with rubber dam clamp placement in children and adolescents. MATERIALS AND METHODS: English-language literature from inception until September 6th, 2022 was searched in MEDLINE (via PubMed), SCOPUS, Web of Science, Cochrane, EMBASE, and ProQuest Dissertations & Theses Database Global for articles. Randomized controlled trials (RCTs) comparing methods of reducing the pain and/or discomfort associated with rubber dam clamp placement in children and adolescents were retrieved. Risk of bias assessment was performed using a Cochrane risk of bias-2 (RoB-2) risk assessment tool and the certainty of evidence was assessed using the Grading of Recommendations Assessment, Development and Evaluation (GRADE) evidence profile. Studies were summarized and pooled estimates of pain intensity scores and incidence of pain were calculated. The meta-analysis was conducted in the following groups according to type of interventions (LA, audiovisual (AV) distraction, behavior management (BM), electronic dental anesthesia (EDA), mandibular infiltration, inferior alveolar nerve block (IANB), TA), outcome (intensity or incidence of pain), and assessment tool (face - legs - activity - cry - consolability (FLACC), color scale, sounds - motor - ocular changes, and faces pain scale (FPS)): (a) pain intensity using (LA + AV) vs (LA + BM), (b) pain intensity using EDA vs LA (c) presence or absence of pain using EDA vs LA (d) presence or absence of pain using mandibular infiltration vs IANB (e) Comparing pain intensity using TA vs placebo (f) Presence or absence of pain using TA vs placebo. Meta-analysis was conducted using StataMP software, version 17.0 (StataCorp, College Station, Texas). Restricted maximum-likelihood random effect model (REML), Mean difference (MD) with 95% confidence interval, and log odds ratio (OR) with 95% CI were calculated were calculated. RESULTS: Initially, 1452 articles were retrieved. Sixteen RCTs were finally included for reviewing and summarizing. Nine articles with a total of 867 patients were included for quantitative meta-analysis. The differences in pain intensity scores were not significant in any comparison groups (group a: [MD = -0.04 (95% CI = - 0.56, 0.47), P = 0.87, I2 = 0.00%], group b: [MD = 0.25 (95% CI = -0.08, 0.58), P = 0.14, I2 = 0.00%], group c [MD = -0.48 (95% CI = -1.41, 0.45), P = 0.31, I 2 = 0.00%], group d: [MD = -0.67 (95% CI = -3.17, 1.83), P = 0.60, I 2 = 0.00%], group e: [MD = -0.46 (95% CI = -l.08, 0.15), P = 0.14, I 2 = 90.67%], and group f: [MD = 0.61 (95% CI = -0.01, 1.23), P = 0.06, I 2 = 41.20%]. Eight studies were judged as having some concern for risk of bias and the remaining studies were considered as low risk for bias. The certainty of evidence was considered medium for all comparison groups. DISCUSSION: In the present meta-analysis, a considerable difference was obtained between the included studies regarding intervention methods and pain assessment tools and the analysis was performed in groups with small numbers of the studies. Owing to the mentioned variabilities and the small number of studies, the results of the analysis should be interpreted with caution. The indistinguishability of the manifestations of pain/discomfort from fear/anxiety, particularly in children, should also be considered while using the results of the present study. Within the limitations of the current study, no significant differences were found between the proposed methods for reducing pain and discomfort associated with rubber dam clamp placement in children and adolescents. A larger number of more homogenous studies regarding intervention methods and pain assessment tools need to be conducted in order to draw stronger conclusions. TRIAL REGISTRATION: This study was registered in PROSPERO (ID number: CRD42021274835) and research deputy of Mashhad University of Medical Sciences with ID number 4000838 ( https://research.mums.ac.ir/ ).

Cytotoxicity and induced apoptosis of a new bioceramic cement containing simvastatin on stem cells from human exfoliated deciduous teeth.

Background: This study aims to compare cytotoxicity and induced apoptosis of a new bioceramic cement containing different concentrations of simvastatin on stem cells from human exfoliated deciduous teeth (SHED). Materials and Methods: This research was an in vitro study. To evaluate the cytotoxicity and induced apoptosis of the bioceramic cement containing different concentrations of simvastatin, the SHED were exposed to the cement during 1, 3, and 7 days. Pure bioceramic cement and pure simvastatin with concentrations of 1, 0.1, and 0.01 µM were also tested to evaluate the possible synergic effect. Mineral trioxide aggregate (MTA) as the gold standard of pulp dressing materials was compared. MTT assay and Annexin V assay were used to evaluate cytotoxicity and induced apoptosis, respectively. The data were analyzed using ANOVA and Tukey post hoc tests at the significance level of 0.05. Results: During 7 days, MTA, bioceramic cement, simvastatin 0.1 and 0.01 µM, and bioceramic cement containing 0.1 and 0.01 µM simvastatin increased (P < 0.05) and simvastatin with concentration of 1 µM decreased the cell viability (P < 0.05). Except for MTA and bioceramic cement containing 0.1 and 0.01 µM simvastatin, all other compounds induced apoptosis within 7 days (P < 0.05). Conclusion: After 7 days, the viability of the SHED in the presence of a new bioceramic cement containing 0.1 and 0.01 µM simvastatin was not compromised. Moreover, this cement showed superior results than MTA and provided an environment for cell proliferation. This finding appears to be due to the pharmacological effects of low concentrations of simvastatin.

A Simplified Method for the Restoration of Severely Decayed Primary Incisors.

OBJECTIVES: Caries and dental trauma are common reasons for primary anterior teeth restorations in children. This non-control clinical trial was designed to evaluate crown restorations reinforced with a sectioned file post for the restoration of severely damaged primary maxillary incisors. MATERIALS AND METHODS: Thirty-eight primary maxillary incisors of 12 children (3-5 years old) with early childhood caries (ECC) received composite restorations with a custom made post. The restorations were evaluated using the modified United State Public Health Service (USPHS) criteria. The results were statistically analyzed by descriptive -analytical tests. RESULTS: In this trial, the quality of marginal adaptation decreased after three and 12 months intervals. Recurrent carious lesions were observed during intervals. In terms of restoration retention, only one patient lost both the post and the restoration at the 12-month follow up. CONCLUSION: The sectioned file post technique showed good retention and aesthetics for restoring severely damaged primary maxillary anterior teeth.

Treatment of gingival physiologic pigmentation in adolescents by liquid nitrogen cryosurgery: 24-month follow-up.

Although gingival pigmentation is physiologic in most cases, esthetic concerns regarding "black gums" are common among adolescents. Numerous procedures have been suggested to treat this problem. The aim of this study was to evaluate the efficacy of cryosurgery with liquid nitrogen for the removal of physiologic gingival pigmentation (PGP) in adolescents. Melanin pigmentation of the anterior segments in 15 patients was treated using liquid nitrogen. Standard digital photographs were taken preoperatively and at 3, 12, and 24 months postoperatively. Photographs were analyzed digitally and showed significant differences in gingival color between the preoperative and postoperative follow-ups. Cryosurgery successfully removed PGP in adolescents.

Bi-rooted Primary Maxillary Canines: A Case Report.

This report presents a rare case of bi-rooted primary maxillary canines. A 6-year-old girl presented at the Department of Pediatric Dentistry, Faculty of Dentistry, Mashhad University of Medical Sciences, Iran, with the chief complaint of pain in the lower right quadrant of her dentition. Radiographic examination revealed bifurcation of primary maxillary canine roots. This report discusses the possible etiology of bi-rooted canines, implications for the developing dentition, and treatment options for these teeth.