Association between antihypertensive drugs and the elderly's oral health- related quality of life: Results of Amirkola cohort study.

Background: Hypertension is one of the most common chronic diseases in the world. The prevalence of hypertension in the elderly is increasing. Patients with high blood pressure have to take medication throughout their lives. In this study, the relationship between antihypertensive drugs and oral health-related quality of life in the elderly was evaluated. Methods: This modified cross-sectional study, which is the part of the second phase of the Amirkola Health and Ageing Project (AHAP), was performed on 900 elderly people. Participants included 300 people with hypertension under medical treatment, 300 people with hypertension without medication and 300 people with normal blood pressure. All patients' blood pressure was recorded, and the standard xerostomia questionnaire and GOHAI questionnaire (Geriatric Oral Health Assessment Index) was completed for all participants. Then, the obtained data were analyzed by SPSS 17, whereby student's t-test, ANOVA and chi square, Pearson correlation coefficient and logistic regression model were used. A p<0.05 was considered statistically significant. Results: The mean GOHAI score in the three studied groups: hypertensive under medication treatment, hypertensive without medication treatment and normal blood pressure (51.1±7.4, 51.7±7.3, 51.1±7.5, respectively) did not differ significantly (P=0.533).The frequency of xerostomia was significantly different in the three groups (P=0.008). Among the antihypertensive drugs, the highest rate of xerostomia was due to the use of calcium channel blockers (31.1%) and diuretics (26.8%). Conclusion: In our study, although antihypertensive medications were associated with xerostomia, they did not decrease the oral health-related quality of life.

Effect of MTA and CEM on Mineralization-Associated Gene Expression in Stem Cells Derived from Apical Papilla.

INTRODUCTION: This study assessed the effect of mineral trioxide aggregate (MTA) and calcium-enriched mixture (CEM) cement on odontogenic differentiation and mineralization of stem cells. METHODS AND MATERIALS: After confirmation of stemness and homogeneity of stem cells derived from apical papilla (SCAPs) using flow cytometry, the cells were exposed for 3 weeks to either osteogenic medium (OS) or CEM extract+OS (CEM+OS) or MTA extract in OS (MTA+OS) or DMEM based regular culture media (negative control). Relative expression of alkaline phosphatase (ALP), dentine sialophosphoprotein (DSPP), osteocalcin (OSC), and osterix (SP7) were measured at days 14 and 21 using RT-qPCR method. At the same time points Alizarin Red staining method was used to assess mineralization potential of SCAPS. Gene expression changes analysis were made automatically using REST® software and a P<0.05 was considered significant. RESULTS: After 2 weeks of exposure, expression of all genes were between 3 and 52 times the expression of GADPH (all were upregulated except SP7 in the control, P<0.05). After 3 weeks, relative expressions of the genes: ALP, SP7, DSPP, and OSC were respectively 275.9, 528.3, 98.4, and 603.7 times the expression of GADPH in the control group (OS). These were respectively 17.405, 29.2, 11.8, and 6.5 in CEM+OS group, and 163.8, 119.7, 102.5, and 723.9 in MTA+OS group. All of these were confirmed as upregulated (P<0.05) except for ALP and OSC of DM+CEM group. After 2 weeks, alizarin red staining showed similar mineralized nodules in OS, MTA+OS, and CEM+OS. In third week, larger nodules were seen in MTA+OS and OS, but not in CEM+OS. CONCLUSION: After 2 weeks, gene expressions were almost comparable in OS, CEM+OS, and MTA+OS. After 3 weeks, OS and MTA+OS upregulated genes much greater than in 2nd week. However, upregulation in CEM+OS might not increase in 3rd week compared to those in 2nd week.

Root and Canal Morphology of Mandibular Molars in a Selected Iranian Population Using Cone-Beam Computed Tomography.

INTRODUCTION: The aim of this study was to evaluate the root canal morphology of mandibular first and second molars using cone-beam computed tomography (CBCT) in northern Iranian population and also to indicate the thinnest area around root canals. METHODS AND MATERIALS: We evaluated CBCT images of 154 first molars and 147 second molars. By evaluating three axial, sagittal and coronal planes of each tooth we determined the number of root canals, prevalence of C-shaped Melton types, and prevalence of Vertucci configuration and inter orifice distance. Also the minimum wall thickness of root canals was determined by measuring buccal, lingual, distal and mesial wall thicknesses of each canal in levels with 2 mm intervals from apex to orifice. RESULTS: Amongst 154 first mandibular molars, 149 (96.7%) had two roots, 3 (1.9%) had three roots and 2 (1.2%) had C-shaped root configuration. Of 147 second mandibular molars, 120 (81.6%) had two roots, 1 (0.6%) had three roots and 26 (17.6%) had C-shaped roots. There was no significant difference in the prevalence of Vertucci's type between two genders. The most common configuration in mesial roots of first and second molars were type IV (57%-42.9%) and type II (31.5%-28%). Mesial and distal walls had the most frequency as the thinnest wall in all levels of root canals with mostly less than 1 mm thickness. In second molars the DB-DL inter orifice distance and in first molars the MB-ML distance were the minimum. MB-D in first molars had the maximum distance while ML-DL, MB-DB and ML-D had the same and maximum distance in second molars. CONCLUSION: Vertucci's type IV and type I were the most prevalent configurations in mesial and distal roots of first and second mandibular molars and the thickness of thinnest area around the canals should be considered during endodontic treatments.

Histopathological changes in dental pulp of rats following radiotherapy.

BACKGROUND: Radiotherapy is one of the oral and pharyngeal cancer treatment methods that can cause damage to the tissues in the radiation area; the purpose of this study is to evaluate the effects of radiotherapy on dental pulp tissue in rats. MATERIALS AND METHODS: In this interventional, experimental double-blind study, 30 rats were studied in three groups (n = 10 each). The first group received 12 gray (Gy), the second group received 18 Gy in one session, and the third group was not exposed to radiation (control group). The 5 µm sections of mandibular molar tooth were prepared and stained with hematoxylin and eosin. Samples were studied under optical microscope to evaluate and score inflammation, necrosis, hyalinization, and vascular congestion. The data were coded and analyzed by statistical tests of χ2 and Fisher's exact tests. The significant level of P = 0.05. RESULTS: In Group 1, necrosis in two cases, inflammation in one case, hyalinization in one case, and vascular congestion in four cases were observed. In Group 2, inflammation in four cases, hyalinization in two cases, and vascular congestion in five cases were observed. In Group 3, inflammation was observed only in one case. In comparison between the groups, no significant differences were observed in inflammation (P > 0.05), necrosis (P > 0.05), and hyalinization (P > 0.05). However, the difference was significant for vascular congestion (P < 0.05). CONCLUSION: Radiotherapy with doses of 12 and 18 Gy had no significant effect on inflammation, necrosis, and hyalinization in all groups; however, the difference was significant for vascular congestion.

Comparing the Coronal Flaring Efficacy of Five Different Instruments Using Cone-Beam Computed Tomography.

INTRODUCTION: Fearless removal of tooth structure during canal preparation and shaping has negative effects on the prognosis of treatment. On the other hand, sufficient pre-enlargement facilitates exact measurement of the apical size. The present in vitro study aimed to compare the efficacy of Gates-Glidden drills, K3, ProTaper, FlexMaster and RaCe instruments in dentin removal during coronal flaring using cone-beam computed tomography (CBCT). METHODS AND MATERIALS: A total of 40 mandibular molars were selected and the coronal areas of their mesiobuccal and mesiolingual root canals were randomly prepared with either mentioned instruments. Pre- and post-instrumentation CBCT images were taken and the thickness of canal walls was measured in 1.5- and 3-mm distances from the furcation area. Data were analyzed using the one-way ANOVA. Tukey's post hoc tests were used for two-by-two comparisons. RESULTS: At 1.5-mm distance, there was no significant difference between different instruments. However, at 3-mm distances, Gates-Glidden drills removed significantly more dentin compared to FlexMaster files (mean=0.18 mm) (P<0.02); however, two-by-two comparisons did not reveal any significant differences between the other groups. CONCLUSION: All tested instruments can be effectively used in clinical settings for coronal pre-enlargement.

A CBCT Assessment of Apical Transportation in Root Canals Prepared with Hand K-Flexofile and K3 Rotary Instruments.

INTRODUCTION: Apical transportation changes the physical shape and physiologic environment of the root canal terminus. The aim of the present experimental study was to determine the extent of apical transportation after instrumentation with hand K-Flexofile and K3 rotary instruments by means of cone-beam computed tomography (CBCT). METHODS AND MATERIALS: Forty mesiobuccal root canals of maxillary first molars, with 19-22 mm length and 20-40(°) canal curvature, were selected and assigned into two preparation groups. The first group was prepared with K-Flexofile with passive step-back technique and the second group was prepared with K3 rotary instruments. Pre and post instrumentation CBCT images were taken under similar conditions. The amount of root canal transportation was evaluated by Mann-Whitney U test and the chi-square test was used for the qualitative evaluation. RESULTS: The amounts of apical canal transportation with the K3 and K-Flexofile instruments were 0.105±0.088 and 0.150±0.127 mm, respectively with no statistically significant differences. In the manual technique, 25% of the canals had no apical transportation; while 30% of the canals in the K3 group were transportation free. CONCLUSION: Both systems were able to preserve the initial curvature of the canals and both had sufficient accuracy. Preparation with K3 rotary instruments resulted in apical transportation similar to that of K-Flexofile.

Cone-beam computed tomography for evaluation of apical transportation in root canals prepared by two rotary systems.

INTRODUCTION: Due to the importance of apical transportation during root canal preparation, the aim of the current study was to use cone-beam computed tomography (CBCT) to assess the extent of apical transportation caused by ProTaper and Mtwo files. METHODS AND MATERIALS: Forty extracted maxillary first molars with 19-22 mm length and 20-40 degrees of curvature were selected. The mesiobuccal canals were prepared using either Mtwo or ProTaper rotary files (n=20). CBCT images were obtained before and after canal preparation to compare the apical transportation in different cross-sections of mesial and distal surfaces. The apical transportation values were analyzed using the SPSS software. The results were compared with student's t-test and Mann-Whitney U test. RESULTS: There was no significant difference in the extent of apical transportation between Mtwo and ProTaper systems in different canal cross-sections. The apical transportation value was less than 0.1 mm in most of the specimens, which was clinically acceptable. CONCLUSION: Considering the insignificant difference between the two systems, it can be concluded that both system have low rates of apical transportation and can be assuredly used in clinical settings.

Histopathologic Responses of the Dental Pulp to Calcium-Enriched Mixture (CEM) and Mineral Trioxide Aggregate (MTA) in Diabetic and Non-Diabetic Rats.

Diabetes mellitus is a chronic disease which affects the healing ability of the pulp and periodontium. The aim of the present study was to assess the histopathologic response of dental pulp to pulp capping using MTA or CEM cement in diabetic rats. Thirty two Wistar male rats aged between 8 and 10 weeks (weight: 200-250g) were divided into two groups of diabetic (n=16) and healthy (n=16) animals and then subdivided into MTA and CEM subgroups. In each group, 10 MTA treated, 10 CEM treated and 12 intact (without any intervention) teeth were analyzed. Intact teeth were considered as a baseline inflammation control. Then, class I cavity was made in the maxillary first molars teeth with pinpoint pulpal exposure. Either MTA or CEM cement was then placed over exposed pulp as pulp capping agent and the cavities were restored using resin- modified glass ionomer cement. Both teeth of rats in subgroups remained intact without any intervention. After four weeks, the rats were sacrificed and the teeth were subjected to histological evaluation in terms of inflammation intensity, dentin bridge formation and dentin bridge continuity. The CEM cement treated diabetic rats exhibited a significant higher inflammatory response when compared to healthy control group (P=0.004) whereas, MTA treated diabetic rats did not exhibit a significant higher inflammatory response in comparison to healthy controls. There was no significant difference between MTA and CEM cement in the induction of dentin bridge formation in diabetic and healthy controls. This preliminary study suggests that MTA is a superior dental material than CEM cement for pulp therapy in subjects with diabetes.

Analgesic effect of etoricoxib compared to ibuprofen on post endodontic pain.

AIMS: Etoricoxib is a second-generation selective COX-2 inhibitor. There are a few researches investigating analgesic effect of Etoricoxib in dentistry. METHODS: This randomized, double-blind, active-control study included sixty patients with clinical pulpal diagnosis of necrosis of the first mandibular molar and an associated periapical radiolucency who experienced severe pain (more than 60 out of 100 in scale of Visual Analog Scale (VAS). The patients were equally randomized into four groups, who received 60 mg etoricoxib (group 1), 90 mg etoricoxib (group 2), 120 mg etoricoxib (group 3), and 400 mg ibuprofen (group 4). All patients randomly received a single dose of the drug after the first session of the root canal therapy. Using VAS, the severity of pain was recorded 2, 4, 6, 12, 24, 48, and 72 hours after the drug was administered. RESULTS: Changing trends of pain over the time was significant for all groups (P=0.003). In addition, there was not a significant difference between various study arms (P=0.146). CONCLUSION: The results showed that ibuprofen had a comparable effect with various dosage of etoricoxib and may remain as the choice analgesic for dental pulpal pain.