Journal of Emergency Medicine, Trauma and Acute Care - Current Issue

Background: Pyogenic granuloma (PG) is one of the most prevalent tumor-like lesions in the mouth, with two distinct histological variants: Non-Lobular Capillary Hemangioma (NLCH) and Lobular Capillary Hemangioma (LCH). This study aims to evaluate and compare the immunohistochemical expression of Ki-67 (proliferative activity) and CD 105 (angiogenic activity) in both types to find the conflict between the two.

Methods: Data from clinical information and microscopic findings were collected. The selection criteria, including sufficient tissue, minor bleeding and/or inflammation, and proper fixation, were used to examine 24 cases of PG (10 LCH, 14 NLCH) that performed hematoxylin and eosin (H&E) staining and immunostaining of anti-Ki-67 antibodies and anti-CD105 antibodies.

Results: Our study showed female predilection, as 66.7% of cases were female (10 cases in LCH and 6 cases in NLCH). The mean patient age was 32.71%±15.35 years. LCH type of PG showed moderate positive expression of Ki-67 in 9 cases (64.3%); only two cases (14.3%) had a negative expression, while in 6 cases (60%) of NLCH, mild positive expression was seen, and in 4 cases (40%) it was moderate. The average number of blood vessels measured in LCH and NLCH samples treated with the anti-CD105 antibody was (72.7857±39.21479) and (47.1600±30.02855) respectively, with no significant difference between the two types of PG for both markers.

Conclusions: The results of the present study confirm that there are no differences between the LCH and NLCH types of PG in proliferative rate and angiogenesis activity, so both types seem to have the same biological behavior.

Aim: This study aims to assess the oral presentation in hemodialysis patients using Hospital Anxiety and Depression Scale (HADs).

Material and method: Forty Iraqi patients were involved in this study aged 22 to 66 years. The selected patients were admitted to the hemodialysis center in Al-Karama teaching hospital. All patients were on dialysis for 3-4 hours/week for 5 years. HAD scale was applied with an oral examination for all patients.

Results: Bordered line and abnormal cases for HAD scale shared the same oral manifestation, including caries, attrition, abrasion, gingivitis, and coated tongue, with a percentage prevalence of 55, 90, 35, 50, and 60%, respectively. Depression has more impact than anxiety on developing an oral disease in hemodialysis patients for all diagnosed oral diseases.

Conclusions: Depression and anxiety are directly associated with developing caries, attrition, abrasion, gingivitis, and coated tongue. Moreover, depression was more effective in developing the disease.

Clinical significance: HAD scale was a very effective evaluation tool for anxiety and depression. Hemodialysis patients should take into consideration anxiety and depression with oral changes.

Objective: To determine the degree of psychological stress in undergraduate dental students & explore related gender variation.

Methods: 100 5th-year dental students at Al-Rafidain University College (RUC), Iraq, participated in the study by completing The Modified Dental Environment Stress Questionnaire (DES).

Results: The primary sources of stress were found to be Completing the clinical requirement, the Atmosphere created by the clinical supervisors, Full working day, Patients being late or not showing up for their appointments, Difficulty in learning precision manual skills required for clinical and laboratory work, examination, and grades & fear of unemployment. The highest score source was (patients being late or not showing), followed by (examination and grades). Regarding gender differences, the (Full working day) was the highest stressor item for the male student’s team, while female students chose (Atmosphere created by clinical supervisors) as their top stressor.

Conclusion: The highest perceived sources of stress reported by students should be further explored by longitudinal studies, and strategies to minimize the resulting stress should be developed and implemented since psychological stress in study years of dentistry predicts occupational stress later.

Background This study aims at assessing the age and gender distribution among patients with various clinical conditions who sought treatment at the Department of Oral and Cranio-maxillofacial Surgery in Al Kindy Teaching Hospital in Baghdad, Iraq.

Methods The research data for this study was obtained from the Department of Oral and Cranio-maxillofacial Surgery at Al Kindy Teaching Hospital in Baghdad, Iraq. The data was collected between April 2019 and February 2020, involving 1443 patients spanning various age groups, from infants to 85-year-olds. The patients are categorized based on age, sex, and diagnosis using the International Classification of Diseases. The diagnosed diseases were classified according to the Contemporary Oral and Maxillofacial Surgery textbook guidelines.

Results The majority of patients are in their second decades, and most of the samples that attended the hospital are from the male category, female patients had to do with temporomandibular problems, trauma, and surgical extraction. In contrast, the most common category among male patients is trauma, followed by jaw fractures. Trauma, Follow-up, Facial Palsy, Ranula, Trigeminal Neuralgia, and Parotid Gland Swelling were all significantly different between males and females when compared on their own in each category.

Conclusions Males exhibit a higher hospital attendance rate compared to females, with males being more prone to oral trauma, while females are more susceptible to temporomandibular joint disorders. Young children have a greater likelihood of experiencing trauma rather than jaw fractures due to the presence of a thicker adipose tissue layer and the absence of paranasal sinus pneumatization.

This research aims to explore the potential of MMP-8 as a biomarker for diagnosing periodontitis using the latest classification system for this condition. This study enrolled 63 patients with periodontitis and classified them into stage II and stage III periodontitis groups. Additionally, 18 healthy/intact periodontium individuals were included as a control group. Clinical periodontal parameters were assessed, and 3 ml of whole unstimulated saliva was collected from each participant. The results revealed that both PLI (Plaque Index) and BOP (Bleeding on Probing) were considerably elevated in both stages of periodontitis compared to the healthy/control group. There were no statistical differences between periodontitis stages for PLI, BOP, and PPD (Probing Pocket Depth); however, Clinical Attachment Level (CAL) showed a substantial difference across the different stages of periodontitis. The concentrations of MMP-8 were substantially higher in both stages than in the control group, with a significant difference between the periodontitis stages, as the mean concentration was higher in stage II than in stage III. Furthermore, a significant positive correlation was observed between aMMP-8 levels and all periodontal indices. ROC analysis showed that salivary MMP-8 had good diagnostic accuracy for differentiating between periodontal health and periodontitis. However, salivary MMP-8 was unable to distinguish between periodontitis stages.

Background: Dentin hypersensitivity is a discomfort arising from unprotected dentin as a response to heat, cold, touch, or pressure stimuli. Various treatment modalities, including laser light, have been used to manage such a problem. This study aims to evaluate the efficacy of diode laser 940 nm, with different powers in managing dentin hypersensitivity.

Materials and Methods: A cross-sectional study was conducted from 1 January–5 April 2023 on a cohort of patients presented to the dental department clinics of our college with dentine hyper-sensitivity. A 10-second continuous mode diode laser light 940 nm at two different powers was used to evaluate its desensitizing effect for managing dentin hypersensitivity for six patients with a total number of teeth treated, 38 teeth. A jet of air/water was applied for a specific period and a certain distance from the tooth surface. Scores were documented for evaluating responses using the VAS scale.

Results: A statistically significant decrease in dentine hypersensitivity was found immediately after one treatment session and after a 14-day follow-up period.

Conclusions: It was established that using a diode laser (940 nm) successfully resolved instant and longstanding dentin hypersensitivity pain.

This study investigates the effect of health risk factors on apical periodontitis in fitted endodontically and non-endodontically treated teeth in army soldiers (environmental risk factor) and diabetic patients (biomedical risk factor). This cross-sectional study included patients aged 25–40 years. After participants were filtered based on exclusion criteria and questionnaire (DASS-21) responses, 108 males were chosen and divided into three groups of 36 participants each (G1: soldiers, G2: diabetic, G3: healthy). The periapical status of the participants’ teeth according to OPG X-ray outcomes was independently evaluated using a periapical index. The healthy group showed a higher ratio of fitted teeth to both non-endodontically and endodontically treated teeth (98.8%, 70%) than diabetic patients (98.6%, 52.1%) and soldiers (95.6%, 35.3%). Meanwhile, soldiers showed higher apical defects of both non-endodontically and endodontically treated teeth (7.8%, 33.3%) than diabetic patients (6.4%, 12%) and healthy individuals (5.7%, 7.1%). A statistically non-significant relationship existed between being healthy and experiencing apical defects for all fitted non-endodontically and endodontically treated teeth among all groups. The higher prevalence of apical periodontitis in soldiers and diabetic patients suggests a positive relationship between worsened apical areas of teeth and health risk factors, such as diabetes mellitus disease and environmental stress.

Background: Dental caries and acute coronary syndrome (ACS) are prevalent chronic multifactorial disorders with several etiopathological risk factors. This study aims to assess the association between carious teeth and the number of coronary arteries identified by angiography among ACS patients.

Material and Methods: 118 patients with ACS were evaluated clinically by cardiologists. Participants’ dental hygiene was assessed using the DMFT index. Before having their coronary angiography evaluated, all individuals had their urea, creatinine, and troponin serum levels checked. Echocardiography was also done. The relationship between the DMFT scoring index and echocardiographic and angiographic data was examined.

Results: All subjects studied had poor dental health overall (13.7±9.8), and their mean ages were 57.2±10.2 years. There were 118 participants in this study, and males made up 77.1% of the group. The majority of ACS (60.7%) had a high DMFT score (DMFT > 9), which in most cases indicated a significant number of missing teeth (10.9±8.9). Around half of the patients had poor carious status (DMFT > 10). The DMFT index and LVEF% measurements had non-significant positive relationships. According to the ROC curve, DMFT and its components lacked the diagnostic capacity to distinguish participants with one occluded coronary artery from ACS patients affected by multiple coronary arteries.

Conclusion: Although it cannot be used to predict the severity of the ACS, oral hygiene regarding dental status is related to the number of stenosed coronary arteries (but not LVEF%).

Background: Hyaluronic acid acts as a barrier to plaque bacteria and fulfills several extracellular functions vital to preserving healthy gingival tissue.

Objectives: To evaluate the efficacy of 0.2% Hyaluronic Acid Comprising Gel (Gingegel), combined with motivation, instruction, and scaling polishing to decrease gum inflammation among patients with gingivitis.

Methods: This was a parallel-design, double-blind, randomized control trial involving plaque-induced gingivitis patients 19–40 years of age. The sample was divided into two groups: Group 1 (n=20) was the test group, receiving motivation, instruction, scaling, polishing, and Gingegel application, and Group 2 (n=30) was the control group, receiving motivation, instruction, scaling, and polishing only. Each patient’s plaque and gingival indices were recorded at baseline and after two weeks of treatment.

Results: There was a statistically significant enhancement in the clinical parameters of both groups after two weeks, including a reduction in the Plaque index (PLI) from 0.967 at baseline to 0.663 after two weeks and mean reductions in the Gingival Index (GI) from 0.994 at baseline to 0.725 after two weeks (p <0.001).

Conclusions: There was a statistically significant decrease in GI of the total sample (including the test and control groups) at baseline and after two weeks.

Nanotechnology’s dental applications and application time are investigated. Selective dentin caries removal improves pulp tissue without surgery. Modern caries therapy cures the disease, saves pulp, and remineralizes teeth. Chitosan nanoparticles administer Amoxicillin intracellularly to treat bacterial infections. Chitosan nanoparticles are produced by tri-polyphosphate ionic gelation. Chitosan nanoparticle size and sodium tri poly phosphate (TPP) concentrations were examined to maximize chitosan nanoparticle size. The pH and ultrasonication time were also constant. SEM and FT-IR describe chitosan nanoparticles. Chitosan nanoparticles and their loaded antibiotics kill and inhibit Cariogenic gram (+) bacteria because of their nanoparticle morphologies. Antibacterial activity improved with antibiotic loading.

Background: Dental caries is one of preschool children’s significant common infectious chronic diseases. Early childhood caries (ECC) is the most prevalent chronic childhood disease worldwide. HNP 1-3 are part of the non-oxidative antimicrobial mechanisms of neutrophils and can increase innate immunity by stimulating pro-inflammatory responses. Interleukin-6 (IL-6) is a pleiotropic cytokine produced by various nonimmune and immune cells responsible for regulating many aspects of the local immune response.

Aim of Study: This study was conducted to evaluate the salivary levels of HNP1–3 in children with dental caries and to study the effect of the HNP1–3 level on the secretion of IL-6 in this disease.

Materials and Methods: Eighty children 4-5 years old were enrolled in this study. They were divided into two groups; 40 children with ECC as the study group and 40 caries-free children as the control group who matched the study group in age and gender: oral examination and measurement of clinical parameters of caries experience determined by dmfs index. Saliva samples were taken from all subjects. ELISA assay was carried out to estimate salivary levels of HNP1–3 and IL-6.

Results: The current study found a significant elevation (P<0.05) in mean levels of HNP1-3 and IL-6 among children with ECC compared to caries-free children. Moreover, salivary HNP1-3 level showed a significant positive correlation with IL-6. On the other hand, there was no significant correlation between HNP1-3 and dmfs, whereas there was a positive correlation with IL-6.

Conclusions: These findings indicated that high levels of HNP1–3 and IL-6 may play a crucial essential ECC, and a positive correlation between them confirms the effect of antimicrobial peptides on cytokine production.