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

Background: Recently, the importance of salivary proteins as periodontal disease biomarkers creates “high-impact diagnostics” that significantly influence clinical judgment, patient outcomes, and healthcare costs. The study aimed to evaluate the diagnostic accuracy of salivary biomarkers Matrix metalloproteinase-9 (MMP-9) as well as interleukin-6 (IL-6) in distinguishing between various stages of periodontitis and healthy individuals.

Materials and Methods: A case-control study of 120 volunteers was classified into four groups based on periodontal health: healthy controls, stage I, II, and III periodontitis. Salivary samples were collected, and an enzyme-linked immune sorbent assay was employed to measure IL-6 and MMP-9 levels. The diagnostic precision of both biomarkers was evaluated using the area under curve (AUC) and receiver operating characteristic (ROC).

Results: IL-6 demonstrated strong diagnostic ability; its AUC values ranged from 0.888 to 1 across comparisons. Precisely, in differentiating control from stage III periodontitis, IL-6 showed a perfect diagnostic efficacy at a cut-off of 5.75. Conversely, MMP-9 exhibited diverse AUC values according to the stage of disease with a cut-off of 1.715, when comparing the control to stage III.

Conclusion: Salivary IL-6 consistently demonstrates robust diagnostic accuracy in distinguishing periodontitis stages, suggesting its potential as a valuable tool for non-invasive periodontal assessments. MMP-9 also presents diagnostic promise, and its application is more stage-specific.

Periodontitis is a multifactorial inflammatory disease brought on by a state of imbalance between the gingival microbiome and the immune responses of the host. Neutrophils are the key cells that play an important role in fighting pathogenic microorganisms in infectious disorders, either by killing them within the cell or secreting antimicrobials attached to large web-like structures known as neutrophil extracellular traps (NETs) through a cell death process known as NETosis. Formation of NETs is important for maintaining homeostasis in periodontal tissues and improvement of health. In periodontitis, an immune-based inflammation impedes NETs formation or causes its destruction, thereby enabling inflammation to progress and destroy periodontal tissues.

Polymorphonulear neutrophils (PMNs) inhibit microorganisms and decrease inflammation by secreting of NETs into the pocket environment. Conversely, elevated NET levels can elicit an inflammatory response and provide an environment that is favorable for pathogenic bacteria. NETs biomarkers may prove to be helpful in the diagnosis of periodontitis. However, it is necessary to make future research on the specific mechanism of NETs and the exact interaction between a single bacterium and NETs.

Aims and Objectives: Temporomandibular disorder is a broad term for the joint musculoskeletal problems. This study was aimed to assess the therapeutic effect of hyaluronic acid (HA) and platelet-rich plasma (PRP) on salivary matrix metalloproteinases (MMPs) 2 and 9 expression in patients with internal derrangment.

Materials and Methods: Fifty-two patients with tempromandibular joint internal derrangment were participated in this study. Patients were separated into two groups: HA and PRP groups. Saliva was obtained before treatment and 6 months after treatment. The expression of MMP-2 and 9 was identified using enzyme-linked immunosorbent assay kit.

Results: The expression of both salivary MMP-2 and 9 was significantly decreased after treatment (p = 0.000). A positive correlation was established between MMP-2 and 9 with the mean pain scale and joint click score. However, a negative correlation was found between MMP-2 and 9 with the maximum mouth opening (MMO).

Conclusion: Both HA and PRP showed a beneficial therapeutic effect revealed through the reduction of salivary MMP-2 and 9 as an inflammatory biomarkers.

Background and Aim: Soft liners are designed to modify the surfaces of prostheses that interact with the mouth’s soft tissues to improve denture performance. One method of improving its mechanical properties involved the application of nanotechnology. This work aimed to determine impact of cerium oxide nanoparticles (CeO2NPs) on acrylic-based soft liner’s surface hardness and shear bond strength.

Materials and Methods: CeO2NPs were added to soft liner monomer with weight percentages of 0%, 2%, and 3%. Sixty samples were prepared for shear bond test and surface hardness test with 30 samples each. Shear bond samples were prepared by constructing two acrylic blocks which assembled over each other creating a square space in the middle with dimensions around 25 mm in length and width and 3 mm in depth for the addition of soft liner material. The surface hardness samples were constructed as a disc with diameter of 35 mm and 6 mm thickness. Instron testing machine with a load of 50 KN and cross-head speed 0.5 mm/min was used for testing the shear bond strength, while surface hardness was tested by Shore A durometer. The morphological features of soft liner samples before and after the addition of CeO2NPs were examined by scanning electron microscopy (SEM). The data were analyzed for normality and homogeneity by Shapiro-Wilk test and for significance by ANOVA and Tukey’s multiple comparisons tests using SPSS version 21 software.

Results: Soft liner samples demonstrated a significant increase in shear bond strength from 11.6 ± 1.51 MPa for the control group to 16.1 ± 1.37 MPa and 18.9 ± 1.29 MPa for 2%wt. and 3%wt. CeO2NPs treated groups, respectively. The surface hardness value of the samples with the addition of 3%wt. CeO2NPs increased significantly to 61.01 ± 0.98 Shore A in comparison to the control group 59.47 ± 0.97. However, the 2%wt. CeO2NPs-treated group exhibited no significant difference with the rest groups. SEM showed that after CeO2NP incorporation, the nanoparticles were homogenously distributed on the sample surface leading to a decrease in surface porosity.

Conclusion: The addition of 2%wt. CeO2NPs improved the shear bond strength of the soft lining material with a non-significant effect on surface hardness. This shows the efficacy of CeO2 in improving some material mechanical properties.

Background: The utilization of amalgam fillings has been minimized to just consider its mercury content. Mercury exposure may present a health hazard, as well as the Cavity design of amalgam restoration includes unnecessary removal of sound tooth structure which may lead to fracture of remaining tooth structure.

Objective: To estimate dentists’ and patients’ information, knowledge, and concern about the mercury content of amalgam and their preference for more esthetic restoration in Baghdad, the capital of Iraq.

Methods: A cross-sectional study of 282 dentists and 616 patients was conducted at Al-Rafidain University College to validate Iraqi patients’ perceptions and dentists’ attitudes towards dental amalgam use.

Results: It was found that half of the patients don’t have any idea about the restoration type and outcome of dental materials for their well-being. A total of 259 participants (80.19%) specified that they would not prefer amalgam restoration in their teeth as being unaesthetic. 22.69% of dentists used amalgam, and 37.94% did not use amalgam. The decision to avoid employing amalgam is based on two primary factors: the aesthetic and the presence of mercury.

Conclusion: Dental amalgam awareness is not enough among participating patients. Although dentists do not frequently use dental amalgam, disagreement on banning dental amalgam was their choice.

Background: Periodontitis is a chronic inflammatory noncommunicable disease that affects all tooth-supporting apparatus. The traditional method of treatment is non-surgical periodontal therapy. If this mechanical debridement is ineffective, an adjunctive therapy may be useful. Black tea with salt and chlorhexidine has been evaluated in the current research as an adjunctive treatment modality.

Aims: To investigate the antibacterial properties of black tea with salt rinse on periodontal disease and compare its efficacy to chlorhexidine rinse.

Methods: Non-randomized control study consisting of sixty participants with age range from 25 to 55 years was divided into three groups: control (no treatment), chlorhexidine mouthwash, and black tea with salt mouthwash. Prior to initiating adjunctive therapy, scaling was performed for all groups.

Results: Statistically significant differences have been found between the effects of mouthwash of black tea with salt versus (0.12) chlorhexidine mouthwash. The findings demonstrated that the group utilizing black tea with salt rinses showed more significant reduction in both plaque and gingival indices in comparison to the chlorhexidine rinse group. Moreover, comparisons between all groups showed highly significant differences in periodontal indices between visits.

Conclusion: Using black tea with salt mouthwash could be effective and useful adjunctive therapy for periodontal diseases. In the future, it is necessary to conduct further studies with a larger sample size in order to make more precise assessment of the impact of black tea with salt mouthwash.

Aim: The aim of the study was to investigate the relationship between delayed eruption of the permanent second molars and dietary habits, body mass index, and lifestyle of the teenagers.

Method: A cross-sectional study was performed at a private dental center. 110 teenagers with an age range of 13–16 years old were screened for delayed permanent second molars. The panoramic X-ray was used to localize the unerupted permanent second molar. The body mass index (BMI) of the patients was calculated. A questionnaire was distributed, and the data were collected via Google Forms. Responses were gathered from February 2024 to March 2024. The questionnaire included three main categories: food type and routine, activity and exercise, and medical and dental health.

Results: The percentage of the orthodontic population of teenagers at the time of the study was 22%. Among the screened teenagers, only 11% had at least one unerupted second molar. A higher prevalence of unerupted permanent second molars was found in girls than boys (58.3%, 41.6%, respectively). The highest percentage of delayed eruption of permanent second molar was found on both sides of the maxilla (83.3%). In regards to food type, fast food (66.6%) and noodles or pasta (33.3%) were found to be a common meal at dinner. Chocolate (75%) and crisps (58.3%) were the major snacks. Calcium rich food and nuts were found to be either never or not regularly consumed by teenagers, 66.6% and 83.3%, respectively. Regarding body activity and exercise, the majority of the participants were normal weight (58%). Only 16.6% were found to be obese. The majority of the participants slept later than midnight (83.3%). All participants used the cell phone, with some spenting 5–10 hours (41.6%) on these devices. In terms of medical and dental health, all participants were healthy except 25% suffered from asthma and/or anemia. All participants were regularly visit the dental clinic; however, 41.6% of participants were not aware of delay eruption of permanent second molars.

Conclusion: The quality of the food may impact the normal time of eruption of the permanent second molars. Female gender and maxillary arch were found to be more likely to have delayed eruptions. Unhealthy lifestyle, such as sitting long hours on electronics, may impact oral health. Additional risk factors should be considered in future research.

Background: Artificial intelligence (AI) in dentistry could improve future clinical practice.

Aim: This questionnaire survey was commissioned to evaluate the knowledge and perspective of Iraqi dental students on AI application in dentistry.

Methods: The survey was administered to 310 dental students, 112 males and 198 females, ages 19–24. Eighty students were in the 2nd grade, 70 in the 3rd grade, 80 in the 4th grade, and 80 in the 5th grade. They completed questionnaires, selecting one option from the list of possible answers for each of the 11 survey questions about AI.

Results: A 42.7% of the 310 participants in the study had experience with AI and its software. However, only 35.3% of dental students understood how to incorporate AI into their work. Students in 5th grade were more likely to think that AI has a future in Iraq (p = 0.034), whereas students in 4th grades rejected the idea of using AI in decision-making (p = 0.045) significantly.

Conclusion: Dental students lack a basic grasp of AI; therefore, activating their interest helps them learn about AI and its potential uses. To acquaint dental students with AI and its applications, seminars, lectures, and workshops should coincide with the material they introduce in the curriculum.

Background: Neutrophils destroy pathogens via phagocytosis. Neutrophils are effective innate and acquired immunity phagocytes. Low-density neutrophils are distinct neutrophil phenotypes linked to several systemic and infectious diseases. To our knowledge, low-density neutrophil phagocytosis in periodontitis has not been examined. Opsonized and non-opsonized fluorescent beads mixed with low-density neutrophils were gated and analyzed by flow cytometry to count cells that consumed at least one bead.

Aims of the Study: To estimate the potential impact of antibody (Ab)-labeled and non-labeled phagocytosis capacity of low-density neutrophils in the 60 patients with periodontitis compared to 40 patients with healthy periodontium.

Methods: Blood samples were collected from 100 subjects with no systemic diseases and allocated into a periodontitis group of sixty unstable periodontitis patients compared to a control group of forty subjects with healthy periodontium. Flow cytometry was used to estimate both groups’ Ab-labeled and non-labeled phagocytosis assays of low-density neutrophil groups.

Results: Ab-labeled and non-labeled low-density neutrophil phagocytic assays showed no significant difference (p-value > 0.05) between research groups. In both study groups, low-density neutrophils had higher Ab-labeled phagocytosis than non-labeled. A significant positive correlation was observed between Ab-labeled and non-labeled phagocytosis in the control group.

Conclusion: Low-density neutrophils express the same labeled and non-labeled phagocytic index in both groups (periodontitis and control). However, the intra-group comparison revealed enhanced Ab-labeled phagocytosis compared to non-labeled phagocytosis in both groups (periodontitis and control).

Background: Subclinical hypothyroidism (SH), or so-called mild thyroid failure, is analyzed when serum thyroid stimulating hormone (TSH) levels are beyond the highest limit of the reference range whereas free T4 concentrations are normal.

Aim of the Study: Determine delayed tooth eruption and hemoglobin levels in children with SH.

Methods: Case control study was directed amongst 120 children with age not exceed than 12 years old in Diyala governorate. Thyroid function, hemoglobin level, and a common oral manifestation in children with SH were evaluated to find an association between them and compared with healthy children. Children who have SH, after experiencing thyroid tests, have their mouths examined and their hemoglobin levels inspected; after receiving ethical clearance, informed consent was obtained from the relatives of participants.

Results: Concerning patients (first group), which is comprised of 100 children with SH, control (second group) comprises of 20 children without SH. The delayed eruption of teeth was (7%) in SH children statistically showed a highly significant association. Level of TSH in the children with SH group was statistically highly significant increased as compared with the control group with Mean ± SE (8.93 ± 0.32) versus Mean ± SE (1.84 ± 0.25). In addition, a highly significant association existed when compared the control group and children with SH concerning hemoglobin level, with Mean ± SE (13.09 ± 0.14) versus Mean ± SE (10.89 ± 0.19).

Conclusion: Low level of hemoglobin and high prevalence of delayed tooth eruption were detected in children with SH compared to non-diseased control group.

Background: Adenoid cystic carcinoma (ACC) is a type of salivary gland cancer with a poor long-term survival rate. Understanding the pathophysiology of this type of cancer will expand the available therapy options. The B-cell lymphoma 2 (Bcl-2) protein produces this early component within the Bcl-2 family of regulatory proteins, which can stimulate proapoptotic or inhibit cell death.

Aims: The goal of this study was to detect the expression of Bcl-2 in ACC of the salivary glands and relate the results to clinicopathological characteristics.

Materials and Methods: This study examined 35 histopathologically verified ACC of the salivary glands in the oral pathology laboratory at Specialist Surgical Hospital for the period (2011–2015). Bcl-2 expressions were investigated using an immunohistochemical analysis method. The expressions were correlated with clinical and histological evidence using the Statistical Package for the Social Sciences (SPSS) software version (20.0).

Results: The expression of Bcl-2 revealed the high frequency of tumors with free margin was in the mild score and the high frequency of tumor with neural invasion was in the moderate score. Additionally, the distribution of the location and type elements along with interesting comparisons was provided. The neural invasion group’s distribution of the tumor revealed high significant difference.

Conclusion: Adenoid cystic malignancy expresses antiapoptotic Bcl-2. Its expression may be useful in predicting behavior and establishing ACC-specific treatment.

Background: Aesthetic zone refers to maxillary anterior region, from canine to canine, which is important in smile aesthetics. However, based on smile width, this area may be extended to include premolars. The aim of this study was to navigate the aesthetic zone of the upper premolar region for dental implant treatment.

Methods: This study was conducted at a private dental center in Baghdad. Dental implant cases treated between January 2018 and April 2023 were included in the study. One hundred and ninety-six patients were included in the study.

The demographic data, surgical information, dental implant zones, anterior aesthetic, premolars, and molar non-aesthetic zones, were recorded. Patients with incomplete data were excluded from the study. Descriptive and inferential statistics were implemented. The chi-square test was used to determine the relationship between nominal study variables.

Results: The male-to-female ratio was 1:2. The highest percentage of implant replacement was found in the upper premolar region (28.7%), followed by the lower molar (23.6%), and the upper anterior aesthetic zone: the upper incisors (16.1%), and the upper canines (3.4%). Early success rate was approximately equal in the anterior, premolar, and other zones, but with the highest value in the premolar area (94%).

Conclusion: There is a high demand for upper premolar implants by both genders compared to the aesthetic zone. This highlights the peculiarity of this zone and underpins the suggestion for classifying the upper premolar zone as aesthetic zone II.

Background: Pleomorphic adenoma (PA) is the most frequent benign epithelial neoplasm of salivary glands, displaying a remarkable degree of morphological variety. The aim of the study is to illustrate the clinicopathological characteristics of PA with particular emphases on epithelial cell morphology and mesenchymal elements.

Materials and Methods: A total of 132 PA collected between 2002 and 2017 were recruited from Al Shahid Ghazi Al Hariri Hospital and the Department of Oral Pathology, College of Dentistry, Baghdad University, Baghdad, Iraq, and analyzed for their demographic and histopathological features. All data were analyzed using descriptive statistics.

Results: A slightly higher incidence of PA was detected in females (52.3%) compared to male subjects (47.7%), with an average age of 36.9 years. The palate was the most frequently involved site (64.5%), followed by the parotid gland (31.8%). Microscopically, there were 52 classic, 53 cellular, and only 27 myxoid PAs. Plasmacytoid cells were commonly observed as myoepithelial cells, followed by spindle cells. Trabeculae patterns were the most common archetypes created by the epithelial cells. Myxoids with chondroid mesenchymal-like tissues were the most commonly noticed stromal tissue, mostly making the nominated myxo-chondroid stroma.

Conclusion: PAs are neoplasms with a wide range of histological characteristics, including a diversity of cell morphology such as plasmacytoid, spindle, and cuboidal cells, as well as duct-like areas and a high incidence of myxochondroid stroma. Most PAs do not exhibit atypical features such as increased mitotic activity, cellular pleomorphism, or necrosis.

Background: Providing the patient with an evidence-based overview of the orthodontic therapy risks is a crucial part of clinical practice. This is necessary for obtaining valid consent, facilitating collaborative decision-making, and providing person-centered care. This study aimed to assess the orthodontist’s agreement on patients’ alertness about certain orthodontic treatment risks as part of the consent form.

Methods: This online survey of Iraqi orthodontists ran from May to September 2020. A custom questionnaire was created using Google Forms and distributed within a Telegram group for the Iraqi Orthodontists Society.

Results: According to the survey, orthodontists concurred that patients should be informed about six hazards before providing consent: oral hygiene status (99%), patients’ poor compliance (99%), relapse risks (95.3%), and the need to modify eating habits to prevent appliance breakage (93.4%). The main controversies were found in regards to the importance of root resorption, incisor trauma, canine impaction complications, achieving desired tooth movements, ceramic brackets, and soft tissue injuries.

Conclusion: There are certain inherent risks that Iraqi orthodontists may overlook or undervalue, so greater emphasis is needed to raise awareness of them, likely through repeated programs of continuous education.

Background with Aim of the Study: The intraoral scanner in the market contends with challenges, specifically in accurately detecting metallic surfaces of prostheses affected on the fitness of the restoration; therefore, several scanning agents were used to evaluate the internal fit of the zirconia crown.

Methods: 45 prefabricated titanium abutments (n = 45) were selected for this study. Samples were divided into three groups (n = 15 each) according to the application of scanning aid agents. Group 1 (G1: control) used a scan body; G2: used liquid paint as the scanning aid agent; and G3: used powder spray as the scanning aid agent. Each abutment was applied with an imaging scanning aid agent to scan and mill the crown. All scans were performed using the same intraoral scanner, and the internal fit was analyzed digitally using digital silicone replica techniques and Geomagic Control X software. Statistical analysis was performed using the one-way ANOVA test.

Results: There was no significant difference among the three groups.

Conclusion: Scanning aid agents showed similar accuracies for the internal fit of the crown, with no significant differences observed.