Frontiers in Dentistry

Objectives: The purpose of the present study was to evaluate the antimicrobial effect of various sizes and concentrations of zinc oxide (ZnO) nanoparticles on Streptococcus mutans (S. mutans), Enterococcus faecalis (E. faecalis), Lactobacillus fermentum (L. fermentum), and Candida albicans (C. albicans). Materials and Methods: Solutions at the concentration of 10 µg/ml were prepared using 20-nm, 40-nm, and 140-nm nano ZnO (nZnO) powder. The antimicrobial effect of nZnO was determined using the disk diffusion method. The inhibition zone (mm) was measured using a ruler. Data were analyzed by analysis of variance (ANOVA) and the Bonferroni correction. The minimum inhibitory concentrations (MICs) and minimum bactericidal concentrations (MBCs) of nZnO were determined using the broth microdilution method in Mueller-Hinton Agar (MHA) for S. mutans and E. faecalis, De Man, Rogosa, and Sharpe (MRS) agar, and Sabouraud Dextrose Agar (SDA). Results: The greatest inhibition zones were observed against S. mutans with 20-nm and 40-nm nZnO, while 140-nm nZnO formed the greatest inhibition zones against S. mutans and E. faecalis. The smallest inhibition zones were observed against C. albicans with the three nZnO particle sizes. The MICs for C. albicans with 40-nm and 140-nm particles and for L. fermentum with 140-nm particles were higher than 10 µg/ml. A significant correlation was found between the particle size and the antibacterial activity against S. mutans (P=0.00), L. fermentum, and E. faecalis (P<0.02). Conclusion: The antimicrobial activity of nZnO increases with decreasing the particle size. The greatest antimicrobial effect was observed against S. mutans and E. faecalis. S. mutans is more sensitive to the changes in the particle size compared to other bacteria.

OBJECTIVES: Toothpastes and mouthwashes contain ingredients that may be toxic for oral mucosal tissues. This study aimed to assess the cytotoxicity of the ingredients of commonly used toothpastes and mouthwashes. MATERIALS AND METHODS: This experimental study was performed on 16 toothpastes and four mouthwashes widely available in the Iranian market. First, the concentration of six main ingredients of these products, namely sodium fluoride (NaF), sodium lauryl sulfate, cocamidopropyl betaine, zinc lactate, paraben, and sodium benzoate, was determined. The methyl thiazolyl tetrazolium (MTT) assay was used to assess the cytotoxicity of these materials for human gingival fibroblasts (HGFs). The MTT assay was performed at 1, 15, and 30 minutes following exposure to five concentrations of each material in triplicate (according to the concentrations obtained in the isolation step). Data were analyzed using three-way analysis of variance (ANOVA). RESULTS: The difference in the cytotoxicity of the materials was statistically significant (P<0.001). Cytotoxicity was time- and concentration-dependent; by an increase in the concentration of the materials, their cytotoxicity increased over time. The cytotoxicity of sodium lauryl sulfate and cocamidopropyl betaine was >90%. The cytotoxicity of NaF varied from 25% to 70%, and the cytotoxicity of all concentrations of zinc lactate and sodium benzoate was <50% for HGFs. CONCLUSION: To decrease the cytotoxic effects of toothpastes, sodium lauryl sulfate and cocamidopropyl betaine should be replaced with safer detergents, and the concentration of fluoride should be decreased to 400 parts per million (ppm). Alternatively, fluoride may be replaced with other antibacterial and cariostatic agents.

Pain is a constant symptom of dentin hypersensitivity (DH), which is a common condition that affects daily life and negatively affects the quality of life (QoL). Diagnosis and outcome measurements following the treatment of the disease require accurate pain assessment. The definition of pain underlies the complexity of its measurement as different factors modulate daily experience. The reproducibility of the prescribed stimuli for inducing DH pain clinically is difficult to achieve. This pain mevaasurement is made with unidimensional scales that are inadequate to capture the other dimensions of pain. The only specific QoL tool available for DH still requires testing in other populations and cultures. This article reviews the appropriateness of the current methods of DH pain assessment and the tools that consider the other pain dimensions. It also looks at its impact on the oral health-related quality of life (OHRQoL) of people with DH. The findings will create interest and facilitate research in this field of DH pain measurement and management.

As the coronavirus disease-2019 pandemic outbreak continues to be a global public health concern, dentists should seek means to provide oral health care with minimal risk. To meet the recommendations of the Center for Disease Control, alternative non-aerosol generating techniques have been proposed to minimize the risk of disease transmission to patients and dental healthcare personnel. Among recent materials, silver diammine fluoride (SDF) has been shown to be effective in preventing and arresting caries. This along with an atraumatic restorative treatment with glass ionomer cements (GICs) makes it a potentially attractive adjunctive therapy for caries management in pediatric patients. In this technique, SDF is applied over carious tissue and the lesion is restored with auto-polymerizing GIC. This review article aims to provide a practical background and clinical guide for the application of silver-modified atraumatic restorative technique (SMART) as a safe way to provide dental services to children during the pandemic.

We aimed to investigate the effects of propolis nanoparticles (prpNPs) on antimicrobial property and shear bond strength (SBS) of orthodontic composite bonded to bovine enamel. Materials and Methods: Sixty bovine teeth were randomly divided into five groups (n=12). PrpNPs were prepared at concentrations of 0% (control), 1%, 2%, 5%, and 10% in Transbond XT composite to bond stainless steel brackets to the teeth. SBS between brackets and teeth was measured using a universal testing machine. After debonding, the adhesive remnant index (ARI) on bracket bases was measured. In the microbial test, composites with the aforementioned concentrations of prpNPs were cured in metal discs. The bacteria included Streptococcus mutans (S. mutans), Streptococcus sanguinis (S. sanguinis), and Lactobacillus acidophilus (L. acidophilus), and antimicrobial effects of prpNPs were investigated by anti-biofilm, disc agar diffusion and eluted component tests. Results: The 10% prpNPs group showed the lowest SBS. Colony growths of S. mutans and S. sanguinis at all concentrations (except for 1%) was significantly lower than the control group. L. acidophilus colony growth was significantly reduced at 5% and 10% concentrations. Growth inhibition zone developed at 2%, 5%, and 10% concentrations for S. mutans and S. sanguinis. The lowest numbers of S. mutans and S. sanguinis colonies at all concentrations were observed on day 15. L. acidophilus colonies decreased significantly at all concentrations (except for 1%) until day 30.

Objectives: The purpose was to determine the antibacterial properties of propolis and to evaluate its use as an antibacterial mouthwash with minimal complications. Materials and Methods: In this experimental laboratory study, an alcoholic propolis extract was prepared. The minimum inhibitory concentration (MIC) was calculated for four bacterial species including Staphylococcus aureus (S. aureus), Streptococcus mutans (S. mutans), Lactobacillus acidophilus (L. acidophilus), and Enterococcus faecalis (E. faecalis) using agar dilution. According to the MIC, a propolis antibacterial mouthwash was produced and compared to water, chlorhexidine (CHX), and Listerine using laboratory rats for clinical examination. Salivary specimens of rats were collected at 12 hours, 1 week, and 2 weeks after using the mouthwash and examined by the real-time polymerase chain reaction (RT-PCR). Data were analyzed using one-way analysis of variance (ANOVA) and repeated measures ANOVA (α=0.05). Results: The results of agar dilution by the number of colony-forming units (CFU) showed the lowest MIC for S. aureus and the highest for L. acidophilus. The results of the RT-PCR indicated that water alone had no effect on the level of oral bacteria. Propolis mouthwash showed a significant difference with CHX and Listerine (P<0.05) in terms of the number of S. mutans, E. faecalis, and L. acidophilus colonies, while CHX and Listerine were less efficient. There was no significant difference between CHX and propolis (P=0.110) regarding S. aureus colonies, but Listerine had a lower efficacy than either (P<0.05). Conclusions: According to the results, propolis mouthwash was more efficient against the studied oral bacteria compared to CHX and Listerine.

Objectives: The objective of this study was to evaluate the antimicrobial activity of the essential oil obtained from oleo-gum-resin and seeds of Ferula assa-foetida. Materials and Methods: Ferula assa-foetida plants were collected from Tabas, Yazd Province, Iran, during summer 2017. Then, essential oils were obtained from its seeds and oleo-gum-resin using hydrodistillation. Gas chromatography-mass spectrometry (GC-MS) test was performed to determine the contents of the essential oils. Four different concentrations of each oil were prepared (2.5, 5, 10, and 20 μg/ml), and the antimicrobial activity of each dose against four oral bacteria (Streptococcus mutans, Streptococcus sobrinus, Streptococcus sanguis, Streptococcus salivarius, and Lactobacillus rhamnosus) was evaluated using the disk diffusion method. The data were analyzed using analysis of variance (ANOVA) and Kruskal-Wallis test in SPSS 17 software. Results: The GC-MS findings exhibited that the main compounds found in essential oils yielded from the seeds and oleo gum resin were (Z) -1-propenyl sec-butyl disulfide and (E) -1-propenyl sec-butyl disulfide. Ferula assa-foetida plant showed a significant antimicrobial effect (P<0.05). The essential oil from Ferula assa-foetida oleo-gum-resin had significantly stronger antibacterial properties compared to the essential oil from Ferula assa-foetida seeds (P<0.001). Both essential oils showed antibacterial properties similar to that of Chlorhexidine. The growth inhibition zone was significantly dependent on the essential oil concentration for all bacteria (P<0.05). Conclusion: Our study revealed that essential oils from seeds and oleo-gum-resin of Ferula assa-foetida have antimicrobial properties. More laboratory studies are required to reach a definitive conclusion.

Objectives: This study aimed to compare the marginal fit of temporary restorations fabricated by the conventional chairside method, 3D printing, and milling. Materials and Methods: In this in vitro, experimental study, 14 temporary restorations were conventionally fabricated over an implant abutment and analog that had been mounted in a phantom model at the site of canine tooth, using auto-polymerizing acrylic resin and putty index. In digital manufacturing, the original model was scanned, and the final restoration was designed. Fourteen temporary restorations were milled out of polymethyl methacrylate (PMMA) blocks, and 14 others were printed by a 3D printer. Temporary crowns were placed on the abutment, and images were obtained from specific areas under a stereomicroscope at x100 magnification to measure the amount of marginal gap. Data were analyzed using one-way ANOVA and Tukey’s test (α=0.05). Results: The mean marginal gap values for the temporary crowns in the 3D printing, milling, and chairside groups were 91.40, 75.28 and 51.23 µm, respectively. The crowns that were conventionally fabricated chairside exhibited the lowest marginal gap, and the difference in this respect was significant among the three groups (P<0.05). Conclusion: Temporary crowns fabricated by the chairside method showed significantly smaller marginal gap; however, the marginal gap of all three groups was within the clinically acceptable range.

OBJECTIVES: This study aimed to evaluate the mucograft collagen matrix (CM) to increase keratinized tissue around teeth compared to free gingival graft (FGG). MATERIALS AND METHODS: The present double-blind, randomized, controlled clinical trial studied 12 patients who had 2 mm or less keratinized gingiva bilaterally around mandibular premolars. The 6-month width of keratinized tissue, periodontal parameters (preoperatively and 1, 3, and 6 months postoperatively), color match, pain, and total surgical time were measured. RESULTS: The mean dimensional change of keratinized gingiva 6 months postoperatively was 4.1±0.7 mm for FGG and 8±1.7 mm for CM. Periodontal parameters were not affected in the two groups. The CM group had a significantly lower pain, experienced less surgery time, and gained better aesthetics compared to the FGG group. CONCLUSION: CM appears to be a suitable substitute for FGG in procedures designed to increase keratinized tissue around teeth. It has remarkable benefits, such as acceptable keratinized tissue gain, less pain, less surgical chair time, and better aesthetics.

OBJECTIVES: The present study aimed to evaluate the bond strength of heat-cure denture base resin to newly designed Iranian artificial acrylic teeth. MATERIALS AND METHODS: In this in-vitro experimental study, shear bond strengths of Ivoclar acrylic, Apple composite, and B-Star nanocomposite teeth to heat-cure acrylic denture base resin were compared. A total of 18 samples were selected from each group of teeth. The samples were attached to heat-cure resin according to ISO 10477 standard. For the assessment of bond strength, the samples were placed in a universal testing machine and were subjected to shear forces at a speed of 1 mm/minute to record the fracture load. Descriptive statistics, including frequency, mean, and standard deviation, were calculated using SPSS 20 software. Two-way analysis of variance was used to compare the shear bond strength of the groups with and without monomers and the studied artificial teeth. RESULTS: The mean shear bond strengths of Ivoclar acrylic teeth were 392.22±23.76 MPa and 337.11±32.18 MPa with and without adding monomers to the tooth surface, respectively. The mean shear bond strengths were 250.44±29.84 MPa and 238.33±27.28 MPa (without monomers) and 438.33±24.16 MPa and 311.56±32.78 MPa (with monomers) for Apple composite and B-Star nanocomposite artificial teeth, respectively. CONCLUSION: The greatest shear bond strength was attributed to Ivoclar acrylic teeth followed by Apple composite and B-Star nanocomposite artificial teeth. Addition of monomers to the tooth surface significantly strengthened the shear bonding of acrylic base resin to the teeth.

Developing a laboratory-grown construct integrating viable bone and oral mucosal tissues with strong adhesion between the hard and soft tissue layers presents a significant challenge. This engineered tissue construct holds promise as a versatile graft material for diverse oral surgeries and as an in vitro model for evaluating dental materials, dental implants, and oral healthcare products, potentially replacing the need for in vivo studies. Additionally, it offers a valuable tool for investigating various aspects of oral diseases and evaluating the efficacy of different treatments, eliminating the need for animal models. The success of such osteo-mucosal constructs depends on achieving proper adhesion between the bone and connective tissue layers, prompting researchers to conduct studies exploring interlayer adhesion mechanisms. This review provides a comprehensive overview of advances in osteo-mucosal models, conducted through a search of articles published in journals indexed in PubMed, ScienceDirect, Scopus, and Google Scholar databases from January 2010 to January 2024. First, we outline the methods used to construct various components of osteo-mucosal models, including the materials and fabrication techniques. Next, we provide a detailed discussion of the adhesion methods employed. Lastly, we compare the effectiveness of each adhesion method by summarizing the results of cell viability studies, which are crucial for the success of tissue regeneration. This review provides a comprehensive understanding of recent advancements in osteo-mucosal models and their interfacial adhesion, paving the way for promising clinical applications.

Objectives: Heat-cure acrylic resin is commonly used for the fabrication of denture base; however, it does not meet all the ideal requirements of a denture base material. This study was performed to assess the surface hardness and roughness of natural wool fiber-reinforced heat-cure acrylic resin as a denture base material. Materials and Methods: Sixty acrylic specimens were fabricated in this in vitro study; they were divided into three main groups. The first group (control) included acrylic specimens without fiber reinforcement, the second group (NW) included acrylic specimens reinforced with 0.25wt% natural wool fibers and the third group (SW) included acrylic specimens reinforced with 0.25wt% silane-treated natural wool fibers. Each group was further subdivided into two subgroups based on the tests performed, surface hardness test group and surface roughness test group. Surface hardness was measured by a Shore D hardness tester. A profilometer was used for measurement of surface roughness. The results were statistically analyzed using one-way ANOVA and Tukey's post-hoc test and P≤0.05 was considered statistically significant. Results: The SW group had the highest mean surface hardness value, followed by the NW group, whilst the control group had the lowermost mean value. However, the statistical significant difference was only evident between the SW group and the control group (P=0.018). Meanwhile, no statistically significant difference was found in surface roughness among the tested groups (P>0.05). Conclusion: The surface hardness of heat-cure acrylic resin can be improved by reinforcement with silane-treated natural wool fibers without significantly affecting its surface roughness.

Objectives: Azadirachta indica var. siamensis Valeton, also known as neem, possesses various beneficial biological properties, including antibacterial activity. Neem paste (NZ-paste) was developed to enhance its application. This study aimed to investigate the antibacterial activity of NZ-paste against Lactobacillus rhamnosus (L. rhamnosus), its penetration ability, and its cytotoxicity for human dental pulp stem cells (hDPSCs). Materials and Methods: The active compounds of the neem extract were identified using high-performance liquid chromatography (HPLC). The rheological and physicochemical characteristics of 20mg/g NZ-paste were evaluated by pH measurement, penetration testing, and rheometer analysis. The antibacterial activity of NZ-paste against L. rhamnosus was assessed using agar disc diffusion and live/dead BacLight® assays in dentin, and confirmed by confocal laser stereomicroscopy (CLSM). The methyl thiazolyl tetrazolium assay was used to determine its cytotoxicity for hDPSCs. Results: HPLC analysis identified azadirachtin, quercetin, nimbin, and nimbidin as the main bioactive compounds. NZ-paste had a smooth, fluid-like texture, was water-soluble, and exhibited a pH of 7.09. Although its inhibition zone was comparable to that of Ca(OH)₂, NZ-paste demonstrated superior antibacterial efficacy in the dentinal tubule invasion model, as indicated by the lowest live/dead ratio confirmed by CLSM. NZ-paste at concentrations up to 10mg/mL did not affect hDPSC viability. Conclusion: The novel NZ-paste exhibits antibacterial activity against L. rhamnosus, with suitable penetration ability and favorable biocompatibility with hDPSCs at low concentrations.

Objectives: Calcium hydroxide (CH) remnants in root canals can compromise root canal sealing, highlighting the need for effective removal techniques. This study assessed the efficacy of Gentlefile Finisher Brush (GB), in combination with ethylenediaminetetraacetic acid (EDTA), for CH removal by stereomicroscopic evaluation. Materials and Methods: This in vitro study evaluated CH removal from 66 extracted single-rooted mandibular incisors. After canal preparation with ProTaper up to F2 and CH application, the specimens were incubated for 10 days and randomly divided into six groups on the basis of the irrigation method and instrument used: master apical file (MAF) or GB with saline or 17% EDTA (n=15 each) and positive and negative control groups (n=3 each). The CH was removed accordingly, and the teeth were longitudinally sectioned. The residual CH was quantified under a stereomicroscope at ×10 magnification using Digimizer software to compare the efficacy of different protocols. Data were analyzed using ANOVA and Tukey’s test (alpha=0.05). Results: The combination of GB with 17% EDTA resulted in the lowest residual CH (8.30%±6.29%) significantly outperforming all other protocols (P<0.05). MAF with saline resulted in the highest residue (52.27%±19.24%). The Tukey’s post-hoc test confirmed that both the GB methods were significantly more effective than their MAF counterparts (P<0.05), while no significant difference was observed between the two MAF-based methods (P>0.05). Conclusion: GB with 17% EDTA demonstrated superior efficacy in removing CH from root canals. These results highlight the importance of combining chelating irrigation with dynamic mechanical agitation to optimize intracanal cleanliness.

Objectives: This study compared the efficacy of photodynamic therapy (PDT) with that of conventional methods for disinfection of clear thermoplastic sheets used for the fabrication of aligners. Materials and Methods: In this study, 70 pieces of clear dental aligners measuring 15×15mm were gamma-sterilized, and randomly assigned to two groups (n=35) for inoculation with Streptococcus mutans and Lactobacillus acidophilus. After biofilm formation, the specimens were randomly assigned to 7 subgroups for disinfection with 0.2% chlorhexidine (CHX), 2.5% acetic acid, 3% hydrogen peroxide (HP), 100 µL/mL methylene blue (MB), PDT with MB and diode laser, diode laser alone, and distilled water (control). After sonication and culture, the colonies were counted and compared using ANOVA, Tamhane, and one sample t-test (alpha=0.05). Results: HP showed the highest efficacy in both bacterial groups (P<0.05). In S. mutans group, CHX had a significantly higher efficacy than the other modalities (P<0.05). Distilled water showed no significant difference compared with MB or laser (P>0.05), and acetic acid showed no significant difference compared with PDT (P>0.05). In the L. acidophilus group, CHX demonstrated significantly higher efficacy than the other modalities (P<0.05). Distilled water showed no significant difference compared with laser, and acetic acid showed no significant difference compared with PDT (P>0.05). Conclusion: Within the limitations of this in vitro study, PDT demonstrated moderate antibacterial activity against S. mutans and L. acidophilus biofilms. However, HP followed by CHX showed significantly greater antibacterial efficacy and remained the most effective disinfection approach among those evaluated.

Objectives: This study compared the penetration depth of three different root canal sealers—AH Plus resin-based, Apexit Plus calcium hydroxide (CH)-based, and BioRoot RCS bioceramic-based sealers—into dentin after removal of CH intracanal medicament. Materials and Methods: In this in vitro study, 60 extracted single-rooted mandibular premolars were decoronated with a diamond disc under water cooling to a standard length of 16mm; 12 samples were selected as control, and the rest received CH mixed with rhodamine dye as an intracanal medicament. Two weeks later, CH was removed by manual filing and irrigant activation using EndoActivator. Samples were then divided into 3 groups (n=12) depending upon the sealer used as AH Plus, Apexit Plus, and Bioroot RCS sealer. All sealers were combined with fluorescein dye, and obturation was performed using F3 gutta-percha with lateral compaction technique. After 2 weeks, the teeth were transversally sectioned into coronal, middle, and apical thirds. The penetration depth of sealers was measured via an imaging software. Statistical analysis was performed using ANOVA followed by the Tukey’s post-hoc test (alpha=0.05). Results: A statistically significant difference was observed among the groups (P<0.05). The penetration depth of sealers was the lowest in the apical third, and the highest in the coronal third in all three groups. BioRoot RCS showed the highest penetration depth at all three levels, despite CH medicament remnants. Conclusion: Bioroot RCS bioceramic sealer was superior to AH Plus resin-based and Apexit Plus CH-based sealers regarding penetration depth into dentin after removal of CH intracanal medicament.

Objectives: This study evaluated the reliability of panoramic radiography in comparison with lateral cephalometry for angular measurements in different skeletal classes. Materials and Methods: In this retrospective study, the gonial angle, the angle formed between the palatal plane and the Frankfort plane (palatal plane inclination), and the angle formed between the incisal edge of the upper incisor and the Frankfort plane (upper incisor vertical index) were measured on panoramic and lateral cephalometric radiographs of 278 patients in three skeletal classes. Intraclass correlation coefficient (ICC) was calculated to compare panoramic and lateral cephalometric radiographs. Paired t-test was used for comparison of the right- and left-side angles on panoramic radiographs. Results: The ICCs were 0.941, 0.927, and 0.954 for the gonial angle, 0.650, 0.605, and 0.320 for the palatal plane inclination, and 0.812, 0.810, and 0.758 for the maxillary incisor vertical index in skeletal Class I, II and III patients, respectively. The ICCs were all statistically significant (P<0.05) except for the palatal plane inclination in Class III patients (P>0.05). There was a significant difference in the gonial angle of Class II patients between the right and left sides (P<0.05). The upper incisor vertical index in the right and left sides showed significant differences in all three skeletal classes (P<0.05). The difference between the right and left sides in other angles and skeletal classes was not statistically significant (P>0.05). Conclusion: Skeletal class does not affect the reliability of panoramic radiographs for angular measurements, except for the palatal plane inclination in Class III patients.

Objectives: Using computers from a young age can affect cognitive development and social behavior of children. This study aimed to assess the effect of digital gaming habit on anxiety and behavior of children in a dental setting. Materials and Methods: A total of 137 children between 4 to 6 years seeking their first dental treatment were selected for this cross-sectional study. In the first session, the children were familiarized with the dental setting. In the second session, the parents received a questionnaire regarding the digital gaming habit of their children to fill out. Then, the children underwent dental treatment. The behavior of children during the procedure was video-taped, observed, and scored according to the Frankl behavior rating scale (FBRS) and the Venham clinical anxiety scale (VCAS). Data were analyzed by the Pearson’s correlation coefficient at 0.05 level of significance, and multiple linear regression-backward method at 0.1 level of significance. Results: The mean score of the gaming questionnaire was 44.21 out of 100. The coefficient for the correlation of VCAS and FBRS scores with the gaming questionnaire score was 0.556 and -0.496, respectively. The FBRS and VCAS scores had no significant correlation with demographic variables (P>0.1). But the gaming questionnaire score had a significant correlation with mothers’ occupation (P=0.072). Conclusion: The present results revealed that digital gaming habit increased dental anxiety and negative behavior of children. It is imperative to educate the parents and children at the community level regarding selection of appropriate games and duration of playing.

Objectives: This study assessed the association of dental care utilization with individual and contextual characteristics, and measured disparities based on age and contextual deprivation. Materials and Methods: This cross-sectional study recruited 1,510 randomly selected adults residing in Tehran by phone-based interviews between January 2023 and June 2023. A questionnaire that consisted of questions about predisposing (sociodemographic), enabling (economic status, insurance coverage, neighborhood deprivation, and dental knowledge), and needs characteristics (oral health-related problems, and time loss) influencing dental care utilization was used for data collection. Dental care utilization was assessed using a dichotomized variable. The hierarchical logistic regression model and concentration indices were applied for data analysis using STATA 16 (alpha=0.05). Results: The participants' mean age was 46.21±18.43 years. Approximately 48.0% of the participants reported no dental care utilization. Enabling sources [dental insurance (P<0.001) and neighborhood deprivation (P<0.001)], and need factors [time loss due to oral conditions (P<0.001) and not wearing dentures P<0.001)] were significantly associated with dental care utilization. Age as a predisposing factor had a significant association with dental care utilization with a concentration index of -0.27 (P<0.001). Conversely, the concentration index of socioeconomic status was 0.03 (P=0.005). Conclusion: Disparities in dental care utilization were evident in more affluent groups and among younger age groups. Dental care utilization was associated with psychosocial loss, productivity loss, and contextual deprivation barriers. Moreover, Andersen’s model revealed that social structure, time loss, and enabling sources, rather than the other indicators, determined dental care utilization.

Objectives: This study aimed to examine the impact of social media oral health interventions, using storytelling and text-based education, on the knowledge, practice, and satisfaction of toddlers’ mothers. Materials and Methods: This controlled clinical trial was conducted in 2020 and involved 118 Iranian mothers with toddlers who were active Instagram users. The participants were randomly assigned to two groups storytelling (n=35) and text-based education (n=83). After two weeks, the mothers’ knowledge (n=8 questions), practice (n=7 questions), and satisfaction (n=5 questions) were assessed using an online questionnaire. The Mann-Whitney test and generalized linear model were used for statistical analyses (alpha=0.05). Results: The mean scores of knowledge, practice of mothers regarding their children, and their practice regarding themselves were 34.71±6.85, 10.54±5.05, and 8.65±1.84 in the storytelling group, and 34.87±6.80, 10.32±3.97, and 9.18±1.76 in the text-based education group, respectively. Of all, 71.4% of those in the storytelling group and 72.3% of the text-based education group described the received content as very good. Mothers’ knowledge (P=0.002, β=0.094) and practice regarding their children (P=0.041, β=0.099) were directly correlated with their satisfaction. The satisfaction score was significantly lower in mothers with a higher educational level (P=0.003, β=-1.3). Conclusion: While mothers displayed a relatively desirable level of knowledge, their oral health practice fell short. However, it is worth noting that mothers expressed high satisfaction with both interventions. Hence, online learning should be considered and promoted alongside traditional methods to effectively accelerate oral health practices. Implementing these methods over an extended period will help establish more sustainable effects Objectives: This study aimed to examine the impact of social media oral health interventions, using storytelling and text-based education, on the knowledge, practice, and satisfaction of toddlers’ mothers. Materials and Methods: This controlled clinical trial was conducted in 2020 and involved 118 Iranian mothers with toddlers who were active Instagram users. The participants were randomly assigned to two groups storytelling (n=35) and text-based education (n=83). After two weeks, the mothers’ knowledge (n=8 questions), practice (n=7 questions), and satisfaction (n=5 questions) were assessed using an online questionnaire. The Mann-Whitney test and generalized linear model were used for statistical analyses (alpha=0.05). Results: The mean scores of knowledge, practice of mothers regarding their children, and their practice regarding themselves were 34.71±6.85, 10.54±5.05, and 8.65±1.84 in the storytelling group, and 34.87±6.80, 10.32±3.97, and 9.18±1.76 in the text-based education group, respectively. Of all, 71.4% of those in the storytelling group and 72.3% of the text-based education group described the received content as very good. Mothers’ knowledge (P=0.002, β=0.094) and practice regarding their children (P=0.041, β=0.099) were directly correlated with their satisfaction. The satisfaction score was significantly lower in mothers with a higher educational level (P=0.003, β=-1.3). Conclusion: While mothers displayed a relatively desirable level of knowledge, their oral health practice fell short. However, it is worth noting that mothers expressed high satisfaction with both interventions. Hence, online learning should be considered and promoted alongside traditional methods to effectively accelerate oral health practices. Implementing these methods over an extended period will help establish more sustainable effects