Hussein Jameel Abd Noor Al-essawi

Abstract: Background:The use of local anesthetics with vasoconstrictors in hypertensive patients undergoing dental procedures remains a clinical concern due to potential adverse cardiovascular events. This study aimed to provide a comprehensive comparison of the hemodynamic, inflammatory, and genetic responses to lidocaine with epinephrine versus plain mepivacaine in controlled hypertensive patients undergoing tooth extraction. Materials and Methods:This prospective, randomized, double-blind clinical trial included 80 controlled hypertensive patients scheduled for tooth extraction. Patients were randomly assigned to receive either 2% lidocaine with 1:80,000 epinephrine (Group L, n=40) or 3% mepivacaine plain (Group M, n=40). Hemodynamic parameters (systolic blood pressure [SBP], Diastolic Blood Pressure [DBP], Heart Rate [HR]) were recorded at baseline, 3 minutes post-injection, and 3 minutes post-extraction. Venous blood samples were collected at baseline and 30 minutes post-extraction to analyze inflammatory biomarkers (hs-CRP, IL-6, TNF-α) and for genotyping of CYP1A2 and ADRB2 polymorphisms. Results: Group L demonstrated significantly greater hemodynamic stability, with smaller fluctuations in SBP and HR compared to Group M (p<0.05). Post-procedure, Group M showed a significant increase in serum hs-CRP and IL-6 levels (p<0.01), whereas Group L showed no significant change. Patients with the CYP1A2 *1F allele (A/A genotype) showed slower lidocaine metabolism and a transient increase in DBP. A significant association was found between the ADRB2 Gly16Arg polymorphism and increased HR variability in both groups. Discussion:The finding of more significant hemodynamic instability and inflammatory response within the mepivacaine group suggests that inadequate anesthesia causes a substantial endogenous catecholamine stress response, which is likely more damaging than a minimal amount of exogenous epinephrine. Additionally, genetic differences in CYP1A2 and ADRB2 influence individual physiologic responses and support a biological explanation for the variability is seen across patients. Conclusion: Lidocaine with epinephrine was associated with superior hemodynamic stability and a blunted systemic inflammatory response compared to plain mepivacaine. These findings suggest that the inclusion of a vasoconstrictor may offer a safer and more controlled anesthetic profile for hypertensive patients. Pharmacogenetic variations in CYP1A2 and ADRB2 may influence individual patient responses, highlighting the potential for personalized anesthetic

Abstract Gingival hyperpigmentation is a frequent esthetic issue, but the impact of gingival thickness on outcomes of depigmentation procedures has not been studied extensively. This study aimed to investigate and compare the clinical outcomes of surgical scalpel depigmentation in patients with thick versus thin gingival tissue, as classified by the probe transparency method. In this prospective comparative clinical study, 40 patients with physiologic gingival melanin hyperpigmentation were recruited and classified into a thick gingiva group (n=20) or a thin gingiva group (n=20) through the probe transparency method. All patients were treated with surgical scalpel depigmentation. All patients were treated with surgical scalpel depigmentation. The primary outcome was postoperative pain assessed by VAS. Secondary outcomes included DOPI, Hedin Melanin Index, wound healing, bleeding time, and repigmentation, evaluated at baseline, one week, and three months postoperatively. Both groups showed significant reductions in DOPI and Hedin Melanin Index scores at one week and three months (p<0.001). The thin gingiva group reported significantly higher VAS pain scores at 24 h (4.65±1.10 vs. 3.40±0.92; p=0.001) and one week (2.35±0.95 vs. 1.20±0.68; p=0.030). No significant intergroup differences were found in wound healing or bleeding time. Repigmentation at three months was higher in the thin group (30%) than the thick group (15%), though not statistically significant (p=0.235). Surgical scalpel depigmentation effectively reduces gingival melanin hyperpigmentation regardless of gingival thickness. However, patients with thin gingival tissue may experience greater postoperative discomfort. A preliminary, non-statistically significant trend toward higher repigmentation was observed in the thin gingiva group; this exploratory finding requires confirmation in adequately powered studies with longer follow-up. These results should be interpreted within the constraints of the probe transparency classification method used.

Abstract: Introduction:Gingivitis represents the most prevalent form of periodontal disease in children worldwide, characterized by reversible gingival inflammation without loss of connective tissue attachment. Despite its preventable nature, gingivitis affects a substantial proportion of school-age children globally, with prevalence rates that vary significantly across different populations and geographic regions. Limited contemporary data exist regarding gingivitis prevalence among Iraqi children, particularly in the post-conflict era in which healthcare systems and oral health promotion programs have faced significant challenges. The purpose of this study was to determine the prevalence of gingivitis and identify associated risk factors among primary school children aged 7–11 years in AlNajaf city, Iraq. Materials and Methods: A cross-sectional study was conducted among 531 children (200 boys and 331 girls) from four randomly selected primary schools in Al-Najaf city between December 2021 and January 2022. Clinical examinations included assessment of gingival inflammation using the Löe and Silness Gingival Index and plaque accumulation using the Silness and Löe Plaque Index. Data on oral hygiene practices, sociodemographic factors, and dental care utilization were collected through structured questionnaires. Statistical analysis involved descriptive statistics, chi-square tests, and multivariate logistic regression to identify associated factors. Results: The overall prevalence of gingivitis was 16.6% (88/531), with 83.4% of children showing healthy gingiva. Mild gingivitis was observed in 13.0% of participants, moderate gingivitis in 2.8%, and severe gingivitis in 0.8%. Significant associations were found between gingivitis and toothbrushing frequency (p < 0.001), plaque accumulation (p < 0.001), and dental caries experience (p < 0.05). Children who never brushed their teeth had 3.2 times higher odds of developing gingivitis compared to those who brushed twice daily (OR = 3.2, 95% CI: 1.8-5.7). The presence of dental plaque was the strongest predictor of gingivitis (OR = 4.8, 95% CI: 2.9-7.9). Discussion: The 16.6% prevalence aligns with global epidemiological data, positioning gingivitis as a significant local health issue. The strong predictive power of plaque presence and lack of toothbrushing confirms that the disease in this cohort is overwhelmingly linked to modifiable hygiene practices. This finding is particularly critical given that over a third of the children reported never brushing, highlighting a substantial gap in basic oral self-care that directly contributes to the observed disease burden. These findings underscore the urgent need for targeted public health interventions, such as school-based oral health programs, to address these modifiable risk factors and improve the oral health of children in this post-conflict region. Conclusion: The prevalence of gingivitis among school children in Al-Najaf is consistent with global estimates and shows significant associations with modifiable risk factors. Enhanced oral health education programs and improved access to preventive dental care are essential for reducing the burden of gingival disease in this population.

Abstract: Introduction:Gingivitis represents the most prevalent form of periodontal disease in children worldwide, characterized by reversible gingival inflammation without loss of connective tissue attachment. Despite its preventable nature, gingivitis affects a substantial proportion of school-age children globally, with prevalence rates that vary significantly across different populations and geographic regions. Limited contemporary data exist regarding gingivitis prevalence among Iraqi children, particularly in the post-conflict era in which healthcare systems and oral health promotion programs have faced significant challenges. The purpose of this study was to determine the prevalence of gingivitis and identify associated risk factors among primary school children aged 7–11 years in AlNajaf city, Iraq. Materials and Methods: A cross-sectional study was conducted among 531 children (200 boys and 331 girls) from four randomly selected primary schools in Al-Najaf city between December 2021 and January 2022. Clinical examinations included assessment of gingival inflammation using the Löe and Silness Gingival Index and plaque accumulation using the Silness and Löe Plaque Index. Data on oral hygiene practices, sociodemographic factors, and dental care utilization were collected through structured questionnaires. Statistical analysis involved descriptive statistics, chi-square tests, and multivariate logistic regression to identify associated factors. Results: The overall prevalence of gingivitis was 16.6% (88/531), with 83.4% of children showing healthy gingiva. Mild gingivitis was observed in 13.0% of participants, moderate gingivitis in 2.8%, and severe gingivitis in 0.8%. Significant associations were found between gingivitis and toothbrushing frequency (p < 0.001), plaque accumulation (p < 0.001), and dental caries experience (p < 0.05). Children who never brushed their teeth had 3.2 times higher odds of developing gingivitis compared to those who brushed twice daily (OR = 3.2, 95% CI: 1.8-5.7). The presence of dental plaque was the strongest predictor of gingivitis (OR = 4.8, 95% CI: 2.9-7.9). Discussion: The 16.6% prevalence aligns with global epidemiological data, positioning gingivitis as a significant local health issue. The strong predictive power of plaque presence and lack of toothbrushing confirms that the disease in this cohort is overwhelmingly linked to modifiable hygiene practices. This finding is particularly critical given that over a third of the children reported never brushing, highlighting a substantial gap in basic oral self-care that directly contributes to the observed disease burden. These findings underscore the urgent need for targeted public health interventions, such as school-based oral health programs, to address these modifiable risk factors and improve the oral health of children in this post-conflict region. Conclusion: The prevalence of gingivitis among school children in Al-Najaf is consistent with global estimates and shows significant associations with modifiable risk factors. Enhanced oral health education programs and improved access to preventive dental care are essential for reducing the burden of gingival disease in this population.

ABSTRACT Background: Periodontal diseases are an infection caused by many factors include different bacterial pattern. Biofilm is the main reason for periodontal disease that consists of many microorganisms. Streptococci of Mitis group such as Streptococcus mitis, Streptococcus oralis, are early colonizers within development of dental biofilms, which is the cause of periodontal disease. The periodontal diseases treatment focuses primarily on the reduction of the microorganism count thus antimicrobials agents has been used as an adjunct to conventional therapy. Multi-drug resistance within the treatment of infectious diseases is a growing problem and also the widespread use of broad-spectrum antibiotics has created antibiotic resistance for several human microorganisms. Recently, nanoparticles have significant attention for medical applications because of their antimicrobial effectiveness. Gold nanoparticles (Au Nps) were considered as potential agent to control oral bacterial infection because of its optimal antibacterial activity and non-acute cytotoxic effects on human cells. In this study, gold Nps with average particles size (43 nm) will be use. The objective of this study is to investigate the antibacterial effect of gold nanoparticles against Streptococcus mitis in dental plaque. Materials and Methods: The first step of present study was tacking aerobic and anaerobic plaque samples from 10 patients with periodontal disease. Second step was morphological and microscopicale examination in addition to the biochemical tests and vatic 2 machines were used to confirm identification of Streptococcus mitis. The next steps were synthesis of gold nanoparticles by chemical method (seed growth method) and testing its characterization. Finally test the potential antimicrobial effect of gold nanoparticles on Streptococcus mitis. The data were analyzed by using descriptive statistics including mean and standard deviation, LSD were done for the analysis of MIC of (gold nanoparticles) against (Streptococcus mitis Bacteria). Significance of all the statistical tests were determined at p<0.05 using SPSS (Statistical Package for SocialScience) version 22 software. Results: The gold NP in (100 ppm) concentration has the same antimicrobial effect of chlorhexidine against Streptococcus mitis, and there is no significant difference between them, (p>0.05). Conclusions: Gold nanoparticles were effective against Streptococcus mitis similarly to chlorhexidine when it was used in high concentration as antimicrobial agent. Key words: Antibacterial, Chlorhexidine, Streptococcus mitis, Gold nanoparticles

ABSTRACT This research aimed to determine the relationship between the maxillary posterior teeth and maxillary sinus floor (MSF), as well as the impact of nearby tooth loss on the space between MSF and posterior maxillary roots. A number of 120 digital panoramic radiographs were obtained from the archives of several clinics in Al-Najaf, Iraq, with the overall teeth examined in these radiographs including 236 of the 1st premolars, 227 of the 2nd premolars, 227 of the 1st molars, and 231 of the 2nd molars, from the right and left sides. The distances between the apices of the teeth and the maxillary sinus were determined. There are three categories of relationships between upper posterior teeth roots and MSF. These include type Os (root apex exists below or outside MSF), Type Co (root apex in contact with the MSF), and Type Is (root apex above or inside MSF). Type Os is the most encountered among premolars, Type Co is mostly encountered among the 2nd molars, and Type Is, in the 1st and 2nd molars. The study finds no correlation between age, gender, and the distribution of maxillary posterior tooth roots attached to the MSF. The first premolars were the furthest from MS, while the first molars were the closest. The most frequent link between maxillary molar roots and the MS was the Co-relation for the 2nd maxillary molar and the Is relation for the 1st maxillary molar. There is a non-significant decrease in the distance between the apices of the 1st maxillary premolar, 2nd maxillary premolar, and 1st maxillary molar and the MS before and after extraction. KEYWORDS: panoramic radiography, floor of maxillary sinus, upper posterior teeth ABBREVIATIONS: MSF: Maxillary Sinus Floor; MS: Maxillary Sinus; Co: Root in contact with sinus floor; Is: Root inside the sinus; Os: Root outside the sinus INT