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BACKGROUND Dental fear and anxiety (DFA) refers to the fear of and anxiety towards going to the dentist. It exists in a considerable proportion of children and adolescents and is a major dilemma in paediatric dental practice. However, temperament has been suggested to be a predictive factor for the child’s reaction to dental treatment especially in young ages. This study was done to assess the role of temperament in the levels of anxiety and cooperation in preschool and elementary school children in the dental office. METHODS This descriptive, cross-sectional study evaluated 70 preschools (4 - 6 years of age) and elementary school (7 - 10 years of age) children presenting to the paediatric dental clinic of TUMS School of Dentistry. The children were generally healthy and had at least one carious primary molar requiring pulp therapy or restorative treatment under local anaesthesia. The temperament trait of children was determined using the Persian version of Malhotra’s Temperament Schedule that measures the nine temperament traits identified by Thomas and Chess. Next, the cooperation and level of anxiety in children were determined during anaesthetic injection and cavity preparation using the Venham Clinical Cooperation Scale (VCCS) and Venham Clinical Anxiety Scale (VCAS). Data was analyzed using a regression model. RESULTS The temperament trait of children had a significant correlation with their parent’s education level (P = 0.038). Lower sociability scores were significantly correlated with higher level of anxiety and uncooperative behaviour of children during anaesthetic injection and cavity preparation (P < 0.05). Rhythmicity was significantly correlated with anxiety during anaesthetic injection, and higher intensity of response/energy was significantly correlated with poor cooperation of children during injection and higher anxiety during cavity preparation (P < 0.05). CONCLUSIONS Within the limitations of this study, the results of temperament trait can predict the behaviour of children and their level of anxiety and cooperation in the dental office setting. KEY WORDS Anxiety; Cooperation; Child, Preschool; Temperament; Paediatric Dentistry.

Background. Premature loss of deciduous teeth can lead to loss of space and have a negative effect on occlusion. The use of space maintainers can reduce the severity of problems such as crowding. However, the literature is controversial regarding the effects of early loss of primary first molars The aim of this study was to determine the factors affecting the need for unilateral space maintainer for the first deciduous molars in late mixed dentition. In this cross-sectional study, fifty children between 6 to 8 years who had lost a primary first molar unilaterally later than 6 months ago were randomly selected. Midline deviation, molar and canine relationships at both sides, facial growth pattern, and the amount of space loss were all assessed. Data were analyzed using SPSS version 25 via one-sample t-test, paired t-test, and linear regression ( alpha = 0.05 ). Methods. In this cross-sectional study, 47 children aged 8 to 10 years with early unilaterally loss of first primary molar in the past 6 months were randomly selected. First, the type of occlusion based on the angle molar relationship and the growth pattern of face based on the Hall and Farkas and midline were assessed. Anterior crowding was measured. SPSS 25 program and Chi-square, t-test, ANOVA, and linear regression were used to analyze the data. A significance level of 0.05 was considered. Results. The results showed that the amount of space loss is 0.56 mm ( maxilla = 0.54 and mandible = 0.58 ), which is not clinically significant, and there is no need for space maintainer. Increasing age ( p = 0.021 ) and increasing the percentage ratio of facial pattern ( p = 0.009 ) significantly reduced the space loss and increased the duration of tooth loss ( p = 0.002 ), and molar relationship in the control side ( p = 0.05 ) and increasing the canine to lateral distance ( p = 0.016 ) significantly increased the space loss. Other factors such as crowding, midline deviation, and canine relationship on the control side did not have significant effects on space loss. Conclusion. Space loss due to extraction of the first primary molars in late mixed dentition was neither statistically nor clinically significant. However, in cases of severe crowding, the vertical growth pattern of the face, and molar relationship, further studies are needed, and follow-up of patients is recommended.

Purpose: The objectives of this study were to estimate the prevalence and associated factors of cigarette smoking and the association between cigarette smoking and opium use among patients visiting an outpatient clinic in Afghanistan. Methods: A cross-sectional study was conducted on consecutive patients aged 18 years and older from January 2018 to April 2018. Data on patients’ sociodemographic characteristics and clinical variables were collected using an interview-based survey. Results: Six hundred and twenty-two patients (391males vs. 231 females) were interviewed for this study. The overall prevalence of current smoking was 50.2% (95% confidence interval [CI]: 46.2–54.2). Males were (odds ratio [OR] = 9.5; 95% CI: 5.3–17.1) more likely to smoke cigarettes than females. The odds of current cigarette smoking increased with having a family member smoker or a friend smoker (OR =3.3; 95% CI: 2.0–5.3). Cigarette smoking was significantly associated with the level of education (illiterate OR = 8.9; 95% CI: 4.0–19.8), primary/private education (OR = 7.8; 95% CI: 3.9–15.6), and secondary education (OR = 4.4; 95% CI: 2.3–8.4), with high school or higher education as the reference group. Rural residents were 3.7 times (95% CI: 2.3–6.2) more likely to smoke cigarette than urban residents. Opium users were 23.0 times (95% CI: 12.5–42.3) more likely to smoke cigarettes than non-opium users. Conclusions: The prevalence of cigarette smoking among patients visiting an outpatient clinic in Afghanistan was high, and there was an association between cigarette smoking and male gender, a family history of smoking or a friend history of smoking, level of education, rural residency, and opium consumption.

Background: Fissured tongue is a common manifestation of the tongue, marked by the presence of multiple prominent grooves or fissures on the dorsal surface of the tongue. However, there is a lack of studies focusing on the prevalence and factors associated with fissured tongue among patients attending an outpatient clinic living in regional areas of Afghanistan. Aims: The purpose of the current study was to determine the prevalence and factors associated with fissured tongue among adult outpatients in Afghanistan in regional areas of Afghanistan. Methods: The cross-sectional survey was conducted among outpatient populations in Andkhoy, Afghanistan, between September 2019 and December 2019. Socio-economic status, smoking, nass use (smokeless tobacco use) and medical data were also assessed. We used the logistic regression models to identify factors associated with fissured tongue. Results: The studied population consisted of 1182 participants, of whom 573 (48.5%) were male and 609 (51.5%) female. The prevalence of fissured tongue was 27.2% (95% CI: 24.7-29.9%) with male having significantly higher prevalence than female (47.5%, 95% CI: 43.3-51.6% versus 8.2%, 95% CI: 6.2-10.7%, pConclusions: This study suggested that there was a high rate of fissured tongue among an outpatient clinic in Andkhoy, Afghanistan. Male gender, diabetes mellitus, and nass consumption were associated with fissured tongue. Therefore, these factors might usefully be targeted in local health promotion, prevention and early intervention programs.

Introduction. Although primary teeth have a determinative role in development of normal occlusion, few studies about anomalies related to deciduous dentition have been conducted so far. Regarding recent improvements in common knowledge and the importance of maintaining primary teeth until eruption of succedaneous teeth, identifying the morphology of primary teeth and probable variations is of great importance to achieve optimal therapeutic outcome. This study aims to determine the prevalence of three-rooted mandibular primary molars in a population of northwestern Iran. Materials and Methods. In this descriptive cross-sectional study, periapical radiographs of patients attending private oral and maxillofacial radiology offices in the northwestern region of Iran from 2017 to 2019 were retrospectively reviewed. A total of 300 cases in the 3– 10 -year age range having bilateral periapical radiographs from mandibular primary molars were screened. First and second primary molars were observed meticulously. Gender, side of the mandible (right or left), symmetry, overall prevalence, and prevalence considering the type of molar (D or E) were recorded and analyzed. Results. Overall prevalence of three-rooted mandibular primary molars was 9.33 % ( 28 / 300 ), 92.9 % of which were unilateral. The prevalence of teeth showing supernumerary roots among all teeth examined was 2.5 % ( 30 / 1200 ). Considering symmetry and gender, the occurrence of these three-rooted primary molars did not differ significantly (respectively, p = 0.832 and p = 0.541 ). However, there was a significant relationship between the occurrence of supernumerary roots and left side for three-rooted first molars and right side for three-rooted second molars ( p = 0.021 ). Conclusion. Obtained data show that three-rooted mandibular primary molars in children of northwest region of Iran have a prevalence of approximately 10 % which urges some specific considerations in exodontic and endodontic procedures.

Aims and Objectives: The aim of the study is to assess the knowledge, attitude, and practice of forensicodontology among undergraduate dental students at Kabul university of medical science, Kabul,Afghanistanafter adding this subject in their curriculumMaterial and Methods: This cross-sectional study is conducted among 150 undergraduate dental studentsof Kabul University of medical sciences aged 18 and 23 years during the period from December 2020to February 2021.A questionnaire of Abdul et al. (2019) study was used; the questionnaire consisted of19 questions that assessed the knowledge, attitudes, and practice of the participants. The questionnaire isdivided into three parts: knowledge, attitude and practice. The collected data were analyzed using SPSS-24software, chi-square test.Results: Ninety percent of the participants were aware of the branch of science called forensic dentistry.All the included participants welcomed the idea of adding a module on forensic odontology to the currentundergraduate curriculum. Almost 88.7% of the participants were aware that dental record help foridentification of deceased person’s age however, The most of undergraduate dental students (90.7%), claimthat they have lack of the knowledge related forensic odontology. Most of participants were willing tomaintain dental record in their future clinics.Conclusion: Our study showed that the knowledge, attitude, and practice in undergraduate dental studentsare better since it’s added into curriculum of Kabul University of medical science. However,there are noworkshops, seminars, and continuing dental education programs for dental students.There is a need forfurther exposure and formal training to bring awareness among all health-care providers.

Mohammad Hassan Hamrah,1,2 Ali Baghalian,1 Sara Ghadimi,1 Saeedeh Mokhtari,1 Mojgan Kargar,3 Maryam Khosrozadeh,1 Toba Dahi,4 Abdurrahman Charkazi,5 Mohammad Shoaib Hamrah,6 Mohammad Hussain Hamrah2 1Department of Paediatric Dentistry, School of Dentistry, Tehran University of Medical Sciences, Tehran, Iran; 2Curative Clinic, Andkoy, Faryab, Afghanistan; 3Department of Paediatric Dentistry, School of Dentistry, Shahid Sadoughi University of Medical Sciences, Yazd, Iran; 4Abant Izzet Baysal University Faculty of Dentistry, Bolu, Turkey; 5Health Education and Promotion, Environmental Health Research Center, Faculty of Health, Golestan University of Medical Sciences, Gorgan, Iran; 6Shaheed Ostad Esmail”Aslam” Aimaq Hospital, Anadkhoy, Faryab Province, AfghanistanCorrespondence: Mohammad Hussain HamrahCurative Clinic Andkhoy, Amir Timor Street, Shari now, Andkhoy, AfghanistanEmail hkmu1991@gmail.comBackground: Fissured tongue is a common manifestation of the tongue, marked by the presence of multiple prominent grooves or fissures on the dorsal surface of the tongue. However, there is a lack of studies focusing on the prevalence and factors associated with fissured tongue among patients attending an outpatient clinic in Afghanistan.Aim: The purpose of the current study was to determine the prevalence and factors associated with fissured tongue and its effects on the general health of adult outpatients in Afghanistan.Patients and Methods: The cross-sectional survey was conducted among outpatient populations in Andkhoy City, Afghanistan, between September 2019 and December 2019. A convenience technique was applied by including 1182 patient aged 18– 80 years. Socio-economic status, smoking, nass use (smokeless tobacco use) and medical data were collected using face-to-face interviews. We used logistic regression analysis to identify factors associated with fissured tongue. A convenience technique was applied by including patient aged 18– 80 years.Results: The studied population consisted of 1182 participants, of whom 573 (48.5%) were males and 609 (51.5%) females. The prevalence of fissured tongue was 27.2% (95% CI: 24.7– 29.9%) with males having significantly higher prevalence than females (47.5%, 95% CI: 43.3– 51.6% versus 8.2%, 95% CI: 6.2– 10.7%, p< 0.001). Male participants (OR=7.1, 95% CI: 4.8– 10.3), diabetes mellitus (OR=1.6, 95% CI: 1.1– 2.3) and smokeless tobacco use (OR=12.0, 95% CI: 8.1– 17.6) were the only variables independently associated with fissured tongue.Conclusion: This study suggested that there was a high rate of fissured tongue among an outpatient clinic in Andkhoy, Afghanistan. Male gender, diabetes mellitus, and nass consumption were associated with fissured tongue. Therefore, these factors might usefully be targeted in local health promotion, prevention and early intervention programs.Keywords: fissured tongue, prevalence, risk factors, Andkhoy, Afghanistan

Objective: To review current models and scientific evidence on the influence of mother’s knowledge of oral health behaviors on their preschool children’s oral health.Method: MEDLINE, EMBASE and Scopus databases were searched for articles published between January 2009 and December 2019 on mother’s oral health behavior.Results: A total of 324 citations were retrieved, with 17 articles finally included in the analysis. The studies utilized various methods, including text messaging, phone conversation, of which motivational interviewing method was more effective in their knowledge and behaviors about their preschool child’s oral health.Conclusion: Mother’s knowledge has a direct effect influence on their preschool children’s oral health. Oral health education programs aimed at preventive actions are needed to provide children not only with adequate oral health, but better quality of life. Special attention should be given to the entire family, concerning their lifestyle and oral health habits.

Left ventricular hypertrophy (LVH) and proteinuria are known as independent predictors of cardiovascu- lar death in hypertension. However, LVH and its association with proteinuria have not been investigated in adult hypertensive patients in Afghanistan. The objective of this research was to determine the prevalence of LVH and the correlation between LVH and proteinuria among the Afghan adult hypertensive popula- tion visiting an outpatient clinic in Afghanistan. We retrospectively evaluated 789 hypertensive patients (mean age is 56 years and 46% were men) who visited the clinic between December 2014 and August 2016. Patient characteristics and laboratory and clinical findings were recorded. The rate of LVH among hypertensive patients was 54.4%. Patients with proteinuria had a significantly higher LVH percentage compared to those without proteinuria (73.2% versus 55.8%; P

Dyslipidemia is known as an independent risk factor for cardiovascular disease. Recently, interest has been raised on the risk of new onset of diabetes mellitus with statin treatment. We report on a 41-year-old man with dyslipidemia. His blood tests at the time of admission showed that there was a rise in low-density lipoprotein levels (155 mg/dl), low high-density lipoprotein levels (34 mg/dl), normal triglyceride levels (82 mg/dl), normal fasting blood sugar levels (85 mg/dl), and normal glycated hemoglobin (HbA1c) (5.3%). Follow-up for about 2.5 years for statin use revealed that the patient’s lipid profile has improved; however, his HbA1c increased from 5.3 to 6.1%. The patient was prescribed Metformin and the statin was replaced with Ezetimibe. Little changes in blood HbA1c levels were observed at 1-year follow-up. Then, dipeptidyl peptidase-4 inhibitors, Sitagliptin, was introduced at 25 mg once per day, and Metformin was discontinued. One year later, the patient’s laboratory tests showed: low-density lipoprotein (77 mg/dl), high-density lipoprotein (33 mg/dl), triglycerides (108 mg/dl), and HbA1c (5.5%). This finding revealed that the dipeptidyl peptidase-4 inhibitor, Sitagliptin is more likely to be the successful drug for the treatment of prediabetes with statin therapy.

Proteinuria in hypertension is an early marker of renal disease and a predictor for the progression of end stage renal disease, and cardiovascular diseases. This study was designed to determine the prevalence of proteinuria and its association with cardiovascular risk factors among adult hypertensive patients in Afghanistan. Five hundred fifty-five patients with a high blood pressure recorded in an outpatient clinic in Andkhoy, Afghanistan from December 2014 to May 2015, were included in this study. Data obtained from each patient, included demographic characteristics, body mass index, blood pressure patterns, cardiovascular history, cardiovascular risk factors, comorbidity, and current drug-therapy. Dipstick screening for proteinuria was performed with reagent test strips. The mean age of the patients was 57.9 ± 13.3 years, and a female predominance was observed (n = 333, 60%). The prevalence of proteinuria was 67.2%. The predictors of proteinuria were found to be age ≥65 years (odds ratio [OR] 1.02, 95% confidence interval [CI] 1.00–1.04), smoking (OR 1.88, 95% CI 1.17–3.02), heart failure (OR 2.23, 95% CI 1.13–4.41), and diabetes mellitus (OR 3.41, 95% CI 1.49–7.81). In conclusion, this study shows that proteinuria is highly prevalent among hypertensive outpatients in an outpatient clinic in Andkhoy, Afghanistan, especially in those with high cardiovascular risk.

Background: The association between Helicobacter pylori infection and cardiovascular risk factors remains controversial. The high prevalence of H. pylori infection among Afghan patients warranted the investigation of this association. The aim of the present study was to determine the association between H. pylori infection and cardiovascular risk factors among patients visiting an outpatient clinic in Andkhoy, Afghanistan. Methods: We performed a cross-sectional study of 271 consecutive patients in an outpatient clinic in Andkhoy, Afghanistan from April 2017 to June 2017. The diagnosis of H. pylori infection was achieved using an enzyme-linked immunosorbent assay test. The patients were divided into H. pylori positive (n=189) and H. pylori negative (n=82) groups. The association between H. pylori infection and cardiovascular risk factors was analyzed. Results: Of the total 271 study participants, 102 (37.6%) were male and 169 (62.4%) female. The mean age ± standard deviation of the patients who were H. pylori-positive and H. pylori-negative was 51.0 ± 17.6 years and 51.6 ± 17.6 years, respectively. In multivariate logistic regression analyses, H. pylori infection was significantly associated with diabetes mellitus (DM) (odds ratio [OR] 3.16, 95% confidence interval [CI] 1.31-7.62, P = 0.011), and body mass index (BMI) levels (OR 1.17, 95% CI 108-1.26, P < 0.001). Conclusions: Our study indicated that H. pylori infection was significantly associated with DM and elevated BMI levels in patients from an outpatient clinic in Andkhoy, Afghanistan. More aggressive measures, including DM, obesity control, and H. pylori eradication are needed.

There is a relationship between mental and physical health. Depression and anxiety are linked with the development of several chronic diseases. The purpose of the present study was to determine the prevalence and factors associated with anxiety and depression among adult hypertensive outpatients in Afghanistan. Methods. Two hundred thirty-four consecutive hypertensive patients from December 2015 to August 2016 were recruited to complete the Hospital Anxiety and Depression Scale (HADS) questionnaire, which has scores for classifying the participants having anxiety and depression symptoms. Results. Of the total 234 patients, 81 (34.6%) were males and 153 (65.4%) were females. The mean age was 54.6±12.7 for the hypertensive patients with anxiety and 63.8±15.0 for the hypertensive patients with depression while this figure was 49.5±10.2 for the adult participants in general population in Kabul city (Saeed, 2013). The prevalence of anxiety and depression (42.3% vs. 58.1%) among hypertensive persons is compared with the same mental disorders among Afghan refugees (39.3% vs. 22.1%) in Dalakee Refugee Camp (in Iran) (Hosseini Divkolaye and Burkle, 2017). Of the total participants, 99 had anxiety (42.3%), 136 had depression (58.1%), and 66 had (28.2%) comorbid anxiety-depression. Multivariate analysis was used. For anxiety age, female gender, smoking, diabetes mellitus, and 2 or more chronic diseases had a significant association. For depression, age and diabetes mellitus had a significant association, and for comorbid anxiety, depression, age, diabetes mellitus, and 2 or more chronic diseases had a significant association. Conclusion. This study shows that anxiety and depression are highly prevalent among hypertensive patients in an outpatient clinic in Afghanistan. There was an association between some sociodemographic and clinical characteristics and anxiety and depression. More studies are needed on a national level to inform the development of strategies for the prevention and control of psychological distress among patients with chronic diseases in Afghanistan.