Oral Biology and Oral Pathology Commons^™

A Comprehensive Analysis Of The Accurate Diagnosis Of Chronic Non-Bacterial Osteomyelitis Of The Jaw In Young Patients: An Assessment Of Clinical And Laboratory Data, Alexander Yu Kugushev, Andrey V. Lopatin, Suzan Dagher

International Arab Journal of Dentistry

Objectives: Chronic non-bacterial osteomyelitis (CNO) is a rare autoinflammatory bone disorder predominantly affecting pediatric and adolescent populations. The clinical presentation is heterogeneous, with persistent pain and swelling representing the most frequent and often initial symptoms. These manifestations are commonly localized to the mandible, although involvement of other skeletal sites, including long bones, clavicle, and vertebrae, may occur in more advanced cases. Beyond localized symptoms, some patients exhibit mild systemic features such as low-grade fever, fatigue, or malaise; however, these systemic signs are generally less pronounced than those observed in infectious osteomyelitis. The diagnostic evaluation of CNO is intricate and necessitates …

Investigate The Role Of Tgfβ3 In Regulating Irf6 And Δnp63 In Periderm Desquamation, Nam Ha

Theses & Dissertations

Introduction: Failure in palatal fusion during palate development results in cleft palate, one of the most common birth defects in the US. During the final phases of palatogenesis, the palatal periderm (a protective cell layer that prevents premature fusion and adhesion with oral epithelium) must be removed, also known as desquamation. This process is a prerequisite for establishing the midline seam in the fused palate. Previous studies have shown that transforming growth factor-β3 (TGFβ3) plays an irreplaceable role in palate development in mice. Our previously published mechanistic models outline the role of TGFβ3 and its downstream signaling cascade involving proteins …

The Cytotoxicity And Anti-Inflammatory Properties Of 1’S-1’-Acetoxychavicol Acetate (Aca) On Oral Cells, Nur Umairah Atiqah Sabri, Nor Syazwani Muhammad Zahidan, Zulfahmi Said, Siti Noor Adnalizawati Adnan, Normaliza Ab Malik

Journal of Dentistry Indonesia

Objective: Mouthwash is widely used to maintain oral health by reducing the prevalence of pathogenic microbiomes. Nonetheless, chlorhexidine, a common active ingredient, is associated with side effects including teeth staining, mucosal peeling, mouth and tongue numbness. This has prompted interest in natural alternatives. This study aimed to identify the cytotoxicity and anti-inflammatory properties of 1’S-1’-acetoxychavicol acetate (ACA) isolated from Alpinia conchigera rhizome against human primary gingival fibroblast and keratinocyte (HPGF and HPGK). Methods: Cytotoxicity of ACA (1.57 mg/mL) against HPGF and HPGK was assessed using the MTT assay. Meanwhile, the anti-inflammatory property of ACA was analyzed based on …

Prevalence Of Bruxism And Its Association With Stress Among Dental Students: A Questionnaire-Based Cross-Sectional Study, Ketavatu Durga Prasad Naik, Prasanthi Gortha, Madhu Varma, Mohan Kumar, Rama Laxmi Koruprolu, Mounika Rameswarapu

Journal of Dentistry Indonesia

Objective: Bruxism has been described as a parafunction associated with a multifactorial etiology, but primarily as a psychological factor. This study determined the prevalence of bruxism among dental students and explored the potential contributing factors. Methods: A cross-sectional self-administered questionnaire survey was conducted among dental students across various academic years. The prevalence of bruxism (awake and during sleep) was assessed along with stress levels, lifestyle factors, and demographic variables. Statistical analyses were performed using the chi-square test and multivariate logistic regression. Results: The prevalence of bruxism was significantly associated with stress and academic workload. Most participants exhibited moderate to severe …

Musculoskeletal Disorders In Dentistry: An Insight Into Dental Techniques And Practices, Mehwash Kashif, Aman Ashar, Amna Rehman, Abdul Aleem, Sidra-Tul-Muntaha Hashmi, Muhammad Yousuf Ali

Journal of Dentistry Indonesia

Objective: Musculoskeletal disorders (MSDs) are common workplace hazards in dentistry resulting from poor ergonomics and static postures, which lead to back, neck, and upper limb (shoulder, elbow, wrist, and hand) problems among dentists, resulting in harm to their health, productivity, and career. This study aimed to assess the frequency of MSDs, risk factors related to MSDs, and awareness of ergonomics among clinicians. Methods: Data were collected from 400 dental professionals, including house officers, postgraduate trainees, general dentists, and teachers/consultants, each with at least 12 months of practice. Data were collected using a structured, closed-ended questionnaire. Before data collection, ethical approval …

Matrix Metalloproteinase-9 (Mmp-9) Levels In Dentinal Fluid As A Diagnostic Biomarker For Irreversible Pulpitis, Aryo Megantoro, Valeria Widita Wairooy, Ratna Meidyawati, Endang Winiati Bachtiar

Journal of Dentistry Indonesia

Objective: Pulpitis is an inflammatory condition of the dental pulp. The inflammatory status can be accurately assessed by histological examination. Biomarkers, such as matrix metalloproteinases (MMPs), are effective indicators of inflammation severity. Among these, matrix metalloproteinase-9 (MMP-9) has emerged as a key mediator of inflammatory processes associated with pulpitis. However, its clinical application as a biomarker remains limited owing to challenges in its extraction. This study aimed to evaluate the effectiveness of MMP-9 extracted from the dentinal fluid as a biomarker for pulpitis. Methods: Dentinal fluid was collected using the blunt tip of a sterile paper point, following clean …

Targeted Injection Therapies For Temporomandibular Joint Disorders: A Comparative Review Of Hyaluronic Acid And Botox Techniques, Timothy Alexander, Marissa Siegel, Noah Schnoor, Elizabeth A. Starns

Journal of Sports Medicine and Allied Health Sciences: Official Journal of the Ohio Athletic Trainers Association

Purpose: This study aimed to evaluate the effectiveness of different injection therapies for temporomandibular joint disorders (TMD) and answer the research question: how do botulinum toxin (onabotulinumtoxinA, Botox) and hyaluronic acid (HA) injections affect symptoms of temporomandibular joint disorder (TMD)? Methods: An electronic search of three databases was performed using the search terms “Treatment of TMD or TMJ” and one of the following: 1) “Hyaluronic Acid Injection” or 2) “Intramuscular Botox Injection”. Based on studies done with human patients, the effects of both hyaluronic acid and Botox injections as treatments for TMD were observed and analyzed. Inclusion criteria were: full …

Remineralization Effect On Enamel Physicochemical Properties After Chlorine-Induced Erosion, Sara Adel Botros, Mohamed Samy Salama, Mahmoud Al Ankily, Nora Ahmed Alzayyat

Dentistry

No abstract provided.

Induction Of Myelopoiesis By Candida Dubliniensis Drives Protective Trained Immunity Against Sepsis In A Card9-Dependent Manner, Shannon Esher Righi, Elizabeth A. Lilly, Amanda J. Harriett, Patrick W. Daly, Maryjane Jones, Chad Steele, Mairi C. Noverr, Paul L. Fidel

School of Dentistry Faculty Publications

Trained immunity is a long-term functional reprogramming of innate cells that allows for the formation of immune memory akin to adaptive responses, but with a more rapid nonspecific response. We recently identified an anti-inflammatory trained immunity response, termed trained tolerogenic immunity (TTI), induced by low virulence Candida dubliniensis, that protects against acute lethal polymicrobial sepsis via myeloid-derived suppressor cells (MDSCs). Trained immunity and MDSCs arise following hematopoietic stem and progenitor cell (HSPC) expansion in the bone marrow. Here, we show that C. dubliniensis induces inoculum-dependent protection and HSPC expansion, whereas depletion of HSPCs following C. dubliniensis immunization abrogates protection. We …

A Bibliometric Analysis Of The 100 Most Cited Papers In Molecular Biology Studies Of Oral Submucous Fibrosis, Sahil Thuse, Abhirami Premarajan, Gargi Sarode, Muhammad Ruslin, Rajesh Shetty, Sachin Sarode

Journal of Dentomaxillofacial Science

Objective: To systematically map the existing research about molecular biology of OSF along with the notable amount of research in the past and the future insights of the same.

Material and Method: The analysis evaluates the research trends in OSF using Scopus as a primary source due to its comprehensive coverage of peer reviewed literature. The search was performed on 25 April 2025. Only original and review articles were selected wherein "molecular biology" and "oral submucous fibrosis" were the Boolean terms applied. Hundred most cited articles were shortlisted. Network visualisation and bibliometric mapping was performed by VOS viewer. Keyword co-occurrence …

Cytotoxicity And Osteogenic Potentials Of Mesenchymal Stem Cells Via A Novel Formulation Of Mineral Trioxide Aggregate: An In Vitro Study, Ahmed Elgendi, Ehab Hassanien, Mohamed Nagy, Iman Fathy, Ashraf Abu Seida, Elhassan Hassanein

International Arab Journal of Dentistry

Objectives: Root perforations can lead to periodontitis and alveolar bone loss. This study compared cytotoxicity and osteogenic potential of zirconia-containing mineral trioxide aggregate (MTA) Matreva (MAT group) to MTA Angelus (ANG group) as root perforation repair materials.

Methods: Bone marrow mesenchymal stem cells (BM-MSCs) were extracted from two albino rats and cultivated. The cytotoxicity of the studied materials was determined using the 3-(4,5-dimethylthiazol-2-yl)-2,5-diphenyl tetrazolium bromide (MTT) assay at three time points: 3, 7, and 14 days. The evaluated materials were employed to guide the osteogenic differentiation of BM-MSCs into osteoblasts. The osteogenic impact was evaluated by assessing calcium …

Evaluation Of The Remineralizing Agents After Orthodontic Bracket Debonding: A Sem-Edx Investigation, Bassant Ashraf Badr, Medhat Elzainy, Noha Ibrahim, Hend El Messiry

International Arab Journal of Dentistry

Objectives: To compare the remineralizing efficacy of (Fluoride (Fl) Varnish, Nanohydroxyapatite (n-HAp) serum and NovaMin-containing toothpaste) on premolars subjected to orthodontic debonding and a pH-cycling model.

Methods: 60 human premolars were divided into six groups (n=10). Group IA, sound enamel, IB, orthodontically treated premolars, IC, orthodontically treated premolars subjected to demineralization cycles. Three experimental groups included orthodontically treated premolars subjected to demineralization cycles and treated with Fl varnish (IIA), n-HAp serum (IIB), and NovaMin toothpaste (IIC). Surface topography and mineral content were evaluated using SEM-EDX analysis, and data were statistically analyzed using ANOVA test and Tukey’s post-hoc test. …

Impact Of Systemic Statins On Periodontal Health: A Retrospective Study In A Lebanese Population, Elsa Boustany, Georgio Saad, Wassim Al Manhal

International Arab Journal of Dentistry

Introduction: Statins, primarily used for cholesterol management, have shown potential in improving periodontal health due to their anti-inflammatory and bone-regenerative properties.

Methods: A retrospective study was conducted on 30 patients under statin medication. A control group of 30 non-statin users was selected using propensity score matching (PSM) to minimize bias. Data on pocket depth, attachment loss, and radiographic bone loss were collected at two time points: T0 and T1. Statistical analysis was performed using RStudio, with a significance threshold set at p < 0.05.

Results: The study revealed significant decrease in pocket depth (p = 0.0027), attachment loss (p …

Oral And Maxillofacial Pathology Case Of The Month, John E. Kacher Dds

The Journal of the Michigan Dental Association

This case concerns a 39-year-old female patient presenting with an asymptomatic radiolucency and spiking root resorption in the right posterior mandible (tooth #30). The patient delayed treatment for three years due to the COVID-19 pandemic and fear of surgery. Upon return, the lesion had greatly expanded in size (approximately 22-by-17 mm), with increased root resorption. Surgery involved extraction of the tooth and thorough curettage of the lesion. Microscopic examination showed cellular tumor composed of plump spindle cells and interspersed psammoma body calcifications. The final diagnosis was aggressive ossifying fibroma, psammomatoid variant. Treatment typically involves complete local excision and curettage …

J Mich Dent Assoc October 2025

The Journal of the Michigan Dental Association

Each month, the Journal of the Michigan Dental Association delivers news, information, and features about Michigan dentistry to our state's oral health community and the MDA's 6,200+ members. It remains the main publication reaching Michigan dentists and is available worldwide through ADACommons. The October 2025 (Volume 107, No. 10) issue of the Journal is published in a digital-only format to provide updates and insights for Michigan's oral health community and MDA members. Print editions will resume in November. The October issue highlights the critical importance of advocacy through the MDA Dental Political Action Committee (PAC) and provides practical, management-focused information …

Effect Of Gingival Pigmentations And Anterior Crown Heights On Smile Attractiveness Regarding Gingival Exposure Assed By Orthodontists, Dentists, And Laypeople: A Randomized Controlled Trial, Ziad Tannoury, Marianne Moussallem, Joseph Ghoubril, Adib Kassis, Elie Khoury

International Arab Journal of Dentistry

Objectives: The purpose of this study was to evaluate the effect of gingival pigmentations and anterior crown heights in conjunction with the maxillary gingival display on the perception of smile attractiveness assessed by orthodontists, dentists, and laypersons.

Methods: Frontal intraoral photograph of ideally aligned teeth was modified to generate 3 levels of gingival smile exposure (2 mm, 3 mm, and 4 mm) with 4 different degrees of gingival pigmentation index according to DOPI and 5 different central incisors crown heights (7.7 mm, 8.7 mm, 9.7 mm, 10.7 mm, and 11.7 mm). Attractiveness of these 24 smiles was evaluated by orthodontists …

N Y State Dent J August-September 2025

The New York State Dental Journal

In the August-September 2025 issue, the reader will find the following feature articles:

• "Subcutaneous Facial Emphysema and Pneumomediastinum Following a Class V Dental Restoration"
• "Beyond Brushing: Can Toothpaste Cure Your Child’s Peanut Allergy?"
• "Gorlin-Goltz Syndrome with Familial Manifestation: A Case Report with Emphasis on Early Diagnosis"

This issue includes regular columns with regional news impacting the New York membership including: editorial and legal columns, association activities, component news, continuing education opportunities, and classifieds.

Beyond Brushing: Can Toothpaste Cure Your Child’S Peanut Allergy?, Michael J. Heiss D.D.S., Benjamin Solomowitz Dmd

The New York State Dental Journal

Peanut allergies pose significant health risks globally, with an increasing prevalence observed over the past two decades. Accidental exposures to peanuts can lead to severe allergic reactions, including anaphylaxis, prompting the exploration of innovative therapeutic approaches to mitigate these risks. This literature review examines the potential use of peanut proteins embedded within toothpaste formulations as a novel avenue for inducing tolerance in individuals with peanut allergies. It includes recent studies and clinical trials in oral immunotherapy, focusing on mechanisms of action, safety profiles and long-term outcomes associated with controlled allergen exposure. Key findings suggest that oral mucosal therapy, particularly sublingual …

Gorlin-Goltz Syndrome With Familial Manifestation: A Case Report With Emphasis On Early Diagnosis, Ravinder Singh, Deepak Gupta, Aashna Garg, Aanchal Gupta, Sushruh Nayak

The New York State Dental Journal

Gorlin-Goltz syndrome is a hereditary autosomal dominant disorder. It has multiple clinical manifestations caused by mutation in the patched gene (PTCH), which is responsible for the growth and development of healthy tissue and for regulating the cell cycle. Early diagnosis of the condition and an extended duration of follow-up are essential to prevent complications, such as basal cell carcinomas and facial deformities, leading to a more favorable prognosis. This case was diagnosed with the presence of three major and two minor criteria, which confirmed the condition. We hereby report a case of a young male patient diagnosed by clinical, radiological …

Cooling Protocols Impact On Nickel-Titanium Rotary Instruments Cyclic Fatigue Resistance Under Extreme Curvatures And Sodium Hypochlorite, Palak Ravjibhai Ranparia, Chintan Joshi, Mona Somani, Aashray Patel, Urooj Desai, Janki Prajapati

Journal of Dentistry Indonesia

Objective: In this work, Hyflex CM, TruNatomy, and Plex V heat-treated nickel titanium rotary instruments were evaluated at body temperature (36 °C ± 1 °C) with and without a cooling protocol to assess the cyclic fatigue resistance. Methods: A 90° curved stainless-steel block was used for cyclic fatigue tests on 60 randomly selected rotary instruments, divided into two groups of 30: body temperature (n = 10) and body temperature with cooling (n = 10). Instruments were further subdivided into 6 groups of 3 different instruments. Cooling protocol group instruments received 5-second spray cooling every 30 seconds, along with continuous 5% …

Self-Medication Behavior Of Dental Students With Oral Ulceration Lesions: A Cross-Sectional Study In Yogyakarta, Indonesia, Fita Fathaya Iriana, Hendri Susanto, Rosa Amalia

Journal of Dentistry Indonesia

Objective: Self-medication refers to medication behavior for self-diagnosed symptoms. Oral ulcers are self-medicated lesions in the oral cavity. Dental students have different knowledge about oral cavity lesions and may self-medicate using drugs. This study aimed to determine the self-medication behavior of dental students for oral ulcers. Methods: This cross-sectional study was conducted on dental students in the Faculty of Dentistry from different batch years. Purposive sampling was used to select students with oral ulcer lesions in the last six months. A validated and reliable questionnaire was used to assess self-medication behavior. Data collection using the online form. Student behavior …

Neutral Zone Vs. Conventional Denture Fabrication: A Randomized Crossover Study On Denture Performance, Karthik Kannaiyan, Arunima Chauhan, Vijayendranath Nayak, Riyshmaa Devendaran, Dashmita Peterson, Pavittra Kanesan, Vityaa Lakshmi

Journal of Dentistry Indonesia

Objectives: It is challenging to achieve satisfactory outcomes in a complete denture for patients with resorbed residual ridges. Utilization of neutral zone techniques to guide posterior denture tooth arrangement and denture base contouring has been considered for many decades. However, the evidence is still not enough to revise protocols. This study aimed to compare patient satisfaction and stability of neutral zone denture with conventional denture. Methods: A crossover clinical trial was conducted among patients with resorbed mandibular ridges. Each participant received two sets of dentures: one fabricated using the neutral zone technique and one using the conventional method, in a …

Papillon–Lefèvre Syndrome: A Report Of Four Cases In One Family, Muhammed Abdullah Çege, Dilek Aynur Çankal, Ebru Binici, Bilge Turhan Bal

Journal of Dentistry Indonesia

Papillon–Lefèvre syndrome (PLS) is a rare genetic disorder caused by mutations in the cathepsin C gene and inherited in an autosomal recessive pattern. The risk of its occurrence is heightened by consanguineous marriages. PLS affects both genders and presents with hyperkeratotic patches on the hands and feet and precocious aggressive periodontitis. Although teeth initially erupt normally, rapid resorption in periodontal tissues leads to swift tooth loss, and prosthetic rehabilitation is complicated due to aggressive alveolar bone resorption. Case report: In 2021, a brother and sister sought dental treatment at Gazi University’s Faculty of Dentistry. After thorough examinations, the brother underwent …

Comparison Of Pharyngeal Airway And Dentoskeletal Effects Of 2 And 4 Premolar Extraction Treatment In Adult Orthodontic Patients, Esra Genc, Ahmet Karaman

Journal of Dentistry Indonesia

Objective: This study aimed to compare pharyngeal airway and dentoskeletal effects of 2 and 4 premolar extraction treatments in adult patients separately for each gender. Methods: The study was conducted with 60 adults (26 males; 34 females) aged 18-35 years. Individuals were divided into 3 groups as non-extraction, 2-premolar extraction, and 4-premolar extraction. Pre-treatment (T0) and post-treatment (T1) dentoskeletal and pharyngeal airway measurements were performed on cephalometric radiographs. Results: A significant increase in nasopharyngeal airway (PNS-ad2) and anterior hyoid bone movement (CV3ai-H) was observed in the 4-extraction group; whereas in the 2-extraction group, inferior oropharyngeal airway (IAS) narrowing and hyoid …

Temporomandibular Joint Osteoarthritis And Systemic Inflammation: A Cadaveric Study For Dental Insights, Nathan Kent Bs, David Patterson Bs, Alyssa Luu Bs, Samantha Pipkin Bs, Jason Ciccotelli Dpt, Phd, Jeremy James Dmd, Ms, Jessica Immonen Phd, Ms

The Journal of Integrative Physiology

The objective of this study was to determine if gross signs of cadaveric osteoarthritis (OA) have

a tendency to present systemically and if this presentation includes pathology found at the

temporomandibular joint (TMJ). Signs of OA were then correlated to gross alterations of the aorta and common carotid arteries seen with atherosclerotic cardiovascular disease. Ipsilateral synovial joints including the TMJ, knee joint, radiocarpal joint and trapeziometacarpal (TMC) joint were all assessed for signs of OA in 4 cadaveric donors (3 males; 72, 82 and 92 years-old / 1 female; 89 years-old) using a validated scale of disease severity. A Grade …

Assessment Of Incisive Canal Morphology And Position In A Sample Of Egyptian Population: A Cone Beam Computed Tomography Study, Sherif Shafik

Dentistry

ABSTRACT Several studies have highlighted the diversity in the anatomy of the incisive canal. Evaluation of incisive canal as well as its approximation to the maxillary incisor root is crucial before orthodontic treatment, implant placement and other surgical procedures in the anterior maxillary area. Cone beam computed tomography (CBCT) provides detailed three-dimensional information and have been used to evaluate the nasopalatine region with high accuracy along with relative safety due to low radiation exposure. Aim: The study aimed to provide analysis of the nasopalatine canal anatomy using cone-beam computed tomography (CBCT) in a sample of the Egyptian population. Materials & …

Orofacial Manifestations Of Highly Active Antiretroviral Therapy (Haart) And Pre-Exposure Prophylaxis (Prep): Implications For Dental Care And Guidelines For Management, Alec Donelian, Yuedi Yu, Ezzard Rolle Dds, Alison Newgard Dds

The New York State Dental Journal

HAART and PrEP have demonstrated reduction of HIV-related mortality and HIV infection, respectively. A range of orofacial side effects has been associated with both HAART and PrEP. As PrEP usage has increased, there has also been an increase in sexually transmitted infections that have orofacial symptoms. As oral health-care providers, it is important that we recognize these orofacial side effects and symptoms. Further, we offer clinical recommendations for dental professionals treating patients who are on either HAART or PrEP and their associated risk factors.

Revealing The Role Of Saccharibacteria (Tm7) In The Oral Cavity And Its Potential Applications In Fighting Gum Disease, Tyrese Ostin-Bordeaux

PSU McNair Scholars Online Journal

This study explores the physiology of TM7, a mysterious microbe, in preventing gum disease. A literature review of 42 articles examines TM7's interactions with other microbes, deeming the microbe's behavior could help modulate pathogenic bacteria in the oral cavity as a probiotic.

A Multi-National Questionnaire-Based Analysis Of Dental Students’ Knowledge Of The Management Of Deep Caries And The Exposed Pulp, Venkateshbabu Nagendrababu, Arindam Dutta, Ana Arias, Aleksandar Jakovljevic, Ahmed Hieawy, Frank C. Setzer, Jugoslav Ilic, Milos Beloica, Meric Karapinar Kazandag, Nandini Suresh, Paul V. Abbott, Raghavendra M. Shetty, Srinivasan Narasimhan, Victoria Sh Yu, Vellore Kannan Gopinath, Ya Shen, Henry F. Duncan

School of Dentistry Faculty Publications

Introduction and aims: To evaluate knowledge regarding the management of deep carious lesions and exposed pulps among undergraduate and postgraduate endodontic students from ten dental institutions across ten countries, and the impact of operator (material, antibiotic prescription) and patient-related (age, symptoms) factors on their treatment protocols. Methods: An online questionnaire was distributed to evaluate student knowledge of the management of deep caries and exposed pulp related to four clinical scenarios. Simple descriptive statistics were used to describe the data and McNemar tests were employed to identify significant differences between the scenarios. The P-value was set at 5%. Results: A total …

Evaluation Of Dentistry Students' Perceptions And Attitudes Towards Artificial Intelligence In Kazakhstan, Yasin Yasa, Kubeisin Altynbekov, Nazgul Onaibekova

Journal of Dentistry Indonesia

Objective: Artificial intelligence’s (AI) potential to analyze medical data and improve patient outcomes is driving its rapid integration into healthcare systems. This study addresses the knowledge gap regarding Kazakhstani dental students’ attitudes toward AI in dentistry. Methods: A survey with 213 participants assessed dental students’ views on AI in dentistry at two Kazakhstani universities. A self-administered questionnaire (22 items) via Google Forms was used to gather data on demographics, baseline knowledge (information sources, understanding of AI principles, and familiarity with dental AI applications), and attitudes/perceptions. Frequency analyses and chi-square tests (p < 0.05) explored the responses. Results: The survey included 213 dental students (mean …