Giomer composite compared to glass ionomer in occlusoproximal ART restorations of primary molars: 24-month RCT

BACKGROUND

Occlusoproximal restorations of primary molars usually fail, so it is necessary to investigate new materials that may overcome this challenge. Thus, this trial aimed to evaluate the longevity of occlusoproximal ART restorations in primary molars using a glass ionomer cement - GIC (Equia Forte^® - GC Corp) and a Giomer resin composite - GCR (Beautifil Bulk Restorative^® - Shofu Inc) after 24 months.

METHODS

One hundred and eighty-two (182) children aged from 4 to 8 years were selected and randomly assigned to GIC or GCR. A paediatric dentist treated them in the school setting in Cerquilho, Brazil, and the restorations were assessed after 3, 6, 12, 18 and 24 months. The primary outcome was the restoration survival, evaluated using the Kaplan-Meier and superiority Cox regression analyses. Intention to treat (ITT) was performed as a sensitivity analysis using superiority test P value and confidence interval (CI = 95%). Independent variables included gender, age, molar, jaw, cavity volume and caries experience.

RESULTS

The restoration survival after 24 months was GIC = 58.1% and GCR = 49.1% (HR = 1.24; CI = 0.97-1.59). ITT analysis showed a success of GIC = 61.1% and GCR = 52.2% (RR = 1.17; CI = 0.91-1.52). The superiority hypothesis was not proved in both analyses (P > 0.05).

CONCLUSION

GCR does not have superior longevity than GIC in occlusoproximal ART restorations of primary molars.

Bond Strength of Self-Adhesive Flowable Composites and Glass Ionomer Cements to Primary Teeth: A Systematic Review and Meta-Analysis of In Vitro Studies

Background: Conventional composites are largely used in pediatric restorative dentistry and demonstrate successful clinical outcomes. However, the need for simplification of operative steps in young or uncooperative children demands reliable alternatives. Therefore, the aim of the present systematic review and meta-analysis was to evaluate the in vitro bond strength of glass ionomer cements (GICs) and self-adhesive flowable composites (SFCs) on deciduous teeth. Methods: A comprehensive literature search according to the PRISMA checklist was manually and electronically performed by two independent reviewers through the following databases: MEDLINE/PubMed, Google Scholar, Scopus, and Embase, to include in vitro studies comparing GICs and SFCs bond strength values of restorations on primary teeth. In addition, three groups of meta-analyses were conducted using random-effects models. Results: Three articles meeting the inclusion criteria were selected and subjected to both qualitative and quantitative assessment. No statistically significant difference was found between SFC versus GIC; however, both groups significantly differed with conventional flowable composites (CFs). Conclusions: Despite the absence of significant difference in bond strength values, SFCs may be considered a valid alternative to GICs in the restoration of deciduous teeth, although CFs proved better in vitro performances.

Efficacy of laser photobiomodulation pulpotomy in human primary teeth: A randomized controlled trial

BACKGROUND

Laser photobiomodulation (LPBM), also called Low Level Laser Therapy (LLLT), has shown potential to reduce the pulpal inflammation and to preserve the dental pulp vitality, thereby improving healing. Lasers being minimally invasive, safe, and patient friendly prompt its application in pediatric dentistry.

AIM

The aim of this study was to evaluate and compare the clinical and radiographic success rates of LPBM and formocresol pulpotomy at 9 months post intervention in human primary molars.

MATERIALS AND METHODS

A randomized controlled, split-mouth study design was followed involving children aged 4-7 years with at least two primary molars indicated for pulpotomy. Sixty-eight eligible primary molars were randomly allocated to two interventions - formocresol pulpotomy (Group I) and LPBM pulpotomy (Group II).

STATISTICAL ANALYSES

Chi-square test was used for statistical analysis fixing significance level at P ≤ 0.05.

RESULTS

There was no statistically significant difference in the clinical success rates between the formocresol group (97.05%) and the photobiomodulation group (94.1%) (χ² = 0.34, P = 0.55); however, the radiographic success rate was significantly high in the laser group (94.1%) compared to the formocresol group (58.82%) (χ² = 11.76, P = 0.001).

CONCLUSION

LPBM could be a viable nonpharmaceutical alternative for formocresol pulpotomy in human primary teeth.

Biomimetic hydroxyapatite and caries prevention: a systematic review and meta-analysis

Dental caries is still one of the most prevalent diseases worldwide. Research has shown that fluoride has a role in caries prevention. For many reasons there are concerns about young children using fluoride-containing oral care products. Consequently, there is a need to identify effective fluoride-free products. A large body of literature now exists on the use of biomimetic hydroxyapatite (HAP) as an active ingredient in oral care products to combat caries.

AIM

To conduct a systematic review of the clinical evidence of the effects of HAP-based fluoride-free oral care products in caries reduction and conduct a meta-analysis of available randomized clinical trials (RCTs).

METHODS

Using the PICO question "In individuals of all ages (P), do fluoride-free oral care products containing HAP as the anti-caries agent (I), compared to products with fluoride or without caries control products (C), reduce the risk of dental caries (O)?" Ovid MEDLINE (PubMed), Scopus, EMBASE, and Web of Science databases were searched using the following keywords: apatite, hydroxyapatite, caries, dental decay, dentin(e), enamel, toothpaste, dentifrice, mouthwash, gels, biofilm, (dental) plaque, ero(de, ded, sion), (de, re)mineral(ise, ized, ised, ization, isation). Reviews, tooth whitening, tooth sensitivity, and in vitro studies were excluded. PRISMA was used for the search and GRADE was used to assess quality. Clinical trials were subjected to the Cochrane Risk of Bias assessment followed by meta-analysis.

RESULTS

291 studies were retrieved; 22 were suitable for systematic review, 5 were clinical caries trials and 4 were RCTs. A meta-analysis of 3 RCTs was possible showing HAP provided 17% protection against caries. The other 17 trials had simpler proxy outcomes for anticaries effects. Some trials showed non-inferior performance of HAP products compared to those with fluoride.

CONCLUSION

There is good evidence that hydroxyapatite in oral care products in the absence of fluoride effectively reduces caries.

Oral health status for primary dentition - A pilot study

INTRODUCTION

Formulating an oral health status which will include oral hygiene index (OHI) exclusively for children, deft index, and the incidence of white spot lesions (WSL) will make it easier for the examiner to assess the current oral health status of a child and help in planning preventive strategies. This index will provide a comprehensive yet quick way to assess the oral health status of children as it includes past caries experience, present oral hygiene status, and future prediction of caries.

MATERIALS AND METHODS

Two hundred children (100 male, 100 female) aged 3-5 years (primary dentition) were included in this study. OHI, recorded index tooth wise and segment wise, deft index, and the WSLs classification were recorded in all the children. Receiver operating characteristics (ROC) curve was used to evaluate the accuracy of recording OHI in children index tooth wise and segment wise.

RESULTS

All the three indices were recorded for the 200 subjects, and based on the area under the curve of receiver operating characteristics, it was found that the OHI for primary dentition can be recorded tooth wise or segment wise. Index teeth chosen for primary dentition were labial surfaces of 54, 61, and 64, lingual surfaces of 82, 75, and 85.

CONCLUSION

It includes the past caries experience, present hygiene status, and the future prediction of caries, making it a wholesome index. This cumulative index can be widely used in studies of epidemiology and ensure quicker evaluation during dental health programs in public school systems.

Pit-and-fissure sealants on primary molars are a cost savings

BACKGROUND

In this study, the authors examine the cost-effectiveness of light-polymerized resin-based fluoride sealants on primary molars in high caries risk children younger than 6 years.

METHODS

The authors examined the cost-effectiveness of pit-and-fissure sealant (PFS) treatment on primary molars by comparing sealed and unsealed molars treated in the outpatient clinic or operating room. Using 1,884 primary molars followed over a 5-year period, the authors used a mixed-effects regression model to estimate the probability of caries development. They used restricted means to estimate years free of caries for carious molars. They used a decision tree to address uncertainty due to PFS treatment failure, predict the expected value associated with each strategy, and estimate the incremental cost-effectiveness ratio using a 3% discount rate to adjust future cost and outcomes to present value.

RESULTS

Over 5 years, the cost of care was $90 for unsealed molars and $75 for sealed molars. Unsealed molars remained caries free for 4.32 years compared with 4.85 years in sealed molars. The cost-effectiveness of PFS treatment was dominant, leading to a savings of $25 for each caries-free year gained and overall savings of $742 million for the United States dental health system over a 5-year period.

CONCLUSIONS

PFS treatment is associated with cost savings and a delay in caries development and should be considered in children with high caries risk.

PRACTICAL IMPLICATIONS

Policy makers should consider reimbursement of PFS treatment on primary molars in high caries risk children.

Vital Pulp Therapy in Primary Dentition: Pulpotomy-A 100-Year Challenge

Pulpotomy has long been the most indicated vital pulp procedure in primary molars with extensive caries. The success of a pulpotomy is highly technique sensitive and it depends upon many factors, such as diagnosis accuracy, caries excavation method, pulp dressing material, quality of the final restoration and operator experience. This paper provides an overview of the pulpotomy procedure in primary teeth over a century, with reference to advances in technique, medication and restoration possibilities and challenges and controversies surrounding the subject as well as future directions.

An Update on Newer Pulpotomy Agents in Primary Teeth: A Literature Review

Primary molars with asymptomatic reversible pulpitis are commonly treated by pulpotomy procedure. Different pulpotomy materials used so far for pulpotomy that have been mentioned in the literature have been included in this article. This literature review includes all medicaments including natural alternatives. Many significant medicaments with their success rates have been mentioned in this paper. To increase the therapeutic success of pulpotomy procedure, it is necessary to identify a novel effective and preferably natural pulpotomy medicament.

Parental Attitude and Awareness toward Preventive Dentistry in Riyadh, Saudi Arabia: A Cross-Sectional Study

Introduction:

Preventive oral health of a child is dependent on the parental knowledge toward caries control, care of deciduous tooth, use of space maintainers for malocclusion, and utilization of various procedures available for preventing oral diseases by oral health professionals. This study was aimed to assess the attitude and awareness of preventive dentistry among parents residing in Riyadh city, Kingdom of Saudi Arabia.

Methodology:

A cross-sectional, questionnaire study was conducted among 300 male parents. Questionnaire was sent through the use of social media, and responses were collected.

Results:

Seventy-four percent of male Saudi parents were aware of prevention of oral diseases. 38.45% of male parents were aware of preventive dentistry procedure, but preventive dentistry utilization rate was seen among 6% population only. Attitude toward the prevention of oral disease was statistically not significant according to the age group and income but statistically significant according to education. The utilization of preventive procedures was significant according to education and income (P < 0.05).

Conclusion:

Awareness about preventive dentistry was more among Saudi parents but utilization rate was directly correlated to their education and income. After The utilization of preventive procedures was significant according to education and income (P < 0.05).

The Efficacy of Non-fluoridated Toothpastes on Artificial Enamel Caries in Primary Teeth: An In Vitro Study

Aims

The aim of this study was to evaluate the remineralizing effect among various non-fluoridated toothpastes on artificial caries in primary teeth.

Materials and Methods

Fifty sound primary incisor teeth were embedded in self-curing acrylic resin and immersed in demineralizing solution for 4 days forming artificial caries. All teeth were divided into five groups (10 teeth/group): Group I deionized water (control); Group II 1000 ppm F (Kodomo^®); Group III non-fluoridated toothpaste containing calcium glycerophosphate and calcium lactate (Dokbuaku^®); Group IV casein phosphopeptides-amorphous calcium phosphate (CPP-ACP) paste (GC Tooth Mousse^®), and Group V non-fluoridated toothpaste containing nanohydroxyapatite (NHA) (Apagard^®). The specimens were subjected to pH-cycling and immersed in toothpaste slurry twice for 7 days. Baseline, before, and after pH-cycling surface microhardness (SMH) values were measured by Vickers hardness numbers, and the percentage recovery of SMH (%SMHR) was calculated. Data were analyzed by one-way analysis of variance and Tukey's multiple comparison at 95% confidence intervals.

Results

The SMH values of test groups were significantly higher than those of the control group (p = 0.00). The %SMHR was -5.72±7.03% in the control group, Group II was significantly higher than Group III but there were no significant differences among Groups II, IV, and V (p > 0.05).

Conclusion

Non-fluoridated toothpastes containing CPP-ACP or NHA for young children had efficacy in remineralizing effect on primary teeth comparable with 1000 ppm fluoridated toothpaste.

Survival rate and associated factors affecting pulpectomy treatment outcome in primary teeth

Objectives

To evaluate the survival rates of pulpectomized primary teeth treated under general anesthesia (GA) or local anesthesia (LA), and to determine which factors affected tooth survival following pulpectomy.

Materials and methods

This retrospective study collected data from dental records. Patients under 5 years of age received dental treatment under GA or LA during 2007–2016, with at least one anterior or posterior tooth receiving a pulpectomy, were recruited. Pulpectomy was considered a failure if the tooth required extraction or retreatment due to pulp treatment failure. Survival analysis was used to assess the outcome. The cumulative survival probability was analyzed with the Kaplan–Meier estimator. Cox regression analysis was used to evaluate the associations between tooth survival and possible prognosis factors; sex, age, dental arch (upper/lower), tooth type (anterior/posterior), molar type (first/second molar), molar location (upper/lower molar), root filling material type, restoration type, preoperative radiographic findings and presence of pathologic root resorption.

Results

Two hundred and twenty‐seven primary teeth were included. At the 5‐year follow‐up, the survival rates of the pulpectomized teeth treated under GA and LA were 81.4% and 87.4%, respectively, which were not significantly different (p ≥ 0.05). A radiolucency on the preoperative radiograph was the only factor associated with tooth extraction or retreatment following pulpectomy, with a hazard ratio of 3.88 (95% CI = 1.29–11.65).

Conclusions

Pulpectomized primary teeth treated under GA and LA demonstrated high survival rates. Preoperative radiolucency is a possible associated factor that decreases tooth survival following pulpectomy.

Why this paper is important

Pulpectomy treatment under GA and LA provided high 5‐year cumulative survival rates, which were not significantly different.

Pulpectomy treatment in teeth with a preoperative radiolucency were 3.9‐fold as likely to fail as teeth without pathology.

Based on our findings, practitioners could apply these findings and discuss with caregivers about the treatment options, outcomes, and prognosis of pulpectomized teeth.

Meta-Analysis of In-Vitro Bonding of Glass-Ionomer Restorative Materials to Primary Teeth

Restoration of primary teeth is among the main clinical applications of glass-ionomer cements (GIC). The aim of the study was to review and summarize existing evidence of in vitro bond strength of glass-ionomer (GI) restoratives to enamel and dentin of primary teeth. A literature search was performed in PubMed/Medline, Scopus, Web of Science, Cochrane, and Google Scholar databases to identify studies published until April 2021. The search strategy was: (“glass”) and (“ionomer”) and (“primary” or “deciduous”) and (“bond” or “tensile” or “shear”). Two researchers independently retrieved articles that reported on the bond strength of GIC to primary dentin and/or enamel. The meta-analysis was performed to compare the bond strength values of conventional (C) GIC and resin-modified (RM) GIC to different substrates. From 831 potentially eligible articles, 30 were selected for the full-text examination, and 7 were included in the analysis. Studies were rated at high (3), medium (3), and low (1) risk of bias. RM-GIC showed higher bond strength to primary enamel and dentin compared to the C-GIC. Meta-analysis of in vitro studies, evaluating bonding properties of GI restoratives to primary teeth, suggests the superior performance of RM-GIC. However, there is a lack of studies that examine the properties of novel GI formulations.

Odontoblast markers and dentine reactions in carious primary molars with and without hypomineralised enamel defects

BACKGROUND

Wnt/β-Catenin signalling and DMP1 have key roles in tertiary dentinogenesis.

AIM

To compare the relationship between remaining dentine thickness (RDT), tertiary dentine thickness (TDT), β-catenin and dentine matrix protein 1 (DMP1) in carious second primary molar teeth with normal (SPM) and hypomineralised enamel (HSPM).

DESIGN

Extracted carious SPM and HSPM were fixed, sectioned (5 μm) and stained with haematoxylin and eosin or with indirect immunofluorescence for β-catenin and DMP1. Image analysis was performed to determine RDT, TDT, β-catenin and DMP1 intensity in the odontoblast layer and dentine-pulp complex.

RESULTS

Carious SPM (n = 11; mean RDT = 1536.1 μm) and HSPM (n = 12; mean RDT = 1179.9 μm) had mean TDT 248.6 μm and 518.1 μm, respectively (P = .02). There were no significant differences in intensity values in the odontoblast layer and dentine-pulp complex for β-catenin and DMP1 for both groups.

CONCLUSION

There was no observable variation in Wnt/β-catenin and DMP1 expression between HSPM and SPM despite a statistically significant twofold increased TDT in HSPM compared with SPM that had similar RDT. Thus, the observed increased TDT in HSPM is more likely due to an earlier onset of repair processes rather than an amplified response to caries.

Total crown replacement technique: A biological treatment option for grossly destructed primary molars

BACKGROUND

Restoration of severely damaged primary molars with very short clinical crowns is a big challenge and often extracted due to the lack of restorative options. Total crown replacement (TCR) is a novel treatment alternative for the restoration of such teeth through bonding of the biological restorations which are the sterile decoronated crowns of the extracted human teeth, obtained from a tooth bank.

CASE REPORT

Presented here is a report of two cases restored with the TCR technique. A 9-month follow-up showed satisfactory results in terms of function, esthetics, gingival health, and morphology including occlusal wear. TCR can be a viable and economical alternative for restoration of severely decayed/damaged primary teeth, otherwise indicated for extraction.

Comparative evaluation of a modified endodontic approach using Curcuma longa L. and conventional pulpectomy in primary molars: A randomized clinical trial

Background

Turmeric (Curcuma longa) is known for its anti-inflammatory and anti-septic properties.

Aim

The aim is to compare a modified endodontic approach using turmeric and conventional Metapex® pulpectomy in primary molars.

Materials and methods

Thirty children, in the age range of 4-9 years, with at least one primary mandibular molar indicated for pulpectomy, were included. Teeth were randomly assigned to turmeric and Metapex® groups. For those that were assigned to turmeric, after coronal and radicular pulp extirpation, a freshly prepared paste of turmeric powder and methyl cellulose (2:1) with saline was packed in the coronal pulp chamber. In the Metapex® group, a conventional pulpectomy was performed. Clinical and radiographic success was recorded at 3-, 6-, and 12-month follow-up visits. The data was statistically analyzed using the Chi-square test.

Results

There were no clinical and radiographic failures at 3- and 6-month visits in both groups. The 12-month evaluation revealed clinical success rates of 92% (12 out of 13) and 100% (14 out of 14) for turmeric and Metapex®, respectively, whereas, the radiographic success rates were 85% (12 out of 13) for turmeric and 93% (13 out of 14) for Metapex®. No statistically significant differences were found between the groups at different follow-ups (P > 0.05).

Conclusions

A modified endodontic approach using turmeric and conventional Metapex® pulpectomy did not differ significantly in total success after 12 months.

A novel report of dental development pattern in a 3-year-old girl with three congenitally missing primary canines: A review of the literature and a case study

Dentists may encounter patients with numerical dental anomalies in clinical practice and understanding of these conditions would allow early detection as well as intervention. The absence of one or more teeth congenitally is referred as hypodontia. This dental anomaly is rarely reported in primary dentition and the most commonly affected teeth in the primary dentition are mandibular lateral incisors and primary canines are remarkably very rare and this entity has not been often reported. This case study was aimed to report a 3-year-old Indian girl with the absence of three canines primary dentition and also evaluate the overall dental development pattern of developing permanent teeth. Furthermore, a new finding for pediatric dentists that the development of permanent canines in case of missing primary canines.

The effect of acid concentration and etch time on morphology and tensile bond strength of primary dentin: An in vitro study

BACKGROUND

There are conflicting results concerning the ideal time for etching primary dentin and its effect on the bond strength of adhesive restorative materials.

AIM

To assess in vitro, the effect of varied acid concentration and etch time on the morphological features and tensile bond strength of primary dentin.

MATERIALS AND METHODS

Forty healthy primary molars were prepared by exposing the dentin of the occlusal surface, creating a smear layer. A 3 mm × 3 mm test indow was demarcated, and specimens were randomly allocated to four groups (n = 10): Group 1A 10% phosphoric acid, 7 s; Group 1B 10% phosphoric acid, 15 s; Group 2A 37% phosphoric acid, 7 s and Group 2B 37% phosphoric acid, 15 s. Surface analysis was done using atomic force microscope and scanning electron microscope. For tensile bond strength evaluation, 24 specimens prepared as mentioned were mounted in acrylic blocks and allocated to four groups according to the prescribed etching protocol. Resin rods were bonded and tested in tension after 24 h (n = 6). Data were analyzed statistically using unpaired t-test.

RESULTS

Etching of primary dentin using 37% phosphoric acid for 7 s produced the highest tensile bond strength of 9.51 ± 2.19 MPa.

CONCLUSION

Etching time of 7 s may improve the adhesion of resin restorative materials with primary dentin.

Prevalence and correlation of OXIS contacts using Cone Beam Computed Tomography (CBCT) images and photographs

BACKGROUND

The contact areas in between primary teeth are broader, flatter, and located further cervically when compared with the contact areas of permanent molars.

AIM

We investigated the prevalence of interproximal contact area types of primary molars using CBCT images in children aged 3-10 years. Our second objective was to correlate OXIS contact areas when observed with CBCT images and clinical photographs.

DESIGN

A retrospective cross-sectional study was performed with 367 CBCT images of children, aged 3-10 years, obtained from Children's Dental Centre, South Korea. The type of contacts in between primary molars was scored at various levels, specifically, occlusal, middle, and cervical thirds, according to OXIS criteria. Following this, the same patient's records were checked for the presence of clinical photographs and scored according to the same criteria. Prevalence was stated as percentages along with numbers. Chi-square test was applied to determine association of contact areas across genders and arches. The correlation between the two methods was done by Cohen's Kappa correlation test.

RESULTS

The prevalence of the OXIS contacts obtained from CBCT images was as follows: I (79.7%), followed by X (10.0%), S (6.6%), and, finally, O (3.7%). The overall score of all the 1343 contact areas matched with the score observed at the occlusal third. All included contacts were of O (open) type at cervical third, and 1,231 contacts were of O (open) type at the middle third. Significant results were observed with respect to arches (P < .001). The correlation between the two methods was found to be 0.958.

CONCLUSIONS

The contact area observed at the occlusal level determined the overall type of contact based on OXIS criteria. Thus, reports in the literature concluded that contact areas are broad, flat, and extend further gingivally should be revised. The study also concluded almost perfect agreement between CBCT images and clinical photographs.

Nondestructive evaluation of microleakage in restored primary teeth using CP-OCT

Background

Although the demand for esthetic filling of primary teeth with resin composite is increasing, there is no enough data on the adhesive performance of composite restorations in primary teeth. Despite the improvements in resin composites, interfacial gap is still a disadvantage as it may cause marginal staining, secondary caries, and restoration failure. Previous studies have validated the efficiency of optical coherence tomography (OCT) in the evaluation of adhesive interface in permanent teeth, but not in primary teeth.

Aims

The aim of this study was to assess microleakage upon composite restorations in primary teeth using cross-polarization OCT (CP-OCT).

Methodology

Cylindrical class-V cavities were prepared in extracted human primary second molars and divided into four groups randomly. In groups 1 and 2, cavities were restored using Tetric N-Universal adhesive in the self-etch mode followed by IPS Impress Direct Composite and Ceram.x One Universal composite, respectively. In groups 3 and 4, one-step self-etch Prime and Bond Elect adhesive was used followed by ID composite and CX composite in groups 3 and 4, respectively. The specimens were then immersed in a contrasting solution followed by interfacial microleakage examination under CP-OCT. The recorded images were analyzed to quantify the mean gap percentages.

Results

All tested groups showed variable degree of interfacial microleakage under composite restorations. Two-way ANOVA showed the composite factor was significantly influencing the results, unlike the adhesive. Group 1 and 2 had the lowest and highest mean gap percentage, respectively, which were significantly different from the other groups. Groups 3 and 4 were not significantly different.

Conclusion

Based on the current finding, a polymeric restorative system from the same manufacturer reduces the risk of interfacial microleakage in primary teeth.

Parental Acceptance for the Use of Silver Diamine Fluoride on Their Special Health Care-Needs Child's Primary and Permanent Teeth

Purpose

The effectiveness and simplicity of the procedure and the low expense are the main advantages of silver diamine fluoride (SDF). It is useful for controlling caries in challenging patients such as those with special health care needs (SHCN). First aim of this study was to assess parents’ acceptance towards using SDF in SHCN children in their primary and permanent teeth. Second aim was to determine the factors that influence parents’ decisions toward dental treatment options.

Patients and Methods

This descriptive cross-sectional study included the parents of SHCN children aged 12 years old and younger who were actively seen in pediatric dentistry clinic at King Fahad Medical City (KFMC) and were receiving dental treatment. A previously developed and tested questionnaire was used. The surveyors received training about the questionnaire and participants’ consent was obtained before enrolling in the survey. The statistical significance level was set at P<0.05.

Results

Two hundred twelve participants completed the study questionnaire. Parents had a higher acceptance of SDF use regardless of the tooth location and type when their child had a positive history of pain and/or inflammation (P=0.019). In addition, parents had higher acceptance of SDF staining in primary teeth compared to permanent teeth (P=0.006). Moreover, the acceptance of SDF staining was higher in posterior teeth compared to anterior teeth in both primary and permanent dentition (P<0.001).

Conclusion

Parental acceptance of SDF was higher for primary compared to permanent teeth and posterior compared to anterior teeth in both dentitions, as well as for those with a positive history of dental pain and/or inflammation.

Associations Between Prenatal, Perinatal, and Early Childhood Vitamin D Status and Risk of Dental Caries at 6 Years

BACKGROUND

Previous studies have suggested that insufficient concentrations of vitamin D are associated with dental caries in primary teeth, but evidence remains inconclusive.

OBJECTIVES

We assessed the longitudinal associations between prenatal, perinatal, and early childhood serum 25-hydroxyvitamin D concentrations [25(OH)D] and the risk of dental caries in 6-year-old children.

METHODS

This research was conducted within the Generation R Study, a large, multi-ethnic, prospective cohort study located in Rotterdam, the Netherlands. Dental caries were assessed in children using the decayed-missing-filled-primary teeth index at a mean age of 6.1 years (90% range, 4.8-9.1). We measured serum total 25(OH)D concentrations at 3 time points: prenatally (at 18-24 weeks of gestation), perinatally (at birth), and during early childhood (at age 6 years). We performed logistic regression analyses to determine the longitudinal association of serum 25(OH)D concentrations with caries risks in 5257 children. Additionally, we constructed a Genetic Risk Score (GRS) for the genetic predispositions to serum total 25(OH)D concentrations based on 6 vitamin D-related single nucleotide polymorphisms in a subsample of 3385 children.

RESULTS

Children with severe prenatal and early childhood serum 25(OH)D deficiencies (<25 nmol/L) were more likely to be diagnosed with caries [OR, 1.56 (95% CI, 1.18-2.06) and 1.58 (95% CI, 1.10-2.25), respectively] than children with optimal concentrations (≥75 nmol/L). After adjustment for residuals of serum 25(OH)D concentrations at other time points, only the early childhood serum 25(OH)D concentration was inversely associated with the caries risk at 6 years (OR, 0.97; 95% CI, 0.95-0.98). However, our GRS analysis showed that children who are genetically predisposed to have lower serum 25(OH)D concentrations do not have a higher risk of developing caries in primary teeth.

CONCLUSIONS

Our study suggests a weak association between serum 25(OH)D concentrations and risks of caries in primary teeth. Based on our results, we do not recommend vitamin D supplementation for the prevention of dental caries in children.

Evaluation of Biodentine in Pulpotomies of Primary Teeth with Different Stages of Root Resorption Using a Novel Composite Outcome Score

This study aimed to assess the success of pulpotomy in primary molars using Biodentine, new-developed tri-calcium, di-calcium-based silicate cement, at 6 and 12 months. The hypothesis was that stages of root resorption could influence the treatment success. A novel composite score was used based on five clinical and radiographic outcomes: soft-tissue pathology, pain to percussion, pathologic mobility, radiolucency and pathologic root resorption. Patients’ compliance and intraoperative pain experience were recorded using the Frankl scale and the Wong–Baker scale. A total of 22 primary molars, 9 in stage S (stability) and 13 in stage R (resorption) were submitted to pulpotomy using Biodentine and restored with composite resin. The success rate was 92.3% in the R group compared to 100% in the S group at both 6 and 12 months (p = 0.850). There was no statistically significant effect of type of molar, tooth position and type of carious lesions on the composite outcome (all p > 0.05). Overall, 73% of the children experienced no or mild/moderate pain and 77% had a cooperative attitude. Children younger than 7 years old experienced more pain (p = 0.04). Biodentine is a promising biomaterial for pulpotomy of primary teeth regardless of the stage of root resorption.

Effect of Cavity Disinfectants on Adhesion to Primary Teeth-A Systematic Review

Some authors have been proposing the use of cavity disinfectants in order to reduce, or even eliminate, the effect of the microorganisms present in a dental cavity before a restoration is placed. The aim of this study was to evaluate the effect of different cavity disinfectants on bond strength and clinical success of composite and glass ionomer restorations on primary teeth. The research was conducted using Cochrane Library, PubMed/MEDLINE, SCOPUS, and Web of Science for articles published up to February 2021. The search was performed according to the PICO strategy. The evaluation of the methodological quality of each in vitro study was assessed using the CONSORT checklist for reporting in vitro studies on dental materials. Sixteen in vitro studies and one in situ study fulfilled the inclusion criteria and were analyzed. Chlorhexidine was the most studied cavity disinfectant, and its use does not compromise dentin bonding. Sodium hypochlorite is a promising alternative, but more research on its use is required to clearly state that it can safely be used as a cavity disinfectant for primary teeth. Although other disinfectants were studied, there is a low-level evidence attesting their effects on adhesion, therefore their use should be avoided.

Dental trauma in toddlers 1-3 years of age living in multicultural areas of Stockholm, Sweden: A retrospective cohort study

BACKGROUND/AIM

Traumatic dental injuries are common and affect many children. The aim of this retrospective study was to investigate the prevalence and characteristics of dental trauma as well as the costs and resource use in a cohort of children aged 1-3 years in low socioeconomic areas (low income and educational level) of Stockholm.

MATERIALS AND METHODS

Data were extracted from a larger intervention trial and analyzed for the prevalence and other characteristics of dental trauma as well as patient characteristics of children (n = 1346) from six dental clinics in low-income, multicultural areas. Variables describing the trauma, socioeconomic status, direct and indirect costs, and time spent at the emergency visit for the dental trauma were retrieved from the dental records. The study also recorded which healthcare profession handled the first and follow-up visits.

RESULTS

The prevalence of dental trauma in the study cohort was 8.2%, and higher among boys (n = 71) than girls (n = 39). Boys exhibited a significantly higher risk for dental trauma (OR, 1.76; 95% CI = 1.17-2.65). Maxillary incisors were the teeth most often traumatized, and lateral luxation was the most common diagnosis. The mean time spent per child during the first year following the dental trauma was 36 min, and the mean costs per child were EUR 878. The total average per-child cost (direct and indirect costs) for dental trauma was EUR 2107. Dental visits due to traumatic injuries were significantly less common among children with an immigrant background and in families with an income ≤EUR 2000 per month.

CONCLUSIONS

Toddlers in families who have a low socioeconomic status, a foreign background, and live in multicultural areas of Stockholm visit dental clinics for traumatic dental injuries less often than non-immigrant children living in families with a high socioeconomic status.

A 5-year data report of traumatic dental injuries in children and adolescents from a major dental trauma center in Greece

BACKGROUND/AIM

Prevalence and demographic characteristics of traumatic dental injuries (TDI) differ in different countries. The aim of this retrospective study was to assess TDI in primary and permanent teeth among children and adolescents who presented to the Department of Paediatric Dentistry, National and Kapodistrian University of Athens, Greece, during the last 5 years.

MATERIAL AND METHODS

Dental records of 236 new patients who presented with dento-alveolar trauma to the Postgraduate Dental Clinic from 1/1/2014 to 31/12/2019 were reviewed. Data recorded were gender, age, month of the year the injury occurred, type of trauma, and number of traumatized teeth. Injuries were classified as fracture, luxation, or combination injuries. Descriptive statistics, chi-squared (x² ), and Fisher's exact tests were used to evaluate the results. Level of significance was set at 5%.

RESULTS

The age of the patients ranged from 1 to 18 years old, with a mean of 8.63 years (SD: 3.52). There were 395 anterior traumatized teeth and 2 cases with traumatized posterior teeth. Children suffered trauma more often at the ages of 5 years, 7 years, and 11 years. In this cohort, 60% were boys who had a higher chance of having trauma than girls (odds ratio = 1.418 95% CI = 0.724, 2.777). Most TDI occurred in March and May, followed by June and February, and most traumatized teeth were permanent (80%). Maxillary central incisors in both dentitions were injured most often and significantly more compared to lateral incisors (p < 0 .01). The most common type of injury was a fracture in the permanent dentition (60%) and luxation injuries (69%) in the primary dentition.

CONCLUSIONS

Traumatic dental injuries in this cohort occurred mostly in spring, affected boys more than girls, permanent teeth more than primary teeth, maxillary incisors more than mandibular incisors, and central incisors more than lateral incisors, while children aged 5, 7, and 11 years old had the most injuries.