Magnification: The game changer in dentistry

During dental examinations and treatments, many dentists are using magnification to improve their vision. The dental operating microscope serves as the most effective tool for this purpose, enhancing the quality, longevity, and outcome of clinical work. This review will explore the latest research and data on the importance of magnification devices in dentistry, including diagnostic methods, treatment options and ergonomics in specialities such as restorative dentistry, endodontics, pedodontics, periodontics, and prosthodontics. This review aims to provide insights into the optimal magnification for different clinical situations, the specific benefits of dental operating microscopes for each dental branch, and their limitations.

Biaxial flexural strength and surface characterization of multilayer zirconium dioxide after polishing, glazing and clinical adjustments

PURPOSE

To evaluate how laboratory polishing and glazing and clinical adjustments, i.e., by grinding and polishing affect the biaxial flexural strength and surface characterization of multilayer zirconia.

METHODS

Specimens of KATANA™ Zirconia YML, containing Enamel-Body 1 or Body 2-3 layers, and UTML were divided into 18 groups (n = 11) according to material/layer and finish treatment: laboratory polishing, glazing, or both, or followed by clinical adjustments. The surface roughness, surface structure and elemental composition were evaluated. Thermocyclic-mechanical cyclic loading and biaxial flexural strength test were performed. Three- and two-way ANOVA were used (α = 0.05).

RESULTS

The yttrium amount decreased in the order UTML, YML Enamel-Body 1, and YML Body 2-3. Body 2-3 showed higher flexural strength than Enamel-Body 1 and UTML, in that order. Flexural strength after clinical adjustments was higher in Body 2-3 but lower in Enamel-Body 1 and UTML. Finish treatments had indistinguishable impact on Enamel-Body 1. Body 2-3 had higher strength after polishing, polishing and glazing, and glazing, in that order. UTML displayed the highest strength after polishing and glazing or glazing. The surface roughness was lowest after polishing regardless of material/layer.

CONCLUSIONS

Laboratory treatments and clinical adjustments of multilayer zirconia affect the flexural strength and surface roughness differently depending on the zirconia type. Composition-gradient zirconia should be polished, and shade-gradient zirconia (≥ 5 mol% yttria) should be polished and glazed. Clinical adjustments of zirconia with higher yttria content are detrimental for the flexural strength and should be performed with caution.

Saliva-acquired pellicle inspired multifunctional gargle with wet adhesion, photodynamic antimicrobial, and In situ remineralization properties for dental caries prevention

Dental caries is primarily caused by cariogenic bacteria metabolizing carbohydrates to produce acidic substances that erode the dental hard tissues. Traditional remineralization treatments often have limited efficacy due to their lack of antibacterial activity. According to the Interrupting Dental Caries (IDC) theory, ideal caries-preventive materials should possess both antibacterial and remineralizing properties. Furthermore, effective adhesion to dental surfaces is crucial. Inspired by the wet adhesion properties of the salivary acquired pellicle, we developed a multifunctional gargle named Ce6@PDN-SAP (CP-SAP). This formulation employed peptide dendrimer nanogels (PDN) as a carrier for the photosensitizer Ce6, further functionalized with saliva-acquired peptide (SAP) to confer wet adhesion properties. CP-SAP rapidly adhered to the dental surface and remained effective for extended periods. Upon laser irradiation, Ce6 generated reactive oxygen species (ROS), disrupting bacterial outer membrane integrity, causing protein leakage, and reducing ATP levels, thereby achieving potent antibacterial effects. Following this, PDN and SAP acted as nucleation templates to promote in situ remineralization of demineralized dental hard tissues. In vivo studies using rat models demonstrated that CP-SAP provided significantly superior caries-preventive effects compared to chlorhexidine gargle. In conclusion, CP-SAP, as an innovative approach grounded in the IDC theory, holds great promise for the prevention and treatment of dental caries.

The impact of artificial intelligence on medical article writing: A boon or a bane?

As artificial intelligence continues its ascent across numerous sectors, it presents both exciting opportunities and unique challenges for the future of academic publishing. Artificial intelligence (AI) is the way of computer systems to perform tasks that has been done by human brain before, such as learning, problem-solving, and decision-making. In the realm of medical writing, AI is being harnessed through various applications. The increasing amalgamation of AI into medical writing has ignited a fervent debate, with experts and stakeholders divided on whether it represents a valuable tool for progress or a potential threat to the integrity and quality of scientific publications. While proponents celebrate AI's potential to streamline research, enhance efficiency, and broaden access to knowledge, critics voice concerns about ethical implications, the risk of plagiarism, and the potential for deskilling among researchers. Therefore, it is pivotal to acknowledge that AI has the potential to be both a boon and a bane, and its ethical and practical implications must be carefully considered to ensure its responsible and beneficial integration into the spectrum of medical writing.

Assessing the safety of midazolam: A comprehensive analysis of adverse events from FAERS

Midazolam, a potent sedative from the benzodiazepine class, is widely used in anesthesia and intensive care, but it has been linked to severe and life-threatening cardiopulmonary adverse events (AEs). This study investigated real-world AEs associated with midazolam using data from the U.S. Food and Drug Administration (FDA) adverse event reporting system (FAERS) from 2004 to 2024. Disproportionality analysis was performed using four signal detection methods-reporting odds ratio, proportional reporting ratio, Bayesian confidence propagation neural network, and multi-item gamma Poisson shrinker-to assess midazolam-related AEs. A total of 2952 AE reports were identified, involving seven system organ classes, with 31 specific AEs meeting criteria across all four algorithms. Unexpected AEs not listed in the product label, such as seizure, coma, respiratory failure, anaphylactic shock, and hypothermia, were also observed, with most AEs occurring within the first 10 days of midazolam use. This pharmacovigilance study highlights the need for increased awareness of serious and unexpected AEs, including respiratory failure, anaphylactic shock, hypothermia, and metabolic acidosis, to promote safer use of midazolam in clinical practice.

In situ remineralization of enamel caries lesions with a toothpaste supplemented with fluoride, amorphous calcium phosphate casein phosphopeptide and trimetaphosphate

OBJECTIVES

This in situ study aimed to evaluate the effect of a new toothpaste formulation containing fluoride (F), casein phosphopeptide amorphous calcium phosphate (CPP-ACP) and sodium trimetaphosphate (TMP) on the remineralization of initial caries lesions.

METHODS

This was a blind, crossover study, performed in 5 experimental phases with a duration of 3 days each. At first, the initial surface hardness (SH) and hardness after demineralization (SH1) were determined. Then, volunteers (n = 10) used palatal appliances containing 4 bovine enamel specimens with initial caries lesions. The treatment regimens were: 1) Placebo (No F-TMP-CPP-ACP), 2) 1100 ppm F (1100F), 3) 1100F+3 %TMP (1100F-TMP), 4) 1100F+10 %CPP-ACP (1100F-CPP-ACP) and 5) 1100F-CPP-ACP-TMP. After 3 days, the final surface hardness (post-remineralization) (SH2), percentage of surface hardness recovery (%SHR), integrated recovery of subsurface hardness (ΔIHR), fluoride- (F), calcium- (Ca) and phosphorus- (P) concentration in the enamel were determined. Data were analyzed by ANOVA (one-way, repeated measures) and Student-Newman-Keuls test (p < 0.05).

RESULTS

The enamel surface showed greater remineralization (SH2) when treated with 1100F-CPP-ACP-TMP (224.8KHN±1.6) compared to 1100F (163.9KHN±2.0) (p < 0.033). Treatment with 1100F-CPP-ACP-TMP led to remineralization of the subsurface lesion (ΔIHR) by 84 % and 91 % when compared to the 1100F and 1100F-CPP-ACP treatments (p < 0.05). For the F concentration values in the enamel, there was an increase of ⁓ 63 % compared to 1100F (p < 0.05). The Ca concentration in the enamel after 1100F-CPP-ACP-TMP treatment was significantly higher in ⁓ 65 %, ⁓ 28 % and ⁓ 15 % when compared to the 1100F, 1100F-CPP-ACP and 1100F-TMP treatments (p < 0.05). The highest concentration of P was observed for 1100F-ACP-CPP-TMP, which was ⁓ 41 % and ⁓ 17 % higher than the 1100F and 1100F-TMP treatments respectively (p < 0.05).

CONCLUSION

The result of this study demonstrates that the combined use of remineralizing agents (F, CPP-ACP, and TMP) in a single toothpaste formulation (1100F-CPP-ACP-TMP) significantly enhances mineral gain compared to conventional toothpaste, as evidenced by a short-term in situ model.

CLINICAL SIGNIFICANCE

The findings of our study offer essential insights for future investigations and potential clinical applications, especially for individuals with initial caries lesions.

Eight weeks of high-intensity interval training alters the tongue microbiome and impacts nitrate and nitrite levels in previously sedentary men

Nitric oxide (∗NO) is a key signalling molecule, produced enzymatically via ∗NO synthases (NOS) or following the stepwise reduction of nitrate to nitrite via oral bacteria. Exercise training upregulates NOS expression and improves systemic health, but its effect on oral health, and more particularly the oral microbiome, has not been investigated. We used an exercise training study design to investigate changes in the tongue dorsum microbiome, and in nitrate and nitrite levels in the saliva, plasma and muscle, before, during and after an exercise training period. Eleven untrained males (age 25 ± 5 years, mass 64.0 ± 11.2 kg, stature 171 ± 6 cm, V˙ O2peak 2.25 ± 0.42 l min-1) underwent 8-weeks of high-intensity interval training (HIIT), followed by 12-weeks of detraining. The tongue dorsum microbiome was examined using Pac-Bio long-read 16S rRNA sequencing. Nitrate and nitrite levels were quantified with high-performance liquid chromatography. Grouped nitrite-producing species did not change between any timepoints. However, HIIT led to changes in the microbiome composition, increasing the relative abundance of some, but not all, nitrite-producing species. These changes included a decrease in the relative abundance of nitrite-producing Rothia and a decrease in Neisseria, alongside changes in 6 other bacteria at the genus level (all p ≤ 0.05). At the species level, the abundance of 9 bacteria increased post-training (all p ≤ 0.05), 5 of which have nitrite-producing capacity, including Rothia mucilaginosa and Streptococcus salivarius. Post-detraining, 6 nitrite-producing species remained elevated relative to baseline. Nitrate increased in plasma (p = 0.03) following training. Nitrite increased in the saliva after training (p = 0.02) but decreased in plasma (p = 0.03) and muscle (p = 0.002). High-intensity exercise training increased the abundance of several nitrite-producing bacteria and altered nitrate and nitrite levels in saliva, plasma, and muscle. Post-detraining, several nitrite-producing bacteria remained elevated relative to baseline, but no significant differences were detected in nitrate or nitrite levels. Switching from a sedentary to an active lifestyle alters both the microbiome of the tongue and the bioavailability of nitrate and nitrite, with potential implications for oral and systemic health.

Extracellular vesicles of Candida albicans show dual effects on Enterococcus faecalis growth and virulence: A laboratory-based investigation

AIM

Previous studies have shown the important relationships between Enterococcus faecalis and Candida albicans in post-treatment endodontic disease (PTED). However, the fungal-bacterial interactions and their possible functional routes are less understood. In this study, we investigated the effect of extracellular vesicles (EVs) derived from C. albicans on E. faecalis growth and pathogenicity.

METHODOLOGY

Candida albicans EVs were isolated from a yeast nitrogen base (YNB) medium, and their morphology, size distribution, and protein concentration were observed and identified. The effects of EVs on planktonic E. faecalis were evaluated using growth curves and colony-forming unit counts, whereas the effects on E. faecalis biofilms were determined using scanning electron and confocal laser scanning microscopes. The ability of E. faecalis to resist a detrimental environment, infect dentinal tubules, and biofilm formation on gutta percha was examined. Additionally, the effect of EVs on cell invasion and cytotoxicity of E. faecalis were assessed. Statistical analysis was performed using one-way analysis of variance, and p-values of <.05 were considered significantly different.

RESULTS

Candida albicans EVs were nanoparticles with bilayer membranes and with peak sizes of 111.9 and 230 nm. EVs exhibited a complex effect on E. faecalis and its biofilms; 5 μg/mL of EVs showed inhibitory effects whereas 0.156 μg/mL of EVs facilitated their growth. The EVs showed consistent effects on E. faecalis virulence. Notably, 5 μg/mL of EVs reduced the damage to RAW264.7 cells caused by E. faecalis, as well as the invasion ability of E. faecalis to macrophages and the intracellular survival ability of E. faecalis after macrophage phagocytosis, whereas 0.156 μg/mL of EVs had completely opposite effects.

CONCLUSION

Candida albicans EVs showed dual effects on E. faecalis growth and virulence in vitro, suggesting C. albicans EVs are involved in fungal-bacterial communication. Moreover, the inhibitory effects exhibited by 5 μg/mL of EVs in vitro may suggest a new agent for the control of E. faecalis.

Restricting Periodontal Treatment Frequency: Impact on Tooth Loss in Danish Adults

OBJECTIVE

The study aimed to estimate the effect of a periodontal treatment policy that would restrict the receipt of periodontal therapy to no more than once every second year, on the 10-year risk of tooth extraction among Danish adults.

METHODS

Data from linked nationwide Danish registers consisted of a random sample of 20 000 50-year-olds who were followed from the beginning of 1990 to the end of 2021. The longitudinal modified treatment policies' causal inference framework was used. In each of two slightly different counterfactual scenarios, the receipt of supragingival or subgingival periodontal therapy was restricted to no more than once every second year. The cumulative incidence of tooth extraction from 2012 to 2021 was compared between the counterfactual scenarios and the observed periodontal visiting pattern, while informative censoring, and time-varying and time-invariant confounding were accounted for using the social, economic and dental service utilisation history.

RESULTS

During the 10-year follow-up period, 5021 (25.1%) individuals received at least one tooth extraction. In the two counterfactual scenarios, the number of years receiving supragingival or subgingival periodontal therapy was 30%-50% lower than in the observed data. The 10-year cumulative incidence of tooth loss was practically the same in the two counterfactual scenarios as under the observed periodontal visiting patterns.

CONCLUSION

The findings indicate that a considerable decrease in the number and frequency of periodontal care visits would not have significant impact on the incidence of tooth loss in Denmark.

Oral health practitioners' knowledge, perceptions, and practices relating to e-cigarettes

OBJECTIVES

Despite the oral health risks associated with e-cigarette use (i.e., vaping) and the importance of cessation, research exploring the experiences and views of oral health practitioners in relation to e-cigarettes and delivering cessation counselling is limited. This study investigated oral health practitioners' (i) experiences with the oral health effects of e-cigarette use, (ii) knowledge and perceptions of e-cigarettes, and (iii) confidence in providing cessation advice to patients. We also explored desired support and preferences for training and education related to e-cigarettes.

METHODS

A cross-sectional online survey was completed by 192 oral health practitioners (e.g., dentists, oral health therapists) working in Australia. The survey measured experiences with patient e-cigarette use, perceptions of e-cigarettes, confidence providing patients with cessation advice, and needs and preferences for practitioner training.

RESULTS

There was near universal concern (n = 184, 96 %) regarding the effects of e-cigarette use on oral health. Two-thirds of respondents (n = 122, 65 %) rated their level of knowledge about e-cigarette use and detecting oral health damage from e-cigarette use as low. Only 29 % (n = 56) of respondents believed they had sufficient knowledge to provide advice and support to patients who use e-cigarettes. Interest in education related to e-cigarettes was high, with 98 % (n = 188) of respondents expressing an interest in completing an education module designed specifically for oral health practitioners.

CONCLUSIONS

A clear opportunity to improve vaping-related knowledge among oral health practitioners was identified. Providing oral health practitioners with evidence-based education about e-cigarettes and training in the delivery of appropriate cessation support is critical to increasing practitioner knowledge and confidence.

CLINICAL SIGNIFICANCE STATEMENT

Despite the oral health risks associated with e-cigarette use and the importance of cessation, few oral health practitioners report feeling well-supported in their efforts to manage e-cigarette use in their patients. The development of vaping-related resources, clinical guidelines, or training activities for oral health practitioners is urgently needed to facilitate evidence-based discussions with patients.

The One-step No-prep technique for non-invasive full-mouth rehabilitation of worn dentition using PICN CAD-CAM restorations: Up to 9-year results from a prospective and retrospective clinical study

OBJECTIVES

To report up to 9-year results of a prospective and retrospective study on non-invasive full-mouth rehabilitation of worn dentition with PICN CAD-CAM restorations using the One-Step No-Prep technique. The secondary objective is to evaluate the influence of restoration thickness on fracture of restorations.

METHODS

A total of 580 Vita Enamic restorations (218 anterior and 362 posterior; 260 monoblock (MO) and 320 multiColor (MC)) in 24 patients were clinically evaluated once a year (up 9 months to 9 years) according to FDI criteria. Patient data and prosthetic parameters were registered. The minimum thickness of restorations was measured in 15 patients.

RESULTS

The Kaplan-Meier survival rate of restorations at 9 years was 98.4 % (100 % for anterior and 96.7 % for posterior) and the success rate was 79.7 %, while the success rate excluding minor chipping requiring only polishing as failure was 86.7 %. Actually, minor chipping was the leading cause of failure and significantly more fractures were observed in the posterior region (9.2 times higher risk), particularly in the first and second molars or when the restoration thickness was less than 0.56 mm. Except for fracture, FDI evaluation showed clinically acceptable results for all restorations, mostly rated as excellent. Results remained consistent over time, including material luster and color, with no staining. MC showed superior esthetics compared to MO. Patient satisfaction was high.

SIGNIFICANCE

The One-Step No-Prep technique exhibits successful long-term outcomes, and PICN (hybrid ceramic) is an appropriate material for this non-invasive treatment of tooth wear. Nevertheless, the minimum thickness of posterior restorations should be 0.6 mm, particularly at occlusal contact points. MultiColor blocks are recommended for esthetics.

Impact Absorption Power of Polyolefin Fused Filament Fabrication 3D-Printed Sports Mouthguards: In Vitro Study

BACKGROUND/AIM

This study aims to evaluate and compare the impact absorption capacities of thermoformed ethylene vinyl acetate (EVA) mouthguards and 3D-printed polyolefin mouthguards used in sports dentistry applications. The objective is to determine whether 3D-printed polyolefin mouthguards offer superior impact toughness compared to traditional EVA mouthguards commonly used in sports settings.

MATERIALS AND METHODS

Six material samples were assessed: five pressure-formed EVA mouthguards (PolyShok, Buffalo Dental, Erkoflex, Proform, and Drufosoft) and one 3D-printed synthetic polymer (polyolefin). The materials were evaluated using a modified American Society for Testing and Materials (ASTM) D256 Test Method A for Izod pendulum impact resistance of plastics. Polyolefin samples were 3D-printed using fused filament fabrication (FFF) technology. Notably, the FFF process included samples printed with notches placed either parallel or perpendicular to the build direction. This orientation served as a study factor, allowing for comparison of material behavior under different printing conditions. Impact testing was conducted using an Izod impact tester to assess the materials' performance under controlled impact conditions.

RESULTS

The study achieved a high power (1.0) in power analysis, indicating strong sensitivity to detect significant differences. Among molded materials, PolyShok showed significantly lower impact toughness compared to others (p = 0.06). The mean impact absorption of EVA materials was 5.4 ± 0.3 kJ/m2, significantly lower than polyolefin materials, which demonstrated 12.9 ± 0.7 kJ/m2 and superior performance (p = 0.0). Horizontal-notched polyolefin samples exhibited higher impact strength compared to vertical-notched samples (p = 0.009).

CONCLUSIONS

3D-printed polyolefin mouthguards exhibited significantly higher impact toughness than thermoformed EVA mouthguards. While EVA materials demonstrated structural robustness, their lower impact resistance and observed tearing in other test specimens suggest the need for alternative testing standards to better reflect real-world conditions. 3D-printed mouthguards fabricated with build orientations perpendicular to the direction of impact demonstrate significantly enhanced impact absorption. Further research into manufacturing methods and testing protocols is recommended to optimize mouthguard performance under impact scenarios.

Digital planning and decision making for severe congenital oligodontia with Angle class-III malocclusion

As maxillofacial surgery becomes increasingly digitized and the transformative impact of pre-surgical scanning and computer simulation is recognized, this clinical paper presents an algorithm for the selection of interventions in severe congenital oligodontia with Angle class-III malocclusion (OCIII) utilizing such technologies. A complex, multifactorial condition with varying degrees of craniofacial involvement, OCIII is associated with edentulous facial appearance, mandibular prognathism and deep underbite, as well as malocclusion. Our methodology involves the integration of CBCT imaging, intra- and extra- oral scanning, and 3D planning with the assessment of bone volume, number of missing teeth, skeletal discrepancies, and patient compliance in the selection of suitable treatments. This approach accounts for unique patient characteristics by promoting personalized medicine and facilitating the development of predictable treatment modality results by offering a decision-tree for standardized treatment selection in cases of OCIII. This study unequivocally establishes the importance of digital treatment planning for OCIII, enabling the adaptation of surgical protocol for specific concerns and underlying limitations, thereby orchestrating successful treatments, improving patient satisfaction, and surpassing conventional methods.

Needs of non-pharmacological management versus sedation or general anesthesia for dental treatment in older adults with special needs: A systematic review

BACKGROUND

Adults with special needs have dental problems requiring treatment; however, patient management could be extremely difficult under local anesthesia. This review aimed to compare the needs of pharmacological approaches versus non-pharmacological approach for dental treatment to adults with special needs.

METHODS

This systematic review was registered in PROSPERO (CRD42024528488). The systematic search was conducted in databases: PUBMED; EBSCO; SCOPUS, April 10, 2024. Clinical studies published in English from 2000 to June 2024, demonstrating the needs for pharmacological as compared with non-pharmacological approach in older adults over 18 years old were included. The primary outcome was the completion of dental treatment.

RESULTS

Titles and abstracts were screened after the initial search, then forty studies were identified for potential inclusion. After retrieving full-text studies, Information relevant to objectives and outcome measures was recorded by using a data extraction form and analyzed again by three reviewers. Only 2 articles were eligible and included.

CONCLUSIONS

The best patient management approach could not be conclusive. Pharmacological approach remains necessary in many situations. Preparation of health care setting and multidisciplinary team is important to ensure patient safety. Further studies focusing on older adults with special needs are needed.

Your Teeth, You Are in Control: A Process Evaluation of the Implementation of a Cognitive Behavioural Therapy Intervention for Reducing Child Dental Anxiety

AIM

To explore the views of patients, caregivers, and dental professionals on the factors that influence implementation, processes, and effectiveness of a guided self-help cognitive behavioural therapy (CBT) intervention, 'Your teeth, you are in control' (YTYAIC), in the CALM trial.

METHODS

Semi-structured interviews were conducted as part of this qualitative component of the process evaluation, and data were analysed using a framework approach based on the Consolidated Framework for Implementation Research (CFIR) and the Five Areas Model of CBT.

RESULTS

Thirty-seven participants were recruited. Potential mechanisms of action were identified using the Five Areas Model of CBT. Participants felt the intervention may exert change through targeting unhelpful thoughts and feelings (e.g., building trust and perceptions of control) and behaviours (e.g., encouraging effective communication and coping strategies) and facilitating a more positive situational context (e.g., developing more supportive relationships). Enablers (e.g., adaptability, design and delivery) and barriers (e.g., time/resource constraints, cost) to implementation were identified using the CFIR.

CONCLUSIONS

This study revealed multiple potential mechanisms of action which could reduce dental anxiety and examined how implementation and contextual factors may influence this change process. The results of the research revealed that the intervention could be implemented in primary dental care and identified the potential barriers which should be addressed to aid successful implementation of the intervention in real world contexts.

TRIAL REGISTRATION

This clinical trial has been registered with an international registry and has been allocated an International Standard Randomised Controlled Trial Number (ISRCTN27579420).

Comprehensive review of 3D printing techniques emphasizing thermal characterization in biomedical prototyping

The rapid advancement of 3D printing technology has revolutionized biomedical engineering, enabling the creation of complex and personalized prototypes. Thermal properties play a crucial role in the performance and safety of these biomedical devices. Understanding their thermal behavior is essential for ensuring their effectiveness, reliability, and compatibility with the human body. This review article aims to provide a comprehensive overview of the thermal properties of 3D printed biomedical prototypes. It categorizes these prototypes based on thermal characteristics, examines the thermal attributes of various 3D printing materials, explores the thermal considerations for different biomedical devices, and identifies the challenges and future prospects in this dynamic field.

Calcium phosphate nanoclusters modify periodontium remodeling and minimize orthodontic relapse

Orthodontic relapse is one of the most prevalent concerns of orthodontic therapy. Relapse results in patients' teeth reverting towards their pretreatment positions, which increases the susceptibility to functional problems, dental disease, and substantially increases the financial burden for retreatment. This phenomenon is thought to be induced by rapid remodeling of the periodontal ligament (PDL) in the early stages and poor bone quality in the later stages. Current therapies including fixed or removable retainers and fiberotomies have limitations with patient compliance and invasiveness. Approaches using biocompatible biomaterials, such as calcium phosphate polymer-induced liquid precursors (PILP), are an ideal translational approach for minimizing orthodontic relapse. Here, post-orthodontic relapse is reduced after a single injection of high concentration PILP (HC-PILP) nanoclusters by altering PDL remodeling in the early stage of relapse and improving trabecular bone quality in the later stage. HC-PILP nanoclusters are achieved by using high molecular weight poly aspartic acid (PASP, 14 kDa) and poly acrylic acid (PAA, 450 kDa), which resulted in a stable solution of high calcium and phosphate concentrations without premature precipitation. In vitro results show that HC-PILP nanoclusters prevented collagen type-I mineralization, which is essential for the tooth-PDL-bone interphase. In vivo experiments show that the HC-PILP nanoclusters minimize relapse and improve the trabecular bone quality in the late stages of relapse. Interestingly, HC-PILP nanoclusters also altered the remodeling of the PDL collagen during the early stages of relapse. Further in vitro experiments showed that HC-PILP nanoclusters alter the fibrillogenesis of collagen type-I by impacting the protein secondary structure and forming aggregates. These findings propose a new approach for treating orthodontic relapse and provide additional insight into the PILP nanocluster's structure and properties on collagenous structure repair.

Influence of Using a Puncturing Method and Cooldown Period Before Pressing the Second-Layered Sheet on the Final Thickness of Double-Layered Sports Mouthguards: An Experimental Study

AIM

The thickness of the mouthguard is a crucial factor in its protective ability for athletes. This study aimed to investigate the final thickness of double-layered sports mouthguards, which were fabricated using different methods before pressing the second layer.

MATERIALS AND METHODS

Seven upper working models (n = 7 per group) were prepared for mouthguard fabrication. The first 3-mm mouthguard sheet underwent heating, pressing, and vacuuming onto the model, followed by various protocols before the second 3-mm sheet was pressed. Group 1: The second sheet was pressed immediately. Group 2: The first sheet underwent a 1-h cooldown period before pressing the second sheet. Group 3: The interproximal areas of the first sheet were punctured followed by immediate pressing of the second sheet. Group 4: The first sheet was punctured followed by a 1-h cooldown before pressing the second sheet. After 24 h, the mouthguard thickness was measured at various points on the left and right central incisors and first molars using a digital caliper. The thickness analysis was performed using SPSS 29.0 with one-way ANOVA and Tukey post hoc analysis.

RESULTS

At the labial surface of the central incisors, Group 4 exhibited the highest thickness, while Group 3 had the lowest (p < 0.001). Groups 1 and 2 did not show significant differences in thickness. At the incisal edges, Group 3 again had the lowest thickness (p < 0.05), with no significant differences observed among the other groups. There were no significant differences in thickness across all areas at the first molars, including cusp tips, pits, and buccal surfaces (p > 0.05). Group 4 demonstrated greater uniformity at the central incisors in thickness compared with the other groups.

CONCLUSIONS

Using the puncturing method at interproximal areas combined with a cooldown period could enhance mouthguard thickness at the labial surfaces of the central incisors and improve its thickness uniformity.

Clinical outcomes of novel CAD/CAM-designed functional space maintainers produced via additive and subtractive methods: A randomized controlled trial

OBJECTIVE

Since passive fixed space maintainers do not restore the lost tooth or provide chewing function, this study seeks to assess the effectiveness of an innovative approach for maintaining space following the premature extraction of first primary molars, utilizing functional space maintainers designed with CAD/CAM.

METHODS

This randomized controlled trial included 28 patients allocated into two groups (15 in 3D Printing group and 13 in Milling group). The inclusion criteria required extraction or loss of the first primary molar due to complications of caries, with a prolonged period until eruption of the successor. Space maintainers were fabricated using 3D printing metal (Co 69 %, Cr 25 %, W 9.5 %, Mo 3.5 %, Si 1 %, Scheftner, Germany) and milling composite (breCAM.HIPC, Bredent, Germany). This study evaluated the efficiency of space maintainers through clinical check-ups at one, three, and six months, maximum occlusal bite force, and masticatory performance assessments.

RESULTS

A positive clinical trend was noted over time, with the "type of space maintainer" factor (Milling vs. 3D Printing) influencing the degree of clinical assessment (p < 0.001). There were no significant differences in maximum occlusal bite force between sides for both types of space maintainers (p = 0.270 for 3D Printing and p = 0.765 for Milling). Significant improvements were observed in masticatory performance after the placement of both types of space maintainers.

CONCLUSION

A six-month follow-up showed that 3D-printed metal outperformed milled composite ones, with no significant differences in bite force or masticatory performance, indicating that CAD/CAM technology could set new standards in producing functional space maintainers.

CLINICAL SIGNIFICANCE

This study underscores the potential of the manufacturing technologies to set new standards in pediatric dentistry, particularly for maintaining space following premature tooth loss, while ensuring improved functional outcomes for young patients.

Co-Authoring and Reporting on Lived Experience Engagement in Mental Health and/or Substance Research: A Qualitative Study and Guidance Document

INTRODUCTION

There is a move towards engaging people with lived experience and families (PWLE/F)-also referred to as PWLE/F engagement-in mental health and/or substance use research. However, PWLE/F engagement is inadequately reported on in mental health and/or substance use research papers.

OBJECTIVE

To understand what PWLE/F and researchers perceive are important components to report on related to engagement in mental health and/or substance use research.

METHODS

This study included a qualitative description study underpinned by pragmatism. Data were collected through virtual interviews with 13 PWLE/F and 12 researchers across Canada and analysed using template analysis. The results were used to develop a reporting guidance document for engagement in mental health and/or substance use research.

RESULTS

The results from the template analysis were structured through the following themes: (1) establishing the need for a guidance document; (2) aspects of engagement to report and reflect on; (3) guidance around co-authorship with PWLE/F; (4) practical tips for reporting on engagement and (5) considerations for journals. Participants identified a need for tailored guidance that is flexible and reflective, yet can promote transparency, accountability and learning in the field. A reporting guidance document was developed for engagement in mental health and/or substance use research that balances flexibility and standardisation while incorporating reflection into reporting. Guidance around co-authorship with PWLE/F partners was also included.

CONCLUSION

The guidance document is intended to be used as a roadmap to help guide authors to meaningfully write about engagement without the rigid boundaries of a reporting guideline. We encourage research teams that engage PWLE/F in mental health and/or substance use research to consider using the guidance document as they write up their work.

PATIENT AND PUBLIC INVOLVEMENT

PWLE/F members were engaged throughout the study from conception to manuscript production. This included a PWLE partner on the doctoral committee and a Lived Experience Advisory Group consisting of two PWLE and one family partner.

Does Teething Disrupt Infant Sleep? A Longitudinal Auto-Videosomnography Study

OBJECTIVE

To examine prospectively the relationship between teething and infant sleep using objective sleep measurements.

STUDY DESIGN

Over a 4-week period, 849 infants aged 3-18 months (mean = 8.4 ± 1.8) from the US and Canada were monitored using auto-videosomnography, based on computer-vision technology to decode video footage from crib camera monitors. Parents also provided reports of tooth eruption timing, symptoms, and management strategies. Objective sleep metrics, including total sleep time, night-time awakenings, and parental crib visits, were compared between teething and nonteething nights using generalized estimating equations and changepoint analysis.

RESULTS

Both analytic approaches showed no significant differences in sleep metrics between teething and nonteething nights. Although over one-half of the parents reported sleep disturbances during teething, these subjective reports were not corroborated by the objective data.

CONCLUSIONS

These findings challenge the widely held belief that teething disrupts sleep and highlight the need for pediatric health care professionals to consider alternative explanations for infant sleep problems. Educating parents with evidence-based information may prevent potentially harmful management strategies for teething (eg, excessive use of analgesics and local anesthetics) and improve sleep problem management. Future research should explore these relationships using multiple objective measures and more diverse populations.

Changes in the caries-associated microbiota and caries experience in children and adolescents with type 1 diabetes: A systematic review and meta-analysis

OBJECTIVE

This systematic review aimed to determine the differences in the caries-associated microbiota and caries experience among children with type 1 diabetes (T1D) compared to healthy children in observational studies.

DESIGN

Registered in PROPSERO (CRD42024529842), this review involved searching four electronic databases (PubMed, Embase, Scopus and Web of Science) from inception to April 2024. Citation searching was further performed on eligible studies from the database search. Observational studies comparing the cariogenic taxa between paediatric participants (0-18 years of age) with T1D and healthy paediatric participants were included. Caries experience was analysed where available in eligible studies. Outcomes were narratively and tabularly synthesised, and meta-analysis performed where appropriate. All studies were critically appraised using the relevant Joanna Briggs Institute appraisal tool.

RESULTS

425 studies were identified, of which 14 studies were eligible. After assessing 534 citations, 2 additional studies were included. Overall, 16 studies (15 cross-sectional, 1 longitudinal) satisfied the inclusion criteria. Differences in cariogenic bacteria were observed when glycaemic control was considered. Children with T1D and poorer glycaemic control exhibited an increase in Streptococci and Lactobacilli taxa compared to those with improved glycaemic control and healthy children. A small number of studies also found increases in the caries experience with poorer glycaemic control.

CONCLUSION

Overall, the evidence indicates that children with T1D who have poorer glycaemic control exhibit an increase in cariogenic bacteria. Early evidence suggests that these children also experience more caries. However, further research with improved and longitudinal study designs are required to strengthen the existing evidence.

Psychosocial Determinants of Poor Dental Attendance Among Young Mexican-Identifying Adults in California

OBJECTIVE

Engagement in preventive dental care is a complex health behaviour and is determined by multiple factors. The study aimed to understand the association of psychosocial determinants with poor dental attendance.

METHODS

Survey data from 333 Mexican-identifying adults in California aged 21-40-year were analysed. Poor dental attendance was a composite of time since last dental visit and reason for visit. Responses of 'more than 1 year ago' for last dental visit, or 'something was wrong, bothering or hurting/emergency dental problem' as the reason for last dental visit were categorised as poor dental attendance. Psychosocial determinants including dental anxiety assessed using the Modified Dental Anxiety Scale, participant reported quality of provider interactions, and perceived social support were assessed. Logistic regression analyses examined associations after accounting for covariates.

RESULTS

Over half (58%) had poor dental attendance. Among those with poor dental attendance, 22% had high dental anxiety, 41% perceived low quality of dental explanation, and 48% reported provider occasionally/never checked patient understanding. Participants with high anxiety had twice the odds of poor dental attendance (OR = 2.07, 95% CI = 1.01-4.22) than those with low dental anxiety. Additionally, those reporting that providers did not explain oral health status or treatments well had two times higher odds of poor dental attendance than those reporting adequate explanation (OR = 2.06, 95% CI = 1.11-3.83). Checking patient understanding or perceived social support was not significantly associated with dental attendance.

CONCLUSION

Dental anxiety and poor provider interactions affect use of dental services. Interventions targeting dental staff should prioritise enhancing communication skills and checking patient understanding to improve their dental attendance.

The employment of recommended root canal treatment procedures by dentists in Croatia and the Czech Republic

AIM

This study aimed to evaluate the compliance of dentists in Croatia and the Czech Republic with endodontic recommendations and identify the subjective and objective factors influencing their adherence to them.

METHODOLOGY

A total of 1386 dentists from Croatia and the Czech Republic participated in an online survey through a self-administered, author-designed questionnaire. After excluding those who did not perform root canal treatments (RCT), 1376 responses (394 from Croatia and 982 from the Czech Republic) were statistically analysed.

RESULTS

The median age of respondents was 40 years, with a higher proportion of females in both countries. Croatian dentists treated fewer patients weekly but performed more RCTs and placed more composite fillings than their Czech counterparts. Czech dentists more frequently employed magnification devices, rubber dam (RD), pre-endodontic build-ups, nickel-titanium (NiTi) instruments, irrigant activation, bioceramic sealers, indirect post-endodontic restoration of lateral teeth, and single-visit treatments. These practices were also more common among endodontists than general dental practitioners and other specialists in both countries. Croatian dentists adhered more consistently to the recommended irrigation protocol. In the Czech group, adherence to recommended procedures, such as magnification, RD usage, and irrigation protocol correlated with younger age, smaller weekly number of patients, and preference for treating patients in the supine position. No such correlations were observed among the Croatian dentists.

CONCLUSIONS

Despite notable improvements in recent years, dentists still do not fully comply with the recommended RCT working procedures in Croatia and the Czech Republic.

Association between oral microbiome dysbiosis and Sjogren Syndrome. A systematic review of clinical studies

OBJECTIVES

This systematic review investigates the association of oral microbiome dysbiosis with Sjogren Syndrome (SS).

MATERIALS AND METHODS

Indexed databases (PubMed/Medline, EMBASE, OVID, Web of Science, and Scopus) were independently searched for relevant manuscripts published until August 2024. Clinical studies on oral microbial flora count and diversity in SS patients were included. Risk of bias across individual studies was performed using the Risk of Bias in Nonrandomized Studies of Interventions tool.

RESULTS

Out of the initial 295 studies, 15 clinical studies met the selection criteria. The protocols were similar across the studies but varied in diagnostic criteria for SS, salivary flow estimation methods, dental and periodontal status findings, and the type of oral microbes observed. Out of 15 studies, 14 showed an alteration in the oral microbiome and differences in microbial diversity in SS patients. Higher oral microbial counts of Prevotella, Viellonella, and Firmicutes in SS were reported, whereas a higher prevalence of caries-associated bacteria Streptococcus, Lactobacillus, and Viellonella was found in SS patients. Overall, the studies had a low risk of bias.

CONCLUSIONS

The findings of the present review have shown the existence of significant oral microbial dysbiosis and differences in microbial diversity in SS patients compared to healthy subjects. Future well-designed longitudinal studies are needed to validate the results.

Survival of periodontal ligament myofibroblasts after short-term mechanical strain in rats and in vitro: Could myofibroblasts contribute to orthodontic relapse?

OBJECTIVES

To investigate in vivo whether myofibroblasts formed in the PDL after exposure to short-term high experimental orthodontic forces in rats survive. To study in vitro whether human PDL fibroblasts can differentiate into myofibroblasts and survive when chemical or mechanical stimuli are removed.

DESIGN

Nine 6-week-old male Wistar rats were used in this experiment. Rat molars were exposed to high but rapidly decreasing experimental orthodontic forces by applying a rubber band and analyzed for the presence of myofibroblasts using ASMA staining. In vitro, human periodontal ligament (PDL) fibroblasts were exposed to transforming growth factor β1 (TGFβ1) and/or mechanical stress and monitored for myofibroblast formation and survival after these stimuli were abrogated.

RESULTS

In vivo exposure to orthodontic forces strongly induced myofibroblast formation in the stretched regions of the PDL. Furthermore, many PDL myofibroblasts remained present 6 days after exposure to these short-term high orthodontic forces. Human PDL fibroblasts were shown to differentiate into myofibroblasts after 2 days of TGFβ1 exposure and survive for at least 2 more days after removing chemical stimuli (TGFβ1) or mechanical strain. Under in vitro conditions, both TGFβ1 and mechanical strain for 3 days promoted (myo)fibroblast formation, and these cells persisted for 3 more days after the removal of both stimuli.

CONCLUSIONS

PDL myofibroblasts survive after the removal of mechanical strain in vivo and in vitro. This supports the hypothesis that myofibroblasts, which form in response to mechanical strain and chemical cues in the periodontal ligament (PDL), play a role in relapse following orthodontic tooth movement.

A New Approach for Analyzing Root Development in Autogenous Tooth Transplants Using Computed Tomography

INTRODUCTION

The aim of this study was to evaluate root development in autotransplanted teeth using cone-beam computed tomography (CBCT) images.

METHODS

Twelve premolars with incomplete root formation, which were selected to replace prematurely lost upper central incisors, were analyzed by CBCT on two different occasions. The first CBCT examination (T1) was conducted before tooth autotransplantation. The second CBCT examination (T2) was performed over a follow-up period of at least 12 months and < 5 years. Three previously calibrated evaluators assessed root development. The positions of the tomographic planes were standardized. The mean root length in sagittal and coronal tomographic sections was used to validate the root length at T1 and T2. Longitudinal root development of the transplanted tooth was determined by calculating the difference in root length between T2 and T1. The intraclass correlation coefficient (ICC), paired t-test, and Pearson test were applied, with significance set at 5%.

RESULTS

The mean time elapsed between T1 and T2 was 962 days/2.6 years. The ICC was > 0.75. The measurements obtained at T2 were significantly greater than at T1 (p = 0.001). The mean increase in root length was 2.83 mm. There was no significant correlation (p = 0.413; r = 0.261) between root length increase and the time elapsed between T1 and T2.

CONCLUSION

Premolar teeth with incompletely formed roots transplanted to the upper central incisor region showed continued root development during postoperative follow-up.

Transoral approach for hilo-parenchymal submandibular stones: outcomes and predictors of success

OBJECTIVE

To evaluate the efficacy and safety of transoral surgical management for complex submandibular gland (SMG) stones.

STUDY DESIGN

A retrospective cohort study of 240 patients treated for sialolithiasis between 2015 and 2018, focusing on 57 cases of SMG stones that underwent stone removal procedures. Treatment methods, success rates, and complications were analyzed using Kaplan-Meier analysis, Cox proportional hazards regression, and multiple logistic regression.

RESULTS

Transoral surgical release was successful in 72.9% of cases. The overall complication rate was 10%. Stone size (hazard ratios [HR] = 0.85, P = .004) and hilar location (HR = 0.72, P = .036) were associated with longer symptom resolution time. Multivariate analysis revealed that stone size (odds ratios [OR] = 0.78, P = .009) and hilar location (OR = 0.45, P = .029) decreased the odds of successful removal.

CONCLUSIONS

Transoral surgical management of hilo-parenchymal SMG stones appears to be a safe and effective approach, potentially reducing the need for sialoadenectomy.

From Teeth to Body: The Complex Role of Streptococcus mutans in Systemic Diseases

Streptococcus mutans, the principal pathogen associated with dental caries, impacts individuals across all age groups and geographic regions. Beyond its role in compromising oral health, a growing body of research has established a link between S. mutans and various systemic diseases, including immunoglobulin A nephropathy (IgAN), nonalcoholic steatohepatitis (NASH), infective endocarditis (IE), ulcerative colitis (UC), cerebral hemorrhage, and tumors. The pathogenic mechanisms associated with S. mutans frequently involve collagen-binding proteins (CBPs) and protein antigens (PA) present on the bacterial surface. These components facilitate intricate interactions with the host immune system, thereby potentially contributing to various pathological processes. Specifically, CBP is implicated in the deposition of IgA and complement component C3, which exhibits characteristics reminiscent of IgAN-like lesions through animal models, recent clinical studies suggest a potential involvement of S. mutans in IgAN. In addition, CBP binds to complement component C1q, effectively inhibiting the classical activation pathway of the complement system. In addition, CBP promotes the induction of host cells to produce interferon-gamma (IFN-γ). Furthermore, CBP leads to direct inhibitory effects on platelets and the activation of matrix metalloproteinase-9 (MMP-9) at sites of vascular injury. Moreover, PA enhances the ability of S. mutans to invade hepatic tissue. Through utilization of its PAc, S. mutans excessively produces kynurenine (KYNA), which promotes the development and progression of oral squamous cell carcinoma (OSCC). This article synthesizes the latest advancements in understanding the mechanisms of intricate interactions between S. mutans and various systemic conditions in humans, expanding our perspective beyond the traditional focus on dental caries.

Effect of manufacturing trinomial and restoration thickness on the fabrication trueness, fit, and margin quality of additively manufactured resin-based ultrathin laminate veneers

OBJECTIVE

To evaluate the effect of the manufacturing trinomial (manufacturing technology, three-dimensional printer, and material) and restoration thickness on the fabrication trueness, fit, and margin quality of additively manufactured resin-based ultrathin laminate veneers (LVs) by comparing to those produced subtractively.

METHODS

Reference LVs were designed from the scan files of two identical maxillary central incisor typodonts prepared for 0.3 mm and 0.5 mm LVs. LVs were manufactured additively with resins of different compositions, either using a tilting stereolithography (Irix Max [AM-IX] and Irix Plus [AM-IP]) or a digital light processing printer (VarseoSmile Crown Plus [AM-VS] and Tera Harz TC- 80DP [AM-GR]), and subtractively (Tetric CAD [SM-TC]) (n = 10). All LVs were digitized to evaluate their fabrication trueness and fit. The margin quality was assessed through visual examination. The trueness and fit data were analyzed with two-way analysis of variance and Tukey tests, while the chi-squared test was used to evaluate the margin quality (α = 0.05).

RESULTS

The interaction between the main factors and the manufacturing trinomial affected the fabrication trueness and fit, while restoration thickness affected the fit of tested LVs (P ≤ 0.001). AM-IP mostly had the lowest deviations, followed by AM-IX, and mostly had the lowest gaps (P ≤ 0.037). Thinner LVs had lower gaps (P < 0.001). Tested LVs mostly had slightly rough margins with small defects.

CONCLUSIONS

LVs fabricated with the tilting stereolithography printer mostly had higher trueness. Using AM-IP or fabricating 0.3 mm LVs improved the fit. Nevertheless, all tested LVs had clinically accep fit.

CLINICAL SIGNIFICANCE

Ultrathin laminate veneers fabricated with the manufacturing trinomial involving tested tilting stereolithography printer and resins may require less clinical adjustments. In addition, one of the resins (AM-IP) within this manufacturing trinomial or fabricating 0.3 mm laminate veneers may improve the fit.

Assessing diagnostic accuracy and monitoring of caries progression using optical coherence tomography (OCT): A systematic review

OBJECTIVES

This systematic review analyzed studies concerning the effectiveness of Optical Coherence Tomography (OCT) in detecting and monitoring dental caries in enamel and dentin.

DATA

Studies comparing the diagnostic accuracy of OCT in diagnosing caries clinically or using extracted teeth were included.

SOURCES

Databases, including PubMed/MEDLINE, Web of Science, EMBASE, and Scopus were searched for clinical trials and studies conducted using human teeth between 2010 and 2024. The process of study selection and data extraction followed the PRISMA guidelines. The methodological quality of the included studies was evaluated using the Critical Appraisal Skills Programme (CASP) diagnostic study checklist.

STUDY SELECTION

Seven studies met the inclusion criteria out of 1,266 articles identified. OCT modalities used in these studies include Cross-polarization OCT (CP-OCT), Swept-source OCT (SS-OCT), and polarization-sensitive (PS-OCT), with wavelengths ranging between 1310 and 1330 nm; axial resolutions were between 7.5-22 μm. SS-OCT had a high sensitivity of 74.1 % and specificity of 95.7 % when applied to caries detection. CP-OCT was able to identify dentin-penetrating lesions with greater accuracy than conventional radiography. There were strong correlations in the OCT measurements with the established diagnostic gold standards: polarized light microscopy (PLM), r = 0.63, P < 0.01; transverse microradiography (TMR), r = 0.75, P < 0.001.

CONCLUSION

OCT has demonstrated better performance regarding early caries detection and its activity compared with traditional diagnostic methods. However, standardization of the imaging protocol and further larger clinical trials are required.

CLINICAL SIGNIFICANCE

OCT offers significant clinical advantages in the diagnosis of dental caries. This technology enables early detection of carious lesions, facilitating timely intervention and potentially preserving tooth integrity. Investigating the clinical effectiveness of OCT is crucial to validate its utility in dental practice and to establish standardized protocols for its implementation in caries diagnosis.

Lifetime Use of Dental Services and Dental Caries in Adolescents in 2004 Pelotas Birth Cohort

OBJECTIVE

To examine the association between the lifetime utilisation of dental services and dental caries experience in mixed dentition among adolescents participating in the 2004 Pelotas Birth Cohort, Southern Brazil.

METHODS

This longitudinal study analysed a sample of 996 adolescents aged 12-13 years. Dental caries experience and untreated dental caries were the outcomes, assessed by the mean of decayed, missed and filled in deciduous (dmfs index) and in permanent (DMFS index) teeth, based on World Health Organization criteria. The main exposure was lifetime use of dental services, defined as: always have gone to the dentist for preventive reason; have gone to the dentist at times for preventive reason, at times for problem-oriented reason; always have gone to the dentist for problem-oriented reason (reference category). Family income mobility during the first 4 years of the child's life, maternal schooling, adolescent sex and skin colour were the confounders. Crude and adjusted analyses were conducted using negative binomial regression, estimating mean ratios (MR), and 95% confidence intervals (95% CI).

RESULTS

In the adjusted analysis, adolescents who consistently utilised dental services for preventive reasons exhibited a mean 49% lower dental caries indexes (MR = 0.51; 95% CI 0.35-0.76) and 56% lower mean of untreated dental caries (MR = 0.44; 95% CI 0.26-0.74) compared to their counterparts who consistently sought dental care for problem-oriented reasons. The utilisation of dental services occasionally for preventive reasons and occasionally for problem-oriented reasons was also associated with lower caries indexes.

CONCLUSION

The lifetime utilisation of dental services, whether always or occasionally for preventive reasons, was found to be a protective factor for dental caries in adolescence. These findings reinforce the importance of raising awareness among the public regarding the preventive use of dental services. Additionally, there is a need to organise dental services to facilitate the provision of preventive dental care since early childhood.

Twelve tips for using phenomenology as a qualitative research approach in health professions education

Phenomenology is a qualitative research approach that seeks to understand the individual meanings of lived experience . This 12 Tips article highlights the importance of understanding the philosophical foundations that inform the choice of phenomenological research study, including descriptive and interpretive phenomenology. The article provides a practical guide to the choice of the most appropriate phenomenological research approach and the process of data collection, iterative data analysis and interpretation, with consideration of the essential aspects of bracketing and reflexivity.

Reactivity of aragonite with dicalcium phosphate facilitates removal of dental calculus

Dental calculus, a main contributor of periodontal diseases, is mostly composed of inorganic calcium phosphate species such as dicalcium phosphate, whitlockite, octa calcium phosphate, and hydroxyapatite. Under physiological pH 7.4, dicalcium phosphates can gradually interact with calcium carbonate to form hydroxyapatite. Therefore, we hypothesized that aragonite (Arg) could react with dental calculus, facilitating its removal. To assess the reactivity of Arg with dental calculus, we examined the changes in surface morphology, composition, and topography of Arg and dental calculus upon exposure to each other in an aqueous environment. The impact of Arg on the removal of dental calculus was assessed by brushing polished sections of dental calculus, enamel, and dentin with slurries of Arg and measuring the depth of abrasion using a stylus profilometer. Our results demonstrate that Arg can react with dental calculus in aqueous environment. This reaction increases calculus surface roughness which in turn facilitate dental calculus removal by brushing. Aragonite could be a promising abrasive for toothpaste design for management of dental calculus.

Toxicity of resin-matrix composites in a dental clinical setting

The aim of this study was to perform a systematic review to comprehensively explore the factors contributing to the resin-matrix composites' toxicity in patients. A systematic review was performed according to the PRISMA guidelines. The bibliographic review was performed in the following databases: PubMed, Cochrane Central and Web of Science. Inclusion and exclusion criteria were established to retrieve articles published in English over the last 20 years. The research yielded 1261 articles, with 1227 articles remaining after removing duplicates. Following a title and abstract screening, 20 articles underwent full-text review, and 12 in vivo studies were included. Detectable levels of free monomers and potential toxicity exposure were reported in the selected studies on saliva, urine, and blood samples. The selected in vivo studies suggest relatively low local and systemic toxicity although the available methods show technical limitations and therefore further studies are required. Dental operator-dependent factors were also identified. Standard chair-side guidelines on handling of resin-matrix composites placement plays a key role on the properties of the materials. The results reported noticeable changes in samples were not considered significant to affect patient's health, although, manufacturer's instructions must be followed whilst using resin-matrix composites. In fact, adequate light curing parameters maintain a high degree of conversion of the resin-matrix composites  decreasing the release of residual monomers and thus the probability of related  toxicity.

Photonic platform coupled with machine learning algorithms to detect pyrolysis products of crack cocaine in saliva: A proof-of-concept animal study

The non-invasive detection of crack/cocaine and other bioactive compounds from its pyrolysis in saliva can provide an alternative for drug analysis in forensic toxicology. Therefore, a highly sensitive, fast, reagent-free, and sustainable approach with a non-invasive specimen is relevant in public health. In this animal model study, we evaluated the effects of exposure to smoke crack cocaine on salivary flow, salivary gland weight, and salivary composition using Attenuated total reflection-Fourier transform infrared (ATR-FTIR) spectroscopy. The exposure to crack cocaine was performed in an acrylic box apparatus with a burned activation of crack/cocaine 400 mg for 10 min for 14 consecutive days. Crack/cocaine exposure increased the salivary secretion without changes in parotid and submandibular weights. Hierarchical Clustering Analysis (HCA) was applied to depict subgrouping patterns in infrared spectra, and Principal components analysis (PCA) explained 83.2 % of the cumulative variance using 3 PCs. ATR-FTIR platforms were coupled to AdaBoost, Artificial Neural Networks, Naïve Bayes, Random Forest, and Support Vector Machine (SVM) algorithms tool to identify changes in the infrared salivary spectra of rats exposed to crack cocaine. The best classification of crack cocaine exposure using the salivary spectra was performed by Naïve Bayes, presenting a sensitivity of 100 %, specificity of 80 %, and accuracy of 90 % between crack cocaine and control rats. The SHAP features of salivary infrared spectra mostly indicate the vibrational modes at 1331 cm-1 and 2806 cm-1, representing CH2 wagging commonly linked in lipids and C-H stretch often attributed to the CH2 or CH3 groups in lipid molecules, respectively, as the main responsible vibrational modes for crack cocaine exposure discrimination. In summary, the present pre-clinical findings indicate the potential of the ATR-FTIR platform coupled with machine learning to effectively detect changes in salivary infrared spectra promoted by exposure to crack cocaine.

Restorative management of permanent teeth affected by molar incisor hypomineralization: a survey of dentists in Saudi Arabia

BACKGROUND

This electronic survey-based study aimed to explore the variations in treatment decisions made by dentists from different specialties in Saudi Arabia when treating anterior and posterior permanent teeth afflicted by molar incisor hypomineralization (MIH) of varying severity.

METHODS

A cohort of dental professionals, including general dentists, pediatric dentists, and restorative dentists/prosthodontists, participated in a validated electronic survey-based study between January and March 2023. The survey consisted of the following three sections: The first section collected demographic information from the participating dentists. The second part includes case scenarios and photographs of four clinical cases (two permanent first molars and two permanent incisors) diagnosed with MIH of varying degrees of severity. Following each case, the participants were asked to choose the treatment approach and final restorative material they preferred to manage the tooth in question. In the third part, participants were asked to select factors that influenced their treatment decisions.

RESULTS

In total, 109 dentists responded to the questionnaire. For posterior permanent molars with both mild and severe MIH, general dentists and restorative dentists/prosthodontics preferred resin-based composite restoration. In contrast, pediatric dentists considered stainless steel crowns (SSCs) as the preferred modality. Resin infiltration was the most common treatment chosen for permanent anterior teeth with mild MIH. Resin-based composite restorations were predominantly chosen for severe cases. Tooth prognosis and dentist experience were among the top cited factors influencing the decision of preferred treatment in cases of permanent first molars diagnosed with MIH, and aesthetics was the most considered factor in cases of permanent incisors diagnosed with MIH.

CONCLUSION

According to the survey, different dental specialties manage MIH cases differently depending on the severity and type of permanent tooth (anterior/posterior).

Putting the mouth back in the body - the neglected area of dental and oral travel health

The lack of dental travel health care has been deplored for some time. Travel medicine's remit is to prepare people for travel. People travel with their mouth firmly in their body, yet the mouth's wellbeing does not rate a mention. This article represents the first exploration of a range of topics relevant to an until now neglected, yet potentially highly important, area of health care. A range of dental mishaps can occur while away from home, from simple toothache to accidents, serious emergencies, or restoration failures. Other problems originate in unwise behaviour, including holiday-inspired body modifications.Unless there is pain, teeth are typically not thought about much. However, examining the practical side of dental hygiene during travels, several overlooked and perhaps surprising topics emerge that - through the travel lens - take on a different and important role: the oral microbiome, toothbrush hygiene, the toilet plume, and traveller diarrhoea. Based on this discussion, recommendations are made for clinical practice, education, and further research.The historical chasm between dentistry and medicine, despite long-standing calls for change, does not seem to go away and impairs holistic high quality travel health care. Travel medicine can bypass this unproductive division. It has the unique opportunity to be the first medical specialty cooperating closely with dentists to bridge this gap by providing quality travel health care to travellers with all their body parts attached.

Your right to choose: parents' preferences toward a pediatric dental center

BACKGROUND

Timely dental care during childhood can effectively prevent many dental issues and their potential long-term complications.

AIM

To identify factors associated with the selection of clinics providing dental care and services for children from parental perspective.

DESIGN METHOD

A thematic qualitative study was conducted, involving parents of children aged 6-12 years who visited pediatric dentists in public/private dental centers in Isfahan city from December 2022 to July 2023. Twenty semi-structured face-to-face interviews were conducted in private rooms within the selected centers. A thematic analysis method was used to analyze interview transcripts.

RESULTS

Seven main theme and 20 sub-themes were identified. They included accessibility (geographical location, proximity to residential area, parking), familiarity with pediatric dental center (recommendations from other dentists, recommendations from other patients, previous visits), amenities (general amenities, visual amenities), appointment arrangements (center's working hours, waiting queue, appointment booking), treatment cost (tariffs of dental care and services, installment plans, contracts with insurance companies), quality of medical equipment (supervision over treatment, quality of dental materials, diagnostic equipment, adherence to hygiene protocols), and staff (administrative and treatment staff). Treatment cost (tariffs of dental care and services, installment plans, contracts with insurance companies).

CONCLUSION

Parents consider various aspects of pediatric dental centers to select ones that best in line with their priorities and needs. Specifically, parents focus on both financial aspects of pediatric treatments-and non-financial considerations.

Turnover and Turnover Intention Among Nurses Working in Saudi Arabia: A Qualitative Evidence Synthesis

AIMS

This review's primary objective is to explore factors causing turnover and turnover intention in nurses working in KSA and to identify ways to prevent turnover and reduce turnover intention in the KSA nursing workforce.

DESIGN

Qualitative evidence synthesis (QES).

DATA SOURCES

MEDLINE/Ovid/PubMed, Web of Science, PsychINFO, CINAHL, and Google Scholar (GS) underwent a structured search for articles. Articles were selected for inclusion if they reported primary studies with qualitative or mixed methods study designs published in English or Arabic in the peer-reviewed literature or as a thesis or dissertation.

REVIEW METHODS

In order to determine which type of synthesis to choose, we applied the RETREAT framework recommended in the Cochrane handbook and used by other researchers. Thematic synthesis was the most applicable choice, so this approach was selected.

RESULTS

Seven studies published in nine reports in the years 2016 through 2022 were included. The final coding framework included five predominant themes related to 19 subthemes. Three main findings were that there are leadership challenges at all levels in the KSA healthcare system leading to nurse turnover, a complex web of discrimination discourages nurses from remaining in the Saudi healthcare workforce, and societal pressure experienced by both Saudi and non-Saudi nurses leads to turnover and turnover intention.

CONCLUSIONS

KSA leaders should focus on intervening in the leadership challenges found at all levels of the KSA healthcare system. Addressing this issue could also positively impact the related issues of discrimination and societal pressure in the workplace and could begin to take steps toward improving occupational conditions and reducing nurse turnover and turnover intention.

IMPACT

Addressing the serious problem of the leadership challenges in healthcare would likely have a strong positive impact on the other two findings that relate to discrimination and societal pressure.

PATIENT OR PUBLIC CONTRIBUTION

Not applicable.

Evaluation of the Knowledge and Experience of the Brazilian Orthodontists in the Handling of Traumatized Teeth: A Quantitative Study

AIM

This is the quantitative part of a study that aimed to evaluate the knowledge and experience of orthodontists in managing the orthodontic treatments of traumatized teeth.

MATERIAL AND METHOD

The study was divided into 4 stages: first, a structured interview; second, face validity; third, test-retest; and fourth, administering the questionnaire. The first three stages aimed at developing the questionnaire, while the fourth consisted of the application of the instrument in a sample of 395 orthodontists properly licensed with the Regional Councils of Dentistry of Brazil. The questionnaire was sent to these orthodontists through the social media platform Instagram.

RESULTS

It was found that the majority of participants had encountered this type of emergency in their offices, had moderate knowledge of the subject, and were successful in their orthodontic treatments. Furthermore, almost all professionals recognized the importance of additional training, and only a small portion of them were familiar with any care protocols for these cases.

CONCLUSION

It can be concluded that the orthodontists had limited experience and a moderate knowledge about the orthodontic management of traumatized teeth.

Cost-effectiveness of atraumatic restorative treatment combined with the Hall Technique for managing dental caries in remote Indigenous children

BACKGROUND

Indigenous children in remote Australia face significant disparities in oral health and have limited access to dental care. This study evaluated the cost-effectiveness of Atraumatic Restorative Treatment combined with the Hall Technique (ART-HT) compared to usual care.

METHODS

A cost-effectiveness analysis using data from a 1-year ART-HT trial estimated dental caries status and costs from a health-provider perspective. Two scenarios were examined: (1) actual treatment costs and (2) minimum dental services. The incremental cost per decayed, missing, and filled teeth (dmft) prevented was calculated in AUD 2021 prices. A probabilistic sensitivity analysis was conducted.

RESULTS

Among 228 children (ART-HT = 122; usual care = 106), deterministic analysis showed ART-HT required additional costs of $59.54 and $72.37 for scenarios 1 and 2, with 0.90 dmft prevented. Probabilistic sensitivity analysis revealed ART-HT resulted in better oral health outcomes with a mean dmft prevented of 0.58 (95% uncertainty interval: 0.09 to1.07). The mean additional cost per dmft prevented was $118.50 and $181.84 for scenarios 1 and 2.

CONCLUSIONS

ART-HT effectively managed dental caries in Indigenous children, providing better oral health outcomes compared to usual care, albeit with modest additional costs. This approach may improve access to culturally appropriate dental care in remote communities.

Vision Changes After Head and Neck Cancer Treatment

BACKGROUND

Literature about ocular toxicity after head and neck cancer (HNC) treatment is scarce. This study aimed to describe visual function and ocular symptoms among HNC patients.

METHODS

The study used a cross-sectional design. Two surveys, The National Eye Institute Visual Functioning Questionnaire (NEI-VFQ) and an Ocular Symptom Scale, were sent to participants via e-mail. Descriptive statistics were used to describe the sample in the vision change and non-vision change groups. Chi-square and t-tests were used to compare groups.

RESULTS

Of the 485 HNC patients emailed, 126 responded to the survey (26%). Of those, 114 completed the surveys. The scores of NEI-VFQ were significantly lower in the vision change group than in the non-vision change group (p < 0.001). Similarly, all ocular symptoms were significantly different between the two groups (p < 0.05).

CONCLUSIONS

These findings and a scarcity of literature suggest that vision screening after HNC treatment is warranted.

Innovative learning in dental education: integrating narrative and 3D industrial design for teaching caries health disease processes

INTRODUCTION

Dental education requires innovative pedagogical tools to understand the evolution of the health-disease process in individuals with dental caries. "The Origin of Teeth" integrates narrative storytelling with industrial character design to address this need.

AIM

To create and implement industrial designs based on characters from "The Origin of Teeth" to improve teaching outcomes and student engagement with the health-disease process of caries.

MATERIALS AND METHODS

Using Computer-Aided Design (CAD) and high-precision 3D printers, four anthropometric character models were developed and legally registered. A quasi-experimental study was conducted with 30 dental students from the Universidad Nacional Toribio Rodríguez de Mendoza. Pre- and post-intervention knowledge assessments were conducted using a validated multiple-choice questionaire, and data were analized using paired t-tests to evaluate the effectiveness of the intervention.

RESULTS

The educational intervention significantly increased students´ understanding of dental caries processes, with posttest scores demonstrating a mean improvement of 35% compared to pretest scores (p < 0.001). The characters successfully embodied educational content, facilitating learning through tactile and visual interaction.

CONCLUSION

Integrating narrative storytelling with 3D industrial design is a powerful educational approach, enhacing student comprehension and engagement in dental education.This methodology hold promise for broader applications in health education.

Assessment of the correlation between fluorescence-featured intraoral scanner, laser fluorescence and spectrophotometric analyses in caries-affected dentin: an in-vitro diagnostic accuracy study

To investigate the relation between the caries scoring system of the fluorescence intraoral scanner (IOS) Trios 4 (3Shape, Denmark)a red laser light-induced fluorescence device DIAGNOdent Pen (Kavo, Germany), and the color parameters (L*a*b*) by a clinical contact type hybrid spectrophotometer Rayplicker (Borea, France) in the assessment of caries affected dentin tissue. Caries lesions were minimally invasively removal from 186 extracted molars. Teeth were scanned using Trios4, and the integrated software scored the cavity floor regarding the colors (yellow, initial caries; red, moderate-extensive caries) depending on the fluorescence features. Then the DIAGNOdent measurements were obtained from each cavity's deep and discolored surface points following the previously obtained Trios4 colors. Thus, the Trios4 reading could be quantitatively assessed. Cross-polarization photographs were using the Rayplickerand L*a*b color parameters, and 3D Master (VITA) color mapping was obtained by using the RayPlicker's software. Spearman's Rho Correlation, Kappa, Mann Whitney-U, One-way Analysis-of-Variance, and Kruskal Wallis tests were used for the statistical analyses (P < 0.05). Sensitivity, specificity and AUC were calculated. Trios4 and DIAGNOdent were positively correlated (r = 0.733;P < 0.001). The L*parameter by Rayplicker and Trios4 was negatively correlated(r=-0.742;P < 0,001). The a*parameter by Rayplicker and Trios4 scoring positively correlated(r = 0.552;P < 0.001). No significant correlation was observed between b*parameter by Rayplicker and Trios4 (r = 0.023; P = 0.760). DIAGNOdent readings according toTrios4 scorings were significant (P < 0.001). The teeth without caries scored by the Trios4 corresponded to the median value of 29 in DIAGNOdent readings, and 88 for the teeth with caries (by Trios4 / yellow-red). The agreement between the Trios4 and DIAGNOdent was 52.2% for the specimens with no residual caries. The presence of caries scores by the Trios 4 corresponded to the DIAGNOdent readings of %100 for all the teeth evaluated. Regarding the RayPlicker assessments, 33% of the sound cavities corresponded to 2M3 color, and 73% corresponded to 5M3 color. Trios4 scorings presented 0.782 AUC, 56.30% sensitivity, and 100% specificity in DIAGNOdent reference. Trios4 scoring was considered coherent with the DIAGNOdent Pen. DIAGNOdent readings and the Level of L* and a* parameters in the dentin tissue might be considered interrelated. Fluorescence-featured scanner devices can be useful clinical tools to evaluate remaining dentin tissue during the caries removal procedure.

How does gender influence student learning, stress and career choice in endodontics?

The influence of gender is underexplored in endodontic educational research. This review examines the effect of gender on learning within the domains of skill acquisition, performance and difficulties encountered. It also analyses the stress and confidence experienced by male and female students during clinical endodontics, as well as their preparedness at the end of their undergraduate studies. Finally, this review analyses the influence of gender on student career choices in dentistry with a focus on endodontics. The review highlights that gender is invariably studied as a secondary outcome in endodontic education. Based on current evidence, it appears that female students tend to underestimate their skills and knowledge more than male counterparts in endodontics. They are also often more stressed than males, feeling less confident and not as prepared. A recognition of gender differences in learning and stress management is important. Student aspirations regarding their choice of endodontic postgraduate speciality appear to be relatively well balanced in terms of gender. Finally, there is a need for further research to elucidate more clearly the impact of gender in endodontic education and endodontic career choice.

Factors Associated with Opioid and Antibiotic Prescribing at US Academic Dental Institutions: 2011 to 2020

INTRODUCTION

In the United States, dentists are one of the leading prescribers of opioids and antibiotics. Because dental schools are the training grounds for future dentists, it is crucial to understand how prescribing has changed and why these medications are being prescribed in academic settings.

OBJECTIVES

The objective of this research was to describe the prescribing trends and factors associated with opioid and antibiotic medication prescribing at US academic dental institutions between 2011 and 2020.

METHODS

Data from electronic dental records collected through the BigMouth data repository from 9 anonymized dental institutions between 2011 and 2020 were used. Prescribing rates were defined as the percentage of patients who received an opioid/antibiotic prescription. The primary outcome was whether at least 1 opioid or antibiotic medication was prescribed at the encounter. Monotonicity and statistical significance of prescribing trends by year were assessed using the Mann-Kendall test, and a statistical analysis using an adjusted multilevel mixed-effects logistic regression model was performed to identify significant patient-, visit-, and dental provider-level factors associated with prescribing of these medications.

RESULTS

In total, 5,720,166 patient encounters from 905,426 patients had aggregate opioid and antibiotic prescribing rates of 2.0% and 2.7%, respectively, between 2011 and 2020. For both medications, a downward prescribing trend was observed from 2013, which increased in 2020. Opioid prescribing was most likely for young adults aged 15 to 24 y (odds ratio [OR] = 5.26;95% confidence interval [CI]: 4.99-5.55) and by oral surgeons (OR = 10.03; 95% CI: 8.02-12.55). Antibiotic prescribing had a higher odds for patients aged >65 y (OR = 5.04; 95% CI: 4.62-5.49) and by periodontists/implant specialists (OR = 6.21; 95% CI: 4.96-7.78). Multiple treatments at the same dental visit and pain-associated dental procedures were associated with statistically significantly higher odds of being prescribed both medications.

CONCLUSION

There are significant differences in opioid and antibiotic prescribing by dentist specialty, patient age, whether the dental visit had multiple treatment procedures, and whether 1 or more postoperative dental pain-associated procedures were performed.Knowledge Transfer Statement:This study provides an understanding of patient-, dentist-, and visit-level factors associated with opioid and antibiotic medication prescriptions issued by clinicians at academic dental institutions in the United States. The results can contribute further to predict clinical scenarios related to the prescribing of these medications and the development of specific interventions to reduce inappropriate and excessive opioid and antibiotic medication prescribing.

Expert consensus on the clinical strategies for orthodontic treatment with clear aligners

Clear aligner treatment is a novel technique in current orthodontic practice. Distinct from traditional fixed orthodontic appliances, clear aligners have different material features and biomechanical characteristics and treatment efficiencies, presenting new clinical challenges. Therefore, a comprehensive and systematic description of the key clinical aspects of clear aligner treatment is essential to enhance treatment efficacy and facilitate the advancement and wide adoption of this new technique. This expert consensus discusses case selection and grading of treatment difficulty, principle of clear aligner therapy, clinical procedures and potential complications, which are crucial to the clinical success of clear aligner treatment.

Influence of the pandemic on the mental health of professional workers

BACKGROUND

This study focuses on the influence of the pandemic on professional workers from an explicitly comparative perspective. High levels of stress and burnout have been reported among professional workers pre-pandemic, but the pandemic has had unique consequences for certain professional workers. Gender has emerged as a particularly important factor. While the existing research yields important insights of mental health concerns among professional workers, there is a need for more research that examines these impacts empirically, explicitly from a comparative perspective across professions taking gender more fully into consideration.

METHODS

This paper undertakes a secondary data analysis of two different pan Canadian sources to address the pandemic impact on professional workers: The Canadian Community Health Survey (2020, 2021) administered by Statistics Canada and the Healthy Professional Worker survey (2021). Across the two datasets, we focused on the following professional workers - academics, accountants, dentists, nurses, physicians and teachers - representing a range of work settings and gender composition. Inferential statistics analyses were conducted to provide prevalence rates of self-perceived worsened mental health since the pandemic and to examine the inter-group differences.

RESULTS

Statistical analysis of these two data sources revealed a significant effect of the pandemic on the mental health of professional workers, that there were differences across professional workers and that gender had a notable effect both at the individual and professional level. This included significant differences in self-reported mental health, distress, burnout and presenteeism prior to and during the pandemic, as well as the overall impact of the pandemic on mental health. The high levels of distress and burnout during the pandemic were particularly evident in nursing, teaching, and midwifery - professions where women predominate.

CONCLUSIONS

Interventions to address the mental health consequences of the pandemic, including their unique gendered and professional dimensions, should consider the intersecting influences and differences revealed through our analysis. In addition to being gender sensitive, interventions need to take into account the unique circumstances of each profession to better respond to the mental health needs of all genders within each professional group.