The impact of dental caries and its treatment by conventional or biological approaches on the oral health-related quality of life of children and carers

Effect of sleep on oral health: A scoping review

Sleep is a vital biological process that facilitates numerous vital functions integral to mental and physical restoration of the body. Sleep deprivation or poor sleep quality not only affects physical health but may also affect oral health. This scoping review aims to collate existing evidence related to the impact of sleep duration and/or quality on oral health. A systematic search strategy using PubMed, Embase, Scopus and CINAHL databases was performed to identify studies that assessed the association between sleep quality or duration and oral health or hygiene. Two researchers independently screened and extracted the data. Eligible studies were critically appraised using the NIH quality assessment tool for observational cohort and cross-sectional studies checklist. The search identified 18,398 studies, from which 14 fulfilled the inclusion criteria. Of the 14 papers, four papers were associated with effect of sleep on caries, 8 papers described the effect of sleep on gingival and periodontal health, and two papers described the effect of sleep on general oral health and oral disease symptoms. This review found a direct link between sleep and dental decay in children, and short sleep duration was associated with an increased risk of periodontitis adults.

Evaluation of near-infrared digital imaging transillumination compared with bitewing radiography for proximal caries detection in children

BACKGROUND

Limitations in traditional caries detection tools have driven the development of alternatives methods, focused on the early lesion detection such as near-infrared digital imaging transillumination (NIDIT).

AIM

The aim of this study was to evaluate the performance of NIDIT compared with bitewing radiography (BWR) in the detection of interproximal carious lesions in children.

DESIGN

A retrospective audit of data from children who had NIDIT, BWR and intraoral photographs was conducted. Carious lesions were scored on a tooth surface level with BWR acting as the primary reference for comparison. Accuracy was determined using multi-class area under the curve (AUC), and correlation was determined using Fleiss' Kappa.

RESULTS

Data from 499 tooth surfaces involving 44 children were included in this study. The average age across the participants was 86 months (~7 years) with an average dmft (decayed, missing and filled teeth in primary dentition) of 5.29. Multi-class AUC comparing NIDIT to BWR was 0.70. The correlation between NIDIT and BWR was moderate (0.43), whereas the correlation between photographic examination and BWR was 0.30, which is fair.

CONCLUSION

When compared to BWR, NIDIT showed a high specificity but a low sensitivity for proximal caries detection in primary teeth.

Oral Health-Related Quality of Life Following Root Canal Treatment of First Permanent Molars Among Children. A Cross-Sectional Study

Aim

This study aimed to assess the Oral Health-Related Quality of Life (OHRQoL) of pediatric patients (9-18 years old) who underwent root canal treatment (RCT) on first permanent molars (FPMs).

Methods

A cross-sectional study was conducted at three healthcare centers in Jeddah, Saudi Arabia. Participants (n = 482) completed the validated OHIP5-Ar questionnaire to assess OHRQoL. Responses were classified as "optimal" (no problems) or "less than optimal" (any reported problems). Logistic regression analyzed the relationship between OHRQoL and sociodemographic factors.

Results

There were 66.8% children reported optimal OHRQoL after RCT. Logistic regression showed no significant association between optimal OHRQoL and gender, family income, or location of treated tooth. However, although not statistically significant. Treating only one FPM with RCT (compared to multiple teeth) and lower family income (compared to higher income) were more likely to have decreased or increased odds of optimal OHRQoL (AOR = 0.684 or 1.424; respectively).

Conclusion

RCT on FPMs can be a successful treatment option for pediatric patients, offering optimal oral health-related quality of life.

Knowledge, Attitudes, and Practices About the Use of Silver Diamine Fluoride Among Dentists in Riyadh, Saudi Arabia: A Cross-Sectional Study

Introduction Dental caries is a worldwide disease affecting children and older populations. There are multiple interventions to treat dental caries that could be sometimes hard to deliver, due to the general status of patients such as insufficient cooperation or medically compromising conditions. Therefore, another alternative to control dental caries is being used and has been recently introduced and approved by the Saudi FDA which is silver diamine fluoride (SDF).  Objectives This study aimed to investigate the level of knowledge, attitudes, and practices about the use of SDF among dentists in Riyadh, Saudi Arabia. Materials and methods This cross-sectional study was conducted using pretested, an online digitally designed questionnaire sent to 500 Saudi Commission for Health Specialties (SCFHS) registered dentists working in the following specialties: general practitioners, interns, restorative, family, pediatric, and public health dentists who are working in public and private hospitals and clinics. One-way ANOVA was used to determine the comparison of participants' knowledge and Practice with three variables (participants' specialty, place of work, and years of experience), while Chi-square was used for the comparison of respondent's attitudes about the use of SDF and the above same variables. Result A total of 265 responses were received (response rate is 53%). The majority of the respondents were general practitioners and interns 144 (54.3%). Over 50% of dentists believed that they were very informed about SDF. The mean score of knowledge and practices of SDF of participants was found below average 49.13 (19.81) and 43 (26.12), respectively. Correlation of the mean score knowledge and practicing SDF with the type of specialty showed that pediatric dentists had statically significant (P<0.05) higher mean of knowledge 66.94 (SD=17.64) and practicing of SDF 61.93 (22.12) as compared to other specialties, while no statistically significant differences were found among the groups in the overall knowledge and practices based on years of experience and workplace. Attitudes were correlated with the three above variables (specialty, years of experience, and place of work) and showed that pediatric dentists had the highest satisfaction with the results of SDF (85.3%) and were more willing to recommend using it to others (91.2%) as compared to the other groups(P<0.05). No statistically significant differences were found with respect to the later variables. Conclusion The findings of this study showed that irrespective of the positive attitude of participants towards SDF, pediatric dentists were found to have higher knowledge and use SDF more than other dentists in different specialties. Furthermore, they showed higher satisfaction with its use. Years of experience and workplace had no effect on the level of knowledge or practice among participants.

Oral Health-Related Quality of Life in a Paediatric Population in the Dominican Republic

Introduction: During the summer of 2019 and within the framework of a social dentistry program carried out in the low-income town of San Francisco de Macorís (Dominican Republic), a descriptive study was carried out on oral health-related quality of life (OHRQoL), aiming to find out the oral health status of a population of children in the aforementioned Dominican city. Objective: The aim of this study was to describe the oral health status of a child population and its relationship with the quality of life perceived by these children in the aforementioned population of San Francisco de Macorís in order to develop an specific oral health program taking into account not only the existing oral health status but also the perceptions and feelings of the child population in this regard. Method: A descriptive cross-sectional study was carried out on a representative sample of children who were examined on their oral health status, following WHO guidelines, by professionals from the University of Seville (Spain) together with professionals from private practice (USA) and students from the Universidad Católica Nordestana (UCNE, Dominican Republic). Likewise, the children's parents voluntarily completed the Oral Quality of Life questionnaire COHIP-19 in its culturally adapted Spanish version. Results: For this purpose, 94 children with a mean age of 10.34 (SD 3.38) were observed in our study following WHO recommendations for oral health studies and evaluating OHQoL using the specific questionnaire validated in Spanish COHIP-19 in its short format (SF). The results show a state of oral health with a significant prevalence of caries (80.9%) and a DMFT of 1.70 (SD 1.90). The OHQoL perceived by these children shows that pain, bad breath or feeling sad because of the condition of their teeth were the factors with the worst evaluation score. Conclusions: The conclusion that mainly emerges from this study is that caries continues to be the main problem to be solved (more than other variables studied, such as malocclusion or fluorosis), and this ailment also causes pain, dysfunction, and bad breath and is therefore perceived as a problem to be solved in the children of this Dominican city.

Fluoride release potential of arginine-incorporated fluoride varnishes

The study aimed to examine the fluoride (F) release potential of arginine (Arg)-incorporated F varnishes. Four commercially available F varnishes were included in the study: Duraphat® (5% NaF), Flúor Protector® (0.9% SiH2F2), Fluor Protector S® (NH4F), and Fluorimax™ (2.5% NaF). L-arginine (2% w/v.) was incorporated in these varnishes to estimate F release at 1 h, 4 h, 6 h, 24 h, 3 days, and 7 days using an F-ion selective electrode. The media pH of eluded varnishes was estimated and primary inorganic F extraction was performed. The main effects pH, F release, and computed integrated mean/cumulative F release for experimental groups were significantly higher than the controls (p<0.01). The primary extracted F concentrations for the Arg-containing groups were significantly lower than the control groups (p<0.001) demonstrating a chemical interplay with Arg incorporation. To conclude, irrespective of the inorganic F content, incorporating Arg in F-containing varnishes increases their F release potential.

Association between dental caries and adherence to the Mediterranean diet, dietary intake, and body mass index in children

BACKGROUND

Children with healthier nutritional status are less likely to develop severe caries than those with a high-sugar content diet. Studies evaluating dental caries and nutritional status in school-age children have generally focused on dietary intake, diet quality, or anthropometric measures, and the number of studies evaluating them together is limited.

OBJECTIVE

It was aimed to evaluate the relationship between dental caries adherence to the Mediterranean Diet (MD), dietary intake, and Body Mass Index (BMI) in school-age children.

MATERIALS AND METHODS

This study was conducted with 300 healthy children (52.0% boys, 48.0% girls) aged between 6 and 12 years. The data collection forms included sociodemographic characteristics, oral health practices of children, Mediterranean Diet Quality Index for children and adolescents (KIDMED), and food consumption records. Anthropometric measurements (body weight and height) of the children were taken. Dental examinations were performed by a pediatric dentist.

RESULTS

While the DMFT mean score of the children was 1.7 ± 2.09, the mean dft score was 2.9 ± 3.29. The mean of KIDMED scores was 5.9 ± 3.32. DMFT and dft scores decreased statistically as maternal education increased (p < 0.05). DMFT and dft scores were not statistically different between BMI groups according to gender and age (p > 0.05). DMFT scores differed statistically between KIDMED groups (p < 0.05). This difference was between low-optimal and low-improvement-needed groups. While there was a low negative correlation (r=-0.169) between calcium intake and DMFT score, a low positive correlation was found between glucose (r = 0.172) and fructose (r = 0.149) intake and dft score (p < 0.05). In regression analysis, while the children's age related DMFT scores positively, maternal education and KIDMED scores related DMFT scores negatively. Also, children's age and maternal education related dft scores negatively.

CONCLUSION

In this study, adherence to the MD rather than nutrients was found to be important in dental caries. Also maternal education level was also found to be a determinant factor in dental caries in children. DMFT and dft did not differ between BMI groups.Further studies should be conducted to assess the impact of the MD on dental caries in children to develop dietary interventions for preventative purposes.

Exploring Jordanian children and parents' awareness, behavior, and perception of pediatric oral health

BACKGROUND

To evaluate children's and parents' practice and attitude toward oral hygiene and their knowledge about oral hygiene.

METHODS

This cross-sectional questionnaire-based study was conducted on randomly selected children who were seen in the Pediatric dentistry clinic in different Royal Medical Services hospitals. A modified questionnaire was used to gather information from the child or parents to gather the child's demographic data and evaluate the children's and parents' practice and attitude toward oral hygiene, their knowledge about oral hygiene, information about the parent and family, and oral examination, the questionnaire questions' reliability and validity were assessed by test-retest and Cronbach's Alpha test.

RESULTS

Three hundred seventy four patients were included, and the average age was 5.06 ± 3.58 SD years. Children's and parents' practice toward oral hygiene was inadequate where the majority (83.3%) brush their teeth occasionally, change their toothbrushes infrequently, apply toothpaste inappropriately, and less than half (47.2%) clean their tongue after teeth brushing. A significant number (73%) of candidates were aware that oral health has a significant role in their general health and can prevent dental problems. Participants agreed that maintaining a healthy mouth is an individual responsibility. The majority of participants came from large family size (the average family members 6.1 ± 1.7 SD) who live below the poverty line.

CONCLUSION

Our study demonstrated that awareness of oral health status in children below the age of 12 was poor. Although their oral knowledge was good their attitude and behavior were inadequate. These findings urge the need for expanded, well-organized, preventive educational programs that include school's syllabus, house visits, and hospitals for parents and children alike.

Sugar-sweetened beverage intake and convenience store shopping as mediators of the food insecurity-Tooth decay relationship among low-income children in Washington state

INTRODUCTION

There are oral health disparities in the U.S. and children in food-insecure households have a higher burden of tooth decay. Identifying the mechanisms underlying the food insecurity-tooth decay relationship could inform public health interventions. This study examined how sugar-sweetened beverage (SSB) intake and frequent convenience store shopping mediated the food insecurity-tooth decay relationship for lower-income children.

MATERIALS AND METHODS

Cross-sectional study data included a household survey, beverage questionnaire, and dental examination. The sample included 452 lower-income, racially-diverse, child-caregiver dyads in 2018 from King County in Washington state. The exposure was household food insecurity, the outcome was untreated decayed tooth surfaces, and the proposed mediators were SSB intake and frequent convenience store shopping (≥2 times/week). Causal mediation analyses via the potential outcomes framework was used to estimate natural indirect and direct effects.

RESULTS

Fifty-five percent of participants were in food-insecure households, the mean number of decayed tooth surfaces among children was 0.87 (standard deviation [SD] = 1.99), the mean SSB intake was 17 fluid ounces (fl/oz)/day (SD = 35), and 18% of households frequently shopped at a convenience store. After adjusting for confounders, household food insecurity and log-transformed SSB intake (fluid ounces/day) were positively associated with decayed tooth surfaces, but not at the a α = 0.05 level (mean ratio [MR] 1.60; 95% confidence interval [CI] 0.89, 2.88; p = .12 and MR 1.16; 95% CI 0.93, 1.46; p = .19, respectively). Frequent convenience store shopping was associated with 2.75 times more decayed tooth surfaces (95% CI 1.61, 4.67; p < .001). SSB intake mediated 10% of the food insecurity-tooth decay relationship (p = .35) and frequent convenience store shopping mediated 22% (p = .33).

CONCLUSIONS

Interventions aimed at addressing oral health disparities in children in food-insecure households could potentially focus on reducing intake of SSBs and improving access to healthful foods in lower-income communities.

In Vitro Evaluation of Viscosity, Depth of Penetration, Microleakage, and Shear Bond Strength of Conventional and Hydrophilic Sealants

Background

Sealants are effective in preventing and arresting pit and fissure caries. Newer brands of sealants continue to be developed despite the lack of scientifically based information addressing the caries-preventive properties of these materials. Hence, laboratory in vitro tests play a vital role in providing the necessary information regarding the efficacy of new products in a short period of time.

Objectives

To compare and evaluate the viscosity, resin tag length, microleakage, and shear bond strength between conventional and hydrophilic sealants.

Materials and methods

A total of 40 extracted third molars were selected. Only 20 were evaluated for microleakage and resin tag length and another 20 for shear bond strength evaluation between group I-ClinPro and group II-UltraSeal XT hydro. After sealant placement, specimens were immersed in 0.1% rhodamine dye, followed by thermocycling. Microleakage testing was done using a confocal laser scanning microscope and resin tag length evaluation using a scanning electron microscope (SEM) and shear bond strength using an Universal Instron machine. Viscosity was assessed using an Anton Paar viscometer. Results were subjected to statistical analysis using Statistical Package for the Social Sciences (SPSS) software version 20.

Results

Viscosity and mean microleakage scores for group I (0.92 MPa and 1.50) were found to be higher than for group II (0.72 MPa and 0.60). Mean resin tag length and mean shear bond strength for group I (7.46 ± 0.95 μm and 13.71 ± 0.94 MPa) were found to be less compared to group II (10.03 ± 1.00 μm and 20.39 ± 0.98 MPa). The results were found to be statistically significant (p < 0.05).

Conclusion

Group II was found to be less viscous, which resulted in the formation of resin tags of sufficient length and showed less microleakage and higher shear bond strength than group I.

How to cite this article

Prabakar J, Jeevanandan G, Kengadaran S. In Vitro Evaluation of Viscosity, Depth of Penetration, Microleakage, and Shear Bond Strength of Conventional and Hydrophilic Sealants. Int J Clin Pediatr Dent 2023;16(5):745-750.

Agreement between schoolchildren and their parents on rating the child's oral health-related quality of life

The perceptions of parents/caregivers regarding their children's oral health can influence the standard of care and decision-making regarding oral health. The children's perspective on their own oral health-related quality of life (OHRQoL) may differ from the parents/caregivers' views. This cross-sectional study aimed to analyze the agreement between the perceptions of parents/caregivers and schoolchildren regarding OHRQoL. It was conducted with a sample of children between 8 and 11 years old and their parents/caregivers from Pelotas. Children answered the Child Perceptions Questionnaire 8-10 (CPQ), and parents/caregivers answered the short form of the Parental-Caregiver Perceptions Questionnaire (P-CPQ). Socioeconomic data were also collected. Children's dental caries, traumatic dental injuries, and malocclusions were examined. The Spearman's correlation test was performed. A total of 119 parents/caregivers-children pairs were included. There was an agreement between the total scores of parents/caregivers and children (0.2770; p = 0.003), in the oral symptoms (0.1907; p = 0.038), and functional limitations (0.2233; p=0.015) domains. The Bland-Altman graph showed an agreement between children's and parents/caregivers' OHRQoL total score, but there was an underestimation of approximately two points in the parents/caregivers' perception compared to the children's score. There was an agreement between the reports of parents/caregivers and children regarding children's OHRQoL.

Association of MTR and MTRR genes and oral health-related quality of life in children with dental caries

This study aimed to assess whether genetic polymorphisms in MTR and MTRR are potential biomarkers of oral health-related quality of life (OHRQoL) in children with caries. A cross-sectional study was designed wherein pairs of parents/caregivers and children (aged two-five years) were selected. Clinical examination was used to detect dental caries, which were classified as low-severity and high-severity caries. The Early Childhood Oral Health Impact Scale (ECOHIS) questionnaire was used to assess OHRQoL. Genomic DNA extracted from the saliva was used to analyze two missense genetic polymorphisms: MTR (rs1805087) and MTRR (rs1801394). Mann-Whitney non-parametric test was used to analyze candidate genes with OHRQoL scale and domain, with a significance level of p≤0.05. MTR (rs1805087) was found associated (p = 0.05) with children's OHRQoL subscale scores in the dominant model (GG + AG). Genetic polymorphisms in MTR may increase the risk of poor OHRQoL in children with caries. Further studies are needed to investigate genetics, molecular factors, and OHRQoL.

Influence of salivary acquired pellicle on colour changes and minerals content of dentine after application of silver diamine fluoride followed by potassium iodide

PURPOSE

This study evaluated whether the presence of the salivary acquired pellicle (AP) had any effect on the dentin's darkening and on the caries arresting effect after the use of SDF + KI, in a cariogenic challenge.

METHODS

Human dentin specimens were standardised, submitted to artificial caries lesion formation, and divided into five groups (n = 20): C: control group-no treatment, SDF: 38% SDF, APSDF: SDF 38% and AP, KISDF: 38% SDF and KI, and APKISDF: 38% SDF, KI and AP, that were submitted to pH cycling. Colour evaluation (CIE L*a*b* system) and surface hardness were performed before and after the treatments/pH cycling.

RESULTS

SDF and APSDF groups showed no difference in colour. KISDF and APKISDF groups showed significantly different colours than the groups without KI. SDF, APSDF, and APKISDF groups had less mineral loss than C and KISDF. SDF, APSDF, and APKISDF revealed significantly greater mineral recovery, compared to KISDF and C.

CONCLUSION

The AP did not influence the dentin´s colour after SDF + KI, but had a protective role in modulating the dentin´s mineral gain/loss. KI used after SDF decreased the dentin´s darkening, and did not interfere with the dentin de/remineralization process.

ECC Status, CRAFT Categorization and OHRQoL Assessment in 3-6-year-old Children: A Cross-sectional Study

Introduction

Early Childhood Caries (ECC) can affect the health and quality of life of the children. Assessing a patient's risk of developing caries is an important aspect of caries management; however, can assessing the caries risk predict the impact of ECC on the OHRQoL? Few Indian studies have reported association between caries status, risk, and the impact on OHRQoL.

Aim

To assess the association between dental caries status, risk assessment, and OHRQoL in 3-6-year-old children.

Methodology

A total of 50 healthy children were recruited in a cross-sectional study. Parents filled the ECOHIS questionnaire. Caries status, risk, and OHRQoL were measured as dmft-pufa, CRAFT (Caries Risk Assessment for Treatment- an indigenous tool) and ECOHIS scores, respectively.

Results

Moderate correlation was seen between dmft and ECOHIS scores (r = 0.496, p < 0.01), and pufa and ECOHIS scores (r = 0.408, p < 0.05). More number of subjects with higher scores of ECOHIS were in the high-risk category of CRAFT (p < 0.05).

Conclusion

Caries status, risk and OHRQoL were associated in 3-6-year-old children. Thus, caries risk assessment may predict poor OHRQoL.

How to cite this article

Iyer CR, Jawdekar AM. ECC Status, CRAFT Categorization and OHRQoL Assessment in 3-6-year-old Children: A Cross-sectional Study. Int J Clin Pediatr Dent 2023;16(2):199-204.

Parental report of dental pain and discomfort in preschool children is associated with sleep disorders: a cross-sectional study in Brazilian families

PURPOSE

To evaluate the prevalence of sleep disorders in Brazilian preschool children and its associations with parental report of dental pain and discomfort.

METHODS

This cross-sectional study involved 604 Brazilian preschoolers (4-5 years old). Sleep disorders (SD) and the parental report of dental pain and discomfort (DPD) were evaluated using the Brazilian versions of the Sleep Disturbance Scale for Children (SDSC) and the Dental Discomfort Questionnaire (DDQ-B), respectively. Bivariate and multivariate Poisson regression analyses with robust variance were performed to analyze the association between SDSC and DP.

RESULTS

Prevalence of SD ranged from 7 to 21%. 7.9% of the children had DPD indicating the need for more invasive dental procedures (DDQ-B ≥ 5). Significant associations were found between DPD and the following SDSC domains: sleep hyperhidrosis (p = 0.024; PR_a = 1.38; 95% CI: 1.04-1.83), disorders of initiating and maintaining sleep (p < 0.001; PR_a = 1.41; 95% CI: 1.15-1.73), parasomnias (p < 0.001; PR_a = 1.82; 95% CI: 1.39-2.37), and sleep-wake transition disorders (p = 0.018; PR_a = 1.28; 95% CI: 1.04-1.58). Children with higher prevalence of DPD presented 20% higher prevalence of SD than children lower prevalence of DPD (p = 0.039; PR_a = 1.20; 95% CI: 1.01-1.44).

CONCLUSION

Preschool children with higher prevalence of DPD are more likely to have SD, such as hyperhidrosis, disorders of initiating and maintaining sleep, parasomnias, and sleep-wake transition.

Childhood dental caries experience in northern Spain: a cross-sectional study

PURPOSE

This study aimed to describe the caries experience in primary and permanent dentition of schoolchildren from a sample taken in public schools in Bilbao, to identify the most vulnerable child population, and compare them with the findings obtained by the Children's Dental Care Programme in the region of the Basque Country (Spain).

METHODS

A cross-sectional study was conducted using a representative sample (n = 1682) of children from 5-year-old early childhood education classes and the first- and second-year elementary classes in public schools in Bilbao. The dependent variable was the caries experience determined through oral examinations carried out by a single dentist. On the other hand, independent variables were measured through questionnaires completed by families, with help from teachers as appropriate. In the statistical analysis, Mann-Whitney and Kruskal-Wallis nonparametric tests, as well as two logistic regressions, were performed, and the significance level was set at α = 0.05 for decision making.

RESULTS

The mean (SD) values of dft, DMFT, DMFS and DMFT of first permanent molars scores were 1.25 ± 2.20, 0.16 ± 0.61, 0.20 ± 0.90 and 0.15 ± 0.57, respectively. Compared to the findings in the most recent PADI report, the schoolchildren in our sample had slightly greater experience of dental caries in primary dentition and much greater experience in permanent dentition.

CONCLUSION

The dft index of the primary dentition for the current sample is 1.25, while the DMFT index for the permanent dentition is 0.16. Among pupils in early childhood and elementary education in public schools in Bilbao, children from families with low socioeconomic status and educational attainment are most vulnerable to developing caries.

Effectiveness of an integrated model of oral health-promoting schools in improving children's knowledge and the KAP of their parents, Iran

INTRODUCTION

The aim of our study was to investigate the effect of an Oral Health Promoting School (OHPS) model on children's oral health in Iran.

METHODS

This interventional quasi-experimental study was conducted in the academic year 2019-20 among 354 primary school students and their parents. A questionnaire including 17 questions was distributed among children before and 5 months after the program (The ranges of possible scores = 0-17). Training workshops for the parents based on the theoretical domains framework were designed. Using educational sessions, pamphlets, tooth brushing dairies, assignments to do at home, educational videos and messages as reminders in social networks, parents were educated about dental caries, its risk factors and prevention principles. Best recommended oral health behaviors including tooth brushing and the use of fluoridated tooth paste were also educated. A questionnaire consisting of 18 knowledge (The ranges of possible scores = 0-18), 13 attitude and 10 practice questions were distributed among parents before and after the workshops. The data were fed into SPSS and analyzed by descriptive and analytic statistics such as T-test, ANOVA and Correlation Coefficients (α = 0.05).

RESULTS

The mean pre-test knowledge (7.8 ± 1.7) was increased significantly in three schools after program, p < 0.001. In the post-test, girls gained significantly higher scores (9.61 ± 1.98 vs. 9.06 ± 1.4, p = 0.025). Among 147 parents, the mean knowledge was raised from 12.3 ± 3.1 (5-18) to 15 ± 3.03 (6-18), p < 0.001. Knowledge score of the parents attending both sessions was higher. Practice of the parents regarding the use of fluoridated tooth-paste was significantly improved (p < 0.001). Also, their attitude toward the ability of children to take care of their teeth was improved (p = 0.029). Based on the self-report of parents, 71.4% (n = 47) of mothers and 45.6% (n = 67) of their children used to brush once or two times daily and there was a correlation between their behaviors (p < 0.001, Spearman Correlation Coefficient = 0.4).

CONCLUSION

It seems that the education provided in OHPS had positive effects on increasing students' awareness and to some extent, the knowledge, attitude and practice of the parents.

Atraumatic restorative treatments and oral health-related quality of life and dental anxiety in Australian Aboriginal children: A cluster-randomized trial

OBJECTIVES

The management of early childhood caries is challenging and the impacts of its treatment on child oral health-related quality of life (COHRQoL) and dental anxiety among Australian Aboriginal children is relatively unknown. The aim of the study was to compare the impact on COHRQoL and dental anxiety after approximately 12 months among Aboriginal children treated for early childhood caries (ECC) using the Atraumatic Restorative Treatment and the Hall Technique (ART/HT: test) or standard care (control).

METHODS

Consenting Aboriginal communities in the North-West of Western Australia were randomized into early (test) or delayed (control) intervention for the management of ECC. Children and parents/carers completed a questionnaire at baseline and at follow-up. The questionnaire sought information on COHRQoL using the proxy-reported Early Childhood Oral Health Impact Scale (ECOHIS) and the self-reported Caries Impacts and Experiences Questionnaire for Children (CARIES-QC). The test group was provided with the ART/HT care at baseline while the control group was advised to seek care through the usual care options available within the community. At follow-up, both groups were offered care using the ART/HT approach. Changes in the mean scores from baseline to follow-up within groups were evaluated using appropriate paired (t-test, Wilcoxon paired test), and between groups with unpaired tests (t-test). Multivariate regression analysis after multiple imputations of missing data used generalized estimating equation (GEE) controlling for clustering within communities.

RESULTS

Twenty-five communities and 338 children (mean age = 3.6 years, sd 1.7) participated in the study (test = 177). One child was excluded from the analysis because of a missing questionnaire and clinical data at baseline and follow-up. At baseline, test group children were older (test = 3.8 years, 95% CI 3.6-4.1;control = 3.3 years, 95% CI 3.1-3.6) and had higher caries experience (test dmft = 4.4, 95% CI 3.8-5.0;control dmft = 3.1, 95% CI 2.5-3.7), but there was no significant difference in COHRQoL or anxiety levels between the groups. At follow-up, parents in the delayed intervention reported worsening of COHRQoL (70% worsening of the family impact section of the ECOHIS and 37% worsening of the total ECOHIS scale), and there was an 8% reduction in child dental anxiety among the early treatment group.

CONCLUSIONS

The application of the ART/HT approaches was feasible, effective, and impacted positively on child oral health-related quality of life and child dental anxiety among Aboriginal children in remote communities. The model of care as tested in this study should be further developed for inclusion in main-stream service delivery programmes.

Minimal Intervention Dentistry (MID) mainstream or unconventional option? Study exploring the impact of COVID-19 on paediatric dentists' views and practices of MID for managing carious primary teeth in children across the United Kingdom and European Union

Purpose

To explore the techniques used to manage carious primary teeth during the COVID-19 pandemic by paediatric dentists and dentists with a special interest in paediatric dentistry (DwSI) who are members of the British Society of Paediatric Dentistry (BSPD) and the European Academy of Paediatric Dentistry (EAPD), and their views on the use of minimal intervention dentistry (MID) in children prior to, during and post the COVID era.

Methods

A total of 212 paediatric dentists and DwSI completed an online questionnaire. Six MID techniques were explored: fissure sealants, resin infiltration, Hall Technique (HT), 38% silver diamine fluoride (SDF), atraumatic restorative treatment (ART), stepwise removal and selective caries removal.

Results

The majority were specialists (26%) followed by clinical academics (23.1%) working mainly in university teaching hospitals (46.2%). Routine dental treatment for children with carious primary teeth was provided by the majority (92.5%) during the pandemic. HT (96%) and 38% SDF (65.7%) were the most commonly used techniques among the BSPD members whereas conventional restoration of non-selective caries removal and pulp therapy remained the most widely used technique among the EAPD members (66.2%). Most of the MID techniques were used as a treatment option (48.1%) rather than a choice (43.4%), with most of these choices having been affected by the patient’s behaviour (82.5%). More than one thirds (39.2%) of the participants were reluctant to adopt MID after the pandemic. Several barriers such as lack of teaching and confidence as well as perceived lack of evidence were identified.

Conclusion

A range of MID techniques is practiced broadly by a sample of paediatric dentists and DwSI across the United Kingdom (U.K) and European Union (E.U). The majority of clinicians are willing to continue using these techniques going forward after COVID restrictions are lifted. The pandemic served as an opportunity for many dentists to become familiar with various MID practices, such as SDF, which has been already established some time ago.

Impact of a Dental Storybook on Parents' Knowledge of Children's Oral Health: A Randomized Controlled Trial

Purpose

To evaluate the effectiveness of a dental storybook on parents' knowledge about oral health of their children and to assess their perception of its effect in reducing dental anxiety levels among their children, as well as improving their oral health knowledge.

Patients and Methods

This was a two-arm parallel, single-blind, randomized controlled trial (RCT) which was performed at the pediatric dental clinics in the Dental University Hospital, King Saud University, Riyadh, Saudi Arabia. Parents of 88 children (6-8 years old) were included in the present study. Parents and their children were randomly divided into two groups as follows: the intervention group (received the storybook and verbal oral hygiene instructions) and the control group (only received verbal oral hygiene instructions; same information included in the book). Three dental visits, including screening, examination/cleaning and treatment, were provided for each child. In the screening visit, baseline parental oral health knowledge was evaluated for all parents. Afterward, parental oral health knowledge was re-evaluated in the examination visit. In the treatment visit, a parental perception questionnaire was administered to parents following treatment to evaluate their satisfaction regarding the use of the storybook in reducing anxiety levels among their children.

Results

There was a significant improvement in the total knowledge score at the follow-up visit in the intervention group compared to the control group (P<0.0001). Overall, the majority of parents perceived the storybook as a useful source of information, and they found it to be effective in reducing dental anxiety levels among their children.

Conclusion

The dental storybook is an effective educational tool that can help parents become more knowledgeable about their children's oral health. Moreover, parents perceived the storybook as an effective tool for enhancing their oral health knowledge and lowering their children's dental anxiety.

Comparing oral health systems for children in six European countries to identify lessons learned for universal oral health coverage: A study protocol

Background: Oral diseases have the highest global prevalence rate among all diseases, with dental caries being one of the most common conditions in childhood. A low political priority coupled with a failure to incorporate oral health within broader health systems has contributed to its neglect in previous decades. In response, calls are emerging for the inclusion of oral health within the universal healthcare domain (UHC). This protocol outlines the methodology for a cross-country comparative analysis of publicly funded oral health systems for children across six European countries, reporting on oral health status in line with the indicators for UHC. Methods: This study will follow Yin's multiple case study approach and employ two strands of data collection, analysis, and triangulation: a systematic documentary analysis and semi-structured interviews with elite participants local to each country. The countries chosen for comparison and providing a representative sample of European dental systems are Denmark, Hungary, the Republic of Ireland, Germany, Scotland, and Spain. A systematic search of five electronic databases and four additional electronic resources will be undertaken, in addition to grey literature and other publicly available sources, with the outcomes verified and further informed by local experts. The WHO Universal Health Coverage Cube will be used to guide data collection and analysis. Conclusions: This research will provide policy makers with an in-depth analysis and comparison of publicly funded oral health systems for children in Europe, including consideration of effective preventive strategies, oral health system reform, and indicators of universal oral health coverage. It is anticipated that the outcomes may help in positioning oral health on governmental health agendas and support its integration into wider health systems' reform in an accessible and affordable manner.

Dental caries severity and oral health-related quality-of-life in Brazilian preschool children

The impact of dental caries on oral health-related quality-of-life (OHRQoL) may be influenced by disease severity. This study evaluated the impact of caries severity on OHRQoL in preschool children. A school-based, cross-sectional study was conducted with 205 children (aged 2-5 years) in Southern Brazil. Parents answered the Brazilian version of the Early Childhood Oral Health Impact Scale (B-ECOHIS) and provided sociodemographic information. The Caries Assessment Spectrum and Treatment criteria were used to evaluate caries severity, and Poisson regression with robust variance estimation conducted to determine the rate ratio (RR) and 95% confidence intervals (CIs) of the mean OHRQoL scores according to severity level. Most children had at least one tooth in the morbidity (37%) or pre-morbidity (35%) stages, and the prevalence of impacts on OHRQoL was 40%. Caries severity was associated with the impact scores: after adjustments, the mean B-ECOHIS scores were 6.31 (95% CI: 4.24-9.38) higher for children in the morbidity stage, and 10.84 (95% CI: 6.51-18.05) higher in the severe morbidity stage, than for healthy children [RR = 10.84 (95% CI: 6.51-18.05)]. Children with carious lesions into dentine or with pulpally-involved or abscessed teeth had poorer OHRQoL than children without such lesions.

Adverse Childhood Experiences and Oral Health Outcomes in U.S. Children and Adolescents: A Cross-Sectional Study of the 2016 National Survey of Children's Health

This study investigated the cross-sectional associations between exposure to nine Adverse Childhood Experiences (ACEs) and U.S. children's and adolescent's oral health outcomes. Data from 41,294 participants of the 2016 National Survey of Children's Health (NSCH) were analyzed. Past year exposure to ACE, oral health outcomes (decayed teeth, bleeding gums, and condition of the teeth), and child and caregiver sociodemographic factors were self-reported. Using SAS v. 9.4, propensity score weighted, multilevel survey-logistic regression estimated adjusted odds ratios (AORs) and 95% Confidence Intervals (CIs) of the proposed associations. The overall mean (SE) age was 8.9 (0.1) years with 51% being male. Fifty-four percent (54%) identified as non-Hispanic white, and 12% as non-Hispanic black. The prevalence of the nine ACE measures ranged from 3% for caregiver death to 25% for financial hardship and parental divorce. Children who experienced caregiver mental illness, when compared to those who did not, were more likely to report decayed teeth (AOR: 1.73 (95% CI: 1.24, 2.42)) and the condition of their teeth as fair/poor (AOR: 1.60, 95% CI: 0.61, 4.19). Children in households with financial hardship were about twice as likely to report dental caries (AOR: 1.85, 95% CI: 1.50, 2.29) and have fair/poor teeth (AOR: 1.87, 95% CI: 1.40, 2.51) and bleeding gums (AOR: 2.39, 95% CI: 1.48, 3.86). ACEs appear to be associated with worse oral health outcomes among children and adolescents. Nevertheless, the cross-sectional nature of this study precludes a causal interpretation of these findings and necessitates more research to elucidate the oral health impacts of exposure to ACEs in longitudinal follow-up studies.

The acid-resistance potential of arginine-fluoride varnish treated enamel

The study objective was to examine the acid-resistance potential of enamel carious lesions treated with arginine (Arg)-sodium fluoride (NaF) varnishes using nano-mechanical testing and chemical mapping. L-arginine (at 1%, 2%, & 4%) was incorporated in 5% NaF varnish. The experimental/control groups were: 1% Arg-NaF, 2% Arg-NaF, 4% Arg-NaF, NaF, and no treatment. Enamel specimen blocks were subjected to incipient carious lesion formation. After treatment, the specimens underwent chemical pH-cycling for 8-days and acid challenge for 2 h. The specimens were characterised for surface nano-hardness (SNH) and calcium/phosphate content of the treated lesions to determine enamel solubility reduction (ESR). Post-acid challenge, X-ray diffraction crystallography (XRD), and energy dispersive X-ray spectrophotometry (EDX) were performed. The SNH for 2%/4% Arg-NaF demonstrated a higher resistance to acid challenge with significantly higher SNH recovery than NaF varnish (p<0.05). The ESR potential of 2%/4% Arg-NaF varnish was significantly higher than NaF varnish (p<0.05). The XRD crystalline phases demonstrated that 2%/4% Arg-NaF had intense hydroxyapatite peaks discerning its increased potential to resist demineralization than NaF varnish. The EDX results showed that 2%/4% Arg-NaF demonstrated Ca/P ratio closer to hydroxyapatite (~1.67) post-acid challenge. Incorporating 2%/4% L-arginine in a 5% NaF varnish enhances the acid-resistance potential of NaF varnish.

The value of bitewing radiographs in the management of carious primary molars

Introduction Bitewing radiographs (BWs) are under-utilised for children, and reliance on visual diagnosis alone is likely to under-diagnose caries. Quantification of the level of the under-reporting of caries and the vital role of BWs would be beneficial when providing dental care to the paediatric population.Aim To quantify the diagnostic value of bitewings in the management of proximal caries in primary molars.Design Cross-sectional study.Materials and methods Thirty children (mean age 6.2 ± 1.3 years) were recruited. A visual inspection (VI) of the primary molars was carried out and bitewings were taken. Radiographic assessment (RA) for primary molar proximal caries was completed separately. VI and RA were compared statistically against three caries thresholds, using the Fisher's exact test. A p value <0.05 was considered statistically significant. Sensitivity and specificity analyses were performed.Results A total of 480 proximal surfaces were assessed. Bitewings detected 44.6% of additional proximal carious lesions (p <0.0001). At d₃ threshold, VI under-reported 51.2% proximal caries (p <0.0001) and 34.1% dentinal proximal caries (p = 0.0012). VI showed high specificity (99%) and low sensitivity (53%).Conclusion Bitewings play a vital role in proximal caries diagnoses of primary molars.

Are they ready? Awareness and preparedness of the emerging workforce for Dental Check by One

Background Dental Check by One (DCby1) is a British Society of Paediatric Dentistry campaign, which aims to increase dental attendance of young children. As the future workforce, dental students have a key role in ensuring its long-term success.Aims To establish final-year dental students' awareness of DCby1. To evaluate their preparedness for providing dental care for young children and to identify perceived barriers to doing so at the time of graduation as they prepare to enter the workforce.Materials and methods An anonymous, online survey was administered to graduating final-year dental students in 2018, 2019 and 2020. Quantitative data were gathered using mixed item formats and Likert scales. Qualitative data were also gathered using free-text questions, allowing evaluation of the opinions of responders.Results The response rate was 83% (n = 63) in 2018, 91% (n = 62) in 2019 and 73% (n = 57) in 2020. Eight percent (n = 5) of responders were aware of DCby1 in 2018, improving to 67% (n = 38) in 2020. Each year, 98% to 100% of responders felt prepared to provide preventive care for young children. Fewer than 60% felt prepared to provide breastfeeding and weaning advice to parents. Responders felt unprepared to examine the dentition of a preschool child. Undergraduate curricula and social media were identified as preferable sources of public health campaign information for students.Conclusion Awareness and preparedness for DCby1 appears to be improving. Ninety-five percent of all responders across three years of study felt prepared to examine a child aged under one year and this is encouraging for the long-term success of DCby1. Targeted curriculum reform including both didactic teaching and online learning platforms appears to have been pivotal to improving undergraduate awareness and preparedness. Social media may offer opportunities for engaging with undergraduate learners.

Influence of caries and molar incisor hypomineralization on oral health-related quality of life in children

OBJECTIVES

This study was aimed to compare the impact of caries and molar incisor hypomineralization (MIH) on oral health-related quality of life (OHRQoL) in children.

MATERIAL AND METHODS

A total of 528 German children aged 7 to 10 years were recruited, half affected by caries and the other half affected by MIH. Both groups were matched according to age, sex, and social status and divided into 3 categories according to severity. The German version of the Child Perceptions Questionnaire for 8- to 10 years old (CPQ-G8-10) was used to analyze the impact on OHRQoL by applying ANOVA models.

RESULTS

Patients with MIH showed a mean CPQ score of 10.7 (± 9.3). This was significantly higher compared to the caries group with 8.1 (± 9.8). The score increased linearly from the low severity category to the high severity category in both groups (caries, 4.1 to 13.8; MIH, 5.2 to 17.7, respectively).

CONCLUSION

With increasing severity, both clinical conditions showed a greater negative impact on OHRQoL. MIH was associated with more impairments.

CLINICAL RELEVANCE

Currently, the focus in pediatric dentistry is placed on the prevention and treatment of caries. Both diseases may have a negative influence on OHRQoL. Since children perceive the impairments by MIH as worse and the prevalence is equal to that of caries, which focus might be shifted in the future.

Does outpatient dental treatment have impact on the quality of life of children with early childhood caries?

AIM

To assess the impact of outpatient dental treatment on oral health-related quality of life (OHRQoL) of children and their families.

MATERIALS AND METHODS

This prospective observational study was conducted with children with untreated dental caries, recruited from a public university/the pediatric dentistry clinic of a public university in the northeastern Brazil. Sociodemographic data were collected, a clinical examination was carried out before and after dental treatment, and the Early Childhood Oral Health Impact Scale (ECOHIS) questionnaire was applied to those responsible for the children, before and after dental treatment. Descriptive and bivariate statistics were used, and the Wilcoxon and Student's t tests were applied (p < 0.05).

RESULTS

The study included 64 children, of both sexes, aged between 3 and 5 years old. The majority had a dmft index higher than or equal to 6 (60.9%), with a mean value of 7.11 (± 4.11). Sociodemographic conditions such as sex, age, and socioeconomic status had no impact on their OHRQoL (p > 0.05). The mean total ECOHIS questionnaire scores and those of its domains decreased after completion of the treatments (p < 0.05), except for scores in the self-image and distress domains of the parents (p > 0.05). This study reinforces the relevance of adopting oral health policies aimed at the prevention and treatment of ECC.

CONCLUSION

Outpatient dental treatment had a positive impact on the OHRQoL of children and their families.

CLINICAL RELEVANCE

The possibility of evaluating the services provided by the pediatric dentistry clinic.

Cost-effectiveness analysis of atraumatic restorative treatment to manage early childhood caries: microsimulation modelling

BACKGROUND

This study assessed the cost-effectiveness of atraumatic restorative treatment and the Hall Technique approach (ART/HT) in managing dental caries in young children under the health provider perspective in order to explore a best-buy alternative to dental general anaesthesia (DGA).

METHODS

Sixty-five observations from a randomized controlled trial were used to construct 20 000 microsimulations representing individual-level clinical outcome and costs of the DGA and ART/HT. Outcome was percentage of successfully managed cases. Costs were reported in 2020 price. Three different scenarios with different assumptions of clinical success of the DGA and the ART/HT were analysed. Probabilistic sensitivity analysis was carried out.

RESULTS

The ART/HT successfully managed more cases at lower cost ($557) than the DGA when the system failure of the DGA was considered. Under per protocol analysis, participants in both arms were successfully managed, but the ART/HT costed $580 less than the DGA. Probabilistic sensitivity analysis confirmed the ART/HT was a dominant intervention.

CONCLUSIONS

The ART/HT approach was non-inferior in managing dental caries in young children but at lower costs than the DGA. The ART/HT could be a viable option in the provision of comprehensive dental care in locations with limited access to DGA and reduce hospital admission.

The effect of arginine-fluoride varnish on biochemical composition of multi-species biofilm

OBJECTIVE

To examine the biochemical components of multi-species biofilm on the arginine (Arg)-sodium fluoride (NaF) varnish-treated enamel following bacterial pH-cycling.

METHODS

l-arginine (at 1%, 2%, & 4% w/v.) was incorporated in a 5% NaF varnish. The experimental and control groups were: 1%, 2%, 4% Arg-NaF, NaF, and no treatment. Enamel blocks were prepared, acid-etched, varnish-treated and then subjected to 72 h bacterial pH-cycling in an oral biofilm reactor. The organic (carbohydrates, proteins, amyloids, and eDNA) and inorganic components (calcium, inorganic phosphate, F) were assayed for the obtained biofilm suspensions. The biofilms were stained for exopolysaccharides (EPS)/bacteria and the respective proportions of live/dead bacteria was determined using confocal imaging.

RESULTS

The total carbohydrate content of the biofilm was the lowest for the 2% and 4% Arg-NaF (p < 0.05). Except for 2% Arg-NaF, the biofilm proteins for 4% Arg-NaF were significantly higher than the other groups (p < 0.05). The amyloids for Arg-NaF groups were significantly lower than the controls (p < 0.05). The eDNA for 4% Arg-NaF was significantly higher than the controls (p < 0.05). The 2% and 4% Arg-NaF-treated enamel had increased biofilm Pi and F compared to the NaF-treated enamel (p < 0.05). The proportion of biofilm EPS matrix to bacteria was significantly reduced in Arg-NaF groups compared to the controls (p < 0.05). The dead bacterial proportions of 4% Arg-NaF were significantly higher than the controls (p < 0.05).

CONCLUSION

Higher concentrations (i.e. 2%/4%) of Arg in 5% NaF varnish have the potential to modulate the biochemical composition of the biofilm growing on the treated enamel.

Children and parents perspectives on children's dental treatment under general anesthesia: a narratology from Saskatoon, Canada

Aim

This study aimed to explore the emotional and psychological effects of dental treatment under general anesthesia (DTGA) on children and parents in Saskatoon city, Saskatchewan, Canada.

Design

Semi-structured interviews, video diaries, drawings, and a questionnaire were used to collect data. The study used a narrative perspective and thematic analysis to analyze data.

Results

The findings from children and their parents (N = 25) indicated DTGA is disconcerting from both views. Parental guilt and the desire of both parents and children to not have to go through the experience again fueled at least short-term compliance with brushing, flossing, and changes in dietary habits.

Conclusion

The children participants provided valuable information to augment that gathered from parents. As the study revealed that the DTGA is psychologically and emotionally troubling for both children and their caregivers, it is imperative to explore ways to ease the GA experience. Specific recommendations were provided for optimizing dental and health services for those children and their families.

A 24-month retrospective study of preformed metal crowns: the Hall technique versus the conventional preparation method

PURPOSE

Conventional and Hall Technique (HT) Preformed Metal Crowns (PMCs) are used for treatment of carious primary molars. The aim was to evaluate the clinical and radiographic success of conventional and HT PMCs in a postgraduate dental setting.

METHODS

A retrospective study using patients' electronic case-notes and radiographic images of carious primary molars treated with either conventional or HT PMCs was conducted to assess clinical and radiographic success/failure. A Kaplan-Meier curve was used to assess PMC survival.

RESULTS

187 PMCs (110 HT and 77 conventional) in 65 children (34 females and 31 males) at 6, 12, 18 and 24 months were assessed. At 24 months, the success rates of conventional and HT PMCs were 97.6% and 93.5%, respectively. Two HT (perforated/abscessed) and four conventional (abscessed) PMCs failures occurred. There was no significant difference in success/failure (p = 0.362) at 12 months, but the HT was more successful at 24 months (p = 0.002) with similar survival times for both methods.

CONCLUSION

HT and conventionally placed PMCs, when placed in a postgraduate paediatric dentistry setting, were clinically and radiographically very successful at 6, 12, 18 and 24 months post operatively with a slightly higher success of the HT at 24 months.

Acid-induced demineralisation of human enamel as a function of time and pH observed using X-ray and polarised light imaging

Acid-induced enamel demineralisation affects many individuals either by exposure to acidic diets, acidic gas pollution (dental erosion) or to dental plaque acids (dental caries). This study aimed to develop in situ X-ray and light imaging methods to determine progression of enamel demineralisation and the dynamic relationship between acid pH and mineral density. Hourly digital microradiograph time-lapse sequences showed the depth of enamel demineralisation in 500 µm thick sections progressed with time from the surface towards the dentine following a power-law function, which was 21% faster than the lateral demineralisation progression after exposure for 85 h to lactic acid (10%, pH 2.2). The minimum greyscale remaining (mineral content) within the induced enamel lesion followed an exponential decay, while the accumulated total greyscale loss with time was linear, which showed a constant anisotropic mineral release within the enamel architecture. This 85 h demineralisation method studied by polarised light microscopy time-lapse sequences showed that once the demineralisation front reached the enamel Hunter-Schreger bands, there was preferential demineralisation along those bands. Mineral density loss was linear with increasing pH acidity between pH 5.2 and pH 4.0 (with 0.4 pH increments) when incubated over a 3-week period exposed to 0.5% lactic acid. At pH 4.0, there was complete mineral loss in the centre of the demineralised area after the 3-week period and the linear function intercepted the x-axis at ~ pH 5.5, near the critical pH for hydroxyapatite (HAp). These observations showed how intrinsic enamel structure and pH affected the progression of demineralisation. STATEMENT OF SIGNIFICANCE: Hydroxyapatite crystallites (HAp) in human enamel dissolve when exposed to an acidic environment but little is known about how the intrinsic structures in enamel and pH influence the demineralisation kinetics. We have developed a time-lapse in situ microradiography method to quantify microscopic anisotropic mineral loss dynamics in response to an acid-only caries model. Correlation with polarised light microscopy time-lapse sequences showed that larger structures in enamel also influence demineralisation progression as demineralisation occurred preferentially along the Hunter-Schreger bands (decussating prismatic enamel). The pH-controlled enamel mineral release in a linear manner quantifying the relationship between HAp orientation and acid solubility. These findings should direct the development of improved anti-demineralisation/ remineralisation treatments to retain/ restore the natural intrinsic enamel structure.

Sustainability of Improvement in Oral Health-Related Quality of Life in Children After Dental Treatment

PURPOSE

Dental treatment has been associated with improvement in the oral health-related quality of life (OHRQoL) in children. There is little evidence of whether the effect of treatment is sustainable over time or not. The aim of this study was to determine whether the effect of dental treatment on OHRQoL is maintained or diminishes over time.

MATERIALS AND METHODS

A consecutive sample of parents of 47 children between 2 and 6 years who received comprehensive dental treatment at a postgraduate dental clinic were recruited. Parents completed the Early Childhood Oral Health Impact Scale (ECOHIS) prior to treatment and at 1 and 4 months after treatment. Parents were also asked three global questions. Score changes (overall and for each section) between time points were analyzed by a repeated-measures analysis of variance and Bonferroni tests.

RESULTS

The children's mean age was 4.7 ± 1.1, and 60% were females. ECOHIS scores were significantly improved from baseline (22.2 ± 6.9) to 1 month after treatment (8.7 ± 6.8) and were further improved at 4 months after treatment (1.9 ± 2.7), P < 0.001, with large effect sizes (2.8 for the child impact section and 2.2 for the family impact section). Parents' perception of changes in the OHRQoL of their children obtained from a global question indicated an improvement in OHRQoL that was sustained over the follow-up period; at 1-month and 4-month follow-up, 89% and 94% of mothers reported that their child's oral health improved a lot after dental treatment, respectively.

CONCLUSION

The impact of dental treatment on OHRQoL continued to remarkably improve during the 4 months following dental treatment.

Validating a short form of the Parental-Caregivers Perceptions Questionnaire (P-CPQ) and the Family Impact Scale (FIS) in Finnish language

Aim

This study aimed to adapt the short-form versions of the Parental-Caregivers Perceptions Questionnaire (P-CPQ), and the Family Impact Scale (FIS) in the Finnish language and to test its validity and reliability. Another aim was to compare the background factors of parents with respect to P-CPQ and FIS outcomes.

Methods

This study was conducted among a convenient sample of parents who visited the public dental clinic in Sievi, Finland, from May to October 2016. A total of 54 parents of 2–8-year-old children completed the short-form of the P-CPQ questionnaire and 50 parents of 2–8-year-olds completed the FIS questionnaire while visiting for their children’s routine dental check-up. Parents completed the self-administered P-CPQ and FIS questionnaires. Reliability and validity of the short-form of the P-CPQ and FIS were assessed. Differences between gender, and family size were evaluated using the Mann–Whitney U test and the differences between age groups were evaluated using the Kruskal–Wallis one-way ANOVA test.

Result

The Finnish versions of both the short forms of the P-CPQ and FIS had alpha values within the acceptable range. The scales also showed good construct validity. Toddlers (2–4-year olds) had the highest scores for both the P-CPQ and FIS-8 subscales. Likewise, families with 5 or more children had high FIS scores.

Conclusion

The short form of the P-CPQ and FIS in Finnish language are valid and reliable. The oral health of the child seems to have the greatest family impact among parents with five or more children and in families with 2–4-year olds.

New insight into dental epithelial stem cells: Identification, regulation, and function in tooth homeostasis and repair

Tooth enamel, a highly mineralized tissue covering the outermost area of teeth, is always damaged by dental caries or trauma. Tooth enamel rarely repairs or renews itself, due to the loss of ameloblasts and dental epithelial stem cells (DESCs) once the tooth erupts. Unlike human teeth, mouse incisors grow continuously due to the presence of DESCs that generate enamel-producing ameloblasts and other supporting dental epithelial lineages. The ready accessibility of mouse DESCs and wide availability of related transgenic mouse lines make mouse incisors an excellent model to examine the identity and heterogeneity of dental epithelial stem/progenitor cells; explore the regulatory mechanisms underlying enamel formation; and help answer the open question regarding the therapeutic development of enamel engineering. In the present review, we update the current understanding about the identification of DESCs in mouse incisors and summarize the regulatory mechanisms of enamel formation driven by DESCs. The roles of DESCs during homeostasis and repair are also discussed, which should improve our knowledge regarding enamel tissue engineering.

Maternal knowledge on early childhood caries and barriers to seek dental treatment in Jordan

Purpose

To assess maternal knowledge, attitudes and beliefs of Early Childhood Caries (ECC) risk factors and to determine barriers in seeking dental treatment among children with ECC.

Methods

A total of 600 mothers of healthy children, aged 3–5 years, with ECC attending maternity and child health centres in Jordan completed a questionnaire using face-to-face interviews. ECC was diagnosed clinically by the chief investigator, based on the diagnostic criteria suggested by American Academy of Paediatric Dentistry (AAPD), and caries was recorded using dmft index.

Results

The majority of the children had poor oral health status (99.2%) with a dmft index of 6.04 (± 1.2). Less than third (25.7%) of the mothers believed that their child had poor oral health with more than half (53.3%) not being aware that their child had dental caries. Most of the mothers had poor knowledge, attitudes and beliefs regarding their children’s oral health (82%). Participants` oral health knowledge was significantly associated with mothers` level of education and profession (p < 0.05). In addition, there was delay in seeking dental treatment for their children by the majority (65.9%) of mothers. Maternal profession, family income and time needed to reach a nearby health centre were found to be significant barriers in seeking dental treatment (p < 0.05).

Conclusion

The majority of the mothers of children in Jordan with ECC had poor knowledge about their children’s oral health status. Moreover, seeking dental treatment was delayed by a large number of mothers of children with ECC.

Enamel remineralization potential of arginine-fluoride varnish in a multi-species bacterial pH-cycling model

OBJECTIVES

To examine the enamel fluoride uptake and remineralization potential of arginine-fluoride (Arg-NaF) varnishes in a simulated clinical condition using a multi-species bacterial pH-cycling model.

METHODS

L-Arginine (at 1 %, 2 %, and 4 % by wt.) was incorporated in a 5 % NaF varnish. Experimental and control groups were: 1 % Arg-NaF; 2 % Arg-NaF; 4 % Arg-NaF; NaF and no treatment. Artificial incipient caries-like lesions were formed on 30 enamel specimen blocks (n = 6). The specimens underwent multi-species bacterial pH-cycling in an artificial mouth system using oral biofilm reactor for 72 h after treatment. The specimens were evaluated for mineral density using micro-CT, Ca/P ratio with SEM-EDX, enamel fluoride uptake (EFU) and plaque fluoride uptake (PFU).

RESULTS

Increasing concentrations of Arg in NaF varnish significantly increased the EFU of incipient caries-like lesions (p < 0.001). The PFU for 1 % Arg-NaF was significantly higher than 4 % Arg-NaF and the control NaF (p < 0.05). Post pH-cycling, Ca/P ratio with 1 %/2 % Arg-NaF was closest to hydroxyapatite (1.67). Mineral gain and % remineralization of 1 %/2 % Arg-NaF was significantly higher than the control NaF varnish (p < 0.05).

CONCLUSION

The prebiotic L-arginine (at 1 %/2 % by wt.) in a 5 % NaF varnish enhanced the enamel fluoride uptake and remineralization potential of the conventional 5 % NaF varnish.

CLINICAL SIGNIFICANCE

The Arg-NaF varnish addresses the limitations of fluorides on cariogenic biofilms. The Arg-NaF varnish appears a promising caries-preventive regimen that counters the pathogenic biofilms by Arg and promotes remineralization with fluorides. In high caries-risk patients, professional application of Arg-NaF varnish might aid to alleviate the global burden of dental caries.

Atraumatic restorative treatment compared to the Hall Technique for occluso-proximal carious lesions in primary molars; 36-month follow-up of a randomised control trial in a school setting

BACKGROUND

Atraumatic Restorative Treatment (ART) and the Hall Technique (HT) are both minimally invasive, non-aerosol generating procedures (non-AGPs). They seem to have never been directly compared, nor has the HT been studied in a non-clinical setting. This study compared the HT and ART restorations placed in a school setting after 36 months.

METHODS

Children (5-10 yo) who had a primary molar with a dentinal occluso-proximal, cavitated carious lesion were allocated to the ART (selective removal) or HT arms.

PRIMARY OUTCOME

restoration survival over 36-months (using Kaplan-Meier survival analysis, log rank test, and Cox regression).

SECONDARY OUTCOMES

(1) occlusal vertical dimension (OVD) (1, 2, 3, 4 weeks) and (2) child self-reported discomfort; (3) treatment acceptability (immediately following interventions); (4) Child Oral Health Related Quality of Life (OHRQoL), before treatment and after 6 months and (5) a post hoc analysis of time to tooth exfoliation (1, 6, 12, 18, 24, 30, 36 months).

RESULTS

One-hundred and thirty-one children (ART = 65; HT = 66) were included (mean age = 8.1 ± 1.2). At 36 months, 112 (85.5%) children were followed-up.

PRIMARY OUTCOME

restoration survival rates ART = 32.7% (SE = 0.08; 95% CI 0.17-0.47); HT = 93.4% (0.05; 0.72-0.99), p < 0.001; Secondary outcomes: (1) OVD returned to pre-treatment state within 4 weeks; (2) treatment discomfort was higher for the HT (p = 0.018); (3) over 70% of children and parents showed a high acceptability for treatments, with crown aesthetics being a concern for around 23% of parents; (4) Child OHRQoL improved after 6 months; and (5) teeth treated with the HT exfoliated earlier than those in the ART group (p = 0.007).

CONCLUSIONS

Both ART and the HT were acceptable to child participants and their parents and all parents thought both restorations protected their child's tooth. However, the crown appearance concerned almost a quarter of parents in the HT arm. Children experienced less discomfort in the ART group. Although both treatments can be performed in a non-clinical setting and have the advantage of being non-aerosol generating procedures (non-AGPs), the HT had almost three times higher survival rates (93.4%) for restoring primary molar occluso-proximal cavities compared to ART (32.7%).

TRIAL REGISTRATION

This trial was registered in ClinicalTrials.gov (NCT02569047), 5th October 2015. https://clinicaltrials.gov/ct2/show/study/NCT02569047?cond=Hall+Technique+Atraumatic+Rest orative+Treatment&draw=2&rank=2.

Significant elevation of salivary human neutrophil peptides 1-3 levels by probiotic milk in preschool children with severe early childhood caries: a randomized controlled trial

OBJECTIVES

To determine salivary human neutrophil peptides 1-3 (HNP1-3) levels in caries-free preschool children and in those with early childhood caries (ECC) or severe-ECC, in a daily probiotic group, receiving reconstituted milk with the probiotic Lactobacillus paracasei SD1 once daily; a triweekly probiotic group, receiving the probiotic milk 3 days a week; and a placebo group.

MATERIALS AND METHODS

Oral examination and unstimulated whole saliva collection were conducted in 354 children at baseline, 6 months after intervention (T6), and after probiotic discontinuation (T12). Of the 354, adequate volume of saliva samples from 268 children were simultaneously analyzed for Streptococcus mutans and total lactobacilli levels using qPCR and for HNP1-3 levels using ELISA.

RESULTS

In the severe-ECC status, significant increases in the median HNP1-3 levels at T12 were found in both daily and triweekly probiotic groups (p < 0.001). The median S. mutans levels in the daily group were significantly decreased at T6 and T12 (p < 0.01), whereas the median total lactobacilli levels were significantly increased at T6 (p < 0.001). Significantly inverse correlations between altered HNP1-3 and S. mutans levels and significant decreases in caries progression were found in both probiotic groups (p < 0.05).

CONCLUSIONS

In the severe-ECC status, daily or triweekly consumption of L. paracasei SD1 significantly enhanced salivary HNP1-3 levels, but reduced S. mutans levels, possibly resulting in reduction of caries progression.

CLINICAL RELEVANCE

Significant enhancement of salivary HNP1-3 levels by probiotic consumption is associated with reduction in S. mutans levels, consistent with diminished caries progression in children with severe-ECC.

Oral Health Related Quality of Life and its Association with Dental Caries of Preschool Children in Urban and Rural Areas of India

Background: In early childhood due to dental neglect, children suffer from multiple decayed teeth and experience pain, interfering with their daily activities. This study aimed to assess Oral Health Related Quality of Life (OHRQoL) of preschool children in urban and rural Bangalore, and to correlate it with their dental caries status. Study design: Oral health examination of 1545 preschool children, aged 3 to 5 years were selected from urban and rural Bangalore. The parents answered the Oral Health-Related Early Childhood Quality of Life OH-ECQOL proforma on OHRQoL of their children. Results: The mean OHRQoL of urban preschool children was 17.86 and was significantly different from 20.42 of rural preschool children. (p<0.001). The mean deft score was 2.60±2.26 in rural preschool children and it was significantly higher than 1.92±2.05 seen in urban preschool children (p< 0.001). A significant correlation was seen between dental caries (deft) and OHRQoL in urban preschool children (p=0.04). Their OHRQoL was significantly associated with the 'decayed' component.(p=0.03) Multiple regression analysis showed OHRQoL to be significantly associated with dental caries. Conclusion: OHRQoL among preschool children living in urban Bangalore was found to be better than those in rural Bangalore.

Microporous Frameworks as Promising Platforms for Antibacterial Strategies Against Oral Diseases

Nowadays, the heavy burden of oral diseases such as dental caries, periodontitis, endodontic infections, etc., and their consequences on the patients' quality of life indicate a strong need for developing effective therapies. Bacterial infections played an important role in the field of oral diseases, in-depth insight of such oral diseases have given rise to the demand for antibacterial therapeutic strategies. Recently, microporous frameworks have attracted tremendous interest in antibacterial application due to their well-defined porous structures for drug delivery. In addition, intensive efforts have been made to enhance the antibacterial performance of microporous frameworks, such as ion doping, photosensitizer incorporation as building blocks, and surface modifications. This review article aims on the major recent developments of microporous frameworks for antibacterial applications against oral diseases. The first part of this paper puts concentration on the cutting-edge researches on the versatile antibacterial strategies of microporous materials via drug delivery, inherent activity, and structural modification. The second part discusses the antibacterial applications of microporous frameworks against oral diseases. The applications of microporous frameworks not only have promising therapeutic potential to inhibit bacterial plaque-initiated oral infectious diseases, but also have a wide applicability to other biomedical applications.

Atraumatic restorative treatments improve child oral health-related quality of life: A noninferiority randomized controlled trial

OBJECTIVES

Management of dental caries under dental general anaesthesia (DGA) in young children improves their quality of life. A randomized controlled trial was undertaken to test the changes in oral health-related quality of life among children treated under a DGA or managed using the Atraumatic Restorative Treatment and Hall crown approaches (ARTs).

METHODS

Children scheduled for a DGA for the management of dental caries after assessment at the Oral Health Centre of Western Australia were invited to participate. Inclusion and exclusion criteria were applied. Child oral health-related quality of life (COHRQoL) was evaluated through the Early Childhood Oral Health Impact Scale (ECOHIS) and the child-specific Caries Impacts and Experiences Questionnaire for Children (CARIES-QC) at baseline and 12 months after consent. The changes in child oral health-related quality of life were analysed on an intention-to-treat basis. Paired t-test and Wilcoxon's matched-pairs rank test were used for within-group comparison and t-test, Mann-Whitney test, and test of proportions for between-group comparisons. Linear regression was used for multivariable analyses of the follow-up scores.

RESULTS

Sixty-five parents/carers agreed to participate and were randomized (Test = 32; Control = 33). Mean age = 4.7 years, SD 1.1; 51% male. At baseline, there were no statistically significant differences in age and sex between the groups; however, the ARTs group reported higher ECOHIS scores. At follow-up, both the ARTs and DGA groups had lower ECOHIS scores (20.7 vs 12.9 and 14.4 vs 13.3, respectively) and CARIES-QC scores (12.6 vs 7.1 and 9.9 vs 8.4, respectively). The within-group differences in the ARTs group were statistically significant while the differences in the DGA group were not, P < .01 and P > .05, respectively. In a linear regression of the follow-up scores, being in the DGA group increased the follow-up scores, but it was no longer statistically significant while baseline impact scores were significantly associated with greater follow-up scores for both the ECOHIS and the CARIES-QC, P < .01.

CONCLUSION

The child oral health-related quality life among children scheduled for dental general anaesthesia improved after receiving minimally invasive, atraumatic restorative treatments of dental caries.

Dental Caries Pattern and Treatment Needs among Ugandan Adolescent Students: A Cross-Sectional Study

Dental caries is still a major public health problem owing to its high prevalence and incidence in several regions. Planning and development of effective preventive and treatment modalities for the management of dental caries demand information on disease pattern and treatment needs of the populations. However, there is a paucity of this information in Uganda. The aim of the present study was to identify the dental caries pattern and treatment needs among Ugandan adolescent students. This was a descriptive cross-sectional study conducted among 11- to 19-year-old adolescents attending two secondary schools in Kampala and Mukono districts of Uganda. At both schools, random sampling was used to select the participating classes and the adolescents. Decayed teeth and treatment needs were recorded using the World Health Organization Basic Oral Health Survey criteria. A total of 406 adolescents comprising of 249 female and 157 male students participated in the study. Data were analysed using STATA, version 12.0. The prevalence of decayed teeth (DT) was expressed as a percentage of individuals with DT score ≥1. The treatment needs were categorised into three groups. Associations between dependent and independent variables were evaluated using cross-tabulation, chi-square test, and Poisson regression analysis. The overall prevalence of decayed teeth was 62.6% and mean DT was 1.7 ± 2.3. A total of 696 decayed teeth were observed, and the molar teeth, particularly the second molar (50.6%), were the most significantly affected. The prevalence of caries was higher in the mandible (51.4%) compared to the maxilla though the difference was not statistically significant. Decayed teeth were significantly (p < 0.05) associated with difficulty in chewing, history of dental pain in the past 12 months, poor perception of tooth state, and the female participants. Majority (59.4%) of the study participants required restorations of teeth. About 83.2% (n = 579) of the teeth needed restorations, while 44 needed extractions. In conclusion, the prevalence of decayed teeth was high among the study population. It is recommended that school health programmes should include oral health preventive and curative interventions to achieve optimum health.

Atraumatic restorative treatments reduce the need for dental general anaesthesia: a non-inferiority randomized, controlled trial

BACKGROUND

A dental general anaesthesia (DGA) is commonly undertaken for the management of dental caries in young children. A randomized-controlled trial was undertaken to test the feasibility of using the Atraumatic Restorative Treatment and Hall Technique approaches (ART/HT) to manage the dental treatment of children recommended for a DGA.

METHODS

Consenting children, recommended a DGA for caries management, at the Oral Health Centre of Western Australia were randomized. Test group children were treated using the ART/HT approach and the control group under a DGA. Children were examined after 12 months by two blinded, calibrated examiners. Analysis was on an intention to treat basis; between and within group comparisons were undertaken using appropriate paired and unpaired tests. Logistic regression was used to test restorative success, controlling for clustering of teeth.

RESULTS

Sixty-five children participated, (Test = 32; Control = 33). At study termination, 28 children (88%) in the ART/HT group and 20 children (61%) in the DGA group had been provided with care, P < 0.01. Crown restorations were protective of restorative failure in a multivariate logistic model (OR 0.05, P < 0.01).

CONCLUSION

Use of the ART/HT approach enabled timely dental treatment of young children recommended for a DGA, and should be among the treatment options considered.

Accuracy of Maternal Reports of Young Children's Dental Disease Status: Avon Longitudinal Study of Parents and Children

Background: Parental reports of their children's health status is integral to pediatric medical and dental care. Therefore, understanding the accuracy of such reports is vital. Our objectives were to (1) assess the correlation between maternal reports of their children's indicators of caries experience (subjective assessment) and actual caries status determined by oral examination (objective assessment), and (2) identify potential modifiers of this correlation. Methods: Longitudinal data from the Avon longitudinal study of parents and children (n = 1429) was used to assess the correlation between maternal reports of the number of missing and filled teeth of children aged 38 months, 54 months, and 5.5 years and clinical oral examinations of decayed, missing and filled teeth conducted when the same children were 31, 43 months, and five years of age. Homogeneity chi-square tests assessed differences in correlations according to sociodemographic factors. Results: Overall, we found a statistically significant correlation that was weak to moderate in magnitude. Maternal reports of missing teeth at 38 months was significantly correlated with decayed teeth, 0.27 (p < 0.001); missing teeth, 0.23 (p < 0.001), and the decayed, missing and filled (dmft) index, 0.35 (p < 0.001) based on oral examination at 31 months. A maternal report of filled teeth at 54 months was significantly correlated with decayed teeth, 0.30 (p < 0.001); filled teeth 0.30 (p < 0.001), and dmft 0.40 (p < 0.001) at 43 months. Mothers tended to underestimate the extent of missing and filled teeth in their children irrespective of the child's age, but the extent of underestimation was greater among younger children. Maternal age, education level, and whether the child had ever visited a dentist were significant modifiers of subjective and objective caries assessments. Conclusions: From a clinical and dental public health perspective, our findings of a weak to moderate correlation of maternal assessments of their children's caries experience may be concerning when reporting the burden of dental diseases in large population studies or for surveillance purposes that rely on self-reported measures and must therefore be utilized with caution because of the potential to result in underestimated disease burden.