Impact of Health Promotion Interventions on Early Childhood Caries Prevention in Children Aged 2-5 Years Receiving Dental Treatment Under General Anesthesia

Anti-Cariogenic Effects of S. cerevisiae and S. boulardii in S. mutans-C. albicans Cross-Kingdom In Vitro Models

Despite the well-documented health benefits of the probiotic Saccharomyces, its application in oral health has not been comprehensively assessed. Dental caries is a transmissible disease initiated by acid production of cariogenic bacteria and yeast, such as Streptococcus mutans and Candida albicans, on tooth enamel and followed by subsequent enamel demineralization. Here, we investigated the effect of two Saccharomyces strains (Saccharomyces boulardii and Saccharomyces cerevisiae) on S. mutans-C. albicans cross-kingdom interactions using a cariogenic planktonic model. Viable cells, pH changes, and gene expression were measured. S. cerevisiae and S. boulardii inhibited the growth of C. albicans in dual- and multi-species conditions at 4, 6, and 20 h. Saccharomyces also inhibited C. albicans hyphal formation. Furthermore, Saccharomyces reduced the acidity of the culture medium, which usually plummeted below pH 5 when S. mutans and C. albicans were present in the model. The presence of Saccharomyces maintained the culture medium above 6 even after overnight incubation, demonstrating a protective potential against dental enamel demineralization. S. boulardii significantly down-regulated S. mutans atpD and eno gene expression. Overall, our results shed light on a new promising candidate, Saccharomyces, for dental caries prevention due to its potential to create a less cariogenic environment marked by a neutral pH and reduced growth of C. albicans.

Deep Sedation for Dental Care Management in Healthy and Special Health Care Needs Children: A Retrospective Study

BACKGROUND

Very young children, and those with disabilities and extensive oral pathology, who cannot be treated in the dental chair, require deep sedation or general anesthesia for dental treatment.

OBJECTIVE

The aim of this study is to describe and compare the oral health status in healthy and SHCN children and the treatments performed under deep sedation on an outpatient basis with a minimal intervention approach, and their impact on quality of life.

METHODS

A retrospective study between 2006 and 2018 was made. A total of 230 medical records of healthy and SHCN children were included. The data extracted were age, sex, systemic health status, reason for sedation, oral health status before sedation, treatments administered during sedation, and follow-up. The quality of life after deep sedation of 85 children was studied through parental questionnaires. Descriptive and inferential analyses were made.

RESULTS

Of the 230 children, 47.4% were healthy and 52.6% were SHCN. The median age was 7.10 ± 3.40 years (5.04 ± 2.42 in healthy children and 8.95 ± 3.09 in SHCN children). The main reason for sedation was poor handling in the dental chair (99.5%). The most frequent pathologies were caries (90.9%) and pulp pathology (67.8%). Healthy children had more teeth affected by decay and with pulp involvement. Patients aged < 6 years received more pulpectomies and pulpotomies. After treatment, parents stated that children were more rested and less irascible, ate better, increased in weight, and had improved dental aesthetics.

CONCLUSIONS

Differences in treatments carried out did not depend on the general health status or the failure rate but on age, with more pulp treatments in healthy children who were younger, and more extractions near to the age of physiological turnover in children with SHCN who were older. Intervention under deep sedation with a minimally invasive treatments approach met the expectations of parents and guardians, as it improved the children's quality of life.

The effect of 8 weeks of child designed vs teacher designed games on physical fitness and creativity in children 8-10 years

A healthy and active lifestyle should start from an early age, as habits learned in childhood are more likely to endure. This study aimed to compare the effectiveness of child-designed games and teacher-designed games on the physical fitness and creativity of children aged 8-10 years. Thirty children participating in a sports club were randomly divided into two groups: teacher-designed games (TDG) and child-designed games (CDG). Subjects practiced two sessions per week for eight weeks, each session lasting 60 min. Fitness factors, such as strength, muscle endurance, aerobic fitness, agility, speed, and creativity were assessed by valid tests before and after the protocols. A repeated measure analysis of variance (ANOVA) was used to analyze the data. The TDG intervention led to a significant improvement in KTK (37.1% vs. -3.2%) and agility (-3.7% vs. -0.4%) compared to CDG intervention, while CDG intervention was associated with a significant improvement in aerobic capacity (10.1% vs. 3.6%) and in the elaboration of creativity test (23.3% vs. 8.6%). Both groups demonstrated substantial improvements in handgrip strength, static balance, long jump, flexibility, core endurance, and creativity tests, with no significant difference between groups. There were no significant changes in anthropometric features following the intervention. The implementation of combined teacher-designed and child-designed approaches in children's classrooms, in addition to promoting all aspects of physical fitness, may be effective in enhancing physical fitness and creativity.

Oral Health of Children One to Six Years after Dental Treatment under General Anaesthesia

(1) Background: The aim of this study was to assess oral health in children following dental treatment under general anaesthesia and to obtain information about oral health measures in both the children and their parents. (2) Methods: Children were scheduled for regular dental re-examination one to six years after dental treatment under general anaesthesia. Scores for mixed dmft/DMFT, the plaque control record (PCR), and the gingival bleeding index (GBI) were determined. Information about children’s/parents’ oral hygiene habits and frequency of dental visits was obtained. Scores for mixed dmft/DMFT as assessed before dental treatment under general anaesthesia/at re-examination were compared (Wilcoxon test). (3) Results: From the 134 parents initially contacted, 35 attended regular dental control visits (response rate: 26%) with their children (median age 6 years). Of the 35 children (20 female, 15 male), 18 (51.4%) were healthy and 17 (48.6%) had a pre-existing condition. Mixed dmft/DMFT scores determined at the recall visit differed significantly from the earlier visit (p = 0.006). Children had 1.74 ± 3.64 teeth newly affected by caries. Four children (11.4%) needed dental treatment under general anaesthesia again. Oral hygiene was mediocre (median PCR: 32%). The GBI was high (median: 14%). Children with a high PCR also had a high GBI. (4) Conclusions: Children who had received dental treatment under general anaesthesia still had a high caries risk. Further prophylaxis programs are necessary to prevent caries and further use of general anaesthesia.

Efficacy and safety of mineral trioxide aggregate (MTA) pulpotomy for caries-exposed permanent teeth in children: a systematic review and meta-analysis

BACKGROUND

This study aimed to evaluate the effect of mineral trioxide aggregate (MTA) pulp capping for caries-exposed permanent teeth. However, the efficacy of MTA in the treatment of children's gums is still controversial, and different studies have shown different efficacy. Therefore, it is necessary to systematically review the efficacy and safety of MTA pulp incision in the treatment of pediatric caries using meta methods.

METHODS

We used meta-analysis to compare differences in the efficacy of MTA and calcium hydroxide (CH) for treating caries in permanent teeth. The mean treatment success rate of MTA for reversible and irreversible pulpitis groups was calculated, and the effect of apical opening condition and surgical type on success rate were investigated.

RESULTS

A total of 15 studies were included, and meta-analysis showed that there was a significant statistical difference between the MTA group and CH group in efficacy [odds ratio (OR) =1.87, 95% confidence interval (CI): 1.28, 2.73, P=0.001, I²=63%, Z=3.25], success rate (OR =3.20, 95% CI: 1.93, 5.30, P<0.00001, I²=0%, Z=4.52), influence of apical foramen condition on success rate (OR =1.77, 95% CI: 1.14, 2.73, P=0.01, I²=15%, Z=2.56), and surgical procedure on success rate (OR =2.64, 95% CI: 1.65, 4.23, P<0.0001, I²=45%, Z=4.05).

DISCUSSION

Our results showed that MTA pulpotomy was superior to CH. Nonclosure of apical openings and complete coronal pulpotomy may be more beneficial than partial pulpotomy.

Multicenter RCT on Intensive Caries Prevention for Children Undergoing Dental General Anaesthesia: Intensive caries prevention for children undergoing dental general anaesthesia

OBJECTIVES

Early childhood caries is a persistent problem often leading to dental treatment under general anaesthesia (GA). Thus, this study investigated the effect of two additional individual caries prevention appointments before and after GA.

MATERIALS AND METHODS

In this multi-center, 2-arm randomized, controlled clinical trial, 408 children (age 2-5 years, mean 4.2±1.04) intended for GA were recruited and randomly assigned to the intervention and control groups with or without two additional intensive oral hygiene appointments before and after the GA. At baseline and at 6-/12-months follow-ups, approximal plaque index (API), gingival sulcus bleeding index (SBI), caries experience (dmft/s) and initial caries were recorded.

RESULTS

Participants in test group and control group (ITT; n=161 vs. n=147) as well as drop-outs in test and control groups (n=40 vs. n=58) showed no statistical significant difference in baseline characteristics. Test and control groups showed equivalent baseline oral health parameters (API: 78 and 77%, SBI: 22.6 and 23.5%, dmft: 8.5 and 8.2, respectively), which continuously improved during the study. The test group exhibited statistically significant greater improvement (API: 42%, SBI: 7%) than the control (API: 54%, OR: 0.48; P=0.003; SBI: 12%, OR=0.44; P=0.005). Due to the robust rehabilitation with predominantly stainless steel crowns and extractions, caries incidence was minimal and, therefore, without statistical significance (mean increase dt, test: 0.5, control: 0.6; P=0.68), which was also true for new initial carious lesions (mean increase test: 0.8 vs. control: 0.9; P=0.55).

CONCLUSIONS

Additional preventive sessions for children undergoing treatment under GA improved their oral hygiene parameters signifiqantly.

CLINICAL SIGNIFICANCE

Intensive caries prevention appointments for children receiving dental treatment under GA improved their oral hygiene and might reduce their caries risk.

Oral-Health-Related Quality of Life and Cosleeping: The Role of Nocturnal Breastfeeding

The purpose of this paper is to analyse the association between cosleeping and the number of breastfeeding sessions in infants, OHRQoL of the child and the family, and the DMFT Child’s index. The sample comprised 273 children (2–4 years old). In addition to the clinical examination of the child to assess the DMFT Index, the mother was requested to complete a questionnaire to collect data about the breastfeeding practice, diet, dental hygiene, dental check-ups, quality of the child’s oral life, and family impact (ECOHIS Scale). The children’s OHRQoL is positively correlated with number of night-time breastfeeding sessions at 12 months (r² = 0.40 **), DMFT index (r² = 0.60 **), impact family (r² = 0.65 **), and duration of cosleeping (r² = 0.36 **). The moderating effect explained 41% of OHRQoL; the interaction between the number of breastfeeding sessions at 18 months and the DMFT index significantly increased the coefficient of determination. A longer practice time for cosleeping was associated with an increase in breastfeeding sessions, a higher impact on OHRQoL, a higher family impact, and a higher DMFT index. More than three night-time breastfeeding sessions moderate the relationship between the DMFT index and the child’s OHRQoL.

Comparison of Survival Rates of Stainless-Steel Crowns Placed with and without Pulpotomy: A Two-Year Retrospective Study

Aim. This study aimed to retrospectively compare the survival outcomes over two years between teeth with proximal dental caries that were restored with stainless-steel crowns to those that were pulpotomized and then restored with a stainless-steel crown in patients who were rehabilitated under general anesthesia. Participants and Methods. The records of 131 patients aged between two to six years who had stainless-steel crowns placed under general anesthesia and had two-year follow-up were screened. 340 teeth with moderate proximal caries on the radiograph (D2) were included in the study. Of these, 164 teeth were treated with a pulpotomy and stainless-steel crown, while 176 teeth were crowned without a pulpotomy. The type of each tooth was compared using the Chi-squared test and Kaplan–Meier survival analysis, and curves were plotted based on the two-year outcomes. Results. Treatment: the sample comprised 59 males (mean age 4.73 years, SD ± 1.4 years) and 72 females (mean age 5.2 years, SD ± 2.0 years). The Kaplan–Meier regression model showed no significant difference in survival outcomes between teeth that had been pulpotomized and those that had not ( $p$  = 0.283). Conclusion. Within the limitations of the current study, we can conclude that performing a pulpotomy does not influence the survival outcome of mild/moderate proximal caries restored with stainless-steel crowns under general anesthesia.

Effect of a Game-Based Physical Education Program on Physical Fitness and Mental Health in Elementary School Children

Promotion of healthy active behaviors should start from early ages, as behaviors learned in youth are more likely to endure. A fundamental body of research in this field focuses on the implementation of programs within physical education (PE), thanks to its favorable characteristics. However, traditional PE based on exercise training and controlling styles seems to have weaker association with students' health benefits. For this reason, the aim of this study was to assess the effects of a game-based PE program on physical fitness and psychological health in schoolchildren aged 10 to 12 years old. A total of 252 students were distributed in experimental (EG, games-centered activities) and control (CG, traditional exercise training activities) groups. The program lasted 6 months. Health-related physical fitness components, psychological wellbeing, self-esteem, stress, and anxiety were assessed before and after the treatment. Both groups increased physical fitness at post-test; however, cardiorespiratory fitness did not improve. No differences were found between the groups at post-test. Our results show that games may be as effective as traditional training methods; yet, they suggest that PE alone may be insufficient for obtaining substantive benefits in cardiorespiratory fitness, regardless of the type of task presented.