Best clinical practice guidance for treating deep carious lesions in primary teeth: an EAPD policy document

Purpose

The European Academy of Paediatric Dentistry (EAPD) has developed this best clinical practice guidance to help clinicians manage deep carious lesions in primary teeth.

Methods

Three expert groups conducted systematic reviews of the relevant literature. The topics were: (1) conventional techniques (2) Minimal Intervention Dentistry (MID) and (3) materials. Workshops were held during the corresponding EAPD interim seminar in Oslo in April 2021. Several clinical based recommendations and statements were agreed upon, and gaps in our knowledge were identified.

Results

There is strong evidence that indirect pulp capping and pulpotomy techniques, and 38% Silver Diamine Fluoride are shown to be effective for the management of caries in the primary dentition. Due to the strict criteria, it is not possible to give clear recommendations on which materials are most appropriate for restoring primary teeth with deep carious lesions. Atraumatic Restorative Technique (ART) is not suitable for multi-surface caries, and Pre-formed Metal Crowns (PMCs) using the Hall technique reduce patient discomfort. GIC and RMGIC seem to be more favourable given the lower annual failure rate compared to HVGIC and MRGIC. Glass carbomer cannot be recommended due to inferior marginal adaptation and fractures. Compomers, hybrid composite resins and bulk-fill composite resins demonstrated similar values for annual failure rates.

Conclusion

The management of deep carious lesions in primary teeth can be challenging and must consider the patient’s compliance, operator skills, materials and costs. There is a clear need to increase the use of MID techniques in managing carious primary teeth as a mainstream rather than a compromise option.

[Prediction of material basis and mechanism of Curcumae Rhizoma in treatment of coronary heart disease]

Coronary heart disease(CHD) is a common cardiovascular disease in clinical practice. Curcumae Rhizoma(CR), an important herbal medicine for breaking blood stasis and resolving mass, is often used for the treatment of CHD caused by blood stasis syndrome. However, the anti-CHD components, targets, and mechanism are still unclear. Therefore, in this study, the chemical components of CR were separated and identified by ultra high performance liquid chromatography-quadrupole-time-of-flight mass spectrometry(UPLC-Q-TOF-MS/MS). Based on the identified components, network pharmacology analysis, including target prediction and functional enrichment, was applied to screen out the main active components against CHD, and the potential mechanism was discussed. Finally, molecular docking was performed to verify the binding between the active components and the targets. The results showed that among the 52 chemical components identified in CR, 28 were related to CHD, involving 75 core targets. The core components included(4S)-4-hydroxy-gweicurculactone, curcumadione, and curcumenone, and the core targets included phosphatidylinositol-4,5-bisphosphate 3-kinase, catalytic subunit alpha(PIK3 CA), mitogen-activated protein kinase 1(MAPK1), and mitogen-activated protein kinase 3(MAPK3). In summary, through the active components, such as(4S)-4-hydroxy-gweicurculactone, curcumadione, and curcumenone, CR regulates the nerve repair, vasoconstriction, lipid metabolism, and inflammatory response, thereby exerts therapeutic effect on CHD.

[Significance of combination of targeted therapy and immunotherapy in conversion therapy of biliary tract cancer]

Biliary tract cancer has insidious onset and high degree of malignancy, and radical resection is often impossible when it is diagnosed.Conversion therapy can achieve tumor downgrading, so that patients who were initially unresectable have a chance to achieve R0 resection.However, due to the high heterogeneity and complex immune microenvironment of biliary tract cancer, conversion therapy is still in the stage of active exploration.As a new type of conversion therapy, combination of targeted therapy and immunotherapy is of great significance to effectively improve the efficiency of conversion therapy.Further exploration of combination mechanism and improvement of immune microenvironment are expected to become the future direction of combination of targeted therapy and immunotherapy.

[Effective substance and mechanism of Ziziphi Spinosae Semen extract in treatment of insomnia based on serum metabolomics and network pharmacology]

This study aims to study the effective substance and mechanism of Ziziphi Spinosae Semen extract in the treatment of insomnia based on serum metabolomics and network pharmacology. The rat insomnia model induced by p-chlorophenylalanine(PCPA) was established. After oral administration of Ziziphi Spinosae Semen extract, the general morphological observation, pentobarbital sodium-induced sleep test, and histopathological evaluation were carried out. The potential biomarkers of the extract in the treatment of insomnia were screened by ultra-high performance liquid chromatography-mass spectrometry(UHPLC-MS) combined with multivariate analysis, and the related metabolic pathways were further analyzed. The "component-target-pathway" network was constructed by ultra-high performance liquid chromatography coupled with quadrupole-Exactive mass spectrometry(UHPLC-Q-Exactive-MS/MS) combined with network pharmacology to explore the effective substances and mechanism of Ziziphi Spinosae Semen in the treatment of insomnia. The results of pentobarbital sodium-induced sleep test and histopathological evaluation(hematoxylin and eosin staining) showed that Ziziphi Spinosae Semen extract had good theraputic effect on insomnia. A total of 21 endogenous biomarkers of Ziziphi Spinosae Semen extract in the treatment of insomnia were screened out by serum metabolomics, and the metabolic pathways of phenylalanine, tyrosine and tryptophan biosynthesis, phenylalanine metabolism, and nicotinate and nicotinamide metabolism were obtained. A total of 34 chemical constituents were identified by UHPLC-Q-Exactive-MS/MS, including 24 flavonoids, 2 triterpenoid saponins, 4 alkaloids, 2 triterpenoid acids, and 2 fatty acids. The network pharmacological analysis showed that Ziziphi Spinosae Semen mainly acted on target proteins such as dopamine D2 receptor(DRD2), 5-hydroxytryptamine receptor 1 A(HTR1 A), and alpha-2 A adrenergic receptor(ADRA2 A) in the treatment of insomnia. It was closely related to neuroactive ligand-receptor interaction, serotonergic synapse, and calcium signaling pathway. Magnoflorine, N-nornuciferine, caaverine, oleic acid, palmitic acid, coclaurine, betulinic acid, and ceanothic acid in Ziziphi Spinosae Semen may be potential effective compounds in the treatment of insomnia. This study revealed that Ziziphi Spinosae Semen extract treated insomnia through multiple metabolic pathways and the overall correction of metabolic disorder profile in a multi-component, multi-target, and multi-channel manner. Briefly, this study lays a foundation for further research on the mechanism of Ziziphi Spinosae Semen in treating insomnia and provides support for the development of innovative Chinese drugs for the treatment of insomnia.

[Conversion therapy of biliary tract cancer from the perspective of tumor heterogeneity]

Biliary tract cancer is found in the middle and advanced stages mostly and patients will deprive surgical indications. Conversion therapy can make the stage of some patients down and thus make radical resection feasible. Biliary tract cancer is highly heterogeneous in clinical features, cell origin, histology, molecular biology and other aspects, resulting in a lack of specific and effective conversion therapy strategies. Currently, it is the important development direction to evaluate and classify different individual conditions and select individualized conversion therapy regimens. With the deepening of the research on the pathogenesis and the improvement of treatment protocols, the future conversion therapy will undoubtedly develop towards the direction of individualization and precision.

[Study on quality identification of Curcumae Rhizoma from different origins based on quantitative analysis of appearance color and content of main components]

L~*, a~* and b~* values of prepared slices of Curcumae Rhizoma were measured by spectrophotometer. SPSS 21.0 was used for discriminant analysis to establish the color range and mathematical prediction model of prepared slices of Curcumae Rhizoma. The values of L~*, a~* and b~* of kwangsiensis ranged from 58.09-62.40, 4.53-5.66 and 23.61-24.29, while the values of L~*, a~* and b~* of phaeocaulis were between 64.02-70.71,-0.89-4.13 and 44.59-54.52, respectively. The values of L~*, a~* and b~* of wenyujin were 68.55-70.99,-0.11-1.47 and 28.26-32.19, respectively. The mathematical prediction model was proved to be able to realize 100% identification of Curcumae Rhizome of different origins through original and cross validation and external samples validation. A dual wavelength HPLC was established; the contents of 9 sesquiterpenoids and 3 Curcumae Rhizomes were determined simultaneously; and the contents of Curcumae Rhizome of different origins were determined. The results showed that kwangsiensis had higher contents of neocurdione, β-elemene and isocurcumaenol, phaeocaulis curcumin, furadienone, demethoxycurcumin and curcumin; and wenyujin mainly contained curdione, furadienes and guimarone. Pearson correlation analysis on L~*, a~*, b~* value and content of 12 components showed that curcumin, furadienone, demethoxycurcumin and curcumin had a significant positive correlation with b~* value(P<0.01). There was a significant negative correlation between neocurdione, β-elemene and isocurcumaenol and L~* value(P<0.01). Curdione, furadienes and guimarone were significantly correlated with L~* value(P<0.01),indicating that the appearance co-lor of Curcumae Rhizoma could reflect the change of the content of the internal components. This study provided reference for the rapid recognition of Curcumae Rhizoma and the establishment of quality evaluation system.

Regenerative endodontic therapy (RET) for managing immature non-vital teeth: experiences and opinions of paediatric dental practitioners in the European and Arabian regions

PURPOSE

MTA apical plug approach is considered the gold standard in managing immature teeth with necrotic pulp tissues but does not increase root dimensions. Regenerative Endodontic Therapy (RET) has been advocated as an alternative technique for management of these teeth. This study aimed to assess the knowledge, experience and the opinions of dentists treating paediatric patients in the European and Arabian regions on RET.

METHODS

A cross-sectional, pre-piloted 23-item self-administered questionnaire survey was distributed electronically using the Bristol Online Survey tool through the mailing list of the European Academy of Paediatric Dentistry, the Arabian Academy of Paediatric Dentistry's and the Egyptian Society of Paediatric Dentistry.

RESULTS

308 respondents completed the survey. Approximately half practised RET (N = 158; 51.3%), which was most frequently used to manage non-vital traumatized teeth. Majority of RET practitioners worked in university or dental institute practices. Protocol differences with deviation from the current published RET guidelines were observed. Half of the respondents reported discolouration as an undesirable outcome. Lack of training, materials, evidence and suitable cases were reasons for not using RET.

CONCLUSIONS

Although RET is being practised by European and Arabian paediatric dentists, different protocols are being used with clear deviations from the current evidence-based guidelines.

[Network pharmacology study on potential active components in volatile oil of Dictamni Cortex]

There are many chemical components in the volatile oil of Dictamni Cortex. The complex network relationship of "component-target-disease" can be revealed by using the network pharmacology method, and the mechanism of the efficacy of Dictamni Cortex can be revealed. In this study, we used Swiss Target Prediction database to predict the target of action, STRING database to build protein interaction network, and Cytoscape software to build "component-target-disease" network. The results showed that the antibacterial, anti-inflammatory and antiallergic effects of Dictamni Cortex were closely related to the components of thymol methyl ether, elemenol, anethole, and the related targets of each component were cross-linked to play a multi-target pharmacodynamic role. This study laid a foundation for the study of the effective substance basis and quality control evaluation of the Dictamni Cortex, and provided a scientific basis for further revealing its mechanism.

Interventions for the endodontic management of non-vital traumatised immature permanent anterior teeth in children and adolescents: a systematic review of the evidence and guidelines of the European Academy of Paediatric Dentistry

Aim

This systematic review was undertaken in order to develop guidelines for the European Academy of Paediatric Dentistry for the management of non-vital permanent anterior teeth with incomplete root development.

Methods

Three techniques were considered; apexification by single or multiple applications of calcium hydroxide, use of Mineral Trioxide Aggregate (MTA) for the creation of an apical plug followed by obturation of the root canal, and finally a Regenerative Endodontic Technique (RET). Scottish Intercollegiate Guideline Network (SIGN) Guidelines (2008) were used for the synthesis of evidence and grade of recommendation.

Results

Variable levels of evidence were found and generally evidence related to these areas was found to be weak and of low quality. It was not possible to produce evidence-based guidelines based on the strength of evidence that is currently available for the management of non-vital immature permanent incisors.

Conclusions

Based on the available evidence the European Academy of Paediatric Dentistry proposes Good Clinical Practice Points as a guideline for the management of such teeth. It is proposed that the long term use of calcium hydroxide in the root canals of immature teeth should be avoided and apexification with calcium hydroxide is no longer advocated. The evidence related to the use of a Regenerative Endodontic Technique is currently extremely weak and therefore this technique should only be used in very limited situations where the prognosis with other techniques is deemed to be extremely poor. The current review supports the use of MTA followed by root canal obturation as the treatment of choice.

[Clinical features and gene mutation analysis of 13 Chinese juvenile patients with nephronophthisis]

Objective: To explore the clinical features and pathogenic gene mutation of juvenile nephronophthisis (NPHP) in Chinese patients. Method: Clinical data and blood samples of 27 juvenile NPHP patients from 25 families who were initially clinically diagnosed in six hospitals in Guangdong province were collected. NPHP1 homozygous deletions were detected in all patients. Sequencing of NPHP1 gene was performed when homozygous deletions were not found in patients without eye involvement. In patients with eye involvement, NPHP5 sequencing was carried out initially and subsequently NPHP10 gene and NPHP1 when there were no NPHP5 gene mutation found. Result: Diagnosis was confirmed in 13 patients by renal pathology and (or) gene sequencing, including four boys and nine girls with a median onset age of 8.5(0.1-12.8) years. Seven of the 13 patients had a normal routine urine test and six patients had mild to moderate proteinuria. None had persistent hematuria. The estimated glomerular filtration rate of the 13 patients was (12.7±10.7) ml/(min·1.73 m²) at the time of diagnosis. Renal cysts were found in only five patients by iconography. Decreased renal size was observed in nine cases and normal renal size in four patients. Renal pathology was available in five patients, renal cysts formation at the cortical-medullar area, thickening and laying tubular basement membrane, were observed. Two of the thirteen children had eye involvement, one had liver impairment and one had growth retardation. NPHP1 gene defects were detected in seven patients with a mutation rate of 25.9%, and large homozygous deletions were observed in three patients. Four patients had single point mutations, i. e. compound heterozygous mutations (c.13 C>T and c. 1520+ 5 G>A) in one patient; homozygous mutation in three patients, two patients were siblings from the same pedigree harbored c. 1756 C>T and the other one harbored c. 1298delA. NPHP5 gene homozygous mutation was found in one pedigree. The fourteen children without renal pathology and whose genetic tests were negative shared similar clinical features with the thirteen patients whose diagnosis were confirmed by gene mutation and (or) renal pathology. Conclusion: The onset of juvenile NPHP is insidious. Urine and renal iconography changes are mild or negative. The ratio of NPHP1 mutant patient is similar with previous reports, but the proportion of NPHP1 gene homozygous deletions is much lower and all of the NPHP1 gene single point mutations detected in this research were novel, which indicates a genetic discrepancy existed between Chinese NPHP patients and the western ones.

Children's and parents' attitudes towards dentists' appearance, child dental experience and their relationship with dental anxiety

AIM

To evaluate child and parental attitudes towards dentists' appearance, subsequently related to a child's dental experience and their association with child's anxiety levels.

METHODS

402 parent-child pairs were surveyed using interviewer-administered questionnaires at the School Dental Service, Health Promotion Board, Singapore. Standardised pictures of models with different attires, ages, genders and ethnicities were shown to the parent-child pairs. Information on each child's dental experience was obtained. Parental proxy was used to evaluate the children's dental fear levels based on the Children's Fear Survey Schedule-Dental Subscale (CFSS-DS).

RESULTS

Personal protective equipment (PPE) was the attire of choice for both parents and children, followed by the paediatric coat. Formal and informal attire was least preferred by children and parents, respectively. Parents preferred female dentists to treat their child, whereas children preferred a dentist of the same gender (p < 0.001). Parent's and child's preferences for the child's dentist's appearance were shown to be significantly different (p < 0.001). CFSS-DS scores were also significantly associated with the number of previous dental visits (p = 0.002) as well as a history of extractions (p = 0.02), but not with child's demographics, dmft or preference for dentist's appearance (p > 0.05).

CONCLUSION

Regardless of child anxiety levels, the PPE followed by paediatric coats were preferred over other choices of dentists' attire. Children tended to choose a dentist who was of a younger age, and of the same gender and ethnicity as themselves. Parents tended to choose younger, female dentists of the same ethnicity as themselves. Subjective experience of extractions, as well as multiple dental visits appeared to play a more significant role in the development of dental fear than dental caries experience per se.

[Effects of San'ao decoction and its analogous prescriptions on airway inflammation in mice with respiratory syncytial virus- and ovalbumin-induced asthma]

OBJECTIVE

To evaluate the effects of San'ao decoction (SAD) and its analogous prescriptions (APs), compounds of traditional Chinese herbal medicine for asthma, on airway inflammation in mice with respiratory syncytial virus (RSV)- and ovalbumin (OVA)-induced asthma.

METHODS

A total of 110 mice were randomly divided into control group, untreated group, dexamethasone (DM) group, small-dose SAD (SAD-S) group, large-dose SAD (SAD-L) group, AP I-S group, AP I-L group, AP II-S group, AP II-L group, AP III-S group, and AP III-L group. The asthma model was reproduced by sensitization with multipoint intraperitoneal injection of OVA, followed by repeated inhalation of OVA combined with intranasal instillation of RSV. Cells in bronchoalveolar lavage fluid (BALF) were counted and classified. The supernatant of the BALF was used for detecting the contents of interleukin-4 (IL-4), interleukin-5 (IL-5) and interferon-gamma (IFN-gamma) by enzyme-linked immunosorbent assay. Pathological changes in lung tissue were observed by hematoxylin and eosin staining and the scores of pathological changes were also calculated to determine the degree of inflammation.

RESULTS

Compared with the control group, the amounts of lymphocytes, eosinophils, neutrophils in BALF in the untreated group were increased significantly (P<0.01); the changes of lung histopathology in the untreated group were much more serious, and the content of IFN-gamma was sharply decreased, while the contents of IL-4 and IL-5 were significantly increased (P<0.05). The counts of eosinophils in BALF of the treated groups all decreased obviously (P<0.01) as compared with the untreated group. The count of the neutrophils in BALF of the AP II-L group was obviously lower than that in the untreated group (P<0.01). Most of Chinese herbal formulas and DM could increase the level of IFN-gamma, and decrease the level of IL-4. All concentrations of the APs and SAD could decrease the level of IL-5 as compared with the untreated group, especially of the AP II-L and AP I-L (P<0.05, P<0.01).

CONCLUSION

SAD and its APs had some therapeutic effects on RSV-induced asthma in mice. Among the formulas, AP II has a better therapeutic efficacy in treatment of asthma by decreasing the amount of neutrophils.

Photocatalytic oxidation using a new catalyst--TiO2 microsphere--for water and wastewater treatment

Since the suspended TiO2 powder enjoys free contact with UV irradiation in a photoreactor system, it can generally achieve better efficiency than the immobilized TiO2 catalysts. However, the separation and reuse of this catalyst powder from treated water often limit its application in practice. In this study, a new type of TiO2 catalyst called TiO2 microsphere was prepared by a sol-spraying-calcination method, which can easily settle in its aqueous suspensions under gravity. The SEM image of the TiO2 microsphere samples demonstrated that they had an almost spherical shape with a particle size of 30-160 microm, while the XRD analysis indicated that these TiO2 microspheres still had a crystal size of 8.1 nm. Since these TiO2 microspheres had a porous structure with higher specific surface area and pore volume than normal TiO2 powders, they appeared to have strong adsorption ability in its aqueous suspensions. The photocatalytic activity of the TiO2 microspheres was evaluated in the photodegradations of salicylic acid (SA) and sulfosalicylic acid (SSA). The experimental results showed that the reaction rate using the TiO2 microspheres was similar to that using the TiO2 powders in the SA suspensions and even higher than that in the SSA suspensions. Chemical and physical properties of the TiO2 microspheres and powders that are attributed to photoactivity were discussed based on the Langmuir-Hinshelwood kinetic model. The prepared TiO2 microsphere samples were reused in the photooxidation reaction more than 50 times. It was found that there was no significant weakening in their photoactivity and no change in their particle shape. This TiO2 microsphere catalyst can be simply used to conduct an effective photooxidation in its suspension for water and wastewater treatment with ease of recovery from treated water.