Effect of Modified Bioceramic Mineral Trioxide Aggregate Cement with Mesoporous Nanoparticles on Human Gingival Fibroblasts

The ion doping of mesoporous silica nanoparticles (MSNs) has played an important role in revolutionizing several materials applied in medicine and dentistry by enhancing their antibacterial and regenerative properties. Mineral trioxide aggregate (MTA) is a dental material widely used in vital pulp therapies with high success rates. The aim of this study was to investigate the effect of the modification of MTA with cerium (Ce)- or calcium (Ca)-doped MSNs on the biological behavior of human gingival fibroblasts (hGFs). MSNs were synthesized via sol-gel, doped with Ce and Ca ions, and mixed with MTA at three ratios each. Powder specimens were characterized using Fourier-transform infrared spectroscopy (FTIR), X-ray diffraction (XRD), and scanning electron microscopy (SEM). Biocompatibility was evaluated using a 3-[4,5-dimethylthiazol-2-yl]-2,5 diphenyl tetrazolium bromide (MTT) assay following hGFs' incubation in serial dilutions of material eluates. Antioxidant status was evaluated using Cayman's antioxidant assay after incubating hGFs with material disc specimens, and cell attachment following dehydration fixation was observed through SEM. Material characterization confirmed the presence of mesoporous structures. Biological behavior and antioxidant capacity were enhanced in all cases with a statistically significant increase in CeMTA 50.50. The application of modified MTA with cerium-doped MSNs offers a promising strategy for vital pulp therapies.

Dental treatment of a Seven-Year-Old Child with Mastocytosis

AIM

Mastocytosis is a rare disorder characterized by pathologic mast cell degranulation. This paper aims to present the dental management of a seven-year-old girl diagnosed with mastocytosis, in a hospital setting, yet without general anesthesia.

CASE REPORT

A seven-year-old girl, diagnosed with urticaria pigmentosa, was referred to a dental practice. Her parents' main concern was a possible allergic reaction to local anesthetics and antibiotics. It was decided to perform treatment in the operating theatre of a clinic without general anesthesia. Eight primary teeth were restored. The patient was monitored, and no complications occurred throughout the procedure. Follow-ups performed every three months for two years after treatment. Patient's oral hygiene was improved significantly.

CONCLUSION

Collaboration between medical experts, patient's family and the pediatric dentist was crucial. The dentist must be aware of the medical history and potential triggering factors. Due to high probability for life-threatening emergencies, dental treatment in a hospital setting is recommended.

Dental Caries Prevalence and Experience (ICDAS II Criteria) of 5-, 12- and 15-Year-Old Children and Adolescents with an Immigrant Background in Greece, Compared with the Host Population: A Cross-Sectional Study

Evidence regarding disparities in oral health among native and immigrant child and adolescent populations in Europe is scarce. The present study aimed to determine the caries status of 5-, 12-, and 15-year-olds with an immigrant background in Greece in relation to their sociodemographic characteristics and compare their caries levels with those of their native Greek peers. A sample of 707 immigrants underwent clinical examination for caries (ICDAS II criteria), followed by a calculation of caries prevalence and experience estimates (2013-2014). Multivariable regression models assessed the effect of ethnic background on the caries experience (d_3-6mfs/D_3-6MFS) of the total (707 immigrants and 3702 Greeks) population, and the association between parental education level and the immigrants' d_3-6mfs/D_3-6MFS. Among the 5- and 12-year-olds, those with an immigrant background demonstrated higher caries rates and had unfulfilled treatment needs at higher proportions. Among 15-year-old adolescents, no considerable differences in caries status were observed according to ethnic background (native Greek or immigrant). The strength of the association between immigrant background and caries experience levels attenuated gradually with increasing age (IRR = 1.61, 1.27 and 1.10, and p = 0.001, p = 0.006 and p = 0.331 for 5-, 12- and 15-year-olds, respectively). Among the immigrants, adolescents with less educated mothers exhibited elevated caries levels. Public health strategies should prioritize immigrant children and early adolescents in order to reduce the existing ethnic disparities in oral health.

Gagging and cooperation in 4-12-year-old children over a series of dental appointments

PURPOSE

The purposes were to evaluate if gagging can affect children's cooperation with treatment, investigate possible changes in gagging and study factors that can predict children's behaviour over dental treatment.

METHODS

255 children aged 4-12 years, needing at least three consecutive dental appointments, completed the Children's Fear Survey Schedule-Dental Subscale before examination. The Gagging Problem Assessment was performed before the initial examination and after the third/final appointment. Frankl's Behaviour Rating Scale (FBRS) was used to rate children's behaviour. Multivariate Mixed Linear and Logistic Regression Models were used.

RESULTS

Children with definitely positive behaviour were significantly older, less fearful and less likely to gag before treatment. Girls and older children had lower odds of gagging over time, while fearful children had higher odds. There were no statistically significant associations between gagging over time, FBRS and the type of dental treatment at the third appointment. The percentage of children who gagged after the third appointment (27.05%) was significantly lower as compared to the percentage found at the initial appointment (32.54%; p = 0.004).

CONCLUSION

Among the variables studied, age, dental fear, initial GPA and type of treatment were good predictors of children's behaviour during dental treatment.

Oral hygiene and periodontal condition of 12- and 15-year-old Greek adolescents. Socio-behavioural risk indicators, self- rated oral health and changes in 10 years

AIM

To investigate oral hygiene and periodontal status of 12- and 15-year-old Greek adolescents in relation to socio- demographic and behavioural indicators and identify national trends.

MATERIALS AND METHODS

In a stratified cluster sample of 2,478 participants, the Simplified Debris Index (DI-S) and the Community Periodontal Index (CPI) were calculated. Socio- demographic/behavioural data were collected through structured questionnaires. Multivariate ordinary regression examined the effect of socio-behavioural indicators on oral hygiene and periodontal conditions.

RESULTS

51.7% of the 12-year-olds and 56.9% of the 15- year-olds had fair and good oral hygiene, respectively. Approximately 30% of the adolescents had healthy periodontium. Bleeding on probing was detected in 23.6% and 21.6% of the 12- and the 15-year-olds, accordingly. Calculus was found in 46.2% and 44.3% of the 12- and the 15-year-old groups, correspondingly. The prevalence of periodontal pockets ?4mm was 3.2%. Significantly higher DI-S scores were found among 12-year-olds who were males, had lower educated mothers or did not use dental floss and among adolescents who brushed their teeth <twice/day. Inferior periodontal status was found among 15-year-olds who were males, 12-year- olds with lower educated mothers, who did not brush or brushed infrequently, and among subjects who did not floss. Poor self-rated oral health was significantly related to adverse oral hygiene and periodontal health outcomes. Oral hygiene and periodontal status of Greek adolescents improved moderately in ten years.

CONCLUSION

Periodontal health promotion strategies should target vulnerable sub- groups of adolescents to reduce future periodontal burden. Self-rated oral health may be useful for identifying unmet periodontal treatment needs.

Caries prevalence and caries experience (ICDAS II criteria) of 5-, 12- and 15-year-old Greek children in relation to socio-demographic risk indicators. Trends at the national level in a period of a decade

PURPOSE

To study the caries status of 5, 12 and 15-year-old Greek children, assess how disease parameters are related to socio-demographic indicators and identify relevant trends at the national level.

METHODS

A stratified cluster sample of 3702 children in total was randomly selected and examined clinically for caries (ICDAS II criteria). Caries experience was outlined by adapting ICDAS_0-6 criteria to the d/D component of the WHO dmf/DMF index configuration. Percentages (%) of caries experience-free children, of children with initial caries (ICDAS_1-2), and the mean d_1-2t/D_1-2T, d_3-6mft/D_3-6MFT and d_3-6mfs/D_3-6MFS indices were calculated. The probability of presenting with d_1-2t/D_1-2T ≥ 1 was assessed by binary logistic regression analysis, whereas negative binomial regression models examined the effect of socio-demographic parameters on d_3-6mfs/D_3-6MFS indices (level of significance: p ≤ 0.05).

RESULTS

60.1%, 48.1%, and 34.7% of the 5, 12, and 15-year-old children, respectively, had no caries experience at the defect level (d_3-6mft/D_3-6MFT = 0). Initial lesions (ICDAS_1-2) were detected in 17.7%, 19.3% and 17.4% of the 5, 12 and 15-year-olds, accordingly. Mean d_1-2t/D_1-2T was 0.93, 1.70, and 2.51, whereas mean d_3-6mft/D_3-6MFT was 1.48, 1.61, and 2.46 for the 5, 12, and 15-year-olds, respectively. Children with higher educated parents and 15-year-old urban residents exhibited significantly less caries experience at the defect level. Initial caries lesions presented a significantly higher probability of being detected in urban-residing 5- and 15-year-olds, while no consistent trend could be identified for parental education level. Caries prevalence and experience levels declined for all age groups in ten years.

CONCLUSION

Although the dental health of Greek children has improved disparities remain, calling for organised primary and secondary preventive interventions.

Factors associated with gagging during radiographic and intraoral photographic examinations in 4-12-year-old children

AIMS

No studies are available in paediatric samples evaluating gagging during toothbrushing, radiographic and/or intraoral photographic examinations. The aims were to collectively examine potential factors associated with gagging during radiographs and intraoral photographs in 4-12-year-old children.

METHODS

Parents/guardians of 395 children (aged 4-12 years old) completed questionnaires asking about their children's toothbrushing habits. Children completed Greek versions of the Gagging Assessment Scale (GAS) and the Children's Fear Survey Schedule-Dental Subscale (CFSS-DS), while the dentist used the shorter version of the Gagging Problem Assessment (GPA-de-c/SF) to objectively assess gagging. X-ray and Photo Rating Scales were created to evaluate gagging during X-rays and photographs, respectively. Multivariate logistic regression was used to examine the relationship between the potential factors and gagging.

RESULTS

59 of 275 patients (21%) and 56 of 276 patients (20%) who needed X-rays and intraoral photographs, respectively, gagged. Children who gagged during X-rays had significantly higher GAS scores (p = 0.007). Boys, younger children, and those who gagged on GPA-de-c/SF were more likely to gag during X-rays, and children who gagged on GPA-de-c/SF were more likely to gag during photographs. Brushing habits were not related to dental fear or gagging.

CONCLUSION

Of the variables which we studied, GPA-de-c/SF most strongly affected the odds of gagging during taking radiographs and/or intraoral photographs.

Child dental fear and past dental experience: comparison of parents' and children's ratings

PURPOSE

To compare the parental and child versions of the Children's Fear Survey Schedule-Dental Subscale (CFSS-DS) and the parental and child evaluations of the Child's Past Dental Experience (CPDE) in 4- to 12-year-old children in a sample from Greece.

METHODS

537 families (652 children) with 4- to 12-year-old children seeking dental care either at a University paediatric dental clinic (UC) (50.8%) or a paediatric private practice (PP) participated. Parents completed a sociodemographic questionnaire and the parental Greek version of the CFSS-DS, and children independently completed the child's Greek version. All family members answered questions about CPDE. Statistical analyses were based on multilevel models (p < 0.05).

RESULTS

Mothers' and fathers' mean CFSS-DS total scores were not significantly different from each other (p = 0.655), but were significantly higher than the scores of their sons and daughters (p < 0.001), regardless of the child's age. There was a negative association between mother's age and CFSS-DS agreement, but not for fathers. There was poor agreement for CPDE ratings between children and both parents, regardless of gender. Parents' ratings of CPDE were not related to their assessment of their children's dental fear, whilst the children's ratings of their CPDE were significantly related to their current dental fear. Location (UC or PP) had no significant influence on CFSS-DS or CPDE parental-child differences.

CONCLUSIONS

Both parents overestimated their sons' and daughters' dental fear. There was poor agreement on CPDE evaluation between parents and children. Parental CFSS-DS and CPDE evaluations are poor indicators of children's dental fear and prior dental experience.

Gagging prevalence and its association with dental fear in 4-12-year-old children in a dental setting

AIM

The aims were to determine the prevalence of gagging in children in the dental setting, detect any association between gagging and dental fear in that setting, and determine if the association varied by type of setting.

DESIGN

A total of 734 children (4-12 years old), seeking dental care either at a University paediatric dental clinic (UC) or at a private paediatric practice (PP), filled out the Greek version of the Gagging Assessment Scale (GAS, subjective assessment) and the Greek version of the Children's Fear Survey Schedule-Dental Subscale (CFSS-DS). The shorter form of the Gagging Problem Assessment-dentist part for children (GPA-de-c/SF, dentist's objective measurement) was used to assess their gag reflex.

RESULTS

A total of 209 children (28.47%) gagged according to the GPA-de-c/SF. There was no significant difference in gagging between UC and PP children. Children rated as gaggers on the GPA-de-c/SF reported significantly higher GAS and CFSS-DS scores (U = 33 629.000; P < 0.001, U = 31 955.500, P < 0.001, respectively). Also, there was a significant association between GAS and CFSS-DS (rho = 0.307, P < 0.001).

CONCLUSIONS

In the dental setting, there were significant relationships between dental fear, the dentist's objective measurement of gagging severity, and the child's subjective gagging assessment.

Periodontal Impact of Preformed Metal Crowns on Permanent Molars of Children and Adolescents: A Pilot Study

PURPOSE

When treating an early permanent molar with coronal malformation in children, as in severe molar incisor hypomineralization (MIH) cases, preformed metal crowns (PMCs) are a successful mid- to long-term restorative option. The purpose of this study was to evaluate possible changes in periodontal tissues and subgingival microbiota after PMC placement by way of a split-mouth study.

METHODS

Fourteen healthy patients with a mean age of 10.6 (±4.2) years old, attending a university dental clinic, had one MIH severely affected permanent first molar restored with a PMC (study side), while the contralateral relatively healthy tooth was the control. The Turesky plaque index, gingival index (GI), and pocket depth (PD) were assessed, and counts of periodontal pathogens were determined by checkerboard DNA-DNA hybridization at baseline and at the six-month recall.

RESULTS

There were no defective PMCs at either examination time. GI and PD significantly increased statistically in the permanent molars under study from baseline to follow up, as did Porphyromonas gingivalis and Tannerella forsythia counts.

CONCLUSION

The changes found in periodontal status and specific periodontal pathogens six months after preformed metal crown placement on permanent first molars warrant long-term follow-up to ascertain if these are reversible.

Psychometric properties of the Greek version of the Toronto Composite Empathy Scale in Greek dental students

INTRODUCTION

Empathy levels of health practitioners are related to patient satisfaction and treatment outcomes. The Toronto Composite Empathy Scale (TCES) was recently developed to assess cognitive and emotional empathy levels in both professional and personal spheres, and tested in an English-speaking sample of dental students. The aim of this study was to examine the psychometrics of the Greek version of the TCES.

MATERIALS AND METHODS

The TCES was translated into Greek and administered to all of the dental students at Aristotle University of Thessaloniki. A random subset of students completed the questionnaire twice for test-retest analysis.

RESULTS

Nearly all (96.5%) of the students completed the questionnaire. The internal consistencies of each of the four subscales were generally acceptable (Cronbach's alphas: 0.676-0.805), and the scale showed good discriminant and convergent validities (r's for discriminant validity: 0.217 and 0.103; r's for convergent validity: 0.595 and 0.700). Test-retest reliabilities ranged from 0.478 to 0.779. After eliminating items that fell on both cognitive and emotional factors, a rotated factor analysis indicated that the items loaded on two cognitive and three emotional factors.

DISCUSSION

Our results indicate that the Greek version of the TCES has good psychometric properties. The factor analysis indicates that the emotional and cognitive aspects of empathy are distinct, supporting the need to address both aspects in studies of empathy.

CONCLUSIONS

The Greek version of the TCES is a reliable and valid tool for the measurement of cognitive and emotional empathy, in both professional and personal life, in Greek dental students.

Reliability and validity of the Greek version of the Children's Fear Survey Schedule-Dental Subscale

BACKGROUND

The Children's Fear Survey Schedule-Dental Subscale (CFSS-DS) is a commonly used questionnaire which measures children's dental fear.

OBJECTIVE

The aim of this study was to gather data to evaluate the psychometric properties of a Greek version of the CFSS-DS.

METHODS

A sample of 260 children aged 4-12 completed the Greek version of the CFSS-DS while in the waiting room of a paediatric dentist. The dentist, who was unaware of the children's scores, rated the children's behaviour during the dental appointment using the Frankl scale. Children who returned for a second dental appointment during the study period completed the CFSS-DS a second time.

RESULTS

The mean CFSS-DS score was 24.80 (standard deviation = 9.17). Age and gender were not related to mean scores. Invasiveness of dental treatment was not related to mean scores. Children who were most uncooperative/fearful on the Frankl had the highest mean scores (Kruskal-Wallis chi2 = 9.48; d.f. = 2; P = 0.009). The internal consistency (Cronbach's alpha) was 0.85, and the test-retest reliability (intraclass correlation) was 0.74.

CONCLUSIONS

The Greek version of the CFSS-DS appears to be reliable and valid. Further samples should include school samples, to include children who may not go to the dentist.

Periodontal conditions and subgingival microflora in Down syndrome patients. A case-control study

OBJECTIVES

The periodontal conditions and the subgingival microflora of children, adolescents and young adults (8-28 years old) with Down syndrome were investigated in the present cross-sectional study and compared with those of healthy individuals and subjects with cerebral palsy.

MATERIAL AND METHODS

Seventy Down syndrome patients, 121 age-matched healthy individuals and 76 patients with cerebral palsy participated in the present study. Full-mouth recordings of clinical parameters (probing depth, probing attachment level, bleeding on probing, hygiene index) and the community periodontal index of treatment needs were assessed and subgingival plaque samples were taken from the Ramfjord teeth and analysed for 14 species using "checkerboard" DNA-DNA hybridization.

RESULTS

Clinical indices of periodontal inflammation and treatment needs were statistically significant higher among Down syndrome patients compared with the other two groups (ANOVA, p=0.000). Important periodontal pathogens colonize these subjects earlier and at higher levels (chi-squared test, p=0.000).

DISCUSSION

Down syndrome patients display more severe periodontal destruction earlier, and heavier colonization with periodontal pathogens compared with age-matched healthy individuals and patients with cerebral palsy.