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OBJECTIVE: The objective of this study is to investigate the beneficial effect of not rinsing for 30 min in arresting early childhood caries after SDF therapy. METHODS: This randomised clinical trial recruited 3- to 4-year-old kindergarten children with active (soft) dentine caries. A questionnaire was sent to the parents to collect children's demographic data and oral health-related behaviours. A dentist conducted an oral examination and measured the caries experience using dmft index and oral hygiene using visible plaque index. After 38 % SDF therapy, the children were randomly allocated into two groups. Children in group A were instructed to rinse with water immediately, whereas children in group B were asked to refrain from rinsing, drinking, or eating for 30 min. After six months, the same examiner determined the lesion activity (active/arrest) of the SDF-treated carious tooth surface. Generalized Estimating Equations was used to compare the proportion of caries arrest (caries-arrest rate) between the two groups. RESULTS: This study recruited 298 children with 1,158 decayed tooth surfaces receiving SDF therapy at baseline and evaluated 275 (92 %) children with 1,069 (92 %) SDF-treated tooth-surface at the six-month examination. The demographic background, oral hygiene and caries status of two groups were comparable at baseline (p > 0.05). The caries-arrest rate for group A and group B were 65 % (337/519) and 61 % (338/550), respectively (p = 0.28). CONCLUSION: This randomised clinical trial found not rinsing for 30 min after SDF therapy is not better than immediate rinsing in arresting early childhood caries. CLINICAL SIGNIFICANCE: Topical SDF application leaves an unpleasant taste in the mouth, which may affect the acceptance or even rejection of SDF therapy among young children. This study provides clinicians with information to make their decision on postoperative instruction after SDF therapy.
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OBJECTIVE: This systematic review aimed to describe and evaluate the caries patterns among the 21st century preschool children globally. METHOD: Six electronic databases (Pubmed, Embase, Medline, Web of Science, EBSCOhost, and Scopus) were searched using predetermined terms. Dual independent screening of all retrieved abstracts was performed to identify studies conducted after year 2000 and the caries pattern among preschool children was investigated. Data regarding the prevalence of caries by tooth type and surface were extracted. Meta-analyses, subgroup analyses and meta-regression were carried out with the statistics software Stata using the random-effects model. RESULTS: A total of 2642 records were screened, and 43 observational studies were finally included. Cavitated caries lesions were commonly found in the maxillary incisors and molars in both arches among preschool children. The highest caries prevalence was found in the maxillary central incisors (29.1%, 95%CI: 25.5%-32.7%) and the mandibular second molars (28.5%, 95%CI: 24.7%-32.3%), while the mandibular lateral incisors had the lowest prevalence (1.7%, 95%CI: 1.5%-2.0%). Occlusal surfaces of the mandibular molars were the most frequently affected by caries, whereas caries hardly affected the lingual surfaces of lower anterior teeth. Caries pattern on the left and right sides was symmetrical. The overall caries prevalence was significantly higher in the maxillary teeth. Caries prevalence was higher in the older children, whereas the caries pattern was not significantly different among children from countries with different human and economic development levels. CONCLUSION: Cavitated carious lesions were more commonly observed in the maxillary incisors and molars in both arches. The prevalence of caries varies significantly with child's age and primary tooth type. However, preschool children exhibit a similar pattern of caries, regardless of the time, socioeconomic status or geographical location.
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Cárie Dentária , Humanos , Cárie Dentária/epidemiologia , Prevalência , Pré-Escolar , Saúde Global , Dente MolarRESUMO
The objective of this prospective 12-month observational study is to examine the oral health-related quality of life (OHRQoL) among Hong Kong young children aged 3-4 years old receiving silver diamine fluoride (SDF) therapy for carious upper anterior primary teeth. A parental questionnaire was used to collect each child's sociodemographic background and oral health habits at baseline. Data on parents' satisfaction with their child's dental aesthetics were collected at baseline and during a 12-month visit. The Chinese Early Childhood Oral Health Impact Scale (C-ECOHIS) was used to measure OHRQoL. A trained dentist performed examinations and recorded caries experience (dmft) and oral hygiene (visible plaque index) at baseline and 12 months. SDF was applied to the carious lesions. Out of 286 invited children, 248 (87%, 248/286) participated, and 211 (85%, 211/248) attended the 12-month examination. All SDF-treated carious lesions were discoloured at the 12-month examination. Regression analysis showed that the baseline C-ECOHIS score was associated with dmft (p < 0.001). The baseline and 12-month C-ECOHIS scores were 4.6 ± 5.5 and 5.0 ± 5.6, respectively (p = 0.42). The scores for parental satisfaction with dental aesthetics at baseline and 12 months were 59% to 46% (p < 0.001). Satisfaction was negatively associated with the number of discoloured upper anterior teeth (p < 0.001). In conclusion, SDF discoloured the carious upper anterior teeth of the Hong Kong kindergarten children. However, the discoloured lesions had no significant effects on the OHRQoL of these children. However, more parents became dissatisfied with their child's dental aesthetics after SDF therapy. Hence, clinicians should inform parents well before they perform SDF therapy on children.
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OBJECTIVE: This study aimed to examine the global research trend and frontiers in the field of root caries. METHODS: Two independent investigators searched the Web of Science Core Collection to include journal articles published on root caries from 1994 to 2023. They examined citation trends of the selected publications and performed bibliometric analysis using VOSviewer. Cooccurrence and cocitation analysis were used to calculate the burst strength of the most cited keywords and the most cited publications. RESULTS: This study included 1144 publications (1004 scientific research articles and 140 review articles) for bibliometric analysis. The number of publications from 2018 to 2023 was 404, accounting for 35% (404/1144) over the last 30 years. The annual citation count showed a gradual upward trend with a surge from 2018. The cooccurrence analysis classified the publications into four clusters which were in vitro studies, prevention, microbiology, and epidemiology. Cocitation analysis revealed silver diamine fluoride, systematic review, and randomized clinical trial were the three main keywords; and their citation burst strength (period) were 17.2 (2017-2023), 9.4 (2015-2023), and 6.9 (2018-2023), respectively. Noninvasive treatment of root caries (narrative review), aetiology of root caries (narrative review), and use of silver diamine fluoride in arresting root caries (clinical trial) were the topics (publication type) of the three most cited publications; and their burst strength (period) were 8.9 (2017-2020), 5.9 (2017-2021), and 4.7 (2015-2018), respectively. CONCLUSION: This study highlights the recent growing research interest in root caries, particularly on its microbiology, prevention, and the use of silver diamine fluoride.
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The effectiveness of high-quality dental care predominantly lies on the communication between dentist and patient. However, little literature has reported the importance of these "soft skills" in dental practice. The aim of this literature review is to explore strategies for effective dentist-patient communication. Dentist-patient communication is a bidirectional process involving the exchange of ideas that should be clear (easy to understand), correct (accurate), concise (to the point), complete (with essential information), and cohesive (well-organized). Effective communication empowers patients with the knowledge required to make an informed decision about their own oral health. It not only improves the dentist's efficiency and boosts patient confidence, but also alleviates patients' dental anxiety and fear, addresses patients' needs and preferences, increases patients' adherence, and enhances patient satisfaction. To enhance dentist-patient communication, dentists should take the patient-centered approach as a premise. The approach comprises understanding patients' illnesses, shared decision-making, and mindful intervention at the patient's own pace. In addition, dentists should use simple, succinct language, proper body posture, gestures, facial expressions, and eye contact when interacting with patients. Dentists should show empathy, encourage questions and feedback, employ visual aids, and give ample time to patients. Nowadays, dentists and their patients use messaging applications in their communication. This form of telecommunication is not only a convenient way of communication but also reduces the costs associated with a dentist visit. In conclusion, effective dentist-patient communication is vital for the success of dental practice. Dentists who prioritize communication and build positive relationships with their patients are more likely to achieve positive outcomes and foster the expansion of their dental practice.
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BACKGROUND: This is an update of a review first published in 2010. Use of topical fluoride has become more common over time. Excessive fluoride consumption from topical fluorides in young children could potentially lead to dental fluorosis in permanent teeth. OBJECTIVES: To describe the relationship between the use of topical fluorides in young children and the risk of developing dental fluorosis in permanent teeth. SEARCH METHODS: We carried out electronic searches of the Cochrane Oral Health Trials Register, CENTRAL, MEDLINE, Embase, three other databases, and two trials registers. We searched the reference lists of relevant articles. The latest search date was 28 July 2022. SELECTION CRITERIA: We included randomized controlled trials (RCTs), quasi-RCTs, cohort studies, case-control studies, and cross-sectional surveys comparing fluoride toothpaste, mouth rinses, gels, foams, paint-on solutions, and varnishes to a different fluoride therapy, placebo, or no intervention. Upon the introduction of topical fluorides, the target population was children under six years of age. DATA COLLECTION AND ANALYSIS: We used standard methodological procedures expected by Cochrane and used GRADE to assess the certainty of the evidence. The primary outcome measure was the percentage prevalence of fluorosis in the permanent teeth. Two authors extracted data from all included studies. In cases where both adjusted and unadjusted risk ratios or odds ratios were reported, we used the adjusted value in the meta-analysis. MAIN RESULTS: We included 43 studies: three RCTs, four cohort studies, 10 case-control studies, and 26 cross-sectional surveys. We judged all three RCTs, one cohort study, one case-control study, and six cross-sectional studies to have some concerns for risk of bias. We judged all other observational studies to be at high risk of bias. We grouped the studies into five comparisons. Comparison 1. Age at which children started toothbrushing with fluoride toothpaste Two cohort studies (260 children) provided very uncertain evidence regarding the association between children starting to use fluoride toothpaste for brushing at or before 12 months versus after 12 months and the development of fluorosis (risk ratio (RR) 0.98, 95% confidence interval (CI) 0.81 to 1.18; very low-certainty evidence). Similarly, evidence from one cohort study (3939 children) and two cross-sectional studies (1484 children) provided very uncertain evidence regarding the association between children starting to use fluoride toothpaste for brushing before or after the age of 24 months (RR 0.83, 95% CI 0.61 to 1.13; very low-certainty evidence) or before or after four years (odds ratio (OR) 1.60, 95% CI 0.77 to 3.35; very low-certainty evidence), respectively. Comparison 2. Frequency of toothbrushing with fluoride toothpaste Two case-control studies (258 children) provided very uncertain evidence regarding the association between children brushing less than twice per day versus twice or more per day and the development of fluorosis (OR 1.63, 95% CI 0.81 to 3.28; very low-certainty evidence). Two cross-sectional surveys (1693 children) demonstrated that brushing less than once per day versus once or more per day may be associated with a decrease in the development of fluorosis in children (OR 0.62, 95% CI 0.53 to 0.74; low-certainty evidence). Comparison 3. Amount of fluoride toothpaste used for toothbrushing Two case-control studies (258 children) provided very uncertain evidence regarding the association between children using less than half a brush of toothpaste, versus half or more of the brush, and the development of fluorosis (OR 0.77, 95% CI 0.41 to 1.46; very low-certainty evidence). The evidence from cross-sectional surveys was also very uncertain (OR 0.92, 95% CI 0.66 to 1.28; 3 studies, 2037 children; very low-certainty evidence). Comparison 4. Fluoride concentration in toothpaste There was evidence from two RCTs (1968 children) that lower fluoride concentration in the toothpaste used by children under six years of age likely reduces the risk of developing fluorosis: 550 parts per million (ppm) fluoride versus 1000 ppm (RR 0.75, 95% CI 0.57 to 0.99; moderate-certainty evidence); 440 ppm fluoride versus 1450 ppm (RR 0.72, 95% CI 0.58 to 0.89; moderate-certainty evidence). The age at which the toothbrushing commenced was 24 months and 12 months, respectively. Two case-control studies (258 children) provided very uncertain evidence regarding the association between fluoride concentrations under 1000 ppm, versus concentrations of 1000 ppm or above, and the development of fluorosis (OR 0.89, 95% CI 0.52 to 1.52; very low-certainty evidence). Comparison 5. Age at which topical fluoride varnish was applied There was evidence from one RCT (123 children) that there may be little to no difference between a fluoride varnish application before four years, versus no application, and the development of fluorosis (RR 0.77, 95% CI 0.45 to 1.31; low-certainty evidence). There was low-certainty evidence from two cross-sectional surveys (982 children) that the application of topical fluoride varnish before four years of age may be associated with the development of fluorosis in children (OR 2.18, 95% CI 1.46 to 3.25). AUTHORS' CONCLUSIONS: Most evidence identified mild fluorosis as a potential adverse outcome of using topical fluoride at an early age. There is low- to very low-certainty and inconclusive evidence on the risk of having fluorosis in permanent teeth for: when a child starts receiving topical fluoride varnish application; toothbrushing with fluoride toothpaste; the amount of toothpaste used by the child; and the frequency of toothbrushing. Moderate-certainty evidence from RCTs showed that children who brushed with 1000 ppm or more fluoride toothpaste from one to two years of age until five to six years of age probably had an increased chance of developing dental fluorosis in permanent teeth. It is unethical to propose new RCTs to assess the development of dental fluorosis. However, future RCTs focusing on dental caries prevention could record children's exposure to topical fluoride sources in early life and evaluate the dental fluorosis in their permanent teeth as a long-term outcome. In the absence of these studies and methods, further research in this area will come from observational studies. Attention needs to be given to the choice of study design, bearing in mind that prospective controlled studies will be less susceptible to bias than retrospective and uncontrolled studies.
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Fluoretos Tópicos , Fluorose Dentária , Ensaios Clínicos Controlados Aleatórios como Assunto , Fluorose Dentária/epidemiologia , Humanos , Pré-Escolar , Fluoretos Tópicos/administração & dosagem , Fluoretos Tópicos/efeitos adversos , Criança , Cremes Dentais/efeitos adversos , Viés , Estudos de Casos e Controles , Cariostáticos/efeitos adversos , Cariostáticos/administração & dosagem , Estudos de Coortes , Estudos Transversais , Fluoretos/administração & dosagem , Fluoretos/efeitos adversosRESUMO
OBJECTIVE: The study aimed to investigate caries incidence and its associate factors among kindergarten children in Hong Kong. METHOD: This 30-month prospective study recruited 3- to 4-year-old children when they started their kindergarten study. A self-administered parental questionnaire survey was used to collect the children's social demographic information and their oral health-related habits. Child's caries experience was recorded using the decayed, missing, and filled tooth (dmft) index and the visible plaque index (VPI) was used to measure their oral hygiene status. A final examination was performed after 30 months when they were in the final year of kindergarten. Data were analysed using the zero-inflated negative binomial (ZINB) regression model. RESULTS: This study examined 660 children at baseline and 501 children at the final examination (dropout 24%). At baseline, the caries prevalence among 501 children was 23%, with mean (SD) dmft scores of 0.7 (1.8). At the final examination, caries prevalence increased to 41%, with mean (SD) dmft scores of 1.6 (2.8). The 30-month incidence rate was 34%, and the mean (SD) number of new carious teeth developed was 0.9 (1.7). Lower first molars exhibited the highest caries increment rate (11%), followed by upper second molars (9%) and upper central incisors (9%). ZINB regression analysis revealed associations among caries incidence and family income, baseline dmft, and baseline VPI (P < .05). CONCLUSIONS: One third of Hong Kong kindergarten children developed new caries. Low family income, prior caries experience and poor oral hygiene were the significant factors associated with their caries incidence. CLINICAL RELEVANCE: Many children developed new caries during their kindergarten years, with their caries experience more than doubling. Preventive measures, including oral health education and reinforcing oral hygiene practice in kindergarten, are essential to reduce their caries incidence, particularly for children with low family income, caries experience and poor oral hygiene.
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Silver diamine fluoride (SDF) is a topical solution used for managing dental caries. The mixed-methods study consists of a quantitative study (questionnaire survey) and a qualitative study (in-depth interview) to explore the knowledge, attitudes, and practices towards SDF among dentists in Vietnam. A descriptive approach and a thematic approach were performed to analyze data, respectively. The questionnaire survey invited 436 licensed dentists registered for the national annual dental meeting and 226 dentists participated (response rate: 52%). Among them, 174 (77%, 174/226) dentists knew SDF, and 69 (40%, 69/174) dentists used SDF for caries management. Most of them considered SDF therapy as non-invasive (84%, 146/174) and simple (80%, 140/174). However, most of them expressed concern that SDF could discolor the tooth (74%, 128/174). Their most preferred teeth for SDF therapy were primary posterior teeth (92%, 160/174). The in-depth interview consulted 16 dentists to reach data saturation. They learned about SDF from outside curriculum resources as an effective anti-caries agent. They understood the advantages (simple, non-invasive, timesaving) and disadvantages (tooth discoloring, ammonia odor) of SDF. They used SDF to arrest caries in uncooperative children in the clinic and people living in rural areas in outreach services. Most dentists in Vietnam are supportive of SDF therapy, and they know its advantages and disadvantages for caries management. The results addressed the aim of the study to investigate Vietnamese dentists' perspectives towards SDF.
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OBJECTIVES: This study aimed to systematically review the effect of sugar substitute consumption on caries prevention in permanent teeth among children and adolescents. DATA: Randomized controlled trials (RCTs) and controlled clinical trials (CCTs) comparing the clinical effect of sugar substitutes (both high- and low-intensity sweeteners) in preventing caries in permanent teeth among children and adolescents aged 6-19 were included. SOURCES: A systematic search was conducted in three databases (PubMed, Web of Science and Embase) without any restrictions on publication year. STUDY SELECTION: The initial search found 1,859 items, and finally, 15 studies (11 RCTs and 4 CCTs) with a total of 6325 participants (age: 6-18 years) were included. The Cochrane risk-of-bias assessment tools were used for quality assessment. Most (80%, 12/15) were graded as having a 'moderate' or 'high' risk of bias. All trials investigated sugar alcohol, which is a low-intensity sweetener. Xylitol was the most commonly investigated (73.3%, 11/15), followed by sorbitol (46.7%, 7/15), and erythritol (13.3%, 2/15). Results of the meta-analysis showed that both xylitol (standardized mean difference [SMD]: -0.50, 95% confidence interval [CI] -0.85 to -0.16, P = 0.005) and sorbitol (SMD: -0.10, 95% CI: -0.19 to -0.01, P = 0.03) had a significant effect in preventing dental caries compared to no treatment/placebo. No clinical trials on high-intensity sweeteners such as aspartame and saccharin were found. CONCLUSION: The consumption of xylitol or sorbitol is potentially effective in preventing caries in permanent teeth among children and adolescents. No clinical evidence is available regarding the role of high-intensity sweeteners in caries prevention. CLINICAL SIGNIFICANCE: The use of xylitol or sorbitol as sugar substitutes has a beneficial effect in preventing dental caries among children and adolescents.
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Cárie Dentária , Dentição Permanente , Sorbitol , Edulcorantes , Xilitol , Humanos , Cárie Dentária/prevenção & controle , Adolescente , Criança , Xilitol/uso terapêutico , Sorbitol/uso terapêutico , Edulcorantes/uso terapêutico , Eritritol/uso terapêutico , Ensaios Clínicos Controlados Aleatórios como AssuntoRESUMO
OBJECTIVES: This study aimed to identify the oral microbiota factors contributing to low birth weight (LBW) in Chinese pregnant women and develop a prediction model using machine learning. METHODS: A nested case-control study was conducted in a prospective cohort of 580 Chinese pregnant women, with 23 LBW cases and 23 healthy delivery controls matched for age and smoking habit. Saliva samples were collected at early and late pregnancy, and microbiome profiles were analyzed through 16S rRNA gene sequencing. RESULTS: The relative abundance of Streptococcus was over-represented (median 0.259 vs. 0.116) and Saccharibacteria_TM7 was under-represented (median 0.033 vs. 0.068) in the LBW case group than in controls (p < 0.001, p = 0.015 respectively). Ten species were identified as microbiome biomarkers of LBW by LEfSe analysis, which included 7 species within the genus of Streptococcus or as part of 'nutritionally variant streptococci' (NVS), 2 species of opportunistic pathogen Leptotrichia buccalis and Gemella sanguinis (all LDA score>3.5) as risk biomarkers, and one species of Saccharibacteria TM7 as a beneficial biomarker (LDA= -4.5). The machine-learning model based on these 10 distinguished oral microbiota species could predict LBW, with an accuracy of 82 %, sensitivity of 91 %, and specificity of 73 % (AUC-ROC score 0.89, 95 % CI: 0.75-1.0). Results of α-diversity showed that mothers who delivered LBW infants had less stable salivary microbiota construction throughout pregnancy than the control group (measured by Shannon, p = 0.048; and Pielou's, p = 0.021), however the microbiome diversity did not improve the prediction accuracy of LBW. CONCLUSIONS: A machine-learning oral microbiome model shows promise in predicting low-birth-weight delivery. Even in cases where oral health is not significantly compromised, opportunistic pathogens or rarer taxa associated with adverse pregnancy outcomes can still be identified in the oral cavity. CLINICAL SIGNIFICANCE: This study highlights the potential complexity of the relationship between oral microbiome and pregnancy outcomes, indicating that mechanisms underlying the association between oral microbiota and adverse pregnancy outcomes may involve complex interactions between host factors, microbiota, and systemic conditions. Using machine learning to develop a predictive model based on specific oral microbiota biomarkers provides a potential for personalized medicine approaches. Future prediction models should incorporate clinical metadata to be clinically useful for improving maternal and child health.
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Recém-Nascido de Baixo Peso , Aprendizado de Máquina , Microbiota , Boca , RNA Ribossômico 16S , Saliva , Streptococcus , Humanos , Feminino , Gravidez , Estudos de Casos e Controles , Recém-Nascido , Adulto , Saliva/microbiologia , Boca/microbiologia , Estudos Prospectivos , RNA Ribossômico 16S/análise , Streptococcus/isolamento & purificação , Biomarcadores/análise , China , Leptotrichia , Fatores de RiscoRESUMO
OBJECTIVES: Silver diamine fluoride (SDF) has gained popularity in dentistry as an anti-hypersensitive and anti-caries agent. This study aims to review the postoperative instructions for SDF therapy and examine the evidence supporting these instructions in treating dentine hypersensitivity and caries control. DATA AND SOURCES: Two independent reviewers searched three electronic databases (EMBASE, PubMed, and Web of Science) to identify clinical studies that used SDF to treat dentine hypersensitivity and dental caries. Additionally, they searched Google Chrome for information from manufacturers, the department of health, national dental organisations, authoritative dental organisations, and universities regarding SDF therapy for these conditions. Data on postoperative instructions were extracted, and their impact on the treatment of dentine hypersensitivity and caries control was investigated. STUDY SELECTION: This review included 74 clinical studies, 11 sets of instructions from SDF manufacturers, and six recommendations from national dental organisations, departments of health and universities. Amongst the included records, 50 clinical studies, two manufacturers, and one department of health mentioned postoperative instructions for SDF therapy. The recommendations varied, from suggesting no specific instructions, immediate rinsing, refraining from eating or drinking for 30 to 60 min, and even avoiding brushing until the next day after SDF therapy. Notably, no clinical studies reported the effects of these postoperative instructions on the SDF treatment of dentine hypersensitivity or dental caries. CONCLUSIONS: This scoping review highlights the presence of inconsistent postoperative instructions for SDF therapy in the treatment of dentine hypersensitivity and caries control. Furthermore, there is a lack of evidence supporting the effectiveness of these instructions. CLINICAL SIGNIFICANCE: No evidence supports the postoperative instructions for SDF therapy for managing dentine hypersensitivity and dental caries. Studies are necessary to provide guidance for clinicians using SDF in their clinical practice.
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Cárie Dentária , Sensibilidade da Dentina , Fluoretos Tópicos , Compostos de Amônio Quaternário , Compostos de Prata , Humanos , Cariostáticos/uso terapêutico , Cárie Dentária/prevenção & controle , Dessensibilizantes Dentinários/uso terapêutico , Sensibilidade da Dentina/prevenção & controle , Fluoretos Tópicos/uso terapêutico , Cuidados Pós-Operatórios , Compostos de Amônio Quaternário/uso terapêutico , Compostos de Prata/uso terapêuticoRESUMO
OBJECTIVE: To assess the clinical evidence for silver diamine fluoride (SDF) to reduce dentine hypersensitivity in adults. METHODS: Two independent researchers searched the English literature in five databases (Scopus, PubMed, Web of Science, EMBASE and the Cochrane Library) up to 15th July 2023 for clinical trials investigating the desensitising effect of professionally applied SDF to manage dentine hypersensitivity in adults aged 18 or above at any follow-up period. The primary outcome was the change in dentine hypersensitivity between baseline and follow-up visits after SDF application regarding any validated pain outcome measures. The Cochrane guidelines were used for the risk of bias assessment. RESULTS: Three hundred and thirty-one studies were identified, and four of them were finally included. Three of the included studies were rated as having a 'low risk' of bias. The SDF solution reduced dentine hypersensitivity in adults. The percentage reduction in dentine hypersensitivity ranged from 23 % to 56 % after a single application of SDF solution. Moreover, the SDF solution was more effective than potassium nitrate, potassium oxalate and glutaraldehyde plus hydroxyethyl methacrylate in reducing dentine hypersensitivity. Meta-analysis indicated a more significant reduction in visual analogue scales (1-10) by 1.35 (95 % CI:0.9-1.8; p<0.00001) after receiving the SDF application than controls. CONCLUSION: The included clinical trials showed that SDF solution reduced dentine hypersensitivity in adults. However, clinical trials are few, and their protocol varied from one another. Further well-designed clinical trials should be conducted to provide more evidence on its use to manage dentine hypersensitivity. CLINICAL SIGNIFICANCE: SDF is cleared as desensitizing agents by the US Food and Drug Administration to manage dentine hypersensitivity, which induces pain, limits food choice, and impacts the quality of life. Evidence from this systematic review informs clinicians and provides researchers insight for future research on SDF use for dentine hypersensitivity. THE INTERNATIONAL PROSPECTIVE REGISTER OF SYSTEMATIC REVIEWS (PROSPERO) REGISTRATION NUMBER: CRD42023462613.
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Cárie Dentária , Sensibilidade da Dentina , Humanos , Cariostáticos/uso terapêutico , Cárie Dentária/tratamento farmacológico , Sensibilidade da Dentina/tratamento farmacológico , Sensibilidade da Dentina/prevenção & controle , Fluoretos Tópicos/uso terapêutico , Fluoretos Tópicos/farmacologia , Dor , Qualidade de Vida , Compostos de Amônio Quaternário/uso terapêutico , Compostos de Amônio Quaternário/farmacologia , Compostos de Prata/uso terapêutico , Compostos de Prata/farmacologiaRESUMO
OBJECTIVE: The objective of this review is to determine the global prevalence of dental fear and anxiety (DFA) in early childhood and identify its related factors. METHODS: The systematic review utilized three common English-language databases (PubMed, EMBASE, and Web of Science). Two independent researchers performed a systematic search to include observational studies on young children published from 2000 to 2023. They extracted information on prevalence of DFA, assessment tools used, study sites, respondents, and children's dental visit experiences. RESULTS: A total of 2,895 studies were identified, and 25 studies met the inclusion criteria for analysis. The pooled prevalence of DFA among 2- to 6- year-old children was estimated to be 30 % (95 % CI=25, 36). Children without dental visit experience (OR=1.37, 95 % CI=1.18, 1.59) and children with caries experiences (OR=1.18, 95 % CI=1.09, 1.27) had higher odds of experiencing DFA compared to those with dental visit experience or caries-free status. The most commonly used assessment tools in the included studies were the Frankl Behaviour Rating Scale (32 %, 8/25), Children's Fear Survey Schedule-Dental Subscale (20 %, 5/25), and Dental Anxiety Question (20 %, 5/25). CONCLUSIONS: This systematic review reveals that approximately one-third of young children globally experience DFA. Children who lack dental visit experience or have caries experiences are at increased risk of DFA. Clinicians can use this information to make informed decisions regarding dental care provision for young children. CLINICAL SIGNIFICANCE: This study provides comprehensive information on the global prevalence of dental fear and anxiety and its associated factors in early childhood. The findings can assist clinicians in understanding and addressing DFA in their dental care approach for young children. REGISTRATION: PROSPERO (CRD42023446464).
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Ansiedade ao Tratamento Odontológico , Cárie Dentária , Criança , Pré-Escolar , Humanos , Transtornos de Ansiedade , Ansiedade ao Tratamento Odontológico/epidemiologia , Cárie Dentária/epidemiologia , Prevalência , Estudos Observacionais como AssuntoRESUMO
OBJECTIVES: Generative artificial intelligence (GenAI), including large language models (LLMs), has vast potential applications in health care and education. However, it is unclear how proficient LLMs are in interpreting written input and providing accurate answers in dentistry. This study aims to investigate the accuracy of GenAI in answering questions from dental licensing examinations. METHODS: A total of 1461 multiple-choice questions from question books for the US and the UK dental licensing examinations were input into 2 versions of ChatGPT 3.5 and 4.0. The passing rates of the US and UK dental examinations were 75.0% and 50.0%, respectively. The performance of the 2 versions of GenAI in individual examinations and dental subjects was analysed and compared. RESULTS: ChatGPT 3.5 correctly answered 68.3% (n = 509) and 43.3% (n = 296) of questions from the US and UK dental licensing examinations, respectively. The scores for ChatGPT 4.0 were 80.7% (n = 601) and 62.7% (n = 429), respectively. ChatGPT 4.0 passed both written dental licensing examinations, whilst ChatGPT 3.5 failed. ChatGPT 4.0 answered 327 more questions correctly and 102 incorrectly compared to ChatGPT 3.5 when comparing the 2 versions. CONCLUSIONS: The newer version of GenAI has shown good proficiency in answering multiple-choice questions from dental licensing examinations. Whilst the more recent version of GenAI generally performed better, this observation may not hold true in all scenarios, and further improvements are necessary. The use of GenAI in dentistry will have significant implications for dentist-patient communication and the training of dental professionals.
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Inteligência Artificial , Avaliação Educacional , Licenciamento em Odontologia , Humanos , Avaliação Educacional/métodos , Estados Unidos , Reino UnidoRESUMO
The objective of this study was to investigate the relationship amongst early childhood caries (ECC), economic development, and dental public health programmes in Hong Kong. We searched exhaustively qualitative and quantitative data on the oral health policy, dental service, public health strategies of caries control and epidemiologic surveys on ECC. We then performed meta-regression to explore the impact of the Human Development Index (HDI), gross domestic product (GDP) growth, water fluoridation, oral health promotion, dental school establishment, free education, and dental workforce on ECC prevalence in 5-year-olds. We found that the first government oral health survey was conducted in 1960, when Hong Kong experienced significant growth, as the HDI indicated. The survey revealed that 97% of 6- to 8-year-old children experienced ECC. Water fluoridation was implemented in 1961 at 0.7 ppm (0.9 ppm in winter) to prevent caries. The government offered free 9-year education in 1978. In 1981, the government established a dental school to improve a low dentist-to-population ratio of 1:9000. The ECC prevalence amongst 5- to 6- year-old children was reduced from 84% in 1968 to 63% in 1986. The Department of Health created an oral health education division in 1989. The ECC prevalence for 5-year-old children was further reduced to 44% in 1997. The ECC prevalence amongst 5-year-old children was stabilised at 51% both in 2001 and 2011. However in 2021, the prevalence of untreated ECC increased to 57% during the outbreak of COVID-19. Meta-regression analysis showed that ECC prevalence was not linked to GDP growth but decreased with improvements in HDI, the provision of 9-year free education, the establishment of a dental school, fluoridation of water supply, and implementation of territory-wide oral health promotion. In conclusion, better education, living conditions, and dental public health programmes have improved children's oral health in Hong Kong.
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Suscetibilidade à Cárie Dentária , Cárie Dentária , Humanos , Pré-Escolar , Criança , Hong Kong/epidemiologia , Saúde Pública , Cárie Dentária/epidemiologia , Cárie Dentária/prevenção & controle , Saúde Bucal , PrevalênciaRESUMO
OBJECTIVES: This study aimed to systemically review the tools developed for evaluating oral health-related quality of life (OHRQoL) in preschool children. METHODS: Two reviewers systematically searched English-language publications within PubMed, Embase, Scopus, and Web of Science. They screened the titles and abstracts and retrieved the full texts of the selected publications. Studies which developed, validated, or culturally adapted an OHRQoL tool used in preschool children were included. They recorded information regarding tool characteristics, item configuration, discriminative validation, the aim of assessment, and the target group. RESULTS: The study included 59 publications and identified 12 tools for assessing OHRQoL in preschool children. Seven tools were tailored for preschool ages. Most of the scales were generic oral health measures. Dental caries was the most commonly used oral condition for assessing a tool's discriminative validity. Eight tools required parental proxy reports. Three tools were both child-administrated and parent-administrated. One tool was designed to be answered solely by children. Ten tools assessed the oral health-related impact on children, including oral condition-related, functioning, environmental, and emotional/social domains. Four tools included items regarding the impact on both children and family. CONCLUSIONS: This review identified 12 tools developed for evaluating OHRQoL in preschool children, 7 of which were tailored for preschool age. The 12 tools were validated but incomprehensive due to the subjective and multidimensional nature of the OHRQoL concept. Researchers can choose a suitable tool for their studies by understanding the basic characteristics and item setting of the tools. Researchers can have an overview of the tools developed for evaluating OHRQoL in preschool children. They can use the findings from this review to choose a suitable tool for their studies regarding the OHRQoL in preschool children.
Assuntos
Cárie Dentária , Pré-Escolar , Humanos , Saúde Bucal , Pais , Qualidade de Vida , Inquéritos e QuestionáriosRESUMO
BACKGROUND: Using silver diamine fluoride (SDF) for caries management has raised dentists' interests in Southeast Asia (SEA). However, information about the teaching of SDF in dental schools in SEA is limited. Therefore, this survey aimed to describe the extent to which SDF had been introduced into the education of undergraduate students in the dental schools in SEA. METHODS: An online questionnaire survey was conducted on the duration, method, contents, and barriers regarding the teaching of SDF. Teachers in charge of undergraduate program in pediatric dentistry and those in community dentistry in all the 90 dental schools in SEA were approached and we required each department to reply once only. Descriptive statistics and Chi-square test were used to describe and assess the differences between the two departments in the teaching of SDF. RESULTS: A total of 81 responses from the departments of 49 schools were received, giving a school-level response rate of 54% (49/90). SDF was taught in the undergraduate program in 86% (42/49) of the respondent schools, and 50% (21/42) of these schools had included SDF in the teaching for five or more years. Almost all (98%) of the departments taught SDF through lectures. Furthermore, 55% of them adopted SDF in clinical practice. Regarding the teaching content, the use of SDF for arresting cavitated caries lesion was the most commonly covered (82-97%), followed by for arresting early noncavitated lesions (69-82%), for preventing new caries development (66-79%) and for treating dental hypersensitivity (77%). There were variations in the post-treatment instruction taught. For the departments not teaching SDF, the most common reason (10/19, 53%) was that SDF was not available. CONCLUSION: SDF is covered in the undergraduate program in most of the dental schools in SEA. The use of SDF to arrest cavitated caries lesions in primary teeth is usually taught. However, other applications of SDF, such as for prevention of caries and treatment of dental hypersensitivity, are less commonly mentioned in the teaching.
Assuntos
Cárie Dentária , Criança , Humanos , Cárie Dentária/prevenção & controle , Cárie Dentária/tratamento farmacológico , Cariostáticos/uso terapêutico , Faculdades de Odontologia , Fluoretos Tópicos/uso terapêutico , Compostos de Amônio Quaternário/uso terapêutico , Compostos de Prata/uso terapêuticoRESUMO
Diet, nutrition, and oral health are closely linked. Malnutrition is a challenging health concern in older adults that is associated with physical decline affecting their daily activities and quality of life. The aim of this review is to provide an evidence-based summary of the relationship between diet and nutrition and oral health in older adults and its implications. The World Health Organization has declared healthy ageing a priority of its work on ageing. The American Dental Association confirmed the bidirectional relationship between diet and nutrition and oral health. The literature shows that diet and nutrition are related to oral diseases, including dental caries, periodontal diseases, tooth wear, and even oral cancer. Insufficient nutritional intake and poor dietary habits increase the risk of oral diseases, such as dental caries, in older adults. On the other hand, in older adults, poor oral conditions such as periodontal disease may induce pain, infection, and tooth loss, affecting nutritional intake. Surveys have shown that older adults, in particular, those in disadvantaged communities, suffered from nutritional deficiencies or imbalances affecting their oral health. In addition, the current literature shows that malnutrition is associated with frailty, hospitalization, mortality, and morbidity. Good oral health and functional dentition are essential to maintain sufficient nutritional intake among older adults and reduce the risk of malnutrition. Therefore, integrating oral health into general health care service in older adults is imperative to improve their nutritional and oral health status to achieve healthy ageing.