Partial pulpotomy success in primary molars followed up for 24 months: A randomized controlled clinical trial using mineral trioxide aggregate, biodentine, and acemannan.

BACKGROUND: Finding the best treatment approach and suitable capping materials in primary molars with deep carious lesions remains unresolved. AIM: To compare the success rates of partial pulpotomy in deep caries lesions in primary molars treated with mineral trioxide aggregate (MTA), biodentine, or acemannan for 6-24 months. DESIGN: A parallel-design, non-inferiority randomized controlled clinical trial was performed. Ninety mandibular primary molars from 65 children meeting the criteria, aged 3-8 years, were included. After inflamed pulp tissue removal and hemostasis, each tooth was randomly allocated into the MTA control group, or the biodentine or acemannan experimental group (N = 30 per group). All teeth were restored with a stainless steel crown. The outcomes were evaluated for 6-24 months. A generalized estimating equation model was used to compare the overall success rate in each group. RESULTS: After 24 months, 58 children (83 teeth) were available for evaluation. The results indicated that the success rate in the MTA, biodentine, and acemannan groups was 83.3%, 76.9%, and 74.1%, respectively. No significant difference in success rates among groups, however, was observed at the 6- to 24-month follow-ups (at 24th month, p = .30). CONCLUSION: There was no statistically significant difference between MTA, biodentine, or acemannan in the partial pulpotomy success after 24 months.

Combined use of stannous fluoride-containing mouth rinse and toothpaste prevents enamel erosion in vitro.

OBJECTIVE: To compare the protective effect of commercial stannous-containing mouth rinses on enamel erosion in a simulated 5-day in vitro cycling model. MATERIALS AND METHODS: 81 human enamel specimens were embedded in resin blocks and divided into nine groups as follows; group 1: stannous fluoride (1000SnF2) toothpaste; groups 2,3, and 4 were the same as group 1 plus Elmex®, PerioMed™, and Meridol®, respectively, group 5: stannous fluoride (1450SnF2) toothpaste, groups 6, 7, and 8 were the same as group 5 plus Elmex®, PerioMed™, and Meridol®, respectively, group 9: negative control. An erosive challenge was induced with a 1 min hydrochloric acid (0.01 M, pH 2.2) treatment 3 times per day. Each cycle included immersing in the toothpaste slurry twice for two minutes and a one-minute rinse. The enamel slabs were immersed in artificial saliva between each erosive cycle and incubated overnight at 37 °C. Surface hardness loss and enamel loss were determined by Knoop surface hardness and non-contact profilometry, respectively. Finally, enamel surfaces were analyzed by scanning electron microscopy and X-ray energy dispersive spectroscopy (SEM/EDS). RESULTS: All three mouth rinses had similar protective effects against erosion when using adjunct with 1000 SnF2 toothpaste (p > 0.05). With 1450 SnF2 toothpaste, Elmex® presented significantly lower surface hardness loss than Meridol® (p < 0.05). The combined use of Elmex® or PerioMed™ with toothpaste provided significantly better erosion protection than toothpaste alone, either 1000 or 1450 SnF2. In addition, 1000SnF2 toothpaste adjunct with mouth rinse is comparable to 1450 SnF2 toothpaste alone in preventing enamel erosion. CONCLUSION: All three mouth rinses reduced enamel erosion. The additional use of a high concentration stannous containing mouth rinse with 1450 SnF2 toothpaste increases the protective effect against enamel erosion in vitro. CLINICAL SIGNIFICANCE: To date, no standard protocol for preventing dental erosion is available. There are three stannous-containing mouth rinses on the market; however, no study compared their efficacy or indicated whether using adjuncts with anti-erosion toothpaste provides additional benefits. This study found that adding stannous mouth rinse to twice-daily toothpaste increases erosion protection.

Survival rate and associated factors affecting pulpectomy treatment outcome in primary teeth.

OBJECTIVES: To evaluate the survival rates of pulpectomized primary teeth treated under general anesthesia (GA) or local anesthesia (LA), and to determine which factors affected tooth survival following pulpectomy. MATERIALS AND METHODS: This retrospective study collected data from dental records. Patients under 5 years of age received dental treatment under GA or LA during 2007-2016, with at least one anterior or posterior tooth receiving a pulpectomy, were recruited. Pulpectomy was considered a failure if the tooth required extraction or retreatment due to pulp treatment failure. Survival analysis was used to assess the outcome. The cumulative survival probability was analyzed with the Kaplan-Meier estimator. Cox regression analysis was used to evaluate the associations between tooth survival and possible prognosis factors; sex, age, dental arch (upper/lower), tooth type (anterior/posterior), molar type (first/second molar), molar location (upper/lower molar), root filling material type, restoration type, preoperative radiographic findings and presence of pathologic root resorption. RESULTS: Two hundred and twenty-seven primary teeth were included. At the 5-year follow-up, the survival rates of the pulpectomized teeth treated under GA and LA were 81.4% and 87.4%, respectively, which were not significantly different (p ≥ 0.05). A radiolucency on the preoperative radiograph was the only factor associated with tooth extraction or retreatment following pulpectomy, with a hazard ratio of 3.88 (95% CI = 1.29-11.65). CONCLUSIONS: Pulpectomized primary teeth treated under GA and LA demonstrated high survival rates. Preoperative radiolucency is a possible associated factor that decreases tooth survival following pulpectomy. Why this paper is important Pulpectomy treatment under GA and LA provided high 5-year cumulative survival rates, which were not significantly different. Pulpectomy treatment in teeth with a preoperative radiolucency were 3.9-fold as likely to fail as teeth without pathology. Based on our findings, practitioners could apply these findings and discuss with caregivers about the treatment options, outcomes, and prognosis of pulpectomized teeth.

Comparing protection-motivation theory-based intervention with routine public dental health care.

OBJECTIVES: Tooth brushing with fluoride toothpaste has a major effect on the reduction in dental caries. However, among young children, tooth brushing requires skill and motivation from caregivers and is not widely practised. To find a more effective way to train caregivers, Protection-Motivation Theory (PMT)-based educational programmes were compared with the basic one with regard to the incremental caries rate in children, caregiver's motivation and caregiver's awareness. METHODS: In a quasi-experimental study, 9- to18-month-old children and their caregivers (N = 102) were allocated to PMT or control groups. The PMT group received PMT-based oral health education programme while the control group received public hospital's current one. Children's caries status and motivation and awareness among caregivers were measured. Mann-Whitney U test was used to find out the difference between control and test groups. RESULTS: After 12 months, the PMT group showed lower dmft, dmfs and incremental caries rate compared with control. Chi-square test showed the control group was at more risk of developing additional dental caries (RR 2.23, 95% C.I.: 1.41-3.54, p < 0.001), and when early carious lesions were included (RR 2.40, 95% C.I.: 1.56-3.69, p < 0.001). In terms of motivation and awareness among caregivers, the PMT group rated their perception of disease severity and belief in self-efficacy significantly higher than the control group. CONCLUSIONS: PMT-based education programmes encourage suitable motivation and awareness that changes oral healthcare behaviour of caregivers, relating to decreased incremental caries rate in infants and toddlers comparing with regular health education methods.

Early Childhood Caries and Its Associated Factors among 9- to 18-Month Old Exclusively Breastfed Children in Thailand: A Cross-Sectional Study.

Objective: The objective of this study was to investigate the early childhood caries (ECC) status and its risk factors in 9- to 18-month-old exclusively breastfed children in Thailand. Methods: Generally healthy 9- to 18-month-old children who had been exclusively breastfed were recruited. Information on children's oral hygiene practices and breastfeeding behaviors was collected through parental interviews using a questionnaire. Children's oral health status was assessed following the WHO caries diagnostic criteria, modified to record the noncavitated lesions. Multivariate logistic regression analysis was adopted to investigate its association with feeding and oral hygiene practices. Results: In total, 513 mother and child dyads (47% boys) were recruited. The prevalence of ECC was 42.5%. The mean (SD) d1mft and d1mfs scores (d1 included noncavitated and cavitated carious teeth/tooth surfaces) were 1.1 (1.4) and 1.3 (2.0), respectively. Multivariate logistic regression analysis revealed that older children with higher plaque scores (OR = 75.60; 95% CI: 40.19-142.20) who were breastfed to sleep (OR = 2.85; 95% CI: 1.48-5.49) and never had their teeth cleaned (OR = 8.51; 95% CI: 1.53-47.14), had a significantly higher chance of having ECC (p < 0.05). Conclusion: Prevalence of ECC is high among exclusively breastfed children aged 9-18 months in Thailand. ECC prevalence is significantly associated with the age of children, the level of dental plaque, breastfeeding to sleep, and oral cleaning. Among all factors, the level of dental plaque is the most significant factor associated with ECC among breastfed children.

Adjunctive use of fluoride rinsing and brush-on gel increased incipient caries-like lesion remineralization compared with fluoride toothpaste alone in situ.

Objective: The objective of this study was to compare the remineralizing effect of sodium fluoride (NaF) mouth rinse or NaF gel as an adjunct to NaF dentifrice on incipient caries-like lesions in an in situ cross-over design study, with three sessions of 30 days each. Materials and methods: Orthodontic brackets with artificial demineralized enamel slabs were attached to the upper first molars of 12 participants. A set of 3 test specimens from the same tooth was randomly assigned to each participant and allocated into three 30-day sessions: 1) brushing with 0.22% NaF dentifrice 2 times/day (F dentifrice), 2) brushing with 0.22% NaF dentifrice 2 times/day+ rinsing with 0.05% NaF before bedtime (F mouth rinse), 3) brushing with 0.22% NaF dentifrice 2 times/day + brushing with 1.1% NaF gel before bedtime (F brush-on gel). The mineral gain and lesion depth of the specimens were evaluated by micro-computed tomography. Results: The mean mineral gain from the NaF mouth rinse and the NaF brush-on gel was similar, but greater than that from the NaF dentifrice (p < .05). The NaF brush-on gel yielded the greatest mean depth of remineralization (168 µm), followed by the NaF mouth rinse (144 µm). Both depths were significantly greater than that of the NaF dentifrice (84 µm) (p < .05). Conclusions: Both 0.05% NaF mouth rinse and 1.1% NaF brush-on gel, used at bedtime, increased incipient caries-like lesion remineralization in situ in combination with brushing with NaF dentifrice twice a day.

Stimulation of Dentin Regeneration by Using Acemannan in Teeth with Lipopolysaccharide-induced Pulp Inflammation.

INTRODUCTION: This study investigated the effects of acemannan, a polysaccharide from Aloe vera, on human deciduous pulp cells in vitro and the response after vital pulp therapy in dog deciduous teeth. METHODS: Human primary dental pulpal cells were treated with acemannan in vitro and evaluated for proliferation, alkaline phosphatase activity, type I collagen, bone morphogenetic protein (BMP-2), BMP-4, vascular endothelial growth factor, and dentin sialoprotein expression and mineralization. Osteogenesis-related gene expression was analyzed by complementary DNA microarray. Pulpal inflammation was induced in dog teeth for 14 days. The inflamed pulp was removed, retaining the healthy pulp. The teeth were randomly divided into 3 treatment groups: acemannan, mineral trioxide aggregate, and formocresol. Sixty days later, the teeth were extracted and evaluated histopathologically. RESULTS: Acemannan significantly increased pulp cell proliferation, alkaline phosphatase, type I collagen, BMP-2, BMP-4, vascular endothelial growth factor, and dentin sialoprotein expression and mineralization approximately 1.4-, 1.6-, 1.6-, 5.5-, 2.6-, 3.8-, 1.8-, and 4.8-fold, respectively, compared with control. In vivo, partial pulpotomy treatment using acemannan generated outcomes similar to mineral trioxide aggregate treatment, resulting in mineralized bridge formation with normal pulp tissue without inflammation or pulp necrosis. In contrast, the formocresol group demonstrated pulp inflammation without mineralized bridge formation. CONCLUSIONS: Acemannan is biocompatible with the dental pulp. Furthermore, acemannan stimulated dentin regeneration in teeth with reversible pulpitis.

Clinical, radiographic, and histologic analysis of the effects of acemannan used in direct pulp capping of human primary teeth: short-term outcomes.

Acemannan has been previously reported as a direct pulp-capping agent in animal study. This natural material demonstrated its biocompatibility and enhanced reparative dentin formation. The objective of this study was to investigate the action of acemannan as a direct pulp-capping material in human primary teeth with deep caries. Forty-two deeply carious mandibular primary molars from 37 children, aged 7-11 years old diagnosed with reversible pulpitis were studied. After completely removing the infected dentine, teeth with a pinpoint pulpal exposure were randomly divided into two treatment groups: acemannan or calcium hydroxide. A glass-ionomer cement base was applied to all teeth prior to restoration with stainless steel crowns. Clinical and radiographic evaluation was performed 6 months post-treatment. The teeth due to exfoliate were extracted and histopathologically evaluated for inflammation, dentine bridge formation, and soft tissue organization. At 6 months, the overall clinical and radiographic success rates of direct pulp capping with acemannan and calcium hydroxide at 6 months were 72.73 and 70.0 %, respectively. The histopathological results indicated that the acemannan-treated group had significantly better histopathological responses compared with the calcium hydroxide-treated group (p < 0.05). These data suggest acemannan offers a valuable alternative biomaterial for vital pulp therapy in primary teeth.

Sodium fluoride mouthrinse used twice daily increased incipient caries lesion remineralization in an in situ model.

OBJECTIVES: To investigate the remineralizing effects of fluoride mouthrinses used at different times and frequency in addition to fluoride toothpaste. METHODS: A randomized crossover single blinded study comprised 4 experimental phases of 21 days each. Twelve orthodontic volunteers were fixed with an orthodontic bracket containing an artificial carious enamel slab, which was from the same tooth in all 4 phases, and were randomly assigned to the following groups: (1) brushing with F toothpaste 2× per day (F- brush), (2) F- brush+rinsing with 0.05% NaF (F- rinse) after lunch, (3) F- brush+F-rinse before bedtime, and (4) F- brush+F- rinse 2× per day. Mean mineral gain after each phase was determined from mineral density profiles obtained using Micro-CT. RESULTS: The mean mineral gain in all treatments with F- brush and F-rinse were significantly greater than those in F- brush (p<0.05). Moreover F- rinse 2× per day increased lesion remineralization more than F- rinse once a day. CONCLUSIONS: The twice-daily use of 0.05% NaF mouthrinse combined with twice-daily regular use of fluoride toothpaste resulted in the greatest remineralization of incipient caries. These data indicate that rinsing frequency is a factor affecting the effectiveness of fluoride mouthrinse. CLINICAL SIGNIFICANCE: The rinsing frequency of NaF mouthrinse, when used with fluoride toothpaste, also affects the remineralization. This finding, if confirmed by a clinical study, would lead to a new recommendation for fluoride mouthrinse used in high caries risk patients who could benefit from using it twice a day.