Investigating the efficacy of a varnish containing gallic acid on remineralization of enamel lesions: an in vitro study.

This study evaluated the efficacy of a formulated remineralizing gallic acid (GA) varnish in treating artificial enamel caries lesions. Fifty-five intact bovine incisors were collected. Enamel blocks (5 × 9 mm) were prepared. A third of each block's surface remained intact. Primary carious lesions were induced on the middle and bottom thirds of the blocks by immersing the samples in a demineralization solution for 6 h. The bottom third of the blocks were further remineralized by randomly applying 0.5%, 2%, or 8% GA varnishes and 2.26% fluoride varnish (V varnish, Vericom, Seoul, Korea), or the varnish base without active ingredients (n = 11 each). The specimens were immersed in a remineralizing solution for 4 h and then subjected to a 2-hour immersion in the demineralizing solution. After six days of pH cycling, the surface microhardness was measured at depths of 30, 75, and 120 µm. The percentage of surface microhardness recovery (SMHR%) was compared among the groups using the Shapiro-Wilk, ANOVA, and Tukey HSD post-hoc tests (α = 0.05). The SMHR% of all experimental groups was higher than the control group at 30 µm (p < 0.05). The 0.5% GA varnish showed the highest SMHR% at all depths; however, the difference with the other experimental groups was significant at a depth of 30 µm (p < 0.05). The SMHR% of the fluoride and the 2% and 8% GA varnishes was comparable at all depths. All treatments potentially remineralize enamel lesions, with 0.5% GA varnish having the greatest effect, particularly on the top surface layer. As such, this newly developed varnish may emerge as a promising alternative to fluoride varnish.

Barriers to the Accessibility of Emergency Pediatric Dental Care Services during the COVID-19 Pandemic: A Qualitative Study in Mashhad, Iran.

Objectives: The aim of this study was to investigate barriers to the accessibility of emergency pediatric dental care services during the coronavirus disease 2019 (COVID-19) pandemic from the viewpoint of parents in Mashhad, Iran. Materials and Methods: A qualitative study was conducted on a purposive sample of parents seeking emergency dental care for their children during the COVID-19 pandemic. Data were collected through semi-structured face-to-face interviews. The participants were asked, "Were there any barriers encountered when seeking emergency dental care for your child during the COVID-19 pandemic?". If any barrier was faced, the parents were asked to explain about it. All interviews were recorded and transcribed verbatim. The thematic content analysis of the transcripts began after the first interview, and the interviews and analysis process continued until data saturation was achieved. Results: In total, 26 parents were interviewed. The thematic content analysis of the transcripts led to the recognition of three main categories of barriers: "fear of COVID-19", "financial constraints", and "dentists' less occupational activity". "fear of COVID-19" had two subcategories: "fear of contracting COVID-19" and "fear of transmitting COVID-19 to others". "financial constraints" also had two subcategories: "increased costs" and "decreased income". Conclusion: From the viewpoint of parents seeking emergency dental care for their children in Mashhad, Iran, there were various barriers to the accessibility of emergency pediatric dental care services during the COVID-19 pandemic. The barriers were not limited to the fear of COVID-19 and were partly outside the control of dentists and parents.

Effects of probiotic yogurt, casein phosphopeptide-amorphous calcium phosphate, and xylitol chewing gums on the salivary count of Streptococcus mutans: A single-blinded randomized controlled clinical trial.

Background: Dental caries is a preventable multifactorial disease, with Streptococcus mutans being suggested to be its primary pathogen. Our study aim was to compare the effects of three different low-cost and easy-to-use regimens with that of the gold standard (chlorhexidine [CHX] mouthwash) on the count of salivary S. mutans in dental students over 30 days. Materials and Methods: In this single-blinded parallel randomized controlled clinical trial, a total of 120 dental students were included and randomly allocated into four intervention groups: (1) CHX mouthwash (control(, (2) probiotic yogurt, (3) casein phosphopeptide-amorphous calcium phosphate chewing gum, and (4) xylitol chewing gum. Salivary S. mutans counts were evaluated at baseline, 15 days, and 30 days after initiation of the study and compared at different times and among different groups using the repeated measures analysis of variance design analysis and least significant difference test with SPSS software version 20. The level of significance was determined to be 0.05. Results: The microorganism count variable at baseline, first, and second follow-ups was significantly different for all groups except the probiotic yogurt group (P = 0.340). S. mutans count was significantly different when comparing the first follow-up and baseline values in the CHX and xylitol gum groups (P = 0.027, P = 0.037). When comparing the second follow-up with baseline values, a significant difference was observed in the xylitol gum group (P = 0.003). Conclusion: Xylitol chewing gum seems to be a viable alternative to the gold standard (CHX mouthwash) in reducing the salivary count of S. mutans.

Cytotoxicity and induced apoptosis of a new bioceramic cement containing simvastatin on stem cells from human exfoliated deciduous teeth.

Background: This study aims to compare cytotoxicity and induced apoptosis of a new bioceramic cement containing different concentrations of simvastatin on stem cells from human exfoliated deciduous teeth (SHED). Materials and Methods: This research was an in vitro study. To evaluate the cytotoxicity and induced apoptosis of the bioceramic cement containing different concentrations of simvastatin, the SHED were exposed to the cement during 1, 3, and 7 days. Pure bioceramic cement and pure simvastatin with concentrations of 1, 0.1, and 0.01 µM were also tested to evaluate the possible synergic effect. Mineral trioxide aggregate (MTA) as the gold standard of pulp dressing materials was compared. MTT assay and Annexin V assay were used to evaluate cytotoxicity and induced apoptosis, respectively. The data were analyzed using ANOVA and Tukey post hoc tests at the significance level of 0.05. Results: During 7 days, MTA, bioceramic cement, simvastatin 0.1 and 0.01 µM, and bioceramic cement containing 0.1 and 0.01 µM simvastatin increased (P < 0.05) and simvastatin with concentration of 1 µM decreased the cell viability (P < 0.05). Except for MTA and bioceramic cement containing 0.1 and 0.01 µM simvastatin, all other compounds induced apoptosis within 7 days (P < 0.05). Conclusion: After 7 days, the viability of the SHED in the presence of a new bioceramic cement containing 0.1 and 0.01 µM simvastatin was not compromised. Moreover, this cement showed superior results than MTA and provided an environment for cell proliferation. This finding appears to be due to the pharmacological effects of low concentrations of simvastatin.

Evaluation of the Impact of Dentoalveolar Trauma Management Training Course on Physicians and Dentists' Education in Multiple Hospitals in Mashhad, Iran.

Background: Dental trauma injuries are the second most common traumatic injuries among children and adolescents. An incorrect diagnosis or a delayed treatment of traumatic injuries may lead to irreparable damages. Thus, proper management provided by physicians and dentists is crucial for patients affected by these injuries.This study aimed to evaluate the impact of dentoalveolar trauma management training on improving physicians' and dentists' knowledge in different emergency wards in Mashhad, Iran. Methods: In this educational interventional study, a total number of 60 residents and interns selected from the following categories: maxillofacial surgery residents, emergency medicine residents, ear-nose-throat (ENT) residents, and medical interns were included, who were randomly selected. We gathered information using a valid and reliable questionnaire. Afterward, we provided the participants with booklets about dental traumas. By passing one month, the above-mentioned questionnaire was used to re-evaluate the target groups' knowledge. The results were statistically analyzed using Chi-square, One-way ANOVA and paired sample T-test with statistically significant differences defined for p < 0.05. Results: Prior to the training, the interns had the lowest knowledge, while the maxillofacial surgery residents had the highest level of knowledge in comparison to interns, ENT residents, and emergency medicine residents, respectively (p < 0.001). After completing the course, the maxillofacial surgery residents once again represented the highest knowledge, followed by emergency medicine residents, ENT residents, and medical interns, respectively. A statistically significant difference was noticed in pre- and post-course knowledge evaluation. Conclusion: A comparison of the results before and after the training course demonstrates a significant lack of knowledge on dentoalveolar traumas among physicians and also reveals that providing this education is necessary because it significantly increases their knowledge in this regard.

The effect of Remin Pro on the microhardness of initial enamel lesions in primary teeth: An in vitro study.

BACKGROUND: Remineralization is currently considered a treatment option for many clinicians. The present study was conducted to compare the effect of three remineralizing agents on microhardness of initial caries lesions in primary teeth. MATERIALS AND METHODS: In this in vitro study, 96 enamel samples were prepared. Microhardness was first measured for all the samples using the Vickers microhardness test. After developing the initial caries lesions, the microhardness of all the demineralized samples was measured, and the samples were then divided into four groups (n = 24). Casein phosphopeptide-amorphous calcium phosphate in Group 1, Remin Pro in Group 2, and acidulated phosphate fluoride gel in Group 3 were placed on the samples for 4 min. The control group received no treatments. The microhardness of the samples was measured again following a pH cycle of 5 days. The data were analyzed by ANOVA and the post hoc test at the significance level of P < 0.05. RESULTS: The mean microhardness reduced significantly in all the groups following the development of initial caries lesions and after the pH cycle of 3 days (P < 0.001). After the remineralization and pH cycle of 5 days, the mean microhardness was significantly lower in the control group compared to the other three groups (P < 0.001) and had increased in the three treated groups. The microhardness recovery rate also increased in the treated groups compared to the control group, but no significant differences were observed between the three groups themselves (P > 0.05). CONCLUSION: Remin Pro can be used as an effective substance for preventing tooth caries in children.

Effect of Casein Phosphopeptide Amorphous Calcium Phosphate and Xylitol Chewing Gums, and Probiotic Yogurt on Periodontal Parameters: A Randomized Clinical Trial.

Objectives: This study aimed to assess the effect of casein phosphopeptide amorphous calcium phosphate (CPP-ACP) and xylitol chewing gums, and probiotic yogurt, as chemical plaque control strategies, on periodontal parameters. Materials and Methods: This randomized clinical trial evaluated 120 eligible dental students that were randomly divided into four groups (n=30) for use of (I) CPP-ACP chewing gum, (II) xylitol chewing gum, (III) probiotic yogurt, and (IV) chlorhexidine (CHX) mouthwash. The oral hygiene index-simplified (OHI-S), Silness and Loe gingival index (GI), and Silness and Loe modified plaque index (PI) were measured before and on days 15 and 30 after using the products. Paired t-test or its non-parametric equivalent was used to analyze the parameters after the intervention compared with baseline. The study groups were compared using one-way ANOVA or its non-parametric equivalent. Results: The OHI-S did not change over time, and most participants had a good OHI-S. The CHX group had the most favorable, and the probiotic yogurt group had the least favorable GI. Pairwise comparisons of the groups did not reveal a significant difference in GI between the CPP-ACP gum and CHX groups (P>0.05). CHX caused the greatest improvement in PI, with significant differences with other groups. Conclusion: CHX was the most effective for improvement of periodontal parameters followed by CPP-ACP, which showed better results compared with other groups.

Evaluation of retentive strength of four luting cements with stainless steel crowns in primary molars: An in vitro study.

BACKGROUND: Stainless steel crown (SSC) is the most reliable restoration for primary teeth with extensive caries. Retention is of great importance for a successful restoration and is provided by various factors such as luting cements. The aim of this study was to evaluate the retentive strength of SSC cemented with four different luting cements. MATERIALS AND METHODS: In this in vitro study, A total of 55 extracted primary first molars were selected. Following crown selection and cementation (one with no cement and four groups cemented with resin, glass ionomer, zinc phosphate, and polycarboxylate), all the specimens were incubated and thermocycled in 5°C-55°C. Retentive properties of SSCs were tested with a mechanical test machine. First dislodgement of each specimen and full crown removal were recorded. One-way ANOVA test followed by least significant difference test and Kruskal-Wallis test was used for retentive strength comparison at the level of significance of P < 0.05. RESULTS: The results of the study showed that the specimens cemented with zinc phosphate exhibited higher retentive strength as compared to glass ionomer and polycarboxylate (P < 0.001 and P = 0.023, respectively). CONCLUSION: Zinc phosphate cement showed the most promising results; thus, it can be preferably used for cementation of the teeth with no grossly broken down crowns.

Viability and Reproducibility of Periodontal Ligament Cells on Avulsed Teeth Stored in Ham's F-10 Solution.

OBJECTIVES: The purpose of the present study was to evaluate the efficacy of Ham's F-10 in maintaining the viability and reproducibility of PDL cells on avulsed teeth. STUDY DESIGN: Sixty mature, healthy extracted premolars were used. The experimental media used were Ham's F-10, Hank's balanced salt solution (HBSS), skim milk, and tap water (n = 15 specimens each). Cell viability was tested after 1, 3, 6, and 24 h storage in medium. Cell reproducibility was assessed by methyl-thiazol-tetrazolium (MTT) assay after1, 3, and 6 h storage in Ham's F-10, HBSS, and tap water. RESULTS: The viability of PDL cells stored in Ham's F-10 and HBSS was significantly greater than that of samples stored in milk and tap water at all-time points (P<0.001). A significant difference in cell viability between samples stored in Ham's F-10 and HBSS (favoring the former) was observed only at 6h (P=0.04). MTT assay results were significantly better for samples stored in Ham's F-10 and HBSS than for those stored in tap water (P<0.001), with a significant difference between Ham's F-10 and HBSS observed only at 3h (P<0.001). CONCLUSIONS: Ham's F-10 is capable of preserving PDL cells viable and reproducible better than milk and tap water and similar to HBSS.

Effect of a passive sonic irrigation system on elimination of Enterococcus faecalis from root canal systems of primary teeth, using different concentrations of sodium hypochlorite: An in vitro evaluation.

Background. This in vitro study aimed to compare the antibacterial effect of different concentrations of sodium hypochlorite on elimination of Enterococcus faecalis from root canal systems of primary teeth with or without a passive sonic irrigation system (EndoActivator). Methods. The root canals of 120 extracted single-rooted primary incisors were prepared using the crown-down technique. The teeth were autoclaved and inoculated with E. faecalis. The infected samples were then randomly divided into 6 experimental groups of 15 and positive and negative control groups as follows: group 1: 0.5% sodium hypochlorite solution; group 2: 2.5% sodium hypochlorite solution; group 3: 5% sodium hypochlorite solution; group 4: 0.5% sodium hypochlorite solution + sonic activation; group 5: 2.5% sodium hypochlorite solution + sonic activation; and group 6: 5% sodium hypochlorite solution + sonic activation. Microbiological samples were collected before and after disinfection procedures and the colony-forming units were counted. Statistical analyses were performed using the two-way ANOVA and post hoc Duncan's tests in cases of significant difference. Results. There were no significant differences between the groups in any of the variables (concentration of antiseptic or use of sonic irrigation system). Conclusion. Use of passive sonic irrigation systems in endodontic treatment of single-rooted primary teeth is of no benefit compared to regular needle irrigation. The results of this study also recommends use of lower concentrations of sodium hypochlorite solution (0.5%) for irrigation of the root canal system rather than higher concentrations given approximately equal efficacy.

The effects of three remineralizing agents on regression of white spot lesions in children: A two-week, single-blind, randomized clinical trial.

BACKGROUND: This study investigated the effect of three remineralizing agents on improving white spot lesions (WSLs). MATERIAL AND METHODS: This clinical trial included children who had at least one WSL on anterior teeth of upper or lower jaws. The participants were randomly assigned to 4 groups by treatment: 1) a cream containing casein phosphopeptide-amorphous calcium phosphate and fluoride (MI Paste Plus); 2) a cream containing hydroxyapatite and fluoride (Remin Pro); 3) a 2% sodium fluoride gel; and 4) usual home care (control). The treatment was performed for 3 times over 10 days using special trays for retaining remineralizing agents. The area and mineral content of WSLs were measured at baseline (T1) and 1 day after finishing treatment (T2). Blinding was applied for outcome assessment. RESULTS: Eighty patients were assigned to MI Paste Plus, Remin Pro, NaF or control groups. The application of all remineralizing agents caused a significant decrease in area and a significant increase in mineral content of WSLs (p<0.05), whereas the control patients did not experience any significant alteration (p>0.05). At T2, the area of WSLs was significantly lower in three experimental groups compared to the control group (p=0.023), but between-group difference in mineral content of WSLs failed to achieve statistical significance (p=0.08). CONCLUSIONS: The in-office application of either MI Paste Plus or Remin Pro was as effective as 2% NaF for reducing area and increasing mineral content of WSLs. MI Paste Plus and Remin Pro could be recommended as suitable alternatives to NaF for managing WSLs. Key words:White spot lesion, caries, casein phosphopeptide-amorphous calcium phosphate, hydroxyapatite, sodium fluoride, CPP-ACP, MPlus, Remin Pro, NaF.

Clinical evaluation of fiber-reinforced composite crowns in pulp-treated primary molars: 12-month results.

OBJECTIVE: The aim of this study was to evaluate the clinical performance of tooth-colored fiber-reinforced composite (FRC) crowns in pulp-treated second primary mandibular teeth. MATERIALS AND METHODS: This split-mouth randomized, clinical trial performed on 67 children between 3 and 6 years with two primary mandibular second molars requiring pulp treatment. After pulp therapy, the teeth were randomly assigned to stainless steel crown (SSC) or FRC crown groups. Modified United States Public Health Service criteria were used to evaluate marginal integrity, marginal discoloration, and secondary caries in FRC crowns at intervals of 3, 6, and 12 months. Retention rate and gingival health were also compared between the two groups. The data were analyzed using Friedman, Cochran, and McNemar's tests at a significance level of 0.05. RESULTS: Intact marginal integrity in FRC crowns at 3, 6, and 12 months were 93.2%, 94.8%, and 94.2%, respectively. Marginal discoloration and secondary caries were not found at any of the FRC crowns. The retention rates of the FRC crowns were 100%, 98.3%, and 89.7% at 3, 6 and 12 months, respectively, whereas all the SSCs were found to be present and intact after 12 months (P = 0.016). There was no statistically significant difference between the two groups in gingival health. CONCLUSION: According to the results of this study, it seems that when esthetics is a concern, in cooperative patients with good oral hygiene, FRC crowns can be considered as a valuable procedure.

A Simplified Method for the Restoration of Severely Decayed Primary Incisors.

OBJECTIVES: Caries and dental trauma are common reasons for primary anterior teeth restorations in children. This non-control clinical trial was designed to evaluate crown restorations reinforced with a sectioned file post for the restoration of severely damaged primary maxillary incisors. MATERIALS AND METHODS: Thirty-eight primary maxillary incisors of 12 children (3-5 years old) with early childhood caries (ECC) received composite restorations with a custom made post. The restorations were evaluated using the modified United State Public Health Service (USPHS) criteria. The results were statistically analyzed by descriptive -analytical tests. RESULTS: In this trial, the quality of marginal adaptation decreased after three and 12 months intervals. Recurrent carious lesions were observed during intervals. In terms of restoration retention, only one patient lost both the post and the restoration at the 12-month follow up. CONCLUSION: The sectioned file post technique showed good retention and aesthetics for restoring severely damaged primary maxillary anterior teeth.

Knowledge of Emergency Management of Traumatized Teeth among Schoolteachers in Mashhad, Iran.

Background and aims. Dental trauma is an important oral health problem in children that requires immediate and appropriate management for long term success. The aim of this study was to evaluate the knowledge of elementary school teachers about emergency management of traumatic dental injuries in children. Materials and methods. A total of 163 teachers from 21 elementary schools from Mashhad, Iran participated in this study. Data were collected using a two-part questionnaire comprised of questions regarding demographic data and participants' knowledge about dental trauma. Results. The level of the teachers' knowledge was moderate (53.3%). Of the 163 participants, 104 (63.8%) were females and 59 (36.2%) were males. Among several predictors that were surveyed in this study, only the age of respondents signifi-cantly impacted the teachers' knowledge (P = 0.004). Conclusion. The results of this study showed the moderate level of knowledge of teachers regarding emergency manage-ment of traumatized teeth. Adding dental trauma management courses in the teacher training curriculum and requiring teachers to be updated in regards to this issue can improve their knowledge and thus led to better management of traumatic dental injuries in children.

A review on vital pulp therapy in primary teeth.

Maintaining deciduous teeth in function until their natural exfoliation is absolutely necessary. Vital pulp therapy (VPT) is a way of saving deciduous teeth. The most important factors in success of VPT are the early diagnosis of pulp and periradicular status, preservation of the pulp vitality and proper vascularization of the pulp. Development of new biomaterials with suitable biocompatibility and seal has changed the attitudes towards preserving the reversible pulp in cariously exposed teeth. Before exposure and irreversible involvement of the pulp, indirect pulp capping (IPC) is the treatment of choice, but after the spread of inflammation within the pulp chamber and establishment of irreversible pulpitis, removal of inflamed pulp tissue is recommended. In this review, new concepts in preservation of the healthy pulp tissue in deciduous teeth and induction of the reparative dentin formation with new biomaterials instead of devitalization and the consequent destruction of vital tissues are discussed.

Treatment of severe rotations of maxillary central incisors with whip appliance: Report of three cases.

The routine treatment for rotated maxillary incisor is a fixed appliance, but in some instance the use of this method is impossible. In addition, in only limited cases of rotation, removable appliance is applicable. In this study, the use of a semi-removable appliance is presented, which has some benefits over the other methods. In this study, the corrections of about 70-90° rotation of the maxillary central incisors in different phases of mixed dentition were performed in three patients using whip appliance. This method was performed using a simple removable appliance such as Hawley appliance and whip spring that forced the couple to derotate the tooth. In all cases, treatment was successfully completed in relative short duration. Whip appliance can be recommended as an effective method to correct rotation of maxillary incisor in mixed dentition with several advantages like rapid correction.

New approaches in vital pulp therapy in permanent teeth.

Vitality of dental pulp is essential for long-term tooth survival. The aim of vital pulp therapy is to maintain healthy pulp tissue by eliminating bacteria from the dentin-pulp complex. There are several different treatment options for vital pulp therapy in extensively decayed or traumatized teeth. Pulp capping or pulpotomy procedures rely upon an accurate assessment of the pulp status, and careful management of the remaining pulp tissue. The purpose of this review is to provide an overview of new approaches in vital pulp therapy in permanent teeth.

Apexogenesis and revascularization treatment procedures for two traumatized immature permanent maxillary incisors: a case report.

Traumatic injuries to an immature permanent tooth may result in cessation of dentin deposition and root maturation. Endodontic treatment is often complicated in premature tooth with an uncertain prognosis. This article describes successful treatment of two traumatized maxillary central incisors with complicated crown fracture three months after trauma. The radiographic examination showed immature roots in maxillary central incisors of a 9-year-old boy with a radiolucent lesion adjacent to the right central incisor. Apexogenesis was performed for the left central incisor and revascularization treatment was considered for the right one. In 18-month clinical and radiographic follow-up both teeth were asymptomatic, roots continued to develop, and periapical radiolucency of the right central incisor healed. Considering the root development of these contralateral teeth it can be concluded that revascularization is an appropriate treatment method in immature necrotic teeth.

Management of a severely submerged primary molar: a case report.

Ankylosis is a condition frequently associated with primary molars, wherein the ankylosed primary teeth remain in a fixed position, while the adjacent teeth continue to erupt, moving occlusally. In this case report, a five-year-old boy, who had a retained and submerged left lower second primary molar, was presented. Luxation of ankylosed primary molar was considered as a treatment approach. After four months, the tooth erupted to the occlusal level, and there was evidence of further development of a permanent successor in radiographic evaluation. After one year, tooth mobility, bone formation, and development of a permanent successor were in good condition.

The parents' knowledge and behavior towards the effects of using iron supplements on tooth staining and dental caries in Mashhad, Iran.

BACKGROUND: Iron deficiency is estimated to be the most common nutritional deficiency in both developed and underdeveloped nations. Iron supplements at early age may prevent iron deficiency. The aim of this study was to assess the knowledge and management of parents about using iron supplements related to dental caries and staining among Iranian children (6 months to 2 year-old) and to identify some factors underlying these attitudes. MATERIALS AND METHODS: This randomized cross sectional study was carried out on the parents of 220 children (6 months to 2-year-old) evaluated in health services centers in Mashhad in 2008. Parents filled questionnaires assessing their opinions on the risk of using iron supplement on tooth staining and dental caries. The results were statistically analyzed by descriptive-analytical, Mann Whitney and Kruscal Wallis tests. RESULTS: According to this study the relation between iron supplement application with tooth staining and its effect on dental caries, it must be noted that most parents (82.7%) had a moderate range of knowledge. Major of the parents (72.7%) had a moderate level of behavior. There was a significant difference between the knowledge level of fathers with their level of education (P = 0.01). CONCLUSION: The finding of this study indicates that parental knowledge about consumption of iron supplements by their children (6 months to 2-year-old) has been moderate. But their behavior was poor and needs more attention.