Impact of fully online flipped classroom on academic achievement in undergraduate dental education: An experimental study.

INTRODUCTION: The last two decades have seen a shift towards blended learning in education due to technological advancements. This study focuses on dental education, comparing two blended learning models -enriched virtual and fully online flipped classroom - in terms of academic achievement, aligning with the Association for Dental Education in Europe's competencies. MATERIALS AND METHODS: The research was modelled in a quantitative design with a pre-post-test control group experimental design. The study was conducted at Ege University Faculty of Dentistry in Turkey for 4 weeks with the experimental (n = 44) and control (n = 39) groups divided into two groups by impartial assignment. To the experimental group, the theoretical part of the course was tried to be conveyed before each lesson with video lessons prepared with EdPuzzle containing reinforcement questions and a question set consisting of case questions. The practical learning objectives of the course were tried to be gained through the discussion of the previously presented case questions in the online synchronous course. As tools for collecting data, a unique academic achievement test, a course evaluation form and a semi-structured qualitative data collection form were used. RESULTS: It was seen that the flipped classroom model had a more positive effect on students' academic achievement than the enriched virtual classroom model. The general satisfaction levels of the participants regarding these two models are also higher in favour of the flipped classroom model. CONCLUSION: This study provides significant findings for educational institutions, policymakers and educators about the impact of fully online teaching methods on academic achievement. In this context, the flipped classroom method can be preferred both in cases where education is blocked and in dental education institutions that want to ensure digital transformation efficiently and partially remotely.

Does casein phosphopeptid amorphous calcium phosphate provide remineralization on white spot lesions and inhibition of Streptococcus mutans?

OBJECTIVE: The aim of this study was to evaluate the remineralization effect of Casein Phosphopeptid Amorphous Calcium Phosphate (CPP-ACP) on white spot lesions (WSL) and its inhibitory effect on Streptococcus mutans colonization. STUDY DESIGN: The study group consisted of 60 children exhibiting at least 1-WSL. Subjects were randomly divided into 2 groups: a test group of using CPP-ACP cream (Tooth Mousse, GC Europe N.V., Leuven, Belgium) and a control group using only fluoride containing toothpaste for a period of 3-months. Baseline WSLs were scored using DIAGNOdent device (KaVo Germany) and the saliva samples were collected to measure S. mutans counts. After the 3-month period the WSLs were again recorded and the saliva sample collection was repeated. Wilcoxon Signed Ranks Test was used for statistical analysis. RESULTS: DIAGNOdent measurements were increased by time (p = 0.002) in control group and no statistically significant diference (p = 0.217) was found in test group by the 3-month period. In both groups, the mutans counts were decreased in 3-month experimental period. CONCLUSIONS: These clinical and laboratory results suggested that CPP-ACP containing cream had a slight remineralization effect on the WSL in the 3-month evaluation period however longer observation is recommended to confirm whether the greater change in WSLs is maintained.

Oral findings and salivary parameters in children with celiac disease: a preliminary study.

OBJECTIVE: The aim of this study was to investigate the prevalence of dental enamel defects, recurrent aphthous stomatitis (RAS) and caries experience and to measure salivary flow rate, buffer capacity, saliva and plaque pH and salivary cariogenic microflora in patients with celiac disease (CD) compared to healthy subjects. SUBJECTS AND METHODS: Thirty-five patients, aged 6-19 years, with a diagnosis of CD and 35 healthy children of the same age participated in the study. Enamel defects were diagnosed and classified using Aine's classification. The patients with RAS and dental caries were recorded using WHO criteria. The parents were interviewed about various oral health-related factors. Saliva samples were collected to measure the stimulated salivary flow rate, buffer capacity and pH values of saliva and plaque. Salivary mutans streptococci and lactobacilli were counted. RESULTS: The enamel defects and RAS prevalence were statistically higher (40 and 37.1%, respectively) in the CD group, and the prevalence of salivary mutans streptococci (48 and 14%) and lactobacilli (51 and 34%) colonization was statistically lower (p = 0.012, p = 0.010) in the CD group; the DMFS and dfs values were similar in both groups. CONCLUSION: CD appeared to be associated with a significantly higher prevalence of developing enamel defects and RAS, but a lower prevalence of salivary mutans streptococci and lactobacilli colonization, and the diagnosis of these oral manifestations might be helpful for an early diagnosis of CD.

Autotransplantation of a Maxillary Premolar to Replace a Central Incisor: A Seven-Year Follow-Up.

Purpose: To discuss the transplantation of a maxillary premolar to replace a maxillary central incisor in a seven-year follow-up period.
Methods: An avulsed permanent maxillary central incisor was reimplanted by a pediatric dentist but it presented progressive external root resorption. Transplantation of the maxillary right first premolar was planned, as the patient presented a Class II malocclusion with increased overjet that would be treated with extractions of the maxillary premolars.
Results: The transplanted tooth did not present any negative symptoms other than discoloration, which was treated with bleaching for three years. At the end of a three- year follow-up period, a full ceramic restoration was done to improve translucency properties to provide better esthetics. The transplanted tooth presented healthy periapical and periodontal tissues in both clinical and radiographic examinations at the end of the seven-year follow-up period.
Conclusions: Autotransplantation of maxillary premolars can be a viable alternative to provide adequate physiologic and esthetic components for avulsed and reimplanted permanent incisors that presented unsuccessful results.

Evaluation of Glass-Ionomer versus Bulk-Fill Resin Composite: A Two-Year Randomized Clinical Study.

Background: The aim of this split-mouth design research was to compare the clinical performance of a glass-ionomer cement system on Class I/II cavities against the clinical performance of bulk-fill resin composite restoration materials. Methods: Thirty-five patients were randomized and enrolled in the study, aged between 10 and 12 years, all of whom had a matched pair of permanent mandibular carious molars with similar Class I/II. A total of 70 restoration placements were performed. The patients were each given two restorations consisting of either a glass-ionomer cement with a nano-filled coating or a bulk-fill resin composite after the use of a self-etch adhesive. The cumulative survival rates were estimated using log-rank test and the Kaplan−Meier method. For comparison of the restorative materials in line with the modified Ryge, the McNemar test and the Wilcoxon signed rank test were employed. Results: With regard to retention, the glass-ionomer cement system and bulk-fill resin composite performed similarly in permanent molars in Class I/II cavities over a period of up to 24-months (p > 0.05). Over the 24-month period, Class I restorations showed statistically better survival rates than Class II restorations (p < 0.05). In the case of glass-ionomer cement systems, over the two-year period, more common chipping and surface degradations were observed. Conclusions: The glass-ionomer cement system and bulk-fill resin composite restorative materials display good clinical performance over a period of 24-months.

Comparison of conventional versus colored compomers for class II restorations in primary molars: a 12-month clinical study.

OBJECTIVE: To evaluate the 12-month clinical performance of conventional (Compoglass F) and colored (Twinky Star) compomer restorative materials in class II restorations of primary molars. MATERIALS AND METHODS: A total of 196 restorations were placed in 98 children aged between 5 and 10 years (mean age: 7.43 +/- 1.31 years) who had bilateral matched pairs of carious posterior class II primary molars. A split-mouth design was used in which 2 materials (Compoglass F, Twinky Star) were randomly placed on contralateral sides by 3 dentists. At baseline, after 6 and after 12 months, the restorations were evaluated using modified US Public Health Service criteria for: secondary caries, marginal integrity, marginal discoloration, anatomic form and surface texture. The Alpha and Bravo scores were considered as clinical success. The data were subjected to statistical analysis by the Wilcoxon and McNemar tests (p < 0.05). The Kaplan-Meier survival method was applied to estimate survival percentages. RESULTS: No significant difference was found among the groups at all recalls regarding marginal integrity, marginal discoloration, anatomic form, secondary caries and surface texture. The 12-month mean cumulative survival rate of Compoglass F was 95.7%, while in the Twinky Star group, the survival rate was 93% in class II restorations with no significant difference between the groups for either material. CONCLUSION: Both conventional and colored compomer materials are suitable restorative materials for primary teeth for at least 12 months. Colored compomers could also be a good alternative to tooth-colored compomers in the restoration of primary molars.

Colonization and vertical transmission of Streptococcus mutans in Turkish children.

The aim of the study was to establish the colonization of Streptococcus mutans and to determine the possibility of intra-familial transmission in a group of Turkish children and their parents. A total of 56 children participated in the study together with their parents (20 fathers and 49 mothers). Saliva samples were collected from the individuals and cultivated on S. mutans selective TYCSB agar. The typical isolates of S. mutans were identified by using classical microbiological methods, as well as molecular typing of S. mutans clones which was performed by using AP PCR with OPA5 primer for the detection of transmission. The vertical transmission of salivary S. mutans was detected among 14 mother-father-child, 35 mother-child (one twins) and 6 father-child combinations. The homologies of strain types were recorded as 24% and 16.6% for mother-child and father-child combinations, respectively. A significant positive correlation (p<0.001) was found between the infected children and their parents with high S. mutans counts.

The effect of a chlorhexidine containing cavity disinfectant on the clinical performance of high-viscosity glass-ionomer cement following ART: 24-month results.

PURPOSE: To evaluate the effect of a chlorhexidine-gluconate-based cavity disinfectant on the clinical performance of high viscosity glass-ionomer cement following the ART approach under field conditions after 24 months. METHODS: 126 school children 6-8 years old who had bilateral matched pairs of carious Class I and II primary molars were included. A split mouth design was used in which Ketac Molar was randomly placed with or without the use of chlorhexidine-gluconate-based cavity disinfectant on contralateral sides by three dentists. The restorations were evaluated after 6, 12 and 24 months by two experienced examiners using USPHS-Ryge criteria. RESULTS: The 24-month mean cumulative survival rates of Ketac Molar without the use of disinfectant were 97.7% and 69.4% while in the disinfectant group, the survival rates were 95.2% and 63.9% in Class I and II restorations, respectively with no significant difference between the groups in both class types. In the non-disinfected group, large Class II cavities had significantly better survival rates than did small Class II cavities (P = 0.023). In the disinfected group, the failure rates in mean cumulative survivals from 6 to 12 months and 12 to 24 months significantly increased with time (P = 0.004 and P = 0.016 respectively).

A long-term effect of caries-related factors in initially caries-free children.

AIM: The aim of this study was to examine the rate and pattern of early childhood caries development in caries-free children based on their dental plaque accumulations, salivary Streptococcus mutans levels, maternal sharing, oral hygiene, and feeding attitudes at baseline and at 24-month follow-up period. DESIGN: A total of 92 children, aged between 15 to 35 months, comprised the study group. The children's dental examinations were first carried out at baseline, and 56 of them were re-examined 24 months later to determine the changes in dental status. The mothers were also interviewed at each examination based on a prepared questionnaire. RESULTS: The prevalence of caries incidence was 45% at 24-month evaluation period among initially caries-free children. The new caries formation was mostly observed on occlusal and aproximal surfaces of maxillary molars (28% and 26%) followed by mesial, distal and buccal surfaces of anterior teeth, respectively. Significant correlations between dental caries formation and maternal sharing, S. mutans levels, and plaque scores were found. CONCLUSION: The results indicated that early S. mutans colonization, high plaque accumulation, and maternal sharing were important factors on a child's caries development.

A clinical evaluation of resin-based composite and glass ionomer cement restorations placed in primary teeth using the ART approach: results at 24 months.

BACKGROUND: The authors evaluated the 24-month performance of a packable resin-based composite/dentin bonding system and a high-viscosity glass ionomer cement (GIC) in restorations placed in primary molars with the atraumatic restorative treatment (ART) approach. METHODS: Three dentists placed 419 restorations in 219 children aged 6 through 10 years who had bilateral matched pairs of carious posterior Class I and II primary teeth. They used a split-mouth design to place the two materials, which were assigned randomly to contralateral sides. The authors evaluated the restorations according to U.S. Public Health Service Ryge criteria. RESULTS: After 24 months, 96.7 percent of the Class I GIC restorations and 91 percent of the resin-based composite restorations survived, while the success rates for the Class II restorations were 76.1 percent and 82 percent for the GIC and resin-based composite restorations, respectively. The survival rate of the Class II resin-based composite restorations was 5.9 percent higher than that of the GIC restorations at the 24-month evaluation, but this difference was not statistically significant. However, the study results showed a statistically significant difference in survival rates between Class I and II restorations for both materials. CONCLUSION AND CLINICAL IMPLICATIONS: The two-year clinical performance of both materials was satisfactory for the restoration of Class I and II primary molars using the ART approach.

Oral and dental manifestations of gastroesophageal reflux disease in children: a preliminary study.

PURPOSE: The aim of this study was to investigate the effects of gastroeophageal reflux disease (GERD) on: (1) erosion; (2) caries formation; (3) salivary function; and (4) salivary microbiological counts. METHODS: Thirty-eight GERD patients with a mean age of 6 1/2 years and 42 healthy children of the same age and gender and social background comprised the study group. All subjects answered a detailed frequency questionnaire related to acidic drinks, foods, and sugar consumption and participated in a clinical dental examination. The caries experience of the children was recorded according to World Health Organization criteria, and erosion was scored according to the Eccles and Jenkins grading scale. The children were also investigated for stimulated salivary flow rate, buffer capacity, and salivary mutans streptococci (MS), lactobacilli, and yeast colonization. RESULTS: The prevalence of dental erosion and the salivary yeast and MS colonization in GERD children was found to be significantly higher than for healthy subjects (P<.05). The caries experience, salivary flow rate, buffering capacities of the children, and frequency of acidic drinks, foods, and sugar consumption were found to be similar in both groups. CONCLUSION: This current investigation has shown that GERD children were at an increased risk of developing erosion and caries compared with healthy subjects.

Association of maternal-child characteristics as a factor in early childhood caries and salivary bacterial counts.

UNLABELLED: The aim of this study was to investigate the caries-related microorganisms in saliva and the prevalence of Early childhood caries (ECC) in 15- to 35-month-old Turkish children and their associations with the characteristics of the mothers, socioeconomic criteria, and feeding habits of the children. METHODS: Saliva samples of 101 children were studied to determine the numbers of Streptococcus mutans, lactobacilli, and Candida albicans. A questionnaire regarding the characteristics of the mothers, socioeconomic criteria, and feeding habits of the children was carried out before the dental examinations of the mother-child pairs. RESULTS: The regression analyses revealed DMFS scores of the mothers as an impact factor for the children's caries experience. The prolonged usage of feeding bottle with sweetened milk, pacifier use, and maternal sharing were strongly associated with the colonization of S. mutans, lactobacilli, and C. albicans, respectively. A significant correlation was also found between maternal education and S. mutans. CONCLUSION: Data indicated that the mother's DMFS scores, education, and feeding habits were strong risk indicators for the colonization of caries-related micro-organisms and ECC.

The comparison of a dentin adhesive with calcium hydroxide as a pulp-capping agent on the exposed pulps of human and sheep teeth.

OBJECTIVE: This study evaluated the biocompatibility of a one-step dentin bonding agent (Prime&Bond 2.1) in pulp capping compared with calcium hydroxide [Ca(OH)2]. METHOD AND MATERIALS: Thirty sheep teeth and 20 intact human premolars were used. After cavity preparation, pulp exposure was achieved with a bur (#390). Adhesive pulp capping was performed in 25 teeth (15 sheep and 10 human). In the control group (12 sheep and 10 human teeth), pulps were capped with Ca(OH)2 and all of the cavities in both groups were sealed with resin composite. Three of the sheep teeth were used as intact controls. Teeth were extracted 7 or 90 days following treatment and prepared for histological examination and bacterial detection. RESULTS: At 7 days, severe inflammatory responses underlying the bonding agent and in the coronal pulp were observed with soft tissue disorganization in both human and sheep teeth capped with Prime&Bond 2.1. All of the teeth capped with Ca(OH)2 exhibited mild inflammatory reactions limited with the perforation area. After 90 days with the bonding agent, in 3 of 9 sheep teeth, chronic inflammatory reactions were significant, while slight pulpal reactions were observed in the others and dentin bridge formation in all of the sheep teeth was found. However, in human pulps, persistent, unresolved inflammation with the lack of dentin bridge formation was observed. In the Ca(OH)2 group, pulp repair with dentin bridging was found in all of the teeth, both sheep and human. No correlation was found between the presence of inflammation and bacterial staining using Spearman rank correlation test (P > .05). CONCLUSION: Prime&Bond 2.1 facilitates enhanced pulp healing and bridge formation in sheep teeth, but in human teeth it was not as successful as Ca(OH)2 as a pulp capping agent.

Lenz microphthalmia syndrome with dental anomalies: a case report.

This report describes the dental management and 7-year follow-up of a 14-year-old boy who showed the typical characteristics of Lenz microphthalmia syndrome, a rare genetic disorder characterized by multiple abnormalities. The main features of the syndrome are microphthalmia, developmental retardation, ear abnormalities, microcephaly, skeletal, digital and urogenital anomalies. The dental anomalies include micrognathia, hypodontia, agenesis of permanent teeth, conic-shaped incisors, and taurodontic molars. The purpose of the report was to document specific oral manifestations and dental anomalies and their management associated with a previously reported case.

Mesiodens in primary, mixed and permanent dentitions: a clinical and radiographic study.

The term mesiodens refers to a supernumerary tooth located between the maxillary central incisors. The aim of the study was to investigate the characteristics of mesiodens among children in Turkey. The study population involved 24 children who attended the Department of Pediatric Dentistry, Ege University for dental problems. The characteristics of mesiodens were obtained from clinical and radiographic examinations. Results showed that twenty-four patients had thirty-four mesiodens for an average of 1.42 mesiodens per person. Males were affected approximately 3 times more frequently in comparison with females. Forty-two percent of the patients had bilateral mesiodens. All of the mesiodens were conical in shape and 91% were in the downward position. The age and sex distribution, location, direction, eruption of mesiodens and effects on permanent maxillary incisors were also presented in this study. It could be concluded that, delayed, ectopic or asymmetric eruption of the central incisors should alert the clinician to the possibility of a mesiodens.

No adverse effect to bonding following caries disinfection with chlorhexidine.

PURPOSE: The purpose of this study was to evaluate the effect of 2% chlorhexidine-based cavity disinfectant on the microtensile bond strength of 3 restorative materials to caries-affected and sound primary dentin. METHODS: Eighteen exfoliated primary molars with occlusal caries and 18 sound primary molars were randomly divided into 3 experimental groups, according to the following restorative materials: (1) high-viscosity glass-ionomer cement (GIC; KetacMolar); (2) resin-modified GIC (Vitremer); and (3) dentin adhesive (Prime&Bond NT) with a packable composite (Surefil). The molars were further divided into 2 subgroups according to the application of chlorhexidine-based cavity disinfectant (Consepsis). Standard restoration blocks of 5 mm high were built up over the treated surfaces. Bond strength results were evaluated using by 1-way analysis of variance, and multiple comparisons were done via Tukey's test (P<.05). RESULTS: No statistically significant differences were found between the high-viscosity and resin-modified GIC and composite showed the highest bond strength values on both dentin surfaces. The distribution of failure modes between the high-viscosity and resin-modified GICs were mostly cohesive where adhesive failures were noted significantly in the composite. CONCLUSION: Using 2% chlorhexidine gluconate did not interfere with the microtensile bond strength of glass ionomer cements and composite.

Effectiveness of 2-year application of school-based chlorhexidine varnish, sodium fluoride gel, and dental health education programs in high-risk adolescents.

OBJECTIVE: To compare the caries preventive effects of 2-year application of school-based chlorhexidine varnish, sodium fluoride gel, and dental health education programs among a high-risk group of 11- to 13-year-olds with low caries activity. METHOD AND MATERIALS: A total of 149 subjects who had previous caries experience in the primary dentition and Streptococcus mutans levels higher than 10(5) at baseline with 0 DMFS index were selected for this randomized clinical trial. Subjects were allocated to one of 3 groups for treatment with chlorhexidine varnish (n = 50), sodium fluoride gel (n = 50), or a dental health education program (n = 49), which were repeated throughout the 2-year study. The outcomes examined at the end of the study were the caries increment (DMFS index), dental plaque scores, and salivary S mutans counts. RESULTS: The subjects in the education group showed a significant increase in the salivary levels of S mutans in comparison with the other groups (P = .004), but there was no significant difference among the groups in the caries increment after 2 years, with mean DMFS +/- SD as 0.95 +/- 1.33, 0.88 +/- 1.47, and 1.05 +/- 2.01 in the chlorhexidine varnish, sodium fluoride gel, and education groups, respectively. There were also no significant differences in the pre- and posttreatment plaque scores between the groups. CONCLUSION: Although all 3 preventive programs in this high-caries-risk group of children with low caries activity resulted in similar plaque and caries values after 2 years, longer follow-up studies are needed to clarify the effect of reduction in S mutans growth by chemotherapeutic agents in caries incidence.

Bacteremia incidence in pediatric patients under dental general anesthesia.

BACKGROUND: The aim of this study was to assess the incidence of bacteremia from various procedures in children undergoing dental treatment under general anesthesia. METHODS: Three blood samples for cultures were obtained from each patient; the first sample (10 ml basal) at the onset of the process and the second sample (10 ml) within 30 seconds following the nasotracheal intubation. The third blood sample (10 ml) was taken 30 seconds after the extraction of a deciduous tooth or a permanent tooth or slow drilling. Following incubation in an automated blood culture system, bacteria were identified by using conventional biochemical methods and commercial identification systems. Chi-square test was used to assess the findings statistically. RESULTS: All blood cultures were negative before intubation (baseline) in every patient. However, the percentage of positive samples in deciduous tooth extraction and permanent tooth extraction groups were 18/26 (69.2%) and 18/25 (72%), respectively. These values were significantly greater than the results of baseline 0/74 (0%), slow drilling 3/23 (13%), and nasotracheal intubation 9/74 (12.3%) (P < .05). CONCLUSION: Consequently, the patients treated under dental general anesthesia have to be evaluated with detailed physical examination and antibiotic prophylaxis should be given if required in order to prevent further unexpected bacterial endocarditis.

Inhibition of cultivable bacteria by chlorhexidine treatment of dentin lesions treated with the ART technique.

The aim of this study was to examine the changes in the cultivable microflora of carious dentin before and after atraumatic restorative treatment (ART) and investigate the inhibitory effect of chlorhexidine-gluconate-based cavity disinfectant in the microflora. Using a split mouth design, 35 primary molar pairs with class II carious lesions in 35 patients (mean age 7.31+/-0.47 years) were selected. The total viable counts (TVC), Streptococcus mutans and lactobacilli were first measured in the center of the infected demineralized lesion and then from the hard dentine after caries removal by the ART technique. Chlorhexidine-gluconate (2%)-based cavity disinfectant was applied to one of the molar pairs and the other molar received no disinfectant treatment. Thereafter, all of the teeth were restored with glass ionomer cement (GIC). Cavities were reassessed after 6 months and again dentine samples were microbiologically investigated. Removal of carious dentine by ART significantly reduced TVC, S. mutans and lactobacilli. After 6 months, application of chlorhexidine exhibited a greater significant reduction in TVC (p=0.013), and a significant reduction in S. mutans compared to the nondisinfected group (p<0.001). A significant reduction in lactobacilli counts was observed in both groups after 6 months, but the difference between the disinfected and nondisinfected groups was not significant (p=0.056). ART was found to be effective in reducing the cultivable microflora and chlorhexidine-gluconate-based cavity disinfectant might serve as a suitable additional agent in inhibiting the residual bacteria in the dentine.

Oral and dental manifestations of young asthmatics related to medication, severity and duration of condition.

BACKGROUND: The aim of this study was to investigate the caries risk of asthmatics in relation to dental plaque indices, salivary flow rate, pH and buffer capacity, saliva composition and salivary levels of Streptococcus mutans compared with healthy subjects and also to evaluate these parameters within different groups of asthmatics according to their medication, duration and severity of the disease. METHODS: The study group composed of 106 asthmatics and 100 healthy controls with the same age and social background aged between 6 and 19-years-old. For dental examinations, World Health Organization criteria and for plaque indices the Silness and Löe plaque index was used. All data were analyzed using t-test, chi2-test, Spearman rank correlation, Kruskal- Wallis, Mann-Whitney U-tests and Logistic Regression Analysis with Forward Stepwise Likelihood ratio method. RESULTS: A statistically significant decrease in the salivary flow rate and pH were found in the asthmatic group. The children in the asthmatic group aged between 6 and 10 years had significantly higher caries prevalence compared with the control group at the same age. There was a negative correlation between the duration of medication and the salivary pH and a positive correlation between duration of illness and the salivary levels of S. mutans in the asthmatics. CONCLUSION: It was found that asthma, through its disease status and its pharmacotherapy, carries some risk factors including decreased salivary flow rate and pH for caries development. It was also demonstrated that the duration of medication and illness had significant influences on the risk of caries in asthmatics.