ChatGPT-A double-edged sword for healthcare education? Implications for assessments of dental students.

INTRODUCTION: Open-source generative artificial intelligence (AI) applications are fast-transforming access to information and allow students to prepare assignments and offer quite accurate responses to a wide range of exam questions which are routinely used in assessments of students across the board including undergraduate dental students. This study aims to evaluate the performance of Chat Generative Pre-trained Transformer (ChatGPT), a generative AI-based application, on a wide range of assessments used in contemporary healthcare education and discusses the implications for undergraduate dental education. MATERIALS AND METHODS: This was an exploratory study investigating the accuracy of ChatGPT to attempt a range of recognised assessments in healthcare education curricula. A total of 50 independent items encompassing 50 different learning outcomes (n = 10 per item) were developed by the research team. These included 10 separate items based on each of the five commonly used question formats including multiple-choice questions (MCQs); short-answer questions (SAQs); short essay questions (SEQs); single true/false questions; and fill in the blanks items. Chat GPT was used to attempt each of these 50 questions. In addition, ChatGPT was used to generate reflective reports based on multisource feedback; research methodology; and critical appraisal of the literature. RESULTS: ChatGPT application provided accurate responses to majority of knowledge-based assessments based on MCQs, SAQs, SEQs, true/false and fill in the blanks items. However, it was only able to answer text-based questions and did not allow processing of questions based on images. Responses generated to written assignments were also satisfactory apart from those for critical appraisal of literature. Word count was the key limitation observed in outputs generated by the free version of ChatGPT. CONCLUSION: Notwithstanding their current limitations, generative AI-based applications have the potential to revolutionise virtual learning. Instead of treating it as a threat, healthcare educators need to adapt teaching and assessments in medical and dental education to the benefits of the learners while mitigating against dishonest use of AI-based technology.

The outcomes of auto-transplanted premolars in the anterior maxilla following traumatic dental injuries.

BACKGROUND/AIMS: Tooth auto-transplantation is a treatment option, which is often not considered to replace anterior maxillary incisors in children and adolescents. There are multiple prognostic factors that may influence the outcomes of premolar auto-transplantation, but there is limited evidence from human studies. The aim of this study was to report the outcomes of auto-transplanted premolars in the anterior maxilla following traumatic dental injuries (TDIs) and to identify their prognostic factors. MATERIALS AND METHODS: The clinical records of patients who had premolars transplanted in the anterior maxilla following TDI, with appropriate radiographs and a minimal of 1-year follow-up, were reviewed retrospectively. A specific data extraction form was developed, tested and used to collect information for the prognostic factors and outcomes. RESULTS: The cohort included 120 patients with 144 auto-transplanted premolars. The mean age was 12.2 years (±2.0), and the mean observation period was 3.7 years (±1.8). The success rate was 80%, and the survival rate was 93%. Unfavourable outcomes included external replacement resorption in 12.5%, uncontrolled external inflammatory resorption in 2.7%, and both resorption types in 4.9% of teeth. Periodontal healing was significantly associated with donor tooth root maturity, graft handling at the time of surgery including ease of donor tooth extraction and placement at the recipient sites, recipient site alveolar bone status, and post-operative transplant mobility. Seventy-four teeth (53.4%) were immature at the time of transplantation where pulp revascularisation was anticipated, and 52 (70%) of those had radiographic and clinical signs of pulp healing. Pulp healing was significantly related to donor tooth eruption stage, ease of extraction of donor tooth, and ease of placement in the recipient site. CONCLUSIONS: Good outcomes were observed for premolar teeth auto-transplanted in the anterior maxilla. The main prognostic factors were ease of extraction of donor tooth and ease of placement in the recipient sites and donor tooth root maturity.

Tooth auto-transplantation: A bibliometric analysis of the top 100 most-cited articles.

BACKGROUND/AIM: Tooth auto-transplantation has recently gained high clinical acceptance. The aim of this study was to identify the top 100 most-cited articles regarding tooth auto-transplantation, to analyse multiple citations and publication metrics and to outline the historical scientific advancements in this field. MATERIALS AND METHODS: An advanced search of the Clarivate Analytics' Web of Science 'Core Collection' and Elsevier's Scopus databases utilising specific keywords related to tooth auto-transplantation between 1971 and 2021 was performed. The retrieved articles were ranked in descending order based on their Web of Science citation counts and further cross-matched with citation data from Scopus. The extracted data included citation counts, citation density, level of evidence, year of publication, contributing authors names and institutes, corresponding author's address, journal of publication, journal local citations index, cumulative growth index, keywords and keywords Plus. Data analysis was performed using descriptive statistics and graphical mapping. RESULTS: A total of 1290 articles were retrieved. The top 100 most-cited articles received a total of 4899 (Web of Science) and 5250 (Scopus) citations. Among these, cohort studies (29%) and case series (18%) were the most common study designs. Scandinavian countries produced major contributions in defining the top 100 most-cited articles and ranked within the top 5 countries based on the number of publications and citations per year. The greatest contributing authors were Schwartz O (n = 12), Andreasen JO (n = 8) and Paulsen HU (n = 6), and they were affiliated with Copenhagen, Denmark. The top contributing journals were American Journal of Orthodontics and Dentofacial Orthopedics, International Journal of Oral and Maxillofacial Surgery, Oral Surgery Oral Medicine Oral Pathology Oral Radiology, European Journal of Orthodontics, Dental Traumatology and Journal of Oral and Maxillofacial Surgery. CONCLUSION: This bibliometric analysis revealed a large geographical scientific interest and broad development in the field of tooth auto-transplantation spanning multiple dental disciplines.

Qualitative study on barriers and coping strategies for dental care in autistic children: Parents' perspective.

BACKGROUND: Children with autism spectrum disorders (ASD) face challenges in home oral care, accessing a dentist and accepting dental treatment. AIM: To determine the barriers to dental care for autistic children in Singapore through the experiences and opinions of their parents. DESIGN: A qualitative exploratory approach comprising semistructured interviews and a focus group discussion was used. Audio recordings were transcribed and coded into themes using NVivo 12 software. RESULTS: Participants were 23 parents of autistic children aged 3-12 years. The following barriers were identified: (1) Sensory, physical and parental knowledge issues are related to toothbrushing difficulties and use of nonoptimally fluoridated toothpaste in autistic children. (2) Accessing dental services was hindered by a lack of parental knowledge on the importance of an early dental home, parental apprehension about the child's acceptance of dental care, lack of information on specialised dentists and perceived high cost of dental visits. Parental suggestions for improvements included understanding the child's sensory profile, more information on finding a suitable dentist and subsidisation of costs for multiple acclimatisation visits. CONCLUSION: Caregivers' education, information about specialised dentists and the availability of specific dental care resources for autistic children in Singapore are needed for optimising their dental care.

Online assessment platforms: What is on offer?

AIMS: Web-based digital assessment platforms offer several benefits for educational providers. The aims of this study were to evaluate digital assessment platforms suitable for design, delivery and quality assurance of assessments in dental education to facilitate informed choices by educational providers. METHODS: The study was based on an online cross-sectional survey. A questionnaire was designed to include relevant details of providers, types of assessments offered, post-assessment psychometrics, remote proctoring, integration with digital learning platforms faculty training, and indicative costs of services. Following a google search, 25 potential providers of digital assessment software were identified and contacted by email. RESULTS: Ten companies responded to the questionnaire. All providers, except one, reported extensive experience in delivering high-stake assessments for programs in dentistry, medicine and allied health professions. All companies confirmed availability of a wide variety of assessment formats and also offer remote proctoring either directly or through third parties. Indicative costs of different assessment platforms were also provided. CONCLUSION: This paper underscores the need for dental institutions to make informed decisions when choosing the most appropriate digital assessment platforms to suit their educational needs. It also provides a snapshot of services offered by commercial providers of assessment platforms. The Association for Dental Education in Europe can serve as a central hub to guide dental institutions on making informed choices for suitable assessment platforms to address their needs.

The use of aesthetic paediatric full coverage restorations among paediatric dental practitioners: an international survey.

Despite the recent growing evidence in support of prefabricated zirconia crown use as a successful option in managing grossly carious anterior and posterior primary teeth, the use of such crowns remains controversial within the paediatric dental profession. This study aims to assess the use of aesthetic full coverage paediatric restorations among paediatric dentists worldwide, with emphasis on aesthetic prefabricated zirconia crowns. This was an online cross-sectional survey questionnaire study comprising of 38 multiple-choice questions disseminated worldwide through the contact lists of national, regional and international paediatric dental organisations and social media platforms. The survey was completed by 556 respondents thus achieving power, with 391 (70.3%) females and 165 (29.7%) males. The respondents were from 55 different countries spread across six continents. The use of aesthetic full coverage restorations was reported by 80% (n = 444) of the respondents. For restoring anterior teeth, participants mainly used either composite strip crowns (94.4%, n = 419) or zirconia crowns (73.6%, n = 327), while those who used aesthetic crowns for restoring posterior teeth mainly used zirconia crowns (68.2%, n = 303). Within the limitations of this study, the results have shown a wide use of full coverage aesthetic restorations, including the use of zirconia crowns, of primary teeth within this international sample of practicing dentists.

Vital pulp treatment for traumatized permanent teeth: A systematic review.

BACKGROUND: Traumatic dental injuries involving the pulp are quite common and there is a need to evaluate the quality of evidence on the success of vital pulp treatment (VPT) interventions in traumatised permanent teeth. OBJECTIVES: The aim of this systematic review was to assess the success of VPT in the management of traumatised human vital permanent teeth diagnosed with complicated crown or crown-root fractures. METHODS: An electronic search of the following databases: Web of Science, Scopus, PubMed, MEDLINE, EMBASE, LILACS, Clinical Trial Registries and the grey literature was performed until 25th /8/2021. Controlled clinical trials, cohort studies, case-control studies, case series with at least five cases and a minimum of 12-months follow-up were included. Non-English language literature was excluded. Two independent assessors performed study selection, data extraction and quality assessment using the National Institutes of Health's quality assessment tool. Disagreements were resolved through consensus/with a third assessor. RESULTS: A total of 14-studies (2-controlled clinical trials, 1-case-control, and 11-case series) published between 1978-2020, with a total of 1081 permanent teeth and an age range between 6-42 years-old were included. Bias analysis ranged considerably from 'good' to 'poor'. Meta-analysis was not performed due to data heterogeneity, unclear reporting, and limited number of controlled clinical studies. Partial pulpotomy was the main reported clinical procedure with an overall success rate between 82.9-100%. Complete pulpotomy and direct pulp capping were associated with lower success rates of 79.4-85.7% and 19.5%, respectively. Calcium hydroxide was the main pulp capping material with favourable clinical and radiographic success (79.4-100%). Biodentine® , mineral trioxide aggregate and IRoot® BP were also associated with a high clinical and radiographic success, 80-91%, 80-100%, and 90-100%, respectively, albeit in fewer studies. DISCUSSION: Although a high success rate has been reported when using VPT in managing pulpally involved traumatised teeth, the results of this systematic review clearly highlighted a paucity and low quality of the available evidence. CONCLUSIONS: Overall high success of VPT in the management of traumatised vital permanent teeth were reported, although based on limited evidence of well-conducted clinical studies. REGISTRATION: PROSPERO database (CRD42020205213).

Present status and future directions: Surgical extrusion, intentional replantation and tooth autotransplantation.

Surgical extrusion, intentional replantation and tooth autotransplantation procedures are important treatment options that clinicians may consider performing in their day-to-day clinical practice. Despite compromised teeth are generally considered for extraction, clinicians must be aware that these cases could be suitable for management by these alternative predictable treatment options. Surgical extrusion, intentional replantation or tooth autotransplantation have similar treatment protocols which includes atraumatic tooth extraction, visualisation of the root portion and replantation. Surgical extrusion is defined as the 'procedure in which the remaining tooth structure is repositioned at a more coronal/supragingival position in the same socket in which the tooth was located originally'. Intentional replantation is defined as the 'deliberate extraction of a tooth and after evaluation of root surfaces, endodontic manipulation and repair, placement of the tooth back into its original position'. Tooth autotransplantation is defined as the 'transplantation of an unerupted or erupted tooth in the same individual, from one site to another extraction site or a new surgically prepared socket'. The same team previously published a narrative review (International Endodontic Journal. 2020, 53, 1636) and European Society of Endodontology position statement (International Endodontic Journal. 2020, 54, 655) on this topic in International Endodontic Journal. The aim of the current updated review was to provide the reader a complete overview and background on these procedures, to established clear clinical protocols and step-by-step for technically perform these therapies in their clinical practice and to establish future directions on the topics. The clinicians must periodically update their knowledge about these three procedures to achieve success.

Effect of dental trauma management resources on dental practitioners' confidence and knowledge: A pilot cross-sectional study.

BACKGROUND/AIM: The knowledge of standardized care guidelines is critical to the confidence of practitioners in managing dental trauma. Therefore, the aim of this study was to assess the awareness, use and impact of the International Association of Dental Traumatology guidelines, and the online Dental Trauma Guide on general dental practitioners' self-reported confidence and knowledge in managing traumatic dental injuries in the primary and permanent dentitions. MATERIALS AND METHODS: A cross-sectional, pre-piloted, 27-item self-administered questionnaire survey was distributed electronically to general dental practitioners' working within five member states of the Gulf Cooperation Council countries (Kingdom of Bahrain, Kingdom of Saudi Arabia, Kuwait, Oman, and Qatar) between September and December 2020. Data were collected and analysed using descriptive statistics and Wilcoxon Signed Rank test analysis for relevant comparisons. RESULTS: A total of 294 respondents completed the survey, with the majority being from the Kingdom of Saudi Arabia (47.4%) and Qatar (27.3%). A lack of evidence-based knowledge in managing traumatic dental injuries was evident among more than half of the respondents. Respondents who were cognizant of the recent International Association of Dental Traumatology guidelines (2020) and those who use the Dental Trauma Guide routinely demonstrated a higher self-reported confidence level in managing both simple and complex primary dentition trauma, as well as simple traumatic dental injuries in the permanent dentition (p < .05). CONCLUSION: This survey highlights critical deficiencies in the knowledge of a large number of the respondents in the management of dental trauma which is likely to cause irreversible long-term patient effects.

Occupational and speech therapists' perceptions of their role in dental care for children with autism spectrum disorder: A qualitative exploration.

BACKGROUND: Children with autism spectrum disorder (ASD) have challenges in home oral care, accessing a dentist and accepting dental treatment. Occupational therapists (OTs) and speech therapists (STs) are likely to be involved earlier in managing communication, behavioural and sensory processing issues. AIM: To determine perceived issues, barriers and potential solutions to dental care for children with ASD in Singapore from the perspective of OTs and STs. DESIGN: Semi-structured interviews and a focus group discussion involving OTs and STs who treat children with ASD were conducted. Audio recordings were transcribed and coded into themes using the NVivo 12 software. RESULTS: Emergent themes indicated that: (i) OTs and STs have important roles in recognition of issues with toothbrushing, oral pathology and harmful oral habits; (ii) OTs and STs were able to identify reasons for difficulties in oral home care for children with ASD and offer helpful strategies; and (iii) OTs and STs can play a role in pre-dental visit preparations but lack a clear dental referral pathway. CONCLUSIONS: OTs and STs exclusively assist in the early identification and referrals of children with ASD to the dentist. Interprofessional collaboration with dentists should be further explored to aid in the provision of preventive dental advice.

INTRA-CANAL ANTIBIOTIC PASTES MAY PROMOTE THICKER DENTIN WALLS AND CALCIUM HYDROXIDE MAY PROMOTE MORE APICAL CLOSURE.

ARTICLE TITLE AND BIBLIOGRAPHIC INFORMATION: Báez, Viviana; Corcos, Lorena; Morgillo, Florencia; Imperatrice, Lorena; Gualtieri, Ariel Félix (2022). Meta-analysis of regenerative endodontics outcomes with antibiotics pastes and calcium hydroxide. The apex of the iceberg. J Oral Biol Craniofac Res 12(1): 90-98. SOURCE OF FUNDING: Non-funded study TYPE OF STUDY/DESIGN: Systematic review and meta-analysis.

A comparison of MTA and Biodentine as medicaments for pulpotomy in traumatized anterior immature permanent teeth: A randomized clinical trial.

BACKGROUND/AIM: The placement of a biocompatible material after performing pulp therapy in traumatically exposed permanent incisors is one of the important factors that determine pulp healing. The aim of this study was to assess the clinical and radiographic outcomes when using mineral trioxide aggregate (MTA) and Biodentine as pulpotomy materials to maintain the vitality of traumatized immature anterior permanent teeth with pulp exposure. MATERIALS AND METHODS: Fifty traumatized immature anterior permanent teeth with exposed pulps were included in the study. Teeth were equally divided and randomly assigned to two groups MTA or Biodentine. After pulpotomy, pulp stumps were covered with MTA or Biodentine followed by a permanent restoration. Blinded clinical and radiographic evaluations were performed at baseline, immediate post-operative and after 6, 12 and 18 months according to pre-determined clinical and radiographic criteria. RESULTS: No statistically significant differences were observed between MTA and Biodentine for any of the clinical parameters, except for discoloration, which was significantly more prevalent in the MTA group (P < .001). No significant statistical difference was observed in the radiographic outcomes between MTA and Biodentine, as evidenced by continued root development and by an increased prevalence of root formation stage H in both groups. CONCLUSIONS: Both MTA and Biodentine showed similar clinical and radiographic outcomes when used as pulpotomy materials in the treatment of traumatized immature anterior permanent teeth. However, discoloration was significantly more prevalent in the MTA group.

Interventions for treating traumatised permanent front teeth: avulsed (knocked out) and replanted.

BACKGROUND: Traumatic dental injuries are common. One of the most severe injuries is when a permanent tooth is knocked completely out of the mouth (avulsed). In most circumstances the tooth should be replanted as quickly as possible. There is uncertainty on which interventions will maximise the survival and repair of the replanted tooth. This is an update of a Cochrane Review first published in 2010. OBJECTIVES: To compare the effects of a range of interventions for managing traumatised permanent front teeth with avulsion injuries. SEARCH METHODS: Cochrane Oral Health's Information Specialist searched the following databases: Cochrane Oral Health's Trials Register (to 8 March 2018), Cochrane Central Register of Controlled Trials (CENTRAL; 2018, Issue 2) in the Cochrane Library (searched 8 March 2018), MEDLINE Ovid (1946 to 8 March 2018), and Embase Ovid (1980 to 8 March 2018). The US National Institutes of Health Ongoing Trials Registry (ClinicalTrials.gov) and the World Health Organization International Clinical Trials Registry Platform were searched for ongoing trials. No restrictions were placed on the language or date of publication when searching the electronic databases. SELECTION CRITERIA: We considered randomised and quasi-randomised controlled trials that included a minimum follow-up period of 12 months, for interventions for avulsed and replanted permanent front teeth. DATA COLLECTION AND ANALYSIS: Two review authors independently selected studies, extracted data and assessed the risk of bias. Authors were contacted where further information about their study was required. MAIN RESULTS: Four studies, involving a total of 183 participants and 257 teeth were identified. Each of the interventions aimed to reduce infection or alter the inflammatory response or both at the time of or shortly after the tooth or teeth were replanted. Each study assessed a different intervention and therefore it was not appropriate or possible to numerically synthesise the data. All evidence was rated as being of very low quality due to problems with risk of bias and imprecision of results. This means that we are very uncertain about all of the results presented in this review.One study at high risk of bias with 69 participants (138 teeth) compared a 20-minute soak with gentamycin sulphate for both groups prior to replantation with the experimental group receiving daily hyperbaric oxygen for 80 minutes for the first 10 days. There was some evidence of a benefit for the hyperbaric oxygen group in respect of periodontal healing, tooth survival, and pulpal healing.One study at unclear risk of bias with 22 participants (27 teeth) compared the use of two root canal medicaments, Ledermix and Ultracal. There was insufficient evidence of a difference for periodontal healing or tooth survival. This was the only study to formally report adverse events with none identified. Study authors reported that Ledermix caused a greater level of patient dissatisfaction with the colour of avulsed and replanted teeth.A third study at high risk of bias with 19 participants compared extra- or intra-oral endodontics for avulsed teeth which were stored dry for longer than 60 minutes before replantation. There was insufficient evidence of a difference in periodontal healing.The fourth study at high risk of bias with 73 participants compared a 10-minute soak in either thymosin alpha 1 or saline before replantation followed by daily gingival injections with these same medicaments for the first 7 days. There was some evidence of a benefit for thymosin alpha 1 with respect to periodontal healing and tooth survival. AUTHORS' CONCLUSIONS: Based on the results of the included studies, there is insufficient evidence to support or refute the effectiveness of different interventions for avulsed and replanted permanent front teeth. The overall quality of existing evidence was very low, and therefore great caution should be exercised when generalising the results of the included trials. There is urgent need for further well-designed randomised controlled trials.

Effectiveness, Costs and Patient Acceptance of a Conventional and a Biological Treatment Approach for Carious Primary Teeth in Children.

BACKGROUND: Over the last years, conventional restorations for the treatment of active carious lesions (CL) in primary teeth have been challenged and a more biological approach has been suggested. This approach involves less invasive techniques that alter the environment of the CL isolating it from the cariogenic biofilm and substrate. AIM: To investigate the cost-effectiveness and patient acceptance of 2 treatment approaches for the treatment of deep CLs in primary teeth in children. METHODS: This was a retrospective/prospective cohort study carried out in 2 UK specialist hospital settings. Data on cost-effectiveness was extracted retrospectively from clinical dental records of 246 patients aged 4-9 years. A prospective study design was used to explore patient acceptance of the 2 treatment approaches. One hundred and ten patients aged 4-9 years and their carers completed 2 questionnaires on treatment acceptance. RESULTS: In total, 836 primary teeth that had received treatment with either approach were included. More than 2 thirds (75.7%) of the restorations in the conventional approach were of non-selective removal to hard dentine followed by pulpotomy (24.3%). In the biological approach, most of the restorations were stainless steel crowns placed with the Hall Technique (95%) followed by selective removal to firm dentine (5%). The majority of the primary teeth remained asymptomatic after a follow-up period of up to 77 months; 95.3% in the conventional and 95.8% in the biological arm. When the treatment costs were analysed, a statistically significant difference was found between the mean costs of the 2 approaches with a mean difference of GBP 45.20 (Pound Sterling; p < 0.001), in favour of the biological approach. The majority of the children and carers were happy with the conventional or biological restorations. CONCLUSION: Although both approaches had similar successful outcomes, the biological approach consisting mainly of Hall Technique was associated with reduced treatment costs. Both approaches were accepted favourably by the children and carers.

The diagnostic accuracy of laser Doppler flowmetry in assessing pulp blood flow in permanent teeth: A systematic review.

BACKGROUND/AIM: Pulp necrosis is a frequent complication following dental trauma. The diagnosis of the state of the dental pulp can be challenging as most commonly used diagnostic tools are subjective and rely on a response from the patient, potentially making their use unreliable, especially in the child population. The aim of the study was to systematically review the evidence on the use of laser Doppler flowmetry in the assessment of the pulp status of permanent teeth compared to other sensibility and/or vitality tests. METHODS: A systematic literature search, using MEDLINE, EMBASE, Cochrane Central Register of Controlled Trials, www.clinicaltrials.gov and www.controlled-trials.com, in addition to citation and manual reference list searches, was conducted up to 15th January 2018. A risk of bias assessment was performed using the quality assessment for diagnostic accuracy studies tool (QUADAS-2) with all steps performed independently by two reviewers. RESULTS: Four studies with a high risk of bias were included in the final analysis. Laser Doppler flowmetry was reported to be more accurate in differentiating between teeth with normal pulps and pulp necrosis with a sensitivity of (81.8%-100%) and specificity of 100% in comparison to other vitality tests such as pulp oximetry (sensitivity = 81.3%, specificity = 94.9%) and sensibility tests such as electric pulp testing (sensitivity = 63.3%-91.5%, specificity = 88%-100%). CONCLUSION: Despite the higher reported sensitivity and specificity of laser Doppler flowmetry in assessing pulp blood flow, these data are based on studies with a high level of bias and serious shortfalls in study designs. More research is needed to study the effect of different laser Doppler flowmetry's parameters on its diagnostic accuracy and the true cut-off ratios over which a tooth could be diagnosed as having a normal pulp.

The impact of dental caries and its treatment by conventional or biological approaches on the oral health-related quality of life of children and carers.

BACKGROUND: The effect of untreated dental caries and the approaches taken to its treatment have not been extensively elucidated in children. AIM: To investigate the impact of untreated dental caries on children aged 4-9 years and whether its treatment with either a conventional or a biological approach influenced the oral health-related quality of life (OHRQoL) of the children and their carers. DESIGN: Children (n = 110) and their carers attending two specialist centres for treatment of carious primary teeth completed the Early Childhood Oral Health Impact Scale and the Self-reported Scale of Oral Health Outcomes for 5-year-old Children at baseline prior to dental treatment and at 3-6 months following completion of dental care. Dental treatment was provided using either a conventional or a biological approach. RESULTS: Dental caries showed a negative impact on the child and family's OHRQoL (P = 0.001). Children reported difficulty eating (55.5%), sleeping (40%), and avoiding smiling because of how the teeth looked (27.3%). More than half of the parents reported their child had toothache. Parents perceived difficulty eating (40.9%), being irritable (38.2%), and difficulty drinking (30.9%) as being impacts of caries on their child's OHRQoL. In addition, approximately half the parents reported feeling a sense of guilt because of their child's dental disease. Following dental treatment, participants reported significant improvement in their overall health status (P = 0.001). Children's age, gender, or the treatment approach were not statistically significantly associated with changes in OHRQoL of the child or carer. Children and parents who initially reported greater impacts of untreated dental caries demonstrated greater improvements in their overall oral health status (P < 0.0001). CONCLUSION: Dental caries was associated with negative impacts on children and parents' quality of life. Treatment of caries improved the quality of life of children and families significantly, irrespective of whether the treatment was provided by a conventional or a biological approach.

Anaesthetic efficacy of 4% articaine and 2% lidocaine for extraction and pulpotomy of mandibular primary molars: an equivalence parallel prospective randomized controlled trial.

AIM: To compare the anaesthetic efficacy for pain and behaviour during treatment with mandibular infiltration using 4% articaine (BI) with inferior dental nerve clock (IDNB) using 2% lidocaine for extraction or pulp therapy in mandibular primary molars. DESIGN: This was equivalence parallel prospective RCT. A total of 98 children aged 5-9 years old were randomly assigned into two groups: BI supplemented by buccal intrapapillary infiltration with 4% articaine; IDNB with 2% lidocaine supplemented with long buccal infiltration. Behaviour during the injection and treatment procedures was assessed using Wong-Baker Facial Rating Scale (W-BFRS), Visual Analogue Scale (VAS), and Frankl Behaviour Rating Scale (FBRS). RESULTS: During the injection phase, the absolute differences in success rates between the two techniques were 0.06 (95% CI: -0.11 to 0.23) for VAS and -0.08 (95% CI: -0.19 to 0.03) for the behaviour of the child (FBRS). FBRS results showed the equivalence of the two, whereas the VAS results showed nonequivalence with the 95% confidence intervals slightly exceeding the equivalence margin (±0.20). W-BFRS success rates were 63.3% for both. During the treatment, VAS results showed similar success rates, demonstrating equivalence between the two as did the results for FBRS. CONCLUSION: The results suggested equivalence in success rates for both anaesthetic techniques during treatment.

Outcomes of the conventional and biological treatment approaches for the management of caries in the primary dentition.

BACKGROUND: In the last few years, conventional restorations including complete removal of carious tissue (CT) with or without pulp therapy for the treatment of carious lesions (CL) in primary teeth have been challenged and a more biological approach has been suggested. This approach involves the use of less invasive techniques which alter the environment of the CL isolating it from the cariogenic biofilm and substrate. Two of these treatment approaches that are becoming increasingly widely accepted and used in paediatric dentistry are the Hall Technique and indirect pulp capping (IPC). AIM: To investigate the outcome of the conventional versus the biological approaches for the treatment of deep CL in the primary teeth in children, delivered in a specialist paediatric dentistry training environment. DESIGN: This was a retrospective cohort study of 246 children aged 4-9 years, treated with either approach, conventional and biological, in two UK specialist hospital settings. Data were extracted from clinical dental records and post-operative radiographs of patients treated during the period 2006-2012. The outcome of the treatment in this study was categorised into three main categories: clinical, radiographic, and final outcome. Clinical and final outcomes were further described as success, minor, and major failure. RESULTS: In total, 836 primary teeth were included. In the conventional approach, 324 teeth had complete CT removal and 104 teeth had a pulpotomy. In the biological approach, 388 teeth had Hall Technique preformed metal crowns (PMC) placed and 20 teeth received indirect pulp capping. PMC were the restoration of choice for most of the cases where a pulpotomy had been carried out, and resin composite was most frequently used restorative material for the complete CT removal group. The majority of the primary teeth treated with either approach remained asymptomatic after a follow-up period of up to 77 months, 95.3% in the conventional and 95.8% in the biological. No significant association was found between the final outcome and the approach used for treatment, age of the patient, gender and number of carious surfaces or tooth type. CONCLUSION: Both the conventional and biological treatment approaches had similar final outcomes and were equally successful for management of CL in the primary dentition.

Anaesthetic efficacy of articaine versus lidocaine in children's dentistry: a systematic review and meta-analysis.

BACKGROUND: Over the last few years, numerous reviews and studies have awarded articaine hydrochloride local anaesthetic (LA) a superior reputation, with outcomes of different studies demonstrating a general tendency for articaine hydrochloride to outperform lidocaine hydrochloride for dental treatment. Nevertheless, there seems to be no clear agreement on which LA solution is more efficacious in dental treatment for children. There is no previous publication systematically reviewing and summarising the current best evidence with respect to the success rates of LA solutions in children. AIMS: To evaluate the available evidence on the efficacy of lidocaine and articaine, used in paediatric dentistry. DESIGN: A systematic search was conducted on Cochrane CENTRAL Register of Controlled Trials, MEDLINE (OVID; 1950 to June 2017), Cumulative Index to Nursing and Allied Health Literature (CINAHL; EBSCOhost; 1982 to June 2017), EMBASE (OVID; 1980 to June 2017), SCI-EXPANDED (ISI Web of Knowledge; 1900 to June 2017), key journals, and previous review bibliographies through June 2017. Original research studies that compared articaine with lidocaine for dental treatment in children were included. Methodological quality assessment and assessment of risk of bias were carried out for each of the included studies. RESULTS: Electronic searching identified 525 publications. Following the primary and secondary assessment process, six randomised controlled trials (RCT) were included in the final analysis. There was no difference between patient self-reported pain between articaine and lidocaine during treatment procedures (SMD = 0.06, P-value = 0.614), and no difference in the occurrence of adverse events between articaine and lidocaine injections following treatment in paediatric patients (RR = 1.10, P-value = 0.863). Yet, patients reported significantly less pain post-procedure following articaine injections (SMD = 0.37, P-value = 0.013). Substantial heterogeneity was noted in the reporting of outcomes among studies, with the overall quality of majority of studies being at high risk of bias. CONCLUSIONS: There is low quality evidence suggesting that both articaine as infiltration and lidocaine IAD nerve blocks presented the same efficacy when used for routine dental treatments, with no difference between patient self-reported pain between articaine and lidocaine during treatment procedures. Yet, significantly less pain post-procedure was reported following articaine injections. There was no difference in the occurrence of adverse events between articaine and lidocaine injections following treatment in paediatric patients.

Outcomes and prognostic factors that influence the success of tooth autotransplantation in children and adolescents.

BACKGROUND/AIM: Tooth autotransplantation has been advocated for replacement of missing teeth or teeth that are unsuitable for restoration. The aim of this study was to investigate the outcomes and prognostic factors that influenced the success of tooth transplantation in a paediatric population. MATERIALS AND METHODS: Data were extracted from the records of 75 patients (89 teeth). Demographic and prognostic factors were recorded and analysed for the clinical and radiographic outcomes for periodontal ligament (PDL) and pulp healing of transplanted teeth. RESULTS: The mean age at transplant was 13.2 years, and the mean follow-up observation period was 2.6±1.8 years with a range of 12.0 months to 9.9 years. The main reason for transplantation was to replace upper central incisors lost or missing due to dental trauma, hypodontia and dilaceration. Of the 45 teeth that were monitored for pulp revascularization, 75.6% showed clinical and radiographic signs of pulp healing and 24.4% showed signs of pulp necrosis and infection. Pulp healing was significantly related to the stage of root development of the transplant. Favourable PDL healing was observed in 87.6% of the transplants, while 13.5% showed signs of replacement resorption. PDL healing was significantly related to the stage of root formation of the transplanted tooth at the time of the surgery, the ease of handling and placement of the tooth, and the status of the alveolar bone at the recipient site at the time of the surgery. Overall success of tooth transplantation was 87.6%, and the survival rate was 94.4%. CONCLUSIONS: Tooth transplantation carried out in children and adolescents demonstrated high success and survival, with the stage of root development influencing both the pulp and PDL healing of the transplanted teeth.