Multiple dental caries management of a 5-year-old child with MIS-C: a case report.

The rare hyper-inflammatory condition known as "multisystem inflammatory syndrome in children (MIS-C)" develops after a COVID-19 infection. Providing dental treatment for patients with MIS-C can be very challenging due to the immunocompromised condition found in these patients leading to rapid progression of other infections, including dental caries. Currently, there is a lack of information regarding the dental management of patients with MIS-C. This case report presents the multiple dental caries management in a 5-year-old Cambodian boy with MIS-C in a dental chair unit, without general anesthesia. Despite the challenges this case presented, i.e., the patient's age, hyper-inflammatory condition due to MIS-C, taking several medications, multiple caries lesions, and the language barrier for behavior management, we were able to meet this patient's needs. The patient's dental and physical health were found to be satisfactorily stable with no complications. At the 6-month recall, his overall oral health had dramatically improved. Careful treatment planning along with a multidisciplinary approach is highly recommended in such cases. The important roles of dentists are not only to treat oral infection, but also to approach patients holistically because the body systems are all connected.

Comparison of Oral Health-Related Quality of Life scores in children treated for early childhood caries under general and local anesthesia: a quasi-experimental study.

PURPOSE: The purpose of this study was to compare the changes in oral health-related quality of life (OHRQoL) scores in children treated for Early Childhood Caries (ECC) under general (GA) and local anesthesia (LA). METHODS: A quasi-experimental study was carried out on 73 children, with 37 in the GA group and 36 in the LA group. The early childhood oral health impact scale (ECOHIS) was used to measure OHRQoL, with the type of anesthesia (LA or GA) serving as the explanatory variable. A Friedman test was used to assess the difference between the LA and GA groups at baseline, one-week, and one-month follow-up points. RESULTS: The results showed a significant difference in the overall mean ECOHIS scores between the LA and GA groups at 1-week (LAmean ± SD = 6.12 ± 1.11, GAmean ± SD = 5.50 ± 0.88; P = 0.01) and 1-month (LAmean ± SD = 5.87 ± 1.12, GAmean ± SD = 4.96 ± 0.99; P < 0.001) follow-up points. Irrespective of the administered anesthesia, a significant (P < 0.001) reduction in the mean score for dental pain was observed at both 1-week (mean ± SD = 1.30 ± 1.16) and 1-month (mean ± SD = 0.81 ± 0.89) timepoints after the treatment, as compared to the baseline assessment (mean ± SD = 2.02 ± 1.02). CONCLUSION: Early treatment for ECC reduces pain, restore normal activities, and improves the quality of life of affected children. Specifically, GA was found to be more beneficial for both children and parents. However, further studies using more robust study designs and carefully considering related factors are necessary to confirm these findings.

Investigation of the effect of music listened to by patients with moderate dental anxiety during restoration of posterior occlusal dental caries.

OBJECTIVE: The aim of this randomized controlled study was to investigate the effect of music therapy during restorative dental treatments on patients with moderate dental anxiety. MATERIALS AND METHODS: Seventy patients were determined to have moderate dental anxiety by the Modified Dental Anxiety Scale (MDAS) and were divided randomly into two groups (n = 35). The first group did not listen to music during their restorative treatment (control group), and the second group listened to music of their choice (experimental group). Systolic blood pressure, diastolic blood pressure, heart rate, oxygen saturation, and body temperature were measured three times for each patient: once before the treatment, once after their dental caries were removed, and once at the end of the treatment. Salivary cortisol samples were taken from each patient before and after the treatment. The MDAS was re-administered to the patients at the end of the treatment, and the data were analyzed statistically. RESULTS: Only the diastolic blood pressure (P = 0.042) and the MDAS scores of the experimental group (P = 0.001) were significantly lower than the control group at the end of the treatment. CONCLUSION: While music listening did not have an effect on the physiologic parameters of the patients during restorative treatment, it decreased the MDAS scores of the patients. CLINICAL RELEVANCE: Although music therapy did not affect the physiological parameters during the restorative dental treatment, it may help to reduce patients' self reported anxiety level.

Desenvolvimento e caracterização fisico-química de um selante resinoso com propriedades antimicrobianas associadas à incorporação do extrato do caule de Schinopsis brasiliensis (Braúna) / Development and physicochemical characterization of a resinous sealant with antimicrobial properties associated with the incorporation of Schinopsis brasiliensis (Braúna) stem extract

Introdução: os selantes resinosos possuem atividade preventiva e terapêutica da cárie dentária oclusal através da criação de uma barreira física que impede a adesão de biofilme. Não existem relatos destes materiais com propriedades antimicrobianas e, neste ensejo, a adição de princípios ativos obtidos de fitoterápicos configura como uma opção possível para resolver esta limitação. Objetivos: avaliar o potencial antimicrobiano do selante Fluroshield® enriquecido com o extrato do caule de Schinopsis brasiliensis (Braúna), bem como, a liberação do princípio ativo, grau de conversão, resistência de união imediata ao esmalte e padrão de falha dos materiais experimentais. Metodologia: trata-se de um estudo experimental in vitro. As cascas da Braúna foram secas a 40 ± 1 °C e o extrato etanólico foi obtido por percolação do pó da casca da Schinopsis brasiliensis. O selante comercial Fluroshield® (Dentsply) foi enriquecido com as proporções em massa (g) [0% (Controle), 20%, 10%, 5%, 2,5% e 1,25%]. Foi realizada a avaliação da Atividade antimicrobiana, a liberação do princípio ativo foi aferida através de Ultra Cromatografia Líquida de Alta Performance (UHPLC), o grau de conversão (GC) através do Micro-Raman, a resistência de união (RU) imediata ao esmalte foi avaliada através do microcisalhamento e padrão de fratura através de análise em estereomicroscópio. Os valores finais foram submetidos aos testes de normalidade Shapiro-Wilky (p > 0,05) e Levene. Os dados paramétricos foram submetidos a análise de variância (ANOVA one-way) com pós-teste de Tukey (p <0,05) e os não paramétricos através do teste de Kruskal-Wallis com pós-teste de Dunn's através do software GraphPad Prism 8 e Microsoft Excel 2018. Resultados: materiais com maior % de extrato apresentaram menor GC, não houve diferença estatisticamente significativa para RU entre os diferentes grupos, o padrão de fratura predominante foi adesiva, houve liberação do princípio ativo em meio aquoso em todos os materiais e os grupos com 20% e 10% de extrato em massa foram capazes de inibir a formação de biofilme de maneira semelhante ao controle positivo (clorexidina 0,12%). Conclusão: a adição do extrato de Schinopsis brasiliensis em concentrações entre 10% e 20% apresenta-se como uma alternativa promissora para a obtenção de propriedades antimicrobianas em selantes resinosos (AU).

Introduction: dental sealants have a preventive and therapeutic activity in the prevention and treatment of dental caries. However, there are no reports of these materials with antimicrobial properties and the addition of phytotherapy molecules would be an option to solve this limitation. Objectives: to evaluate the antimicrobial properties of the Fluroshield™ sealant with the addition of the stem extract of Schinopsis brasiliensis (Braúna), as well as the potential for releasing the active ingredient, degree of conversion and immediate enamel bond strength. Methodology: this is an experimental in vitro study. Braúna barks were dried at 40 ± 1 °C and the ethanolic extract was obtained by percolation of Schinopsis brasiliensis bark powder. The commercial sealant Fluroshield™ was enriched with the proportions by mass (g) [0% (Control), 20%, 10%, 5%, 2.5% and 1.25%]. The evaluation of the Inhibition of Biofilm Formation was carried out, the release of the active principle was measured with Ultra High Performance Liquid Chromatography (UHPLC), the immediate bond strength (BS) to the dental tissue was evaluated with microshear and the degree of conversion (DC) with Micro-Raman. Final values were submitted to Shapiro-Wilky (p > 0.05) and Levene normality tests. Parametric data were submitted to analysis of variance (one-way ANOVA) with Tukey's post-test (p <0.05) and nonparametric data through the Kruskal-Wallis test with Dunn's post-test using the GraphPad Prism software 8 and Microsoft Excel 2018. Results: materials with a higher % of extract had a lower DC, there was no statistically significant difference for BS between the different groups, there was release of the active principle in all materials and groups with 20% and 10 % of extract by mass were able to inhibit biofilm formation similarly to the positive control (0.12% chlorhexidine). Conclusion: the addition of Schinopsis brasiliensis extract in concentrations between 10% and 20% is a promising alternative for obtaining antimicrobial properties in resin sealants (AU).

The use of consent forms in a "call from class" model of dental care for Australian Indigenous children.

ISSUES ADDRESSED: Dental caries is one of the most prevalent non-communicable diseases in children. Indigenous children reported a disproportionately higher prevalence of dental disease compared to their age-matched counterparts. To improve access to dental care a community-controlled service provides culturally appropriate dental services on the site of an Indigenous primary and secondary school. The dental clinic utilises a "call from class" model of care. Consent forms seeking permission to undertake a dental examination without a parent/guardian present during school hours are sent home. When the forms are returned, the student is located in class and a dental examination is undertaken. METHODS: A retrospective audit of dental records from 2019 and 2020 were undertaken. The number of consent forms sent and returned were recorded. RESULTS: In 2019, 87% (n = 220) of the school population were sent consent forms. Of the forms issued, 70% (n = 154) were returned. Almost all students required further treatment (90%, n = 137) and were sent a treatment consent form. Of the total student population, 67% (n = 171) were not seen or had outstanding treatment from unreturned forms. Proportions of incomplete treatment and unseen students were similar in 2020 (64%, n = 173). In this model, barriers are lessened by providing a free dental service on the school site. CONCLUSIONS: Consent is an ethical and legal necessity to undertake dental examination and treatment. Using physical forms were effective for gaining consent for most children. However, less than half of the school population's dental treatment was completed. Future studies should be conducted to explore the acceptability of using consent forms by parents/guardians and different models to gain consent for children from complex social circumstances.

Dental anthropological report: Exploring plant-based treatments through the analysis of dental calculus and sediment of dental caries in a woman from the Late Preceramic period, Peru.

Reconstructing plant-based healing treatments of past societies from a dental anthropological perspective is still challenging due to a wide range of plant species, many with both medicinal and nutritional properties, and limitations on plant-taxa identification. Starch grains and phytoliths retrieved in samples from dental calculus and sediment contained in the cavity of dental caries were examined to investigate the supply of a plant-based treatment in an individual buried in the Late Preceramic site of Huaca El Paraíso (2100-1500 BCE), whose osteological analysis reported the absence of any pathological condition at a bone tissue level. A variety of starch grains such as pumpkins, manioc, maize, and beans had an important role in the diet of the individual. The starch grains were embedded in their dental calculus, all of which, except for manioc, showed signs of cooking damage. Considering the context and characteristics of the crops, the nutritional properties of maize, pumpkins and beans are evident. However, parallel medicinal properties of manioc and maize could not be entirely denied. Phytoliths morphologically ascribed to the Asteraceae plant family, which suggest the consumption of medicinal plants of Andean vernacular use, were retrieved in the sediment of dental caries. Our results prove that the analysis of sediment obtained from dental caries is as valuable in tracing medicinal plant-based treatments as dental calculus in archaeological populations. There are still several limitations to approach this topic in dental anthropology, which are discussed in this report. The performance of both analyses -dental calculus and sediment of dental caries, is highly recommended.

Diagnóstico e decisões de tratamento para cárie induzido por luz: aplicação de uma câmera intraoral com fluorescência / Diagnosis and treatment decisions for light-induced caries: application of an intraoral fluorescence camera

Objetivou-se verificar se 1) o diagnóstico por fluorescência (DF) e o exame visual (EV), são igualmente eficazes em detectar lesões de mancha branca (MB); 2) verificar se imagens obtidas por uma câmera intraoral, no modo luz branca (LB) ou fluorescente (LF) são comparáveis à radiografia digital (RD) no diagnóstico e no auxílio às decisões de tratamento para cárie oclusal e 3) verificar se a câmera intraoral, no modo LF, comporta-se com precisão, ao definir se a remoção químico-mecânica (RQM) de dentina cariada com gel de papaína estabelece um adequado limite para o preparo. Neste contexto, três estudos foram propostos. O primeiro estudo contou com uma revisão sistemática da literatura, a fim de verificar se o DF e o EV, são comparáveis em detectar lesões de MB relacionada a ortodontia fixa. Cinco estudos foram incluídos nesta revisão. O diagnóstico de MB relacionada a ortodontia fixa, realizado por fluorescência, foi satisfatório em relação ao EV, porém com baixa qualidade das evidências. O segundo estudo contou com uma pesquisa ex vivo, com 10 molares permanentes e 26 dentistas avaliadores, e propôs verificar se imagens obtidas pela câmera intraoral SoproLife®, no modo LB e LF, e as RD, são comparáveis no diagnóstico e decisões de tratamento de cárie oclusal, comparado a um padrão-ouro em microtomografia computadorizada (micro-CT). Para o diagnóstico de cárie, não foi encontrada diferença entre os três métodos (p=0,415), com uma concordância geral baixa (média de 15,3%), enquanto para as decisões de tratamento, o percentual de acertos entre os três métodos foi maior para a LB (48,1%) e LF (51,2%) em relação a RD (30,4%) (p<0,001). O terceiro estudo foi realizado ex vivo, a fim de verificar se a câmera intraoral SoproLife®, no modo LF, comporta-se com precisão, ao definir se a RQM de dentina cariada pelo gel é suficiente comparado a um padrão-ouro em micro-CT. A efetividade de dois géis de papaína na remoção de cárie em dentina também foi estudada. Após o escaneamento inicial, 20 molares permanentes foram pareados e divididos em grupos, (G1) Papacárie Duo® e (G2) Brix3000®. O limiar para a detecção de tecido cariado de <1,11 g/cm3, foi utilizado. A eficácia da RQM foi menor para o Papacárie Duo® comparado ao Brix3000® (p<0,05). Ambos os grupos apresentaram falsos positivos quando a câmera intraoral SoproLife® considerou tecido cariado presente. Deste modo, conclui-se que: 1) O diagnóstico de MB relacionada a ortodontia fixa por DF, mostrou-se satisfatório em relação ao EV; 2) Imagens em LB, LF e RD, foram eficazes nas decisões de tratamento de cárie oclusal; 3) a câmera intraoral SoproLife® não definiu apropriadamente se a RQM pelo gel foi suficiente; 4) a utilização dos géis de papaína resultou em remoção de tecido cariado conservativa, preservando tecido dental sadio. (AU)

The aim was to verify if 1) fluorescence diagnosis (FD) and visual examination (VE) are equally effective in detecting white spot (WS) lesions; 2) to verify whether images transmitted by an intraoral camera in white light (WL) mode or fluorescent (FL) are comparable to digital radiography (DR) in diagnosing and aiding treatment decisions for occlusal caries and 3) verify whether the intraoral camera, in FL mode, behaves accurately, when defining whether chemical-mechanical removal (CMR) of carious dentin with papain gel results in appropriate threshold for cavity preparation. In this context, three studies were proposed. The first study was a systematic review of the literature, in order to verify if FD and VE are comparable in detecting WS lesions related to fixed orthodontics. Five studies were included in this review. The diagnosis of WS, performed by fluorescence, was satisfactory in relation to VE, but with very low quality of evidence. The second study included an ex vivo survey, with 10 permanent molars and 26 examiners, and verified whether images obtained by the SoproLife® intraoral camera, in WL and FL mode, and the DR, are comparable in the diagnosis and treatment decisions of occlusal caries compared to a gold standard in micro-computed tomography (micro-CT). For caries diagnosis, no difference was found between the three methods (p=0.415), with a low overall agreement (mean of 15.3%), while for treatment decisions, the percentage of correct answers between the three methods was higher for WL (48.1%) and FL (51.2%) compared to DR (30.4%) (p<0.001). The third study was performed ex vivo, in order to verify whether SoproLife® intraoral camera, in FL mode, behaves accurately, when defining whether the CMR of carious dentin is sufficient compared to a gold standard in micro-CT. The effectiveness of two papain gels in removing caries in dentin was also studied. After the initial scan, 20 permanent molars were paired and divided into groups, (G1) Papacárie Duo® and (G2) Brix3000®. A threshold for carious tissue (<1.11 g/cm3) was used. The effectiveness of CMR was lower for Papacárie Duo® compared to Brix3000® (p<0.05). Both groups showed false positives when SoproLife® intraoral camera evaluated carious tissue present. Thus, it is concluded that: 1) The diagnosis of WS related to fixed orthodontics due to FD, was satisfactory in relation to VE; 2) WL, FL and DR images were effective in defining occlusal caries treatment decisions and 3) SoproLife® intraoral camera did not properly define whether CMR sufficient and 4) the use of papain gels resulted in conservative removal of carious tissue, preserving sound dental tissue. (AU)

Parent perceptions of minimally invasive dental treatment of Australian Aboriginal pre-school children in rural and remote communities.

INTRODUCTION: Aboriginal* children in rural and remote communities in Australia have a higher burden of dental decay and poorer access to dental services than their non-Aboriginal counterparts. In the Kimberley region of Western Australia (WA), Aboriginal children experience six times the rate of untreated dental decay of non-Aboriginal children. Access to dental care is challenged by the availability and appropriate delivery of services in remote locations. This study elicited the experiences and perceptions of parents and carers who participated in a project that tested the minimally invasive atraumatic restorative treatment and the Hall technique approaches (ART-HT) to manage early childhood dental caries among Australian Aboriginal preschool children. METHODS: The core study design was a stepped-wedge, cluster-community-randomised controlled trial. Consenting communities in the Kimberley region of WA were randomised into early and delayed intervention groups. Children were clinically examined at study commencement; the early intervention group was offered dental treatment using the ART-HT approach, and the delayed group was advised to seek dental care from their usual service provider. At the 12-month follow-up, children in both groups were re-examined and offered care using the minimally invasive model of care, and parents and carers were invited to take part in focus group or one-to-one interviews. Semistructured interviews, guided by the yarning approach, were conducted with consenting parents and carers in community locations of convenience to participants. The same open-ended questions were asked of all participants, and the interviews were audio-recorded with permission and transcribed by an independent agency. Thematic analysis was undertaken, the transcripts were coded by NVivo software, and emergent themes were identified and developed. RESULTS: One-to-one interviews were conducted with 29 parents and carers (10 from five test communities; 19 from eight control communities). Interview participants consisted of 3 males and 26 females. Following thematic analysis, three main themes (and subthemes) were identified: (1) access to care (barriers, service availability, impact on family due to lack of access); (2) experience of care (cultural safety, child-centred care, comprehensiveness of care); (3) community engagement (service information, engagement, oral health education). Structural and system factors as well as geography were identified as barriers by parents and carers in accessing timely and affordable dental care in culturally safe environments; parents and carers also identified the impacts from lack of access to care. They valued comprehensive care delivered within community, underpinned by child- and family-centred care. Of equal importance was the holistic approach adopted through the building of community engagement and trusting relationships. CONCLUSION: A high level of satisfaction was reported by parents and carers with their experience of dental care for their children with the minimally invasive approach. Satisfaction was expressed around ease of accessing services delivered in a child- and family-centred manner, and that were well supported by appropriate engagement between service providers, communities and families. The findings from this study suggest a minimally invasive dental care model can be considered effective and culturally acceptable and should be considered in delivering oral health services for young children in rural and remote locations. * The term Aboriginal is inclusive of Aboriginal and Torres Strait Islander peoples.

Treatment of symptomatic, deep, almost cariously exposed lesions using ozone.

The aim of this controlled randomized crossover study was to assess post-treatment pain and the need for root canal treatment after the use of a traditional caries removal method followed by restoration, or after an ozone method of more conservatively managing the deep caries and a restoration. 84 participants (42 males and 42 females, mean age ± SD = 23.9 ± 2.0 years) were randomly allocated to receive either a traditional (n = 42, 21 males and 21 females) or ozone (n = 42, 21 males and 21 females) method. The ozone method only differed from the traditional method by leaving the deep leathery caries on the pulpal floor and then treating this with 20 s of ozone from the healozone X4 (Curozone, Germany). All caries was removed in the traditional group. A conventional glass ionomer cement (Riva Self Cure High Viscosity, SDI, Australia) was placed followed by a bonded composite resin restoration (Filtek Z250 Universal Restorative, 3 M ESPE, USA) in each cavity. The visual analogue scale was used to assess pain scores before treatment and after 24 h. The participants were then followed up for 2 years to assess the need for root canal treatment. Statistical significance levels were set at α ≤ .05. Both groups were associated with significant reduction of pain scores 24 h after treatment (p < .0001). The ozone treatment was associated with less pain 24 h after treatment (p < .0001) and less need for root canal treatment (p = .014), after 2 years follow up, than the conventional treatment. In conclusion, treatment of symptomatic, deep carious lesions by ozone following partial removal of caries was accompanied with less pain and occurrence of RCT after treatment compared to traditional complete caries removal.

[Comparative effectiveness of periodontal methods of anesthesia in the treatment of dental caries]. / Kliniko-funktsional'noe issledovanie effektivnosti i bezopasnosti primeneniya parodontal'nykh sposobov obezbolivaniya pri lechenii kariesa zubov.

AIM: The analysis of the criteria for predicting the effectiveness and safety of the use of periodontal anesthesia methods in the treatment of dental caries was carried out. MATERIALS AND METHODS: The study involved 78 patients: 41 women and 37 men aged from 25 to 56 years without severe somatic pathology, who needed treatment for dental caries. Intraligamental and modified periodontal anesthesia using a 4% articaine solution with different concentrations of vasoconstrictor were used as methods of anesthesia. The «method of the local injection anesthesia of the tooth pulp evaluating¼ was used during the modified periodontal and intraligmental anesthesia which determines the criteria for predicting the effectiveness and safety of the planned anesthesia and which is based on determining the functional parameters of the tooth pulp such as electrical excitability and microcirculation. RESULTS: The obtained results demonstrated the high efficiency and safety of the modified periodontal anesthesia with 4% articaine with epinephrine 1:200 000, which is easier to use and does not require specialized equipment. CONCLUSION: Modified periodontal anesthesia is safe and effective for the treatment of dental caries.

Treatment Strategy for Odontogenic Sinusitis.

BACKGROUND: The treatment options for odontogenic sinusitis (OS) include medical management including antibiotics and saline nasal irrigation, endoscopic sinus surgery (ESS), and dental treatment. OBJECTIVE: The purpose of this study was to evaluate whether OS caused by dental caries and periapical abscess can be cured by dental treatment alone and which patients should consider surgery early. METHODS: A total of 33 patients with OS caused by dental caries and periapical abscess were enrolled. Patients with OS caused by dental implants, trauma, surgery, or tooth extraction were excluded. All patients were initially treated with dental treatment and medical management without ESS. The patients were divided into two groups according to the results of dental treatment and multiple clinical parameters were compared between the two groups. RESULTS: Among the 33 enrolled patients, 22 patients (67%) were cured with dental and medical management, and 11 patients (33%) required ESS after the failure of dental and medical management. Based on the multivariate analysis results, patients who were smokers (OR 33.4) and had a higher Lund-Mackay score on CT (OR 2.0) required ESS after the failure of dental and medical treatment. CONCLUSIONS: Two-thirds of the patients with OS caused by dental caries and periapical abscess were cured with dental treatment and medical management without ESS. We recommend dental treatment and medical management first in OS caused by dental caries and periapical abscess. However, we recommend early ESS in patients with smoking habits and severe CT findings of the sinus.

Effectiveness and Safety of Ozone Therapy in Dental Caries Treatment: Systematic Review and Meta-analysis.

OBJECTIVE: This systematic review and meta-analysis aimed to investigate the effectiveness and safety of ozone therapy for treating dental caries. METHODS: We searched for randomized controlled trials (RCTs) in 8 databases, from inception to April 4, 2020 (MEDLINE, EMBASE, CENTRAL, LILACS, Bibliografia Brasileira de Odontologia, ClinicalTrials.gov, WHO, and OpenGrey). Primary outcome measures were antimicrobial effect and adverse events. We used the Cochrane risk of bias tool to evaluate methodological quality of included RCTs and GRADE approach to evaluate the certainty of the evidence. We used the Review Manager software to conduct meta-analyses. RESULTS: We included 12 RCTs comparing ozone therapy with no ozone, chlorhexidine digluconate, fissure sealants (alone and added to ozone), and fluoride. Considering primary outcomes, ozone therapy showed (a) lower reduction in the bacterial number than chlorhexidine digluconate in children (mean difference [MD]: -5.65 [-9.79 to -1.51]), but no difference was observed in adults (MD: -0.10 [-1.07 to 0.88]); (b) higher reduction in the bacterial number than sealant (MD: 12.60 [3.86-21.34]), but no difference was observed after final excavation (MD: -0.00 [-0.01 to 0.01]). Regarding safety of ozone therapy, results from individual studies presented no adverse events during or after treatment. Most of these results are imprecise and should be interpreted with caution because of clinical and methodological concerns, small sample size, and wide confidence interval, precluding to determine the real effect direction. CONCLUSION: Based on a very low certainty of evidence, there is not enough support from published RCTs to recommend the use of ozone for the treatment of dental caries. Well-conducted studies should be encouraged, measuring mainly the antimicrobial effects of ozone therapy at long term and following the recommendations of the CONSORT statement for the reporting of RCTs.

Light Energy Dose and Photosensitizer Concentration Are Determinants of Effective Photo-Killing against Caries-Related Biofilms.

Caries-related biofilms and associated complications are significant threats in dentistry, especially when biofilms grow over dental restorations. The inhibition of cariogenic biofilm associated with the onset of carious lesions is crucial for preventing disease recurrence after treatment. This in vitro study defined optimized parameters for using a photosensitizer, toluidine blue O (TBO), activated via a red light-emitting diode (LED)-based wireless device to control the growth of cariogenic biofilms. The effect of TBO concentrations (50, 100, 150, and 200 µg/mL) exposed to light or incubated in the dark was investigated in successive cytotoxicity assays. Then, a mature Streptococcus mutans biofilm model under sucrose challenge was treated with different TBO concentrations (50, 100, and 150 µg/mL), different light energy doses (36, 108, and 180 J/cm2), and different incubation times before irradiation (1, 3, and 5 min). The untreated biofilm, irradiation with no TBO, and TBO incubation with no activation represented the controls. After treatments, biofilms were analyzed via S. mutans colony-forming units (CFUs) and live/dead assay. The percentage of cell viability was within the normal range compared to the control when 50 and 100 µg/mL of TBO were used. Increasing the TBO concentration and energy dose was associated with biofilm inhibition (p < 0.001), while increasing incubation time did not contribute to bacterial elimination (p > 0.05). Irradiating the S. mutans biofilm via 100 µg/mL of TBO and ≈180 J/cm2 energy dose resulted in ≈3-log reduction and a higher amount of dead/compromised S. mutans colonies in live/dead assay compared to the control (p < 0.001). The light energy dose and TBO concentration optimized the bacterial elimination of S. mutans biofilms. These results provide a perspective on the determining parameters for highly effective photo-killing of caries-related biofilms and display the limitations imposed by the toxicity of the antibacterial photodynamic therapy's chemical components. Future studies should support investigations on new approaches to improve or overcome the constraints of opportunities offered by photodynamic inactivation of caries-related biofilms.

Prevention and management of periodontal diseases and dental caries in the older adults.

As a result of aging populations, in the future, dental practitioners will be caring for more older adults than ever before. These older adults, especially in developed countries, will demand a greater number of dental services, driven by increased tooth retention and an expectation of excellent oral healthcare throughout the life course. Further, the global rise in the prevalence and incidence of chronic diseases will increase the risk and/or severity of oral diseases and add a layer of complexity to the management of oral diseases in older adults. More older adults will be at a higher risk of periodontal disease and root caries as a result of reduced tooth loss and edentulism. This article reviews information on periodontitis and root caries, oral diseases which reflect the cumulative risk of the individual, and which are best addressed through prevention. Oral healthcare providers must embrace the concept of lifelong emphasis on prevention, as well as participation as active members of a healthcare team which provides healthcare for older adults in various settings (eg, hospital/clinic-based care, community-based settings, and long-term care facilities). National guidelines that address oral health are being considered by some countries, and if these are implemented they will increase the accessibility to oral health for older adults. In parallel to this, revisions of existing older adult insurance schemes (eg, the inclusion of routine oral healthcare in the US Medicare program) would promote the maintenance of a functional dentition that is pain-free and conducive to general health. The opportunity exists to implement a holistic approach to oral health that will align oral health with general health and emphasize that true health can only be achieved with the inclusion of oral health.

Effect of nano-hydroxyapatite and ozone on approximal initial caries: a randomized clinical trial.

The aim of the study was to assess the efficacy of three methods of enamel remineralization on initial approximal caries: (1) a nano-hydroxyapatite gel, (2) gaseous ozone therapy, (3) combination of a nano-hydroxyapatite gel and ozone. Patients (n = 92, age 20-30 years) with initial approximal enamel lesions on premolar and molar teeth (n = 546) were randomly allocated to three groups subjected to a 6-months treatment: Group I: domestic nano-hydroxyapatite remineralizing gel, group II: in-office ozone therapy, group III: both domestic remineralizing gel and ozone therapy. Caries lesions were assessed on bitewing radiographs at baseline, after 1 year and after 2 years. At one-year follow-up, the smallest rate of lesions with remineralisation (36.5%) was found in group I, and the highest (69.3%)-in group III. In group III a significant remineralisation was noticed in after 1 year and then a demineralisation after 2 years. Thus nano-hydroxyapatite gel and ozone therapy exert some capacities to remineralize approximal enamel and dentine subsurface lesions of premolar and molar teeth. Moreover, the combination of both methods produces the best effect compared to nano-hydroxyapatite or ozone therapy applied alone. However, the treatment should be continued for a long time in order to achieve nonrestorative recovery of caries.

Mapa de Evidência: aplicação clínica de Ozonioterapia Bucal / Mapa de Evidência: aplicação clínica de Ozonioterapia Bucal / Evidence Map: clinical application of oral Ozonetherapy

Este mapa apresenta uma visão geral das evidências sobre os efeitos da Ozonoterapia Bucal para várias condições clínicas e de saúde das pessoas a partir da caracterização de 15 estudos de revisão, distribuídos graficamente em uma matriz com 6 intervenções em uma série de resultados clínicos agrupados em 9 categorias. A maioria dos estudos concentra-se na intervenção com água ozonizada tópica e mistura gasosa oxigênio-ozônio tópica aplicada no tratamento de cárie, dor, cicatrização e inflamação.

Este mapa proporciona una visión general de la evidencia sobre los efectos de la ozonoterapia oral para diversas afecciones clínicas y de salud de las personas a partir de la caracterización de 15 estudios de revisión, distribuidos gráficamente en una matriz con 6 intervenciones en una serie de resultados clínicos agrupados en 9 categorías. La mayoría de los estudios se centran en la intervención con agua ozonizada tópica y una mezcla tópica de gas oxígeno-ozono aplicada en el tratamiento de caries, dolor, cicatrices e inflamación.

This map displays an overview of the evidence on the effects of oral ozone therapy for various clinical and health conditions from the characterization of 15 review studies, graphically distributed in a matrix with 6 interventions in a series of clinical results grouped in 9 categories. Most studies focus on intervention with topical ozonized water and topical oxygen-ozone gas mixture applied in the treatment of caries, pain, scarring and inflammation.

Allium sativum extract as an irrigant in pulpectomy of primary molars: A 12-month short-term evaluation.

This study indented to assess the clinical and radiographic assessment of Allium sativum extract as an intracanal irrigant for pulpectomy of primary molars. Ninety children with 110 teeth submitted were categorized into two groups. Clinical and radiographic success rates were checked at 3, 6, and 12 months. Qui-square test at a level of significance was ˂0.05. There was no statistically significant difference (p Ë‚ .05) between the two groups that has not been detected clinically or radiographically. Clinical and radiographic success rates of garlic extract at 3 months were (80% and 72.7%), which declined at 6 and 12 months to be 76.4% 6 and 74.5% respectively. For NaOCl group, clinical and radiographic success rates were 87.3% and 85.5% at 3 months, 87.3% and 87.3% at 6 months and 89.1% and 87.3% at 12 months. A. sativum extract can be used efficiently as an irrigant for pulpectomy of primary molar root canals.

Novel Antibacterial Resin-Based Filling Material Containing Nanoparticles for the Potential One-Step Treatment of Caries.

The aim of this work was to study the application of resin filling containing nanomaterials for the potential treatment of caries. Zinc nanoparticles (ZnO@NP, 50 nm) were chosen for their antimicrobial capacity against aerobic bacteria, and here, they have proved to be bactericidal against anaerobic bacterial strains (Streptococcus mutans, Streptococcus mitis, and Lactobacillus spp.). Potential mechanism of action is proposed based on microbiological assays and seems to be independent of oxidative stress because the nanoparticles are effective in microaerophilic conditions. The loading of nanoparticles on the demineralized dental surface and their infiltration power were significantly improved when ZnO@NP were carried by the resin. Overall, this material seems to have a high potential to become a one-step treatment for caries lesions.

Effectiveness of the ozone application in two-visit indirect pulp therapy of permanent molars with deep carious lesion: a randomized clinical trial.

OBJECTIVES: The aim of this randomized, three-arm parallel, single-blinded clinical trial was to evaluate the clinical and microbiological effectiveness of the ozone application in two-visit indirect pulp therapy. MATERIALS AND METHODS: One hundred five lower first molar teeth with deep caries lesion were included and randomly assigned three groups to apply the two-visit indirect pulp therapy. Treatment procedure was applied without any disinfectant (control), with 60-s 2% chlorhexidine digluconate (CHX) or 60-s ozone application. In four different stages (after initial excavation, ozone/CHX application before the temporary restoration, 4 months later immediately after removing temporary restoration, and final excavation), dentin humidity, consistency, and color properties were recorded to evaluate the clinical characteristics of the tissue, and standard dentin samples were collected for the microbiological analysis of mutans streptococci, lactobacilli, and the total number of colony-forming units. The data were analyzed by using Mann-Whitney U test for multiple comparisons. RESULTS: The remaining dentin became harder, drier, and darker after 4 months in all groups. However, CHX and ozone application were statistically better than the control group (p < 0.05). There was a gradual decrease in the total number of microorganisms in all groups. While cavity disinfectant applications were improved the antibacterial efficacy (control, 79.11%; CHX, 98.39%; ozone, 93.33%), CHX application exhibited a greater significant reduction than both groups (p = 0.000). CONCLUSION: The two-visit indirect pulp therapy yielded successful results for all study groups. However, CHX would be conveniently preferable due to improving the treatment success. CLINICAL RELEVANCE: The two-visit indirect pulp therapy applied with cavity disinfectant is a proper alternative treatment procedure in deep carious lesions, instead of conventional technique.

Iodoform Vs Calcium Hydroxide/Zinc Oxide based pastes: 12-month findings of a Randomized Controlled Trial.

This study evaluated clinical and radiographic twelve-month outcomes of root canal treatments (CT) with smear layer removal, performed in primary teeth, using two different root canal filling materials. Pulpectomy was performed on 27 primary teeth with necrosis or irreversible pulpitis, caused by dental caries or trauma, in 23 children (2-7 years old). A single trained operator performed the CT in a single visit in cases without periapical or interradicular radiolucency (PIR) or in multiple visits in cases with PIR. Participants were selected based on specific inclusion and exclusion criteria, and randomly allocated into two groups: Group 1 (G1) - iodoform paste (iodoform + camphorated parachlorophenol + ointment comprising prednisolone acetate 5.0 mg and rifamycin 1.5 mg); Group 2 (G2) - Calen®/ZO paste. Treated teeth were restored with composite resin immediately after the root canal filling. The outcomes were evaluated clinically and radiographically according to specific criteria. Two blinded and standardized evaluators assessed the radiographic outcomes. We used descriptive analyses due to the small sample size. CTs were performed due to caries lesions in 70.4% of the cases and due to trauma in 29.6%. Only one tooth of G1 was unsuccessful; hence, pulpectomy performance in both groups was not influenced by the filling material, nor by any other analyzed variable. The level of the root canal filling was better in the Calen®/ZO group. The clinical and radiographic twelve-month outcomes indicated successful treatment, independently of the root filling material used.