Estimation and Correlation of Alkaline Phosphatase Enzymatic Activity in Saliva with and without Early Childhood Caries in South Indian Children: A Randomized Clinical Trial.

Introduction: Early childhood caries (ECC) is a major common problem seen in children and is the most prevalent chronic disease that leads to discomfort, pain, and poor quality of life, affecting the health of children. Alkaline phosphatase (ALP) is a nonspecific phosphomonoesterase that functions through a phosphoery 1 intermediate to produce free inorganic phosphate. It has different isoenzymes produced by different cell types such as polymorphonuclear leukocytes, osteoblasts, macrophages, and fibroblasts within alveolar bone and/or salivary glands. Various studies show that higher ALP activity is related to periodontal disease and dental caries. Aim: This study aims to estimate and correlate salivary Alkaline Phosphatase enzyme activity in the saliva of children with and without ECC. Materials and methods: A total of 50 children were included in the study, divided into two groups-caries-active and caries-free, each consisting of 25 participants. Unstimulated saliva samples were collected and subjected to a spectrophotometer for analysis. ALP enzyme activity levels were estimated and correlated between caries-active and caries-free children. Results: The correlation between caries score and ALP activity was statistically significant, with a moderate correlation. The comparison of mean ALP activity between caries-active and caries-free groups was statistically significant. However, the comparison of ALP based on different age-groups and gender was not statistically significant. There was a statistically significant correlation between caries scores and the caries-active group. Conclusion: In conclusion, there is a substantial correlation between ALP enzyme levels and the severity of dental caries. An increase in ALP enzyme level is linked to a considerable rise in caries severity. Therefore, prevention may be possible with early detection. How to cite this article: Thimmegowda U, Kuri PN. Estimation and Correlation of Alkaline Phosphatase Enzymatic Activity in Saliva with and without Early Childhood Caries in South Indian Children: A Randomized Clinical Trial. Int J Clin Pediatr Dent 2024;17(5):528-531.

Comparative Assessment of Antimicrobial Activity of Propolis and Chlorhexidine on Salivary Isolates of Candida albicans and Streptococcus mutans in Children with Severe Early Childhood Caries: An In Vitro Study.

Background: Streptococcus mutans and Candida albicans are the chief microbes associated with severe early childhood caries (S-ECC). Diverse antimicrobial agents are widely used to prevent ECC, and a quest for newer natural products has been on the rise in the recent past. Aim: To estimate the antimicrobial activity of propolis with chlorhexidine on salivary specimens from children with S-ECC in vitro. Materials and methods: A total of 60 children with S-ECC were designated. Salivary samples of 30 children (group I) were inoculated onto mitis salivarius agar (MSA) to isolate S. mutans. Another 30 samples (group II) were inoculated on sabouraud's dextrose agar and subcultured on HiCrome Candida differential agar to isolate C. albicans. Sensitivity testing for 0.2% chlorhexidine and 10% propolis extract was done using the agar well diffusion technique using Mueller-Hinton agar medium. The antimicrobial effect was evaluated by calculating the diameter of the zone of inhibition surrounding the well. Results: All saliva samples collected from groups I and II showed growth of S. mutans and C. albicans, respectively. All cultured microbes were sensitive to 0.2% chlorhexidine and 10% propolis extract. The mean inhibition zone for S. mutans with chlorhexidine was 14.57 ± 0.63 mm, and with propolis, 11.93 ± 0.52 mm. The mean zone of inhibition for C. albicans with chlorhexidine was 12.83 ± 0.59 mm, and with propolis, 9.50 ± 0.73 mm. Chlorhexidine consistently showed statistically significantly larger zones of inhibition and hence appeared to be a more potent antimicrobial agent than propolis extract for both S. mutans and C. albicans. However, propolis has irrefutable action against both S. mutans and C. albicans. Conclusion: Propolis may be an acceptable substitute for chlorhexidine for long-term use as it has demonstrated antimicrobial activity and fewer side effects. Hence, this Association of Physicians of India herbal drug can be incorporated into mouthwashes and toothpaste to reduce microbial counts. How to cite this article: Kodgi V, Shetty P, Thimmaiah C, et al. Comparative Assessment of Antimicrobial Activity of Propolis and Chlorhexidine on Salivary Isolates of Candida albicans and Streptococcus mutans in Children with Severe Early Childhood Caries: An In Vitro Study. Int J Clin Pediatr Dent 2024;17(5):591-595.

Role of Salivary Protease Enzymatic Activity in Saliva of Children with and without Early Childhood Caries: A Randomized Clinical Trial.

Background/introduction: Early childhood caries (ECC) is one of the most prevalent diseases in children worldwide. Early childhood caries is driven by a dysbiotic state of oral microorganisms, mainly caused by a sugar-rich diet. Additionally, poor oral hygiene or insufficient dental plaque removal leads to the rapid progression of ECC. Early childhood caries leads not only to dental destruction and pain in children but also affects the quality of life of the caregivers.Additionally, upon neutrophil activation at inflammatory locations, these proteases are externalized in an active state, aiding in the control of inflammatory and immunological responses. Any enzyme that catalyzes proteolysis reactions is known as a protease. Proteases are produced by human glands or derived from microbes in the oral cavity. Additionally, the oropharyngeal mucosae and crevicular fluids are sources of protease. Aim: This study is aimed at the estimation and correlation of salivary protease enzymatic activity in the saliva of children with and without ECC. Materials and methods: A total of 50 children were included in the study, which was divided into two groups: group I (caries-active) and group II (caries-free)-each consisting of 25 children. Unstimulated saliva samples were collected and subjected to a spectrophotometer for analysis. Salivary protease levels were estimated and correlated between caries-active and caries-free children. Results: The correlation between caries score and salivary protease activity was statistically significant with a moderate correlation. The comparison of mean salivary protease activity between caries-active and caries-free groups was statistically significant. However, the comparison of salivary protease activity based on different age-groups was not statistically significant, whereas gender and caries scores in group A were statistically significant. Conclusion: In conclusion, there is a substantial correlation between salivary protease enzyme levels and the severity of dental caries, and an increase in salivary protease enzyme levels is linked to a considerable rise in caries severity. As a result, prevention may be possible with early detection. How to cite this article: Thimmegowda U, Kuri PN, Dhamnekar P. Role of Salivary Protease Enzymatic Activity in Saliva of Children with and without Early Childhood Caries: A Randomized Clinical Trial. Int J Clin Pediatr Dent 2024;17(8):877-880.

Caregiver, community health worker, and dentist feedback on a behavioral intervention for caregivers of children with severe early childhood caries.

Introduction: Severe early childhood caries (S-ECC) is a common disease within marginalized pediatric populations. S-ECC is often treated under general anesthesia to facilitate extensive treatment in young children, but treatment does not address etiology of an infectious disease that is rooted in health behaviors. Without behavior changes related to toothbrushing and sugar consumption, many children experience recurrent disease and some require subsequent surgeries. To improve post-surgery oral health, we developed PROTECT (Preventing Recurrent Operations Targeting Early Childhood Caries Treatment), a community health worker (CHW)-delivered behavioral intervention for caregivers that focuses on children's oral health behaviors. The purpose of this study was to use qualitative research methods to receive feedback on the planned protocol for a pilot study of PROTECT, a six-month intervention initiated at the time of a child's surgery to treat severe early childhood caries. Methods: Study participants included caregivers of children presenting for surgery [n = 12], CHWs [n = 8] and dentists [n = 8] in a series of audio-video recorded semi-structured interviews. Five coders used Braun and Clarke's six-phase framework for data analysis. Results: Participant feedback on the pilot study protocol yielded the following themes: (1) right time, population, and type of support; (2) flexible intervention delivery and content; (3) inclusion of other social determinants of health; and (4) cultural considerations. Implementing a behavioral intervention for caregivers in the immediate time during a child's surgery for treating dental caries was widely deemed important and timely in order to affect post-surgical behavioral and clinical outcomes. Flexibility in content, timing, and communication were all named as facilitators to participant engagement and study retention. Caregivers and CHWs emphasized the relevance of addressing other social determinants of health. CHWs emphasized the importance of training in becoming aware of culture and practicing with understanding and humility, given the influence on health beliefs, behaviors, and family dynamics. Cultural considerations in intervention delivery were deemed an important factor for participant retention and engagement. Discussion: Participant feedback led to critical modifications of the pilot study protocol, specifically in intervention content and CHW-led delivery.

Prevalence and Management of Early Childhood Caries in Preschoolers.

Background: "Early childhood caries (ECC)" is a prevalent and serious oral health issue affecting preschool-aged children globally, with adverse effects on their overall health and well-being. Objective: This center-based research designed to investigate the prevalence and management of ECC among preschoolers within a specific setting and evaluate associated factors. Methods: A cross-sectional research design was employed, involving 300 preschoolers aged 3 to 5 years. Clinical examinations were conducted, and data on demographic characteristics, oral hygiene practices, dietary habits, and dental visits were collected through structured interviews. Statistical analysis was performed to assess ECC prevalence and examine associations between demographic/behavioral factors and ECC severity. Results: The prevalence of ECC among preschoolers was 65%, with a mean dmfs score of 4.2. Factors such as age, gender, socioeconomic status, and oral hygiene practices were associated with ECC severity. Management strategies included topical fluoride application, oral health education, and restorative treatments. Conclusion: ECC remains a significant public health concern among preschoolers. Comprehensive oral health programs targeting this population are essential to mitigate ECC burden and improve oral health outcomes. Further research is needed to address systemic barriers and disparities in ECC prevention and management.

Diet and Caries-associated Bacteria in Severe Early Childhood Caries An In vitro Study.

Background: Severe Early Childhood Caries (S-ECC) is a prevalent oral health issue among young children, often associated with specific caries-associated bacteria. This in vitro study investigates the impact of diet on the growth and activity of caries-associated bacteria in S-ECC. Materials and Methods: Plaque samples of Streptococcus mutans and Lactobacillus species were procured from laboratory. The samples were exposed to different dietary conditions, including high-sugar, high-carbohydrate, and control diets. The growth kinetics of caries-associated bacteria, including S. mutans and Lactobacillus species, were monitored using quantitative polymerase chain reaction (qPCR) and colony-forming unit (CFU) assays. Results: Under high-sugar conditions, the growth of S. mutans increased by 50% compared to the control group, as evidenced by qPCR analysis. Lactobacillus species also exhibited a significant increase in CFU counts in response to high-carbohydrate diets, showing a 40% rise compared to controls. Conclusion: This in vitro study highlights the influence of diet on the proliferation of caries-associated bacteria in severe early childhood caries. High-sugar and high-carbohydrate diets contribute to the growth and activity of S. mutans and Lactobacillus species, exacerbating the progression of dental caries in affected children.

Parental Knowledge, Attitudes, and Practices Regarding Early Childhood Caries in Bihor, Romania: A Cross-Sectional Study.

BACKGROUND/OBJECTIVES: Early childhood caries (ECC) is a significant global health issue, particularly affecting deciduous teeth in young children. ECC is prevalent in Romania, where nearly half of children experience dental caries. This study aimed to assess the influence of gender, age, and living environment on parents' knowledge, attitudes, and practices (KAP) regarding ECC in Bihor County, Romania, using a KAP-type questionnaire. METHODS: A cross-sectional study was conducted between March and September 2024, utilizing an online KAP questionnaire distributed via social networks. The sample comprised 419 parents of children under six years old. Respondents provided socio-demographic data and answered questions regarding their knowledge, attitudes, and practices concerning ECC prevention, treatment, and oral health. Statistical analysis was conducted using Chi-square tests to assess associations between demographic factors and parental KAP. A p-value of less than 0.05 was considered statistically significant. RESULTS: Of the 419 respondents, 83.1% were female, and 62.5% were between the ages of 31 and 40. Significant gender-based differences were found in knowledge about pain from caries (93.7% of female participants vs. 81.7% of male participants, p = 0.004) and the importance of brushing twice daily (93.7% of female respondents vs. 80.3% of male respondents, p = 0.010). Younger parents (aged 18-30) were more likely to affirm the effectiveness of fluoride (65.4%) compared to those aged 31-40 (53.1%, p = 0.02). Urban parents were more likely to correctly identify the timing of tooth eruption (59.1% vs. 52.6% of rural parents, p = 0.021). CONCLUSIONS: The study highlights gender, age, and urban-rural disparities in parental knowledge and attitudes towards ECC. These findings underscore the need for targeted educational interventions to improve oral health outcomes and reduce ECC prevalence in the Bihor region. Tailored public health strategies addressing demographic factors could enhance preventive oral health behaviors and reduce the healthcare burden associated with untreated dental caries.

The relationship between severity of periapical periodontitis and next-generation systemic inflammatory biomarkers in children with early childhood caries.

INTRODUCTION: Early childhood caries (ECC) is closely associated with poor oral hygiene and cariogenic diet. Untreated ECC results in recurrent odontogenic infections and local and systemic consequences. In this study, our goal is to assess the relationship between the intensity of odontogenic infection-associated periapical periodontitis and new generation of systemic inflammatory markers (SII, NLR, PLR) in ECC-affected children. MATERIAL AND METHOD: 95 healthy patients in early childhood and demonstrating periapical periodontitis who underwent dental treatment under general anesthesia (GA) in the last two years were included in the present study. Their periapical statuses were dichotomized as mild and severe. Periapical Index (PAI) scores of 2 and 3 were regarded as "mild" whereas 4 and 5 as "severe". Of the complete blood test (CBC) parameters, systemic inflammatory index (SII), neutrophil-to-lymphocyte ratio (NLR), platelet-lymphocyte ratio (PLR), neutrophilic granulocyte (NEUT), lymphocyte (LYMPH) and platelet (PLT) were recorded. The relationship between the degree of periapical pathology and the evaluated markers was assessed using Receiver Operating Characteristic (ROC) analysis. RESULTS: Results of the present study revealed that mean NLR, SII and NEUT index scores of the patients having severe periapical periodontitis were statistically higher than those of the ones with mild pathology (p < 0.05). A positive, statistically significant interrelationship was found between the number of teeth demonstrating a PAI score of severe periapical periodontitis with the signs of exacerbation (PAI 5) and NLR and SII values (p < 0.05). Area under the ROC curve (AUC) values for NLR and SII were determined as 66.8% and 66.6% respectively, indicating that classification performance was sufficient and statistically significant (p < 0.05). CONCLUSION: Postponing the management of odontogenic infections will induce some complications such as, infective endocarditis and cause the systemic inflammatory process to continue by aggravating the systemic effects of local lesions. Thus, underlying mechanism should be eliminated and oral hygiene should be maintained, also novel biomarkers may be recommended to be used for the decision-making process for the teeth with persistent periapical lesions unresponsive to treatment.

Validation of an Artificial Intelligence-Based Model for Early Childhood Caries Detection in Dental Photographs.

Background/Objectives: Early childhood caries (ECC) is a widespread and severe oral health problem that potentially affects the general health of children. Visual-tactile examination remains the diagnostic method of choice to diagnose ECC, although visual examination could be automated by artificial intelligence (AI) tools in the future. The aim of this study was the external validation of a recently published and freely accessible AI-based model for detecting ECC and classifying carious lesions in dental photographs. Methods: A total of 143 anonymised photographs of anterior deciduous teeth (ECC = 107, controls = 36) were visually evaluated by the dental study group (reference test) and analysed using the AI-based model (test method). Diagnostic performance was determined statistically. Results: ECC detection accuracy was 97.2%. Diagnostic performance varied between carious lesion classes (noncavitated lesions, greyish translucency/microcavity, cavitation, destructed tooth), with accuracies ranging from 88.9% to 98.1%, sensitivities ranging from 68.8% to 98.5% and specificities ranging from 86.1% to 99.4%. The area under the curve ranged from 0.834 to 0.964. Conclusions: The performance of the AI-based model is similar to that reported for the internal dataset used by developers. Further studies with independent image samples are required to comprehensively gauge the performance of the model.

Temporal variation in the oral microbiome and the prediction of early childhood caries in different ethnicities.

Globally, early childhood caries (ECC) is a significant public health concern, necessitating effective prediction and prevention strategies. This study aimed to explore variations in the oral microbiome of saliva from pre-school Han and Uyghur children during ECC development and establish a predictive model based on temporal oral microbiome changes. Saliva samples were collected from a single kindergarten every three months over six months. Forty-four pre-school children provided 132 samples, categorized into six groups: (1) HEF (healthy pre-school Han children), (2) HEO (Han children with caries), (3) HEP (Han children with progressive caries), (4) WEF (healthy pre-school Uyghur children), (5) WEO (Uyghur children with caries), and (6) WEP (Uyghur children with progressive caries). Illumina Miseq sequencing identified oral microbiome differences between groups and time points. The Random Forest (RF) algorithm established ECC prediction models. The T1HEO group exhibited significantly higher Chaol index, observed species index, PD whole tree index, and Shannon index than the T2HEO group (p < 0.01). Similarly, the T1WEO group had significantly higher Chaol index, observed species index, and PD whole tree index than the T2WEO group (p < 0.05). The AUROC value for the ECC prediction model based on temporal oral flora changes was 0.517 (95% CI: 0.275-0.759) for pre-school Han children and 0.896 (95% CI: 0.78-1.00) for pre-school Uyghur children. In the onset of caries in pre-school Han children, bacterial species richness and community diversity in saliva declined, paralleled by a decrease in bacterial species richness in pre-school Uyghur children's oral saliva. The ECC prediction model grounded on temporal oral microflora changes exhibited robust predictive power, particularly for pre-school Uyghur children, potentially leading to more effective ECC prevention measures.

An open-label, parallel-group, randomized clinical trial of different silver diamine fluoride application intervals to arrest dental caries.

BACKGROUND: Silver diamine fluoride (SDF) is an antimicrobial agent and alternative treatment option that can be used to arrest dental decay. While there is optimism with SDF with regard to caries management, there is no true consensus on the number and frequency of applications for children. The purpose of this study was to examine the effectiveness of 38% SDF to arrest early childhood caries (ECC) at three different application regimen intervals. METHODS: Children with teeth that met International Caries Detection and Assessment System codes 5 or 6 criteria were recruited from community dental clinics into an open-label, parallel-group, randomized clinical trial from October 2019 to June 2021. Participants were randomized to one of three groups using sealed envelopes that were prepared with one of three regimens inside: visits one month, four months, or six months apart. Participants received applications of 38% SDF, along with 5% sodium fluoride varnish (NaFV), at the first two visits to treat cavitated carious lesions. Lesions were followed and arrest rates were calculated. Lesions were considered arrested if they were hard on probing and black in colour. Statistics included descriptive and bivariate analyses (Kruskal one-way analysis of variance and Pearson's Chi-squared test). A p-value of ≤ 0.05 was considered significant. RESULTS: Eighty-four children participated in the study (49 males and 35 females, mean age: 44.4 ± 14.2 months). Treatment groups were well matched with 28 participants per group. A total of 374 teeth and 505 lesions were followed. Posterior lesions represented only 40.6% of affected surfaces. Almost all SDF treated lesions were arrested for the one-month (192/196, 98%) and four-month (159/166, 95.8%) interval groups at the final visit. The six-month group experienced the lowest arrest rates; only 72% (103/143) of lesions were arrested (p < 0.001). The duration of application intervals was inversely associated with improvements in arrest rates for all lesions. CONCLUSIONS: Two applications of 38% SDF and 5% NaFV in one-month and four-month intervals were comparable and very effective in arresting ECC. Applications six months apart were less effective and could be considered inferior treatment. TRIAL REGISTRATION: ClinicalTrials.gov NCT04054635 (first registered 13/08/2019).

Study on the association between malnutrition, early childhood caries and caries activity among children aged 3-5 years.

BACKGROUND: This study aims to investigate the association between malnutrition and early childhood caries (ECC) and caries activity among children aged 3-5 years, in order to provide a theoretical basis for preventing and blocking ECC and improving malnutrition. METHODS: Children aged 3-5 years from six kindergartens in Zhao Xian, China were enrolled in this study. The decayed, missing, filled teeth (dmft) of all children were examined and recorded. The Cariostat method was used to detect dental caries activity, collect anthropometric data and measure haemoglobin concentration. Parents were asked to complete a questionnaire on the general characteristics and oral health behaviour of the participants. The "Growth Standards for Chinese Children Under 7 Years Old" was used to assess the nutritional status of all participating children. Wilcoxon rank sum test and multivariate logistic regression analysis were used to analyse and evaluate the relationship between ECC, caries activity and malnutrition. RESULTS: A total of 635 children who met the criteria were included in this study. After adjusting for confounding factors, logistic regression showed that the risk of ECC was significantly increased in underweight children compared with normal children (OR = 5.43, P < 0. 05); compared with normal children, the risk of ECC decreased in overweight and obese children (OR = 0.31, P < 0.001); underweight children had higher caries severity than normal weight children, and the difference was statistically significant (OR = 2.69, P < 0. 05); stunted children had higher caries severity than normal weight children and the difference was statistically significant (OR = 2.28, P < 0.05); underweight was positively associated with caries activity and the association was statistically significant (OR = 2.33, P < 0. 05); stunting was positively associated with caries activity and the association was statistically significant (OR = 2.1, P < 0.05); overweight and obesity were negatively associated with caries activity and the association was statistically significant (OR = 0.61, P < 0.05). CONCLUSIONS: The risk of ECC among children aged 3-5 years was positively associated with undernutrition and negatively associated with overnutrition. The severity of ECC among children aged 3-5 years was positively associated with undernutrition. The caries activity among children aged 3-5 years was positively associated with undernutrition and negatively associated with overnutrition.

Bacterial dynamics in the progression of caries to apical periodontitis in primary teeth of children with severe early childhood caries.

Background: Early childhood caries (ECC) are a prevalent chronic disease in young children. However, there has been limited research on the microbiota in different tissue levels of the same tooth in children with ECC. This study aimed to investigate the dynamic changes in bacterial diversity during the progression of Severe Early Childhood Caries (S-ECC) within the same tooth, from the tooth surface to the root canal, by collecting tissue samples from different areas of the affected tooth. Methods: Twenty primary teeth with periapical periodontitis were selected from 20 children aged 3-5 years, with 100 samples collected from the different layers: uncavitated buccal enamel surface without white spot lesion (surface), the outermost layer of the dentin carious lesion (superficial), the inner layer of carious dentin (deep), necrotic pulp tissue (pulp), and root exudate (exudate). The taxonomy of each OTU representative sequence was analyzed against the 16S rRNA database. Comparisons of alpha diversity between groups were performed. The number of shared and unique genera between groups counted. Beta diversity was contrasted to evaluate differences in bacterial community composition, and the relationships between the microbiota and samples were analyzed. The heatmap analysis of the 30 most abundant genera was used, which highlighted their relative distribution and abundance. The significantly abundant taxa (phylum to genera) of bacteria among the different groups were identified. The differences of relative abundance between bacterial genera among the five groups were analyzed. Significant Spearman correlations were noted, and visualization of the co-occurrence network was conducted. Results: Bacterial 16S rRNA gene sequencing showed that most genera were present in all layers, with the number of shared genera increasing as the disease advanced. The bacterial communities and core genera in the co-occurrence network changed with progression to severe ECC. Conclusion: An increase in both the quantity and complexity of bacterial interactions was observed. This study emphasized the importance of paying attention to the relationship between microbial species rather than just checking changes in bacterial species structure when investigating the role of bacteria in disease progression.

Assessment of overall caries risk and mode of birth delivery in infants and children with and without ECC: a cross-sectional study.

PURPOSE:  The study assessed the caries risk in infants and children with and without early childhood caries (ECC) using American Academy of Pediatric Dentistry Caries Risk Assessment Tool (AAPD CRAT) and identified the association between caries risk and mode of birth delivery. METHODS:  This cross-sectional study included 96 infants and children with all maxillary and mandibular primary anterior teeth and at least two primary molars erupted clinically in the oral cavity. The details on the mode of birth delivery were noted in a preformed template along with the demographic details, followed by caries risk assessment (CRA) to assess the caries risk of an individual. The outcome assessment for overall caries risk was performed for the ECC and non-ECC group and compared against the mode of birth delivery. Descriptive statistics were performed for all the study variables (gender, overall caries risk, mode of birth delivery, and term of delivery). The Chi-square test was used to compare the categorical variables between the two groups (ECC and non-ECC groups). RESULTS:  The high caries risk category contributed to 52.1% and 68.8% in the ECC and non-ECC groups, respectively. The prevalence of vaginal mode of delivery was 41.7% and 52.1% in the ECC and non-ECC groups, respectively. Caries risk increases with increasing age and the non-ECC group shows more risk (68.8%) than the ECC group. In comparison with the variables against the groups (ECC and non-ECC), Chi-square test revealed that only the term of delivery (p value = 0.035) and overall caries risk (p = 0.045) showed statistically significant difference. CONCLUSION:  The proportion of high caries risk subjects was significantly more in the non-ECC groups. Children delivered by the C-section mode showed high caries risk (66.7%) when compared with the vaginal mode of delivery (53.3%). A validated CRAT for predicting caries risk is required.

Effectiveness of silver diamine fluoride (SDF) in arresting coronal dental caries in children and adolescents: a systematic review.

Dental caries remains a significant public health issue for children globally, leading to adverse effects on health and development. Silver diamine fluoride (SDF) is a potential preventive agent that can prevent caries progression in children. This systematic review examined the effectiveness of silver diamine fluoride in arresting caries compared to other fluorides. An electronic search of MEDLINE, PubMed, EMBASE, Cochrane, Web of Science, Scopus databases was carried out examining articles in English from 2001 to 2023. Studies included in the analysis examined the application of SDF in children and adolescents with coronal caries lesions on primary teeth or permanent first molars. Fifteen studies, involving a total of 7895 children, were incorporated. The application regimen varied across studies. Most studies in this review consistently suggested that SDF is effective in arresting caries. An annual application of SDF effectively reduced Streptococcus mutans count. Adverse effects were primarily tooth staining and less commonly, oral mucosal irritation. A majority of studies showed a high risk of bias due to methodological insufficiencies. Overall, the evidence suggests that SDF is effective in arresting dental caries in children. It offers a viable, cost-effective, and minimally invasive treatment option, particularly suitable for use in low-resource settings. However, the aesthetic concern of tooth staining with SDF use remains a challenge. Further well-designed clinical trials may provide a fuller picture of SDF which can shape public health policy and shift towards a minimally invasive treatment approach.

Can silver diamine fluoride reduce invasive treatments with general anesthesia?

This study aims to retrospectively evaluate the differences in dental treatments rendered in general anesthesia (GA) for patients who did or did not receive application of silver diamine fluoride (SDF) prior to GA. 1559 patients (≤6 years) who completed treatment with GA for caries at University of California San Francisco (UCSF) between 2015 and 2019 were included in the study. At baseline patients' electronic health record was reviewed to collect planned treatment, complete dental treatment and demographics. Patients were identified as SDF group (N = 335, 21.49%) or comparison (N = 1224, 78.51%). Dental treatments rendered were compared between the SDF and comparison group with multi-variable regression, including variables for demographics and clinical findings at baseline. The initial analysis identified variations in gender, age, dental pain, pulp involvement, and initial treatment plans between the SDF and comparison groups at baseline. In an unadjusted analysis, the SDF group displayed a statistically significant increase in the number of crown procedures but a notable decrease in the number of pulp therapy and extraction treatments completed (p < 0.05). An adjusted multivariable model affirmed the inverse relationship between SDF application and completion of pulp therapy and extractions at the time of GA (p < 0.05). No significant association was identified with the total number of crowns needed and SDF. The model further indicated a positive correlation between the total count of pulp therapy and extractions completed with patient age and the wait-time for GA. In conclusion, pre-GA application of SDF to carious primary teeth is negatively correlated with completed pulp therapy and extraction. SDF application prior to dental treatment with GA may be a valuable tool to reduce invasive dental procedures in GA.

Dental Caries: The Way Forward.

KNOWLEDGE TRANSFER STATEMENT: It is evident that some progress in reducing ECC prevalence in children has been made, but these improvements are not equally distributed. Systemic inequities in oral health among the youngest, most vulnerable children must be reduced.

From Decay to Delight: A Case Report on Esthetic Rehabilitation in Early Childhood Caries.

Early childhood caries (ECC) continues to be a major global dental health concern for young children. This case report examines a young patient's transformation from decay to delight via comprehensive esthetic treatment. ECC in a four-year-old child resulted in significant dental caries and poor esthetics. In addition to space maintenance and orthodontic examination, essential treatments included dental extractions, stainless steel crowns, and composite restorations. The result showed that the child's smile and self-esteem had been successfully restored, as well as their oral health and function. This case emphasizes the value of early intervention, multidisciplinary teamwork, and individualized treatment plans in the management of early childhood caries and the restoration of pediatric patients' oral health.

Evaluating the Success of Preformed Resin Bonded Composite Strip Crowns for the Primary Central Incisor in Restoring Carious Primary Canine Teeth: A Retrospective Analysis.

Background Restoration of primary canine teeth in pediatric dentistry requires a balance of functional, biological, and esthetic factors. Stainless steel crowns, while effective for posterior restorations, often have patient acceptance issues due to esthetic limitations. Resin-bonded composite strip crowns have gained traction for anterior restorations due to their superior esthetic qualities and repairability. However, their long-term performance in primary canines characterized by unique morphological and functional demands has not been thoroughly evaluated. This study investigates the efficacy of resin-bonded incisor strip crowns in primary canines over three years, assessing their functional durability, biological integrity, and esthetic performance to provide a comprehensive evaluation of their long-term success in this application. Methods This retrospective observational study, conducted from September 2023 to December 2023 at the Department of Pediatric and Preventive Dentistry, Saveetha Dental College and Hospitals, Chennai, Tamil Nadu, India, received ethical approval from the Institutional Human Ethical Committee (IHEC/SDC/PEDO-2103/23/131). Dental records from January 2020 to December 2020 were reviewed by two investigators to identify children aged six years or younger who had undergone pulpectomy in primary canine teeth and were restored with resin-bonded incisor strip crowns. Exclusions included records with missing contact details or post-treatment radiographs. The purpose was to ensure a three-year review period when contacting patients in 2023. Eligible parents were contacted by phone, informed about the study, and invited for a review. Informed consent was obtained in person. Children with exfoliated primary canines and those whose parents did not sign the consent form were excluded. The restored crowns were evaluated using World Dental Federation (FDI) criteria across functional, biological, and esthetic domains by two calibrated examiners. Statistical analysis was conducted using IBM SPSS Statistics for Windows, Version 24 (Released 2016; IBM Corp., Armonk, New York, United States), with categorical variables expressed as n (%), inter-examiner reliability assessed by Cohen's kappa, and chi-square test used for goodness of fit, setting significance at 95%. Results Of the 92 primary canines restored with resin-bonded incisor strip crowns, 60 children were evaluated. The retention rate at the three-year follow-up was 50 (83.3%). Functional evaluation revealed that 48 (80%) of crowns maintained surface texture, 42 (70%) preserved form and contour, and 52 (86.6%) demonstrated acceptable occlusion and wear. Biologically, 55 (91.7%) of the crowns had no secondary caries, and 56 (93.4%) had no dental hard tissue defects at the margin. Esthetically, 48 (80%) of crowns retained surface texture, 46 (76.6%) had a satisfactory color match, and 45 (71.6%) exhibited minimal marginal staining. Statistical analysis confirmed significant results for all functional and esthetic parameters (p < 0.05). Conclusion The technique of placing incisor strip crowns in the place of primary canines can be recommended considering its maintenance of functional, biological, and esthetic properties.

Oral Candida-biome and Early Childhood Caries: A Systematic Review and Meta-Analysis.

OBJECTIVE: Candida is a common fungal pathogen in the oral cavity, with Candida albicans being the most prevalent species. Some studies report a correlation between Candida prevalence and dental caries experience in preschoolers, while others report no such association. This systematic review and meta-analysis aimed to evaluate the association of Candida-biome with Early Childhood Caries (ECC) in preschool children. METHODS: Seven databases were searched for studies evaluating the correlation between Candida and ECC in healthy preschool children under 71 months of age. Dual independent screening, data extraction, bias risk assessment, meta-analysis, and quality evaluation of evidence were conducted. RESULTS: The review included 20 studies with 12 reporting a positive association between Candida prevalence and ECC. The prevalence of Candida albicans in ECC ranged from 60%-84% across sample sites. Certain specific species, including C. dubliniensis and atypical non-albicans Candida (NAC), were also associated with caries severity in preschoolers. The pooled odds ratio (OR) estimate was 7.98 (95%CI; 3.84-16.58) for Candida-biome in plaque samples (I² = 84%), and 9.42 (95%CI: 4.15- 21.40) for Candida-biome in saliva sample (I² = 50%). These results suggest that children with Candida-biome in plaque and saliva have higher odds of having ECC than caries-free children. CONCLUSIONS: Children with Candida-biome in plaque and saliva samples have a higher risk of Early Childhood Caries, predominantly associated with Candida albicans. Standardised methodologies for evaluating and comparing data on Candida species and ECC are recommended for future studies.