Silver Diammine Fluoride: Rejuvination of a 172-Year-Old (or Older?) Dental Caries Attenuation.

In 2015, Elevate Oral Care (http://www.elevateoralcare.com) introduced a 38% silver diammine fluoride (SDF) solution to the dentistry marketplace in North America. The company named the product "Advantage Arrest™ Silver Diamine Fluoride 38%" (Figure 1). The chemistry and nomenclature for SDF (AgFH6N2) is described as such: "Silver diammine fluoride is a metal ammine complex of silver fluoride. The ammonia ligands are thus "ammine", but the term "amine" is sometimes used incorrectly for this chemical. In addition to that spelling difference, it is sometimes also called "ammoniacal silver fluoride", which is also sometimes improperly spelled as "ammonical silver fluoride."1.

Tooth formation is asymmetric when hypodontia exists.

PURPOSE/QUESTION: When hypodontia exists via retrospective analysis of panoramic radiographs in children, is there an increased likelihood of asymmetry in tooth formation? SOURCE OF FUNDING: Information not available. TYPE OF STUDY/DESIGN: Case-control study. LEVEL OF EVIDENCE: Level 2: Limited-quality, patient-oriented evidence. STRENGTH OF RECOMMENDATION GRADE: N/A: Not applicable.

Practice Ownership Intentions of Pediatric Dentistry Residents and the Influence of Educational Debt.

Purpose: The purpose of this study was to investigate the interest in practice ownership among pediatric dentistry residents and influencing factors, particularly educational debt. Methods: An invitation to participate in an anonymous survey was sent to 933 pediatric dentistry residents training in the United States in the spring of 2020. Results: The survey response rate was 32.9 percent. Of the respondents, 61.2 percent reported being extremely or very interested in practice ownership and 49.8 percent anticipated becoming a practice owner within five years of graduation. An inverse relationship was seen between one's level of comfort in assuming a business loan to acquire a practice and having an educational debt burden of $400,000 or greater (P=0.002). Practice management preparation was the most common concern related to future practice ownership. Those feeling completely, very, or moderately prepared to manage a dental practice were over 40 percent more likely to be extremely or very interested in practice ownership than were those who felt slightly or not at all prepared (P<0.001). Conclusions: There appears to be broad interest in practice ownership among pediatric dentistry residents. Relatively high educational debt may negatively influence future practice ownership, but it may be less influential than other factors.

Long-term evaluation of the remineralization of interproximal caries-like lesions adjacent to glass-ionomer restorations: a micro-CT study.

PURPOSE: To compare the remineralization of incipient artificial interproximal caries in the presence of three glass-ionomer cements (highly-filled glass-ionomer cement, compomer, resin-modified glass-ionomer cement) and a resin composite (control). METHODS: Proximal restorations were simulated by placing tooth specimens and the various glass-ionomer cements in closed containers with artificial saliva at 37 degrees C and pH 7.0 for 30 days with constant circulation. Tomographic images were obtained with a micro CT scanner at 90, 180, and 270 days, and density-measuring software was used to calculate the micro-density of artificial caries lesions in the specimens. The mean density changes were compared between groups in order to evaluate the effects of remineralization. All data were analyzed using one-way ANOVA and the post-hoc Tukey multiple comparison test at P < 0.05. RESULTS: While the density of artificial caries lesions increased for all treatments, the increases for the three glass-ionomer groups were significantly higher than that for the resin group in each 3-month period. As time increased, the amount of density also increased for the glass-ionomer groups, and significant differences were found between the remineralization effects of the glass-ionomer groups. The micro CT proved to be an effective evaluation method.

Resin-modified glass-ionomer restoration of primary molars with proximating Class II caries lesions.

Tooth-colored resin-modified glass-ionomer cement has been shown to be a durable and reliable bonded restorative material for primary molars with Class II caries lesions. This technique description identifies a series of steps that can be used to make Class II restorations of primary molars with proximating caries lesions easier, quicker, and more precise. In addition, a nano-filled resin-modified glass-ionomer is introduced.

Phase Four, Randomized, Double-Blinded, Controlled Trial of Phentolamine Mesylate in Two- to Five-year-old Dental Patients.

PURPOSE: The purpose of this study was to evaluate, using a randomized, double-blind methodology: (1) the safety of phentolamine mesylate (Oraverse) in accelerating the recovery of soft tissue anesthesia following the injection of two percent lidocaine plus 1:100,000 epinephrine in two- to five-year-olds; and (2) efficacy in four- to five-year-olds only. METHODS: One hundred fifty pediatric dental patients underwent routine dental restorative procedures with two percent lidocaine plus 1:100,000 epinephrine with doses based on body weight. Phentolamine mesylate or a sham injection (two to one ratio) was then administered. Subjects were monitored for safety and, in four- to five-year-olds, for efficacy during the two-hour evaluation period. RESULTS: There were no significant differences in adverse events between the phentolamine and sham injections. Compared to sham, phentolamine was not associated with nerve injury, increased analgesic use, or abnormalities of the oral cavity. Phentolamine was associated with transient decreased blood pressure in some children. In four- and five-year-olds, phentolamine induced more rapid recovery of lip anesthesia by 48 minutes (P<0.0001). CONCLUSIONS: Phentolamine was well tolerated and safe in three- to five-year-olds; in four- to five-year-olds, a statistically significant more rapid recovery of lip sensation compared to sham injections was determined.

The marketplace for new caries management products: dental caries detection and caries management by risk assessment.

The number of new technologies emerging each year in the realm of dental caries management is growing at an exponential rate. Examining the patent literature, one can see that this growth rate will likely continue, with the outcome that dentistry will see an expanded growth in managing dental caries by risk assessment with medicinal therapeutic interventions. Restorative dentistry solutions, treating the results of dental caries, will continue to grow, while technologies to identify the caries process at its earliest stages will soon invade practices everywhere. The most interesting aspect of these changes will be how industry responds to the inexorable, yet slow change in dental professional demand for these new technologies, while trying to be the "first to market" within the various categories of this business opportunity. This paper will take a close look at how businesses with the core competence to be key players in this emerging growth category will assess the marketplace, and match up their business interests with the changing needs of the dental profession. The paper will also address the strategic planning and business processes that the dental industry will undertake to bring new technologies to market, and how these technologies will be positioned to health care professionals and consumers. The results of the key interactions between industry and the dental profession will determine the extent to which dental caries is managed as a disease, in addition to being managed by surgical restorative interventions.

Silver Diamine Fluoride in Pediatric Dentistry Training Programs: Survey of Graduate Program Directors.

PURPOSE: The purpose of this study was to investigate practice, teaching, and perceived barriers to the use of silver diamine fluoride and other caries control agents in U.S. pediatric dentistry residency programs. METHODS: A 14-question survey regarding use and teaching of caries control agents was sent via email to residency program directors in 2015. Survey participants responded, using a web-based survey tool, by completing a paper and pencil survey instrument, or by interview. RESULTS: Surveys were completed by 74 directors or associate directors (87 percent adjusted response rate). More than a quarter (25.7 percent) reported use of silver diamine fluoride, with 68.9 percent expecting to increase use. The use of silver diamine fluoride was not associated with region or program type. Programs reported commonly used caries control agents of fluoride varnish (100 percent), acidulated phosphate fluoride foam (48.6 percent), silver nitrate (9.5 percent), and povidone iodine (1.3 percent). Most felt silver diamine fluoride should be used only with high-risk patients (89.2 percent), and the majority agreed it could be used in primary and permanent teeth. The most frequently reported barrier to use of silver diamine fluoride was parental acceptance (91.8 percent). CONCLUSIONS: Silver diamine fluoride is being rapidly adopted in graduate pediatric dentistry training programs, with the majority expecting to incorporate it into their teaching clinics and curricula.

Modern Management Principles Come to the Dental School.

The University of Washington School of Dentistry may be the first dental school in the nation to apply lean process management principles as a primary tool to re-engineer its operations and curriculum to produce the dentist of the future. The efficiencies realized through re-engineering will better enable the school to remain competitive and viable as a national leader of dental education. Several task forces conducted rigorous value stream analyses in a highly collaborative environment led by the dean of the school. The four areas undergoing evaluation and re-engineering were organizational infrastructure, organizational processes, curriculum, and clinic operations. The new educational model was derived by thoroughly analyzing the current state of dental education in order to design and achieve the closest possible ideal state. As well, the school's goal was to create a lean, sustainable operational model. This model aims to ensure continued excellence in restorative dental instruction and to serve as a blueprint for other public dental schools seeking financial stability in this era of shrinking state support and rising costs.

The Effect of a Unique Pacifier on Anterior Open Bite and Overjet in the Primary Dentition: A Pilot Study.

PURPOSES: Pacifiers are the most common device used by children to satisfy their sucking needs. Because of their design, reports of anterior open bite and increased overjet are common. The purposes of this pilot study were to measure the effects of a unique pacifier in toddlers who have existing open bites and increased overjets; and secondly to determine the feasibility of recruiting and retaining toddlers for a six-month study. METHODS: Toddlers with existing open bite and increased overjet currently using a conventional pacifier were recruited from a university pediatric dental clinic. Baseline information was obtained. Visual examination and intraoral measurements were obtained. The study pacifier was introduced to replace the existing pacifier. Follow-up data was collected at three and six months post-intervention. RESULTS: Eight of the 11 toddlers (73 percent) completed the study. Recruitment was challenging because of the inclusion criteria and transportation; retaining participants required numerous reminders to parents. There was a significant difference between initial and final open bite and overjet measurements. CONCLUSION: It is feasible to recruit and retain toddlers but it required significant staff interventions. There was a significant improvement in reducing existing open bite and overjet with the pacifier after six months.

Early dental caries detection as a part of oral health maintenance in young children.

There is an ever-growing need to manage the results of dental caries in young children. Other articles in this supplement discuss age-specific recommendations regarding caries management in children. This article will introduce the idea of using technology to assess caries risk in children and also will identify alternative technologies that could be used to detect caries lesions as early as possible. It is hoped that by learning about some of the new technologies that can be used in caring for children's dental needs, a new cadre of general practitioners will be willing to take on a portion of the important role of caring for our children.

A pit-and-fissure clinical protocol.

Decisions regarding prevention and treatment of dental caries lesions forming in enamel pits and fissures can be challenging because of factors such as the "hidden caries" phenomenon, types of materials to use, methods of bonding restorative materials, and concern for conserving tooth structure. This article identifies the techniques of sealing noncarious pits and fissures and restoring teeth having ongoing caries infection. Treatment protocols are described.

Glass ionomer restorative cement systems: an update.

Glass ionomer cements have been used in pediatric restorative dentistry for more than two decades. Their usefulness in clinical dentistry is preferential to other materials because of fluoride release from the glass component, biocompatibility, chemical adhesion to dentin and enamel, coefficient of thermal expansion similar to that of tooth structure, and versatility. The purpose of this paper was to review the uses of glass ionomer materials in pediatric dentistry, specifically as pit and fissure sealants, dentin and enamel replacement repair materials, and luting cements, and for use in glass ionomer/resin-based composite stratification tooth restoration (the sandwich technique). This article can also be used as a guide to research and clinical references regarding specific aspects of the glass ionomer systems and how they are used for young patients.

Dental repair material: a resin-modified glass-ionomer bioactive ionic resin-based composite.

This report documents treatment and repair of three carious teeth that were restored with a new dental repair material that features the characteristics of both resin-modified glass-ionomer restorative cement (RMGI) and resin-based composite (RBC). The restorative products presented are reported by the manufacturer to be the first bioactive dental materials with an ionic resin matrix, a shock-absorbing resin component, and bioactive fillers that mimic the physical and chemical properties of natural teeth. The restorative material and base/liner, which feature three hardening mechanisms, could prove to be a notable advancement in the adhesive dentistry restorative materials continuum.

Glass ionomer cements.

Glass ionomer cements have been used in pediatric restorative dentistry for 20 years. Their usefulness in pediatric restorative dentistry is preferential relative to other materials because of their fluoride release, chemical adhesion to tooth structure, and availability to use in a variety of clinical scenarios. This paper reviews the use of glass ionomer materials in pediatric restorative dentistry. The paper provides a look at glass ionomer cements' use as sealants and restorative materials and examines glass ionomers as adhesives, as a stand-alone material and in the sandwich technique. This paper also provides a useful guide to connecting to other references regarding specific aspects of glass ionomers in children.

Addressing disparities through dental-medical collaborations, part 1. The role of cultural competency in health disparities: training of primary care medical practitioners in children's oral health.

This paper introduces a series of articles examining specific dental-medical educational collaborations intended to decrease oral health disparities. The first article discusses cultural competency and its relationship to oral health disparities. The next two articles present pediatric oral health educational programs for medical practitioners, one targeting primary care practitioners and the other training family practice residents. This introductory article reviews the national public health agenda for oral health, explains the rationale for targeting dental-medical educational collaborations to address health disparities, and identifies important gaps in dental as well as medical education, especially in the area of infant oral health. Key findings of the two projects are reviewed as well as lessons learned. We call for leadership in dental education in three critical areas: cultural competency, infant oral health, and ethical and professional values. Given the historical isolation of dentistry, strong leadership at the level of the dean's office is needed to advance the agenda of eliminating oral health disparities through collaborations among dentistry, medicine, and the other health professions. Finally, an appreciation of the professional obligations of dental educators, practitioners, and the profession of dentistry can add resolve to this new prioritization.

Advances in caries diagnostics and the changing face of dental practice.

Advances in scientific understanding of disease processes and diagnostic technology will lead to changes in the ways caries is managed. These changes will include new relationships with patients that will call for greater skills in the behavioral sciences. Specifically, there will be a need for greater understanding of the biopsychosocial and the socio-cultural bases of disease and health care behavior and enhanced communication skills. The need to understand and respond to demographic forces-especially those that involve population groups at increased risk-and to work collaboratively with medicine will also assume greater significance.

Use of fluoride products for young patients at high risk of dental caries.

Extensive education in oral hygiene home care, nutrition counseling, and routine reinforcement of home-care instructions at periodic check-ups lead to better oral health for many young children and teenagers. In addition, resistance to dental caries infection can be increased significantly by intelligent use of bonded resin sealants and systemic and topical fluoride products. This article discusses protocols for use of in-office applied topical fluoride and daily at-home use of topical fluoride products for children and teens at high risk of dental caries.