How to Intervene in the Caries Process: Early Childhood Caries - A Systematic Review.

For an Organisation for Caries Research/European Federation of Conservative Dentistry consensus, this systematic review is aimed to assess the question of how to manage the caries process in the case of early childhood caries (ECC). Medline via PubMed was searched systematically regarding management of ECC. First priority was existing systematic reviews or randomized clinical trials otherwise cohort studies dealing with management of ECC, primarily with carious anterior teeth. After data extraction, the potential risk of bias was estimated depending on the study types, and the level of evidence was evaluated. Regarding management of ECC, results are presented for silver diamine fluoride (SDF, n = 5), nonoperative caries management (NOCM, n = 10), and restorative approaches (RA, n = 8) separately, as different kinds of studies with different levels of evidence were found for the different aspects in the management of ECC. The 5 systematic reviews on SDF showed a high potential for arrest of ECC on a high level of evidence. In NOCM, a low level of evidence for a moderate effect of fluoride varnish in arresting or remineralizing, especially non-cavitated lesions, was assessed. For RA in carious anterior upper primary teeth, a low level of evidence was found for higher failure rates of glass ionomer cement and composite fillings than composite strip crowns even if placed under general anaesthesia and especially compared to other crowns (stainless steel and zirconia). In conclusions, ECC may be managed successfully with nonoperative (SDF, regular fluoride application) and moderately well with operative approaches, but the decision is affected by many other variables such as pulpal involvement, the child's cooperation, or a general anaesthesia setting.

In vivo assessment of genotoxicity in buccal cells of children undergoing tooth restoration.

OBJECTIVES: Whereas dental materials came in direct or close contact with oral tissue, it is a great concern about the biocompatibility of those materials. This study was performed to evaluate possible DNA damage to buccal cells exposed to dental materials. METHODS: This prospective, longitudinal clinical study was conducted over a three months period. Class II restorations were placed in 60 young patients with no previous filling using one of three tested dental materials (two glass ionomers; Ketac Molar and Ionofil Molar and one compomer material; Twinky Star). DNA damage was analysed by micronucleus assays, in buccal exfoliated epithelial cells. RESULTS: In patients treated with Ketac Molar, a significant frequency of micronuclei (p = 0.027) and binucleated cells in samples taken 30 days following restoration (p = 0.029) was confirmed. In patients treated with Twinky Star, a statistically significant increase in the number of binucleated cells in samples taken after 7 and 30 days following restoration (p = 0.001 and p < 0.001, respectively) was observed. In all samples collected 90 days after treatment, there was no statistical difference in the number of any cell changes. CONCLUSION: In this study long-term biocompatibility of tested materials was confirmed. Glass ionomers and compomers are widely used materials in paediatric dentistry, and this study has proved their safety for usage in children.

The role of parental anxiety, depression, and psychological stress level on the development of early-childhood caries in children.

BACKGROUND: It is important to understand how the psychological status of parents affects oral health in children. AIM: This study aimed to assess the level of depression, anxiety, and stress of parents whose children have early-childhood caries. DESIGN: The study included 235 children and their parents who visited the Dental clinic at the School of Medicine of the University of Split between October 2016 and July 2017. The dental status of each child was recorded, while parents filled out the Depression Anxiety Stress Scale questionnaire and the questionnaire related to the demographic characteristics, questions related to child's habits of the tooth brushing, eating sweets. RESULTS: Multiple regression analysis showed that the incidence of active caries in the children was statistically significantly related not only to the level of parent depression (ß = -0.289; P = 0.040) but also the level of anxiety (ß = 0.186; P = 0.038) and stress (ß = -0.120; P = 0.036). The dmft index in the examined children was negatively significant associated with the parental level of depression (ß = -0.305; P = 0.032). CONCLUSION: Considering the results of our research it is essential to emphasize the need for better health education of parents.

Effect of different thermo-light polymerization on flexural strength of two glass ionomer cements and a glass carbomer cement.

STATEMENT OF PROBLEM: Whether polymerization lights can be used for heating glass ionomer cements (GICs) or glass carbomer (GCP) to improve their mechanical properties is not well established. PURPOSE: The purpose of this in vitro study was to assess the effect of thermo-light polymerization on the flexural strength (FS) of 2 GICs (Fuji IX GP Fast, Ketac Molar) and a GCP. MATERIAL AND METHODS: Specimens (n=10) were prepared in stainless steel molds (2×2×25 mm), compressed, exposed to 3 polymerization lights (500, 1000, 1200 mW/cm2) for 2 cycles of 40 seconds on each side, and stored in petroleum jelly (37°C, 24 hours). RESULTS: Significant FS differences were detected among groups after different thermo-light polymerization regimens (F=50.926, df=11, P<.001). GCP showed the highest mean FS (∼5 times, P<.001) after thermo-light polymerization with power outputs of 1000 (127.1 ±25.8 MPa) and 1200 mW/cm2 (117.4 ±18.5 MPa), with no significance difference between them (P=.98), compared with 500 mW/cm2 (24.1 ±1.7 MPa). For Ketac Molar, compared with autopolymerization setting (15.5 ±3.1 MPa), a significant increase in mean FS (∼2.5 times) was only observed in specimens treated with 1200 mW/cm2 polymerization light (P=.03). For Fuji IX GP Fast, only the light with 1000 mW/cm2 output significantly increased the FS (98.9 ±23.4 MPa, P<.001) compared with the autopolymerization setting (34.9 ±6.4 MPa). CONCLUSIONS: Thermo-light polymerization accelerated the development of FS in the tested GICs, potentially protecting against saliva contamination during the first 3 to 4 minutes after mixing GIC. Thermo-light polymerization of the glass carbomer with power outputs of 1000 and 1200 mW/cm2 also substantially increased FS. The clinical advantages of the findings should be validated by in vivo studies.

Heat transfer properties and thermal cure of glass-ionomer dental cements.

Under clinical conditions, conventional glass-ionomer dental cements can be cured by application of heat from dental cure lamps, which causes acceleration in the setting. In order for this to be successful, such heat must be able to spread sufficiently through the cement to enhance cure, but not transmit heat so effectively that the underlying dental pulp of the tooth is damaged. The current study was aimed at measuring heat transfer properties of modern restorative glass-ionomers to determine the extent to which they meet these twin requirements. Three commercial glass ionomer cements (Ionofil Molar, Ketac Molar and Equia™ Fill) were used in association with three different light emitting diode cure lamps designed for clinical use. In addition, for each cement, one set of specimens was allowed to cure without application of a lamp. Temperature changes were measured at three different depths (2, 3 and 4 mm) after cure times of 20, 40 and 60 s. The difference among the tested groups was evaluated by ANOVA (P < 0.05) and post hoc Newman-Keuls test. All brands of glass-ionomer showed a small inherent setting exotherm in the absence of heat irradiation, but much greater temperature increases when exposed to the cure lamp. However, temperature rises did not exceed 12.9 °C. Application of the cure lamp led to the establishment of a temperature gradient throughout each specimen. Differences were typically significant (P < 0.05) and did not reflect the nominal power of the lamps, because those lamps have variable cooling systems, and are designed to optimize light output, not heating effect. Because the thermal conductivity of glass-ionomers is low, temperature rises at 4 mm depths were much lower than at 2 mm. At no time did the temperature rise sufficiently to cause concern about potential damage to the pulp.

Influence of Dentifrices pH on Enamel Microhardness In Vitro.

Purpose was to evaluate the effect of toothpastes pH on enamel remineralization. Six fluoride toothpaste and one without fluoride were applied to the enamel slabs. Twenty eight enamel slabs were divided into seven groups and subjected to a daily cycling regimen with brushing treatments, demineralization and remineralization in artificial saliva. The surface microhardness (SMH) was calculated from the mean values obtained from six indentations (Vickers hardness number (VHN)) on the enamel surface at baseline and after 12 days. pH of the dentifrices was determined in a slurry with deionized water (1:3). Changes of the enamel surface microhardness at baseline and after remineralization stage were measured and analyzed using the Student t-test and one-way ANOVA. All groups treated with fluorides showed higher SMH values compared to control group. Toothpastes with lower pH (Pronamel, Sensodyne F, Sensodyne Rapid) were statistically superior to other fluoride dentifrices and control group after 12 days pH-cycling regimen (p < 0.001). Obtained results showed that slightly acidified fluoridated toothpastes may have a positive influence on enamel remineralization process.

Taekwondo coaches knowledge about prevention and management of dental trauma.

The aim of this study was to assess level of knowledge about prevention and dental trauma management among taekwondo coaches in Croatia. The questionnaire submitted to the taekwondo coaches contained 16 items about dental trauma prevention and management. The questionnaires were filled in by 131 taekwondo coaches; 28 females and 103 males. Descriptive statistics was used to describe and analyze the obtained data. The coaches were familiar with dental injuries in high percentage: 41 (31.3%) have observed dental injury and 36 (27.5%) have experienced a dental injury themselves. Eight of them had tooth avulsion, fourteen crown fracture, and eight had tooth luxation. About half of all interviewed coaches 68 (52.7%) were aware of the possibility of replanting avulsed teeth. Twenty six (19.8%) were familiar with the tooth rescue kit. Only 99 out of 131 coaches (75.6%) have used a mouthguard. The obtained results show low knowledge about possibilities for prevention of dental trauma. Insufficient use of mouthguards in this contact sport requires more attention of dentists and coaches education about dental trauma prevention.

Shear Bond Strength of Orthodontic Brackets Bonded with Thermo-Cured Glass-Based Materials-An In Vitro Study.

The results of orthodontic therapy largely depend, among other factors, on the preparation of the tooth enamel itself and the choice of material used to bond orthodontic brackets. The aim of this in vitro study was to determine the shear bond strength (SBS) and adhesive remnant index (ARI) score of thermo-cured glass-ionomers on different pretreated enamel, in comparison with the commonly used composite cement. Three commercially available nano-ionomer or highly viscous glass-ionomer cements (EQUIA Forte® Fil, EQUIA Fil, Ketac Universal) and two types of compo-sites (Heliosit Orthodontic, ConTec Go!) were investigated in this study. The research involved two hundred human premolars. The teeth were cleaned and polished, then randomly divided into five groups according to the enamel preparation method and the type of material. The enamel was treated in three different ways: polyacrylic acid, phosphoric acid, 5% NaOCl + etching with phosphoric acid, and a control group without treatment. Glass-ionomer cement was thermo-cured with heat from a polymerization unit during setting. Statistical analysis was performed using a Chi-square test and one-way ANOVA for independent samples. Spearman's Rho correlation coefficient was used to examine the relationship. Regardless of the material type, the results indicated that the weakest bond between the bracket and tooth enamel was found in samples without enamel pretreatment. The majority of the materials stayed on the brackets in samples without enamel preparation, according to ARI scores. The study's findings demonstrated that the strength of the adhesion between the bracket and enamel is greatly influenced by enamel etching and glass-ionomer thermo-curing. Clinical investigations would be required to validate the outcomes.

The Effect of Chemical Degradation and Polishing on the Gloss of Composite Dental Materials.

This aim of this study was to investigate surface gloss changes of different composite dental materials after chemical degradation or polishing. Five different composites were used (Evetric, GrandioSO, Admira Fusion, Filtek Z550, Dynamic Plus). The gloss of the tested material was measured with a glossmeter before and after chemical degradation in different acidic beverages. Statistical analysis was performed using a t-test for dependent samples, ANOVA, and a post hoc test. For comparison between groups, a level of significance was set at 0.05. Initial gloss values ranged from 51 to 93 at baseline to 32 to 81 after chemical degradation. The highest values were obtained for Dynamic Plus (93.5 GU) and GrandioSO (77.8 GU), followed by Admira Fusion (82 GU) and Filtek Z550 (70.5 GU). Evetric showed the lowest initial gloss values. After acidic exposures, the gloss measurements revealed different patterns of surface degradation. The results showed that the gloss of the samples decreased with time regardless of the treatment. The interaction between chemical-erosive beverages and the composite could lead to a decrease in the surface gloss of the composite restoration. The nanohybrid composite showed less gloss changes under acidic conditions, suggesting that it is more suitable for anterior restorations.

The effect of heating and ultrasound on the shear bond strength of glass ionomer cement.

The aim of this study was to compare the influence of externally applied "command set" methods (heat, ultrasound) on shear bond strength to enamel of several glass ionomer cements (GIC). The vestibular surfaces of 180 extracted premolars were wet ground until a flat enamel surface was created, and divided into three groups. Three restorative GICs (Fuji IX GP Fast, Fuji Triage, Ionofil Molar AC) were cured in three ways: standard (SC), ultrasonic excitation (UC) and by an external heat source (HC). In each group, teeth were conditioned in two ways: 30 with 10% polyacrylic acid and 30 without conditioning. The GIC were used to fill teflon molds (3 x 4 mm). The samples were loaded in a Universal testing machine (Lrx Material Testing Machine) at a 1 mm/min crosshead speed. Results showed that heat cured Fuji IX on conditioning enamel had significantly greater shear bond strength (13.3 MPa) than all other tested groups (8.6-10.8 MPa) (p < 0.001). The mean shear bond strength in GIC with SC and without enamel conditioning was 3.6-5 MPa and had significantly lower bond strength. Heating of GIC increase bond strength, improves the properties of GIC restoration and can be recommended for use as a "command set" method.

Effect of LGG yoghurt on Streptococcus mutans and Lactobacillus spp. salivary counts in children.

The aim of this study was to establish effect of 14 day consumption of commercially available yoghurt containing Lactobacillus rhamnosus ATCC53103 - LGG (Bioaktiv LGG, Dukat, Croatia) on Streptococcus mutans and Lactobacillus spp. salivary counts in children. Twenty five patients, 6-10 yr old participated in the study. At the inclusion in the study caries risk for every patient was evaluated. The saliva samples were tested with chair side kits for saliva buffer capacity (CRT buffer, Vivadent, Schaan, Liechtenstein), S. Mutans and Lactobacillus counts (CRT bacteria test, Vivadent, Schaan, Liechtenstein). Seven, 14 and 30d after yoghurt consumption saliva samples were tested again with CRT buffer and CRT bacteria tests. Obtained data were analyzed using chi2 and Kruskal-Wallis tests. Results showed significant increase in saliva buffer capacity 30d after yoghurt consumption. S. Mutans salivary counts were significantly decreased after 30d. Significant differences in Lactobacillus counts were not observed. It could be concluded that daily consumption of yoghurt containing LGG have an inhibitory effect on oral pathogenic bacteria and may be beneficial in caries prevention.

Fusion of Unerupted Mesiodens with a Regular Maxillary Central Incisor: a Diagnostic and Therapeutic Challenge.

The mesiodens is the most frequent type of supernumerary tooth which can appear in the maxillary midline area. The etiology of mesiodentes is not fully understood. This report shows a case of incomplete fusion of an unerupted mesiodens with a permanent maxillary central incisor, aligned in the dental arch. Intraoral and radiographic examinations indicated fusion of the crown and cervical part of the root of the supernumerary tooth with the permanent incisor. The clinical situation was further complicated by the presence of another supernumerary tooth located palatally. The treatment approach has included two phase surgical therapy to extract the supernumerary teeth. Early diagnosis and appropriate surgical treatment of mesiodentes are important to decrease the risk of clinical complications. Pre-operative 3D imaging is strongly advisable since it allows accurate data to be obtained, and reduces the extent of surgery and the possibility of procedural complications. In most cases, a multidisciplinary collaboration is necessary for precise diagnosis and predictable treatment outcome.

Pediatricians' Knowledge of Emergency Management of Dental Injuries and Use of Mouthguards: A Cross-Sectional Survey.

AIM: Dental injuries are one of the most frequent oral health problems in children and adolescents. This study aimed to evaluate Croatian pediatricians' knowledge and practice regarding dental injuries management and the use of mouthguards as means of protection against traumatic injuries. MATERIALS AND METHODS: A questionnaire-based cross-sectional survey conducted among 186 pediatricians examined their demographic characteristics, knowledge and experience with dental injuries. Student t-test or one-way ANOVA, with Tukey's post-hoc were used to analyze obtained data (p ≤ 0.05). RESULTS: The overall mean score of knowledge on the management of dental injuries was 3.6 ± 1.53 points. Male pediatricians (p = 0.016), those who witnessed dental injuries (p = 0.003), and those who had more than ten years of pediatric practice (p = 0.027) showed better knowledge. The results of multiple linear regression analysis demonstrated impact between pediatricians' knowledge in the emergency treatment of traumatic dental injuries concerning the level of health care (practice settings) (ß = -0.254, p = 0.002) and the number of patients treated by a pediatrician per day (ß = -0.187, p = 0.030). CONCLUSION: Pediatricians have a low level of knowledge regarding the primary care of traumatic dental injuries. An additional course on dental injurie management should be recommended as part of the physician and pediatricians' educational training.

Molar Incisor Hypomineralization in Children with Intellectual Disabilities.

The aim of the study is to compare the frequency and the distribution of molar incisor hypomineralization (MIH) in children with intellectual disabilities. METHODS: Seventy-two children with intellectual disabilities and 72 healthy children were included in the study. They ranged in age from 5 to 18 years with the same distribution by age and sex. Standard clinical examination was performed, at a dental clinic or in the institution where the children lived, by using a dental mirror and a probe, according the European Academy of Paediatric Dentistry judgment criteria for MIH. RESULTS: Among the 72 children with intellectual disabilities, eight children (11.1%) presented MIH with 19 affected teeth. In the control group, one child (1.4%) presented MIH with two affected teeth. The difference was statistically significant (p = 0.033). There were no statistically significant differences between boys and girls. The molars, especially the first right molars were the most affected tooth. Brown defects were less common than white defects. CONCLUSION: Children with MIH should be identified because this condition is a common problem in children with intellectual disabilities.

Reliability and Validity of Scales for Assessing Child Dental Fear and Anxiety.

INTRODUCTION: Children with high dental anxiety display uncooperative behavior during dental procedures. Different self-assessment questionnaires are in use to estimate the prevalence of dental fear and anxiety (DFA) in children but they need to be tested for reliability and validity in different populations. OBJECTIVES: The aim of this study was to test the reliability and validity of two scales for the assessment of child dental fear and anxiety in a sample of Croatian children. MATERIAL AND METHODS: The sample comprised 202 pairs consisting of children and their mothers (97 boys and 105 girls) aged 5 - 12 years. Two scales were used to assess children's DFA: the Children's Fear Survey Schedule - Dental Subscale (CFSS-DS) and the Modified Child Dental Anxiety Scale - face version (MCDAS-f). The Corah's Dental Anxiety Scale (CDAS) was used in the sample of children's mothers. The average scores of cooperative children and children with behavior management problem (BMP) were compared. RESULTS: Cooperative children displayed significantly lower CFSS-DS scores than children with BMP (M = 28. 46 vs. M = 39. 36; P < 0.001). The average MCDAS-f score was significantly higher in children with BMP than in cooperative children (M = 28. 07 vs. 20. 01; P < 0.001). The CFSS-DS showed high internal consistency (Cronbach's α = 0. 90), while internal consistency of MCDAS-f was good (α = 0. 73). The maternal CDAS showed good internal consistency (α = 0, 89). The correlations with other self-report measurements of DFS show good validity of all scales. The correlations between CFSS-DS and MCDAS-f were highly significant (r = 0.482; P < 0. 01) as well as the correlations of CFSS-DS and MCDAS-f with CDAS scores (r = 0.223; P < 0. 01 and r = 0.198; P < 0. 01, respectively. CONCLUSION: The obtained results suggest that both the CFSS-DS scale and the MCDAS-f scale are reliable and valid scales for measuring dental fear and anxiety in children in a sample of Croatian children. The MCDAS-f scale has shown slightly lower internal consistency but it is suitable for use in young children. In addition, the MCDAS-f scale is simple to administer.

Acceptance of Orthodontic Therapy according to the Aesthetic Component of the Index of Orthodontic Treatment Need among Schoolchildren - a Cross-Sectional Study.

OBJECTIVE: Orthodontic anomalies with impaired facial aesthetics and disturbed oral functions have a major effect on emotional and social development. It is necessary to determine the degree of acceptance of treatment. This study includes an evaluation of the Index of Orthodontic Treatment Need (IOTN) according to the Aesthetic Component (AC) of dental health in schoolchildren. METHODS: The research included 300 schoolchildren (150 girls, 150 boys) with an age range from 12 to 15 years. An evaluation of the need for orthodontic treatment according to the AC consisted of a ten-grade scale illustrated with a sequence of ten intraoral photographs showing different degrees of acceptability of dental appearance. Results were expressed as absolute and relative frequencies. The Chi-square test (in the absence of the expected frequencies of Fisher's Exact test) was used for testing the significance of differences. Cohen's kappa statistic measure was used for measuring the agreement between the children and dentists. RESULTS: There is a significant substantial agreement between children and dentists in assessing the need for orthodontic treatment. Differences in assessment of the degree of orthodontic anomalies by the doctor of dental medicine with respect to boys and girls, are negligible, and statistical analysis did not show any significant difference. Analysis of the need for orthodontic treatment with respect to the age of the children showed a significant difference. CONCLUSION: The need for orthodontic treatment is more pronounced in older children, and there is no difference between boys and girl.

Influence of Toothpaste pH on Its Capacity to Prevent Enamel Demineralization.

AIM: This study evaluated in vitro the remineralization capacity of commercial toothpastes with different fluoride (F) concentrations and their effectiveness when they are acidified. MATERIALS AND METHODS: One hundred and twelve caries-free teeth were used to prepare enamel specimens, and the specimens were divided into 16 groups (n = 7). Baseline surface Vickers microhardness was measured for all the specimens and all the tested groups were subjected to the pH-cycling regime involved five demineralization challenges each day for 10 days, and surface Vickers microhardness was then measured. Once daily, specimens were exposed for 30 min after last demineralization challenge of the day to the slurry of each toothpaste containing 1450 ppm F, 1000 ppm F, 450 ppm F, and 0 ppm F. The slurry was in original pH or acidulated on 6.5, 6.0, or 5.5 pH. The difference among tested group was assessed by analysis of variance and Newman-Keuls test (P < 0.05). RESULTS: The highest increase in microhardness was detected after treatment with toothpaste containing 1450 ppm fluoride (percentage of increase in microhardness was 6.20%), and the biggest loss was detected after treatment with toothpaste containing no fluoride (percentage of decrease was 6.82%), but there was no significant difference between tested groups. CONCLUSIONS: The highest increase in microhardness was detected after treatment with toothpaste containing more fluorides (1450 ppm F) regardless of the acidity.

Surface Roughness of Glass Ionomer Cements after Application of Different Polishing Techniques.

Glass Ionomer Cements (GIC) have been widely used in clinical practice since they have a wide range of positive characteristics: chemical bonding to the tooth surface, fluoride release, a heat-expansion coefficient similar to the tooth, do not require an absolutely dry working area, less volumetric contraction, good color stability. Physical properties can be improved by using external energy such as ultrasound and radiant heat (thermo-curing), which also accelerates chemical curing. Objectives: The aim of this study was to determine the most effective polishing technique and to compare the surface roughness of two Glass Ionomer Cements after treatment with heat (thermo-curing), and without heat treatment during the setting process. Materials and methods: Two polishing systems (Tungsten carbide burs and Sof-Lex discs) were used on two types of GIC (Equia Fil and Ketac Molar Universal). Bluephase 16i LED (Vivadent, Schaan Liechtenstein) light was used for the specimens treated with heat (thermo-curing). Samples without heat treatment are left for 10 minutes to chemically cure. Surface profilometar was used for measuring the mean surface roughness value (Ra). Results: Group with Mylar strip (control group) of each material showed the lowest (Ra) value. The Equia Fil material samples treated with heat (thermo-curing) achieved lower surface roughness values (Ra), and showed lower surface roughness values (Ra) after polishing with a Sof-Lex discs (p<0.05). The results for Ketac Molar Universal samples showed no statistically significant difference (p>0.05) between polishing with Sof-Lex discs and Tungsten carbide burs. Conclusion: Based on the obtained results, it can be concluded that the smoothest surface roughness is achieved by the Mylar strip. Some types of Glass Ionomer Cements can obtain better surface polishing with heat treatment (thermo-curing).