The relationship between children's media habits and their anxiety and behaviour during dental treatment.

OBJECTIVE: The existing evidence suggests that media habits may have moderating role on children's psychological adjustment in the dental setting. The aim of this study was to investigate the relationship between children's media habits and their anxiety and behaviour management problems (BMP) during dental treatment. MATERIALS AND METHODS: A total of 289 children aged 3-6 years old were included. Dental anxiety (DA) and BMP were assessed using Clinical Anxiety Rating Scale and Frankl's Rating Scale during the dental treatment. The parents reported their own DA, educational level and economic status; and the children's and also their own daily hours of using media. The data were analysed with the Mann-Whitney U, Kruskal-Wallis, Chi-square or Fisher exact tests, Spearman's correlation coefficient and logistic regression. RESULTS: The children with DA had significantly higher amount of watching TV, playing e-games and surfing the Internet, and total amount of using electronic media than those without DA. The amount of watching TV and the total amount of using electronic media were significantly higher in the children with BMP than those without BMP. DA and BMP were significantly correlated with the children's hours of watching TV and total media time. CONCLUSIONS: There was a significant relationship between the amount of electronic media usage and DA and BMP in 3- to 6-year-old children.

Randomized Controlled Trial of Pulpotomy in Primary Molars using MTA and Formocresol Compared to 3Mixtatin: A Novel Biomaterial.

OBJECTIVE: This study was conducted to compare the efficacy of 3Mixtatin (a combination of simvastatin and 3Mix antibiotic) with MTA and Formocresol for the pulpotomy of primary molars. STUDY DESIGN: 114 children aged 3-6 years old with 150 primary molars were randomly allocated to three groups. MTA, Formocresol or 3Mixtatin were used for Pulpotomies. Hard setting zinc oxide eugenol was used to cover these materials. The teeth were restored with amalgam. Blinded radiographic and clinical examinations were conducted at 6, 12 and 24 months after treatment for the presence of pain, tenderness to palpation and percussion, sinus tract, swelling, presence of internal or external root resorption, inter-radicular radiolucency, and periapical lesion. RESULTS: 122 teeth were available for 24-month follow-up study. The overall success rate was 78.9% for FC, 90.5% for 3Mixtatin and 88.1% for MTA group. There was no significant difference in overall success rate among the groups after 24-month follow-up (X2=2.43, df = 2, P =0.27). CONCLUSION: Our findings demonstrated remarkable results of 3Mixtatin in pulpotomy of primary teeth at the 24-month follow-up. Therefore, 3Mixtatin may be considered as an effective material in pulpotomy of primary teeth because of its successful results.

Pulp bleeding color is an indicator of clinical and histohematologic status of primary teeth.

OBJECTIVES: This study was carried out to investigate whether the changes in hematologic characteristic and color of pulpal bleeding is associated with clinical and histologic status of the pulp in primary teeth. MATERIALS AND METHODS: A total of 211 primary molars in 103 patients, 3-6 years old, were treated. One hundred eight teeth had pulpectomy, 57 teeth had pulpotomy after pulp exposure during caries excavation, and 46 teeth had pulpotomy after accidental pulp exposure in sound dentin. After pulpal exposure, pulpal blood was collected in capillary tubes for blood color and hematologic assessment. Coronal and radicular pulp tissues were amputated for histologic assessment. RESULTS: Blood color was significantly darker in pulpectomy cases and samples with severe inflammation. The differences were clinically perceptible by the human eye. A significant negative correlation was detected between white blood cell (WBC) count and blood color. The counts of neutrophils and lymphocytes were significantly different between treatment groups. In addition, WBC, eosinophil, monocyte, neutrophil, and basophils counts were significantly different between degrees of inflammation in coronal pulp. Moreover, severe inflammation was higher in pulpectomy group versus pulpotomy groups. Pulp tissue calcification was also significantly higher in the pulpectomy cases. CONCLUSIONS: Considering the significant difference in pulpal blood color between the pulpectomy and pulpotomy cases, and between the different levels of pulpal inflammation; blood color can be a valid clinical diagnostic criterion of pulpal status and can be used for the selection of appropriate pulp treatment strategy. CLINICAL RELEVANCE: This study shows that pulp bleeding color can be used for selection of an appropriate pulp treatment method in primary teeth.

Barriers and Drawbacks of the Assessment of Dental Fear, Dental Anxiety and Dental Phobia in Children: A Critical Literature Review.

OBJECTIVE: Dental anxiety, fear and phobia have different etiology, response patterns, time courses, and intensities that justify a clear distinction between these constructs. Differentiation of dental anxiety, fear or phobia in practice is a critical prerequisite for developing and implementing effective treatment for children. The aim of this study was to investigate whether current researches in the pediatric dentistry appropriately discriminate the central construct of dental anxiety, fear and phobia. We also highlighted the specific methodological issues in the assessment of these issues in pediatric dentistry. STUDY DESIGN: A systematic search was conducted in Pubmed/medline and Scopus for articles which assessed dental anxiety, fear or phobia in children. RESULTS: 104 research papers were included in the review that had made a distinction between dental anxiety, fear and phobia and had not used them interchangeably. Only five studies used different clinical measures or cut-offs to discriminate between dental anxiety, fear and phobia. CONCLUSION: The dental literature appears unable to capture and also measure the multi-sided construct of dental anxiety, fear and phobia and, therefore, there was a tendency to use them interchangeably.

Oral health status, dental anxiety, and behavior-management problems in children with oppositional defiant disorder.

Mental disorders have been shown to affect children's oral health. This study was carried out to investigate the oral health status, dental anxiety (DA), and behavior-management problems (BMPs) during dental treatment in 6- to 9-yr-old children with oppositional defiant disorder (ODD)/attention-deficit hyperactivity disorder (ADHD). The study and control groups included 40 children with ODD/ADHD and 80 normal children, respectively. All participants received an amalgam restoration. During the procedure, the children's behavior was assessed using the Frankl Rating Scale and the Verbal Skill Scale. Parents rated their children's DA using the parental version of the Children's Fear Survey Schedule-Dental subscale (CFSS-DS). Comorbid anxiety disorders were assessed using the Kiddie-Sads-Present and Lifetime Version questionnaire. Oral health status was assessed using the gingival index and the decayed, missing, and filled teeth score for permanent (DMFT) and primary (dmft) teeth. The findings showed that DA and BMPs were significantly higher in children with ODD/ADHD than in the controls. Furthermore, the frequency of DA and BMPs was higher in children with both ODD/ADHD and a comorbid anxiety disorder than in those without comorbid anxiety disorder. Children with ODD/ADHD had significantly higher DMFT/dmft scores than those in the control group, whereas the difference in gingival index was not statistically significant. In conclusion, children with ODD/ADHD had higher levels of DA, BMP and poorer oral health status.

Does prenatal restraint stress change the craniofacial growth pattern of rat offspring?

A major and frequently encountered condition underlying the long-term programming effects of the intrauterine environment is exposure to stress. Gestational stress is an environmental factor that induces physical and behavioral alterations in offspring. Seventy female virgin Wistar rats were mated with one male rat for a maximum of four times, after which 52 pregnant rats were divided into two groups. In the experimental group the rats were exposed to restraint stress during pregnancy, whereas the control group did not receive the stress protocol. One male litter was randomly chosen from the offspring of each rat with 8-13 pups. A total of 40 male rat offspring were available for analysis. Thirty-one linear and angular measurements were analyzed in both study groups to investigate whether prenatal restraint stress changes the craniofacial growth pattern of rat offspring. In the prenatally stressed group, anterior cranial base length and viscerocranium measures were significantly increased compared with the control group, whereas cranial width, mandibular dimensions, and posterior cranial height and length remained unchanged. Furthermore, the prenatally stressed group showed backward rotation of the midface and decreased flattening of the cranial vault. It was concluded that prenatal chronic stress can induce alterations in the craniofacial growth pattern by promoting endochondral growth in the cranial base and nasal septum.

A randomized trial of direct pulp capping in primary molars using MTA compared to 3Mixtatin: a novel pulp capping biomaterial.

OBJECTIVE: This study aimed to examine the efficacy of 3Mixtatin (a combination of simvastatin and 3Mix antibiotic) as a novel pulp capping biomaterial in DPC of human primary molars. METHODS: In this randomized clinical trial, 160 primary molars from 83 healthy children aged 3-6 years were randomly allocated into four groups. Small traumatic non-caries pulpal exposures were treated by DPC using simvastatin, 3Mix, 3Mixtatin, or MTA. Capping materials were covered with hard-setting zinc oxide eugenol (ZOE) cement, and then, teeth were restored with amalgam. Clinical and radiographic examinations were conducted at 2, 6, and 12 months after treatment. The data were compared using chi-square test at a significance level of 0.05. RESULTS: One hundred and twenty-nine teeth were available for follow-up study. By the end of 12 months, the overall success rates were 93.8% in MTA, 91.9% in 3Mixtatin, 62.5% in 3Mix, and 57.1% in simvastatingroups. No statistically significant difference was found between the outcomes of MTA and 3Mixtatin groups (P > 0.05). 3Mixtatin had statistically superior results compared to 3Mix and simvastatin (P < 0.01). CONCLUSION: Radiographic and clinical outcomes in 3Mixtatin group could suggest it as an acceptable alternative in DPC of primary molar teeth.

Impact of Chlorhexidine Pretreatment Followed by Probiotic Streptococcus salivarius Strain K12 on Halitosis in Children: A Randomised Controlled Clinical Trial.

PURPOSE: The aim of this study was to examine the effect of chlorhexidine disinfection, as a chemical method of oral hygiene practice, and subsequent use of probiotics on halitosis in children. The effects of mechanical and chemical oral hygiene practice methods on the severity of halitosis were also assessed. MATERIALS AND METHODS: 208 children with organoleptic test (OLT) scores of 2 or more were randomly assigned to four groups: A: conventional oral hygiene practices (COH) including toothbrushing and flossing; B: COH + tongue scraping (TS); C: COH + TS + chlorhexidine; D: COH + TS + chlorhexidine + probiotics. OLT was performed at 1-week and 3-month follow-ups. RESULTS: A significant and stable number of participants showed major and moderate levels of improvement in OLT scores in group D (p < 0.001). The improvement of OLT scores in group C was also significant (p < 0.001), but not stable over the follow-ups (p = 0.44). Neither significant nor stable improvements in the OLT scores were detected in groups A and B through follow-ups (p > 0.05). CONCLUSION: Probiotic therapy following oral disinfection with chlorhexidine may reduce the severity of halitosis over longer periods.

Correlations of spheno-occipital synchondrosis, cervical vertebrae, midpalatal suture, and third molar maturation stages.

OBJECTIVES: To estimate the joint correlations among cervical vertebrae maturation (CVM), spheno-occipital synchondrosis (SOS), midpalatal suture maturation (MPS), and third molar mineralization (TMM) and to assess the predictive potential of SOS on CVM and MPS. MATERIALS AND METHODS: 570 pretreatment cone-beam computed tomogram (CBCT) scans from three private practices were analyzed, and MPS, CVM, SOS, and TMM stages were categorized and recorded by two independent investigators. Intra- and inter-rater reliability tests were evaluated with weighted Cohen's kappa tests. Spearman correlation coefficients for ordinal data were used to estimate the pairwise correlations among SOS, CVM, MPS, and TMM. To evaluate if SOS could predict CVM and MPS, ordinal regression models were estimated and cross-validated. RESULTS: The analysis demonstrated a robust positive correlation between SOS and CVM (r = 0.845) and between SOS and MPS (r = 0.742). A significant correlation was also observed between CVM and MPS (r = 0.659). Further correlations were identified between TMM and SOS (r = 0.444), TMM and MPS (r = 0.392), and TMM and CVM (r = 0.358). Ordinal regression models indicated the potential of using SOS as a predictive marker for CVM and MPS stages. CONCLUSIONS: With a comprehensive analysis, SOS is strongly correlated with CVM and MPS, and SOS stage can be used to predict CVM and MPS using ordinal regression. Since MPS stages are challenging to categorize due to their anatomy, this finding suggests a diagnostic tool using SOS stages or when more information on skeletal maturity of the patient is desired.

Biomaterials and Extracellular Vesicle Delivery: Current Status, Applications and Challenges.

In this review, we will discuss the current status of extracellular vesicle (EV) delivery via biopolymeric scaffolds for therapeutic applications and the challenges associated with the development of these functionalized scaffolds. EVs are cell-derived membranous structures and are involved in many physiological processes. Naïve and engineered EVs have much therapeutic potential, but proper delivery systems are required to prevent non-specific and off-target effects. Targeted and site-specific delivery using polymeric scaffolds can address these limitations. EV delivery with scaffolds has shown improvements in tissue remodeling, wound healing, bone healing, immunomodulation, and vascular performance. Thus, EV delivery via biopolymeric scaffolds is becoming an increasingly popular approach to tissue engineering. Although there are many types of natural and synthetic biopolymers, the overarching goal for many tissue engineers is to utilize biopolymers to restore defects and function as well as support host regeneration. Functionalizing biopolymers by incorporating EVs works toward this goal. Throughout this review, we will characterize extracellular vesicles, examine various biopolymers as a vehicle for EV delivery for therapeutic purposes, potential mechanisms by which EVs exert their effects, EV delivery for tissue repair and immunomodulation, and the challenges associated with the use of EVs in scaffolds.

Testing for COVID-19 in dental offices: Mechanism of action, application, and interpretation of laboratory and point-of-care screening tests.

BACKGROUND: The dental office potentially possesses all transmission risk factors for severe acute respiratory syndrome coronavirus 2. Anticipating the future widespread use of COVID-19 testing in dental offices, the authors wrote this article as a proactive effort to provide dental health care providers with current and necessary information surrounding the topic. METHODS: The authors consulted all relevant and current guidelines from the Centers for Disease Control and Prevention and the US Food and Drug Administration, as well as online resources and review articles. RESULTS: Routine COVID-19 screening and triage protocols are unable to detect all infected people. With the advancements in diagnostic tools and techniques, COVID-19 testing at home or in the dental office may provide dentists with the ability to evaluate the disease status of their patients. At-home or point-of-care (POC) tests, providing results within minutes of being administered, would allow for appropriate measures and rapid decisions about dental patients' care process. In this review, the authors provide information about available laboratory and POC COVID-19 screening methods and identify and elaborate on the options available for use by dentists as well as the regulatory requirements of test administration. CONCLUSIONS: Dentists need to be familiar with COVID-19 POC testing options. In addition to contributing to public health, such tests may deliver rapid, accurate, and actionable results to clinical and infection control teams to enhance the safe patient flow in dental practices. PRACTICAL IMPLICATIONS: Oral health care must continue to offer safety in this or any future pandemics. Testing for severe acute respiratory syndrome coronavirus 2 at the POC offers a control mechanism contributing to and enhancing the real and perceived safety of care in the dental office setting.

Characteristics and Detection Rate of SARS-CoV-2 in Alternative Sites and Specimens Pertaining to Dental Practice: An Evidence Summary.

Knowledge about the detection potential and detection rates of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) in various body fluids and sites is important for dentists since they, directly or indirectly, deal with many of these fluids/sites in their daily practices. In this study, we attempt to review the latest evidence and meta-analysis studies regarding the detection rate of SARS-CoV-2 in different body specimens and sites as well as the characteristics of these sample. The presence/detection of SARS-CoV-2 viral biomolecules (nucleic acid, antigens, antibody) in different clinical specimens depends greatly on the specimen type and timing of collection. These specimens/sites include nasopharynx, oropharynx, nose, saliva, sputum, bronchoalveolar lavage, stool, urine, ocular fluid, serum, plasma and whole blood. The relative detection rate of SARS-CoV-2 viral biomolecules in each of these specimens/sites is reviewed in detail within the text. The infectious potential of these specimens depends mainly on the time of specimen collection and the presence of live replicating viral particles.

Oral health status and oral health-related quality of life in children with attention-deficit hyperactivity disorder and oppositional defiant disorder.

AIMS: Oral diseases can affect various aspects of life in patients with attention deficit hyperactivity disorder/oppositional defiant disorder (ADHD/ODD). This study aimed to assess the oral health status and oral health-related quality of life (OHRQOL) in ADHD/ODD children. METHODS: Forty ADHD/ODD and 80 control children aged 3-7 years old were included in the study. Gingival index (GI), dmft score, and the pediatric oral health-related quality of life (POQL) questionnaire were used to determine the oral health status and OHRQOL, respectively. RESULTS: The mean dmft and GI were significantly higher in the ADHD/ODD group than the control group (P = .002 and P = .001). In the ADHD/ODD children, the total score of OHRQOL and the mean scores of the emotional, physical, role, and social domains were lower than that in the control group (P = .0004, P = .027, P = .002, P = .014, and P = .043, respectively). Poisson's regression showed that there was a significant relationship between OHRQOL and dmft scores (P-value < .001). However, the association between GI and OHRQOL scores was not significant. CONCLUSION: Higher dmft and GI scores were found in children with ADHD/ODD than the control children. A lower POQL score was detected in ADHD/ODD patients, which translates to a better level of OHRQOL.

Primary tooth pulpectomy overfilling by different placement techniques: A systematic review and meta-analysis.

Background. This study was conducted to investigate root canal overfilling with different material placement techniques in primary teeth. Methods. A systematic search was undertaken by searching PubMed/MEDLINE and Scopus for English language peer-reviewed articles published until February 2018 that reported primary tooth pulpectomy overfilling. Two reviewers independently screened and identified studies in terms of the selection criteria and independently collected the data using a specially designed data extraction form. The overfilling rate was the primary summary measure. The weighted pooled overfilling rates were estimated by random-effects meta-analysis. Results. Twenty clinical and four in vitro studies met the eligibility criteria. In the clinical studies, the pooled overfilling rate for zinc oxide-eugenol (ZOE) was 23.3% with a lentulo spiral mounted on a handpiece, 22.7% with a hand-held lentulo spiral, and 17% with a plugger. The pooled overfilling rate for calcium hydroxide-based materials was 16.7% with a lentulo spiral mounted on a handpiece, 14.7% with a hand-held lentulo spiral, 19.6% with a syringe, and 25.7% with a plugger. In the in vitro studies, neither individual overfilling rates nor two-by-two comparisons were subjected to meta-analysis because of an inadequate number of studies. Conclusion. The lowest overfilling rate in the clinical studies was related to plugger and handheld lentulo spiral techniques for ZOE and calcium hydroxide-based materials, respectively.

Does the length of dental procedure influence children's behavior during and after treatment? A systematic review and critical appraisal.

The aim of this systematic review was to investigate the effect of treatment duration on children's behavior and/or anxiety in the dental setting. To this end, a systematic search was conducted in Pubmed/Medline and Scopus from 1970 to march 2017 for English language articles that assessed the relationship between dental treatment duration or length, and fear/anxiety or behavior in children aged <12 with no confounding medical and/or psychological history and neuro-psychiatric disabilities. Four studies investigating the effect of treatment duration on children's behavior during and/or after treatment were included. None of the reviewed studies investigated the effect of treatment duration on children's dental anxiety or fear. There was a general tendency towards deterioration of children's behavior with an increase in treatment duration. In conclusion, our results undermine the validity of current suggestions about the appropriate treatment duration. Further clinical trials are needed to establish appropriate treatment duration for more effective behavioral management of pediatric patients during dental proce-dures.

Can galvanic skin conductance be used as an objective indicator of children's anxiety in the dental setting?

BACKGROUND: Assessment of procedural distress is essential at assisting children during invasive dental treatments. This study aimed to determine the validity and reliability of galvanic skin response as a measure for assessment of dental anxiety in children. MATERIAL AND METHODS: 151 children, aged 5-7 years, participated in this study. Similar dental treatments were rendered to all subjects. At the beginning and end of the session, modified child dental anxiety scale (MCDAS), clinical anxiety rating scale (CARS) and galvanic skin response (GSR) were used to determine children's anxiety. RESULTS: GSR was significantly correlated with both MCDAS (rs=0.62, p=0.02) and CARS (rs=0.44, p=0.032). The correlation between MCDAS and CARS was also significant (rs = 0.9, P<0.001). Anxiety decreased during the session in both GSR (rs=0.52, p=0.001) and MCDAS scales (rs=0.77, p=0.001). CARS also showed a reduction between the initial and second assessment, but it was not statistically significant (rs=0.12, P=0.36). CONCLUSIONS: The findings suggest that GSR is a reliable and valid measure for assessment of children's dental anxiety in the clinical context. GSR may help to identify clinically anxious children before dental treatment to provide appropriate interventions. Key words:Dental anxiety, reliability, validity, galvanic skin response.

Sealing efficacy of mineral trioxide aggregate with and without nanosilver for root end filling: An in vitro bacterial leakage study.

BACKGROUND: Various materials have been added to mineral trioxide aggregate to enhance its properties. This study was aimed to compare the sealing efficacy of MTA with and without nanosilver using bacterial leakage approach. MATERIAL AND METHODS: Seventy canine teeth were prepared and obturated. Then, after apical resection, the root-end cavities were prepared by ultrasonic retrotips. Teeth were randomly divided into 4 groups containing two experimental groups (n=30) and two negative and positive controls (n=5). In group 1 and 2, root-end cavities were respectively filled with MTA and MTA with nanosilver (by 1% weight). Leakage assessment was carried out by bacterial leakage apparatus with Enterococcus faecalis species. Leakage comparison between experimental groups was done using Mann-Whitney test by Spss 16 software at significancy level of 0.05. RESULTS: The median bacterial leakages for MTA and MTA with nanosilver were 19 and 2, respectively. The mean bacterial leakages for MTA and MTA with nanosilver were 30.06±28.67 and 9.66±14.25, respectively. Mann-Whitney test indicated that there was a significant difference in bacterial leakage day between two experimental groups (P=0.002). CONCLUSIONS: Based on the findings of this in-vitro bacterial leakage study, adding nanosilver to MTA decreased its sealing ability. Key words:Root canal therapy, root canal obturation, root canal filling materials, nanosilver, MTA.

Assessment of Factors Affecting Adolescent Patients' Compliance with Hawley and Vacuum Formed Retainers.

INTRODUCTION: Success of orthodontic retention with removable retainers almost entirely depends on patients' compliance. AIM: This study was carried out to investigate the relationship between adolescent orthodontic patients' compliance and various clinical and social factors. MATERIALS AND METHODS: The data were collected from 77 orthodontic patients aged 7-11 years old who had finished the full fixed appliance therapy. Hawley's retainers were used in 34 patients and 43 patients used Vacuum Formed Retainers (VFRs). The subjects completed a questionnaire including several identifiers allowing the respondents to be classified into subgroups. They were also asked to indicate how long they wore their retainers during the day, by writing the number of hours in the report-card for the next three months. Comparison of the results was performed by one-way ANOVA and independent sample-t tests. RESULTS: No significant differences were found between males and females. Type of the retainer, patients' grade of study, mothers' occupation, clinicians' and parents' attitudes and filling the report cards had significant effect on mean wear hours per day. When compliance of the patients was assessed according to treatment location, Living place, parents' educational degrees and ethnicity, no significant differences could be found. CONCLUSION: The adolescent patients' compliance was greater with VFRs than with Hawley's retainers. Parental attitude and doctor-patient relationship had a great impact on adolescent patients' compliance.

Arch width changes in patients with Class II division 1 malocclusion treated with maxillary first premolar extraction and non-extraction method.

BACKGROUND: The aim of this study was to determine arch width changes during maxillary first premolars extraction and non-extraction treatment in patients with Class II division 1 malocclusion. MATERIAL AND METHODS: Dental casts of 91 Class II division 1 patients (36 males and 55 females) were evaluated. The minimum age of the subjects at the beginning of treatment was above 16 years. 48 patients were treated with extraction of the maxillary first premolars and 43 patients were treated without extraction. Pre- and post-treatment maxillary and mandibular inter-canine and inter-molar arch widths were measured. RESULTS: At the end of treatment, maxillary and mandibular inter-canine widths of both groups increased significantly. The maxillary inter-molar width decreased in the extraction group and increased in the non-extraction group. The mandibular inter-molar width increased significantly in both groups. No significant differences were observed between males and females. CONCLUSIONS: The results of this study indicated that there was a tendency for an increase in arch width during both the extraction and non-extraction treatment except maxillary inter-molar width in the extraction cases. Key words:Dental arch, malocclusion, angle Class II, tooth movement, extraction.