Impact of Syrian Conflict on the Oral Health of Adolescents: A Cross-Sectional Study.

BACKGROUND: The Syrian conflict has had a negative impact on the psychological and overall health of adolescents. However, little is known about the oral health of those who are internally displaced. AIMS: The purpose of this study was to investigate the relationship between mental health state and self-reported oral health and habits in Syrian adolescents. METHODS: A total of 99 adolescents living in Syria were included in the study. The participants were given four questionnaires: the International Trauma Questionnaire (ITQ), the Depression Anxiety Stress Scale-21 (DASS-21), the Epworth Sleepiness Scale (ESS), and the World Health Organization (WHO) Oral Health Questionnaire for Children (2013). The relationship between self-reported oral and mental health was evaluated. RESULTS: Adolescents with symptoms of mental disturbances or abnormal sleep conditions were statistically more likely to self-report the health of their teeth and gums as below average, less likely to brush their teeth regularly, and reported more frequent smoking (p<0.05). Moreover, symptoms of mental disturbances and abnormal sleep conditions were statistically more likely in adolescents living in rural areas and whose parents' education did not exceed secondary school (p<0.05). CONCLUSION: Syrian adolescents reported mental disturbances, which were reflected in their poor oral health and habits. These findings confirm the need for psychiatric and oral health care programs for Syrians who remain in areas of conflict.

Adhesion to enamel and dentine: an update.

With the continuous development of adhesive technology leading to a wide variety of bonding systems in the market, clinicians are often faced with a vast number of systems to choose from. Although research and manufacture of bonding systems is constantly progressing, the focus has generally been on simplifying the bonding process by reducing the number of clinical steps, with little emphasis on evidence-based performance. This article draws attention to the current strategies of common commercially available products to guide clinicians during bonding system selection and application.

A self-etch bonding system with potential to eliminate selective etching and resist proteolytic degradation.

OBJECTIVES: Bonded restorations using self-etch (SE) systems exhibit a limited lifespan due to their susceptibility to hydrolytic, enzymatic or fatigue degradation and poor performance on enamel. This study was conducted to develop and assess the performance of a two-step SE system using a functional monomer bis[2-(methacryloyloxy)ethyl]phosphate (BMEP) and demonstrate a strategy to enhance stability of bonded resin composite restorations to both enamel and dentine. METHODS: A two-step SE system was formulated with a primer containing BMEP, with an adhesive with or without BMEP, and compared to a commercial 10-MDP-containing system, ClearfilTM SE Bond 2 (CFSE). The systems were evaluated on enamel for surface roughness and microshear bond strength (µSBS) and on dentine for microtensile bond strength (µTBS), nanoleakage, MMP inhibition and cyclic flexural fatigue. RESULTS: Whilst all bonding systems resulted in statistically similar µSBS, BMEP-based primers yielded greater enamel surface roughness than the CFSE primer. The BMEP-free adhesives resulted in statistically similar or higher µTBS and lower nanoleakage compared to CFSE. In situ zymography revealed minimal to no MMP activity within the hybrid layer of BMEP-based systems. The BMEP-free adhesive exhibited flexural strength and fatigue resistance statistically similar to CFSE. CONCLUSIONS: Incorporation of BMEP in the primer led to satisfactory bond strengths with both enamel and dentine, potentially eliminating the need for selective enamel etching. Combined with an adhesive formulation that is solvent-free and hydrophobic, and confining the acidic functional monomer in the primer resulted in minimal interfacial leakage, and resistance to proteolytic degradation and the cyclic nature of chewing. CLINICAL SIGNIFICANCE: The SE bonding system containing BMEP combines the potent etching of phosphoric acid with the therapeutic function of the phosphate-based monomer in creating a homogenous hybrid layer with protection against endogenous proteolytic enzymes. This strategy may overcome current challenges that arise during selective enamel etching.

A multi-functional dentine bonding system combining a phosphate monomer with eugenyl methacrylate.

OBJECTIVE: The tooth-resin composite interface is frequently associated with failure because of microbial contamination, hydrolytic and collagenolytic degradation. Thus, designing a dentine bonding system (DBS) with an intrinsically antimicrobial polymerisable monomer is of significance especially if it can be used with self-etching primers enabling resistance to degradation of the interface. METHODS: Experimental adhesives were developed incorporating eugenyl methacrylate (EgMA) at concentrations of 0,10 or 20 wt%, designated as EgMA0, EgMA10 and EgMA20, respectively, for use as a two-step self-etch DBS with the functional monomer bis[2-(methacryloyloxy) ethyl] phosphate (BMEP) in the primer. The curing, thermal and wettability properties of the adhesives were determined, and hybrid layer formation was characterised by confocal laser scanning microscopy, microtensile bond strengths (µTBS) and nanoleakage by back-scattered SEM. In situ zymography was used to assess MMP inhibitory activity of the BMEP-EgMA DBS. RESULTS: EgMA in the adhesives lowered the polymerisation exotherm and resulted in higher Tg, without negatively affecting degree of conversion. Water sorption and solubility were significantly lower with higher concentrations of EgMA in the adhesive. The formation of a distinct hybrid layer was evident from confocal images with the different adhesives, whilst EgMA20 yielded the highest µTBS post water storage challenges and lowest nanoleakage after 6 months. The experimental DBS exhibited minimal to no MMP activity at 3 months. SIGNIFICANCE: The hydrophobic nature of EgMA and high cross-link density exerts considerable benefits in lowering water uptake and polymerisation exotherm. The application of EgMA, adhesives in conjunction with BMEP in a multi-functional self-etching DBS can resist MMP activity, hence, enhance longevity of the dentine-resin composite interface.

The influence of hardness and chemical composition on enamel demineralization and subsequent remineralization.

OBJECTIVES: The objectives were to investigate the hardness and chemical composition of sound, demineralized and pH-cycled bovine enamel and determine their influence on demineralization and remineralization behavior. METHODS: Ninety-four, 5 × 5 × 2-mm bovine enamel specimens were demineralized using three different times [(24 h (n = 33), 48 h (n = 30), 96 h (n = 31)]. The specimens were then pH-cycled using either 367 ppm F sodium fluoride or deionized water. Knoop hardness (HK) and energy-dispersive X-ray spectroscopy (measured elements: Ca, P, F, C, Mg, N) were performed at three stages (sound, after demineralization, after pH-cycling) and transverse microradiography was performed after demineralization and pH-cycling. Comparisons were determined by ANOVA. RESULTS: Results showed that HK, integrated mineral loss and lesion depth were significantly different between stages, demineralization times and treatments. The weight% of F at the surface was significantly affected by treatment, irrespective of demineralization time, while the Ca:P ratio of the enamel remained stable even after de- and remineralization protocols. The F in fluoride groups and the artificial saliva in non-fluoride groups were both able to induce enamel remineralization, indicating the protective effect of salivary pellicle against demineralization even in the absence of fluoride. CONCLUSIONS: Harder specimens and those with greater surface F weight% were less susceptible to demineralization and were more likely to remineralize. However, the amount of surface Ca and P did not influence de- or remineralization behavior. CLINICAL SIGNIFICANCE: This in vitro study can help clinicians better understand the caries process and the impact of the physical and chemical characteristics of enamel on its behavior during de- and remineralization. The over-the-counter fluoride toothpaste containing 1100 ppm-F was used, and was able to produce a mineralized enamel surface layer.