Management of fear and anxiety in dental treatments: a systematic review and meta-analysis of randomized controlled trials.

OBJECTIVES: This systematic review was to compare the effects of interventions for the management of fear and anxiety for dental treatments. METHODS: This research project was applied to PubMed, CENTRAL, Web of Science, Cochrane library databases. The last search was run on March 31st, 2021. A list of references of relevant articles and previous reviews were checked. Qualitative and quantitative analyses were performed. RESULTS: A total of 20 eligible randomized controlled trials were included, and 969 participations in experimental group and 892 participations in the control group were involved. Anxiety levels decreased more in intervention groups than in control groups (Z = 3.47, P = 0.0005, SMD = - 0.62, 95% CI - 0.98 to - 0.27). For adults, there was statistical difference between experimental and control groups [Z = 2.14, P = 0.03, 95% CI - 0.54 (- 1.03, - 0.04)], while there was not no such statistical difference in children and adolescents [Z = 1.62, P = 0.11, 95% CI - 0.60 (- 1.32, 0.13)]. Patients experienced a significant decrease in anxiety level using sedation drugs [Z = 2.44, P = 0.01, 95% CI - 0.61 (- 1.10, - 0.12)] and audio-visual distractions [Z = 3.1, P = 0.002, 95% CI - 0.86 (- 1.40, - 0.32)]. For the informative intervention groups, patients did not show significant difference than control groups [Z = 1.22, P = 0.22, 95% CI - 0.55 (- 1.43, 0. 33)]. There was no statistical difference in vital signs [Z = 1.39, P = 0.16, 95% CI - 0.25 (- 0.61, 0.10)] and pain levels [Z = 0.69, P = 0.49; SMD = - 0.06, 95% CI (0.27, 0.11)] between intervention and control groups. CONCLUSIONS: Interventions should be used in managing anxiety and fear for dental treatment. It might be effective for anxiety alleviating for adults, but there was a low certainty of evidence that interventions could reduce anxiety level in children and adolescents. Sedation drugs and audio-visual distractions might be useful for managing dental fear and anxiety. Pain levels and vital signs could not be improved form our study. High-quality randomized clinical trials are required for further study.

Fabrication of Multilayered Biofunctional Material with an Enamel-like Structure.

The oral cavity is an environment with diverse bacteria; thus, antibacterial materials are crucial for treating and preventing dental diseases. There is a high demand for materials with an enamel-like architecture because of the high failure rate of dental restorations, due to the physical differences between dental materials and enamel. However, recreating the distinctive apatite composition and hierarchical architecture of enamel is challenging. The aim of this study was to synthesize a novel material with an enamel-like structure and antibacterial ability. We established a non-cell biomimetic method of evaporation-based bottom-up self-assembly combined with a layer-by-layer technique and introduced an antibacterial agent (graphene oxide) to fabricate a biofunctional material with an enamel-like architecture and antibacterial ability. Specifically, enamel-like graphene oxide-hydroxyapatite crystals, formed on a customized mineralization template, were assembled into an enamel-like prismatic structure with a highly organized orientation preferentially along the c-axis through evaporation-based bottom-up self-assembly. With the aid of layer-by-layer absorption, we then fabricated a bulk macroscopic multilayered biofunctional material with a hierarchical enamel-like architecture. This enamel-inspired biomaterial could effectively resolve the problem in dental restoration and brings new prospects for the synthesis of other enamel-inspired biomaterials.

An enamel-inspired bioactive material with multiscale structure and antibacterial adhesion property.

Conventional dental materials lack of the hierarchical architecture of enamel that exhibits excellent intrinsic-extrinsic mechanical properties. Moreover, restorative failures frequently occur due to physical and chemical mismatch between artificial materials and native dental hard tissue followed by recurrent caries which is caused by sugar-fermenting, acidogenic bacteria invasion of the defective cite. In order to resolve the limitations of the conventional dental materials, the aim of this study was to establish a non-cell-based biomimetic strategy to fabricate a novel bioactive material with enamel-like structure and antibacterial adhesion property. The evaporation-based, bottom-up and self-assembly method with layer-by-layer technique were used to form a large-area fluorapatite crystal layer containing antibacterial components. The multilayered structure was constructed by hydrothermal growth of the fluorapatite crystal layer and highly conformal adsorption to the crystal surface of a polyelectrolyte matrix film. Characterization and mechanical assessment demonstrated that the synthesized bioactive material resembled the native enamel in chemical components, mechanical properties and crystallographic structure. Antibacterial and cytocompatibility evaluation demonstrated that this material had the antibacterial adhesion property and biocompatibility. In combination with the molecular dynamics simulations to reveal the effects of variables on the crystallization mechanism, this study brings new prospects for the synthesis of enamel-inspired materials.

Synthesis of a graphene oxide/agarose/hydroxyapatite biomaterial with the evaluation of antibacterial activity and initial cell attachment.

Various materials are used in bone tissue engineering (BTE). Graphene oxide (GO) is a good candidate for BTE due to its antibacterial activity and biocompatibility. In this study, an innovative biomaterial consists of GO, agarose and hydroxyapatite (HA) was synthesized using electrophoresis system. The characterization of the synthesized biomaterial showed that needle-like crystals with high purity were formed after 10 mA/10 h of electrophoresis treatment. Furthermore, the calcium-phosphate ratio was similar to thermodynamically stable HA. In the synthesized biomaterial with addition of 1.0 wt% of GO, the colony forming units test showed significantly less Staphylococcus aureus. Initial attachment of MC3T3-E1 cells on the synthesized biomaterial was observed which showed the safety of the synthesized biomaterial for cell viability. This study showed that the synthesized biomaterial is a promising material that can be used in BTE.

Electrophoresis-Aided Biomimetic Mineralization System Using Graphene Oxide for Regeneration of Hydroxyapatite on Dentin.

Graphene oxide (GO) is an emerging luminescent carbon nanomaterial with the ability to foster hydroxyapatite (HA). A specially designed electrophoresis system can be used to accelerate the mineralization process. The aim of this study was to promote HA crystal growth on demineralized dentin using a GO incorporated electrophoresis system. GO was successfully synthesized by carbonization of citric acid and its presence was confirmed by Fourier transform infrared and UV-visible spectrophotometry evaluation. Dentin slices were placed in demineralized solution and divided into control (without the electrophoresis system) and experimental group. Demineralized dentin slices in the experimental group were remineralized using the electrophoresis system for 8 h/1.0 mA, with one subgroup treated without GO and the other with GO. Energy dispersive spectroscopy evaluation showed that the calcium/phosphate ratio of the crystal formed in control and experimental group with addition of GO was close to natural hydroxyapatite. However, scanning electron microscopy evaluation showed that the exposed dentinal tubules were occluded with rod-like crystals, which is similar to native enamel morphology, in the experimental group with addition of GO compared to the flake-like crystal in the control group. Mechanical evaluation revealed that the nanohardness and modulus of remineralized dentin were significantly higher in the experimental group. In conclusion, GO is a promising material to remineralize dentin and the introduction of an electrophoresis system can accelerate its process.

Dental fear association between mothers and adolescents-a longitudinal study.

AIM: To assess the longitudinal association between adolescents' and their mothers' dental fear. STUDY DESIGN: A longitudinal questionnaire survey study. METHODS: A randomized sample of 12-year-old adolescents were selected from local Hong Kong schools. Adolescents and their mothers self-completed the Modified Dental Anxiety Scale (MDAS). The sociodemographic background of the mothers and the oral health habits of the adolescents were also collected and these measurements were repeated at 15- and 18-years-old. Non-parametric tests (Mann-Whitney U test/Kruskall Wallis test) were used to test associations between MDAS dental fear items and independent variables. Logistic regression (adjusted for family's sociodemographic background and adolescent's oral health habits) was performed to evaluate the longitudinal association between adolescents' and mothers' dental fear. RESULTS: A total of 212 mother-child pairs were recruited at baseline (12-year-old adolescents). In the first and second follow-ups (15- and 18-years-old), 195 and 182 mother-child pairs completed the survey. Significant associations between mother's and child's scores in "feeling about having their teeth scraped and polished", "having teeth drilled", and 'having an injection in the gum' were found when adolescents were 12- years-old (P < 0.01) and 18-years-old (P < 0.05), but not at 15-years-old. CONCLUSION: Adolescents' and mothers' dental fear is associated at 12-years-old and 18-years-old, but not at 15-years-old, which is likely specific to the Hong Kong context but may be extrapolated to other industrialized countries with caution.

Constructing an Antibiofouling and Mineralizing Bioactive Tooth Surface to Protect against Decay and Promote Self-Healing.

Numerous methods have been investigated to manage dental caries, one of the top three diseases threatening human health as reported by the World Health Organization. An innovative strategy was proposed to prevent dental caries and achieve self-healing of the decayed tooth, and a novel bioactive peptide was designed and synthesized to construct an antibiofouling and mineralizing dual-bioactive tooth surface. Compared to its original endogenous peptide, the synthesized bioactive peptide showed statistically significantly higher binding affinity to the tooth surface, stronger suppression of demineralization, and a certain promotion of tooth remineralization. The abilities of the peptide to inhibit Streptococcus mutans (S. mutans) biofilm formation and S. mutans adhesion on the tooth surface were not affected after synthesis. Biocompatibility tests revealed the safety of the synthesized bioactive peptide. Interaction mechanisms between the synthesized bioactive peptide and tooth surface were also explained by molecular dynamic simulation analysis. In summary, the synthesized bioactive peptide could be applied safely to prevent dental caries and effectively induce in situ self-healing remineralization for treatment of the decayed tooth.

Repair of dentine-related lesions without a drill or injection.

For covering the shortages of traditional treatments, a novel and non-invasive system was developed with the simple adaption of nature's own repair process, while an extrinsic electric field was introduced to improve its remineralization kinetics. In an in vivo study, acid-etched rabbit dentine was used to evaluate the remineralization efficacy and safety of the system. The exposed dentine tubules were fully occluded after 5 hours/1.0 mA and 8 hours/0.5 mA of remineralization. After 5 hours of remineralization (1.0 mA), the micro-hardness of the demineralized dentine was fully recovered, equal to native rabbit dentine. Haematoxylin-eosin staining demonstrated no obvious inflammatory reaction. This study provides a feasible solution to realize rapid repair of dentine.

In vitro and in vivo evaluation of electrophoresis-aided casein phosphopeptide-amorphous calcium phosphate remineralisation system on pH-cycling and acid-etching demineralised enamel.

Casein phosphate-amorphous calcium phosphate (CPP-ACP), as a remineralisation agent, is extensively used in managing demineralised enamel; however, its remineralisation kinetics is low. This study aimed to improve remineralisation kinetics of CPP-ACP by introducing a rapid remineralisation method with electrophoresis. In vitro, a pH-cycling enamel model was used to test remineralisation potentials of electrophoresis-aided CPP-ACP. For verifying remineralisation potentials of electrophoresis-aided CPP-ACP in vivo in a rabbit model, acid-etched enamel surface on rabbit maxillary incisors was remineralised by electrophoresis-aided CPP-ACP with 1.0 mA (group A) or 0.5 mA (group B). Both in vitro and in vivo, it was observed that electrophoresis was benefit to improve remineralisation kinetics of CPP-ACP, and the demineralised enamel was completely remineralised after 5 h. The Ca/P ratio in remineralised enamel consisted with that of hydroxyapatite, the microstructure in native enamel. Meanwhile, in vivo the micro-hardness of acid-etched enamel in group A (322.55 ± 31.90) and group B (322.55 ± 31.90) recovered up to the value of native enamel after 5 h remineralisation (p > 0.05). The Hematoxylin-eosin stain demonstrated that the electric field used in this study was safe on rabbit dental pulp. Therefore, this efficient and safe method has the potential to be applied in treating enamel deminerlisation.