Hyaluronic acid as a pulpotomy material in primary molars: an up to 30 months retrospective study.

BACKGROUND: The aim of this retrospective study was to determine the long-term clinical and radiographic success of our previous randomized clinical trial and to compare the success of hyaluronic acid, with the widely used formocresol and ferric sulphate agents. METHODS: This retrospective study is the extension of the 1-year survey of our randomized clinical trial that had compared the effectiveness of a hyaluronic acid pulpotomy over formocresol and ferric sulphate pulpotomies and included clinical and radiographic evaluations with a follow-up period of over 24 months for 44 children who applied to our clinic between May 2019 and September 2019. Long-term clinical and radiographic data were obtained from the periodic files of our department, wherein each tooth's file was examined to identify any clinical and radiographic findings. Descriptive statistics and Pearson's chi-square tests were used to evaluate the data. Statistical significance was considered as p < 0.05. RESULTS: The clinical and radiographic success rates of the hyaluronic acid, formocresol, and ferric sulphate groups were not statistically different at > 24 months. None of the teeth in the hyaluronic acid group showed any clinical findings at > 24 months. CONCLUSIONS: Hyaluronic acid pulpotomies exhibited comparable success rates to formocresol and ferric sulphate materials spanning over 24 months examinations. Because of convenient accessibility and applicability of hyaluronic acid, it may be recommended as a promising alternative medicament for pulpotomy treatments of primary molars. However, further long-term follow-up human studies are needed to better understand the effect of hyaluronic acid on the dental pulp of human primary molars.

Investigation of the fungiform papillae number in children with tooth number anomalies.

OBJECTIVE: This cross-sectional study investigated the association between fungiform papillae (FP) numbers and tooth number anomalies in children, considering variables related to hypodontia and hyperdontia. The aim was to explore this association while adjusting for age and sex differences. MATERIALS AND METHODS: A total of 144 children (aged 8-10) were categorized into hypodontia (n = 48), hyperdontia (n = 48), and control groups (n = 48). Clinical and radiographic diagnoses were used to classify tooth number anomalies. Hypodontia was categorized by number and location, while hyperdontia was categorized by number, shape, and location. FP were assessed using the Denver Papillae Protocol. Data analyses were performed using NCSS software, with p < 0.05 considered statistically significant. RESULTS: The hypodontia group (22.5 ± 8.4) exhibited significantly lower FP than the control group (30.4 ± 9.2) and the hyperdontia group (27.9 ± 7.8) (p < 0.0005, p = 0.003, respectively). No significant difference existed between the hyperdontia and control groups. FP numbers in hypodontia subgroups showed no significant differences based on teeth agenesis numbers or locations. Similarly, hyperdontia subgroup analyses revealed no significant differences in FP numbers based on supernumerary teeth shapes (supplemental, conical, tuberculoid, paramolar) or the numbers of supernumerary teeth. CONCLUSIONS: The lower FP numbers in children with hypodontia suggested an association between teeth and FP number. However, the non-significant difference in FP numbers with hyperdontia underscored the complexity of tooth development, warranting further investigations. CLINICAL RELEVANCE: Children with hypodontia may exhibit distinct FP numbers compared to those without tooth number anomalies.

Management options and long-term follow-ups for permanent double incisors: six to eleven-year case reports.

BACKGROUND: Double teeth are dental anomalies that can lead to aesthetic and orthodontic problems. CASE PRESENTATION: This report discusses two cases involving the multidisciplinary management of permanent maxillary left lateral incisors fused with a supernumerary tooth in two girls aged 9 and 10. Following intraoral and radiographic examinations, one was diagnosed with fusion, and the other was diagnosed with concrescence. The crown of the fused incisor was separated using a burs and extracted intraorally. The concrescent incisor was separated along its length using a laser and intentionally replanted extraorally. After a 6-year follow-up, no pathological signs were observed in the fused incisor. However, after an 11-year follow-up, external resorption was observed in the concrescent incisor. CONCLUSIONS: Both incisors remained asymptomatic throughout the observation period. This case report highlights two different and effective methods employed to preserve the natural function, form, and aesthetics of double incisors.

Retrospective evaluation of traction time for impacted dilacerated maxillary central incisors in mixed dentition.

PURPOSES: This study aimed to contribute to understanding the factors affecting the time of traction treatment of impacted dilacerated maxillary central incisors. METHODS: This retrospective study included children aged 8 - 11 years with a history of trauma, who applied to the pediatric dentistry clinics of Marmara University, School of Dentistry, between December 2013 and December 2019, and were treated for unilateral impacted dilacerated maxillary upper central incisors. Children's age, sex, digital panoramic radiographs, cone-beam computed tomography, and intraoral photographs were retrieved from electronic dental health records. The effects of children's age, sex, the direction of impacted teeth, distance of the teeth to the top of the alveolar crest, and root dilaceration level on traction time were analyzed by Mann-Whitney U test and Spearman's rank correlation coefficient test. RESULTS: The inverse position of the incisors significantly increased the traction time (P = 0.012). However, the traction time did not differ according to the sex of the children (P = 0.707) or the level of root dilaceration (P = 0.429). No correlation was observed between the traction time and the age of children (P = 0.644) or the distance of the incisors from the top of the alveolar crest (P = 0.397). CONCLUSIONS: In cases of the forced eruption of for the impacted dilacerated maxillary central incisors, the direction of the teeth should be evaluated when deciding on the treatment plan, as it may affect the treatment time.

How prenatal environmental factors affect rat molar enamel formation?

Amelogenin (AMELX) and ameloblastin (AMBN) are crucial for enamel formation, and interruptions in the production of these proteins may cause enamel defects. We investigated how prenatal environmental factors (chronic stress, bisphenol A (BPA), amoxicillin, and lipopolysaccharide (LPS)) affect AMELX and AMBN production of ameloblasts. Fifteen pregnant Sprague-Dawley rats were divided into four experimental groups and a control group. Chronic-stress group rats were exposed to a 12:12 light/light cycle (LL) from day E18 until delivery. BPA group rats were orally administered 5 µg/kg BPA daily from day E1 until delivery. Amoxicillin group rats were injected 100 mg/kg amoxicillin daily from day E18 until delivery. LPS-infection group rats were injected 125 µg/kg bacterial LPS once on day E18. Seven pups from the control group and ten pups from the experimental groups were euthanized on P10. Sections were stained with hematoxylin and eosin (H&E) and Gomori's one-step trichrome staining (GT) and incubated with rabbit polyclonal antibodies to AMELX and AMBN, to evaluate staining intensity at ameloblast stages. The surface morphology was evaluated with a stereomicroscope. AMELX (p = 0.008, p = 0.0001, p = 0.009) and AMBN (p = 0.002, p = 0.001, p = 0.0001) staining of all groups were significantly lower than that of the control group in the secretory, transitional, and maturation stages. Abnormal enamel matrix formation was observed in the H&E and GT staining sections of all experimental groups. Yellowish coloration of the amoxicillin group was observed in morphologic evaluation.

A randomized clinical trial of hyaluronic acid gel pulpotomy in primary molars with 1 year follow-up.

OBJECTIVE: This randomized clinical study aimed to evaluate the success of hyaluronic acid (HA) as a pulpotomy medicament of human primary molars and to compare it with formocresol (FC) and ferric sulphate (FS) pulpotomy treatments up to 12 months. MATERIALS AND METHODS: The study was conducted with 130 primary molars of 44 children. The ethical approval and registration to clinical trials (No: NCT04115358) were completed. After the removal of all the coronal pulp tissue, a 0.5% HA gel, or a FC, or a 20% FS solution were applied randomly to the radicular pulp tissues of the primary molars. Then, the pulp chambers were filled with a zinc oxide eugenol cement and restored either with a composite filling material or with a stainless-steel crown. The treatment success rates of the 3 groups were followed and compared clinically and radiographically at 1st-, 3rd-, 6th- and 12th-months. RESULTS: Primary molars treated with FC, FS and HA dressings were clinically successful 77.5%, 86.8% and 87.5% respectively after 12th-month follow-up (p > .05). Radiographic successes of FC, FS and HA groups were lower than clinical successes (57.6%, 68.8%, 57.9% respectively at the 12th-month) but the difference between the groups was not statistically significant (p > .05). Equivalence analysis assuming not more than 10% difference between the materials suggested that HA was not inferior to FC or FS. CONCLUSIONS: Within the limitations of this study, our randomized clinical trial shows that HA is a promising pulpotomy medicament in primary molars. However, further studies are justified to further improve the HA material success.

Relationship between the fungiform papillae number and dental caries in primary teeth: a cross-sectional study.

OBJECTIVES: Fungiform papillae (FP) contain numerous taste buds. A genetic susceptibility between tasting via FP and caries risk has been suggested. This study aimed to investigate the relationship between FP number and dental caries and to determine whether FP number may be considered as a test for caries risk. MATERIALS AND METHODS: The study included 157 children who attended the pediatric dentistry department at a public university. Questionnaires, including the children's medical health, oral health knowledge, fluoride exposure, and taste preferences, were filled in by their parents. The FP number on the dorsal surface of the tongue was counted according to the Denver Papilla Protocol. Caries was recorded using deft/DMFT indices. Statistical analyses were performed using SPSS. RESULTS: The FP number decreased significantly according to age (r = -0.441, p = 0.001), and the mean of the girls' FP number was significantly higher than the boys' (p = 0.022). A greater number of FP was associated with increased deft score (p = 0.02, odds ratio [OR] = 1.164). CONCLUSION: The caries risk increased in children who had more FP (FP > 30); therefore, FP number could be evaluated in terms of caries risk. FP number could be evaluated as a risk factor for determining dental caries since the risk of caries increased after a FP cut-off point of 29 was achieved. CLINICAL RELEVANCE: Clinicians can start preventive treatments for caries earlier by determining the FP number for each child.

Outcome of Mandibular Dentigerous Cysts 1 to 10 Years After Decompression Using a Custom-Made Appliance.

PURPOSE: The aim of this study was to examine the long-term results of mandibular dentigerous cysts treated with decompression using a custom-made appliance. PATIENTS AND METHODS: This retrospective study included 34 patients with dentigerous cysts who were treated as outpatients at the Faculty of Dentistry, Marmara University. Medical history, complaints, intraoral and extraoral clinical findings, treatment time, and complications of these patients were collected. RESULTS: The average age of the patients was 7.94 years. Three tooth buds (canine, first permanent premolar [P1], and second permanent premolar) in 2 cases, two tooth buds in 7 cases (P1 and second permanent premolar in 6 cases and P1 and canine in 1 case), and one tooth bud in 25 cases were related to the cyst. The mean decompression time was 5.97 months (range, 3 to 9 months). No major complications occurred during or after decompression. No evidence of infection, breakdown and/or dehiscence of the soft tissue, or inferior alveolar nerve paresthesia was observed. The complications and complaints were minor and straightforward to resolve. CONCLUSIONS: Decompression is a very effective and successful method for the treatment of mandibular dentigerous cysts.

Fluoride related changes in behavioral outcomes may relate to increased serotonin.

Fluoride ingestion has been linked to changes in behavior in mice and rats, related to dose, sex of the animal, and the timing of exposure. Previous studies have shown the behavior of female rats to be most affected by postnatal fluoride exposure, and in this study we determined the effects of postnatal fluoride exposure on anxiety related behavior and serotonin. Mice given 50 ppm fluoride in drinking water had increased entries in the open arms of the elevated plus maze, suggesting reduced anxiety. Both peripheral and central serotonin was increased in the fluoride treated mice. In a cohort of children drinking water containing 2.5 ppm fluoride, serum serotonin was also increased as compared to controls. The mechanisms by which fluoride results in an increase peripheral and central serotonin are not well understood, but warrant further study, as these effects may also be relevant to prenatal fluoride related changes in behavior in both mice and humans.

Two-fold excess of fluoride in the drinking water has no obvious health effects other than dental fluorosis.

BACKGROUND: There is concern that fluorides in the drinking water is hazardous to health. METHODS: We conducted an observational study in the village of Hanliyenice (population 280), Turkey, which has 2.5 times higher than optimal levels of fluoride in the drinking water and evaluated all children 7-13 years of age (N = 30). We collected information on dental decay, fluorosis, daily water consumption and diet, child history and her family history of cancer, cardiovascular risks/diseases, and asthma, and obtained a blood sample for extraction of genomic DNA. We genotyped ten single nucleotide polymorphisms in aquaporins. RESULTS: As expected, a high number of children were dental caries free (19 out of 30) and had fluorosis (25 out of 30). Family history of cancer, cardiovascular events, and asthma was not different from the expected figures based on Turkey. One variant just upstream of AQP5 was associated with being fluorosis free. (G allele of AQP5 rs296763, p = 6.0E-6). CONCLUSIONS: Exposure to levels of fluoride twice as high than the optimum in the drinking water increases the prevalence of fluorosis, dramatically decreases dental caries, and does not increase the risk of cancer, cardiovascular events, and asthma.

REST Final-Exon-Truncating Mutations Cause Hereditary Gingival Fibromatosis.

Hereditary gingival fibromatosis (HGF) is the most common genetic form of gingival fibromatosis that develops as a slowly progressive, benign, localized or generalized enlargement of keratinized gingiva. HGF is a genetically heterogeneous disorder and can be transmitted either as an autosomal-dominant or autosomal-recessive trait or appear sporadically. To date, four loci (2p22.1, 2p23.3-p22.3, 5q13-q22, and 11p15) have been mapped to autosomes and one gene (SOS1) has been associated with the HGF trait observed to segregate in a dominant inheritance pattern. Here we report 11 individuals with HGF from three unrelated families. Whole-exome sequencing (WES) revealed three different truncating mutations including two frameshifts and one nonsense variant in RE1-silencing transcription factor (REST) in the probands from all families and further genetic and genomic analyses confirmed the WES-identified findings. REST is a transcriptional repressor that is expressed throughout the body; it has different roles in different cellular contexts, such as oncogenic and tumor-suppressor functions and hematopoietic and cardiac differentiation. Here we show the consequences of germline final-exon-truncating mutations in REST for organismal development and the association with the HGF phenotype.

The Internet versus pediatricians as a source of infant teething information for parents in Turkey.

OBJECTIVES: Parents are increasingly searching the Internet to gather information about their children's health care. This study compared infant teething information obtained from publically employed pediatricians in Istanbul with that obtained from different Turkish websites (parenting, health, professional, news and commercial). METHODS: This study had two parts. The first part used a descriptive design, with two checklists to assess the quality and comprehensiveness of the teething-specific content on 62 parenting or health websites. The second part was a cross-sectional study of 75 pediatricians at public hospitals who completed a structured self-administered questionnaire. RESULTS: In total, 54 websites (87.1%) described infant teething as a normal developmental process. The lists that were found on the websites identified the most frequent signs of infant teething as fever and drooling/perioral rash. The most frequent management strategies were chewing non-chilled and chilled objects. For teething problems, some pediatricians recommended teething rings and oral benzocaine, while 23 pediatricians recommended nothing. CONCLUSIONS: Parents should be informed by health professionals, especially regarding specific treatment strategies.

The Internet versus pediatricians as a source of infant teething information for parents in Turkey

OBJECTIVES: Parents are increasingly searching the Internet to gather information about their children’s health care. This study compared infant teething information obtained from publically employed pediatricians in Istanbul with that obtained from different Turkish websites (parenting, health, professional, news and commercial). METHODS: This study had two parts. The first part used a descriptive design, with two checklists to assess the quality and comprehensiveness of the teething-specific content on 62 parenting or health websites. The second part was a cross-sectional study of 75 pediatricians at public hospitals who completed a structured self-administered questionnaire. RESULTS: In total, 54 websites (87.1%) described infant teething as a normal developmental process. The lists that were found on the websites identified the most frequent signs of infant teething as fever and drooling/perioral rash. The most frequent management strategies were chewing non-chilled and chilled objects. For teething problems, some pediatricians recommended teething rings and oral benzocaine, while 23 pediatricians recommended nothing. CONCLUSIONS: Parents should be informed by health professionals, especially regarding specific treatment strategies.

Dental Fluorosis and Catalase Immunoreactivity of the Brain Tissues in Rats Exposed to High Fluoride Pre- and Postnatally.

This study evaluated dental fluorosis of the incisors and immunoreactivity in the brain tissues of rats given chronic fluoride doses pre- and postnatally. Female rats were given drinking water with 0, 30 or 100 ppm fluoride ad libitum throughout gestation and the nursing period. In addition, 63 male offspring were treated with the same water regimens as the mothers after weaning and were followed for 1, 3 or 5 months. The upper and lower incisors were collected, and all teeth were examined under a stereomicroscope and scored by two blinded examiners using a modified rodent enamel fluorosis index. Cortical, hippocampal and cerebellar brain samples were evaluated morphologically and immunohistochemically. All fluoride-treated pups were born with low body weight (p = 0.001). All animals from the fluoride groups had enamel fluorosis with defects of various degrees. The increase in the dental fluorosis scores in the fluoride treatment groups was significant (p < 0.01). The catalase immunoreactivity in the 30- and 100-ppm fluoride groups was significantly higher than that in the controls after 1, 3 and 5 months (p < 0.001). In conclusion, this study showed that rats with dental fluorosis had catalase immunoreactivity in the brain tissues, which may reflect the neurobehavioral toxicity of fluoride.

A 48-month randomized controlled trial of caries prevention effect of a one-time application of glass ionomer sealant versus resin sealant.

The aim of this study was to compare the caries prevention effectiveness, retention rates and the level of fluoride of saliva of a glassionomer sealant (GIS) with that of a resin-based sealant (RS). Eighty GIS and 80RS were placed on the first permanent molars in 40 children aged 7-10 years. Children were re-examined at 6, 12, 24, 36 and 48 months after the procedure. Saliva samples were collected before the sealant was applied and again at each appointment, and fluoride levels were measured. After 48 months, occlusal caries were seen in 4 and 12 teeth in GIS and RS groups respectively. There was a statistically significant difference in the fluoride levels of saliva between baseline and up to 12th month in GIS group. GISs presented effective prevention of caries development, even though the failure rate is higher when compared to the RSs. An increased salivary fluoride level due to GISs might be an additive effect on the prevention of dental caries.

Association of sweet taste receptor gene polymorphisms with dental caries experience in school children.

Sweet taste is a powerful factor influencing food acceptance. The peripheral taste response to sugar is mediated by the TAS1R2/TAS1R3 taste receptors. The aim of the study was to determine the relationship between TAS1R2 (rs35874116 or rs9701796) and/or TAS1R3 (rs307355) single nucleotide polymorphisms with dental caries experience in schoolchildren. A total of 184 schoolchildren aged between 7 and 12 years (101 girls, 83 boys) were included in the study. Genomic DNA was extracted from saliva samples and the genotypes were identified by qPCR. The genotype frequencies were as follows: 6.6% for homozygous wild type, 41.8% for heterozygous and 51.6% for homozygous polymorphic genotype carriers of TAS1R2 gene rs35874116; 27.8% for heterozygous and 72.2% for homozygous polymorphic genotype carriers of TAS1R2 gene rs9701796, and 83.1% for homozygous wild type and 16.9% for heterozygous genotype carriers of TAS1R3 gene rs307355 polymorphism. A significant association was observed between total caries experience (dft + DMFT - decayed filled primary teeth + decayed, missing and filled permanent teeth) and TAS1R2 rs35874116 (p = 0.008) and TAS1R3 rs307355 (p = 0.04) gene polymorphisms but not for TAS1R2 gene rs9701796 polymorphism. TAS1R3 gene rs307355 polymorphism has been found to be an independent risk factor for dental caries experience by logistic regression analysis and to have increased the risk of caries. Moderate caries experience (4-7 caries) was found to be associated with TAS1R3 rs307355 heterozygous genotype, whereas high-risk caries experience (>8 caries) was found to be associated with TAS1R2 rs35874116 homozygous polymorphic genotype.

In vitro evaluation of microleakage under a glass ionomer surface protector cement after different enamel treatment procedures.

AIM: The aim of this in vitrostudy was to evaluate the microleakage of a glass-ionomer surface-protector cement (GC Fuji Triage) placed onto the fissure surfaces of extracted human molars prepared using six different treatment procedures. METHODS: Ninety-six extracted non-carious human molar teeth were divided into five enamel treatment groups: (Gp1) air-abraded (Micadent II, Medidenta); (Gp2) air-abraded and conditioned with 10% polyacrylic acid (GC dentin conditioner); (Gp3) prepared by a bur designed for enameloplasty (#8833 Komet); (Gp4) prepared with a bur and conditioned; (Gp5) conditioned; and (Gp6) no treatment (control). The teeth were then sealed with GC Fuji Triage. The teeth were thermocycled and left in distilled water or artificial saliva for one week, coated twice with nail varnish, and stained in a dye. They were sectioned and scored for microleakage. RESULTS: All groups showed microleakage. Samples that were kept in saliva had better results than those that were kept in distilled water (P<0.05). Samples conditioned before the treatment were also better than non-conditioned groups (P<0.05). In distilled water and artificial saliva, the range of the groups was, from the best, Gp2

A study of manual toothbrushing skills in children aged 3 to 11 years.

The aim of the study was to evaluate toothbrushing management and ability of children in relation to age and gender. The study population consisted of 75 children and were divided into three equal groups as 3-5, 6-8 and 9-11 years of age. The grip type during toothbrushing was recorded on videotape, The most preferred grip types were distal (73%) followed by power (43%) and oblique grips (29%). There were a statistically significant differences between age groups and the grip types (p < 0.0041) but no significant difference was seen between boys and girls in grip preferences (p > 0.05). The mean duration of toothbrushing was shorter in 3-5 years of age group (28 seconds) than the 6-8 and 9-11 age groups (35 and 47 seconds respectively).

Canal length evaluation of curved canals by direct digital or conventional radiography.

OBJECTIVES: The purpose of this study was to compare the accuracy of a digital radiograph imaging system (DDR) with conventional radiography for the purpose of estimating endodontic file lengths in curved canals of mandibular molars. STUDY DESIGN: Sixty extracted human mandibular molars with root curvatures ranging from 5 degrees to 52 degrees were mounted in plastic blocks. Canal length was estimated by using on-screen DDR with both 2- and 3-click measurement and from conventional E-speed radiographs by using a millimeter ruler and x2 magnification. Two operators familiar with both radiographic methods performed the estimates. RESULTS: One-way analysis of variance and Newman-Keuls tests revealed no significant differences between the groups. Although both conventional and DDR methods of analysis overestimated the true canal length, the DDR accuracy improved as the curvature severity increased. CONCLUSIONS: The image quality of DDR systems has improved to the point that they can now be used for estimating canal lengths, even for curved canals, with accuracy comparable to that of conventional radiographs. However, further work remains to be done to optimize image quality.