Comparing cytocompatibility of two fluoride-containing solutions and two resin-based restorative materials-a pilot study.

Background: Cytocompatibility should always be considered, especially if the surface of treated carious lesions is close to soft tissue or is accidentally exposed to the oral soft tissue by the clinician. Methods: The aim of the present study was to compare the cytocompatibility of two fluoride-containing liquids and two resin-containing restorative materials with buccal mucosa fibroblasts. The fluoride-containing materials were silver diamine fluoride and water-based silver fluoride. Results: The statistical analysis was completed by comparing the positive control growth of the buccal mucosa fibroblasts to the growth of cells exposed to various materials. The one-way ANOVA with Tukey's HSD result was completed. All the assessed materials compared to the control wells for both the 24 and 48 h time intervals indicated a significant cytocompatibility result, except for the test wells with Stela (SDI) at the 24 h time interval. There was no significant difference between the step 2 liquids and the two dental materials in cytocompatibility at the 24 h interval. All four materials indicated no significant differences between the cytocompatibility of any dental materials for 48 h. Conclusion: The cytocompatibility assessment for Riva Star and Riva Star Aqua with the direct method in a full dispensing drop is not viable for step 1 of the fluoride-containing liquids. The use of Stela Light Cure is a suitable material that will be in contact with buccal mucosa as it showed potential for increased cytocompatibility compared to Riva Light Cure. Riva Star Aqua is more cytocompatible than Riva Star.

Remineralization and inactivation of carious lesions treated with silver fluoride in Brazilian children with special healthcare needs.

Introduction: Providing conventional, restorative dental care to children with special healthcare needs (CSHCN) often requires sedation using general anesthesia. Saliva consistency, diet, and oral hygiene practice are different for CSHCN, and limited evidence is available on the efficacy of silver fluoride (SF) for the management of carious lesions for this vulnerable population. Methods: Parents of CSHCN were educated about silver fluoride as a treatment option for caries. In total, 550 carious lesions from 100 participants were identified and scored according to the Nyvad Caries criteria. A total of 100 lesions with Nyvad scores 1, 2, and 3 were treated with a single application of silver fluoride and observed postoperatively at 1, 3, and 6 weeks. Result: The results indicate statistically significant (p < 0.05) differences in lesion remineralization over the 6-week follow-up period. At the 6-week follow-up, more than 85% of all lesions were remineralized across all children, regardless of condition or original Nyvad score of 1, 2, or 3. Conclusion: A single application of silver fluoride has demonstrated effectiveness in remineralization and inactivation of carious lesions over 6 weeks among Brazilian CSHCN. Silver fluoride should be considered an option for the management of carious lesions among CSHCN. Further studies are recommended, including larger sample sizes, longer follow-up times, a second application of SF, and different special needs conditions.

A pilot study on the global practice of informed consent in paediatric dentistry.

Background: Conducting oral treatment early in the disease course, is encouraged for better health outcomes. Obtaining informed consent is an essential part of medical practice, protecting the legal rights of patients and guiding the ethical practice of medicine. In practice, consent means different things in different contexts. Silver Diamine Fluoride (SDF) and Silver Fluoride (SF) is becoming popular and cost effective methods to manage carious lesions, however, cause black discolouration of lesions treated. Obtaining informed consent and assent is crucial for any dental treatment-and has specific relevance with SDF/ SF treatments. Methods: The aim of this paper is to describe informed consent regulations for dental care in a selection of countries, focusing on children and patients with special health care needs. An online survey was shared with a convenience sample of dental professionals from 13 countries. The information was explored and the processes of consent were compared. Results: Findings suggest that there are variations in terms of informed consent for medical practice. In Tanzania, South Africa, India, Kenya, Malaysia and Brazil age is the determining factor for competence and the ability to give self-consent. In other countries, other factors are considered alongside age. For example, in Singapore, the United Kingdom, and the United States the principle of Gillick Competence is applied. Many countries' laws and regulations do not specify when a dentist may overrule general consent to act in the "best interest" of the patient. Conclusion: It is recommended that it is clarified globally when a dentist may act in the "best interest" of the patient, and that guidance is produced to indicate what constitutes a dental emergency. The insights gathered provide insights on international practice of obtaining informed consent and to identify areas for change, to more efficient and ethical treatment for children and patients with special needs. A larger follow up study is recommended to include more or all countries.

Management of a permanent lateral incisor with a talon cusp and immature apex: A case report.

This case report focuses on the diagnosis and treatment of a maxillary lateral incisor affected by a talon cusp, a rare developmental dental anomaly. The case presented with irreversible pulpitis and an immature apex. The article discusses the prevalence, etiology, classification, and treatment options for talon cusps, highlighting their clinical significance and potential complications. Clinical and radiographic findings obtained from a periapical radiograph and a cone-beam computed tomography (CBCT) scan are outlined. The treatment approach involved the removal of the talon cusp, endodontic therapy including apexification with mineral trioxide aggregate, and aesthetic restoration of the tooth. The report underscores the value of precise diagnosis, careful treatment planning, and the utility of CBCT scans in effectively managing talon cusps.

Penetration of SDF and AgF from the infected dentine towards the unaffected tooth structure.

Background: The use of SEM-EDS line scan analysis to evaluate the movement of ions from dental materials towards the tooth structure and the concept of ion movement is well established. This analysis technique was used to determine the ion movement of two commercially available silver- and fluoride-containing products. Methods: This study aimed to compare the elemental analysis of primary molar teeth treated with silver diamine fluoride (SDF) and water-based silver fluoride (AgF) and to analyse the penetration of SDF and AgF from the infected dentine towards the healthy dentine. The teeth were cleaned from debris and contaminants off the roots and stored until use. A total of 15 primary molars with large active cavitated lesions, not extending into the pulp (specimens), were divided into three test groups: silver diamine fluoride (SDF) (n = 5), water-based silver fluoride (AgF) (n = 5), and deionised water (W) (n = 5) as the control group. The teeth were sectioned, embedded, and received SEM-EDS line scans. The line scan had a total length of 82.65 µm. The visible end of the infected dentine and the start of the more affected dentine were chosen as the starting point to ensure that the infected caries' line distribution towards the affected dentine's transition area was as standardized as possible. Therefore, the infected dentine length of the scan was 22.80 µm (8 scan points of 2.85 µm apart), and the affected dentine, including the healthy dentine, was 59.8 µm (21 scan points). The SEM-EDS line scan from each specimen determined the average fluoride, iodide, and silver weight percentage for that specimen. Results: The 15 sample SEM-EDS line scans were used to determine the average ion movement in wt%. The Kruskall-Wallis test and Tukey's HSD test were completed at a p < 0.05. SDF and AgF presented no significant fluoride movement in terms of the weight percentage. There was, however, significantly more fluoride movement from infected caries to the healthy dentine with SDF and AgF (p = 0.0010053) compared to the control specimens treated with deionised water. There was no significant difference between SDF and AgF for the movement of the iodide (p = 0.5953) and silver (p = 0.3708) from infected caries to the healthy dentine. Conclusion: SDF and AgF easily penetrated through infected caries and affected tooth structure to the healthy dentine for the line scan of 82.65 µm. There was no significant difference between SDF and AgF for the movement of ions within the infected dentine nor in the affected/healthy dentine.

Child dental neglect and legal protections: a compendium of briefs from policy reviews in 26 countries and a special administrative region of China.

Background: Child neglect is a public health, human rights, and social problem, with potentially devastating and costly consequences. The aim of this study was to: (1) summarize the oral health profile of children across the globe; (2) provide a brief overview of legal instruments that can offer children protection from dental neglect; and (3) discuss the effectiveness of these legal instruments. Methods: We summarized and highlighted the caries profile and status of implementation of legislation on child dental neglect for 26 countries representing the World Health Organization regions: five countries in Africa (Nigeria, South Africa, Sudan, Tanzania, Zimbabwe), eight in the Americas (Argentina, Brazil, Canada, Chile, Mexico, Peru, Unites States of America, Uruguay), six in the Eastern Mediterranean (Egypt, Iran, Libya, Jordan, Qatar, Saudi Arabia), four in Europe (Italy, Latvia, Serbia, United Kingdom), two in South-East Asia (India and Indonesia) and one country (China) with its special administrative region (Hong Kong) in the Western Pacific. Results: Twenty-five of the 26 countries have legal instruments to address child neglect. Only two (8.0%) of these 25 countries had specific legal instruments on child dental neglect. Although child neglect laws can be interpreted to establish a case of child dental neglect, the latter may be difficult to establish in countries where governments have not addressed barriers that limit children's access to oral healthcare. Where there are specific legal instruments to address child dental neglect, a supportive social ecosystem has also been built to facilitate children's access to oral healthcare. A supportive legal environment, however, does not seem to confer extra protection against risks for untreated dental caries. Conclusions: The institution of specific country-level legislation on child dental neglect may not significantly reduce the national prevalence of untreated caries in children. It, however, increases the prospect for building a social ecosystem that may reduce the risk of untreated caries at the individual level. Social ecosystems to mitigate child dental neglect can be built when there is specific legislation against child dental neglect. It may be more effective to combine public health and human rights-based approaches, inclusive of an efficient criminal justice system to deal with child dental neglect.

COVID-19 vaccine hesitancy and its drivers among dental students at University of the Western Cape, South Africa.

Background: Vaccine hesitancy has seen an uprising over the decades, even though there have been many advances regarding vaccine-preventable diseases. Of late, vaccine hesitancy has resurged towards the coronavirus disease 2019 (COVID-19) vaccine. The SARS-CoV-2 virus has major effects on the human body and has led to the development of different vaccines, which have been shown to provide immunity against the novel coronavirus. Dentists are at an increased risk to COVID-19 because of the nature of their work. It is imperative to have high vaccination coverage for this group. Aim: The aim of this study is to determine vaccine hesitancy and drivers associated with vaccine hesitancy among dental students at a university in South Africa. Setting: A dental school in South Africa was chosen as the setting for this study. Methods: An analytical cross-sectional study was conducted by means of an anonymous, online, validated questionnaire to determine vaccine hesitancy. Results: Of the 205 dental students participated, 83.9% (n = 172) students were vaccine not hesitant. The main concerns regarding the vaccines were identified as safety and efficacy of the vaccine. Pressure by family or friends and the university to get vaccinated was evident. Conclusions: Vaccine hesitancy is high despite mandatory vaccination policies in South Africa. Specific drivers contributing to vaccine hesitancy were identified as doubt in the efficacy and safety of the vaccine. Contribution: This study has highlighted the prevalence of vaccine hesitancy among dental students at University of the Western Cape, prior to compulsory vacccination implementations.

Global Oral Health Policies and Guidelines: Using Silver Diamine Fluoride for Caries Control.

Silver diamine fluoride (SDF) was developed in Japan in the 1960s. It is a clear solution containing silver and fluoride ions. Because of its anti-bacterial and remineralizing effect, silver diamine fluoride has been used in managing dental caries for decades worldwide. This paper aims to summarize and discuss the global policies, guidelines, and relevant information on utilizing SDF for caries management. SDF can be used for treating dental caries in most countries. However, it is not permitted to be used in mainland China. Several manufacturers, mainly in Australia, Brazil, India, Japan, and the United States, produce SDF at different concentrations that are commercially available around the world. The prices differ between contents and brands. Different government organizations and dental associations have developed guidelines for clinical use of SDF. Dental professionals can refer to the specific guidelines in their own countries or territories. Training for using SDF is part of undergraduate and/or postgraduate curriculums in almost all countries. However, real utilization of SDF of dentists, especially in the private sector, remains unclear in most places because little research has been conducted. There are at least two ongoing regional-wide large-scale oral health programs, using SDF as one of the components to manage dental caries in young children (one in Hong Kong and one in Mongolia). Because SDF treatment does not require caries removal, and it is simple, non-invasive, and inexpensive, SDF is a valuable strategy for caries management in young children, elderly people, and patients with special needs. In addition, to reduce the risk of bacteria or virus transmission in dental settings, using SDF as a non-aerosol producing procedure should be emphasized under the COVID-19 outbreak.