Enamel Veneer Rehabilitation of a Premolar to an Incisor After Autotransplantation.

Tooth autotransplantation is one of the methods used for tooth loss rehabilitation in children. Premolars are usually used as autotransplants requiring esthetic alterations. The purpose of this paper is to present an innovative, alternative and inexpensive way to restore auto-transplanted teeth using the crown of the tooth of the recipient site. A seven-year-old male with a non-contributory medical history presented with an intrusion of his permanent maxillary right central incisor. The tooth underwent orthodontic extrusion using fixed appliances but eventually showed signs of ankylosis. At 10 years old, autotransplantation of a premolar to substitute the ankylosed incisor was undertaken. Six weeks after the autotransplantation, the premolar was restored to an incisor by modifying the extracted ankylosed tooth to a veneer for the transplanted tooth, providing functional and esthetic restoration. The patient has been followed up for two years without any complications. This technique can help clinicians restore autotransplants in an easy and esthetic manner.

Cariogenic Diet Assessment and Analysis Tools in Children and Adolescents: A Systematic Review.

PURPOSE: To collect and evaluate the available evidence on existing tools used in research and clinical practice to assess and analyse the diet of children and adolescents for its cariogenicity. MATERIALS AND METHODS: Multiple databases were searched up to October 2022, with no date, publication, or language restrictions, followed by a manual search. Study screening, data extraction, and risk of bias assessment were performed in duplicate. Dietary assessment tools and dental clinical parameters tested were retrieved for qualitative assessment and synthesis. RESULTS: Of the 2896 papers identified, 9 cohort and 23 cross-sectional studies fulfilled the inclusion criteria. To assess dietary data, 13 studies used a 24-h recall, 11 used a food diary, and 7 used a food frequency questionnaire. For analysis, five studies reported using the Healthy Eating Index, ten used a score based on consumption of sugars, and the remaining analysed cariogenic diet based on the weight and frequency of sugars consumed, or the daily caloric intake from free sugars. Risk of bias assessment suggested that 65.7% of the studies were of moderate and 31.5% of high quality. CONCLUSION: Inconsistency exists regarding methods used for the assessment and analysis of dietary cariogenicity. Although every dietary assessment tool has different strengths and limitations, the 24-h recall was the most commonly used method for the assessment of dietary cariogenicity and the most consistent in detecting a positive relationship between sugary diet and carious lesions. A standardised method for cariogenic analysis of dietary data needs to be determined.

Sports drinks effect on salivary volume and pH in children after exercise: a randomized clinical study.

BACKGROUND: The aim of this study was to examine the sports' related oral health behavior and the effect of sports drinks on the salivary volume and acidity of 6 to 14 years old children. METHODS: Sixty-eight children with a median age of 8 years old from Waterford Tennis Association camp participated in the study. Each child was randomly assigned to either the control group that consumed water or the experimental group that consumed a sports drink. Salivary volume and acidity were measured for all groups before exercise, right after exercise and after consuming the rehydrating agent. Salivary volume was measured by dripping into a pre-measured (mL) plastic medicine cup while salivary acidity was measured using an electric pH meter with 0.01 sensitivity. RESULTS: Oral health behavior did not differ between the two groups. No statistically significant difference was detected in the salivary volume before and after exercise. A statistically significant increase (P=0.005) was found in the salivary volume before (1.73ml) and after re-hydration (2.92ml) regardless of the drink consumed (P=0.813). Salivary pH increased significantly (P=0.012) before (7.06) and after exercise (7.73), and dropped significantly (P=0.001) after the consumption of the rehydration drink (6.63) among the same group. The pH decrease was greater in the sports drink group (P=0.013). CONCLUSIONS: No difference in the children's salivary volume was found between the two groups. However, consumption of sports drinks reduces significantly salivary pH and thus, water should be the drink of choice for rehydration in children.

Impact of the COVID-19 lockdown on the oral health status of paediatric dental patients in Greece.

BACKGROUND: Limited evidence regarding the post-COVID-19 dental status of paediatric patients is available, with most studies assessing only children's oral health habits. AIM: To evaluate the effect of the COVID-19 lockdown on the oral health of paediatric dental patients in Greece. DESIGN: This was a retrospective cohort study that included a questionnaire on children's oral health behavior and a clinical examination assessing dental caries and dental treatment needs using the International Caries Detection and Assessment System criteria, dmft/DMFT, and Treatment Need Index. The Wilcoxon signed-rank test was used for a statistical comparison between questionnaire and clinical data before, during, and after the lockdown. RESULTS: A total of 102 children with a median age of 9 years were recruited from the current cohort of patients that had their last dental examination 6 months prior to the lockdown. Results from the questionnaire showed decreased brushing frequency with increased eating frequency and sugar consumption during the lockdown period (p < .001). Moreover, 16.5% had to visit the dentist for urgent care during the lockdown, 13.6% experienced dental pain, and 51.5% did not experience any dental emergencies. Clinical examination, after the lockdown, recorded significantly increased mean dmft/DMFT scores by 0.63 units in the primary dentition (p = .01) and 0.52 units in the permanent teeth (p = .002). Significantly higher treatment needs, with more carious lesions requiring extensive treatment after the lockdown, were recorded (p < .001). CONCLUSION: The COVID-19 lockdown negatively affected children's oral health behavior: caries prevalence increased and more complex dental treatments were required.

Guidance for Permanent First Molar Extraction in Molar-Incisor Malformation: Report of Two Cases.

Molar-incisor malformation (MIM) is a newly described dental developmental anomaly that predominantly affects primary second molars, permanent first molars, and, in some cases, permanent central incisors. Diagnosis is usually made upon radiographic examination. The molars usually present with significant cervical constriction, flattened pulp chambers, and absent or thin, short, and narrow roots, whereas the incisors usually exhibit coronal dilaceration. Loss of these compromised teeth in the long term may be inevitable. Thus, clinicians should be aware of this condition and the factors to consider to advise their patients as early as possible. The purpose of this paper is to present two cases of MIM and discuss the factors clinicians should take into consideration to make a care plan in these cases.

Dental Reshaping Using the Composite Resin Injection Technique After Dental Trauma and Orthodontic Treatment.

Severe dental trauma can often result in tooth loss at an early age. Orthodontic space closure and reshaping of the teeth are a conservative treatment approach. The purpose of this paper is to present a fast and predictable way to reshape teeth using the composite resin injection technique. A 10-year-old female presented for orthodontic treatment with a Class II malocclusion, lateral open bite and loss of the permanent maxillary left central incisor due to trauma. The treatment plan involved mesialization of the maxillary left teeth and reshaping of the maxillary left canine and lateral incisor to the shape of the lateral and the central incisor, respectively. At the end of the orthodontic treatment, an impression was made and a transparent silicone index was fabricated based on the diagnostic wax-up. Through the index, flow composite resin was injected at the site to form the direct composite resin restorations.

Early Childhood Caries and Weight Status: A Systematic Review and Meta-Analysis.

Purpose: The purposes of this study were to: (1) examine the association between body weight status and caries experience; and (2) determine if overweight or underweight children are at greater risk of developing early childhood caries. Methods: A search of studies in PubMed, Cochrane Library, and Google Scholar databases that tested the association of body weight with dental caries index in preschool children was conducted in April 2018. Studies' characteristics were extracted for the qualitative review, and means and standard deviations of decayed, missing, and filled teeth/surfaces (dmft/dmfs) index by body mass index standardized categories were retrieved for quantitative syntheses. Random effects meta-analyses were conducted by calculating the mean difference and the associated 95 percent confidence intervals. Results: A total of 293 studies were identified through the databases' search. Thirty-two qualified for qualitative review and 12 of them reported data to conduct a meta-analysis. The meta-analysis showed that overweight/obese children are at a statistically significant greater risk of having early childhood caries (P<0.01). Conclusions: The results of the included studies were inconsistent; however, the meta-analysis suggested that overweight/obese children are at greater risk of having early childhood caries.

Prevalence of molar-incisor hypomineralization in Milwaukee, Wisconsin, USA: a pilot study.

Purpose: This pilot study investigated the prevalence of Molar-Incisor Hypomineralization (MIH) in third-grade school children in Milwaukee Wisconsin, USA. Methods: A convenience sample of third-grade school children in the Milwaukee Public School System (MPS) participated in the study. Calibrated examiners trained on the European Academy of Paediatric Dentistry (EAPD) MIH recommendations examined the children between December 1, 2014 and June 30, 2015. Children were examined at their schools using a flashlight and mirror after receiving consent from parents/caregivers and assent from each child. Findings were recorded onto a standardized form by one of five trained examiners. Summary statistics were calculated, and bivariate analysis were done to identify factors associated with MIH. Results: A total of 375 children (average age =8.66 years, range 7-12) were examined, 60% females and 41% Hispanics. Overall, 36 (9.6%) of the children demonstrated findings consistent with the diagnosis of MIH. Among the teeth with MIH defects, severe defects were higher in lower molars. There were no statistically significant differences between those with and without MIH by sex, race/ethnicity, and socioeconomic status in this study. Conclusion: The study revealed that 9.6% of the children examined were affected by MIH. Future studies should focus on statewide and/or nationwide surveys in the United States to ascertain the extent and severity of the condition.

Oral health of cystic fibrosis patients at a north american center: A pilot study

Background: The objective of this study was to describe the oral health status of Cystic Fibrosis (CF) children in a US facility. Material and Methods: Twenty CF children ages 6-18 were recruited from Children's Hospital of Wisconsin Pulmonary Clinic. Parents completed a health questionnaire. Clinical examinations checked dental caries using the dmft/DMFT index, dental hygiene using the Simplified Greene-Vermillion Index (DI-S), gingival inflammation using the Community Periodontal Index of Treatment Needs, and enamel defects using the modified Developmental Defects of Enamel Index. Results: The majority (90%) brush twice a day, 65% consume sugary snacks, and 70% visit the dentist every 6 months. Clinically, they presented DMFT 0.25 and dmft 0.90, fair oral hygiene with DI-S 1.02, 75% had mild gingivitis and 50% had enamel defects. The more antibiotics they took, significantly more frequent (p = 0.007) and more severe (p = 0.017) enamel defects were noted. Similar trend was found between the number of surgeries and the presence of enamel defects (p=0.076) and dental caries (p = 0.028). Conclusions: Within the limitations of this study, CF patients were found to be at oral health risk due to the high prevalence of dental enamel defects. Oral health for CF children should be part of the multidisciplinary care

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Assessing the Effect of Low Calorie Soda Beverages on Primary Tooth Enamel: An In Vitro Study.

Objective: The purpose of this study was to evaluate the effect of low calorie soda beverages on the enamel of primary teeth. Study Design: Fifty enamel slabs were prepared from twenty primary extracted teeth and were equally divided into five groups: a) 0.9% NaCl (Control), b) Coca-Cola Classic (Sucrose), c) Diet Coke (Aspartame), d) Zevia Cola (Erythritol), e) Coca-Cola Life (Stevia). Each specimen was exposed to the beverage for a total of sixty minutes. Enamel surface roughness was measured before and after the exposures using a LEXT OLS4000 3D Laser Measuring Microscope. Results: All tested sodas resulted to a statistically significant change on the surface roughness of the enamel (p =.000). However, this effect did not differ significantly between the different treatment groups (p =.103). Conclusions: Both regular soda and low calorie soda containing different commercial sweeteners appear to have an effect on the surface morphology of primary tooth enamel. Thus, it is important to discourage the intake of any type of soda as part of the dietary advice provided in the dental office.

Association of food insecurity with early childhood caries.

OBJECTIVES: The aim of this study was to examine the association of food insecurity on the prevalence of dental caries in preschool children. METHODS: Eighty-two children, aged 12-71 months old, from the Marquette University School of Dentistry Community South Clinic and their caregivers participated in this cross-sectional study. Following informed consent, parents completed the validated six-item US Department of Agriculture food insecurity questionnaire and questions regarding demographic information and family structure. Upon clinical examination caries was recorded using the decayed, missing, filled teeth (dmft) index based on the International Caries Detection and Assessment System criteria. RESULTS: The correlation between dmft and food insecurity was found statistically significant (P = 0.002, R2 = 0.115), and children of higher food insecurity demonstrated higher levels of dental caries. Food insecurity was also positively correlated with parental age (P = 0.034), whereby higher levels of food insecurity were associated with the father being less than 25 years of age. Results from the questionnaire revealed that 58.5 percent of the families were fully secure, 11.0 percent had marginal, 24.4 percent had low, and 6.1 percent had very low food security. Results from clinical examination reported dmft 4.09 ± 4.38, dt 2.20 ± 2.83, and ft 1.83 ± 2.95. Most of the children (79.7 percent) were Hispanic, 53.1 percent were female and the median age of the sample was 48 months. CONCLUSIONS: Results of the present study suggest that preschool children with food insecurity have higher levels of dental caries.

Experiential learning in oral health education.

Experiential learning is an innovative learning method that knowledge is gained through experience. The aim of this paper was to review the application of experiential learning in health education and suggest an oral health education program using experiential learning. Experiential learning has been used in the past successfully in health education mostly in university curricula. In oral health education, its use is limited and without following a comprehensive structure. An experiential learning oral health education program, implemented in the classroom by a trained teacher, is proposed to be integrated in the school's curriculum. Initially, using brainstorming students express their opinions and feelings toward oral health. Then, students are allocated to working groups to develop oral health projects. The outcome of these projects is presented in the classroom to their peers through role playing, posters, songs, games, etc., Finally, a discussion is stimulated by the teacher to encourage children to express their feelings about oral health issues and thus experientially recognize the importance of oral health. Experiential learning has been effectively used in health education and can be a successful method for oral health education. For optimal results, a predetermined experiential method structure has to be followed.

Induced ankylosis of a primary molar for skeletal anchorage in the mandible as alternative to mini-implants.

BACKGROUND: Mesial protraction of mandibular posterior teeth requires increased anchorage to avoid undesired tooth movements. Orthodontic mini-implants have become a popular and successful way to increase skeletal anchorage in such cases. However, mini-implants may cause injury to adjacent teeth or anatomical structures and may lead to tissue inflammation. Induced ankylosed primary teeth have been used in the past as abutments for the protraction of the maxilla in cases of maxillary retrognathism. However, this technique has not been described in the literature for the protraction of mandibular molars. The aim of this paper is to present, through a case report, an alternative to mini-implant devices to maximize anchorage in the mandible by inducing ankylosis on a primary molar. FINDINGS: A 13-year-old female with class II right malocclusion, deep bite, and congenitally missing right second premolars was referred for orthodontic treatment. Treatment plan involved removal of the primary teeth and mesial protraction of the posterior. In the mandible, ankylosis was induced on the retained primary second molar by extraction, bisection, replantation of the mesial part after endodontic treatment, and bonding of a rigid splint. Ankylosis was diagnosed after 10 weeks and a closing T-loop sectional wire was inserted to move the permanent first molar mesially. At 6 months, the remaining space was closed using elastic chain on a rectangular stainless steel wire with tip-back bends, supported by class II elastics. CONCLUSIONS: Induced ankylosis of primary teeth can be an alternative to orthodontic mini-implants in selected cases, with minimal risks and maximum biocompatibility.

Comparative clinical study testing the effectiveness of school based oral health education using experiential learning or traditional lecturing in 10 year-old children.

BACKGROUND: School based oral health education through traditional lecturing has been found successful only in improving oral health knowledge, while has low effectiveness in oral hygiene and gingival health. The aim of this study was to evaluate the effectiveness of experiential learning (EL) oral health education to traditional lecturing (TL), on enhancing oral health knowledge, attitude and behavior as well as oral hygiene, gingival health and caries of 10-year-old children. METHODS: Eighty-four children were recruited for the EL and 100 for the TL group from 3 locations in Greece. Data regarding oral health knowledge, attitude and behavior were collected via questionnaires. Data regarding dental plaque, gingivitis and caries were collected by clinical examination. The evaluation using questionnaires and clinical examination was assessed at baseline and 6 and 18 months afterwards. Two calibrated pediatric dentists examined the students using a periodontal probe and artificial light. Modified hygiene index (HI) was used for dental plaque recording, the simplified gingival index (GI-S) was used for gingivitis and DMFT, based on BASCD criteria, for dental caries. Based on a dedicated manual, the teacher applied in the classroom the oral health educational program using EL. RESULTS: EL group had statistically significant better hygiene than the TL at 6 months (p < 0.05). Within the same group, both groups had enhanced oral health knowledge at 6 and 18 months (p < 0.05) and improved oral health behavior (p > 0.05) and attitude (p > 0.05) at 6 months in comparison to baseline. CONCLUSION: EL program was found more successful than TL in oral hygiene improvement. Both oral health education programs improved the oral health knowledge, attitude and behavior of children. TRIAL REGISTRATION: ClinicalTrials.gov (NCT02320162).

Congenital adrenal hyperplasia: a case report with premature teeth exfoliation and bone resorption.

Congenital adrenal hyperplasia (CAH) is an inherited autosomal recessive disorder characterized by insufficient production of cortisol. The aim of this case report was to present a child with CAH, premature exfoliation of primary teeth and accelerated eruption of his permanent teeth related to bone resorption. A 4.5-year-old Caucasian boy with CAH and long-term administration of glucocorticoids was referred for dental restoration. Clinical examination revealed primary molars with worn stainless steel crowns, severe attrition of the upper canines, and absence of the upper incisors. Before the completion of treatment, abnormal mobility of the first upper primary molars and the lower incisors was detected, and a few days later the teeth exfoliated prematurely. Histologic examination revealed normal tooth structure. Alkaline phosphatase and blood cells values were normal. Eruption of the permanent dentition was also accelerated. Tooth mobility was noticed in the permanent teeth as soon as they erupted, along with bone destruction. Examination revealed an elevated level of receptor activator of nuclear factor-κB ligand and lower-than-normal osteoprotegerin and vitamin D levels. The patient was treated with vitamin D supplements, and his teeth have been stable ever since. CAH is a serious chronic disorder appearing in children with accelerated dental development and possibly premature loss of primary teeth.

School-based oral health-education program using experiential learning or traditional lecturing in adolescents: a clinical trial.

The aim of this project was to compare the effectiveness of experiential learning (EL) and traditional lecturing (TL) school-based oral health education on the oral health knowledge, attitude, habits, oral hygiene, gingival health and caries incidence of 13-year-old Greek children. Eighty-seven children for the EL group and 80 for the TL group were selected from two areas of Greece. Information on oral health knowledge, attitude and behaviours were obtained using a questionnaire. Dental plaque was recorded using a modified hygiene index, gingivitis was assessed using the simplified gingival index and dental caries was measured by recording the number of Decayed, Missing and Filled teeth (DMFT) using the British Association for the Study of Community Dentistry (BASCD) criteria. All children were examined by two calibrated dentists, using a World Health Organisation (WHO) periodontal probe and artificial light. Questionnaires were delivered and clinical examinations were performed at baseline and at 6 and 18 months post-intervention. The EL oral health educational programme was implemented by teachers using the programme's manual. Oral health knowledge had improved significantly (P < 0.001) in both groups at 6 and 18 months post-intervention. Oral health behaviour (P < 0.001) and attitude (P < 0.05) had improved significantly at 6 months, and oral hygiene and gingival health had improved significantly at both 6 (P < 0.001) and 18 (P < 0.05) months for the EL group. Lower caries incidence was recorded for the EL group, 18 months post-intervention (P < 0.05). School-based oral health EL for adolescents was found to be more effective than TL in improving oral health attitude and behaviour at 6 months, in improving oral hygiene and gingival health at both 6 and 18 months and in reducing caries incidence 18 months post-intervention.

Giant cell fibroma in children: report of two cases and literature review.

BACKGROUND: Giant cell fibroma is a type of fibrous tumour of the oral mucosa which rarely affects children under the age of 10. The purpose of this paper was to contribute two clinically and histologically documented cases of giant cell fibroma in the free gingiva of a 7 and 6 year old boys. METHODS: Both nodules were presented in the mandibular anterior region. In the differential diagnosis several fibrous hyperplastic lesions were considered such as traumatic fibroma, papilloma, peripheral ossifying fibroma, peripheral odontogenic fibroma, giant cell fibroma and odontogenic hamartoma. RESULTS: The lesions were removed and the histological examination revealed fibrocollagenous connective tissue with the presence of stellate giant cells which confirmed the diagnosis of giant cell fibroma. CONCLUSIONS: Dentists should be aware of the existence of giant cell fibroma in children, which must be included in the differential diagnosis of nodular lesions of the gingiva and adequately diagnosed and treated by removal and histopathological examination.