Effect of Modified Bioceramic Mineral Trioxide Aggregate Cement with Mesoporous Nanoparticles on Human Gingival Fibroblasts.

The ion doping of mesoporous silica nanoparticles (MSNs) has played an important role in revolutionizing several materials applied in medicine and dentistry by enhancing their antibacterial and regenerative properties. Mineral trioxide aggregate (MTA) is a dental material widely used in vital pulp therapies with high success rates. The aim of this study was to investigate the effect of the modification of MTA with cerium (Ce)- or calcium (Ca)-doped MSNs on the biological behavior of human gingival fibroblasts (hGFs). MSNs were synthesized via sol-gel, doped with Ce and Ca ions, and mixed with MTA at three ratios each. Powder specimens were characterized using Fourier-transform infrared spectroscopy (FTIR), X-ray diffraction (XRD), and scanning electron microscopy (SEM). Biocompatibility was evaluated using a 3-[4,5-dimethylthiazol-2-yl]-2,5 diphenyl tetrazolium bromide (MTT) assay following hGFs' incubation in serial dilutions of material eluates. Antioxidant status was evaluated using Cayman's antioxidant assay after incubating hGFs with material disc specimens, and cell attachment following dehydration fixation was observed through SEM. Material characterization confirmed the presence of mesoporous structures. Biological behavior and antioxidant capacity were enhanced in all cases with a statistically significant increase in CeMTA 50.50. The application of modified MTA with cerium-doped MSNs offers a promising strategy for vital pulp therapies.

Do Maternal Beliefs, Knowledge and Practices for Own and Young Child Oral Care Reflect on Actual Child Oral Health?

AIM: The aim of the present study was to evaluate whether mother's oral health habits and knowledge for child oral care actually reflect on her young child's oral health and hence sought for direct evidence for this association. MATERIALS AND METHODS: One hundred mothers accompanied their children, aged 2-5 years to a University Pediatric Dentistry Clinic and completed a three-arm questionnaire. Child dental caries (decayed, missing, filled surfaces-dmfs) and gingival bleeding index (GBI) were recorded. Correlations were sought by the analysis of variance (ANOVA). RESULTS: A negative correlation was observed between maternal education and family income with child dmfs (p < 0.01). Additionally, other maternal factors such as age and correct knowledge of the appropriate age for a child's first dental visit, the initiation of toothbrushing, and fluoride exposure were positively associated with lower dmfs and GBI. Additionally, some maternal practices also contributed to these results. CONCLUSION: Maternal practices and knowledge are predictors of child oral health. CLINICAL SIGNIFICANCE: Mothers-to-be, especially those with low socioeconomic characteristics, should be involved in dental education and motivation interventions in order to practice proper oral hygiene for their children.

Assessment of Young Mothers' Oral Hygiene Practices during Pregnancy and Their Knowledge of Children's Oral Health in Northern Greece.

AIM: The aim of the study was to assess maternal knowledge about oral health practices for children along with oral hygiene perceptions of mothers during pregnancy in the city of Thessaloniki, Greece. MATERIALS AND METHODS: This cross-sectional study was conducted among 300 newly delivered mothers who were admitted to the obstetrician/gynecological (OB/GYN) University Clinic in Thessaloniki, Greece, to give birth. A three-part, self-reported, 40-item questionnaire was designed, collecting socioeconomic data, perceptions, and practices regarding maternal oral hygiene during pregnancy and their knowledge in relation to children's oral health. Collected data were recorded, tabulated, and statistically analyzed with SPSS (Version 24.0), and p < 0.05 was accepted as statistically significant. RESULTS: The sample consisted of mainly Greek, married, university alumni mothers less than 35 years of age. Self-reports of oral hygiene practices during gestation were sufficient but an inadequate level of regular dental visits was recorded. Poor knowledge was equally noted, regarding children's oral health, in the domains of fluoride toothpaste usage, the age of the first dental visit, supervised toothbrushing, nighttime breastfeeding, potential hazards of pacifier use, and thumb sucking. All factors were significantly associated with the mothers' education level (p < 0.05). CONCLUSION: Newly-delivered mothers presented with a lack of knowledge regarding mother/caregiver-related risk factors associated with early childhood caries (ECC), the timing of establishing a dental home, and misconceptions about the safety of dental visits during pregnancy. CLINICAL SIGNIFICANCE: Healthcare professionals interacting with pregnant women or young mothers are a vital element to bridge the existing gap in knowledge and assist those socially and educationally deprived.

Presentation of a Case of Short Root Anomaly in an 11-Year-Old Child.

Short root anomaly (SRA) is a developmental anomaly in which the affected teeth present morphologically normal crowns and short, round roots. The exact cause of SRA is unknown. A case of an 11-year-old female patient with SRA is described. The patient presented short, round roots of all permanent teeth but first molars. Maxillary lateral incisors presented severe root resorption and mobility. Treatment plan included preservation of the maxillary lateral incisors by splinting them to their adjacent teeth using a stainless steel coaxial wire. A custom mouthguard for dental trauma protection was also constructed using a computer-aided design - computer-aided manufacturing (CAD-CAM) system in order to fabricate 3D-printed dental casts. At 2-year follow-up, the mobility of maxillary lateral incisors decreased, and the patient's dentition remained stable. Considerations regarding differential diagnosis, orthodontic management, and treatment options after an eventual loss of teeth are thoroughly discussed.

Oral Health Implications and Dental Management of Diabetic Children.

Aim: To review the effect of diabetes mellitus (DM) on the oral health status of children. Background: Diabetes mellitus (DM) is one of the most severe chronic diseases in children and adolescents. It appears as type 1 DM and type 2 DM. Children are mainly diagnosed with type 1 DM. Genetic, as well as environmental factors, contribute to disease risk, indicating a multifactorial etiology. Early symptoms may vary from polyuria to anxiety or depression disorders. Review results: A variety of signs and symptoms have been reported regarding the oral health of DM children. Both dental and periodontal health is compromised. Qualitative and quantitative changes in saliva have also been reported. Moreover, there is a direct effect of type 1 DM on oral microflora and increased sensitivity to infections. A variety of protocols have been developed regarding the dental treatment of diabetic children. Conclusion: Children with diabetes, due to the increased risk of periodontal disease and dental caries, are recommended to follow an intensive prevention program and a diet with strict instructions. Clinical significance: The dental care provided to children with DM should be personalized, and all patients should follow a strict program of reexaminations. Moreover, the dentist may evaluate oral signs and symptoms of inadequately controlled diabetes and, in coordination with the patient's physician, can play a crucial role in maintaining oral and general health. How to cite this article: Davidopoulou S, Bitzeni-Nigdeli A, Archaki C, et al. Oral Health Implications and Dental Management of Diabetic Children. Int J Clin Pediatr Dent 2022;15(5):631-635.

Cytotoxic Evaluation and Determination of Organic and Inorganic Eluates from Restorative Materials.

Over the last years, diverse commercial resin-based composites have dominated as dental filling materials. The purpose of the present study was to determine organic and inorganic eluates from five restorative materials using GC/MS and ICP-OES and to compare the effect on cell survival of human gingival fibroblasts of a conventional and a bioactive resin. Five commercially available restorative materials were employed for this study: ActivaTM Bioactive Restorative, ENA HRi, Enamel plus HRi Biofunction, Fuji II LC Capsule, and Fuji IX Capsule. Disks that were polymerized with a curing LED light or left to set were immersed in: 1 mL methanol or artificial saliva for GC/MS analysis, 5mL deionized water for ICP-OES, and 5mL of culture medium for cell viability. Cell viability was investigated with a modified staining sulforhodamine B assay.The following organic substances were detected: ACP, BHT, BPA, 1,4-BDDMA, CQ, DBP, DMABEE, HEMA, MCE, MeHQ, MOPA, MS, TMPTMA, and TPSb and the ions silicon, aluminum, calcium, sodium, and barium. Activa Bioactive Restorative was found to be biocompatible. Elution of organic substances depended on material's composition, the nature of the solvent and the storage time. Ions' release depended on material's composition and storage time. The newly introduced bioactive restorative was found to be more biocompatible.

Dental Neglect in Children: A Comprehensive Review of the Literature.

AIM: The purpose of this review is to present the most recent bibliography regarding the etiology, risk factor indicators, types of dental neglect, and the epidemiological studies, showing the relationship between neglect and dental caries indices. Moreover, the review will focus on the role of oral healthcare professionals in evaluating such conditions. BACKGROUND: Untreated oral diseases, like dental caries, can lead to a variety of negative impacts on children including pain and infection. However, such complications can be prevented if a child's basic oral health needs are fulfilled. In addition, it is important to be aware that there are significant inequalities in accessing dental care and poverty, and such cases have to be distinguished from neglect. However, when there is adequate access to oral healthcare services and the parent or the guardian persistently fails to ensure appropriate medical care or treatment for his/her child, the possibility of dental neglect has to be seriously considered. REVIEW RESULTS: Dental neglect can be apart of a child's general neglect with short-term complications, such as caries, as well as long-term consequences that extend to adulthood, such as poor growth and impaired quality of life. CONCLUSION: Early diagnosis of dental neglect plays an important role in avoiding adverse impacts on children. Signs and risk factors for dental neglect should alert the dental team in order to intervene in time and prevent suspected cases. CLINICAL SIGNIFICANCE: Diagnosis of dental neglect can be difficult. However, identifying dental neglect at an early stage and making a child protection referral may safeguard the child and prevent further harm. For this reason, dentists should be informed about dental neglect and they should know how to deal with these cases. Effective education is necessary to increase knowledge and awareness of all aspects of child neglect.

Jet or conventional local anaesthesia? A randomized controlled split mouth study.

OBJECTIVES: To compare the efficacy, acceptance and preference of conventional infiltration technique with a needleless jet anaesthetic device (Comfort-In). MATERIALS AND METHODS: Non-fearful healthy adult volunteers, aged 19-40 years, were recruited in the Dental School of Aristotle University of Thessaloniki, Greece. Intact maxillary premolars were selected for local anaesthesia. Both techniques were applied sequentially with 35 min time gap on either buccal side on the same day by the same operator. The quadrant and the order of administration were randomly assigned using an online randomization generator. Immediately after administration, at 1, 3, 5, 10, 15, 20, 25 and 30 min, pulp vitality and soft tissue pain reaction tests were performed. Each participant was asked 6 questions in order to assess acceptance. At the end of the session, at 24 h and 7 days, all participants were asked to report any adverse events and their preference. RESULTS: In 63 volunteers who were successfully followed, 63 teeth received conventional local infiltration and 63 the Comfort-In. Both techniques presented with similar anaesthetic efficacy at 1, 3, 5, 10 and 15 min, whereas the conventional technique was more efficacious at 20 min (p < 0.005). Both presented similar acceptance apart from higher pain/discomfort during administration of Comfort-In (p = 0.002). Significantly higher preference was reported for the conventional technique immediately after the session, at 24 h and at 7 days (p < 0.0005); 19 (30.2%) reported the presence of ecchymosis or lacerations at the Comfort-In site as opposed to 5 (7.9%) with the conventional method (p < 0.0001). CONCLUSION: Both techniques showed similar effectiveness. Conventional infiltration was preferred to needleless anaesthesia by non-fearful adult volunteers and was associated with less adverse events. CLINICAL RELEVANCE: This study enhances the advantages of conventional local anaesthesia. TRIAL REGISTRATION: ISRCTN17400733.

Computer-aided Design and Manufacturing Crown on Primary Molars: An Innovative Case Report.

AIM: Crowns are applicable on primary teeth with extensive caries, cervical decalcification, developmental defects, interproximal caries extending beyond line angles, and following pulpotomy or pulpectomy. BACKGROUND: Until now, prefabricated crowns, i.e., stainless-steel crowns (SSCs), pre-veneered SSC, and all ceramic/porcelain/zirconia crowns have been available in a range of sizes to match the first and the second primary molar teeth. CASE DESCRIPTION: This case report illustrates a clinical use of computer-aided design and manufacturing technology (CAD/CAM) for the fabrication of a crown for a decayed primary molar using a study model as a reference. The material used was a hybrid ceramic CAD/CAM block. CONCLUSION: This approach has the advantage of the customization of the abutment tooth in contrast to the previously mentioned prefabricated options. HOW TO CITE THIS ARTICLE: Mourouzis P, Arhakis A, et al. Computer-aided Design and Manufacturing Crown on Primary Molars: An Innovative Case Report. Int J Clin Pediatr Dent 2019;12(1):76-79.

Neurofibromatosis type II dental management, case report, and review of the literature.

Α 30-year-old male with features of Neurofibromatosis type II (NF2) including vision and hearing loss, imbalance, and cranial and peripheral nerve tumors, was referred for dental prosthetic rehabilitation. Treatment plan was established to rehabilitate the patient with periodontal, endodontic treatment, extractions, restorative, and prosthetic procedures. Due to severe vision impairment and hearing loss, special communication methods were required in order to achieve patient's cooperation, mainly utilizing the sense of touch. Devices such as tablets and smartphones were also used to facilitate communication and patient's comfort. The patient was followed up every 3 months. During the recalls special emphasis was given to the oral hygiene and motivation. It was possible to surpass the severe vision and hearing impairments of this special care patient and fully treat him in the dental chair under a multidiscipline protocol.

Social and Psychological Aspects of Dental Trauma, Behavior Management of Young Patients Who have Suffered Dental Trauma.

INTRODUCTION: Injuries concerning the skull, the mouth and thus potentially involving the mouth and teeth are characterized as major public health problems due to their high prevalence and very serious functional and aesthetic consequences. Pain, aesthetic and functional problems arising from dental trauma significantly disrupt normal function, and impact, often dramatically, on young patients' quality of life. PROCEDURE: With regards to the behavior management approach to a child who has suffered a dental trauma, dentist's first step is to be to reassure child and parents. They should feel that the emergency is being properly treated on the part of the dentist and feel safe. The dentist should offer psychological support to child and parents and focus on alleviating any possible pain the child may feel. But, before that, a good level of communication with the child should be established. CONCLUSION: This can be achieved through the tell-show-do technique, a presentation of the special session's structure, the positive reinforcement method, the attention distraction method and exploiting the child's imagination. The detailed description of the treatment to be followed is crucial for reducing the child's level of stress, as well as that of the parents. Immediately after the completion of treatment, dentist should give listening time to the parents for any queries and include the child who probably wants to share their experience.

Etiology, Diagnosis, Consequences and Treatment of Infraoccluded Primary Molars.

Infraocclusion is a condition where teeth are found with their occlusal surface below the adjacent teeth, long after they should have reached occlusion. Many terms have been used to describe this condition; the most commonly used being submergence and ankylosis. Infraocclusion is classified as slight, moderate or severe. Studies have shown the commonness ratio of infraocclusion in kids being 1.3-8.9% with an equal male: female ratio. The frequency of infraocclusion of primary molars of mandible is 10-fold higher in contrast to those of the maxilla. Some studies showed that the first mandibular primary molars are most often affected, but others support the second one. Infraoccluded primary molars appear with an increase in 3 year-old children reaching a peak in 8-9 years of age. The main cause is ankylosis, followed by heredity, trauma, infection and various other theories. However, the etiology is still uncertain. Radiographically, an obliteration of the periodontal ligament can be seen using conventional methods and the CT-method can also be used to reveal greater detail. Clinically, other than submersion, a sharp, solid sound is heard on percussion, in contrast to a softer sound in the normal teeth. Infraoccluded primary teeth can cause occlusal disturbances, tilting of the adjacent teeth, supra-eruption of the antagonists, ectopic eruption or impaction of the successor premolars. A treatment decision must take into account whether there is a permanent successor or not. In the first case, patient monitoring is recommended, because these primary teeth usually exfoliate normally. However, in the second case, the therapeutic approach is not standard. The aim of this review of literature was to elucidate the available evidence concerning infraocclusion, its etiology, diagnosis, clinical characteristics, consequences and treatment.

Salivary alpha-amylase activity and salivary flow rate in young adults.

The secretion of salivary alpha-amylase (sAA) is more associated with psychoneuroendocrinological response to stress than with the flow rate and age. The aim of this cross sectional study is to build an explanatory model based on patterns of relationship between age 20-39 in resting and stimulated saliva under no stressful condition in healthy volunteers. Both resting and stimulated saliva were collected from 40 subjects. The sAA values were log-transformed, the normality assumption was verified with the Shapiro-Wilk test and the reliability of the measurements was estimated by the Pearsons' r correlation coefficient. The estimated model was based on the theory of the Linear Mixed Models. Significant mean changes were observed in flow rate and sAA activity between resting and stimulated saliva. The final model consists of two components, the first revealed a positive correlation between age and sAA while the second one revealed a negative correlation between the interaction of age × flow rate in its condition (resting or stimulated saliva), with sAA. Both flow rate and age influence sAA activity.

Heart rate, salivary α-amylase activity, and cooperative behavior in previously naïve children receiving dental local anesthesia.

PURPOSE: Psychosomatic indicators, such as heart rate (HR), salivary alpha amylase (sAA) activity, and behavior, can be used to determine stress. This study's aim was to assess the pattern of changes of salivary alpha amylase, heart rate, and cooperative behavior in previously naïve children receiving dental treatment under local anesthesia. METHODS: Included were 30 children with no prior dental experience who needed 4 or more sessions of dental treatment involving local anesthesia. In each session, sAA, HR, and behavior were assessed before and during the application of local anesthesia and at the end of the treatment. RESULTS: The highest sAA value was always observed at the end of each session; overall, the value was lower in the fourth session. HR always increased during the local anesthesia, and did not vary across sessions. No significant relationship was found between child cooperation and either sAA or HR. CONCLUSION: In this sample, child cooperation may not be an accurate indicator of stress. Based on salivary alpha amylase activity changes, dental treatment involving local anesthesia in naïve children appeared to be less stressful after 3 sessions.

An alternative impression technique for individuals with special care needs.

Impression making may be complicated in individuals with limited ability to cooperate with caregivers. An alternative technique for obtaining full-arch casts from sectional preliminary impressions is described. The technique is a modification of the procedure advocated for impression making in subjects with limited mouth opening. A pair of partial stock trays is selected to fit the right and left side of the arch. Two sectional irreversible hydrocolloid impressions are made separately. The first cast is placed into the second impression prior to pouring, to obtain a cast of the complete arch. The procedure was used during the treatment of an uncooperative young patient with Lesch-Nyhan Syndrome and provided a simple and reliable means to obtain the diagnostic cast of the mandibular teeth. It is recommended not only for uncooperative patients, but also for patients with special needs; such as those with anatomical restrictions, functional impairment, and movement disorders.

Effective treatment of self-injurious oral trauma in Lesch-Nyhan syndrome: a case report.

Lesch-Nyhan syndrome (LNS) is an X-linked disorder originating from deficiency of the enzyme hypoxanthine guanine phosphoribosyl transferase. It is characterized by neurological manifestations, including the dramatic symptom of compulsive self-mutilation, which results in destruction of oral and perioral tissues. Several drug trials have been administered to improve the severe self-destructive behaviour, with questionable effectiveness. Invasive treatment approaches, such as extraction of teeth and orthognathic surgery, have been suggested with variable success. A conservative treatment with an intraoral appliance serving to prevent oral and peri-oral self-injury is presented in this report. The patient was a 14-year-old boy demonstrating the typical LNS behaviour, including compulsive self-biting, significant loss of lip and tongue tissue, spasticity and involuntary movements. An acrylic maxillary appliance was designed and constructed with an occlusal plate raising the bite. The appliance was retained by two Adams' clasps on the first premolars, along with three ball clasps between the incisors. Fabrication, insertion, and maintenance were uncomplicated and non-stressful to the patient. Periodic recall over 3-year period has confirmed the effective healing of the oral lesions and a high level of tolerance of the appliance.

A modified technique on the reattachment of permanent tooth fragments following dental trauma. Case report.

Fractured anterior teeth can be restored by adhesive bonding of the fractured fragment to the remaining tooth structure. One of the major challenges for the practitioner treating traumatized anterior teeth with immediate fragment reattachment is disguising the fracture line, through the correct use of masking and restorative resins to make the restorations imperceptible to the eye as well as improve the retention of the restoration. This paper discusses a modified technique for reattaching a permanent tooth fragment following dental trauma. The initial procedure involved simple reattachment using light cured composite resin between the fragment and the remnant part of the tooth, without additional preparation. The surplus resin was spread across it in an attempt to optimize marginal seal and improve the aesthetics of the restoration. Finally, after taking into account the occlusion, the lingual surfaces of the teeth were veneered with microfilled composite to improve the retention of the reattached fragments.