The effectiveness of Carie-Care™, chemomechanical caries removal technique in primary teeth: randomized controlled clinical trial.

BACKGROUND: Chemomechanical techniques for caries removal have been introduced to overcome the shortcomings of the conventional rotatory instruments. This study aimed to clinically evaluate the effectiveness of the chemomechanical method of caries removal (Carie-Care™) over mechanical caries removal through the Atraumatic Restorative Technique in pediatric patients. METHODS: A randomized controlled clinical trial was conducted. Fifty children fulfilling inclusion criteria were recruited from the outpatient clinic of Pediatric and Dental Public health department, Faculty of Dentistry, Alexandria University. Fifty open carious primary molars were randomly assigned into 2 equal groups according to the method of caries removal. In Group I (test group), caries was removed using the Carie-Care™ system and in Group II (control group), by using mechanical caries removal through the atraumatic restorative technique. Resin modified glass ionomer was used for teeth restoration, the two techniques were compared in each child according to time taken for caries removal, efficacy of caries removal, pain assessment, and child behavior. RESULTS: The mean time taken for caries removal in the Carie-Care™ treatment group was (575.6 ± 114.8) seconds which was statistically significant higher as compared with the ART treatment group (346.1 ± 97.4) seconds (p < 0.001). The mean score of efficacy in caries removal was (0.6 ± 0.8) in the Carie-Care™ group, and (1.3 ± 0.7) in the ART treatment group. When compared to ART, Carie-Care™ was significantly more efficient in caries removal (p < 0.002). When pain was assessed by the SEM scale, it was observed that the Carie-Care™ caries removal technique showed statistically significantly more comfort during the procedure compared with the ART procedure (p < 0.001).Moreover, children in the Carie-Care™ group enjoyed the process and showed more cooperative behavior when assessed at the end of procedure than those in the ART group with statistically significant difference (p = 0.002). CONCLUSIONS: Removal of carious tissue in primary teeth using Chemomechanical Carie-Care™ gel proved to be more time consuming than ART, but on the other hand it was more efficient, comfortable, and accepted by the pediatric patients.

Antibacterial effect and impact on caries activity of nanosilver fluoride and silver diamine fluoride in dentin caries of primary teeth: a randomized controlled clinical trial.

BACKGROUND: The use of silver diamine fluoride (SDF) in caries treatment in children has increased despite the disadvantage of causing tooth discoloration. Nanosilver fluoride (NSF) is a possible alternative. This study aimed to assess the antibacterial effect of NSF and SDF and their impact on the activity of dentin caries in primary teeth. METHODS: Synthesis and characterization of the physical and biological properties of NSF were conducted. Fifty children aged 4-6 years with dentin caries (active caries corresponding to ICDAS code 5) in deciduous teeth were randomly assigned to treatment by NSF or SDF. Baseline assessment of Streptococcus mutans (S. mutans) and lactobacilli counts as CFU/mL in caries lesions was done, followed by the application of the agents. After one month, microbiological samples were recollected, and lesion activity was reassessed. Groups were compared using Mann-Whitney and Chi-Square tests, while intragroup comparisons were done using Wilcoxon and McNemar tests. Multilevel logistic regression analysis was used to assess the effect of different variables on the outcomes. RESULTS: There were 130 teeth in 50 children; mean ± SD age = 4.75 ± 0.76 years, 63% were posterior teeth. At the one-month follow-up appointment, both groups showed a significant decrease from baseline bacterial counts. There was a significant difference in the reduction of S. mutans between NSF and SDF (21.3% and 10.5%, respectively, p = 0.002), while not in lactobacilli (13.9% and 6.0%, respectively, p = 0.094). In both groups, there was a significant reduction in the number of active caries from baseline (p < 0.0001) with no significant difference between groups (percentage inactive = 64.4% and 63.4%, p = 0.903). Multilevel regression revealed non-significant differences in S. mutans and lactobacilli counts (AOR 1.281, p = 0.737 and 1.888, p = 0.341, respectively), and in the number of inactive lesions (AOR 1.355, p = 0.731) between groups. CONCLUSION: The short-term antibacterial efficacy of NSF was similar to that of SDF. In both groups there was a significant reduction of S. mutans and lactobacilli counts in active dentin caries, and two-thirds of the lesions became inactive with no differences between the two interventions. Further research is needed to investigate the long-term efficacy of NSF and its suitability for clinical use in caries management. TRIAL REGISTRATION: This trial was prospectively registered on the clinicaltrials.gov registry with ID: NCT05221749 on 03/02/2022.

The antibacterial effect of nanosilver fluoride in relation to caries activity in primary teeth: a protocol for a randomized controlled clinical trial.

BACKGROUND: Minimally invasive dentistry is a highly convenient and efficient method of managing caries in pediatric patients. Silver diamine fluoride (SDF) is commonly used to arrest active caries lesions. However, the associated black stain, possibility of soft tissue injury, and unpleasant taste often limit its use. Recently, nanosilver fluoride (NSF) emerged as a promising topical fluoride agent with potent cariostatic and antibacterial potentials. This novel anticaries agent has gained attention as an alternative to overcome the drawbacks of SDF in caries arrest. OBJECTIVES: To assess the antibacterial effect of NSF in relation to caries activity in dentin caries lesions, as well as to investigate the change in saliva bacterial levels in primary teeth in comparison to SDF after 1 and 3 months. MATERIALS AND METHODS: Fifty children aged 4 to 6 years old with active dentin caries lesions (score 5 according to International Detection and Assessment System (ICDAS II) criteria) will be enrolled in the study. They will be equally and randomly allocated into 2 groups: a group receiving NSF and a control group receiving SDF treatment. Microbiological samples will be collected from the carious lesions and from unstimulated saliva at the baseline and at the 1 and 3 months' follow-up appointments. Bacterial counts will be assessed using Mitis Salivarius agar (selective culture media for S. mutans) and Rogosa agar (selective culture media for lactobacilli), and the results will be expressed in colony-forming units. Data regarding the children's oral health will be collected and their dmf index will be scored. The arrest of active carious lesions will be measured at the follow-up appointments according to ICDAS II criteria. RESULTS: The relation between bacterial colony counts and lesion activity for both groups will be assessed, as well as the change in salivary bacterial counts. The collected data will be statistically evaluated and tabulated. This clinical trial has been registered on ClinicalTrials.gov in January 2022 (original version) with ID: NCT05221749.

Assessment of risk factors and molecular biomarkers in children with supernumerary teeth: a single-center study.

BACKGROUND: Supernumerary teeth are considered one of the commonly observed dental anomalies in children. Several theories have been proposed to explain the presence of supernumerary teeth, including environmental and genetic factors. This study aimed to identify the different risk factors and molecular biomarkers in patients presented with supernumerary teeth. METHODS: This case-control study included 240 children, 6 to 12-year-old. They were divided into a test group (n = 120 children presented with supernumerary teeth) and a control group (n = 120 children with no supernumerary teeth). Questionnaires were distributed to assess demographics and exposure to several environmental factors. Ten extracted supernumerary teeth from the test group were processed for histopathological analysis. RESULTS: Male gender, dental history of severe oral infection or medical history of chemotherapy treatment, previous history of taking medication or illness during pregnancy, family history of neoplastic disorders, use of electronic devices, and living beside agricultural fields or industrial areas were found to be statistically significant associated with the risk of supernumerary teeth development. Immunohistochemistry panel revealed that supernumerary teeth showed enhanced expression of wingless (Wnt) and sonic hedgehog (SHH) proteins as well as a reduced expression of adenomatous polyposis coli (APC) protein, denoting molecular derangement in a group of pathways classically believed to be involved in its pathogenesis. CONCLUSIONS: Males were more frequently affected by supernumerary teeth than females. Several risk factors were notably correlated with the existence of supernumerary teeth. Additionally, molecular biomarkers assessment demonstrated a high expression level of pro-tumorigenic proteins such as Wnt and SHH in patients with supernumerary teeth.

Intranasal versus sublingual route of dexmedetomidine sedation in paediatric dentistry: A randomized controlled clinical trial.

BACKGROUND: Many children experience dental anxiety during dental treatment. Conscious sedation is used to alleviate anxiety and enhance a child's cooperation. AIM: This study aimed to compare the efficacy of intranasal versus sublingual dexmedetomidine. DESIGN: Forty-two healthy, uncooperative children participated in the study. They were divided randomly into two groups: In the first visit, Group I received intranasal dexmedetomidine and group II received sublingual dexmedetomidine, whereas at the second visit, the alternate route was implemented in a crossover design. The child's acceptance of drug administration method was assessed using a 4-point rating scale. Time until optimum sedation was measured. Anxiety during local anesthesia administration was scored using Venham's rating scale. Postoperative response was recorded through Vernon et al's questionnaire. RESULTS: The sublingual dexmedetomidine route was better accepted than the intranasal route (P=0.01), while the latter acted faster (P>0.001). No significant difference in anxiety scores was found between groups at baseline (P=0.84) or during local anesthetic administration (P=0.44). No negative effect was recorded by the parents who answered the Modified Vernon et al questionnaire 24 hour after the dental visit compared to before the dental visit (P=1.00). CONCLUSIONS: Both routes prevented the increase in anxiety scores equally during local anesthesia and do not have negative effect on postoperative behavior of children. However, the sublingual route showed better acceptance with longer onset time of action than the intranasal route.

Casein Phosphopeptide Amorphous Calcium Phosphate Fluoride Varnish in Remineralization of Early Carious Lesions in Primary Dentition: Randomized Clinical Trial.

Purpose: Casein phosphopeptide amorphous calcium phosphate fluoride varnish (commercially available as MI Varnish®) is a promising minimally invasive remineralizing agent. The purpose of this study was to compare the effectiveness of intensive application of MI and sodium fluoride (commercially available as Duraphat Varnish®) varnishes on white spot lesion remineralization. Methods: This randomized controlled clinical trial included a sample of 44 healthy three- to five-year-old children with at least four active white spot lesions on their anterior primary teeth. They were allocated into two groups: either a test group (MI Varnish®) or a control group (Duraphat Varnish®). Each group received three consecutive varnish applications two weeks apart. Selected teeth were evaluated for lesion activity and change in DIAGNOdent™ readings at follow-up periods of six, 18, and 30 weeks. Results: Both groups showed a significant decrease in the mean oral hygiene debris index score at different follow-up periods compared to baseline (P<0.001). MI Varnish® intervention had a significantly decreased number of active lesions when compared to Duraphat Varnish®, at the 18 week time period. DIAGNOdent ™ scores were significantly reduced in the test group versus the control group at the 30 week assessment (P<0.001). Conclusion: MI Varnish® was more effective than Duraphat Varnish® in white spot lesions mineralization.

Tailored 70S30C Bioactive glass induces severe inflammation as pulpotomy agent in primary teeth: an interim analysis of a randomised controlled trial.

OBJECTIVES: This study compared clinical, histologic, and inflammatory outcomes of Biodentine and Bioactive glass (70S30C-BAG) as pulpotomy agents in primary teeth. METHODS: A randomised, clinical trial was performed recruiting 70 children, 5-9 years old, having ≥ 1 tooth indicated for vital pulpotomy. Participants were randomised to Biodentine or 70S30C-BAG groups. Clinical evaluation was scheduled at 1, 3, 6, 9, and 12 months. Additional 16 teeth were extracted after 6 weeks to assess histologic and inflammatory response (IL-8/IL-10 ratio) using ELISA. Fisher exact, Mann Whitney U test, and t test were used to compare clinical, histologic outcomes and IL-8/IL-10 ratio. RESULTS: After 3 months, 10 teeth treated with Biodentine were clinically successful, while 9 teeth treated with 70S30C-BAG failed (P < 0.001) necessitating trial termination. Causes of failure were analysed by assessing the pH and ionic release of 70S30C-BAG. Biodentine-treated teeth showed minor inflammation, normal pulp, and hard tissue formation.70S30C-BAG-treated teeth showed severe inflammation, abscesses, root resorption without hard tissue formation. There was a significantly greater percent reduction of IL-8/IL-10 ratio in Biodentine than 70S30C-BAG (mean ± SD = 66.39 ± 18.56 and 40.66 ± 0.86, P = 0.02). CONCLUSIONS: Biodentine showed favourable clinical, histologic, and anti-inflammatory outcomes, promoting pulp healing and regeneration. 70S30C-BAG resulted in pulp necrosis-through persistent inflammation-causing clinical failure. CLINICAL RELEVANCE: Biodentine is a promising pulpotomy agent in primary teeth; it promoted healing and regeneration of the dentine-pulp complex. In its current form, 70S30C-BAG is not a suitable pulpotomy agent; it induced persistent inflammation, negating the pulp ability to heal and regenerate. TRN: NCT03786302, 12/19/2018.

Antimicrobial Effect of Propolis Administered through Two Different Vehicles in High Caries Risk Children: A Randomized Clinical Trial.

OBJECTIVE: To investigate the effect of two methods of propolis administration on plaque accumulation and microbial count as well as patient acceptance of each vehicle. STUDY DESIGN: A randomized clinical trial with two parallel arms was used with a sample of 60 high caries risk children 6-8 years old. Children were divided randomly into two groups. Group I: Children who received propolis chewing gum and instructed to chew it twice daily for at least twenty minutes, for two weeks. Group II: children who received propolis mouthwash and instructed to rinse twice daily for one minute. A plaque index was recorded and a plaque sample was collected from all participants at base line and after two weeks of treatment. All participants were asked to rate the preparation they received during treatment period on a Visual Analogue Scale chart. RESULTS: Data showed that propolis had a significant effect on reducing plaque scores and colony counts in both vehicles. There was no significant difference between both vehicles neither on plaque reduction nor on microbial count. However children preferred the gum formula. CONCLUSION: Propolis in both vehicles reduced plaque accumulation and microbial count which recommends its use as an antimicrobial agent in different vehicles.

Pain assessment during mandibular nerve block injection with the aid of dental vibe tool in pediatric dental patients: a randomized clinical trial.

OBJECTIVE: This study aimed to evaluate the effectiveness of DentalVibe in pain reduction during local anesthetic injection compared to traditional injection in pediatric patients. METHOD AND MATERIALS: This cross-over randomized controlled clinical trial included a sample of 60 children, aged 5 to 7 years, who were selected based on the need for local anesthesia for bilateral mandibular pulpotomy treatment. They were randomly allocated into two groups. Each group received two mandibular nerve block injections, with a 2-week interval as the washing out period. At first appointment, mandibular nerve block injection was performed either with vibration using DentalVibe at the injection site or benzocaine gel 20% applied before local anesthetic injection; the alternative technique was used at the second appointment. In each visit subjective pain was evaluated using the Wong-Baker FACES Pain Rating Scale and objective pain was evaluated using the FLACC (Face, Legs, Activity, Cry, Consolability) scale. RESULTS: Assessment using the Wong-Baker FACES Pain Rating Scale showed that the mean pain levels in DentalVibe and traditional injection groups were 0.80 ± 1.34 and 2.60 ± 3.22, respectively. The mean pain levels according to the FLACC scale were 2.20 ± 2.04 and 3.13 ± 2.30 in the DentalVibe and traditional injection groups, respectively. Both scales showed statistically significant differences between the two groups in favor of DentalVibe (P < .001). A positive significant correlation between the two scales in the two interventions was recorded, where the Spearman rho was 0.41 for the DentalVibe group, and 0.52 for traditional injection group (P < .001). CONCLUSION: Compared to the traditional approach, DentalVibe reduced pain sensation during mandibular nerve block injection in pediatric patients.

Exposure to Electronic Screens and Children's Anxiety and Behavior During Dental Treatment.

Purpose:The purposes of this study were to (1) assess the relationship between exposure time to electronic screens and children's anxiety and behavior manage ment problems during dental treatment; and (2) evaluate the effect of the underlying confounding factors.
Methods:A cross-sectional study of 95 five- to eight-year-old patients was conducted. The study consisted of two sessions, one week apart. During the first visit, the socioeconomic status of the family was assessed, and examination and preventive measures were performed. One of the parents was asked to report screen time use by the child over a one week period using a valid questionnaire. In the second visit, dental anxiety and behavior management problems were assessed using the Clinical Anxiety Rating Scale and Frankl Behavior Scale, respectively.
Results: Anxiety and behavior management problems during a dental visit were significantly correlated with the participant's total exposure hours to electronic screens. Exposure to violent media was significantly different between participants with and without behavior management problems. Boys showed a significant higher exposure to violent media than girls.
Conclusion: Anxiety and behavior problems in a dental visit correlate to total hours of exposure to electronic screens. Therefore, limiting a child's screen exposure should be considered. (J Dent Child 2019;86(3):139-44).

Comparison between Positive Dental Images and Neutral Images in Managing Anticipatory Anxiety of Children.

OBJECTIVE: To evaluate the impact of positive images versus neutral images on child behavior during dental treatment and their dental anxiety after dental treatment. STUDY DESIGN: Sixty, 4 to 6 year old healthy pediatric dental patients, indicated for pulpotomy and stainless steel crown restorations, were divided randomly into two equal groups. Group I (experimental group viewed positive dental images and group II (control group) viewed neutral cartoon images prior to treatment. Behavior was assessed using Frankl rating scale in all four treatment phases: seating, local anesthesia administration, pulpotomy and overall rating. Patient's anxiety was determined according to Venham Picture Test (VPT) before and after dental procedure. RESULTS: Behavior rating using the Frankl scale showed a statistically significant difference in the two groups in the overall rating (P= 0.003, 0.001 respectively). No statistically significant difference was found between both groups in any of the treatment phases (P= 0.288, 0.060, 0.719 respectively) and between the mean VPT scores before and after procedures (P=0.95, 0.93 respectively. CONCLUSION: Viewing neutral or positive dental images did not have an effect on child's anticipatory anxiety level. However, it is an effective method of improving the behavior in children.