Efficacy of non-instrumental Endodontic treatment in primary teeth: a systematic review of clinical randomized trials.

BACKGROUND: Endodontic therapy in pediatric dentistry is a challenging procedure, especially for special needs, uncooperative, and very young patients. A new conservative approach which is the non-instrumental endodontic treatment (NIET) has been developed to simplify the management of primary teeth requiring pulpectomy. This review aimed to compare the efficiency of NIET and conventional endodontic treatment in primary teeth. METHODS: Electronic databases including MEDLINE (via PubMed), Cochrane Library (CENTRAL), and Scopus without restrictions on publication year or publication language were searched. Only randomized clinical trials reporting clinical and radiographical outcomes of NIET and conventional pulpectomy on primary teeth were considered eligible. Two reviewers extracted the data according to the PRISMA statement and assessed the bias risk using the revised Cochrane risk-of-bias tool and a meta-analysis was performed. RESULTS: From 3322 screened articles, seven articles meeting the inclusion criteria were included. The selected studies included 283 primary molars, of 213 children aged between 3 and 9 years, treated by NIET and conventional pulpectomy, and had follow-up periods ranging from 1 month to tooth exfoliation. Two studies reported good success rates for both the NIET technique and endodontic therapy with no statistically significant difference while three studies showed radiographical significant differences with a low success rate for the NIET technique. Only one study reported better outcomes in the pulpectomy group with statistically significant differences. The quantitative grouping of the included studies showed no significant differences between NIET and conventional endodontic therapy regarding clinical and radiographical success (p value > 0.05). CONCLUSION: No difference between the NIET technique and the conventional endodontic therapy in primary molars requiring pulpectomy could be confirmed. Results of the present review need to be interpreted with caution since the quality of evidence according to the GRADE was considered as moderate to very low. Therefore, additional clinical trials on the NIET technique are recommended.

Clinical status and assessment of caries on first permanent molars in a group of 6- to 13-year-old Tunisian school children.

AIM: The present survey aimed to highlight the clinical status of first permanent molars (FPMs) among a group of children aged between 6 and 13 years in public primary schools in Tunisia and to determine the association between FPMs' dental caries, gingival bleeding, malocclusion, dental fluorosis, and enamel defects. MATERIALS AND METHODS: The survey involved a cross-sectional study based on a dental examination conducted in public primary schools in Monastir Tunisia. A dental caries assessment was performed on FPMs using the International Caries Detection and Assessment System classification; the number of carious lesions in permanent and temporary dentition was established using the decayed/missing/filled teeth (DMFT) index. The Gingival Index and the Dental Aesthetic Index were used to determine the occurrence of gingival bleeding and malocclusions. Dean's index and the modified Development Defects of Enamel index were used to define the enamel defects. The χ2 test was used to assess the difference between more than two groups, and the level of statistical significance was set at .05%. RESULTS: A total of 545 children and 2080 FPMs were examined. The prevalence of dental caries in FPMs was recorded to be 35.8%. The overall mean DMFT index of the study population was 1.62 and the mean DMFT index was 1.41. The proportion of carious FPMs increased significantly with the age of the children (p < .05). The mandibular first permanent molar presented higher caries prevalence than its maxillary counterpart (p < .05). The presence of surfaces affected by molar incisor hypomineralization was recorded in 4.3% and the presence of surfaces affected by fluorosis was recorded in 4.6% of FPMs. No association was reported between FPMs' dental caries, gingival bleeding, malocclusion, and enamel defects (p > .05). CONCLUSION: Although the prevalence of caries in FPMs was considered moderate, health promotion programs should be implemented on a large scale to decrease the prevalence of dental caries among school children.

Are Molar-Incisor Hypomineralization and Hypomineralized Second Primary Molars Predictive of Dental Caries?: A Systematic Review.

To estimate the prevalence of dental caries among children affected concomitantly with molar-incisor hypomineralization (MIH) and hypomineralized second primary molars (HSPM).Electronic databases, including Medline via PubMed, Cochrane Library, Scopus, and Science Direct, were searched. Studies written in English involving children with MIH-HSPM and dental caries were considered eligible. Two reviewers extracted the data according to the PRISMA statement and assessed the bias risk with the Newcastle-Ottawa Scale (NOS) criteria.Out of 535 studies identified in the initial research, only two articles were included in the present review. A significant association between MIH-HSPM and dental caries in permanent dentition was reported in the two included records (AOR: 3.70; p < 0.001). Children with MIH-HSPM expressed significantly higher DMFT and PUFA values than children without MIH-HSPM. However, dmft values did not differ significantly between children with and without HSPM (1.79 [2.4] vs. 1.78 [2.5]; 1.88 [2.73] vs. 1.59 [2.53], respectively.MIH-HSPM lesions were correlated with a higher prevalence and more severe carious lesions in permanent dentition. However, the results should be interpreted cautiously because the findings were generated by only two studies performed by the same authors. Thus, further well-designed studies are highly recommended.

La santé bucco-dentaire au Grand Maghreb : revue systématique de la littérature.

OBJECTIVES: Oral health problems are an important component of the overall burden of morbidity, determining the health status of populations and their expenditure on care. This study aims thus to analyze, through a literature review, the main indicators of oral health in the Maghreb countries between 1990 and 2020. METHODOLOGY: A bibliographic search was conducted during the month of October 2020 on three databases (Pubmed, Sciences Direct and Cochrane). A reading grid based on the STROBE criteria was used to evaluate the articles during critical reading. RESULTS: Of the 2492 references initially identified, 11 articles were selected after the critical reading. Analysis of the results revealed a high morbidity of oral diseases in the Maghreb countries dominated by dental caries and periodontal diseases with a major need for oral care. The prevalence of dental caries exceeded 50% in temporary dentition at 6 years age and 60% in permanent dentition at 12 years. For periodontal diseases, the prevalence exceeds 55% at 15 years age. In addition, inequalities in access to oral care between regions were noted. DISCUSSION: Oral health studies in the Maghreb are rare, old, and conducted at different times, making comparisons difficult between them. This study calls for regular national surveys for an objective and up-to-date assessment of the main epidemiological indicators. The development of an integrated strategy for the promotion of oral health is still a priority of national health systems in the Maghreb.

Dental Management of a Tunisian Child with Sanjad-Sakati Syndrome.

Sanjad-Sakati syndrome (SSS) is a rare autosomal recessive congenital disorder. The present case report is aimed at describing the orofacial manifestations and dental management of a 4-year seven-month-old, Tunisian boy with SSS. The patient has typical dysmorphic facial features and growth retardation. Intraoral examination revealed micrognathic mandible and maxilla, an arched palate, and small dental arches with an open bite. All the maxillary and mandibular teeth were decayed due to the poor oral hygiene, plaque accumulation, and enamel hypoplasia. Oral rehabilitation involved pulpotomies and root canal therapies on decayed teeth. Resin composite restorations were performed on maxillary and mandibular incisors, and stainless-steel crowns were placed on maxillary and mandibular first and second primary molars. Dental treatment of children with SSS should improve their quality of life and their general health. Undeveloped dental arches associated with dental anomalies as well as learning deficit make very difficult of the oral rehabilitation of such patients.

Cone-beam computed tomography in the diagnosis of regional odontodysplasia.

Regional odontodysplasia (RO) in permanent teeth is a rare developmental anomaly of mineralized tissues. Three-dimensional images and data from CBCT allowed to provide useful information on the degree of tooth calcification and consequently confirm the diagnosis of RO and establish a treatment strategy to minimize future damages and sequels.

Early Childhood Caries Prevalence and Associated Risk Factors in Monastir, Tunisia: A Cross-Sectional Study.

Purpose: The present study aimed to investigate the prevalence and risk factors of ECC among preschool children in Monastir, Tunisia. Methods: The survey was designed as a cross-sectional study carried out between February and April 2021 in the main region of Monastir, Tunisia. A total of 381 preschool children were randomly selected using a three-stage clustered sampling technique from 10 daycares. The dental caries were diagnosed using WHO recommendations and a questionnaire in Arabic language was used to record personnel profile of the enrolled children. The chi-square test was used in bivariate analyses to assess the association between ECC and risk factors. Variables showing significant associations were included in multiple logistic regression models. Results: The prevalence of ECC was 20% and the mean dmft score was 0.89 ± 0.24. The prevalence of ECC increased at the age of 48-59 months ([OR] 2.602; 95%CI: 1.122-2.302), the age of 60-71 months ([OR] 2.845; 95% CI: 1.128-2.072), in children with nocturnal feeding ([OR] 2,417; 95% CI: 1.340-4,358), who take sugary drinks in the bottle ([OR] 1.104; 95% CI: 1.667-2.826), stopped breast or bottle feeding after the age of 18 months ([OR] 2.417; 95% CI: 1.340-4.358), do not brush their teeth properly ([OR] 1.435; 95% CI: 1.207-2.915), had visited a dentist ([OR] 2.444; 95% CI: 2.072-1.108), and decreased in children with a more highly educated parents ([OR] 0.797; 95%CI: 0.171-0.650). Conclusion: Given the relatively high prevalence of ECC in Tunisia, it is important to review public dental health policies and develop effective strategies to encourage changes in behavior related to the oral health of children to prevent the spread and worsening of this disease.

Conservative Approach of a Dentigerous Cyst.

Dentigerous cysts (DC) are the most common odontogenic cystic lesions of inflammatory origin occurring in children. These lesions can be treated by enucleation with or without related impacted teeth or marsupialization/decompression. The latter procedures have been used successfully for many years, but decompression is increasingly recommended in children because of its good outcomes and the preservation of the developing tooth. This conservative surgical technic allows simultaneously the normal eruption of the involved permanent teeth and the ossification of the bony defect. The present report describes an 8-year-old female patient with an inflammatory DC associated with an endodontically treated primary molar accidentally discovered on panoramic radiograph. Decompression of the cyst was performed, by means of a removable space maintainer acting as an acrylic obturator after removal of teeth 83 and 84. Ten months after the decompression procedure, a complete resolution and regression of the cystic lesion with full spontaneous eruption of the premolar were observed.

Oral manifestations and dental care management of a young patient with lymphangioma of the tongue: A case report.

Children with lymphangioma of the tongue may require a close collaboration between physician and dentist to establish preventive, conservative approaches, and eradicate any sources of dental infections before undertaking immunosuppressive therapy.

Fusion or Gemination? Diagnosis and Management in Primary Teeth: A Report of Two Cases.

Primary double teeth (PDT), referring to either gemination or fusion, are one of the most important and frequent developmental dental anomalies that can affect children's oral health. Many clinical complications are correlated with these anomalies, such as dental caries, malocclusions, periodontal problems, and dental anomalies in permanent dentition. The aim of this report was to describe, through two cases, a case of gemination and another of fusion, the clinical management, the consequent effects, and the possible repercussions of these two developmental abnormalities on permanent successors. The first case involved gemination of the primary maxillary left central incisor (#61) in a 6-year-old boy. The patient presented with dental caries in the geminated tooth and its contiguous primary left lateral incisor (#62). The radiological examination revealed a slight developmental delay in the permanent left lateral incisor (#22). The treatment plan involved performing a pulpotomy and restoring the dental crowns of the affected teeth. The second clinical case describes a 6-year-old girl with unilateral fusion between a primary mandibular lateral incisor (#72) and a supernumerary tooth (#72'). The treatment included restoration of the deep grooves of the fused teeth using flowable composite and coronal restoration of the contiguous left primary canine (#73). Clinical and radiological follow-ups were performed every 3 months to monitor the development of teeth. No clinical and radiological symptoms were noted during the follow-up visits. PDT may require a multidisciplinary treatment. They should be diagnosed early to avoid and treat any possible complications in both the primary teeth and their permanent successors.

Antibiotic Mixtures in Noninstrumental Endodontic Treatment of Primary Teeth with Necrotic Pulps: A Systematic Review.

OBJECTIVE: To compare the effectiveness of topical antibiotic mixtures used in noninstrumental endodontic treatment (NIET) of primary teeth. METHODS: Electronic databases including MEDLINE, the Cochrane Library, and Scopus database were searched. Randomized clinical trials evaluating the clinical and radiological outcomes of topical antibiotics used in NIET were selected. The revised Cochrane risk-of-bias tool (RoB 2.0) was used to assess the quality of the methodology of the included articles. RESULTS: Five articles comparing the outcomes of four different drugs combination were included. Three studies conducted to evaluate the success rate of two combinations of antibacterial drugs consisting of ciprofloxacin-minocycline-metronidazole (3 Mix) in one group and ciprofloxacin-minocycline-ornidazole in the other group showed no statistically significant difference between both groups (P > 0.05). The ciprofloxacin-minocycline-ornidazole group showed better results compared with the 3 Mix group. One study conducted to compare the effectiveness of 3 Mix with ciprofloxacin-tinidazole-minocycline reported no significant difference between both groups, and one study that compared 3 Mix and ciprofloxacin-metronidazole-clindamycin mixture concluded that the overall success rates of both groups were 80.96% and 76.20%, respectively, with no statistically significant difference. CONCLUSION: Based on the overall success rates, the ciprofloxacin-minocycline-ornidazole mixture was considered more effective than the 3 Mix which was more effective than the ciprofloxacin-tinidazole-minocycline and the ciprofloxacin-metronidazole-clindamycin groups. Clinical Relevance. Different antibiotic combinations, showing good clinical and radiographic success in treating necrotic primary teeth, can be used effectively in NIET and this technique can be considered effective for teeth with advanced root resorption and when conventional endodontic treatment is contraindicated.

Multiple abnormalities in permanent incisors diagnosed six years after a severe intrusive injury in the primary dentition: A case report.

Severe intrusion injuries of primary teeth are frequently associated with serious developmental disorders. This report describes the diagnostic procedures and the multidisciplinary approach for multiple sequelae to permanent incisors due to a severe intrusive injury of the primary maxillary anterior teeth at the age of 18 months in a 7-year-old girl. Clinical examination revealed hypoplasia of tooth 22, and radiographic examination showed crown-root malformation of tooth 21, impaction of tooth 11, and the presence of an odontoma-like malformation on tooth 12. The affected tooth 12 had a poor prognosis, as highlighted by CBCT, and it was extracted. While for the impacted 11, a surgical extraction followed by an orthodontic treatment is scheduled. Aesthetic and functional problems were solved by a functional space maintainer using a removable partial denture. The occurrence of multiple abnormalities in permanent teeth as a result of intrusive injuries in the primary dentition enhances the need for creating awareness among dentists not only of the importance of appropriate immediate management of trauma but also of the importance of establishing a long-term follow up and subsequent management of any sequelae.

Applicability of Willems methods and Demirjian's four teeth method for dental age estimation: Cross sectional study on Tunisian sub-adults.

This study aims to evaluate and compare the applicability of three dental methods for age estimation, including Demirjian's four teeth, Willems I, and Willems II methods in a sample of Tunisian children. Panoramic radiographs of 500 children (241 females, 259 males) aged between 5 and 15 years were examined. The mean absolute error (MAE) was performed to assess the accuracy of age estimation. Independent samples t-test was employed to compare the differences, the chronological age minus dental age (CA-DA), between sexes for the three methods. All of the three methods underestimated the chronological age on the average, and almost for all age groups. The discrepancy between the chronological age and the estimated age was most frequently observed for ages above 8 years for all methods. In our study, the Demirjian's four teeth method underestimated the chronological age by 0.45 years for males and 0.32 years for females, with no significant difference (p=0.124). Whereas the Willems I method is indicted for underestimating the chronological age by 0.40 years for males, and by 0.69 years for females. Willems II method underestimated age by 0.91, and 0.64 years for males and females, respectively. It is established that the Demirjian's four teeth method was more accurate in estimating the dental age than the Willems I and II methods, with a mean absolute error of 0.76 years for males and 0.79 years for females (MAE=1.10, and 0.98 years for the Willems I/1.02, and 0.92 years for the Willems II). According to the results, it is highly recommended that the Demirjian's four teeth method should be applied when estimating the dental age in Tunisian males and females. In forensic cases, when the sex is unknown or doubted, the Willems II method could be appropriate.

Dental age assessment among Tunisian children using the Demirjian method.

CONTEXT: Since Demirjian system of estimating dental maturity was first described, many researchers from different countries have tested its accuracy among diverse populations. Some of these studies have pointed out a need to determine population-specific standards. AIM: The aim of this study is to evaluate the suitability of the Demirjian's method for dental age assessment in Tunisian children. MATERIALS AND METHODS: This is a prospective study previously approved by the Research Ethics Local Committee of the University Hospital Fattouma Bourguiba of Monastir (Tunisia). Panoramic radiographs of 280 healthy Tunisian children of age 2.8-16.5 years were examined with Demirjian method and scored by three trained observers. STATISTICAL ANALYSIS USED: Dental age was compared to chronological age by using the analysis of variance (ANOVA) test. Cohen's Kappa test was performed to calculate the intra- and inter-examiner agreements. RESULTS: Underestimation was seen in children aged between 9 and 16 years and the range of accuracy varied from -0.02 to 3 years. The advancement in dental age as determined by Demirjian system when compared to chronological age ranged from 0.3 to 1.32 year for young males and from 0.26 to 1.37 year for young females (age ranged from 3 to 8 years). CONCLUSIONS: The standards provided by Demirjian for French-Canadian children may not be suitable for Tunisian children. Each population of children may need their own specific standard for an accurate estimation of chronological age.

Survey on hypodontia in Sayada, Tunisia.

OBJECTIVE: To determine dental agenesis prevalence in Sayada, Tunisia, a town from where many patients attend the Pediatric Department of Monastir University Dental School for such abnormalities, and to analyze its mode of inheritance. METHOD AND MATERIALS: A total of 262 schoolchildren in permanent dentition (134 females and 128 males) aged 12 to 18 years (mean, 14.1 +/- 1.2 years) were examined to detect dental agenesis. In the case of a missing permanent tooth, a panoramic radiograph was taken to confirm diagnosis. A family survey questionnaire was completed for each case of multiple agenesis (at least 4 teeth missing). RESULTS: Findings revealed a dental agenesis prevalence of 13.3%. Altogether, 62 teeth were missing. No case of syndromal agenesis was detected; however, 12 children presented multiple agenesis (34.3%). The family survey was completed for only 9 of these subjects. CONCLUSION: Literature review showed a lower dental agenesis prevalence (3% to 7%) than did the present study. In the present study, females were more affected by this abnormality than males (16.4% and 10.3%, respectively). With the exception of third molars, the tooth most often missing was the mandibular second premolar (30.6%), followed by the maxillary second premolar (17.7%); hypodontia seemed to be symmetrical. Family surveys revealed a high rate of consanguinity in Sayada. Pedigree analysis of 9 families showed that dental agenesis was probably related to an autosomal dominant inheritance.