Enhanced Recovery of Local Anesthesia in Pediatric Patients: The Impact of Photobiomodulation on Reversing Anesthesia Effects.

BACKGROUND The split-mouth study design is used in oral health research and usually consists of 2 treatments randomly assigned to either the right or left side. This split-mouth study aimed to evaluate the efficacy of photobiomodulation on reversal of local anesthesia in 50 children aged 8-10 years. MATERIAL AND METHODS The study was conducted among 50 children: 27 girls and 23 boys, aged 8-10 years (mean age 9.38±1.15 years), who presented 2 carious maxillary permanent molars. One side was randomly assigned to the laser group (50 teeth), and the contralateral side to the control group (50 teeth). At the end of the treatment, photobiomodulation (PBM) was performed in the area of infiltration at 6 points, with 635 nm (25 children) (250 mW, 500 mW/cm², 15J) and 808 nm (25 children) (200 mW, 400 mW/cm², 12J) (SmartM PRO, Lasotronix, Poland). On the contralateral side, the laser's off-mode applicator was used. Anesthetic effect was evaluated by palpation test (soft tissues) and electrical test (dental pulp). RESULTS After 15 minutes, in the laser group the return to normal sensations in the palpation test showed 88% (808 nm) and 68% (635 nm), and only 20% in the control group (P=0.04123). After 45 minutes, all the participants from the PBM group returned to normal sensations (P=0.21458). Dental pulp's excitability threshold was lower for both wavelengths compared to the control group (P=0.000001). CONCLUSIONS The identification of factors accelerating the recovery time to normal function, such as PBM, can be used as important data to eliminate self-injury secondary to local anesthesia (LA) in children.

Evaluation of photobiomodulation for postoperative discomfort following laser-assisted vital pulp therapy in immature teeth: A preliminary retrospective study.

BACKGROUND: Minimally invasive endodontics is recommended for young, immature teeth to preserve healthy pulp and dentin tissue. OBJECTIVES: The aim of the study was to examine the cold sensitivity of immature teeth that received photobiomodulation (PBM) after vital pulp therapy (VPT). MATERIAL AND METHODS: The study followed the STROBE guidelines and included 123 healthy patients aged 8-13. The immature teeth (incisors, premolars and molars) that qualified for VPT received the bioceramic material - Biodentine. In this experiment, teeth were treated immediately and at 24 h post-VPT with a 635-nm diode laser using a power of 100 mW, a power density of 200 mW/cm2 and a total energy of 4 J (PBM group, n = 43), while those not treated were the control group (n = 43). The tooth sensitivity to cold was measured using a visual analogue scale (VAS) before and at 6 h, 1 day, 7, 30, and 90 days after treatment. The predictor variable was PBM skills regarding the ability to decrease cold sensitivity after VPT. The primary endpoint was the time to reverse hypersensitivity to cold, and the secondary endpoint was the occurrence of possible side effects. The Mann-Whitney U test, Friedman test along with Dunn's post hoc test, and the χ2 test were used to investigate tooth sensitivity. RESULTS: Eighty-six immature permanent teeth of 86 children were included in the study. It was shown that the difference was significant for sensitivity to a cold stimulus between the groups at 6 h, 24 h, 7 days, and 30 days, but no difference was found preoperatively and at 90 days (6 h, 24 h, 7 days, and 30 days, p < 0.001, and 90 days, p = 0.079). However, patients in both groups reported a decrease in discomfort provoked by cold stimuli throughout the follow-up period. CONCLUSIONS: Photobiomodulation decreased postoperative sensitivity and was more acceptable for patients. Further randomized clinical studies with placebo-controlled groups are needed.

Comparison of Bond Strength of Orthodontic Brackets Onto the Tooth Enamel of 120 Freshly Extracted Adult Bovine Medial Lower Incisors Using 4 Adhesives: A Resin-Modified Glass Ionomer Adhesive, a Composite Adhesive, a Liquid Composite Adhesive, and a One-Step Light-Cured Adhesive.

BACKGROUND This study aimed to compare the bond strength of orthodontic brackets onto the tooth enamel of 120 freshly extracted adult bovine medial lower incisors using 4 adhesives: a resin-modified glass ionomer adhesive, a composite adhesive, a liquid composite adhesive, and a one-step light-cured adhesive. MATERIAL AND METHODS The study group (120 freshly extracted bovine medial lower incisors) was divided into equal subgroups depending on the type of adhesive used to fix the brackets to the tooth enamel (n=30), and then according to the observation time (n=10). Orthodontic brackets were fixed onto the tooth enamel for 24 hours (T1), 3 months (T2), and 6 months (T3) using 4 types of adhesives: resin-modified glass ionomer adhesive Fuji Ortho LC, composite adhesive Transbond Plus Light Cure Band, flowable composite adhesive Transbond Supreme Low Viscosity, and a one-step light-cured adhesive GC Ortho Connect. Shear tests and fracture plane analyses were performed. RESULTS Statistically significant differences at time T1 were noted in the comparison of shear stress values when brackets were fixed with GC Ortho Connect adhesive compared to other adhesives (P<0.05), except for the Transbond Plus adhesive (P>0.05). At time T3, significant statistical differences occurred between GC Fuji Ortho LC and the other 3 adhesives (P<0.05). The fracture analysis showed that, regardless of the time function, adhesive-cohesive fractures without damage to the enamel were the most common for all the assessed materials. CONCLUSIONS Of the adhesives evaluated, GC Ortho Connect appears to be the most appropriate choice for bonding orthodontic brackets to the enamel surface.

Assessing Fluorosis Incidence in Areas with Low Fluoride Content in the Drinking Water, Fluorotic Enamel Architecture, and Composition Alterations.

There is currently no consensus among researchers on the optimal level of fluoride for human growth and health. As drinking water is not the sole source of fluoride for humans, and fluoride can be found in many food sources, this work aimed to determine the incidence and severity of dental fluorosis in Poland, in areas where a low fluoride content characterizes the drinking water, and to assess the impact of fluoride on the enamel composition and microstructure. The dental examination involved 696 patients (aged 15−25 years) who had since birth lived in areas where the fluoride concentration in drinking water did not exceed 0.25 mg/L. The severity of the condition was evaluated using the Dean's Index. Both healthy teeth and teeth with varying degrees of fluorosis underwent laboratory tests designed to assess the total protein and fluoride content of the enamel. Protein amount was assessed spectrophotometrically while the level of fluoride ions was measured by DX-120 ion chromatography. The clinical study revealed 89 cases (12.8%) of dental fluorosis of varying severity. The enamel of teeth with mild and moderate fluorosis contained a significantly higher protein (p-value < 0.001 and 0.002, respectively) and fluoride level (p < 0.001) than those with no clinical signs of fluorosis. SEM images showed irregularities in the structure of the fluorotic enamel. An excessive fluoride level during amelogenesis leads to adverse changes in the chemical composition of tooth enamel and its structure. Moreover, dental fluorosis present in areas where drinking water is low in fluorides indicates a need to monitor the supply of fluoride from other possible sources, regardless of its content in the water.

Tooth and Bone Parameters in the Assessment of the Chronological Age of Children and Adolescents Using Neural Modelling Methods.

The analog methods used in the clinical assessment of the patient's chronological age are subjective and characterized by low accuracy. When using those methods, there is a noticeable discrepancy between the chronological age and the age estimated based on relevant scientific studies. Innovations in the field of information technology are increasingly used in medicine, with particular emphasis on artificial intelligence methods. The paper presents research aimed at developing a new, effective methodology for the assessment of the chronological age using modern IT methods. In this paper, a study was conducted to determine the features of pantomographic images that support the determination of metric age, and neural models were produced to support the process of identifying the age of children and adolescents. The whole conducted work was a new methodology of metric age assessment. The result of the conducted study is a set of 21 original indicators necessary for the assessment of the chronological age with the use of computer image analysis and neural modelling, as well as three non-linear models of radial basis function networks (RBF), whose accuracy ranges from 96 to 99%. The result of the research are three neural models that determine the chronological age.

Management of the Oral Health of Children During the COVID-19 Pandemic in Poland.

Managing the oral health of children during the time of a health emergency linked to the current COVID-19 pandemic presents specific problems. A high number of non-specific effective infection control protocols are available in dental settings. It is of fundamental importance to implement specific protocols relating to those clinical situations that normally do not represent an emergency but which now fall into that category. The aim of this study was the comparison of data obtained from the Regional National Health Fund (NFZ) relating to the number and the type of procedures in the oral health management of children aged 0-18 years from the Wielkopolska region, with the months of March and April of 2019 being compared with those of the, respective, pandemic period of 2020. The results showed statistical differences in the number of performed procedures when comparing 2019 and 2020; especially in April (n = 53,077 in 2019 but only n = 2,287 in 2020), when lockdown restrictions reached their highest level and when only 30% of the dental clinics for children were open for patients in the Wielkopolska region of Poland. Regarding surgical cases, there were no differences in percentage frequency between April 2019 and 2020 in terms of extractions. However, an increase was observed in abscess incisions (3.5-17.8%) and surgical dressings (1.5-10.07%). There was a decrease in the total number of performed conservative dentistry procedures in April 2020, but temporary fillings in primary and permanent teeth showed a prominent increase: from 6.4% in 2019 to 19.3% in 2020; and 5.8-11.4%, respectively. Pulp treatment and mucosal lesions therapy fall into the dental emergency category during this COVID-19 pandemic. These cases have shown an increase from 3.2% in 2019 to 12.8% in 2020 for pulp treatment, and from 2.3 to 4.3% for the treatment of oral mucosal lesions. As suspected, after the lockdown was implemented, the number of pediatric dental cases were low. Moreover, the analysis revealed differences in the profile of clinical situations that represented the emergency cases and the pandemic treatment protocols. Future implications suggest that dental prophylactic procedures be included in pandemic protocols with even dental services being limited to a form of urgent treatment. New approaches and treatment models should be implemented in the control of the infectious spread of the disease in the management of the oral health of children in this pandemic period.

The potential of trace elements mapping in child's natal tooth by laser ablation-ICPMS method.

PURPOSE: Tooth enamel might provide past chronological metabolic, nutritional status and trace metal exposure during development. Thus, the trace elements distribution embedded in tooth tissues represents an archive of the environmental conditions. The choice of biomarker is estimated as critical to the measurement of metal exposure. Natal teeth are defined as teeth being present at birth. METHODS: LA-ICP-MS provides a quantitative assessment of spatial distribution of trace elements in a natal tooth. The objective of the current study was to compare concentrations of building and other elements in a rare but reliable and valid biomarker - natal tooth. RESULTS: It have been reported presence of potentially toxic elements: Pb, Cu, Mn, Cd, Ni distributed in prenatally and perinatally formed enamel and dentine. CONCLUSIONS: Analyses of deciduous enamel can provide answers into individuals' earliest development, including critical pre- and perinatal period. SUPPLEMENTARY INFORMATION: The online version contains supplementary material available at 10.1007/s40201-021-00611-2.

Impact of a toothpaste with microcrystalline hydroxyapatite on the occurrence of early childhood caries: a 1-year randomized clinical trial.

The aim of this trial was to determine whether a toothpaste with microcrystalline hydroxyapatite is not inferior to a fluoride toothpaste in prevention of caries in children. This double-blinded randomized control trial compared two toothpastes regarding the occurrence of caries lesions using International Caries Detection and Assessment System (ICDAS) ≥ code 1 on the primary dentition within 336 days. The test group used a fluoride-free hydroxyapatite toothpaste three times daily while control group used a toothpaste with fluoride. 207 children were included in the intention-to-treat analysis; 177 of them finished the study per protocol. An increase in caries ICDAS ≥ code 1 per tooth was observed in 72.7% of the hydroxyapatite-group (n = 88), compared with 74.2% of the fluoride-group (n = 89). The exact one-sided upper 95% confidence limit for the difference in proportion of participants with ICDAS increase ≥ 1 (-1.4%) was 9.8%, which is below the non-inferiority margin of 20% demonstrating non-inferiority of hydroxyapatite compared to the fluoride control toothpaste. This RCT showed for the first time, that in children, the impact of the daily use of a toothpaste with microcrystalline hydroxyapatite on enamel caries progression in the primary dentition is not inferior to a fluoride control toothpaste (Clinical Trials NCT03553966).

Children's Dental Anxiety during the COVID-19 Pandemic: Polish Experience.

Dental fear and anxiety is a significant issue that affects pediatric patients and creates challenges in oral health management. Considering that the coronavirus disease 2019 (COVID-19) pandemic, along with its associated sanitary regime, social distancing measures and nationwide quarantines, could itself induce public fears, including in children, it is of great interest to explore whether this situation and the necessity of reorganizing dental care could potentially affect the emotional state of pediatric patients facing a need for urgent dental intervention. The present study assessed the emotional state of children ≤ seven years old (n = 25) requiring dental healthcare during a nationwide quarantine in Poland, as well as the anxiety levels of their caregivers. The Faces Anxiety Scale was adopted, and the evaluation was independently performed by the dentist, caregivers and children themselves. The level of anxiety in caregivers was also measured. As demonstrated, children requiring dental intervention during the nationwide quarantine did not reveal a significantly higher anxiety level as compared to the age- and indication-matched pre-pandemic control group (n = 20), regardless of whether their emotional state was evaluated by the dentist, caregivers, or by themselves. However, the share of children scoring the lowest anxiety level in all assessments was smaller in the pandemic group. Boys in the pandemic group had a higher anxiety level, as indicated by a caregiver assessment, and displayed a negative correlation with age in all three types of evaluation. Moreover, caregiver anxiety levels were higher in the pandemic group as compared to the pre-pandemic subset and revealed stronger correlations with the dental anxiety in children. The results suggest that the reorganization of oral healthcare under the pandemic scenario did not have a profound effect on children's dental anxiety. Nevertheless, findings in young boys highlight that they may be more vulnerable and require special care to mitigate their anxiety and decrease the risk of dentophobia in the future-these observations must be, however, treated with caution due to the small sample size and require further confirmation. Moreover, it is important to reassure caregivers of the safety of the dental visit during the pandemic to minimize the effect of their own anxiety on dental fears in children.

The contribution of orthodontic braces to aluminum exposure in humans: an experimental in vitro study.

There is limited information on whether metals such as aluminum (Al) can migrate from orthodontic braces to saliva and subsequently contribute to its exposure in humans. This study aimed to assess this experimentally by incubating elastomeric orthodontic ligatures in artificial saliva for 30 days and other components of orthodontic braces (brackets, arch wires, and retainers) up to 180 days. As demonstrated, significantly higher levels of Al were leached from elastomeric ligatures (mean ± SD 28.2 ± 6.8 µg compared with their stainless steel counterparts (3.6 ± 0.1 µg) during 30 days. The higher the incubation time, the greater levels of Al leaching to artificial saliva were observed with the highest levels found for CNA ß arch wire (252 ± 12 µg), Ni-Ti-Al arch wire (224 ± 11 µg), ceramic brackets (199 ± 10 µg), stainless steel arch wire (108 ± 5 µg), and metallic brackets (81.0 ± 4.2 µg) after 180 days of incubation. However, considering the tolerable weekly intake (TWI) established by the European Food Safety Authority, the intraoral use of orthodontic braces considered in this study would in the worst case constitute 0.04% and 0.09% of TWI in 70-kg adults and 30-kg children, respectively. In conclusion, the orthodontic braces considered in this study have no contribution to Al exposure in humans and can be considered safe in this regard.

Metals and Metalloids Release from Orthodontic Elastomeric and Stainless Steel Ligatures: In Vitro Risk Assessment of Human Exposure.

Elastomeric ligatures are increasingly used as a part of esthetic orthodontic treatment, particularly in children. The aim of the present study was to experimentally test whether these appliances may contribute to exposure to toxic elements. In the present study, elastomeric ligatures (ELs) were incubated in artificial human saliva for 1 month (a typical period of their use) and the release of 21 metals (Ba, Cd, Co, Cr, Cu, Fe, Li, Mn, Mg, Mo, Ni, Pb, Rb, Tl, Ti, Sb, Sr, Sn, Zn, U, V) and 2 metalloids (As and Ge) was studied using inductively coupled plasma-mass spectrometry. For comparison, stainless steel ligatures (SLs) were incubated for 1, 3, and 6 months (since sometimes their use is prolonged) under similar conditions. The determined metal levels were compared to the corresponding safety limits for human exposure. During 1 month, the ELs released Cd, Co, Cr, Mn, Ni, and Sn at total mean ± SD level of 0.31 ± 0.09, 0.98 ± 0.30, 3.96 ± 1.31, 14.7 ± 8.5, 13.8 ± 4.8, and 49.5 ± 27.7 µg, respectively. Other elements were always below the detection limits. In case of SL, the release of Co, Cr, Fe, Ni, Mn, and Sn was observed, and the determined values increased over the studied period. After 6 months, their total mean ± SD levels amounted to 28.6 ± 0.2, 21.7 ± 0.2, 623.5 ± 3.0, 1152.7 ± 1.8, 5.5 ± 0.3, and 22.6 ± 0.2 µg, respectively. The released metal levels from both ligature types were always below safety limits. The release of Ni from SL during 6 months would constitute 5.0 and 11.5% of tolerable intake in adults and children, respectively. The results of this in vitro study highlight that the use of ligatures in orthodontic treatment can be considered safe in terms of metal exposure although elastic ligatures replaced on a monthly basis appear to be advantageous in comparison to the prolonged use of stainless steel appliances.

The mechanical strength of orthodontic elastomeric memory chains and plastic chains: An in vitro study.

BACKGROUND: The loss of physical properties of orthodontic chains has been a topic of discussion among scientists and clinicians, motivating efforts to improve elastic materials and minimize the decrease of force. Orthodontic companies have introduced memory elastomers, which, according to the manufacturers, have improved mechanical properties. OBJECTIVES: The aim of the study was to evaluate the effects of stretching elastomeric chains submerged in 37°C artificial saliva. MATERIAL AND METHODS: The study assessed 2 types of chains. The first phase of the study evaluated 1) the tensile strength of the chains; and 2) elongation at the time of tearing in an environment outside of the oral cavity (without exposition). The second phase of the study evaluated 1) permanent deformation after stretching; 2) elongation at the time of tearing; and 3) the tensile strength of the chain in conditions similar to those present in the oral cavity. RESULTS: In the experiments using artificial saliva, pronounced force decay was observed in the plastic chain, in which, after just 7 days, force decreased almost by half compared to the initial value, with a continuous downward trend. The memory chain, however, showed increased elasticity, and after the first week of exposition the force decay at the time of tearing was around 20% of the initial value. Force decay at the time of tearing remained at a steady level between 14.4 and 25.4% throughout the whole period of exposition. In the plastic chain this value oscillated between 50.3 and 55.9%. In the experiments assessing permanent deformation of the chains performed after each week of exposition, the specimens prepared from the memory chain stretched from 8 cm to approximately 9.5 cm after exposition, while the specimens prepared from the plastic chain stretched to approximately 13 cm. CONCLUSIONS: Memory chains are more effective in orthodontic treatment due to diminished loss of mechanical and elastic capabilities, when compared to plastic chains.

Dental treatment strategies in a 40-year-old patient with cleidocranial dysplasia.

Oral anomalies and dental treatment in a patient with cleidocranial dysplasia (referred to the dental clinic at the age of 40 years) are presented. Five supernumerary teeth were found in the patient: three in the maxilla in the area of molars and two in the mandibula in the area of premolars. Therapy included surgical exposure of impacted teeth in combination with removal of supernumerary teeth.