Silver Diamine Fluoride in Pediatric Dentistry: Effectiveness in Preventing and Arresting Dental Caries-A Systematic Review.

BACKGROUND: Tooth decay is considered a global scourge by the World Health Organization (WHO) starting at an early age. In recent years, silver diamine fluoride (SDF) has regained interest, particularly in pediatric dentistry, used to prevent the development of carious lesions or arrest their progression. OBJECTIVE: The aim of this study was to assess, through a systematic review of the literature, the effectiveness of SDF, used in pedodontics, in temporary teeth, in preventing or arresting dental caries. MATERIAL AND METHODS: An electronic search was conducted on PubMed, Web of Science and Scopus. The effect of SDF on both temporary and permanent teeth has been considered. RESULTS: The inclusion criteria identified 16 randomized controlled trials involving patients aged 18 months to 13 years and followed over a period of 12-30 months. CONCLUSIONS: SDF is a practical, accessible and effective non-invasive way to prevent and arrest caries in temporary and permanent teeth. Its application requires regular monitoring. The resulting black spot is diminished by immediate application of potassium iodide but this may affect its effectiveness.

Developing Bioactive Hydrogels with Peptides for Dental Application.

Dental caries is an avoidable and complex condition impacting billions of individuals worldwide, posing a specific concern among younger generations, despite the progress of oral hygiene products. This deterioration occurs due to the acid demineralization of tooth enamel, leading to the loss of minerals from the enamel subsurface. The remineralisation of early enamel carious lesions could prevent the cavitation of teeth. The enamel protein amelogenin constitutes 90% of the total enamel matrix protein and plays a key role in the bio mineralisation process. The aim of this study is to investigate the self-assembly microstructure and reticulation behaviour of a newly developed bioactive hydrogel with leucine-rich amelogenin peptide (LRAP) intended for enamel remineralisation. SEM, AFM, UV-VIS, and FTIR analyses emphasize the ability of peptides to promote cell adhesion and the treatment of early carious lesions. In conclusion, short-chain peptides can be used in hydrogels for individual or professional use.

Biomaterials Functionalized with Inflammasome Inhibitors-Premises and Perspectives.

This review aimed at searching literature for data regarding the inflammasomes' involvement in the pathogenesis of oral diseases (mainly periodontitis) and general pathologies, including approaches to control inflammasome-related pathogenic mechanisms. The inflammasomes are part of the innate immune response that activates inflammatory caspases by canonical and noncanonical pathways, to control the activity of Gasdermin D. Once an inflammasome is activated, pro-inflammatory cytokines, such as interleukins, are released. Thus, inflammasomes are involved in inflammatory, autoimmune and autoinflammatory diseases. The review also investigated novel therapies based on the use of phytochemicals and pharmaceutical substances for inhibiting inflammasome activity. Pharmaceutical substances can control the inflammasomes by three mechanisms: inhibiting the intracellular signaling pathways (Allopurinol and SS-31), blocking inflammasome components (VX-765, Emricasan and VX-740), and inhibiting cytokines mediated by the inflammasomes (Canakinumab, Anakinra and Rilonacept). Moreover, phytochemicals inhibit the inflammasomes by neutralizing reactive oxygen species. Biomaterials functionalized by the adsorption of therapeutic agents onto different nanomaterials could represent future research directions to facilitate multimodal and sequential treatment in oral pathologies.

Polymer Mixtures for Experimental Self-Limited Dental Burs Development-A Preliminary Approach (Part 1).

Alternative techniques have been investigated for effectiveness in caries removal because conventional metallic dental burs can lead to an excessive loss of sound tissue. The aim of the present study is to realize a preliminary approach in obtaining effective polymer mixtures for polymeric bur development, capable of removing primary dental caries using combinations of polymers to ensure the requirements for such instruments, but also a greater compatibility with the teeth structure. This study assessed the main mechanical properties, water sorption, solubility and microscopic structure of four new polymer mixture recipes to provide essential features in obtaining experimental self-limited dental burs. Two mixtures have in their composition polymer mixtures of Bis-phenol A diglycidyl ether dimethacrylate/Triethylene glycol dimethacrylate/Urethane dimethacrylates (R1, R2), and two other mixtures have Bis-phenol A diglycidyl ether dimethacrylate/Polymethyl methacrylate/Methyl methacrylates (R3, R4). The incorporation of nanoparticles into the polymer matrix has become essential due to the need of polymer biocompatibility increasing along with teeth surface remineralization, so that the powder charge was added to four recipes, such as 5% glass with BaF2 and 0.5% graphene with silver particles. All data sets were analyzed using the One-Way ANOVA test. R3, R4 showed higher compressive strength and diametrical compression values; these values increased when glass and graphene were added. Moreover, the addition of glass particles lead to an increase in flexural strength. Regarding the sorption, sample R3 had the most significant differences between day 69 and the rest of the investigation days, while the solubility varied at different intervals. From the mechanical evaluation, we could conclude that the Bis-GMA/PMMA/MMA mixtures fit the mechanical characteristics supported by polymer burs, following future studies regarding their use on the affected dentin.

Salivary Biomarkers of Anti-Epileptic Drugs: A Narrative Review.

Saliva is a biofluid that reflects general health and that can be collected in order to evaluate and determine various pathologies and treatments. Biomarker analysis through saliva sampling is an emerging method of accurately screening and diagnosing diseases. Anti-epileptic drugs (AEDs) are prescribed generally in seizure treatment. The dose-response relationship of AEDs is influenced by numerous factors and varies from patient to patient, hence the need for the careful supervision of drug intake. The therapeutic drug monitoring (TDM) of AEDs was traditionally performed through repeated blood withdrawals. Saliva sampling in order to determine and monitor AEDs is a novel, fast, low-cost and non-invasive approach. This narrative review focuses on the characteristics of various AEDs and the possibility of determining active plasma concentrations from saliva samples. Additionally, this study aims to highlight the significant correlations between AED blood, urine and oral fluid levels and the applicability of saliva TDM for AEDs. The study also focuses on emphasizing the applicability of saliva sampling for epileptic patients.

A Local Desiccant Antimicrobial Agent as an Alternative to Adjunctive Antibiotics in the Treatment of Periodontitis: A Narrative Review.

Periodontitis is one of the most common oral polymicrobial infectious diseases induced by the complex interplay between the altered subgingival microbiota and the host's dysregulated immune-inflammatory response, leading to the initiation of progressive and irreversible destruction of the periodontal tissues and eventually to tooth loss. The main goal of cause-related periodontal therapy is to eliminate the dysbiotic subgingival biofilm in order to arrest local inflammation and further periodontal tissue breakdown. Because, in some cases, subgingival mechanical instrumentation has limited efficiency in achieving those goals, various adjunctive therapies, mainly systemic and locally delivered antimicrobials, have been proposed to augment its effectiveness. However, most adjunctive antimicrobials carry side effects; therefore, their administration should be precociously considered. HybenX® (HY) is a commercial therapeutical agent with decontamination properties, which has been studied for its effects in treating various oral pathological conditions, including periodontitis. This review covers the current evidence regarding the treatment outcomes and limitations of conventional periodontal therapies and provides information based on the available experimental and clinical studies related to the HY mechanism of action and effects following its use associated with subgingival instrumentation and other types of dental treatments.

Effect of Remineralizing Agents on Shear Bond Strength of Orthodontic Brackets-In Vitro Study.

Orthodontic treatment can be effective only with the proper adhesion strength of the bonded elements on the teeth. The aim of the study was to analyze the influence of different remineralization products on the brackets (Evolve Low Profile Brackets 0.022 Roth prescription (DB Orthodontics Ltd., Silsden, England) shear bond strength (SBS)). In all, 40 teeth were investigated for this study; n = 30 demineralized (immersed in 0.1% citric acid for 30 min, twice a day, for 20 consecutive days) and n = 10 immersed only in artificial saliva. After the demineralization process, remineralization agents were applied to each group (n = 10): Group I: Elmex Sensitive professional® toothpaste (CP, Gaba GmbH, Witten, Germany) and GC MI Paste Plus® (GC, Leuven, Belgium), Group II: Elmex Sensitive professional® toothpaste (CP, Gaba GmbH, Germany) and GC Tooth Mousse® (Leuven, Belgium), Group III: Elmex Sensitive professional® toothpaste (CP, Gaba GmbH, Germany). For the teeth in control group C, Elmex Sensitive professional® toothpaste was used. SBS tests were performed by means of an advanced materials-testing machine that generated maximum load and tensile strength values. The data obtained underwent statistical analysis (ANOVA and Tuckey test) with a statistical threshold of p < 0.05. The SBS values were higher for group II (14.20 MPa) and I (10.36 MPa) and lower for group III (4.25 MPa) and C (4.11 MPa), with statistically significant differences between groups I and II when compared with groups III and C (p < 0.05). In conclusion, GC Tooth Mousse® and MI-Paste Plus® have no adverse effect on brackets SBS and are recommended to be used for enamel remineralization during orthodontic treatment.

Oral Health-Related Knowledge, Attitude and Practice among Patients in Rural Areas around Cluj-Napoca, Romania.

The intent of the KAP (knowledge, attitude, practices) survey is to collect information about a specific target group related to their knowledge, what they consider to be known, and what they do about a particular topic. The aim of this study was to identify the level of importance of oral health, especially the level of knowledge, attitude and practices of rural patients around Cluj-Napoca, Romania. MATERIAL AND METHODS: A questionnaire consisting of five parts was used, trying to assess the self-perception of oral health, knowledge and attitude towards oral health, dental hygiene practices and eating habits. A clinical examination was also performed in order to identify the number of missing teeth, the caries and the presence of calculus. RESULTS: The study revealed that most patients have an average and good self-perception of oral health, although three-quarters of them have calculus deposits, and about half of them have more than three carious lesions and at least one extracted tooth. There is also a discrepancy between declared knowledge of oral health, eating habits and dental practices. CONCLUSIONS: The basic knowledge of rural patients about oral health can be considered satisfactory, but the practices, unfortunately, do not reflect this knowledge.

New and Recovered Temporary Anchorage Devices, In Vitro Assessment of Structural and Surface Properties.

The orthodontic miniscrew (TADs) is a device that is fixed into bone in the short term for the purpose of enhancing orthodontic anchorage. The aim of our study was to investigate the structural and surface properties of recovered TADs after orthodontic treatment, and compare them to new TADs. TADs (n = 15) from the same manufacturer (Absoanchor; Dentos, Daegu, Korea) were assessed; n = 10 were recovered from patients after orthodontic treatment and n = 5 were new. We performed electrochemical investigations, scanning electron microscopy (SEM) and microbiological analysis. Qualitative analysis on general electrochemical polarization revealed that the TADs retrieved from the patients provided much lower current densities in the passivity zone, and the oxidative processes taking place on their surface were of lower intensity. The surface morphologies of the tips of the retrieved mini-implants showed less sharp tips and smooth surfaces. Defects in the form of pores or cracks could be identified in both evaluated TAD groups. All retrieved TADs showed signs of biological materials (SEM analysis) and contamination on their surfaces. In conclusion, these results can assist orthodontists in comprehending the complexities of TAD behavior with respect to their design and structure.

Cytotoxic Effects on Gingival Mesenchymal Stromal Cells and Root Surface Modifications Induced by Some Local Antimicrobial Products Used in Periodontitis Treatment.

(1) Background: this study aims to test the cytotoxicity of three antimicrobial products used in periodontitis treatment on gingival mesenchymal stem cells (gMSCs) and their influence on root surfaces and gMSC adhesion. We tested the null hypothesis that the effects of the antimicrobials did not differ. (2) Methods: the commercial products based on sulphonic/sulphuric acids, sodium hypochlorite and silver nanoparticles, in five different concentrations, were added to culture medium for growing gMSCs. Cell proliferation capacity was tested using the Cell Counting Kit-8 (CCK8) and their viability was determined by succinate dehydrogenase activity (MTT) assay. Scanning electron microscopy evaluated the adhesion of gMSCs on root samples treated mechanically and with commercial products. (3) Results: the products induced a dose-dependent cytotoxicity in terms of reduced proliferation and viability of gMSCs, as well as cell shape modifications. Significant differences in CCK8 values between the different commercial products were observed. Based on proliferation tests, the null hypothesis was rejected. When MTT values of the three products were compared with each other, no significant differences were observed for any of the five concentrations (p = 0.065, p = 0.067, p = 0.172, p = 0.256, p = 0.060). (4) Conclusions: the three antimicrobials had a certain degree of cytotoxicity on gMSCs. gMSCs repopulated treated root surfaces.

Surface Characteristics, Fluoride Release and Bond Strength Evaluation of Four Orthodontic Adhesives.

Orthodontic adhesives have similar properties in terms of fluoride release, roughness, shear bond strength or cement debris for specific clinical conditions. Three commercial consecrated orthodontic adhesives (Opal Seal®, Blugloo®, Light Bond®) were compared with an experimental orthodontic material (C1). Brackets were bonded to enamel using a self-etch technique followed by adhesive application and then de-bonded 60 days later. Share bond strength evaluation, scanning electron microscopy, atomic force microscopy and fluoride release analysis were performed. The highest amount of daily and cumulative fluoride release was obtained for the experimental material, while the lowest value was observed for Opal Seal®. The materials evaluated in the current study presented adequate shear bond strength, with the experimental material having a mean value higher than Opal Seal and Blugloo. The atomic force microscopy measurements indicated that the smoothest initial sample is Opal Seal® followed by Light Bond®. Scanning electron microscopy evaluation indicated different aspects of cement debris on the enamel and/or bracket surface, according to the type of adhesive. The experimental material C1 presented adequate properties in terms of shear bond strength, fluoride release, roughness and enamel characteristics after de-bonding, compared to the commercial materials. Under these circumstances, it can be considered for clinical testing.

Dental Sealant Composition-Retention Assessment in Young Permanent Molars.

Tooth decay in children and adolescents remains a public health problem, despite prophylaxis and preventive measures being largely available. The aim of our study was to evaluate the clinical behavior of four dental sealants, related to first permanent molar topography and patient age (when sealant was applied for the first time). We assessed, by means of visual inspection and palpation with a dental probe, a group of 200 children, enrolled corresponding to school age-grade (mean age of 7 years at baseline) and randomly divided according to the material used as dental sealant (Admira seal©, Embrace Wet Bond©, Fotoseal©, GC Fuji Triaje©) in 4 groups (n = 50). Sealant clinical evaluation was made at 6-, 12-, 18-month intervals for dental material retention assessment. At 6 months, the sealant detached the most from 3.6 molars, and the material used was Fotoseal© (27.6%). At 12 months, Fotoseal© (48.3%) and GC Fuji Triaje© (41.4%) from 3.6 molars express detachment. At 18 months, 4.6. molars sealed with Admira Seal© (25.7%) and Embrace Wet Bond© (28.6%) lost the sealant. We noticed less detachment in maxillary molars and if sealant was applied around 7 years of age. In conclusion, sealant application on first permanent molars must be encouraged and practitioners can choose between various materials available.

Toothpaste Composition Effect on Enamel Chromatic and Morphological Characteristics: In Vitro Analysis.

The aim of this in vitro study was to assess the effect of toothpastes, with different compositions, on optical and morphological features of sound and demineralized enamel. We selected twenty-five teeth, recently extracted for orthodontic purposes, for this in vitro study. The teeth were caries free, without stains, fissures, filling or hypoplasia observed at inspection under standard conditions. Teeth were brushed (for 2-3 min, twice a day, for 21 days), with five different toothpastes (four commercially available and an experimental one) containing fluoride and hydroxyapatite. After that, teeth were demineralized with 37% orthophosforic acid (Ultra Etch®, Ultradent Products Inc., South Jordan, UT, USA) for 60 s. We repeated the brushing protocol for another 21 days on demineralized enamel. Enamel vestibular surfaces were examined using a spectrophotometer (Vita EasyShade -Vita Zahnfabrik, Bad Sackingen, Germany) and a Scanning Electron Microscope (Inspect S®, FEI Company, Hillsboro, OR, USA). Differences were statistically significant for colour parameters L* and ΔE*. SEM evaluation reveals demineralized enamel mineral gain after brushing with selected toothpastes. Toothpastes with specific ingredients can represent a balance between aesthetic and mineralization, and an oral hygiene correct algorithm is able to preserve enamel characteristics during ortodontic treatement with fixed appliances.

Pit and fissure sealants penetration capacity and their correlation with fissure morphology.

BACKGROUND AND AIMS: Pit and fissure sealant placement corresponds to an effective approach of the prevention of caries on occlusal surfaces. Fissure morphology and dental material characteristics are the key factors for sealant effectiveness. The aim of this in vitro study was to compare the penetration ability of two commercially available pit and fissure sealants. METHODS: Twenty sound human premolars extracted for orthodontic purpose have been sealed according to manufacturer's instructions as follows: Group I (n=10), light-cured unfilled resin-based sealant, Admira Seal® (Voco GmbH); Group II (n=10), resin modified glass ionomer sealant without varnish, GC Fuji Triage® (GC Corporation). The teeth have been sectioned buccal-lingually in the middle of the occlusal surface, and the sections were examined at 40× with an inverted microscope. RESULTS: Penetration of the sealants was found to be greater in U-type fissure pattern (91.69%) followed by V-type (75.42%), IK-type (71.24%) and then in I-type (63.98%). The depth of penetration of GC Fuji Triage® (82.85%) demonstrated to be superior to Admira Seal® (76.28%). CONCLUSION: U fissure design was more common than other fissure patterns and showed significantly higher penetration for the two type of sealants evaluated. Resin modified glass ionomer sealant used in the present study perform comparably with the filled resin sealant.

Proximity of the roots of posterior teeth to the maxillary sinus in different facial biotypes.

INTRODUCTION: Orthodontists consider facial growth pattern and oral function when developing a treatment plan. Less attention is given to the relationship between the maxillary posterior teeth and the maxillary sinus. We aimed to evaluate the relationship between the roots of the maxillary posterior teeth and the floor of the maxillary sinus. METHODS: Proximity of the roots to the maxillary sinus was scored for the left and right first and second premolars and molars (scores, 0-3). Mean scores per patient and per tooth type were calculated. The influences of age, sex, and facial biotype on mean scores per patient and tooth were analyzed. RESULTS: The mean scores per patient and the second molar scores were significantly lower in the normodivergent subjects compared with the hypodivergent subjects, and in the hypodivergent vs the hyperdivergent groups, indicating that the hypodivergent biotype had significantly fewer second molar roots into the sinus than the normodivergent and hyperdivergent biotypes. Age had no effect on mean score per patient, but in the hyperdivergent group, the second molar score increased with age, meaning that second molar roots tend to be closer to the sinus floor. CONCLUSIONS: In a young population (7-24 years), the positions of the apices of the maxillary second molar roots in relation to the maxillary sinus floor are associated with the facial biotype. In a hypodivergent biotype, the roots of the second molars are located farther from the sinus floor compared with the normodivergent and hyperdivergent facial patterns.

Psycho-social impact of orthodontic treatment in Romanian teenagers and young adults.

BACKGROUND AND AIMS: This survey evaluated the psycho-social impact of oral health on the quality of life in Romanian teenage and young adult orthodontic patients. METHODS: Of the 300 standard questionnaires distributed in four dental offices, 125 questionnaires were returned. Each questionnaire contained 110 items, focusing on aspects like patients' satisfaction, self-confidence, school/work performances and aesthetic concern, in relation to oral health. The patients were 16-25 years of age and all were undergoing or had undergone orthodontic treatment in the previous two years. Data analysis was performed using the Statistical Package for the Social Science software (SPSS), version 19.0. RESULTS: 57.90% of the orthodontic patients participating in this study were happy about their dental status, 56.52% declared themselves not shy because of their oral health issues, 52.33% considered themselves as attractive to other people, and 57.29% replied (awarding a score between 8 and 10) that they were confident when smiling. Regarding self-confidence and school/work performances, 58% of the participants declared they avoided speaking in public because of the aspect of their teeth and 47.42% considered that their school/work performances during the fix appliance therapy stayed the same as before appliance. Nevertheless, the self-perceived facial aspect improved during orthodontic treatment (64.74% of replies had scores between 8 and 10 during the treatment versus 24.67% before the treatment). Several correlations were found between aspects such as psycho-social and functional variables, physical self-evaluation, and oral health issues. CONCLUSION: Patients' satisfaction was improved during and after appliance therapy, for more than half of the participants. Self-confidence was low in relation to school/work performances; almost half of the patients reported stagnation in their school/work performances during the fix appliance therapy. However, more than 64% of the patients participating in this study were quite satisfied about their facial aspect during and after the orthodontic treatment. Thus, the common concerns of the patients anxious about their aspect during appliance therapy are not supported by the findings of this study.

Development of a novel biomaterial with an important osteoinductive capacity for hard tissue engineering.

In this study we designed a composite biomaterial based on a high viscosity soft propolis extract (70% propolis) and shell clam, with antiseptic and osteoinductive qualities, that can be used in dentistry, orthopedics and other areas where hard tissue regeneration is needed. We assessed it in interaction with stabilized human cells isolated from dental papilla of wisdom teeth (D1MSCs). We performed detailed characterization of the obtained material by Scanning Electronic Microscopy (SEM), X-Ray Diffraction (XRD), Energy Dispersive X-Ray Spectroscopy (EDX), Fourier Transform Infrared Spectroscopy (FTIR) techniques. SEM investigation revealed the roughness and porosity of the shell, which acted like a scaffold, as it allowed cells to penetrate the pores, proliferate on the surface, spread and grow in the depressions provided by the substrate. in vitro cell viability, proliferation and differentiation assays showed that the newly obtain biomaterial presented low toxicity on D1MSCs and determined the development of numerous osteogenic nodules that were in a higher number even than in the specific induction medium. Our results demonstrated that the shell-propolis based biomaterial promoted and sustained human stem cells attachment, proliferation and differentiation, presenting an important osteoinductive effect essential for mineralized tissue reparation process.

Modern management of dental decay in children and adolescents - a review.

Health is a right that requires responsible individual actions. Oral health corresponds to an important part of general health, even if for a large majority of people healthy teeth are equal with beautiful teeth. For children and adolescents "having an attractive smile" is synonymous with social acceptance and success. Dental decay has a high incidence in children in our country and progress in decay prevention, diagnosis and treatment is not reflected in children and adolescents' oral health. It is established by studies conducted by dentists and psychologists that dental decay can affect the quality of life by engendering specific eating behaviors, particular ways of speech or smile and unfortunately pain. The aim of this article is to emphasize the modern approach of dental decay in line with principles of non-invasive strategies. An important element to be considered - prophylactic methods - must be included in every treatment plan, in order to control individual caries risk. The time invested in prevention during childhood represents a real benefit for the future adult's oral health. Many a dental problems can be avoided if dental decay management relies on the link between medical science and every day practice.

Deleterious oral habits in children with hearing impairment.

BACKGROUND AND AIMS: Deleterious oral habits represent a serious public health issue. The information available about this problem in children with hearing impairment is insufficient. The purpose of this study was to investigate the prevalence of deleterious oral habits among children with hearing impairment and comparing results against children without hearing impairment. METHOD: This epidemiological study was carried out in a sample size of 315 children. We used a random sampling technique that included 150 children with hearing impairment and 165 without hearing impairment. All subjects were submitted to a clinical examination. The parents/legal guardians were asked to complete a questionnaire regarding the deleterious habits of their children. RESULTS: The data collected indicated a higher prevalence of deleterious oral habits among children with hearing impairment: 53.3% as opposed to 40.6% among children without hearing impairment. There was a higher incidence of malocclusion in children with hearing impairment (79.3%) compared to children without hearing impairment (57%). CONCLUSIONS: This study highlighted the need to establish protocols for preventive orthodontic treatment at an early age, in order to reduce the deleterious oral habits and prevent malocclusion. Dental institutions/clinicians need to implement oral care programs including proper oral education aiming to promote oral health.

Waardenburg syndrome type 2: an orthodontic perspective.

Waardenburg syndrome is a rare form of neurocristopathy. It is a disorder in the development of neural crest cells, caused by an altered cellular migration during the embryonic phase. That alteration causes an association of different abnormalities such as pigmentary disturbances of the hair, iris, skin, stria vascularis of the cochlea, dystopia canthorum and sensorineural hearing loss. We report a case of a 14-year-old Romanian male, with a family history of Waardenburg syndrome (mother) and Usher syndrome (father - congenitally sensorineural hearing loss and retinal degeneration). The case particularities are: the correlation between malocclusion and Waardenburg syndrome due to hypoplastic alae nasi and also factors that produced hearing loss, which could be Waardenburg syndrome, Usher syndrome or the presence of the connexin 26 (W24X) gene mutation.