Remineralization potential of dentifrices with calcium sodium phosphosilicate and functionalized tri-calcium phosphate in the deeper incipient carious lesions: An in vitro study.

OBJECTIVES: This study evaluated the remineralization potential of calcium sodium phosphosilicate and functionalized tri-calcium phosphate (f-TCP) dentifrices in deeper incipient carious lesions (ICLs). MATERIALS AND METHODS: Artificial ICLs were created by placing premolars into demineralizing solutions. Teeth were randomly assigned into four groups: calcium sodium phosphosilicate (Group 1), f-TCP (Group 2), 1450 ppm fluoride (Group 3), and distilled water (Group 4), which were subjected to 10-day pH cycling. Mineral density (MD) was assessed using microcomputed tomography (Micro-CT), while hardness (H) and elastic modulus (EM) were assessed using nanomechanical testing. RESULTS: MD % gain was higher in Groups 1-3 than in Group 4. In addition, Groups 1 and 2 exhibited significantly higher MD % gain than Group 3. Also, Groups 1-3 showed significantly higher EM and H values than Group 4 in the outer enamel area; yet, Groups 1 and 2 displayed significantly higher EM and H values than Groups 3 and 4 in the inner enamel. CONCLUSIONS: The MD, EM, and H of ICLs significantly increased with the addition of calcium sodium phosphosilicate or f-TCP to fluoridated dentifrices compared to standard fluoride dentifrices. The added active ingredients remineralized the deeper parts of the ICLs, while remineralization at the lesion surface was similar between tested dentifrices.

Visual attention to food cues and dental caries-Are they associated?

BACKGROUND: The role of diet has a key role in dental caries. Attention to food cues can be an indicator for food choices. AIM: This study investigates children's visual attention to images with healthy and unhealthy food cues and correlates it with that of their parents and with their dental caries status using eye-tracking technology. DESIGN: A total of 30 children with and without dental caries and their 30 parents were calibrated to the eye-tracking device (Tobii Nano Pro) to ensure standardisation. Participants viewed matching images of healthy and unhealthy food cues, whereas an eye-tracking device tracked their eye movements. Children had a dental examination and were classified as children with dental caries (n = 15) and their parents (n = 15), and children without dental caries (n = 15) and their parents (n = 15). RESULTS: In children with dental caries, visual attention duration was longer to healthy foods than to unhealthy foods. Likewise, parents of children with dental caries spent longer time looking at healthy foods than unhealthy foods. CONCLUSION: Our preliminary findings indicate a significant association between children's visual attention to healthy and unhealthy food cues and their dental caries status. This underscores the need for further investigation into the correlation between children's and their parents' visual attention to food, particularly in the context of children with dental caries. Such exploration holds promise for informing targeted interventions in food choice education.

Visual interpretation of clinical images among dental students using eye-tracking technology.

BACKGROUND: Tele-consultations are increasingly used for screening and diagnosis. Only a few studies have assessed dental students' visual attention to clinical images. AIM: To (i) determine dental students' gaze behavior, visual fixations, and diagnostic competence while viewing clinical images, and (ii) explore potential opportunities to strengthen the teaching-learning approaches. DESIGN: Tobii Pro Nano-device captured the eye-tracking data for 65 dental undergraduate students in this cross-sectional study. The predetermined areas of interest (AOI) for all five clinical photographs were uploaded onto Tobii software. All participants used a think-aloud protocol with no restrictions to view time. RESULTS: A total of 325 clinical pictures were analyzed, and the average view time was 189.25 ± 76.90 s. Most participants started at the center of the image (three frontal photos), spent a significant share of their view time on prominent findings, did not follow a systematic pattern, and exhibited diagnostic incompetence. Also, most participants followed a "Z" viewing pattern (oscillating movement from left to right) for the remaining two pictures. CONCLUSIONS: Subjects frequently fixated on the prominent AOI, however, failed to make the correct diagnosis. Their view patterns revealed no sequential viewing. Therefore, emphasizing knowledge about common dental abnormalities and focusing on full coverage of clinical pictures can improve dental students' diagnostic competence and view patterns.

Silver Diamine Fluoride Staining With Potassium Iodide: A Prospective Cohort Study.

BACKGROUND: Staining after silver diamine fluoride (SDF) treatment limits treatment acceptability but is also used as a clinical indicator of lesion stability. Potassium iodide (KI) has been postulated to modify SDF staining. Understanding the natural history and resultant shade of SDF/KI-treated lesions will inform clinical decision-making. This study describes the change in colour of carious lesions in primary teeth treated with SDF and KI. METHODS: One hundred carious lesions in primary teeth were treated with SDF + KI (Riva Star, SDI) and followed up over 6 months. Lesion shade was determined using standardised intraoral photography and broadly categorised into 4 shades: yellow, light brown, dark brown, and black. Lesions were digitally isolated, and colour was evaluated using CIELAB (L*: lightness, a*/b*: hue) and perceptible colour change (ΔE). RESULTS: One hundred valid observations were analysed on 129 lesions included in the study. Lesions were excluded if subsequently restored (n = 15), teeth exfoliated (n = 2), exhibited pulpal exposure (n = 1), or failed to attend at follow-up visits (n = 11). At baseline, the shade of carious lesions was yellow (n = 22), light brown (n = 19), dark brown (n = 29), or black (n = 30). The changes in shade between baseline and 6 months were clinically perceptible to the human eye, with the mean ΔE being 12.2 (SD = 6.9). Neither tooth type, lesion severity, nor baseline shade was statistically associated with the degree of perceptible change at 6 months. CONCLUSIONS: Carious lesions exhibited clinically significant changes in colour after application of SDF + KI, primarily attributed to differences in L* of lesions over the 6 months.

Mouthwashes: Alternatives and Future Directions.

This narrative review summarises "alternative" or "natural" over-the-counter (OTC) mouthwashes not covered elsewhere in this supplement and newly emerging products, as potential mouthwashes of the future. The "natural" mouthwashes reviewed include saltwater, baking soda, coconut oil, charcoal, propolis, seaweeds, and probiotics. Other than essential oils, it is apparent that their clinical effectiveness is still under debate, but there is some evidence to suggest that propolis reduces plaque and gingivitis. This review also covers the host immune response, via novel anti-inmmunomodulant mouthwashes, such as erythropoietin to reduce inflammation with oral mucositis (OM) after radiotherapy. The emerging concept of nanoparticle-containing mouthwashes, such as iron oxide, is further discussed for OM, this agent having the potential for more targeted delivery of chemical antimicrobials. Unfortunately, there are impacts on the environment of widening mouthwash use with more new products, including increased use of packaging, antimicrobial resistance, and possible detrimental effects on marine life. Further, there are roadblocks, relating to regularly approvals and side effects, that still need to be overcome for any OTC deivered immunomodulant or nanoformulation mouthwashes. Despite these caveats, there are many new mouthwashes under development, which could help manage major oral diseases such as caries, gingivitis, and periodontal disease.

Head lice-induced anemia in a child and implications for oral health: Case report.

Pediculosis capitis, colloquially referred to as head lice, engenders adverse social and economic consequences among children. While generally not considered a health hazard, chronic and severe head lice infestations have been linked to secondary iron-deficiency anemia. This case report documents a 7-year-old girl who presented for dental treatment with a history of social isolation and poor school attendance. Upon examination, the patient was found to have head lice and scabies infestations, resulting in secondary iron-deficiency anemia. The patient could return to full-time education after successful treatment for the head lice infestation administered by the dental team. This case underscores the need for treatment guidelines to manage children with diagnosed or suspected cases of head lice from a dental perspective. In instances of severe infestation, referral to a medical professional may be necessary for further management. This report highlights the importance of a multidisciplinary approach in managing head lice infestations and its implications on dental management.

Heterozygous Variants in FREM2 Are Associated with Mesiodens, Supernumerary Teeth, Oral Exostoses, and Odontomas.

BACKGROUND: Supernumerary teeth refer to extra teeth that exceed the usual number of dentitions. A mesiodens is a particular form of supernumerary tooth, which is located in the premaxilla region. The objective of the study was to investigate the genetic etiology of extra tooth phenotypes, including mesiodens and isolated supernumerary teeth. METHODS: Oral and radiographic examinations and whole-exome sequencing were performed on every patient in our cohort of 122 patients, including 27 patients with isolated supernumerary teeth and 94 patients with mesiodens. A patient who had multiple supernumerary teeth also had odontomas. RESULTS: We identified a novel (c.8498A>G; p.Asn2833Ser) and six recurrent (c.1603C>T; p.Arg535Cys, c.5852G>A; p.Arg1951His, c.6949A>T; p.Thr2317Ser; c.1549G>A; p.Val517Met, c.1921A>G; p.Thr641Ala, and c.850G>C; p.Val284Leu) heterozygous missense variants in FREM2 in eight patients with extra tooth phenotypes. CONCLUSIONS: Biallelic variants in FREM2 are implicated in autosomal recessive Fraser syndrome with or without dental anomalies. Here, we report for the first time that heterozygous carriers of FREM2 variants have phenotypes including oral exostoses, mesiodens, and isolated supernumerary teeth.

Systematic review of clinical practice guidelines for traumatic dental injuries.

BACKGROUND/AIMS: Traumatic dental injuries (TDI) are considered a public health problem due to their high prevalence and associated physical, economic, psychological and social consequences. Hence, good Clinical Practice Guidelines are essential to achieving a favourable prognosis. The aim of this review was to appraise the existing Clinical Practice Guidelines (CPGs) on TDI using AGREE II and AGREE-REX. MATERIALS AND METHODS: A systematic search for existing guidelines on TDI was performed on PubMed, EMBASE, CINAHL, Cochrane Library, ProQuest, National Institute for Health Care Excellence, BMJ Best Practice, Trip database, Guideline International Network, Scottish Intercollegiate Guidelines Network, World Health Organisation, Web of Science and 'Ministry of Health worldwide' databases. Four appraisers independently appraised the included CPGs. The AGREE II tool was applied to assess the methodological quality, while AGREE REX assessed the quality of recommendations of the included guidelines. RESULTS: Of the 7736 titles screened, three guidelines, namely the International Association of Dental Traumatology Guidelines (IADT), and the Italian and Malaysian guidelines, were included for the final analysis. These guidelines were published between 2019 and 2020. The AGREE II analysis demonstrated scores above 80% for the IADT and Italian guidelines for the scope and purpose domain. Overall, the Malaysian guidelines achieved the highest score for all domains. The AGREE REX analysis indicated variability in implementation across the nine items, with five that scored above the midpoint of 4.0 on the response scale. Both the Italian and the IADT guidelines had a similar score for the values and preference domains (36.36%). CONCLUSIONS: Several deficiencies exist in the methodological quality of existing CPGs on TDI. Future guidelines should consider improvements for domains such as 'rigour of development', 'stakeholder involvement' and 'applicability' to overcome the existing limitations.

DKK1 is a strong candidate for mesiodens and taurodontism.

A mutation in DKK1 gene leads to inhibitory DKK1 function, over-activation of WNT/ß-catenin signaling, disruptive development of dental epithelium, and subsequent mesiodens formation.

Reporting Eye-tracking Studies In DEntistry (RESIDE) checklist.

OBJECTIVES: To (i) provide a scoping review of eye-tracking studies in dentistry, and (ii) propose a "Reporting Eye-tracking Studies in DEntistry" (RESIDE) checklist to facilitate standard reporting of eye-tracking studies. DATA: A comprehensive search of six distinct electronic databases was undertaken. SOURCES: Pubmed, OVID, Wed of Knowledge, Scopus, Cochrane and Google Scholar were used to identify studies that employed eye-tracking technology and dentistry as a subfield STUDY SELECTION: 42 studies met the inclusion criteria. Most studies exhibited several inconsistencies or failed to report on the appropriate items in the RESIDE checklist. These essential components include ethical approval, sample size calculation, location and setting, eye-tracking device attributes, participant calibration, sequence of events, and eye-tracking metrics (quantitative, qualitative and data details). CONCLUSIONS: Evaluation of the published eye-tracking studies in this scoping review provides empirical data, highlighting the inconsistencies and limitations. Importantly, it illustrates the applicability of the RESIDE Checklist, which provides a comprehensive list of reporting elements to assist authors and reviewers of eye-tracking studies in dentistry. Also, RESIDE provides a framework to overcome critical issues to ensure high-quality scientific publications. CLINICAL SIGNIFICANCE: A minimum threshold should be applied before accepting eye-tracking studies for publication in the future. RESIDE checklist promotes transparent and reproducible scientific communication about eye-tracking applications to dentistry. In addition, it provides a comprehensive list of reporting elements to assist authors and reviewers in ensuring high-quality scientific publications.

Sustainable development goals and ending ECC as a public health crisis.

Early Childhood Caries (ECC) remains a global issue despite numerous advancements in research and interventional approaches. Nearly, 530 million children suffer from untreated dental caries of primary teeth. The consequences of such untreated dental caries not only limit the child's chewing and eating abilities but also, significantly impact the child's overall growth. Research has demonstrated that ECC is associated with nearly 123 risk factors. ECC has also been associated with local pain, infections, abscesses, and sleep pattern. Furthermore, it can affect the child's emotional status and decrease their ability to learn or perform their usual activities. In high-income countries, dental care continues to endorse a "current treatment-based approach" that involves high-technology, interventionist, and specialized approaches. While such approaches provide immediate benefit at an individual level, it fails to intercept the underlying causes of the disease at large. In low-income and middle-income countries (LMICs), the "current treatment approach" often remains limited, unaffordable, and unsuitable for the majority of the population. Rather, dentistry needs to focus on "sustainable goals" and integrate dental care with the mainstream healthcare system and primary care services. Dental care systems should promote "early first dental visits," when the child is 1 year of age or when the first tooth arrives. The serious shortages of appropriately trained oral healthcare personnel in certain regions of the world, lack of appropriate technologies and isolation of oral health services from the health system, and limited adoption of prevention and oral health promotion can pose as critical barriers. The oral health care systems must focus on three major keystones to combat the burden of ECC-1. Essential oral health services are integrated into healthcare in every country ensuring the availability of appropriate healthcare accessible and available globally, 2. Integrating oral and general healthcare to effectively prevent and manage oral disease and improve oral health, 3. Collaborating with a wide range of health workers to deliver sustainable oral health care tailored to cater to the oral health care needs of local communities.

Eye movement analysis of children's attention for midline diastema.

No previous studies have investigated eye-movement patterns to show children's information processing while viewing clinical images. Therefore, this study aimed to explore children and their educators' perception of a midline diastema by applying eye-movement analysis using the hidden Markov models (EMHMM). A total of 155 children between 2.5 and 5.5 years of age and their educators (n = 34) viewed pictures with and without a midline diastema while Tobii Pro Nano eye-tracker followed their eye movements. Fixation data were analysed using data-driven, and fixed regions of interest (ROIs) approaches with EMHMM. Two different eye-movement patterns were identified: explorative pattern (76%), where the children's ROIs were predominantly around the nose and mouth, and focused pattern (26%), where children's ROIs were precise, locating on the teeth with and without a diastema, and fixations transited among the ROIs with similar frequencies. Females had a significantly higher eye-movement preference for without diastema image than males. Comparisons between the different age groups showed a statistically significant difference for overall entropies. The 3.6-4.5y age groups exhibited higher entropies, indicating lower eye-movement consistency. In addition, children and their educators exhibited two specific eye-movement patterns. Children in the explorative pattern saw the midline diastema more often while their educators focussed on the image without diastema. Thus, EMHMMs are valuable in analysing eye-movement patterns in children and adults.

Understanding children's attention to traumatic dental injuries using eye-tracking.

BACKGROUND/AIM: Traumatic dental injuries (TDIs) in the primary dentition may result in tooth discolouration and fractures. The aim of this child-centred study was to explore the differences between preschool children's eye movement patterns and visual attention to typical outcomes following TDIs to primary teeth. MATERIALS AND METHODS: An eye-tracker recorded 155 healthy preschool children's eye movements when they viewed clinical images of healthy teeth, tooth fractures and discolourations. The visual search pattern was analysed using the eye movement analysis with the Hidden Markov Models (EMHMM) approach and preference for the various regions of interest (ROIs). RESULTS: Two different eye movement patterns (distributed and selective) were identified (p < .05). Children with the distributed pattern shifted their fixations between the presented images, while those with the selective pattern remained focused on the same image they first saw. CONCLUSIONS: Preschool children noticed teeth. However, most of them did not have an attentional bias, implying that they did not interpret these TDI outcomes negatively. Only a few children avoided looking at images with TDIs indicating a potential negative impact. The EMHMM approach is appropriate for assessing inter-individual differences in children's visual attention to TDI outcomes.

Understanding Children's Attention to Dental Caries through Eye-Tracking.

Visual attention is a significant gateway to a child's mind, and looking is one of the first behaviors young children develop. Untreated caries and the resulting poor dental aesthetics can have adverse emotional and social impacts on children's oral health-related quality of life due to its detrimental effects on self-esteem and self-concept. Therefore, we explored preschool children's eye movement patterns and visual attention to images with and without dental caries via eye movement analysis using hidden Markov models (EMHMM). We calibrated a convenience sample of 157 preschool children to the eye-tracker (Tobii Nano Pro) to ensure standardization. Consequently, each participant viewed the same standardized pictures with and without dental caries while an eye-tracking device tracked their eye movements. Subsequently, based on the sequence of viewed regions of interest (ROIs), a transition matrix was developed where the participants' previously viewed ROI informed their subsequently considered ROI. Hence, an individual's HMM was estimated from their eye movement data using a variational Bayesian approach to determine the optimal number of ROIs automatically. Consequently, this data-driven approach generated the visual task participants' most representative eye movement patterns. Preschool children exhibited two different eye movement patterns, distributed (78%) and selective (21%), which was statistically significant. Children switched between images with more similar probabilities in the distributed pattern while children remained looking at the same ROI than switching to the other ROI in the selective pattern. Nevertheless, all children exhibited an equal starting fixation on the right or left image and noticed teeth. The study findings reveal that most preschool children did not have an attentional bias to images with and without dental caries. Furthermore, only a few children selectively fixated on images with dental caries. Therefore, selective eye-movement patterns may strongly predict preschool children's sustained visual attention to dental caries. Nevertheless, future studies are essential to fully understand the developmental origins of differences in visual attention to common oral health presentations in children. Finally, EMHMM is appropriate for assessing inter-individual differences in children's visual attention.

Visual interpretation of panoramic radiographs in dental students using eye-tracking technology.

PURPOSE: While eye-tracking technology is a validated tool in the field of education it is still in its infancy in the field of Pediatric Dentistry. The primary aim of this study was to determine dental undergraduates' search patterns and visual fixations while viewing panoramic radiographs (PR) using an eye-tracker. The secondary aim was to decide on the potential opportunities to enhance teaching-learning strategies when studying these radiographs. METHODS: Sixty-five dental undergraduates in the final year of their dental education consented to and participated in this study. A Tobii Pro Nano screen-based eye-tracking camera was mounted to the lower edge of a laptop with five different PR uploaded onto the Tobii Studio software. Regions of Interest (ROIs) were pre-determined for the five PR. The participants (17 males and 48 females) viewed all the PR images with no time restrictions and a "think-aloud" protocol was exercised. RESULTS: The average view time for the PR was 245.58 ± 106.7 s. Participants spent significantly less time examining the surrounding structures (14.85 s) than the dentitions (primary: 97.58 s and permanent: 37.58 s). Males demonstrated a slightly higher view time (290.88 ± 97.7 s) than females (229.53 ± 106.05 s). CONCLUSIONS: The results revealed that though the participants focused on the ROI, most of them failed to make the correct diagnosis. In addition, the search patterns of the participants unveiled no sequential viewing of PR. Hence the need to revise the teaching-learning strategies for the systematic interpretation of PR images in the dental curriculum is warranted.

Role of Marginal Ridge Shape and Contact Extent in Proximal Caries Between Primary Molars.

OBJECTIVES: To determine different combinations of marginal ridge shape (MRS) and contact extents in nature of the contact between primary molars and its correlation with the presence of carious lesions on radiographic examination of approximal surfaces. STUDY DESIGN: Retrospective study of 347 clinical records, including photographs and bitewing radiographs, were assessed for intact MRS and caries extent. The carious lesions were scored (0-5, Mejàre scoring system) radiographically and correlated to the intact MRS on clinical photographs, and strength of associations quantified using logistic regression analysis and chi-square tests. RESULTS: Primary molars, 848(contact extent), and 757(MRS) were analyzed. Combination of straight-convex(35.4%) MRS was more common (p<0.001). None of the approximal surfaces were caries-free for straight and straight MRS with 36.4% of both approximal surfaces exhibiting caries in enamel, and 38.2% of one approximal surface exhibiting caries in dentin. Approximately 90% of the primary molars with substantial contacts exhibited carious lesions in the enamel and 80% with light contacts exhibited carious lesions in the dentin (p<0.001). CONCLUSION: Six different combinations of intact MRS were identified. Combination of concave-convex shapes exhibited caries extending into dentin. Substantial and/or light contacts between primary molars showed higher caries experience in the approximal surfaces.

Presence of Interproximal Carious Lesions in Primary Molars.

Purpose: The purposes of this study were to determine the presence of interproximal carious lesions in the primary molars and assess the risk to adjacent and contralateral surfaces when caries is detected in one quadrant. Methods: Clinical records of high caries-risk children, including bitewing radiographs, were assessed for interproximal caries and the extent of marginal ridge breakdown. The carious lesions were scored radiographically by two calibrated examiners with excellent inter- and intraexaminer reliability. Correlations for the presence of adjacent surface caries and caries in another quadrant were determined by employing the strength of the associations, as quantified using chi-square analysis. Results: A total of 1,290 pairs of primary molars (A and B, I and J, K and L, S and T) were included. Only eight percent of interproximal surfaces were caries-free. Approximately 70 percent of the adjacent surfaces (A and B, I and J, K and L, and S and T) exhibited carious lesions in the enamel when there was enamel caries in one quadrant. Furthermore, 90 percent of the adjacent surfaces exhibited caries in the dentin if one adjacent interproximal surface exhibited dentinal caries. Conclusions: In high caries-risk children, only a small proportion of surfaces remain caries-free, and the adjacent surface caries prevalence remains high at 70 percent to 80 percent. The presence of interproximal caries in one quadrant is a good indicator of caries in the other quadrants, as is the marginal ridge breakdown which indicates the proximity to the pulp.

Assessment of medical practitioners' knowledge about paediatric oral diagnosis and gaze patterns using eye tracking technology.

BACKGROUND: Most studies regarding the oral health knowledge of medical practitioners are based on surveys. AIM: To assess medical practitioners' knowledge in diagnosing and managing children oral health issues using eye tracking technology. DESIGN: Forty-one medical practitioners completed a cross-sectional survey questionnaire and subsequently viewed 5 clinical images of children's oral cavities to indicate the issues observed and their management. Tobii eye tracking device captured each participant's visual search behaviours and mean length of fixation (LOF) for each area of interest (AOI). Participant self-reported confidence in examining the oral cavity, and qualification level was recorded for data analysis. RESULTS: No correlation between time spent viewing the soft tissues and self-reported confidence examining the oral cavity was observed (P = .25). Self-reported confidence in examining the oral cavity was not associated with a correct diagnosis. LOF on the decayed teeth was significantly associated with a correct diagnosis of 'caries' (P < .05), and paediatric training was associated with a correct diagnosis of dental caries (P < .05). CONCLUSION: Medical practitioners' diagnosis and management were poorly correlated with their objective visual search behaviours of the intraoral images. Self-reported confidence in examining and managing oral issues was not correlated with a correct diagnosis, with the majority not confident of examining children oral cavity.

Oral Health Policies to Tackle the Burden of Early Childhood Caries: A Review of 14 Countries/Regions.

Aim: Early childhood caries (ECC) has significant public health implications but has received inadequate global attention. There is limited information regarding the success of oral health policies implemented to address the challenges of ECC. This review aimed to summarize such policies to tackle ECC from different countries/regions. Method: Independent collaborators from 14 countries/regions (Australia, Brazil, Cambodia, China, Hong Kong, Egypt, India, Indonesia, Japan, Nigeria, Thailand, UK, USA, and Venezuela) collected the data. The ECC status, dental workforce, oral health policies on ECC prevention in different countries/regions were summarized by each country. Results: The findings indicated that ECC prevalence varied in different countries/regions. The lowest prevalence of ECC among 5-year-old children was found in Nigeria (7%), and the highest was found in Indonesia (90%). The existing dental workforce and resources are limited in most countries. The smallest dentist to population ratio was reported by Nigeria at 1:48,400, whereas the highest ratio was in Brazil (1:600). Out of 14, three (21%) countries namely India, Venezuela and Cambodia had no national oral health policies addressing ECC and four (29%) countries (Cambodia, China, India, Venezuela) had no publicly funded dental care program for 0-5-year-old children. Water fluoridation is available in four countries/regions (Australia, Brazil, Hong Kong, USA). Conclusion: ECC remains a global health challenge and dental workforce is limited. National/regional programs to tackle ECC are not yet prioritized in many countries/regions. Evidence to support demonstration projects is limited. Further research on the cost-effectiveness of interventions strategies is required for policymakers.

Dentigerous cyst formation following trauma to the primary incisors: A case report.

Although usually considered to be of developmental origin, dentigerous cysts (DCs) have been reported to form in response to chronic periapical inflammation associated with primary teeth that have necrotic, infected pulps. This article describes the management of a DC associated with tooth 21 in a seven-year-old Caucasian child with a history of multiple TDIs to the primary maxillary incisors. Chronic periapical inflammation associated with a necrotic pulp in tooth 61 was identified as the likely cause of the lesion. Initial conservative management involved marsupialization of the lesion by extracting the necrotic tooth 61. Following significant decompression of the cyst, surgical enucleation was carried out under general anaesthesia and an orthodontic attachment was bonded to the crown of the unerupted tooth 21 to facilitate traction. Histopathological assessment of the enucleated tissue confirmed it to be a DC. Two years after the initial presentation, teeth 21 and 22 had erupted into the oral cavity, improving patient aesthetics. However, the root of tooth 22 was transposed with the crown of the unerupted tooth 23. This case highlights the undesirable sequelae that may occur following delayed and inappropriate management of TDIs.