ORIENTATE: automated machine learning classifiers for oral health prediction and research.

BACKGROUND: The application of data-driven methods is expected to play an increasingly important role in healthcare. However, a lack of personnel with the necessary skills to develop these models and interpret its output is preventing a wider adoption of these methods. To address this gap, we introduce and describe ORIENTATE, a software for automated application of machine learning classification algorithms by clinical practitioners lacking specific technical skills. ORIENTATE allows the selection of features and the target variable, then automatically generates a number of classification models and cross-validates them, finding the best model and evaluating it. It also implements a custom feature selection algorithm for systematic searches of the best combination of predictors for a given target variable. Finally, it outputs a comprehensive report with graphs that facilitates the explanation of the classification model results, using global interpretation methods, and an interface for the prediction of new input samples. Feature relevance and interaction plots provided by ORIENTATE allow to use it for statistical inference, which can replace and/or complement classical statistical studies. RESULTS: Its application to a dataset with healthy and special health care needs (SHCN) children, treated under deep sedation, was discussed as case study. On the example dataset, despite its small size, the feature selection algorithm found a set of features able to predict the need for a second sedation with a f1 score of 0.83 and a ROC (AUC) of 0.92. Eight predictive factors for both populations were found and ordered by the relevance assigned to them by the model. A discussion of how to derive inferences from the relevance and interaction plots and a comparison with a classical study is also provided. CONCLUSIONS: ORIENTATE automatically finds suitable features and generates accurate classifiers which can be used in preventive tasks. In addition, researchers without specific skills on data methods can use it for the application of machine learning classification and as a complement to classical studies for inferential analysis of features. In the case study, a high prediction accuracy for a second sedation in SHCN children was achieved. The analysis of the relevance of the features showed that the number of teeth with pulpar treatments at the first sedation is a predictive factor for a second sedation.

Orthodontic and dentofacial orthopedic treatments in patients with ectodermal dysplasia: a systematic review.

OBJECTIVE: The objective of this systematic review was to determine the orthodontic and dentofacial orthopedic treatments carried out in patients with ectodermal dysplasia to facilitate functional and aesthetic rehabilitation. METHODS: The systematic review was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-analysis statement. We systematically searched PubMed, Web of Science, Scopus, Scielo, LILACS, EBSCOhost and Embase databases up to 6 January 2022. We included articles describing patients with any type of ectodermal dysplasia who received orthodontic or dentofacial orthopedic treatment to facilitate functional and aesthetic oral rehabilitation. The search was not restricted by language or year of publication. The quality of the studies was assessed using the Joanna Briggs Institute Quality Assessment Scale of the University of Adelaide for case series and case reports. The review was registered at the University of York Centre for reviews (CRD42021288030). RESULTS: Of the initial 403 studies found, 29 met the inclusion criteria. After applying the quality scale, 23 were left for review-21 case reports and 2 case series. The initial age of patients ranged from 34 months to 24 years. Thirteen studies were on hypohidrotic and/or anhidrotic ectodermal dysplasia, of which two were X-chromosome linked. In one study, the patient had Wiktop syndrome, and in nine the type of ectodermal dysplasia was not specified. The duration of treatment was 7 weeks to 10 years. The treatments described were: fixed orthodontic appliances or simple acrylic plates designed for tooth movement, including leveling and aligning, closing of diastemata, retraction of impacted teeth in the dental arch; clear aligners; fixed and/or removable appliances for the correction of skeletal and/or dentoalveolar relationships; palatal expanders in combination with face masks for orthopedic traction of the maxilla; and orthognathic surgery. Only three studies provided cephalometric data. CONCLUSION: The level of evidence of the articles reviewed was low and most orthopedic and dentofacial orthodontic treatments described were focused on correcting dental malpositioning and jaw asymmetries and not on stimulating growth from an early age. Studies with greater scientific evidence are needed to determine the best treatment for these patients.

Developmental Dental Defects in Permanent Teeth Resulting from Trauma in Primary Dentition: A Systematic Review.

The objective was to determine whether trauma in primary dentition causes alterations in the development of permanent dentition. Searches were made in May 2020 using PubMed, MEDLINE, MEDES, Scopus, Lilacs, and Embase. Papers in English, German, and Spanish, without restrictions in the year of publication, were included. The quality of the studies was analyzed using the NOS Scale. The search retrieved 537 references, and seven studies were included for a qualitative analysis. The results showed that trauma to a deciduous tooth can damage the bud of the permanent tooth. Enamel discoloration and/or hypoplasia were the most common sequelae in the permanent teeth after trauma to the primary predecessor. The type and severity of sequelae in the permanent tooth are associated with the development phase of the bud. Children with trauma of their primary teeth should receive checkups until the eruption of the permanent teeth for the early diagnosis and treatment of possible sequelae. Intrusion of the primary tooth was the trauma that caused the most damage and enamel alterations the most frequent sequelae.

Apical approach in periodontal reconstructive surgery with enamel matrix derivate and enamel matrix derivate plus bone substitutes: a randomized, controlled clinical trial.

OBJECTIVES: This parallel, randomized controlled clinical trial evaluated the influence of bone substitutes (BS) on the efficacy of the non-incised papillae surgical approach (NIPSA) with enamel matrix derivate (EMD) in resolving deep, isolated, combined non-contained intrabony and supra-alveolar periodontal defects, preserving the soft tissue. MATERIAL AND METHODS: Twenty-four patients were randomized to treatment with NIPSA and EMD or NIPSA plus EMD and BS. Bleeding on probing (BoP), interproximal clinical attachment level (CAL), interproximal probing depth (PD), recession (REC), location of the tip of the papilla (TP), and width of the keratinized tissue (KT) were evaluated before surgery and at 1 year post-surgery (primary outcomes). Wound closure was assessed at 1 week post-surgery, and supra-alveolar attachment gain (SUPRA-AG) was recorded at 1 year post-surgery. RESULTS: At 1 week, 87.5% of cases registered complete wound closure and there were no cases of necrosis, without differences between groups (p > .05). At 1 year, all cases showed negative BoP. A significant PD reduction (NIPSA + EMD 8.25 ± 2.70 mm vs. NIPSA + EMD + BS 6.83 ± 0.81 mm) and CAL gain (NIPSA + EMD 8.33 ± 2.74 mm vs. NIPSA + EMD + BS 7.08 ± 2.68 mm) were observed (p < .001) in both groups, without significant between-group differences (p > .05). The residual PD was < 5 mm in all defects (NIPSA + EMD 2.50 ± 0.67 mm vs. NIPSA + EMD + BS 2.67 ± 0.78 mm). Soft tissues were preserved without significant between-group differences (REC: NIPSA + EMD 0.25 ± 0.45 mm vs. NIPSA + EMD + BS 0.17 ± 0.58 mm, p > .05; KT: 0.00 ± 0.43 mm vs. 0.08 ± 0.67 mm, p > .05). There were improvements in the papilla in both groups (TP: NIPSA + EMD 0.33 ± 0.49 mm vs. NIPSA + EMD + BS 0.45 ± 0.52 mm, p > .05), which was only significant in the NIPSA EMD + BS group (0.45 ± 0.52 mm; p < .05). In both groups, CAL gain was recorded in the supra-alveolar component, showing full resolution of the intrabony component of the defect in all cases (SUPRA-AG: NIPSA + EMD 1.83 ± 1.11 mm vs. NIPSA + EMD + BS 2.00 ± 1.76 mm, p > .05). CONCLUSIONS: NIPSA and EMD with or without BS seem to be a valid surgical approach in the treatment of isolated, deep non-contained periodontal defects. In our study, both treatments resulted in significant PD reduction and CAL gain, that extended in the supra-alveolar component, without differences with the use of BS. Both treatments resulted in soft tissue preservation. However, the addition of BS may improve interdental papillary tissue. CLINICAL RELEVANCE: NIPSA, with or without bone substitutes, resulted in significant periodontal improvement, with soft tissue preservation in isolated, deep non-contained periodontal defects. The application of bone substitutes may provide interproximal soft tissue gain. CLINICAL TRIAL REGISTRATION: Clinicaltrials.gov: NCT04712630.

Effects of Fluoride and Calcium Phosphate-Based Varnishes in Children at High Risk of Tooth Decay: A Randomized Clinical Trial.

BACKGROUND: The aim of this study was to investigate the effect of the application of two varnishes-MI Varnish (5% sodium fluoride with CPP-ACP) and Clinpro White Varnish (5% sodium fluoride with fTCP)-applied every three months in children with high caries risk for 12 months on plaque indexes, salivary pH, salivary lactic acid and chemical elements concentrations. METHODS: We included 58 children aged 4-12 years, assigned to control (placebo), Clinpro and MI groups. Baseline and three-month saliva samples were taken. We assessed changes in pH, lactic acid concentrations and chemical elements in saliva. RESULTS: At 12 months, all groups showed a nonsignificant increase in pH levels and a reduction in lactic acid, which was greatest in the placebo group. There was a significant reduction in 24Mg (p = <0.001), 31P (p = 0.033) and 66Zn (p = 0.005) levels in the placebo group (p ≤ 0.05), but not in the other elements studied: 23Na, 27Al, 39K, 44Ca, 52Cr, 55Mn, 57Fe, 59Co, 63Cu, 75As, 111Cd, 137Ba, 208Pb and 19F. CONCLUSIONS: Neither pH, lactic acid concentrations or most salivary chemical elements were useful in defining patients at high risk of caries or in monitoring the effect of MI Varnish and Clinpro White Varnish after three-month application for 12 months. However, the appearance of new cavities was stopped, and the hygiene index improved, probably due to hygienic and dietary measures and the use of fluoridated toothpaste. TRIAL REGISTRATION: ISRCTN registry, ISRCTN13681286.

Immediate implant placement in fresh alveolar sockets with a minimal split-thickness envelope flap: A randomised controlled clinical trial.

OBJECTIVES: Comparing PES/WES scores, modified success rate, survival, success, buccal bone thickness and patient-reported outcomes of immediate dental implants placed in fresh alveolar sockets using a flap or a minimal split-thickness envelope flap (MSTEF). MATERIALS AND METHODS: Implants following random assignment into a flap or MSTEF group were placed immediately in anterior and premolar areas. Guided bone regeneration and autogenous connective tissue graft were used in all cases. A temporary prosthesis was provided followed by the final prosthesis at 16-18 weeks. Success and survival rates together with radiographic buccal bone thickness and patient satisfaction were evaluated at 12-month post-loading. The aesthetic outcome was evaluated through the Pink (PES) and White (WES) Aesthetic Score by 8 blind clinicians of different training background and incorporated in modified success criteria. RESULTS: 28 implants were placed on 28 patients. No statistically significant differences were noted in PES (10.54 control versus 10.80 test), WES scores (6.97 control versus 6.95 test) or success criteria including aesthetic parameters (modified success criteria) for the different specialty groups (Range 69%-92%). In addition, no statistically significant differences were noted in survival (100%), success (100%), buccal wall thickness between control (0.72 ± 0.22) and test group (0.92 ± 0.31) and patients' reported outcomes. CONCLUSIONS: Immediate dental implant treatment with flap/ MSTEF provided similar mean PES/WES scores, modified success rate, survival, mean buccal bone levels and patients' satisfaction. However, aesthetic failures were common in both groups.

Short Dental Implants (≤8.5 mm) versus Standard Dental Implants (≥10 mm): A One-Year Post-Loading Prospective Observational Study.

BACKGROUND: Recent data have shown that short dental implants can be the preferred treatment in most of cases of posterior atrophic alveolar ridges, offering higher survival and lower complication rates than long implants. The survival rates, stability, and marginal bone level changes were compared between short implants (7 and 8.5 mm) and standard-length implants (≥10 mm). METHODS: Prospective observational study in which adult patients requiring ≥1 osseointegrated implants to replace missing teeth were recruited consecutively. A clinical examination was performed on the day the definitive prosthesis was placed and after 6 and 12 months. Implant stability quotient (ISQ), marginal bone level (MBL) changes, and the correlation between these parameters and the characteristics of the implants were evaluated. RESULTS: A total of 99 implants were inserted (47 short, 52 standard) in 74 patients. The 12-month survival rate was 100%. ISQ values showed a similar pattern for both types of implants. No correlation was found between ISQ changes after one year and MBL values, nor between the latter and the characteristics of the implants. CONCLUSIONS: With clinical treatment criteria, shorter implants (7 and 8.5 mm in length) can be just as useful as standard-length implants in atrophic alveolar ridges, demonstrating similar rates of survival, stability, and crestal bone loss.

Biocompatibility of a HA/ß-TCP/C Scaffold as a Pulp-Capping Agent for Vital Pulp Treatment: An In Vivo Study in Rat Molars.

Bioceramic materials possess desirable biological properties, highlighting their non-reactivity and osteoconductivity. Their use has been extended in vital pulp treatment. The purpose of this study was to evaluate and compare the effects of beta-tricalcium phosphate (ß-TCP), hydroxyapatite (HA), and collagen (C) scaffold with mineral trioxide aggregate (MTA) on the vital pulp of rat molars. Thirty-two molars of Sprague-Dawley rats underwent direct pulp capping with ß-TCP/HA/C (n = 16) and MTA (n = 16). After 30 days, the following parameters were evaluated in the tested samples: the degree of pulp inflammation and pulp vitality, the presence of reparative dentin, the homogeneity of the odontoblastic layer, and the presence of pulp fibrosis. No statistically significant differences were observed between HA/ß-TCP/C and MTA in terms of the degree of inflammation (p = 0.124). Significant differences were found in reparative dentin formation between the treatment groups (p = 0.0005). Dentin bridge formation was observed in the MTA-treated group. The local action of HA/ß-TCP/C is similar to that of MTA when used as an agent for pulp vital treatment in terms of absence of inflammation and maintenance of pulp vitality, although there are significant differences between both materials regarding the formation of dentin bridges.

Influence of Fluoride Varnish Application on Enamel Adhesion of a Universal Adhesive.

Purpose: To study the effect of the varnish type, application time and surface polishing on the shear bond strength (SBS) of a universal adhesive in healthy and demineralized bovine enamel. Materials and Methods: 432 bovine primary central incisors were assigned to 18 groups according to enamel mineralization [healthy and demineralized], topical varnish [Clinpro White Varnish (CWV; 3M Oral Care) and Profluorid (PFV, Voco)], remineralization time [24 h or 21 days] and polishing or not of the enamel surface. Adhesion was tested using Futurabond M (Voco)+ and GrandioSO (Voco). Sheer bond strength (SBS) was measured and the fracture mode studied. The statistical analysis was performed using two-way ANOVA, Tukey's test, and Pearson's chi-squared test. Results: In healthy bovine enamel, CWV reduced SBS at 24 h and 21 days; polishing significantly improved SBS. PFV increased SBS in healthy enamel at 21 days and demineralized enamel at 24 h and 21 days; polishing had no effect on SBS. The application time and polishing of the enamel surface affected the behavior of varnishes with respect to SBS. There was a correlation between the type of fracture and the degree of mineralization as well as the timepoint of varnish application. Conclusions: Remineralization of demineralized enamel with fluoride varnishes permits the recovery of the bond strength obtained in healthy enamel. Of the two varnishes studied, PFV had the highest SBS and more uniform behavior, regardless of the application timepoint, degree of mineralization, and surface treatment of the enamel..

La concentración de fluoruro en las aguas consumidas en la Región de Murcia no es suficiente para prevenir la caries dental / Fluoride concentrations in water consumed in the Region of Murcia are not sufficient to prevent dental caries

INTRODUCCIÓN: La caries sigue siendo la enfermedad crónica más frecuente en el niño y es considerada un problema de salud pública. El flúor es la principal medida protectora contra la caries dental y el agua de consumo es la principal fuente de ingesta de flúor. Objetivo El objetivo de nuestro trabajo fue calcular la concentración de ión fluoruro en el agua de abastecimiento de 10 zonas y en 10 aguas embotelladas comercializadas en la Región de Murcia. MATERIAL Y MÉTODOS: La concentración de fluoruro en las aguas se determinó con un electrodo ion-selectivo para flúor previamente calibrado con patrones de fluoruro preparados con TISAB II. RESULTADOS: En el agua de abastecimiento, se detectaron concentraciones de fluoruro entre 0.09 y 0.18 mgF/L (ppm) en las aguas embotelladas la concentración de fluoruro varió desde 0.04 a 0.50 ppm. CONCLUSIONES: El fluoruro está presente en aguas consumidas en la Región de Murcia pero en concentraciones que no alcanzan niveles preventivos para la caries dental. Es necesario prescribir suplementos de flúor en niños con alto riesgo de caries y para ello se deben contabilizar todas las fuentes externas de flúor, incluido el agua

INTRODUCTION: Dental caries remains the most frequent chronic disease in childhood and is considered a public health problem. Fluoride has proven effectiveness in the prevention of caries and drinking water is the main source of fluoride intake. The objective of this study was to determine fluoride concentrations in tap water from 10 areas and in 10 bottled waters sold in the Region of Murcia. MATERIALS AND METHODS: The concentration of fluoride in water was determined using a fluoride ion-selective electrode with a direct technique previously calibrated with standard fluoride concentrations prepared with TISAB II. RESULTS: In tap water, fluoride concentrations from 0.09 to 0.18 mgF/L (ppm) were detected; in bottled waters the concentration of fluoride varied from 0.04 to 0.50 ppm. CONCLUSION: Fluoride is present in the water consumed in the Region of Murcia but in concentrations that do not prevent dental caries. Fluoride supplements should be prescribed in children at high risk of caries, and for this, all external sources of fluoride intake, including water, must be accounted for

Prevalence of Sleep-Disordered Breathing in Children Referring for First Dental Examination. A Multicenter Cross-Sectional Study Using Pediatric Sleep Questionnaire.

Background: Sleep-related breathing disorders (SRDB) are a group of pathological conditions characterized by a dysfunction of the upper airways. The value of SRDB's prevalence, in the pediatric population, ranges from 2 to 11% depending on the different methodologies used in measure and the difficulties in the diagnosis. The aim of this study was to assess the prevalence of SRDB using the Pediatric Sleep Questionnaire (PSQ). Methods: 668 patients were enrolled from the Department of Oral and Maxillo-Facial Sciences, Sapienza University of Rome, Italy and from the Unit of Integrated Pediatric Dentistry, University of Murcia, Spain. The questionnaires were administered to patients with no previous orthodontic and surgical treatment who attended on the first visit at the two units of pediatric dentistry. Data regarding general health status were extracted from the standard anamnestic module for first visit. Prevalence and logistic regression models were computed. Results: The ages ranged from 2 to 16 years old (average 7 years old). The prevalence of SRDB was 9.7% for the entire sample. The models showed a positive correlation between three variables (snoring, bad habits, and anxiety) and SRDB. Conclusions: The prevalence obtained demonstrates the relevance of sleep disorders in the pediatric population and highlights the central role of pediatric dentists in the earlier diagnosis of these disorders.

Perception, knowledge, and attitudes towards molar incisor hypomineralization among Spanish dentists: a cross-sectional study.

BACKGROUND: Molar incisor hypomineralization (MIH) is a growing health problem, and its treatment is a challenge. The purpose of the present study was to evaluate and compare the perceptions, knowledge, and clinical experiences of MIH in general dental practitioners (GDPs) and paediatric dentists (PDs) in Spain. METHODS: All dentists belonging to the College of Dentists of the Region of Murcia, in the South-East of Spain, were invited to participate in a cross-sectional survey. They were asked to complete a two-part questionnaire including sociodemographic profiles and knowledge, experience, and perceptions of MIH. Data were analysed using Pearson's chi-square test, Fisher's exact test and Cramer's V test. RESULTS: The overall response rate was 18.6% (214/1147). Most respondents were aged 31-40 years (44.86%), with more than 15 years of professional experience (39.72%). They worked mainly in the private sector (84.58%) and were licensed in dentistry (74.30%): 95.45% of PDs had detected an increase in the incidence of MIH in recent years (p <  0.001). Only 23.80% of GDPs claimed to have made a training course on MIH. With respect to the aetiology, chronic medical conditions (p = 0.029) and environmental pollutants (p = 0.008) were the only factors that showed significant between-group differences. Durability (p = 0.009) and remineralization potential (p = 0.018) were the factors where there was a between-group difference in the choice of the restoration material. In the case of post-eruptive fractures and opacities, the preferred material for both groups was resin-modified glass ionomer (RMGIC). However, in incisor lesions, composite was the material of choice for both groups, with significant differences (p = 0.032) in the use of glass ionomer. Most respondents expressed a need for continuing education on MIH. CONCLUSION: Spanish dentists perceived an increase in the incidence of MIH. The material of choice was RMGIC for non-aesthetic sectors and composite for incisors. Dentists believe it is difficult or very difficult to manage MIH, since the long-term success of restorations of MIH lesions is compromised because resin adhesion is not good. Both GDPs and PDs believe they need more training on the aetiology, diagnosis, and treatment of MIH.

Melatonin as an Agent for Direct Pulp-Capping Treatment.

Melatonin plays an essential role in the regulation of bone growth. The actions that melatonin exerts on odontoblasts may be similar to its action on osteoblasts. This research aimed to evaluate the pulp response to melatonin used for direct pulp capping to evaluate the antioxidant effect of melatonin administered orally and its influence on dental pulp. Direct pulp capping was performed on the upper molars of Sprague Dawley rats using melatonin or Mineral Trioxide Aggregate (MTA). The study groups were: MTA; Melatonin; MTA + Melatonin administered orally; and Melatonin + Melatonin administered orally. In the latter two groups, the animals drank water dosed with melatonin ad libitum (10 mg/100 mL). After 30 days, the animals were sacrificed, and 5 ml of blood, the kidneys, and the liver were extracted in order to evaluate oxidative stress using thiobarbituric acid reactive substances testing (TBARS). Fragments of the maxilla containing the study molars were prepared for histological evaluation. The degree of pulp inflammation and pulp necrosis, the presence of reparative dentin and dentin bridging the pulp chamber, the presence and regularity of the odontoblastic layer, and the presence of pulp fibrosis were evaluated. No significant differences were found between the four study groups for any of the studied histological variables. The oral administration of melatonin did not modify the local effects of MTA or melatonin on dental pulp, or reduce basal-level oxidative stress. The effect of melatonin on pulp is similar to that of MTA and may be used as an agent for direct pulp capping.

[Fluoride and heavy metals concentration in bottled waters: barrier measures against dental caries and fluorosis]. / Concentración de flúor y metales pesados en aguas embotelladas: medidas barrera frente a caries dental y fluorosis.

OBJECTIVE: The daily consumption of fluoridated water is one of the most beneficial measures in dental caries prevention. The objective of this paper was to analyze the content of fluorine and heavy metals in the bottled natural mineral water available in stores in Spain. METHODS: A descriptive and transversal study was done throughout 2019. Analysing a total of 20 bottled waters marketed in Spain during this year. Mainly, fluoride concentration (ppm/ml) was analyzed with an ion-specific electrode (Orion model 96-09, Orion Research, Cambridge, MA) coupled to an ion analyzer (Orion EA-940). The heavy metals were analyzed by ICP-MS (Agilent model 7900). A descriptive statistical study of the data was carried out. RESULTS: The minimum value of fluorine found was 0.05 ppm and the maximum 0.95ppm. 80% of the brands analyzed contain less than 0.6 ppm F. Only 1 brand exceeds 0.8 ppm F. Chromium and arsenic were the heavy metals present in all brands, without exceeding the maximum dose. No brand of bottled water indicated heavy metals on the label, and only 1 mark indicated the fluoride concentration on the label. CONCLUSIONS: There is a great variability in the chemical composition of bottled waters marketed in Spain. Most have a fluoride concentration lower than that recommended to prevent tooth decay, which would require an extra supply of fluoride. In the bottled waters analyzed there are heavy metals but they did not exceed the maximum doses established by legislation.

OBJETIVO: El consumo diario de agua fluorada es una de las medidas mas beneficiosas en la prevención de la caries dental. El objetivo de este estudio fue analizar el contenido de flúor y metales pesados en el agua mineral natural embotellada disponible en los comercios de España. METODOS: Se realizó un estudio descriptivo y transversal a lo largo de 2019, analizando 20 marcas de aguas embotelladas comercializadas en España en ese año. Se midió principalmente la concentración de flúor (partes por millón/mililitro) (ppm/ml), que fue analizada con un electrodo ion-específico (modelo Orión 96-09, Orion Research, Cambridge) acoplado a un analizador de iones (Orion EA-940). Los metales pesados se analizaron mediante ICP-MS (Agilent modelo 7900). Se realizó un estudio estadístico descriptivo de los datos. RESULTADOS: El valor mínimo de flúor encontrado fue de 0,05 ppm y el máximo de 0,95 ppm. El 80% de las marcas analizadas contenían menos de 0,6 ppm F. Solamente una marca superó las 0,8 ppm F. Cromo y arsénico fueron los metales pesados presentes en todas las marcas, sin superar la dosis máxima. Ninguna marca de agua embotellada indicaba los metales pesados en la etiqueta, y solo una marca indicó la concentración de flúor en la etiqueta. CONCLUSIONES: Existe una gran variabilidad en la composición química de las aguas embotelladas comercializadas en España. La mayoría tienen una concentración de fluoruro inferior a la recomendada para prevenir la caries dental, por lo que se necesitaría un aporte extra de flúor. En las aguas embotelladas analizadas existen metales pesados, pero no superan las dosis máximas establecidas por la legislación.

Influence of a preventive program on the oral health-related quality of life (OHRQoL) of European pregnant women: a cohort study.

The aim of this study was to compare the impact of oral health on quality of life of a group of pregnant women enrolled in a program of oral health with respect to a control group of non-pregnant women. A cross-sectional study involving a sociodental indicator OHIP-14 and a dental examination was completed to assess pregnant women's knowledge of oral health, hygienic habits, periodontal and caries index. Data were collected from 113 pregnant women and 113 non-pregnant women. Sociodemographic data for both groups were homogeneous. Pregnant women have better values of general and oral health, even though they have not perceived need for dental treatment, compared with control group. A worse periodontal health was observed for the control group. Our results showed that quality of life in pregnant women has been influenced with a statistical significance (p < 0.05) by the variables age, unemployment, level of education, immigration, frequency of brushing, type of dental practice, self-reported general and oral health and perceived treatment needs. The oral quality of life of pregnant women seems to be positively influenced by the incorporation of preventive oral programs during pregnancy.

Concentración de flúor y metales pesados en aguas embotelladas: medidas barrera frente a caries dental y fluorosis / Fluoride and heavy metals concentration in bottled waters: barrier measures against dental caries and fluorosis

FUNDAMENTOS: El consumo diario de agua fluorada es una de las medidas mas beneficiosas en la prevención de la caries dental. El objetivo de este estudio fue analizar el contenido de flúor y metales pesados en el agua mineral natural embotellada disponible en los comercios de España. MÉTODOS: Se realizó un estudio descriptivo y transversal a lo largo de 2019, analizando 20 marcas de aguas embotelladas comercializadas en España en ese año. Se midió principalmente la concentración de flúor (partes por millón/mililitro) (ppm/ml), que fue analizada con un electrodo ion-específico (modelo Orión 96-09, Orion Research, Cambridge) acoplado a un analizador de iones (Orion EA-940). Los metales pesados se analizaron mediante ICP-MS (Agilent modelo 7900). Se realizó un estudio estadístico descriptivo de los datos. RESULTADOS: El valor mínimo de flúor encontrado fue de 0,05 ppm y el máximo de 0,95 ppm. El 80% de las marcas analizadas contenían menos de 0,6 ppm F. Solamente una marca superó las 0,8 ppm F. Cromo y arsénico fueron los metales pesados presentes en todas las marcas, sin superar la dosis máxima. Ninguna marca de agua embotellada indicaba los metales pesados en la etiqueta, y solo una marca indicó la concentración de flúor en la etiqueta. CONCLUSIONES: Existe una gran variabilidad en la composición química de las aguas embotelladas comercializadas en España. La mayoría tienen una concentración de fluoruro inferior a la recomendada para prevenir la caries dental, por lo que se necesitaría un aporte extra de flúor. En las aguas embotelladas analizadas existen metales pesados, pero no superan las dosis máximas establecidas por la legislación

BACKGROUND: The daily consumption of fluoridated water is one of the most beneficial measures in dental caries prevention. The objective of this paper was to analyze the content of fluorine and heavy metals in the bottled natural mineral water available in stores in Spain. METHODS: A descriptive and transversal study was done throughout 2019. Analysing a total of 20 bottled waters marketed in Spain during this year. Mainly, fluoride concentration (ppm/ml) was analyzed with an ion-specific electrode (Orion model 96-09, Orion Research, Cambridge, MA) coupled to an ion analyzer (Orion EA-940). The heavy metals were analyzed by ICP-MS (Agilent model 7900). A descriptive statistical study of the data was carried out. RESULTS: The minimum value of fluorine found was 0.05 ppm and the maximum 0.95 ppm. 80% of the brands analyzed contain less than 0.6 ppm F. Only 1 brand exceeds 0.8 ppm F. Chromium and arsenic were the heavy metals present in all brands, without exceeding the maximum dose. No brand of bottled water indicated heavy metals on the label, and only 1 mark indicated the fluoride concentration on the label. CONCLUSIONS: There is a great variability in the chemical composition of bottled waters marketed in Spain. Most have a fluoride concentration lower than that recommended to prevent tooth decay, which would require an extra supply of fluoride. In the bottled waters analyzed there are heavy metals but they did not exceed the maximum doses established by legislation

Microleakage of conventional light-cure resin-based fissure sealant and resin-modified glass ionomer sealant after application of a fluoride varnish on demineralized enamel.

BACKGROUND: International guidelines on the prevention of caries recommend sealing of the pits and fissures of the permanent molars. There is no evidence on which type of material is most effective on demineralized enamel. AIM: To evaluate the microleakage of a conventional light-cured, resin-based fissure sealant (LCRBS), GrandiO Seal, and a resin-modified glass ionomer sealant (RMGIS), Vitremer, after application of a fluoride varnish, Bifluorid 12, on demineralized enamel. DESIGN: 80 human third molars were divided into eight groups. The groups combined the three study factors (1) type of enamel (intact or demineralized); (2) enamel non-varnished or varnished with Biflourid12; and (3) type of sealant (GrandiO Seal or Vitremer). The percentage of microleakage after thermocycling was measured using imaging analysis software. The Kruskal-Wallis plus Dunn tests were used to compare differences in microleakage in the different groups. RESULTS: The lowest microleakage was in the unvarnished groups, and was the same for GrandiO Seal and Vitremer. When varnish was applied, microleakage was greater in demineralized enamel than in intact enamel for both LCRBS and RMGIS. CONCLUSION: The application of fluoride varnish on demineralized enamel increases the microleakage of both GrandiO Seal and Vitremer.

Structural differences in enamel and dentin in human, bovine, porcine, and ovine teeth.

BACKGROUND: The aim was to study differences between crystalline nanostructures from the enamel and dentin of human, bovine, porcine, and ovine species. METHODS: Dentine and enamel fragments extracted from sound human, bovine, porcine and ovine incisors and molars were mechanically ground up to a final particle size of <100µm. Samples were analyzed using X-ray diffraction (XRD), Fourier transform infrared spectroscopy (FTIR), and differential scanning calorimetry (DSC). RESULTS: Human enamel (HE) and dentin (HD) showed a-axis and c-axis lengths of the carbonate apatite (CAP) crystal lattice nearer to synthetic hydroxyapatite (SHA), which had the smallest size. Enamel crystal sizes were always higher than those of dentin for all species. HE and HD had the largest crystal, followed by bovine samples. Hydroxyapatites (HAs) in enamel had a higher crystallinity index (CI), CIRietveld and CIFTIR, than the corresponding dentin of the same species. HE and HD had the highest CIs, followed by ovine enamel (OE). The changes in heat capacity that were nearest to values in human teeth during the glass transition (ΔCp) were in porcine specimens. There was a significant direct correlation between the size of the a-axis and the substitution by both type A and B carbonates. The size of the nanocrystals and the crystallinity (CIRietveld y CIFTIR) were significantly and negatively correlated with the proteic phase of all the substrates. There was a strongly positive correlation between the caloric capacity, the CIs and the crystal size and a strongly negative correlation between carbonates type A and B and proteins. CONCLUSIONS: There are differences in the organic and inorganic content of human, bovine, porcine and ovine enamels and dentins which should be taken into account when interpreting the results of studies using animal substrates as substitutes for human material.

Influence of fluoride varnish on shear bond strength of a universal adhesive on intact and demineralized enamel.

The aim was to evaluate the effect of fluoride varnish on the shear bond strength (SBS) on polished and non-polished intact and demineralized enamel. Bovine incisors (half demineralized) were used. Bifluorid 12™ was applied. Bonding was made with Futurabond®M + and GrandioSO, 24 h and 7 days after varnishing. In some groups, varnish was removed by polishing before bonding. SBS was measured. Fracture type was determined by stereomicroscopy and scanning electron microscope (SEM) observations of the enamel surface were made. Between-group differences were determined by one-way ANOVA and the Tukey test. Associations between study factors and fracture modes were analysed using contingency tables and Pearson's chi-squared test. For intact enamel, SBS on varnished enamel at 24 h was significantly less than in the other groups. SBS recovered 7 days after varnishing. Varnish elimination after 24 h significantly increased the SBS. However, removal at 7 days did not modify SBS. SBS on demineralized enamel groups was significantly less than in intact enamel, except for demineralized enamel varnished and removed at 7 days. Demineralized enamel was associated with cohesive enamel fractures and intact enamel with cohesive fractures of the composite and adhesive fractures. SEM of varnish surfaces showed a homogenous layer scattered with amorphous precipitate. In conclusion, on intact enamel fluoride varnish had a negative effect on SBS at 24 h, which disappeared after 7 days. On demineralized enamel, varnish did not reduce SBS at either time. Polishing the varnished enamel surface showed a similar SBS to intact enamel after 7 days.

Effect of antibiotics and NSAIDs on cyclooxygenase-2 in the enamel mineralization.

The objective of this study was to determine whether the use of the most commonly prescribed antibiotics and non-steroidal anti-inflammatory drugs in childhood could disturb enamel mineralization. Forty-two Swiss mice were divided into seven groups: controls; amoxicillin; amoxicillin/clavulanate; erythromycin; acetaminophen; ibuprofen and celecoxib, to inhibit cyclooxygenase 2 (COX2). SEM-EDX analysis was conducted on all cusps of the third molars. Calcium (Ca), phosphorus (P), aluminum, potassium, sodium, magnesium and chlorine were quantified. The stoichiometric Ca/P molar ratios were calculated. Immunohistochemical quantification of COX2 in incisors was carried out by image analysis using COX2-specific immunostaining. Groups treated with antibiotics showed no significant differences in the content of the chemical elements. Only acetaminophen and celecoxib showed a significant decrease in Ca and P compared with the control samples. Ca/P ratios showed no difference. Groups treated with amoxicillin, amoxicillin/clavulanate, erythromycin and acetaminophen showed significantly lower amounts of immunoreactive COX2 at the enamel organ maturation stage of the mouse incisors. Our results suggest that COX2 is involved in the maturation stage of the enamel organ and that its inhibition would appear to alter amelogenesis, producing hypomineralization.