Risk of Severe Early Childhood Caries over Time in Low-Income Preschoolers.

INTRODUCTION: Early childhood caries (ECC), and the progression to severe ECC (S-ECC), is a serious oral health issue, leading to acute pain, sepsis, tooth loss, and compromised quality of life. Although the association between sociodemographic factors and ECC has been widely discussed, it remains unclear whether the same association exists between inequality and S-ECC. OBJECTIVES: To investigate the impact of low income on the oral health of preschool children and explore any additional risk factors for developing ECC and S-ECC during follow-up. METHODS: The study used Taipei Child Development Screening Program data from 2014 to 2019. It included children aged 3 to 5 y who had more than 2 oral exams and completed baseline oral health questionnaires. Low-income children were matched 1:4 with controls by age and gender. Evaluation of ECC and S-ECC used the dmft index during follow-up exams. Generalized estimating equations (GEEs) assessed the impact of household income on ECC and S-ECC risk over time. RESULTS: Of the 895 participants, 179 were from low-income households. We revealed a significantly higher risk of developing S-ECC (adjusted odds ratio [aOR] 1.99; 95% confidence interval [CI] 1.25-3.17) in children from low-income households, with no significantly increased of risk of developing ECC. Children who consumed sugary beverages >4 times per week showed elevated risks of developing both ECC (aOR 1.77; 95% CI 1.07-2.94) and S-ECC (aOR 1.89; 95% CI 1.13-3.17). Protective factors included children with mothers with a college education (S-ECC: aOR 0.50; 95% CI 0.32-0.79). CONCLUSION: Children from low-income households have a significant risk of developing S-ECC compared with children from non-low-income households during follow-up. Factors contributing to this risk include lower maternal education, poor maternal oral health, and increased consumption of sugar-sweetened beverages. Policymakers should develop health measures to reduce the prevalence of ECC and S-ECC in children from low-income households whose mothers have lower educational levels and poor oral health. KNOWLEDGE TRANSFER STATEMENT: The results of this study highlight the significant S-ECC risk among preschool children from low-income households in Taipei, with other risk factors including higher consumption of sugar-sweetened beverages, lower maternal education, and poor maternal oral health. Policymakers can use our findings to develop targeted policy and behavioral interventions to reduce S-ECC in vulnerable populations.

Development and validation of Tamil version of CARIES-QC questionnaire among socially marginalized school children in Chennai City.

BACKGROUND: The Caries Impacts and Experiences Questionnaire for Children (CARIES-QC), which was developed to assess dental caries-specific Child Oral Health Related Quality of Life (COHRQoL), has been translated into few world languages. AIM: To develop and validate the Tamil version of Caries Impacts and Experience Questionnaire for Children (CARIES-QC). DESIGN: This cross-sectional study was conducted among socially marginalized school children in Chennai City. The initial translation of the English CARIES-QC questionnaire to Tamil was made by two independent translators followed by an expert committee discussion to derive a prefinal version of the Tamil questionnaire. Subsequently, content validation was performed by bilingual subject experts followed by preliminary pilot testing among 30 school children aged 8-10 years studying in Adidravidar Welfare High School, Chennai, to produce the final version of the questionnaire. Convergent validity, discriminant validity, and test-retest reliability of the translated questionnaire were tested among 191 children. RESULTS: The content validation process revealed that the translated version had relevant questions and content coverage (Scale-wise Content Validity Index score = .91). The children with and without dental caries had mean CARIES-QC scores of 5.39 + 3.7 and 3.71 + 5.1, respectively, and their statistically significant difference (p-value = .04) between them indicates the scale's satisfactory discriminant validity. The Cronbach's alpha was .87 indicating the questionnaire's good internal consistency. CONCLUSION: The newly developed Tamil CARIES-QC questionnaire is a valid and reliable tool for assessing COHRQoL among Tamil-speaking school children.

The impact of malnutrition on dental health of 12-year-old children: a study on permanent teeth caries, cariogenic bacteria and salivary IgA.

INTRODUCTION: Malnutrition in children is epidemic in developing countries. Several health issues and consequences are believed to develop due to this phenomenon. Children's oral health is also affected by malnutrition. The main aspects of oral health status are caries experience, the existence of cariogenic bacteria, and salivary immunoglobulin A.

Exploring the efficacy of in-vitro low-temperature plasma treatment on single and multispecies dental cariogenic biofilms.

The primary aim of this study was to investigate the impact of treatment with low-temperature plasma (LTP) for varying exposure durations on a multispecies cariogenic biofilm comprising C. albicans, L. casei, and S. mutans, as well as on single-species biofilms of L. casei and C. albicans, cultured on hydroxyapatite discs. Biofilms were treated with LTP-argon at a 10 mm distance for 30 s, 60 s, and 120 s. Chlorhexidine solution (0.12%) and NaCl (0.89%) were used as positive (PC) and negative controls (NC), respectively. Argon flow only was also used as gas flow control (F). Colony-forming units (CFU) recovery and confocal laser scanning microscopy (CLSM) were used to analyze biofilm viability. LTP starting at 30 s of application significantly reduced the viability of multispecies biofilms by more than 2 log10 in all treated samples (p < 0.0001). For single-species biofilms, L. casei showed a significant reduction compared to PC and NC of over 1 log10 at all exposure times (p < 0.0001). In the case of C. albicans biofilms, LTP treatment compared to PC and NC resulted in a significant decrease in bacterial counts when applied for 60 and 120 s (1.55 and 1.90 log10 CFU/mL, respectively) (p < 0.0001). A significant effect (p ≤ 0.05) of LTP in single-species biofilms was observed to start at 60 s of LTP application compared to F, suggesting a time-dependent effect of LTP for the single-species biofilms of C. albicans and L. casei. LTP is a potential mechanism in treating dental caries by being an effective anti-biofilm therapy of both single and multispecies cariogenic biofilms.

Advanced Dental Care: ß-Chitosan Zinc Oxide Nanoparticles Targeting Cariogenic Microorganisms.

Introduction Dental caries, primarily caused by cariogenic microorganisms, remains a significant global health concern. ß-Chitosan, known for its biofilm-targeting properties, and zinc oxide (ZnO) nanoparticles (NPs), recognized for their potent antimicrobial effects, offer a promising approach for caries prevention and treatment. This study investigates the synthesis, characterization, and antimicrobial properties of ß-Chitosan-derived ZnO NPs (ß-Ch-ZnO-NPs) against these pathogens. Methodology ß-Chitosan from fresh squid bones was isolated using demineralization and deproteinization methods. ß-Ch-ZnO-NPs were synthesized and characterized using UV-vis spectroscopy and Fourier-transform infrared spectroscopy (FTIR) to confirm their size, shape, and stability. Antibacterial efficacy(agar well plate method)was assessed through standardized assays, demonstrating significant inhibition of cariogenic bacteria. The results were represented as mean± standard deviation. The Kruskal-Wallis test with post hoc analysis (Mann-Whitney U test) was conducted for statistical analysis. Molecular docking studies (blind docking method) were conducted to elucidate the interactions between ß-Ch-ZnO-NPs and key bacterial enzymes involved in microbial genetic material synthesis, also known as dihydroorotate dehydrogenase (DHODH, PDB ID-2J0Y). Results The synthesized ß-Ch-ZnO-NPs exhibited well-defined characteristics verified by UV-vis spectroscopy and FTIR confirming their nanoparticulate nature and stability. The antimicrobial effects of Streptomycin (50 µg/mL) and ß-Ch-ZnO-NPs were compared across various microorganisms. ß-Ch-ZnO-NPs at 100 µg/mL consistently showed larger inhibition zones than Streptomycin and ß-Ch-ZnO-NPs at 50 µg/mL against Escherichia coli​​, Enterococcus faecalis, Staphylococcus aureus, Streptococcus mutans, and Candida albicans.This suggests that ß-Ch-ZnO-NPs at a higher concentration have potent antimicrobial activity across a broad spectrum of pathogens, highlighting their potential as effective antimicrobial agents. Kruskal-Wallis test showed statistically significant differences (P < 0.001) for all microbes, and post hoc analysis (Mann-Whitney U test) confirmed the P-value was less than 0.05. Molecular docking studies indicated strong binding affinities between ß-Ch-ZnO-NPs and bacterial enzymes crucial for biofilm formation, suggesting inhibition of enzyme activity critical for bacterial virulence and survival. Conclusions This study highlights the synergistic potential of ß-Chitosan and zinc oxide NPs in combating dental caries. The synthesized ß-Ch-ZnO-NPs demonstrated effective antimicrobial activity against cariogenic microorganisms, attributed to their ability to disrupt bacterial metabolism and inhibit biofilm formation. Molecular docking analysis provided mechanistic insights into how ß-Ch-ZnO-NPs interact with bacterial enzymes, reinforcing their role in impeding biofilm development. Overall, the findings support using ß-Ch-ZnO-NPs as a promising therapeutic strategy for preventing and treating dental caries, leveraging their combined biofilm-targeting capabilities and antimicrobial effects.

Effectiveness of silver diamine fluoride (SDF) in arresting coronal dental caries in children and adolescents: a systematic review.

Dental caries remains a significant public health issue for children globally, leading to adverse effects on health and development. Silver diamine fluoride (SDF) is a potential preventive agent that can prevent caries progression in children. This systematic review examined the effectiveness of silver diamine fluoride in arresting caries compared to other fluorides. An electronic search of MEDLINE, PubMed, EMBASE, Cochrane, Web of Science, Scopus databases was carried out examining articles in English from 2001 to 2023. Studies included in the analysis examined the application of SDF in children and adolescents with coronal caries lesions on primary teeth or permanent first molars. Fifteen studies, involving a total of 7895 children, were incorporated. The application regimen varied across studies. Most studies in this review consistently suggested that SDF is effective in arresting caries. An annual application of SDF effectively reduced Streptococcus mutans count. Adverse effects were primarily tooth staining and less commonly, oral mucosal irritation. A majority of studies showed a high risk of bias due to methodological insufficiencies. Overall, the evidence suggests that SDF is effective in arresting dental caries in children. It offers a viable, cost-effective, and minimally invasive treatment option, particularly suitable for use in low-resource settings. However, the aesthetic concern of tooth staining with SDF use remains a challenge. Further well-designed clinical trials may provide a fuller picture of SDF which can shape public health policy and shift towards a minimally invasive treatment approach.

Clinical application of Er:YAG laser and traditional dental turbine in caries removal in children.

This study compares the clinical efficacy of erbium-doped:yttrium-aluminium-garnet (Er:YAG) laser and traditional dental turbine in caries removal in children. The study cohort comprised 78 children aged 5 to 10 years with caries in two symmetrical maxillary molars. Different carious sides of the same child were randomly divided into control and observed sides. For each child, the caries on the control side were treated with a traditional dental turbine, while the observed side was treated with an Er:YAG laser. The study evaluated the use of anesthetics, pain levels, tooth hypersensitivity and the occurrence and severity of tooth fractures during caries removal with different methods. Additionally, the clinical anxiety and cooperative behavior of the children were observed. The time required for caries removal and cavity preparation by both methods was recorded, and the success rate of treatment was assessed after one year of follow-up. The results indicated a significant reduction in the use of anesthetics, pain and the incidence and severity of tooth hypersensitivity with the use of Er:YAG laser (p < 0.05). No significant difference was found in the occurrence of tooth fractures between the two groups (p > 0.05). The children treated with Er:YAG laser demonstrated better clinical anxiety levels and cooperative behavior. However, the time required for cavity preparation was longer with the use of Er:YAG laser (p < 0.05). After a 12-month follow-up, there was no significant difference in the success rate of treatment between the two groups (p > 0.05). In conclusion, compared to the traditional dental turbine, the use of Er:YAG laser improves treatment comfort and cooperation in children with caries and reduces the need for intraoperative anesthetics.

Oral health status and dental treatment needs in children with autism spectrum disorder.

Objective: To evaluate oral health care practices, health status, and dental treatment needs in children with Autism Spectrum Disorder (ASD). Methods: This cross-sectional study included 96 children diagnosed with ASD per the DSM-V criteria and 96 typically developing healthy children. The WHO form assessed oral health status and dental treatment needs. Results: Over 50 % of ASD children had mild/moderate autism, 35.4 % had severe autism, and 13.5 % had autistic traits. ASD children experienced more toothbrushing difficulties compared to non-ASD children. Based on Nyvad's criteria and decayed/filled teeth (dft) index, non-ASD children had higher caries prevalence than ASD children, indicating less need for restorative treatments in the ASD group. However, ASD children had poorer plaque scores than non-ASD children. A significantly higher percentage of ASD children exhibited harmful oral behaviors, including mouth breathing, lip biting, bruxism, nail biting, object biting, and self-injury (p < 0.001). ASD children also showed increased traumatic dental injuries compared to non-ASD children. Conclusion: Compared to non-ASD peers, children with ASD have lower dental caries prevalence and less need for restorations, yet poorer plaque control. They also demonstrate more frequent oral self-injuries. ASD status appears related to toothbrushing difficulties. These findings highlight the need for tailored oral health interventions for children with ASD.

Artificial Intelligence (AI) Assessment of Pediatric Dental Panoramic Radiographs (DPRs): A Clinical Study.

This clinical study aimed to evaluate the sensitivity, specificity, accuracy, and precision of artificial intelligence (AI) in assessing permanent teeth in pediatric patients. Over one thousand consecutive DPRs taken in Kielce, Poland, with the Carestream CS9600 device were screened. In the study material, 35 dental panoramic radiographs (DPRs) of patients of developmental age were identified and included. They were automatically evaluated with an AI algorithm. The DPRs were then analyzed by researchers. The status of the following dichotomous variables was assessed: (1) decay, (2) missing tooth, (3) filled tooth, (4) root canal filling, and (5) endodontic lesion. The results showed high specificity and accuracy (all above 85%) in detecting caries, dental fillings, and missing teeth but low precision. This study provided a detailed assessment of AI performance in a previously neglected age group. In conclusion, the overall accuracy of AI algorithms for evaluating permanent dentition in dental panoramic radiographs is lower for pediatric patients than adults or the entire population. Hence, identifying primary teeth should be implemented in AI-driven software, at least so as to ignore them when assessing mixed dentition (ClinicalTrials.gov registration number: NCT06258798).

Caregiver Perception of the Oral-Health-Related Quality of Life of Children with Special Needs: An Exploratory Study.

BACKGROUND: Compared to the general population, individuals with special needs tend to have worse oral health, potentially diminishing their quality of life. This study aimed to evaluate the perception of parents and caregivers regarding the effect of oral health on the quality of life of individuals with special needs who received dental treatment under general anaesthesia, as well as the impact on their and their families' quality of life. MATERIALS AND METHODS: This cross-sectional study involved participants with special needs who had undergone a dental treatment under general anaesthesia. Before the intervention, an oral examination was conducted to count the number of teeth affected by caries. Parents or caregivers filled out a specially designed questionnaire that included sociodemographic information, details about the children's oral hygiene and dietary habits, and questionnaires on the impact of their child's oral health on their quality of life (P-CPQ) and the influence of the oral health of children with psychophysical difficulties on the family (FIS). The data collected were analysed both descriptively and using the chi-square test, Fisher's exact test, Kruskal-Wallis test, and Spearman's correlation analysis. The level of significance was set at p ≤ 0.05. RESULTS: This study involved 42 children (24 females and 18 males) with an average age of 21.14 ± 8.34 years. The average number of carious teeth per participant was 9.74 ± 5.63. About 66% of respondents reported that their children performed oral hygiene with their help, while 9.5% of them did not do so at all. Individuals with a higher number of caries had statistically significantly higher scores on the emotional well-being (p = 0.004) and social well-being (p = 0.033) subscales of P-CPQ, as well as on the parental emotions subscale of FIS (p = 0.020). Also, there was a difference in the number of carious teeth in participants due to unhealthy habits (drinking sweetened beverages, p = 0.030) and due to comforting with food (p = 0.004). CONCLUSION: The increase in the number of carious teeth in individuals with special needs has been associated with the quality of life of their families. To address this, it is crucial to promote the prevention of oral health issues by educating individuals with special needs and their caregivers on proper oral hygiene techniques and diets tailored to their specific requirements.

Hospital Visits Associated With Oral Infections in Patients With Neurofibromatosis Type 1: A Register-Based Analysis.

Various forms of oral involvement have been reported in patients with neurofibromatosis 1 (NF1). Here, we analyze register-based associations between NF1 and hospital visits related to oral infections. The Finnish NF1 cohort encompasses all individuals with verified NF1 who have visited the Finnish central and university hospitals in 1987-2011. The Finnish Care Register for Health Care allowed the follow-up of 1349 individuals with NF1, their 1894 siblings without NF1, and 13,870 matched controls for diagnoses related to oral infections in 1998-2014. We observed clearly increased hazards for hospital visits associated with dental caries (ICD-10 K02; NF1 vs. controls, hazard ratio [HR] 4.42, 95% CI 3.23-6.04), diseases of pulp and periapical tissues (K04; HR 3.85, 95% CI 2.68-5.54), and gingivitis and periodontal diseases (K05; HR 3.63, 95% CI 2.37-5.56). In contrast, hospital visits related to diseases of salivary glands (K11), and stomatitis and related lesions (K12) did not show significantly increased hazard in NF1 compared with the controls or the non-NF1 siblings. In conclusion, the findings suggest that hospital visits related to oral infections are relatively common among individuals with NF1. The results highlight the need for early detection, proactive prevention, and timely treatment of oral infections in individuals with NF1.

A Supramolecular Nanoformulation with Adaptive Photothermal/Photodynamic Transformation for Preventing Dental Caries.

In the context of an increasingly escalating antibiotics crisis, phototherapy has emerged as a promising therapeutic approach due to its inherent advantages, including high selectivity, noninvasiveness, and low drug resistance. Photothermal therapy (PTT) and photodynamic therapy (PDT) are two complementary and promising phototherapies albeit with inherent limitations, noted as the challenges in achieving precise heat confinement and the associated risk of off-target damage for PTT, while the constraints due to the hypoxic microenvironment are prevalent in biofilms faced by PDT. Herein, we have designed a supramolecular nanoformulation that leverages the complexation-induced quenching of guanidinium-modified calix[5]arene grafted with fluorocarbon chains (GC5AF5), the efficient recognition of adenosine triphosphate (ATP), and the oxygen-carrying capacity of the fluorocarbon chain. This intelligent nanoformulation enables the adaptive enhancement of both photothermal therapy (PTT) and photodynamic therapy (PDT), allowing for on-demand switching between the two modalities. Our nanoformulation utilizes ATP released by dead bacteria to accelerate the elimination of biofilms, rendering bacteria unable to resist while minimizing harm to healthy tissues. This research highlights the particular recognition and assembly capabilities of macrocycles, offering a promising strategy for creating potent, combined antibiofilm therapies.

Improved Esthetics Using Silver Diamine Fluoride in the Management of Early Childhood Caries: A Case Series.

Dental caries prevention using an application of silver diamine fluoride (SDF) is an emerging advanced treatment modality in pediatric dentistry. However, a major drawback of SDF application is the black staining of carious lesions, which limits its clinical use due to esthetic concerns. Improving the esthetic outcome by reducing black staining would significantly enhance the opportunity for the universal use of SDF. This case series comprises three cases demonstrating the clinical success of using potassium iodide (KI) to reduce staining, followed by glass ionomer cement (GIC) restoration in primary molars. Upon 12-month follow-up visits, the treated teeth remained clinically asymptomatic, with esthetically acceptable restoration margins. Additionally, the esthetic results were acceptable to both parents and patients. The significance of utilizing KI and GIC following SDF application lies in their synergistic effect on masking discoloration resulting from SDF treatment while enhancing tooth functionality, thereby meeting patients' esthetic requirements and improving chewing efficiency.

Enhanced Diagnostic Accuracy for Dental Caries and Anomalies in Panoramic Radiographs Using a Custom Deep Learning Model.

Background  Dental caries is one of the most prevalent conditions in dentistry worldwide. Early identification and classification of dental caries are essential for effective prevention and treatment. Panoramic dental radiographs are commonly used to screen for overall oral health, including dental caries and tooth anomalies. However, manual interpretation of these radiographs can be time-consuming and prone to human error. Therefore, an automated classification system could help streamline diagnostic workflows and provide timely insights for clinicians. Methods This article presents a deep learning-based, custom-built model for the binary classification of panoramic dental radiographs. The use of histogram equalization and filtering methods as preprocessing techniques effectively addresses issues related to irregular illumination and contrast in dental radiographs, enhancing overall image quality. By incorporating three separate panoramic dental radiograph datasets, the model benefits from a diverse dataset that improves its training and evaluation process across a wide range of caries and abnormalities. Results The dental radiograph analysis model is designed for binary classification to detect the presence of dental caries, restorations, and periapical region abnormalities, achieving accuracies of 97.01%, 81.63%, and 77.53%, respectively. Conclusions The proposed algorithm extracts discriminative features from dental radiographs, detecting subtle patterns indicative of tooth caries, restorations, and region-based abnormalities. Automating this classification could assist dentists in the early detection of caries and anomalies, aid in treatment planning, and enhance the monitoring of dental diseases, ultimately improving and promoting patients' oral healthcare.

Quantitative assessment of early caries lesion activity using novel dye-enhanced fluorescence imaging.

OBJECTIVES: This study aimed to evaluate the validity of the dye-enhanced quantitative light-induced fluorescence (DEQLF) method for assessing early enamel caries activity. METHODS: Seventy extracted human teeth with early enamel caries on smooth surfaces were included. Two dentists evaluated the caries activity using the Nyvad system followed by the DEQLF method. The teeth were hydrated with distilled water for 60 s, dehydrated with compressed air for 10 s, and stained with 100 µM fluorescein sodium solution for 10 s. White and fluorescent images were captured using a QLF-D 2+ Billuminator. The change in fluorescence (ΔΔG) was calculated using image analysis software. Independent-sample t-tests were performed to evaluate the difference in ΔΔG between active and inactive lesions for both DEQLF and conventional quantitative light-induced fluorescence (QLF) methods. Receiver operating characteristic (ROC) curve analysis was used to assess the validity of ΔΔG for distinguishing lesion activity using the area under the ROC curve (AUROC). RESULTS: Among the 70 caries lesions, 33 were active and 37 were inactive. Using the DEQLF method, the ΔΔG for active lesions (3.8 ± 5.6) was significantly higher than that for inactive lesions (1.0 ± 2.5) (P < 0.05). With the conventional QLF method, there was no significant difference in ΔΔG between active (-1.1 ± 1.7) and inactive (-1.3 ± 1.7) lesions. DEQLF-derived ΔΔG demonstrated an AUROC of 0.72, a sensitivity of 0.67, and a specificity of 0.76. CONCLUSIONS: Applying the DEQLF method to human teeth enabled the quantitative assessment of lesion activity based on dye penetration. DEQLF-derived ΔΔG values showed significant differences based on lesion activity status and demonstrated high validity in distinguishing lesion activity. CLINICAL SIGNIFICANCE: Clinicians can use the DEQLF method, which involves applying a fluorescent dye for 10 s prior to conventional QLF, to objectively quantify and distinguish the activity status of early enamel caries, potentially replacing the traditional reliance on subjective visual assessments.

Impact of Clinical Consequences of Pulp Involvement due to Caries on Oral Health-Related Quality of Life in Children and Adolescents: A Systematic Review and Meta-Analysis.

INTRODUCTION: Dental caries with pulp involvement potentially impacts the oral health-related quality of life (OHRQoL). This meta-analysis aimed to evaluate whether clinical consequences of pulp involvement due to dental caries impacts OHRQoL of children and adolescents. METHODS: Observational studies evaluating whether children/adolescents (population) with pulp involvement due to caries (exposition) compared with those without it (comparison) have more negative impact on their OHRQoL (outcome) were included. A systematic search was undertaken in August 2022 in seven databases. Alerts were set until August 2023. JBI Critical Appraisal tool for cross-sectional studies was used for methodological quality assessment. Random-effects meta-analyses were performed to calculate mean differences (MD) or standardized mean differences (SMD) of impact on OHRQoL. For studies with dichotomous outcome, meta-analysis calculated the odds ratio (OR). Robustness, heterogeneity, certainty of evidence, and publication bias were evaluated. RESULTS: From 29 included studies, 14 assessed preschoolers, nine assessed schoolchildren, four assessed adolescents, and two assessed children/adolescents. PUFA was the main index used to assess the exposure. ECOHIS (preschoolers) and CPQ (children/adolescents) were the main tools used to assess the outcome. Only five articles fully adhered to the quality criteria. The meta-analyses found the following main results: (a) preschoolers: MD -10.79 (-16.50; -5.09); (b) schoolchildren: MD -5.12 (-7.51; -2.72); (c) adolescents: MD -1.86 (-4.59; 0.87); (d) overall impact: SMD -2.18; (CI: -3.21;-1.15) and OR 0.52 (CI: 0.30; 0.90). CONCLUSION: Pulp involvement impacted OHRQoL of children negatively. In adolescents, this impact was not observed. Results must be interpreted with caution due to very low certainty of evidence.

Methods used for caries detection and diagnosis in Ontario dental practices: a cross-sectional survey.

BACKGROUND: Early detection of caries is essential for applying non-surgical treatment procedures and preventing the formation of cavitated lesions leading to unnecessary removal of tooth structure. Understanding dentists' preferences for caries detection tools can inform stakeholders about their strategies and knowledge of contemporary, evidence-based caries management approaches. However, there is a lack of research exploring the detection methods of caries commonly used by dentists in Ontario, Canada. The objective of this study was to investigate the methods of caries detection and diagnosis preferred by dentists in Ontario. METHODS: A 21-item self-reported survey was mailed to one thousand Ontario dental practices in the Winter of 2022. Descriptive and bivariate data analysis were performed to determine the associations between: demographics and professional practice characteristics (explanatory variables), and methods for detecting and diagnosing dental caries (outcome variables) using SPSS Statistics 29.0. RESULTS: A total of 325 dentists (33%) responded to the survey, with 274 answering all of the questions completely. The highest proportion of respondents were 35-44 years of age (32.8%) and male (53.4%). More than half of the respondents reported using a dental explorer to assess primary occlusal caries (57.6%), secondary caries (57.1%), and cervical caries (57.5%). Likewise, 57.9% of the participants reported using dental radiographs to diagnose proximal caries. Among additional caries detection tools, digital radiography (89.8%) and traditional radiography (84.7%) were the most used methods/modalities, while cone beam computed tomography was the least (12.8%). Most study participants did not use any caries classification system (77.7%) or caries risk assessment tool (85.3%). CONCLUSIONS: Participants preferred conventional methods for caries detection, instead of contemporary visual-tactile caries lesions classification and/or caries risk assessment systems. These findings indicate a need for continuing dental education programs tailored to evidence-based caries management approaches.

Evaluation of the cytotoxicity of new formulations of cariostatic agents containing nano silver fluoride: an in vitro study.

The objective of the study was to assess the indirect cytotoxicity of 600 ppm and 1500 ppm nano silver fluoride (NSF) compared to other commercial cariostatic agents. 56 dentin discs with 0.4 mm in thickness were obtained from intact human molars and adapted to artificial pulp chambers (APCs). The discs were divided into seven groups according to treatment (n = 8): no treatment (positive control-PC), 29% hydrogen peroxide (negative control-NC), 30% Cariestop (CS30), 38% Riva Star (RS38), 38% Advantage Arrest (AA38), 600 ppm NSF (NSF600), and 1500 ppm NSF (NSF1500). The cariostatic agents were applied on the occlusal surface of the dentin discs (facing upward), and the pulp surface (facing downward) remained in contact with the culture medium. Immediately after the treatments, the extracts (DMEM + cariostatic agent components diffused through the discs) were collected and applied to MDPC-23 cells, which were assessed for viability (CV-alamarBlue, live/dead), adhesion/spreading (F-actin), alkaline phosphatase (ALP) activity, and mineralization nodule (MN) formation. The data were statistically analyzed by ANOVA/Games-Howell (p = 0.05). CV and ALP activity in CS30, RS38, AA38, and NSF600 were similar to PC (p > 0.05). MN formation significantly decreased only in NC, CS30, RS38, and AA38 compared to PC (p < 0.001). Only NSF600 and NSF1500 did not differ from PC (p > 0.05) with mineralization nodules, and this specific cell activity significantly decreased in all other groups (p < 0.05). NSF solutions (600 ppm and 1500 ppm) did not cause transdentinal toxicity on MDPC-23 cells.

Developing a novel calcium silver zeolite for caries management.

OBJECTIVE: To develop a novel calcium silver zeolite (Ca-Ag-Zeo) and assess its biocompatibility, physiochemical properties and antimicrobial effects. METHODS: Ca-Ag-Zeo was synthesized using ion-exchange method with calcium chloride, silver nitrate and Zeolite X (Zeo). Silver zeolite X (Ag-Zeo) and Zeo were set as control. The chemical structure, morphology, crystal structure and elemental composition of Ca-Ag-Zeo was characterized by X-ray diffraction spectrum, scanning electron microscopy, transmission electron microscopy and energy dispersive spectroscopy, respectively. Its biocompatibility on the human gingival fibroblasts was assessed by cell counting kit-8 assay. Its physiochemical properties were determined by the released calcium and silver ion using Inductive Coupled Plasma Emission Spectrometry for up to 12 weeks. The antimicrobial properties on Streptococcus mutans, Lactobacillus acidophilus, Lactobacillus casei, and Candida albicans were assessed by minimum bactericidal concentration (MBC) or minimum fungicidal concentration (MFC) assay. RESULTS: Ca-Ag-Zeo with a hexagonal cage structure was synthesized. As for biocompatibility, the half-maximal inhibitory concentration (± SD in mg/mL) of Ca-Ag-Zeo, Ag-Zeo and Zeo in human gingival fibroblasts were 0.52 ± 0.05, 0.15 ± 0.01 and 3.35 ± 0.58, respectively (Zeo > Ca-Ag-Zeo > Ag-Zeo; p < 0.05). As for physiochemical properties, the accumulated ion release (± SD in mg) of Ca-Ag-Zeo, Ag-Zeo and Zeo were 0.011 ± 0.003, 0 and 0 for calcium ion, respectively (Ca-Ag-Zeo > Ag-Zeo, Zeo; p < 0.001), and 0.213 ± 0.032, 0.209 ± 0.019 and 0 for silver ion, respectively (Ca-Ag-Zeo, Ag-Zeo > Zeo; p < 0.001). As for anti-microbial ability, the MBC/MFC (mg/mL) of Ca-Ag-Zeo, Ag-Zeo and Zeo were 32, 16 and > 256 against Streptococcus mutans; 32, 16, > 256 against Lactobacillus acidophilus; 16, 16, and 256 against Lactobacillus casei; 0.25, 0.125; and 2, 1, > 256 against Candida albicans, respectively. CONCLUSION: A novel Ca-Ag-Zeo was developed. It presented better biocompatibility compared to Ag-Zeo. It released calcium and silver ions sustainably, and it could inhibit the growth of common cariogenic microorganisms.