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.

Extraction of primary maxillary incisors and children's speech production: A case series.

Dental caries (tooth decay) is a disease with a significant global burden. Management may necessitate the extraction of teeth to restore oral health. The association between dental extractions and children's speech is unclear, with clinical implications for speech-language pathologists and dentists. This case series describes a prospective study reporting the impact of primary maxillary incisor teeth extraction on speech sound accuracy for three children (C1 aged 5;6 (years; months), C2 aged 4;6, C3 aged 3;10). Their speech was assessed using the Diagnostic Evaluation of Articulation and Phonology (DEAP) and the Intelligibility in Context Scale (ICS) before (T1) and 1 month after dental treatment (T2). Speech analysis included the percentage of consonants correct (PCC) and error-type analyses. Caregiver and child perception of the child's oral health-related quality of life (OHRQoL) were assessed pre- and post-operatively using a modified Scale of Oral Health Outcomes for 5-year-old children (SOHO-5). At T1, all three children scored >1 standard deviation below the mean on normative data in the DEAP. There was no clinically significant change in PCC for any child (C1 T1: 89.6%, T2: 90.6%, C2 T1: 78.0%, T2: 75.9%, C3 T1: 56.1%, T2: 63.1%). OHRQoL measures were improved for C1 by the carergiver report and remained stable for C2 and C3 and all child reports. Speech sound difficulties were present before dental treatment in all participants and extraction of primary maxillary incisors did not significantly impact speech production. Dental extractions appear to be independent from speech production in this case series of preschool children.

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.

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.

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.

Eye-tracking in dentistry: what do children notice in the dental operatory?

OBJECTIVES: To determine, using eye-tracking technology, (i) what children notice the most when they look at images of dental operatories and (ii) the effect of distractors on gaze pattern. MATERIALS AND METHODS: Forty-one children aged 4-12 years (21 girls, 19 boys) viewed 13 images of dental operatories taken from different perspectives on a computer screen. One child was excluded due to calibration issues with the eye-tracking equipment. Areas of interest (AOI's) were pre-defined on each image, then a Tobii X2-60 eye-tracking camera was used to track the location of participant's gaze. Count of participants to fixate and mean length of fixation (LOF) for each AOI were measured. RESULTS: Significant differences in the mean LOF was noticed for bracket tables, handpieces, and the dental chair. Significantly differences in mean LOF between different areas of the images were noted where distractors (cartoons) were added. CONCLUSIONS: When viewing images of dental operatories on a computer screen, children fixated most on the bracket tables, handpieces, and dental chairs. The addition of distractors was able to change where they looked. Eye-tracking was able to effectively assess where the children looked. CLINICAL RELEVANCE: The findings demonstrate that children have inherent preferences for where they fixate when viewing images of a dental operatory. This has not previously been known and will allow customization of dental operatories where children will be treated.

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.

Unusual sequelae of a subluxated primary incisor on its permanent successor tooth.

Traumatic dental injuries (TDIs) such as subluxations of primary teeth can have significant consequences on their developing successors. The purpose of this report is to present a 3-year-old boy who encountered subluxation injuries to his primary incisors which subsequently had an unusual consequence on the permanent successor. On the day of the TDI, based on clinical and radiographic examinations, a diagnosis of subluxation of teeth 52, 51 and 61 was made. By age 5, the patient reported that tooth 51 had exfoliated, and consequently, tooth 11 had erupted into the oral cavity, but it was very loose. Eventually, the patient lost the crown of tooth 11 during his routine daily activities. Furthermore, radiographic examination at age 11 revealed a small root-like structure in the tooth 11 region. It is very unusual to have premature loss of a permanent incisor following subluxation to its predecessor. Therefore, the present case serves as a good example to emphasize that even minor TDIs are of considerable importance as they may lead to unexpected consequences.

Pulp Chamber Analysis of Primary Molars Using Micro-Computed Tomography: Preliminary Findings.

Purpose: To determine the three-dimensional (3D) tooth morphology of all primary molars and to identify and consolidate positional factors that could potentially have an effect on tooth preparation. Study design: Thirty-one non-carious primary molars were scanned using micro-CT and reconstructed using 3D analysis software. Each pulp horn to its respective cusp tip distance (PHCD) was measured as well as the distances from the pulp chamber to the mesial, distal, lingual and buccal surfaces. One-way ANOVA and post-hoc t-tests were used for data analysis. Results: The mesio-buccal and disto-buccal PHCD was significantly shorter than the mesio-lingual and disto-lingual PHCDs in maxillary second primary molars (P < 0.05). Mesial, distal and lingual walls were thinner than the buccal walls of mandibular molars while in maxillary molars; the mesial and distal walls were thinner than the palatal and buccal walls (P < 0.05). Conclusions: First primary molars have thinner tooth structure surrounding the pulp than second primary molars in the same arch with the exception of the buccal walls of all molars and lingual walls of maxillary molars. The mesial and distal walls are thinner than the buccal walls of all molars and lingual walls in maxillary molars.

Remineralizing Potential of Clinpro® and Tooth Mousse Plus® on Artificial Carious Lesions.

BACKGROUND: Calcium phosphate and fluoride (F) delivery systems claim to facilitate enamel remineralization. AIM: To evaluate and compare (i) the remineralizing potential of Clinpro® Tooth Crème(CTC) and Tooth Mousse Plus®(TMP) on artificial carious lesions, and (ii) the benefit of 1000ppm F dentifrice prior to the application of CTC and TMP. STUDY DESIGN: Carious lesions, 200-300µm deep were produced by placing molars in demineralizing solution for 96h, sections 100-150µm thick were then randomly assigned to six groups(n=150). Specimens were treated thrice daily with a non-fluoridated(Group A), or fluoridated dentifrice[1000ppm, (Group B)], or CTC(Group C), TMP(Group D), fluoridated dentifrice followed by CTC(Group E), or a fluoridated dentifrice followed by TMP(Group F), and then subjected to a 10-day pH cycling model. Lesion evaluation involved polarizing light microscopy and microradiography. RESULTS: Posttreatment maximum mineral content at the surface zone(Vmax) was significantly increased in Groups B, C, and D compared to the other groups. The lesion depth(LD) decreased in Group D>Group C>Group E, and the net mineral content gain(ΔZ) in Group C>Group D, which did not reach statistical significance. CONCLUSIONS: CTC and TMP exhibited similar efficacy in remineralizing artificial carious lesions. Nevertheless, the net mineral gain or lesion consolidation following CTC use was higher than TMP.

Developmental Disturbance of a Maxillary Permanent Lateral Incisor Following Trauma at the Age of 16 Months: A 6-Year Follow-Up.

A 3 year and 8 months old Chinese boy was referred for a consultation regarding his missing maxillary anterior teeth. He had a history of trauma to his primary maxillary anterior teeth due to a fall at the age of 16 months. Clinical examination of the patient indicated multiple carious lesions and inadequate oral hygiene. Radiographic examination revealed intrusion of the primary left lateral incisor, with evidence of damage to the permanent tooth germ. Subsequently, the patient was followed-up for almost six years during which his permanent maxillary left lateral incisor erupted exhibiting an unusual morphology. Clinically enamel hypoplasia and radiographically dens invaginatus were evident in affected tooth.

Efficacy of Alternative Medicaments for Pulp Treatment in Primary Teeth in the Short Term: A Meta-analysis.

OBJECTIVE: This systematic review and meta-analysis aimed to evaluate the overall, clinical, and radiographical success rates of alternative pulpotomy medicaments in primary teeth. METHODS: A systematic search of five databases was conducted following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Prospective clinical trials using alternative pulpotomy medicaments in children were included. The outcome measures were overall, clinical, and radiographic success, expressed in percentages and converted to odds ratios. Fifteen articles were included in the meta-analysis. RESULTS: Combined odds ratios for overall, clinical, and radiographic success was 0.55 (95% confidence interval [CI]: 0.12-2.41; P = .42; I2 = 76%), 1.03 (95% CI: 0.57-1.86; P = .92; I2 = 0%), and 0.84 (95% CI: 0.54-1.47; P = .66; I2 = 34%), respectively. The results suggest an inconclusive outcome in the success rate of alternative medicaments. CONCLUSIONS: There is insufficient evidence to support the efficacy of alternative pulpotomy medicaments for use in primary teeth. Further robust studies are required before such alternative medicaments should be used in clinical practice.

Oral health-related quality of life changes in children following dental treatment under general anaesthesia: a meta-analysis.

OBJECTIVE: To conduct a meta-analysis of studies that have employed the Early Childhood Oral Health Impact Scale (ECOHIS) and Child Oral Health-Related Quality of Life (COHRQoL) instruments, to evaluate the oral health-related quality of life (OHRQoL) changes in children following dental treatment under general anaesthesia (DGA). METHOD: A systematic search of 5 databases was conducted in accordance with the PRISMA guidelines. The inclusion criteria were use of ECOHIS and COHRQoL, pre-and post-operative assessments, patients aged between 0 and 16 years, no restrictions on the follow-up period and DGA. The primary outcome measure was changes in quality of life for both the children, which was based on mean difference (MD). Twenty-two articles were included in the meta-analysis. RESULTS: A favourable outcome in OHRQoL was identified in all studies. The combined MD for ECOHIS and COHRQoL were 1.62 [95% CI 1.52-1.71; P < 0.00001; I2 = 0%] and 0.86 [95% CI 0.74-0.99; P < 0.00001; I2 = 0%], respectively, both with no evidence of heterogeneity. CONCLUSION: There is evidence to support that the OHRQoL of children was improved, with large effect size, in the short-term following DGA. CLINICAL RELEVANCE: Dental treatment under GA significantly improved the OHRQoL of children.

Evaluation of the staining potential of silver diamine fluoride: in vitro.

BACKGROUND: Silver diamine fluoride (SDF) is a cariostatic agent used to adjunctively manage dental caries in high-risk groups. However, black staining is a frequently reported side effect following SDF application and influences the acceptability of this treatment. AIM: To evaluate the staining potential of SDF and the influence of the potassium Iodide (KI) application on the degree of black staining over time. DESIGN: Extracted carious primary molars were collected and sorted into pairs matched by tooth type, size and location of the carious lesion (n = 35). Teeth were stratified to receive either 38% SDF, KI immediately after SDF application, or 12% SDF. Standardised timelapse photography and image processing software was used to evaluate staining over a period of 7 days. RESULTS: Following SDF application, the onset of black staining occurred within 2 min and increased in value for up to 6 h post-application. The use of KI immediately after SDF application resulted in no noticeable staining of the carious dentine or surrounding enamel. No significant differences were evident in the staining potential between the different SDF concentrations (38% and 12%). Furthermore, root surface and cementum was found to stain darker and more readily when compared with the coronal enamel surface. CONCLUSION: SDF has the ability to visibly stain dental hard tissues and its staining potential may be modified by application of KI.

Preliminary investigation of the variations in root canal morphology of hypomineralised second primary molars.

AIM: To investigate the root canal morphology of hypomineralised second primary molars(HSPM) using micro-CT(µCT) compared with non-hypomineralised second primary molars (non-HSPM). METHODOLOGY: Ten HSPM and 10 non-HSPM were divided into Group 1(maxillary HSPM), Group 2 (mandibular HSPM), Group 3(maxillary non-HSPM), and Group 4 (mandibular non-HSPM). All teeth were scanned using µCT to assess the following parameters: (i) root canal configuration, (ii) pulp volumes, and (iii) the influence of the root canal system landmarks on access cavity outline forms and canal curvature. Two-way ANOVA was employed for descriptive analysis (P < 0.05). RESULTS: At the furcation level, there was minimal variation in the number of canals. In the mesiobuccal root, Group 1 showed higher frequency of multiple canals in the middle (85.7%) and apical (85.7%) thirds compared with Group 3. In the mesial root, Group 4 demonstrated multiple canals at the furcation (60%) compared with Group 2(33.3%). In the distal root, Group 2 demonstrated a higher percentage of multiple canals at the apical level (100%) compared with Group 4. The mean pulp volumes of Group 2 and Group 4 were 54.1 mm3 (16.7) and 30 mm3 (5.12), respectively, which was statistically significant (P < 0.05). The canal curvature values did not differ significantly between HSPM and non-HSPM groups. CONCLUSIONS: HSPM exhibited greater variations in their root canal configuration when compared to non-HSPM.

The family impact of dental general anaesthesia in children: A meta-analysis.

BACKGROUND: The health and well-being of children are intimately linked to their parents' physical, emotional, and social health and social circumstances. AIM: To conduct a meta-analysis of studies that have used the Early Childhood Oral Health Impact Scale (ECOHIS) and Child Oral Health-Related Quality of Life (COHRQoL) instruments, to evaluate the family impact scale (FIS) changes following their children's dental treatment under general anaesthesia (DGA). METHODOLOGY: A systematic search was undertaken using the PRISMA guidelines. The inclusion criteria consisted of patients below 16 years of age, DGA, pre- and post-operative assessments, and the use of ECOHIS and COHRQoL. FIS changes were the primary outcome measure, where the mean difference (MD) was calculated. RESULTS: After initial search of 105 studies in the database, twenty-one articles were included in the analysis. A positive outcome in the FIS changes was identified in all studies. The combined MD for FIS using ECOHIS and COHRQoL was 1.52 [95% CI: 1.15-1.89; P < 0.00001; I2 =87%] and 1.10 [95% CI: 0.68-1.52; P < 0.00001; I2 =79%], respectively. CONCLUSIONS: Dental treatment with general anaesthesia for children had a significant positive impact on parental emotions, activity, and conflict. Following DGA, there was significant improvement in the FIS, with large MD.

All Tied Up! Influences of Oral Frenulae on Breastfeeding and their Recommended Management Strategies.

BACKGROUND: Recently, there has been an increased awareness of the role of the labial and lingual frenulae on a neonate's ability to latch and breastfeed efficiently. This critical review explores the (i) oral physiology of a baby nursing (ii) factors that can decrease a baby's ability to nurse efficiently, the problems these cause and their management and the (iii) relation between poor nursing efficacy and the risk of early childhood caries (ECC) Study design: An expansive search of the literature was performed using four electronic databases. RESULTS AND CONCLUSIONS: Most studies assessing the role of labial and lingual frenulae on breastfeeding were of a low quality. The relation between ECC and poor nursing efficacy was found to be largely speculative. Hence, the results of these studies should be interpreted with caution. Despite the limited quality and external validity of the current evidence, in cases where breastfeeding difficulties are identified, surgical management of labial or lingual frenulae may provide some subjective improvements in breastfeeding outcome.

Remineralizing potential of a 60-s in vitro application of Tooth Mousse Plus.

BACKGROUND: No published studies exist on the remineralizing potential of Tooth Mousse Plus® (TMP) when applied for less than 3 min. AIM: To evaluate (i) the remineralizing potential of TMP on artificial carious lesions, when applied thrice daily for 60 s, and (ii) the benefit of using a fluoridated dentifrice prior to TMP application. DESIGN: Carious lesions, 120-200 µm deep, were produced by placing molars in demineralizing solution for 96 h, and sections 100-150 µm thick were then randomly assigned to four groups. Specimens were treated thrice daily with a non-fluoridated (Group A), or 1000 ppm F dentifrice (Group B), or TMP (Group C), or a 1000 ppm F dentifrice followed by TMP application (Group D), and then subjected to a 10-day pH cycling model. Lesion evaluation involved polarizing light microscopy and microradiography. RESULTS: Post-treatment maximum mineral content at the surface zone (Vmax ) was significantly increased and lesion depth (LD) significantly decreased in Group C, while only the Vmax increased in Group D. Increase in LD was observed in Group B; however, no significant differences were noted in percentage LD changes between groups B, C, and D (P > 0.05). CONCLUSIONS: TMP applied for 60 s significantly remineralized the artificial carious lesions. No additional benefit was evident when TMP was preceded by treatment with 1000 ppm F dentifrice.

Quality of life changes in children following emergency dental extractions under general anaesthesia.

OBJECTIVES: To assess the changes in the oral health-related quality of life (OHRQoL) of 221 preschool children who presented to the emergency department with the consequences of untreated dental caries requiring dental extractions under general anaesthesia (DEGA). METHODS: Two hundred and twenty-one healthy preschool children, who required emergency DEGA, were recruited over a period of 12 months. The same parent or caregiver completed the Early Childhood Oral Health Impact Scale (ECOHIS) questionnaire; both, prior to the DEGA and at the 2-week post-treatment visit. Data were analysed using repeated anova with adjustments for multiple comparisons using the Bonferroni tests with the significance level set at 5%. RESULTS: One hundred and twenty-six participants, with a mean age of 4.02 and a mean dmft score of 8.27 (SD = 4.13), completed the 2-week post-treatment questionnaires. The overall ECOHIS, CIS, and FIS scores decreased significantly (P < 0.001) after emergency DEGA, demonstrating large effect sizes. The biggest decrease in prevalence after emergency DEGA was observed for the items of pain in teeth, trouble sleeping, being irritated or frustrated, difficulty drinking food, and parents being upset. CONCLUSIONS: The OHRQoL of preschool children, who presented to the emergency department with the consequences of untreated dental caries, was significantly improved following emergency DEGA.

Changes in the oral health-related quality of life in children following comprehensive oral rehabilitation under general anaesthesia.

OBJECTIVES: To assess changes in the oral health-related quality of life (OHRQoL), after comprehensive oral rehabilitation under general anaesthesia (CORGA), among children (i) <6 years using the Early Childhood Oral Health Impact Scale (ECOHIS) and (ii) aged 6-14 years using the child oral health-related quality of life (COHRQoL) instrument. METHODS: A total of 136 healthy children who had CORGA were recruited over a period of 12 months. The parent or caregiver of the study participants completed the age-appropriate questionnaire prior to the dental treatment and at the subsequent follow-up appointments (2 weeks and 3 months). Data were analysed using repeated-measures anova and Bonferroni tests. RESULTS: The overall ECOHIS scores decreased significantly (P < 0.001) demonstrating large effect sizes. The greatest decreases were for the domains of child oral symptoms (57.5%) and psychology (38.7%) in the child impact section (CIS) and for the domain of parental distress (38.9%) and family function (40%) in the family impact section (FIS). For COHRQoL, the overall P-CPQ and FIS scores decreased significantly for all items (P < 0.001), demonstrating large effect sizes. The greatest decreases were for the domains of oral symptoms (77.7%), functional limitations (74.3%), and the FIS (80.1%). CONCLUSIONS: The OHRQoL of children in both age groups (<6 and 6-14 years) was significantly improved after CORGA.