Evaluation of bleaching agent effects on color and microhardness change of silver diamine fluoride-treated demineralized primary tooth enamel: An in vitro study.

BACKGROUND: The present study aimed to assess the impact of application of fluoridated- 10% carbamide peroxide (CP) with or without potassium iodide (KI) on silver diamine fluoride (SDF)-treated enamel surface in the primary teeth. METHODS: After stained-remineralized caries lesions (s-RCLs) creation, 96 teeth were randomly allocated to four experimental groups: Group 1:SDF-treated enamel followed by 8-h/day application of 10% CP for 2 weeks; Group 2: SDF-treated enamel followed by 15-min/day application of 10% CP for 3 weeks; Group 3: SDF + KI-treated enamel followed by 8-h/day application of 10% CP for 2 weeks; and Group 4: SDF + KI-treated enamel followed by 15-min/day application of 10% CP for 3 weeks. Enamel microhardness (EMH) test (n = 12) and spectrophotometric color assessment (n = 12) was performed at four stages: baseline (intact enamel), demineralized enamel, aged remineralized-stained enamel, and after final intervention. Sixteen samples were used for SEM evaluation. Data were analyzed with the paired t-test, one-way ANOVA, and Tukey's post-hoc test (p < 0.05). RESULTS: EMH values in all groups showed significant decrease after demineralization (all, p < 0.00001). All samples showed complete recovery of EMH values (%REMH) after SDF application compared to demineralization (%REMHSDF) (p = 0.971). Bleaching caused a slight decrease in %REMH for all groups. However, the differences were not statistically significant (p = 0.979). SEM findings revealed no changes in enamel porosity after bleaching. Bleaching application ameliorated the discoloration in all groups (all, p < 0.00001). All samples in Groups 2 and 4 had significantly lighter color after 21 days as compared to 14-day exposure to the bleaching material (both, p < 0.00001). CONCLUSIONS: SDF application on demineralized primary tooth enamel completely recovered enamel microhardness. 10% carbamide peroxide effectively bleached SDF stain without causing significant decrease in EMH values. Color improvement was more evident with the use of KI immediately after SDF application. Both 15-min and 8-h application of fluoridated CP resulted in statistically similar color enhancement in primary teeth.

Effect of Er:YAG laser etching on topography, microstructure, compressive strength, and bond strength of a universal adhesive to calcium silicate cements.

OBJECTIVE: To evaluate the effect of Er:YAG etching on topography, microstructure, compressive strength, and shear bond strength (SBS) of All-Bond Universal adhesive to mineral trioxide aggregate-Angelus (AMTA) and Biodentine (BD). METHODS AND MATERIALS: Sixty cylindrical specimens of each cement (AMTA and BD) in five groups were prepared and stored for 72 h. The control groups were non-etched, and four other groups were acid-etched and laser-etched with a pulse energy of 60, 80, or 100 mJ, followed by compressive strength testing. Surface micromorphology and topography were evaluated. Similar groups were bonded using All-Bond Universal with self-etch and etch-and-rinse (acid-etch) approaches, and laser-etch 60, 80, and 100 mJ, and SBS was tested. Data were analyzed using two-way and one-way ANOVA and the Bonferroni post hoc tests (α = 0.05). RESULTS: BD had a significantly higher compressive strength and SBS (except for laser-etch 100) compared to AMTA, regardless of the etching method (p < 0.001). Acid etching and laser etching 100 of both cements and laser etching 80 of BD alone produced a significantly lower compressive strength than that for the other groups. Contrary to BD, for AMTA, all the treatments significantly increased SBS compared to that of the self-etch group. CONCLUSIONS: Etching of AMTA was needed for stronger bonding; laser etching with 60 or 80 mJ without compromising compressive strength was recommended. Etching not only did not improve bonding ability of BD, but it also negatively affected the strength of BD. CLINICAL RELEVANCE: To achieve successful combined calcium silicate cement-resin material restoration, an adequate bond between the materials is mandatory. This might be provided with the ultramild adhesive through laser etching without compromising compressive strength, depending on cement composition and laser energy level used.

Correction to: Effect of Er:YAG laser etching on topography, microstructure, compressive strength, and bond strength of a universal adhesive to calcium silicate cements.

Figure 2 was incorrect in the original published version of this article. Correct figure in presented here. The original article has been corrected.

Effect of hydroxyapatite nanoparticles on enamel remineralization and estimation of fissure sealant bond strength to remineralized tooth surfaces: an in vitro study.

BACKGROUND: The management of noncavitated caries lesions before sealant therapy is a clinical challenge when the tooth needs sealant application. Sealing noncavitated carious lesions in pits and fissures may lead to failure of the fissure sealant (FS) due to incomplete sealing. Therefore the use of remineralizing agents such as nanoparticles has been suggested. This study investigated the ability of hydroxyapatite nanoparticles (nano-HA) to remineralize enamel, and their effect on sealant microleakage and shear bond strength (SBS). METHODS: A total of 192 third molars were demineralized and pretreated with two concentrations of nano-HA with and without sodium hexametaphosphate (SHMP), followed by phosphoric acid etching and resin FS application. The study groups were 1) etching + FS, 2) etching + nano-HA 0.15% + FS, 3) etching + nano-HA 0.03% + FS, 4) etching + mixture of nano-HA 0.15% and SHMP 0.05% + FS, 5) etching + mixture of nano-HA 0.03% + SHMP 0.01% + FS. The laboratory tests included microleakage in 50 teeth, scanning electron microscopy (SEM) evaluation in 10 samples, and SBS in 100 samples. Enamel remineralization changes were evaluated in 32 teeth with energy-dispersive X-ray spectroscopy (EDS) and field emission scanning electron microscope (FESEM). RESULTS: Nano-HA enhanced the SBS to remineralized enamel in a large percentage of nanoparticles. Mean SBS in group 2 was significantly greater than in groups 1, 3 and 4 (all P < 0.05). SBS was related to nano-HA concentration: nano-HA 0.15% yielded greater SBS (16.8 ± 2.7) than the 0.03% concentration (14.2 ± 2.1). However, its effect on microleakage was not significant. Nano-HA with or without SHMP led to enhanced enamel remineralization; however, the Calcium (Ca)/Phosphate (P) weight percent values did not differ significantly between the groups (P > 0.05). SEM images showed that SHMP did not affect sealant penetration into the deeper parts of fissures. FESEM images showed that adding SHMP led to increased nanoparticle dispersal on the tooth surface and less cluster formation. CONCLUSIONS: The ultraconservative approach (combining nano-HA 0.15% and SHMP) and FS may be considered a minimal intervention in dentistry to seal demineralized enamel pits and fissures.

Comparison of Oral Health Education and Fluoride Varnish to Prevent Early Childhood Caries: A Randomized Clinical Trial.

Early childhood caries, a serious health problem among young children, can be prevented with effective intervention. The aim of this study was to evaluate the efficacy of oral health education and a fluoride varnish in the prevention of caries in children under the age of 3 years. For this single-blind randomized parallel group 1-year clinical trial in Shiraz, 300 children aged 12-24 months with sound primary teeth were selected and randomly divided into three groups (n = 100): (1) control: no preventive intervention; (2) oral health counseling, and (3) oral health counseling and fluoride varnish at baseline and 6 months later. At baseline and 4, 8 and 12 months after the intervention, caries risk reduction was recorded as the primary outcome. The mothers' knowledge and performance regarding oral health in children was used as a secondary outcome. A total of 260 children (mean age: 20.49 ± 7.33 months) completed the study. Compared to group 1, caries risk reduction in group 2 was 28% (95% CI: -39.05 to -17.45) and 31% in group 3 (95% CI: -41.88 to -21.73). However, there was no significant difference between groups 2 and 3 (95% CI: -8.58 to 1.47). In all groups, mothers' knowledge and performance at baseline were low; however, they increased significantly in follow-up appointments in groups 2 and 3 (p < 0.001). Oral health education increased mothers' knowledge and performance regarding oral health in children. Oral health counseling alone or associated with the use of fluoride varnish reduced the caries incidence in young children.

Efficacy of fluoride varnish and casein phosphopeptide-amorphous calcium phosphate for remineralization of primary teeth: a randomized clinical trial.

OBJECTIVE: We aimed to evaluate the efficacy of oral hygiene instruction, fluoride varnish and casein phosphopeptide-amorphous calcium phosphate (CPP-ACP) for remineralizing white spot lesions (WSL), and the effect of these on the dmft index in primary teeth. SUBJECTS AND METHODS: In this 1-year, randomized clinical trial, 140 children aged 12-36 months with WSL in the anterior maxillary teeth were selected and randomly divided into 4 groups of 35 children each. Group 1 (control) received no preventive intervention. In group 2, there was oral hygiene and dietary counseling. In group 3, there was oral hygiene and the application of fluoride varnish at 4, 8 and 12 months after baseline. In group 4, there was oral hygiene and tooth mousse was applied by the parents twice a day over a 12-month period. At baseline and 4, 8 and 12 months after the intervention, the size of WSL in millimeters and the dmft index were recorded. One hundred and twenty-two children completed the study. Data were analyzed using the repeated-measures ANOVA test. RESULTS: In group 1, the mean percent WSL area and dmft index values had increased significantly at 12 months after baseline (p < 0.001). The interventions led to significant decreases in the size of the WSL; the greatest reduction was in group 4 (63%) followed by group 3 (51%) and group 2 (10%) after 12 months. The smallest increase in the dmft index was in group 4 (0.17), followed by groups 3 (0.3) and 2 (0.42). However, there were no significant differences between the groups (p < 0.001). CONCLUSIONS: Oral hygiene along with four fluoride varnish applications or constant CPP-ACP during the 12- month period reduced the size of WSL in the anterior primary teeth and caused a small increase in dmft index values.

Signs and symptoms associated with primary tooth eruption: a clinical trial of nonpharmacological remedies.

BACKGROUND: To evaluate disturbances in primary tooth eruption and their management with nonpharmacological remedies. METHODS: In this nonrandomized clinical trial, 270 children aged between 8 and 36 months were selected and divided into 5 groups with 54 children initially enrolled in each group. The children were seen during an 8-day period during tooth eruption. At each appointment data were recorded from oral examination, tympanic temperature measurement and a questionnaire. The five methods used as remedies to reduce teething symptoms were: 1) cuddle therapy, 2) ice, 3) rubbing the gums, 4) teething rings and 5) food for chewing. Teething symptoms, the type of erupted tooth, symptoms of recovery and the mother's satisfaction with treatment were evaluated. RESULTS: Two hundred and fifty four children (mean age 16 ± 7.2 months) completed the study. The most frequent teething symptoms were drooling (92%), sleep disturbances (82.3%) and irritability (75.6%). These symptoms were more pronounced in low birth weight children (p > 0.05). Canine eruption led to more loss of appetite than incisor (p = 0.033) or molars eruption (p = 0.014). Low grade increases in body temperature were observed only on the day of eruption (36.70 ± 0.39 °C), when body temperature was significantly different compared to the day before and the day after eruption (both p < 0.001). There was no significant correlation between fever as reported by mothers and temperature readings obtained by the investigators. The most favorable results for time to recovery and the mother's satisfaction were seen when teething rings were used, followed by cuddle therapy and rubbing the gums. CONCLUSIONS: There was no association between teething and symptoms such as fever or diarrhea. Low birth weight children may have more teething symptoms. Teething rings, cuddle therapy and rubbing the gums were the most effective methods to reduce symptoms. TRIAL REGISTRATION: Iranian Registry of Clinical Trials: code IRCT201211127402N3.

The effect of antibacterial agents on fissure sealant microleakage: a 6-month in vitro study.

PURPOSE: To evaluate microleakage from an antibacterial adhesive and bonding agent added to the ssure sealant on intact enamel. MATERIALS AND METHODS: One hundred twenty sound third mandibular molars were randomly divided into 6 groups of 20 teeth each. Occlusal pits and ssures were sealed with un lled sealant material (Clinpro, 3M) after pretreatment with 1. phosphoric acid etching (control); 2. acid etching + Adper Single Bond 2 (SB, 3M); 3. chlorhexidine digluconate (CHX, Ultradent) + acid etching; 4. CHX + acid etching + SB; 5. acid etching + Clear l Protect Bond (CPB, Kuraray) 6. CPB alone. After 6-month water storage and thermocycling, the specimens were placed in 0.5% fuschin, sectioned and evaluated under a digital microscope. The data were compared between groups with Kruskal-Wallis and Mann-Whitney tests. RESULTS: Differences between groups were statistically signi cant at P < 0.05. Acid etching alone and with SB showed the lowest microleakage, followed by acid etching + CPB. Chlorhexidine with and without bonding agent showed the greatest microleakage. CONCLUSION: Conventional acid etching alone or with a one-bottle adhesive were the two most effective methods of reducing microleakage from ssures. Acid etching together with a self-etching adhesive showed better results than self-etching alone. Appling CHX increased microleakage in sealed teeth.

Association of characteristics of delivery and medical conditions during the first month of life with developmental defects of enamel.

BACKGROUND: Developmental defects of enamel (DDE) may be influenced by health problems and illness in children. The aim of the study was to identify the main characteristics of birth (delivery) and adverse medical conditions during the first month of life that may be related to DDE in permanent teeth. METHODS: 1000 schoolchildren between the ages of 9 and 11 years were selected for this cross-sectional study by multistage randomization from four educational zones in Shiraz in 2013. Intraoral examination was used to diagnose DDE according to World Health Organization screening guidelines and the Modified DDE Index. The data on seven birth factors as well as health and nutritional conditions during the first month of life were collected by a questionnaire completed by the parents, and were analyzed with the chi-squared test, Spearman's correlation and binary logistic regression. RESULTS: 469 (48.2%) out of 974 schoolchildren had at least one permanent tooth with DDE. The defects were significantly related with Apgar score at birth <7 (p = 0.003) and illness during the first month (p = 0.035). The frequency of DDE was significantly lower in the third child in families compared to the first and second child (p = 0.005). However, DDE showed no significant relationship with gestational age, delivery type, birth weight, gender or type of feeding during early infancy. CONCLUSIONS: Three associated factors were identified (birth Apgar score, illness during the first month of life, birth order) for DDE in permanent teeth. No specific illness was found to be significantly associated with DDE.

Preparation and characterization of a nanohydroxyapatite and sodium fluoride loaded chitosan-based in situ forming gel for enamel biomineralization.

The development of remineralizing smart biomaterials is a contemporary approach to caries prevention. The present study aimed at formulation preparation and characterization of a thermoresponsive oral gel based on poloxamer and chitosan loaded with sodium fluoride (NaF) and nanohydroxyapatite (nHA) to treat demineralization. The chemical structure and morphology of the formulation were characterized using FTIR and FESEM-EDS tests. Hydrogel texture, rheology, and stability were also examined. The hydrogel was in a sol state at room temperature and became gel after being placed at 37 °C with no significance different in gelation time with the formulation without nHA and NaF as observed by t-test. The FTIR spectrum of nHA/NaF/chitosan-based hydrogel indicated the formation of physical crosslinking without any chemical interactions between the hydrogel components. The FESEM-EDS results demonstrated the uniform distribution of each element within the hydrogel matrix, confirming the successful incorporation of nHA and NaF in the prepared gel. The hardness, hydrogel's adhesiveness, and cohesiveness were 0.9 mJ, 1.7 mJ, and 0.37, respectively, indicating gel stability and the acceptable retention time of hydrogels. The formulation exhibited a non-Newtonian shear-thinning pseudoplastic and thixotropic behavior with absolute physical stability. Within the limitation of in vitro studies, nHA/NaF/chitosan-based in situ forming gel demonstrated favorable properties, which could be trasnsorm into a gel state in oral cavity due to poloxamer and chitosan and can prevent dental caries due to nHA and NaF. We propose this formulation as a promising dental material in tooth surface remineralization.

Protective effect of various toothpastes and mouthwashes against erosive and abrasive challenge on eroded dentin: an in vitro study.

The study aimed to compare various toothpastes and mouthwashes on permanent tooth dentin after erosive and abrasive challenges. 130 sound premolars dentin were randomly submitted to an initial erosive challenge and a cycle of erosive and abrasive challenges for five days. The five experimental groups (n = 26) were: (1) Control group (artificial saliva), (2) Elmex erosion protection toothpaste and mouthwash, (3) Vitis anticaries biorepair toothpaste and mouthwash, (4) Oral B Pro-expert toothpaste and Oral B Fluorinse mouthwash, and (5) MI Paste ONE toothpaste and Caphosol mouthwash. Microhardness, surface roughness values, and the topographical characteristics of the dentin surface were assessed. The highest percentage of recovered dentin microhardness (%RDMH) value was observed in groups 2 and 4, followed by groups 5 and 3, respectively. The %RDMH values in groups 2 and 4 did not demonstrate a significant difference (p = 0.855). The highest percentage of improvement in surface roughness was recorded in groups 2 and 4, with no significant differences (p = 0.989). The atomic force microscopy (AFM) findings were consistent with the surface roughness data. The best recovery of dentin microhardness and roughness were measured with the Elmex and Oral B toothpaste and mouthwash, followed by MI Paste ONE toothpaste and Caphosol mouthwash and Vitis anticaries biorepair toothpaste and mouthwash.

Effect of surface pretreatment with two desensitizer techniques on the microleakage of resin composite restorations.

This study evaluated the effect of two desensitizing procedures on the marginal microleakage of composite restorations bonded by a two-step etch-and-rinse adhesive. Class V cavities were prepared on the buccal surfaces of 42 extracted premolars at the cementoenamel junction and randomly divided into three groups of 14 each. In group 1 (control), an adhesive (Excite) was applied according to manufacturer's instructions. In group 2, after the application of oxalate desensitizer (BisBlock) to the cavities, the specimens were etched, and Excite was applied and light cured. In group 3, the cavities were treated with CO(2) laser irradiation (1 W power output in a continuous wave mode, 10 s), and then, the specimens were etched and bonded by Excite. All the cavities were restored with a resin composite. After water storage and thermocycling, the specimens were placed in 1 % basic fuchsin blue dye solution. The dye penetration was evaluated using a stereomicroscope. The data were analyzed by using Kruskal-Wallis and Mann-Whitney statistical tests (α = 0.05). There was a significant difference among three groups at the gingival and occlusal margins (P < 0.05). The specimens treated with BisBlock exhibited higher microleakage at both margins than those of the control and laser-treated groups (P < 0.001). There was no significant difference between the control group and group treated with CO(2) laser at both margins (P > 0.05). CO(2) laser did not show a detrimental effect on the marginal sealing ability of the adhesive system used in resin composite restorations. However, oxalate desensitizer adversely influenced the sealing ability of the restorations.

Restoration of primary anterior teeth using intracanal polyethylene fibers and composite: an in vivo study.

PURPOSE: To evaluate the clinical performance of polyethylene fiber for anterior primary teeth restorations in children after 2.5 years, according to modified Ryge criteria. MATERIALS AND METHODS: Fifty-five maxillary incisors with extensive caries in 24 Iranian patients (mean age 4.2 years) were restored. All teeth were treated endodontically. First, 4-mm layer of paste at the entrance of canal was removed, and a thin base layer of polycarboxylate cement was placed at the bottom of the prepared canal. All tooth surfaces were etched, rinsed and dried, and the dentin adhesive Single Bond (3M ESPE, St Paul, MN, USA) was applied. The teeth received intracanal fiber-reinforced resin (Ribbond Triaxial, Seattle, WA, USA) fixed with a flowable composite and the crowns were reconstructed with microhybrid composite resin (Z250, 3M). All restorations were evaluated every 6 months for 30 months by 2 independent evaluators. Statistical analysis was done with McNemar's test. RESULTS: The surface textures for most of the restorations were judged as excellent. There was no evidence of significant changes in marginal integrity. Most restored incisors (81%) received an Alpha rating for retention. The baseline and recall retention scores differed significantly (p=0.002). CONCLUSION: Polyethylene fiber posts associated with extensive composite restoration showed excellent clinical performance after 2.5 years in primary anterior teeth after pulp therapy.

Shear Bond Strength and Microleakage of Fissure Sealant to Contaminated and Non-Contaminated Enamel: A Systematic Review and Meta-Analysis of In Vitro Studies.

Purpose: The purpose of this study was to review the in vitro literature on shear bond strength (SBS) and microleakage of pit and fissure sealant materials in contaminated (water, human, or artificial saliva) and non-contaminated conditions. Methods: PubMed®, Web of Science™, Scopus®, Embase™, and Cochrane Library databases were used as data sources. Of the 974 studies identified, 56 were considered eligible for full-text screening and 32 were selected for data extraction. Results: The meta-analysis demonstrated that contaminated conditions decreased the SBS of the sealants by 4.33 MPa. In the contaminated subgroup analysis, both unfilled (Clinpro™, 3M™) and filled (FluroShield®, Dentsply) resin-based sealants achieved a similar SBS (P=0.82). Regarding the outcome measurements, extensive methodological heterogeneity was found among the studies for SBS measurements (I 2 equals greater than or equal to 84 percent; P<0.001), whereas homogeneity was found for microleakage (I 2 equals 84 percent; P=0.85). When evaluating resin-based sealants, the level of microleakage in the contaminated and non- contaminated groups was not significantly different (P=0.1). Conclusion: Surface contamination decreases the bond strength between contaminated enamel and both unfilled and filled resin-based sealants, which affects the clinical effectiveness of sealants.

Assessment of knowledge, attitude, and behavior related to children's oral health in pediatricians and students in the pediatric field in Iran: a cross-sectional study.

Background: Pediatricians have an important role to play in motivating and instructing parents on oral health in children. The aim of this study was to assess knowledge of, attitude to, and behavior regarding oral health care in children among pediatricians and students in the pediatric field in Iran. Methods: This cross-sectional study included all students in the pediatric field (those who had started a residency or fellowship) and practicing pediatricians in provincial centers and universities (61 setting centers) throughout Iran in the course of 2021. Participants completed an online questionnaire assessing details of the parameters of knowledge of, attitude to, and behavior toward oral health for each individual. A convenience sampling technique was used to gather the study sample. All data were coded for each of the parameters. The data were analyzed by one-way ANOVA (Analysis of Variance)/Tukey and Pearson's correlation tests and path analysis. Results: Out of 582 participants who visited the website, a total of 217 completed the entire questionnaire (participation rate of 37.2%). On the attitude parameter, 84.8% of participants scored above 75% of the possible attainable score, while only 37.9% and 48.1% of them had adequate knowledge and behavior for the possible score, respectively. Specialists had a higher mean score on behavior and knowledge than residents (P=0.001). There was a significant correlation between the scores on attitude and behavior (r=0.42, P<0.001), attitude and knowledge (r=0.19, P=0.005), and behavior and knowledge (r=0.25, P<0.001). Nearly all of the participants, 216 (99.5%), felt the need for the principles of dentistry to be included in the curriculum. Conclusions: Pediatricians showed a favorable attitude to oral health, but their knowledge of and behavior in the field was inadequate. Improvement of pediatricians' interest and performance in oral health in children should be encouraged through the inclusion of these parameters in the curriculum for students of the pediatric field. Implementing training programs for practical pediatricians or incorporating independent theoretical and clinical courses offered by pediatric dentists in dental school departments into the field curriculum of the students in the pediatric field is recommended.

Antibacterial activity in adhesive dentistry: a literature review.

This literature review summarizes the published research regarding the antibacterial agents used in adhesive dentistry. This article provides information about the clinical applications, beneficial effects, and possible disadvantages of antibacterials when used in various bonding situations.

Penetration ability and microhardness of infiltrant resin and two pit and fissure sealants in primary teeth with early enamel lesions.

To determine the penetration depth and enamel microhardness (EMH) of an infiltrant resin and two fissure sealants in primary teeth with early enamel lesions. We randomly divided 174 sound teeth into six groups (n = 29): (1) phosphoric acid (PA) + Clinpro, (2) PA + Aegis, (3) Icon, (4) hydrochloric acid (HCl) + Clinpro, (5) HCl + Aegis, and (6) control. Percentage penetration (%PP) was analyzed by confocal laser scanning microscopy (n = 15). EMH was measured (n = 12), and the percentage of EMH recovery (%REMH) was calculated. Twelve samples were examined under a scanning electron microscope (SEM). All data were analyzed with the Kruskal-Wallis and one-way ANOVA tests (p < 0.05). Groups 3 and 4 showed the highest %PP (all, p < 0.05). Icon application led to significantly higher %REMH compared to the others (p < 0.05). Groups 2 and 5 showed the lowest reduction in %REMH after pH-cycling. Application of Icon and Clinpro with HCl pretreatment showed the greatest %PP. pH-cycling led to a decrease in %REMH for all of the materials, although this effect was lower in teeth treated with Aegis.

Remineralization effects of self-assembling peptide P11 -4 associated with three materials on early enamel carious lesions: An in vitro study.

The aim of this study was to assess the remineralization of enamel caries lesions using the self-assembling peptide P11 -4 associated with different materials. Artificial early enamel lesions were prepared on 154 primary teeth. The samples were randomly divided into eight groups: (1) control, (2) P11 -4, (3) fluoridate toothpaste (FT), (4) P11 -4 + FT, (5) casein phosphopeptide-amorphous calcium phosphate (CPP-ACP), (6) P11 -4 + CPP-ACP, (7) fluoridate bioactive glass toothpaste (BT), and (8) P11 -4 + BT. The surface enamel microhardness (EMH) and energy-dispersive X-ray spectroscopy (EDS) of the teeth were then measured at the baseline, after demineralization, and after 28 days of remineralization. The enamel surfaces were assessed by field emission scanning electron microscopy (FESEM) and atomic force microscopy (AFM). The data were analyzed with one-way analysis of variance (ANOVA) (p < .05). EMH after demineralization was significantly lower than the baseline value (p < .001). The interventions led to an enhanced percentage of EMH recovery (%REMH), which was higher in Groups 6 and 7. There was no significant difference between Groups 3 and 4. Groups 1 and 2 had the lowest %REMH. The mean calcium/phosphate weight percentage ratio of P11 -4 was significantly lower than the others (p < .001). The FESEM and AFM images revealed mineral deposition on the eroded enamel and reductions in surface roughness in Groups 5 and 7.

Witkop tooth and nail syndrome: a report of three cases in a family.

Witkop tooth and nail syndrome is a rare autosomal dominant ectodermal dysplasia manifested by hypodontia and nail dysplasia. Tooth shape may vary, and conical and narrow crowns are common. Mandibular incisors, second molars, and maxillary canines are the most frequently missing teeth. Nail dysplasia affects the fingernails and especially the toenails and is often more severe in childhood. Nails may be spoon-shaped, ridged, slow-growing, and easily broken. We examined an Eastern Mediterranean family in which three siblings (two girls, one boy) had this syndrome. The severity of finger and toenail anomalies varied. The children's mother had no Witkop-related abnormalities, but their father was reported to have dental and nail anomalies. Early intervention is recommended to manage orofacial disfigurement and avoid negative social consequences for these children.

Evaluation of a school-based pit and fissure sealant programme in Iranian children.

PURPOSE: This study evaluated sealants placed on permanent molars in first-grade students in Shiraz primary schools during 2008 under a school oral health programme. MATERIALS AND METHODS: A total of 420 sealed first permanent molar teeth in 179 students (mean age 8 years, 6 months) were evaluated for fissure sealant retention, occlusal caries status and Feigal criteria. All teeth were examined 1.5 years after application. The fissure sealants (Conceal F, SDI) were placed on occlusal surfaces after traditional acid etching. Statistical analysis was done with the chi-square test (P < 0.05). RESULTS: 57.5% of the seals were completely retained, 29.6% partially lost and 12.9% completely lost. There were no signs of carious lesions in 77.1% of the teeth. According to the Feigal criteria, success rates based on marginal integrity, marginal discolouration and anatomical form were 98.2%, 95.5% and 58.6%, respectively. The overall success rate with all three criteria was 54.14%. There were no significant relationships between the results and patient gender or tooth position in the arch. CONCLUSION: Although fissure sealants are an effective method for preventing tooth caries, the results of this study indicate that public oral health programmes need to be implemented more carefully and that follow-up programmes are advisable.