Evaluation of Internet users' interest in paediatric dental problems during the COVID-19 pandemic.

BACKGROUND: The coronavirus (COVID-19) pandemic had a significant impact on dental care providers; patients had trouble accessing routine dental care due to concerns about dentist and patient safety. People spent more time at home due to lockdown restrictions and a growth in individuals working from home. This increased the likelihood of looking for dental care information on the Internet. In the present study the aim was to compare the trends of Internet searches about paediatric dentistry before and after the pandemic. METHODS: The monthly variation in relative search volume (RSV) and the lists of paediatric dentistry-related queries were determined from December 2016 to December 2021 using Google Trends. Two separate datasets were obtained before and after the pandemic. One-way ANOVA was used to determine whether there was a significant difference in RSV scores between the first 2 years of COVID-19 and the first 3 years before COVID-19. T-tests were used for bivariate comparisons. RESULTS: There was a statistically significant increase in queries regarding dental emergencies, especially toothache (p < 0.01) and dental trauma (p < 0.05). The RSV of paediatric dentistry queries increased over time (p < 0.05). Other queries about recommended dental procedures during the pandemic, such as the Hall technique and stainless steel crowns, showed an increasing trend. However, these were not statistically significant (p > 0.05). CONCLUSIONS: More searches were carried out, related to dental emergencies, on the Internet during the pandemic. Moreover, non-aerosol generating procedures such as the Hall technique became increasingly popular according to the frequency of searches carried out.

Effectiveness of Different Cleaning Solutions in Removing Residual Caries-Detector Dyes.

OBJECTIVE: Caries-detector dyes (CDDs) have proven useful in the identification and removal of carious dentin. However, residues of these cleaning agents may remain in the oral cavity. This study conducted spectrophotomectric analyses to evaluate the effectiveness of different cleaning agents in removing residual CDDs from the oral cavity. MATERIAL AND METHOD: Ninety freshly extracted human third-molar teeth were used in the study. Tooth occlusal surfaces were ground to expose dentin. Specimens were randomly distributed into 3 groups according to CDD [Seek Caries Indicator (SCI), Caries Detector (CD), Caries Marker (CM)], and each group was further divided into 3 sub-groups according to cleaning solution [distilled water (DW), 3% NaOCl, and 3% H2 O2 )]. CDDs were applied to dentin surfaces according to the manufacturer's instructions and then rinsed with a cleansing solution. The effectiveness of cleaning solutions in removing CDD residues was determined according to color change by comparing spectrophotometric measurements of tooth color before CDD application and after cleaning. Data were analyzed using two-way analysis of variance (ANOVA) and Tukey's HSD test (α = 0.05). RESULT: For all CDDs groups, the smallest color differences were observed in the 3% NaOCl sub-groups (P < .05), and the largest in the distilled water sub-groups (P > .05). When compared to the other CDD groups, the SCI group yielded the greatest color differences for all cleaning-agent sub-groups. CONCLUSION: Cleaning solutions such as 3% NaOCl or 3% H2 O2 can be used to remove residual CDD from dentin surfaces. CLINICAL SIGNIFICANCE: This study compared the effectiveness of three different cleaning agents in caries removal process.

Effect of a third-generation LED LCU on microhardness of tooth-colored restorative materials.

OBJECTIVE: To assess the effects of different modes of a third-generation light-curing unit (LCU) (VALO) on the microhardness of restorative materials. DESIGN: A microhybrid composite resin (Filtek(™) Z550), a giomer (Beautifil II), a compomer (Dyract eXtra) and a RMGIC (Photac(™) Fil) were used in the study. Three different modes of VALO were tested and a second-generation LCU (Elipar S10) was used as a control. The microhardness (VHN) was measured using a Vickers Hardness tester. Data were analyzed using two-way anova and post hoc Tukey's test (P < 0.05). RESULTS: The Filtek Z550 group had the highest VHN values followed by Photac Fil, Beautifil II and the Dyract eXtra at both top and bottom surfaces, however the difference between Filtek Z550 and Photac Fil was not statistically significant for the bottom surfaces (P > 0.05). Of the different curing protocols tested, the VALO LCU in Mode 3 resulted in the lowest VHN values at both top and bottom surfaces (P < 0.05). CONCLUSION: Based on the results of this study, it can be concluded that the high-power mode of the VALO LCU can be recommended for clinical applications especially in pediatric patients, as it can shorten the time required to adequately polymerize resin-based tooth-colored restorative materials.

Effect of fluoride varnish with added casein phosphopeptide-amorphous calcium phosphate on the acid resistance of the primary enamel.

BACKGROUND: This study aimed to investigate the effects of a fluoride varnish with added Casein Phosphopeptide-Amorphous Calcium Phosphate (CPP-ACP) treatments on acid resistance of primary teeth enamel. METHODS: Enamel specimens obtained from 40 primary incisors (for surface microhardness testing) and 40 primary molars (for demineralization depth measurement) were randomly divided into four groups (n = 10 incisors and 10 molars) each according to surface treatment: no treatment (control), MI varnish (1-8 % sodium fluoride and 1-5 % CPP-ACP), Clinpro White (1-5 % sodium fluoride and <5 % modified tricalcium phosphate), Duraphat (<5 % sodium fluoride). Specimens were stored for 24 h in a moist environment. After varnish residues were removed, specimens were subjected to pH cycling. The effects of fluoride varnishes were evaluated according to surface microhardness, lesion depth and structural changes. Results were analyzed by ANOVA and Tukey's tests. RESULTS: The lowest changes in surface microhardness and lesion depth occurred in MI varnish group, followed by the Clinpro White, Duraphat and no treatment (control) group (for percentage of loss surface microhardness -20.80, -34.60, -57.80 and -73.40; for lesion depth values 23.60 µm ± 3.36, 29.85 µm ± 3.27, 40.37 µm ± 3.41 and 54.56 µm ± 4.16, respectively). Statistically significant differences in both surface microhardness and lesion depth were observed among all groups (P < 0.05). CONCLUSIONS: Within the limitations of this in vitro study, fluoride varnish containing CPP-ACP was more effective in increasing the acid resistance of primary enamel than other fluoride varnishes. However, further clinical research is needed to confirm these in vitro results.

Postfabrication thickness of single- and double-layered pressure-formed mouthguards.

AIM: The thickness of a mouthguard (MG) plays an important role in its primary function of preventing injuries. Multi-layered MGs have recently come into prominent use due to the disadvantages associated with single-layered MGs. Whereas researchers have evaluated the postfabrication thickness of single-layered MGs, the effects of fabrication procedures on multi-layered MGs are unknown. This study aimed to evaluate postfabrication thickness of various single-layered and double-layered pressure-formed MGs. MATERIALS AND METHODS: Mouthguards were fabricated using stone models produced from impressions of a phantom model maxillary arch. A total of 50 MGs were fabricated from ethylene vinyl acetate (EVA) sheets and divided into 10 groups of five according to the sheet(s) used in fabrication. The initial thickness of each sheet was recorded prior to fabrication. Following fabrication, MG thickness was measured at seven sites per MG. Data were analyzed using independent t-tests and one-way anova followed by Tukey's test. RESULTS: Mean reduction in MG thickness was 36-38% for single-layered MGs and 32-34% for double-layered MGs. Significant differences in thickness were seen between measured sites for all MG groups (P < 0.05). Maximum thinning occurred at the incisal edge of the central incisor, whereas minimum thinning was observed in the molar crown fissure sites for all groups. CONCLUSION: Clinicians should take into account the effects of fabrication on MG thickness. A loss of thickness of approximately 50% should be expected in critical areas of both single-layered and double-layered MGs made from EVA.

The effect of common infant foods on plaque pH.

PURPOSE: To evaluate the effect of cow's milk, milk plus sugar, milk plus honey and formula on plaque pH when compared to a 10% sucrose solution in 8- to 12-year-old children. MATERIALS AND METHODS: Plaque pH was measured using a pH microelectrode at baseline to determine resting plaque pH and at intervals between 1 and 60 min after rinsing with the test liquids. Plaque pH data were analysed using repeated- measure ANOVA and paired t tests. RESULTS: The study findings showed that 10% sucrose has the greatest cariogenic potential, followed by milk plus honey, milk plus sugar, formula and cow's milk. Except for the control group, the evaluated foods did not reduce the pH below 6. CONCLUSION: Although the test groups appear to be non-cariogenic as compared with sucrose, they still lead to considerable acidogenic response in the dental plaque. When bottle feeding is essential, it was confirmed that frequently use of these beverages may cause enamel demineralisation.

Evaluation of elementary school teachers' knowledge and attitudes about immediate emergency management of traumatic dental injuries.

PURPOSE: To investigate teachers' knowledge and attitudes about emergency management of traumatic dental injuries (TDIs) in children. MATERIALS AND METHODS: A total of 764 teachers from 13 elementary schools were included in the study. Data were collected using a self-reporting questionnaire in which teachers were asked about demographic information, previous experience with dental trauma, first-aid training, knowledge of emergency management and how they would respond to two hypothetical TDI cases. RESULTS: Of the 764 participants, 550 (71.4%) returned the questionnaire; of these, 309 (56.2%) were female and 241 (43.8%) were male. While 297 teachers reported having had first-aid training, only 13 (4.4%) of them reported emergency management of TDIs being covered in this training. Less than half of respondents (47.5%, n = 261) correctly answered the question on the appropriate response to a TDI involving a fractured tooth and only one-quarter of respondents (25.4%, n=140) correctly answered the question on the appropriate response to a TDI involving an avulsed tooth. CONCLUSION: The results of this study demonstrated teachers' low level of knowledge about the emergency treatment of TDIs in schoolchildren, suggesting that educational programmes are needed to improve proper emergency management of TDIs by teachers.

Dental development in children with mild-to-moderate hypodontia.

INTRODUCTION: The aim of this study was to compare dental development in a group of children with mild-to-moderate hypodontia with a matched group. METHODS: A study group of 70 children (43 girls, 27 boys) with hypodontia, aged 5.3 to 12.5 years, was matched for race, age, and sex with 140 healthy, normal control subjects. The children's dental ages were calculated by using a modified dental-age estimation method. Differences between dental and chronologic ages were analyzed by t tests, and the correlations between differences in dental and chronologic ages and the numbers of missing teeth were analyzed with the Spearman correlation test. RESULTS: Dental development in children with mild-to-moderate hypodontia was significantly delayed compared with the control group (P <0.05); however, the mean difference did not exceed 0.3 years in either sex. No correlation was observed between the differences in dental and chronologic age and the severity of hypodontia. CONCLUSIONS: Children with mild-to-moderate hypodontia had delayed dental development of a few months; this was statistically significant. Because of individual variations, each patient should be carefully examined.

Effects of casein phosphopeptide-amorphous calcium phosphate (CPP-ACP) application on enamel microhardness after bleaching.

PURPOSE: To evaluate the effect of casein phosphopeptide-amorphous calcium phosphate (CCP-ACP) application on the microhardness of bleached enamel and compare it to that of fluoride application. METHODS: 10 extracted bovine incisors were cut into four sections (4 x 4 x 3 mm) that were randomly distributed among five groups (n = 8). All groups were bleached three times using 38% hydrogen peroxide (HP), with 5-day intervals between bleaching, according to the following treatment protocols: Group A: bleaching only; Group B: bleaching + daily CCP-ACP paste; Group C: bleaching + daily casein phosphopeptide-amorphous calcium fluoride phosphate (CPP-ACPF) paste; Group D: bleaching + daily 250ppm NaF solution; Group E: bleaching + APF gel (once after final bleaching). Specimens were maintained in artificial saliva throughout the experiment. Baseline and post-treatment Vickers microhardness values were obtained for all specimens. Statistical analysis was performed using one-way ANOVA and post-hoc Tukey tests. RESULTS: Groups B and C showed significant increases in enamel microhardness following treatment (P < 0.001), whereas no statistically significant changes were observed in Groups A, D, or E (P > 0.05). One-way ANOVA of delta Vickers microhardness numbers (deltaVHN) revealed significant differences among groups (P < 0.001), with Group B showing the highest deltaVHN and Group A the lowest.

Cytotoxic effects of halogen- and light-emitting diode-cured compomers on human pulp fibroblasts.

OBJECTIVE: The aim of this study was to determine the cytotoxic effects of three different compomers (Dyract AP, Compoglass, and Hytac) cured using a halogen light-curing unit (LCU) and a light-emitting diode (LED) LCU on human pulp fibroblasts. METHODS: Specimens of three compomers were added to human pulp fibroblast cultures. Cytotoxicity was evaluated over 96 h using the agar overlay method. RESULTS: All three compomers tested were found to be moderately cytotoxic to human pulp fibroblasts, regardless of whether they were cured using halogen or LED LCUs. The decolorization zone of Hytac was significantly larger than those of the other compomers tested (P < 0.05). Dyract AP and Compoglass specimens showed greater decolorization when cured with LED than with halogen LCUs (P < 0.05). CONCLUSION: Compomers are potentially toxic to human pulp fibroblasts, and the type of curing unit may affect compomer toxicity.

Shear bond strengths of different adhesive systems to white mineral trioxide aggregate.

This study was conducted to compare the shear bond strengths of different adhesive systems to White Mineral Trioxide Aggregate (WMTA). To this end, 40 cylindrical acrylic blocks with a hole in the middle measuring 4 mm diameter x 2 mm height were prepared. The hole was filled with WMTA, and the specimens were allocated into four groups: Group 1--Prime & Bond NT; Group 2--AdheSE; Group 3--Xeno III; and Group 4--Adper Prompt L-Pop. In each group, a different adhesive system and a compomer (Dyract AP) were applied over WMTA. Shear bond strengths were measured using a universal testing machine, and then the data were subjected to one-way ANOVA and Scheffé's post hoc test (p<0.05). Significantly lowest shear bond strength value was obtained with Adper Prompt L-Pop, whereas Prime & Bond NT revealed higher shear bond strength than the others (p<0.05). In conclusion, an etch-and-rinse adhesive system--which exhibited significantly higher shear bond strength than self-etch adhesive systems--could be a preferred choice when placing compomer materials upon WMTA.

The effects of children's drinks on the color stability of various restorative materials.

OBJECTIVE: To evaluate the effects of exposure to various children's drinks on the color stability of different esthetic restorative material commonly used in pediatric dentistry. STUDY DESIGN: Cylindrical specimens (15 x 2mm) were prepared from four different restorative materials (Fuji IX, Fuji II LC, Dyract Extra, and Filtek Z250). For each material, 20 specimens were prepared and divided into four groups. Each group was stored in a different solution (distilled water chocolate milk, cola, grape juice) for 24 hours. A colorimeter was used to measure the color of each specimen both before and after staining. Color change (deltaE*) was calculated, and data was analyzed using two-way ANOVA and Tukey HSD tests. RESULTS: For all restorative materials, the lowest deltaE* values were recorded for specimens stored in distilled water (0.42), followed by chocolate milk (0.88), grape juice (3.45) and cola (3.97). Among the four restorative materials tested, Fuji II LC showed the most color change (3.71) and Fuji IX the least (1.33). There were statistically significant differences among above groups (p < 0.05). CONCLUSIONS: DeltaE* values were acceptable for all materials tested, with the exception of Fuji II LC. Therefore, the use of RMGIC should be avoided in anterior restorations in children due to esthetic reasons.

Effects of Deproteinization on Bond Strength of Composite to Primary Teeth Affected by Amelogenesis.

Purpose: The purpose of this study was to evaluate the effect of different dentin deproteinization treatments on the microtensile bond strength (µTBS) of composite resin to primary dentin affected by hypocalcified amelogenesis imperfecta (AI). Methods: Flat dentin surfaces were obtained from both extracted hypocalcified AI-affected and sound primary molars and then randomly allocated into three groups according to surface treatment (deproteinization with sodium hypochlorite [NaOCl], deproteinization with chlorine dioxide [ClO2], nontreated controls). µTBS of specimens were measured with a universal testing machine, and data were analyzed using one-way analysis of variance and Tukey's tests. Results: The µTBS values for all groups with sound primary teeth were significantly higher than those of the comparable groups of hypocalcified AI-affected primary teeth (P<0.05). There were no statistically significant differences between the µTBS values of the control and the NaOCl groups for either the hypocalcified AI-affected or sound primary teeth (P>0.05); however, the µTBS values for the ClO2 groups were significantly higher than those of both the control and NaOCl groups (P<0.05). Conclusions: Within the limitations of this in vitro study, deproteinization with ClO2 can be considered effective in enhancing dentin bonding of hypocalcified AI-affected primary teeth.

Orthodontic extrusion of a traumatically intruded permanent incisor: a case report with a 5-year follow up.

This report presents a case of intrusive luxation of the immature left maxillary central incisor in an 8-year-old girl. Initially, it was decided to allow the intruded tooth to spontaneous re-erupt because it had open apices. After 12 weeks of monitoring for spontaneous re-eruption, there was no clinical evidence of its occurrence. Therefore, orthodontic extrusion was initiated. The intruded tooth was repositioned with a fixed multibracketed appliance. Twenty weeks after the beginning of orthodontic extrusion, the position of the intruded maxillary central incisor was restored to its original position before its displacement occurred. After 5 years, no clinical or radiographic pathology was detected and obliteration of the pulp canal of the intruded tooth was observed radiographically.

Multidisciplinary approach to a subgingivally fractured incisor tooth: A case report.

This case report describes a multidisciplinary approach using orthodontic forced eruption to facilitate prosthetic restoration of a subgingivally fractured maxillary permanent central incisor. A 14-year-old male patient presented at the pediatric dental clinic due to unesthetic appareance and for management of a fractured maxillary right central incisor tooth. Intraoral examination revealed that the maxillary right central incisor had sustained a crown-root fracture with pulp exposure. We treated the tooth endodontically and performed orthodontic root extrusion with a modified Hawley appliance prior to prosthetic rehabilitation. Approximately 2-3 mm of extrusion of the tooth was obtained within 8 weeks. A fiber post was then inserted into the root canal, and final restoration was completed with an all-ceramic crown. Follow-up 18 months after treatment revealed good periodontal health, esthetics and normal function.

Parental knowledge and attitudes regarding the emergency treatment of avulsed permanent teeth.

OBJECTIVE: The aim of this study was to examine parental knowledge and attitudes about avulsed permanent teeth and their emergency treatment in children. METHODS: A total of 289 parents of children aged 6-12 years receiving care at the Ondokuz Mayis University Pediatric Dentistry Clinic were included in the study. Questionnaires were used to collect data on parents' demographic characteristics, previous training in traumatic dental injury and treatment and knowledge of avulsed permanent teeth and their emergency management. Chi-square tests were used to identify differences in responses for different variables. RESULTS: More than half of the participating parents were female (69.6%) and between the age of 30-39 years (64.4%). Most (90.7%) reported that they would not replant the avulsed tooth in its socket, and most (68.2%) gave correct answers regarding the optimum time for which an avulsed tooth should be left out of the mouth prior to replantation. However, most parents were not sufficiently informed about the appropriate method for cleaning a dirty avulsed tooth or transporting it to a dentist or doctor. None of the demographic characteristics or training status was found to have a statistically significant effect on the number of correct responses regarding appropriate management of avulsion injuries (P>.05) CONCLUSION: This study revealed that the parental level of knowledge about the emergency treatment of avulsion in children is inadequate and that educational campaigns are necessary to improve proper emergency management of dental avulsion.

Evaluation of survival of 3 different fixed space maintainers.

PURPOSE: The purpose of this study was to provide a comparative evaluation of the survival times and failure rates of different types of fixed space maintainers (SMs). METHODS: A total of 30 4- to 10-year-olds were selected for the study. Children were divided into 3 groups, according to type of SM, namely: band and loop (B&L), direct bonded (DB), and fiber-reinforced composite (FRC). Patients were recalled once every 3 months for clinical evaluation for 1 year or until failure. The survival times of SMs were estimated by means of the Kaplan-Meier method, and confounding factors were investigated using Cox regression analysis. RESULTS: Mean survival time was highest for B&L SMs (11.20 months), followed by DB SMs (9.20 months) and FRC SMs (6.70 months). There were statistically significant differences noted between types of SMs (log rank=11.99; P=.002). The Cox proportional hazards model revealed that age, sex, dental arch, and side of the jaw were not significantly correlated with "success of SMs" (P>.05). CONCLUSIONS: Band and loop fixed space maintainers showed superior performance in terms of both survival time and success rates versus direct bonded and fiber-reinforced composite space maintainers.

Multidisciplinary treatment of a subgingivally fractured tooth with indirect composite restoration: a case report.

In pediatric patients, anterior teeth with fractures that extend subgingivally require a complex treatment plan that addresses biologic, esthetic, and functional factors, such as mastication and speech. The purpose of this clinical report was to describe a technique using indirect composite restoration to restore a subgingivally fractured permanent maxillary right central incisor in a 10-year-old boy. Due to the complex nature of the treatment, a multidisciplinary approach was used to restore the tooth. The crown fragment was removed, and endodontic treatment was performed. The tooth was then extruded orthodontically. A glass fiber post was placed to improve retention, and an indirect composite restoration was placed. A clinical and radiographic evaluation at a follow-up appointment 1 year later confirmed that the technique used in this case can be a good option for restoring anterior teeth with subgingival fractures.

Fluoride release and recharge from different materials used as fissure sealants.

OBJECTIVES: Fluoride release/recharge properties of fissure sealants are important for their long-term inhibition of caries. This study was conducted to examine the relationship between fluoride release and recharge of pit-and-fissure sealants. METHODS: Specimens were prepared from 5 different sealant materials: Fissurit F, a conventional resin; Fuji VII, a glass-ionomer cement (GIC); Fuji II LC, a resin-modified GIC; Ionosit, a polyacid-modified composite resin (PMRC); and Aelite Flo, a flowable composite resin. Specimens stored in a polyethylene test tube containing 5.0 ml ultrapure water. On day 21, specimens were exposed to 1.23% APF gel. Fluoride release was measured using a fluoride-specific ion electrode at 1-7, 14, 21, 22, 28, 35 and 42 days. RESULTS: The glass-ionomer based sealants Fuji VII and Fuji II LC had significantly higher fluoride release than the other materials at all times tested (P<.05). Fluoride release of all materials tested increased following exposure to APF gel (P<.05). CONCLUSIONS: Within the limitations of this short-term study, glass ionomer-based sealants were shown to have higher initial fluoride release as well as higher fluoride recharge capacity than other sealants.

Polyethylene fiber-reinforced composite resin used as a short post in severely decayed primary anterior teeth: a case report.

The case report presented here is of a 4-year-old girl with severely decayed maxillary anterior teeth. After root canal treatment, the primary maxillary central and lateral incisors were reinforced using polyethylene fiber-reinforced composite resin short posts and restored using celluloid strip crowns. The technique described here offers a simple and effective method for restoring severely decayed primary anterior teeth that reestablishes function, shape, and esthetics.