Impact of different restorative treatments for deep caries lesion in primary teeth (CEPECO 1) - study protocol for a noninferiority randomized clinical trial.

BACKGROUND: Due to the lack of evidence to determine the best treatment for deep cavitated caries lesions in primary molars, the search for an effective restorative technique, which results in a minimal discomfort to patients, and reduce the time needed for the treatment, becomes relevant. The objective of this randomized clinical trial was to evaluate if high-viscosity glass ionomer cement (HVGIC) restorations is noninferior to restoration with calcium hydroxide cement associated with HVGIC for treatment of deep lesions in primary molars, as well as the impact of the treatments on cost and discomfort of the patient. METHODS: A non-inferiority randomized clinical trial with two parallels arms (1:1) will be conducted. Children with 4 to 8 years will be selected at Clinic of Pediatric Dentistry at Ibirapuera University. 108 teeth will be randomized into two groups: (1) Calcium hydroxide cement associated with HVGIC and (2) HVGIC restoration. Primary outcome will be considered the pulp vitality and to be evaluated after 6, 12, 18 and 24 months by two calibrated examiners. Survival of restorations will also be evaluated in the equal intervals. The duration of dentals treatment and the cost of all materials used will be considered for estimating of cost-efficacy of each treatment. Individual discomfort will be measured after each dental procedure using the Wong-Baker's Facial Scale. For the primary outcome, Kaplan-Meier survival and the long-rank test will be used to comparison between the groups. Cox regression will be performed to assess the influence of variables on the outcome. For all analyzes, the significance level is set at 5%. DISCUSSION: Based on the philosophy of ART, our hypothesis is that the HVGIC restoration is a possible approach to restore the deep caries lesion with pulp vitality without the use of rubber dam and anesthesia. TRIAL REGISTRATION: Clinicaltrials.gov registration NCT02903979 . Registered on June 9th 2016.

Preformed crowns for decayed primary molar teeth.

BACKGROUND: Crowns for primary molars are preformed and come in a variety of sizes and materials to be placed over decayed or developmentally defective teeth. They can be made completely of stainless steel (know as 'preformed metal crowns' or PMCs), or to give better aesthetics, may be made of stainless steel with a white veneer cover or made wholly of a white ceramic material. In most cases, teeth are trimmed for the crowns to be fitted conventionally using a local anaesthetic. However, in the case of the Hall Technique, PMCs are pushed over the tooth with no local anaesthetic, carious tissue removal or tooth preparation. Crowns are recommended for restoring primary molar teeth that have had a pulp treatment, are very decayed or are badly broken down. However, few dental practitioners use them in clinical practice. This review updates the original review published in 2007. OBJECTIVES: Primary objectiveTo evaluate the clinical effectiveness and safety of all types of preformed crowns for restoring primary teeth compared with conventional filling materials (such as amalgam, composite, glass ionomer, resin modified glass ionomer and compomers), other types of crowns or methods of crown placement, non-restorative caries treatment or no treatment. Secondary objectiveTo explore whether the extent of decay has an effect on the clinical outcome of primary teeth restored with all types of preformed crowns compared with those restored with conventional filling materials. SEARCH METHODS: We searched the following electronic databases: Cochrane Oral Health Group Trials Register (to 21 January 2015), Cochrane Central Register of Controlled Trials (CENTRAL; The Cochrane Library, 2014, Issue 12), MEDLINE via Ovid (1946 to 21 January 2015) and EMBASE via Ovid (1980 to 21 January 2015). We searched the US National Institutes of Health Trials Register (http://clinicaltrials.gov) and the World Health Organization (WHO) International Clinical Trials Registry Platform for ongoing trials and Open Grey for grey literature (to 21 January 2015). No restrictions were placed on the language or date of publication when searching the databases. SELECTION CRITERIA: Randomised controlled trials (RCTs) that assessed the effectiveness of crowns compared with fillings, other types of crowns, non-restorative approaches or no treatment in children with untreated tooth decay in one or more primary molar teeth. We would also have included trials comparing different methods of fitting crowns.For trials to be considered for this review, the success or failure of the interventions and other clinical outcomes had to be reported at least six months after intervention (with the exception of 'pain/discomfort during treatment and immediately postoperatively'). DATA COLLECTION AND ANALYSIS: Two review authors independently assessed the title and abstracts for each article from the search results. and independently assessed the full text for each potentially relevant study. At least two authors assessed risk of bias and extracted data using a piloted data extraction form. MAIN RESULTS: We included five studies that evaluated three comparisons. Four studies compared crowns with fillings; two of them compared conventional PMCs with open sandwich restorations, and two compared PMCs fitted using the Hall Technique with fillings. One of these studies included a third arm, which allowed the comparison of PMCs (fitted using the Hall Technique) versus non-restorative caries treatment. In the two studies using crowns fitted using the conventional method, all teeth had undergone pulpotomy prior to the crown being placed. The final study compared two different types of crowns: PMCs versus aesthetic stainless steel crowns with white veneers. No RCT evidence was found that compared different methods of fitting preformed metal crowns (i.e. Hall Technique versus conventional technique).We considered outcomes reported at the dental appointment or within 24 hours of it, and in the short term (less than 12 months) or long term (12 months or more). Some of our outcomes of interest were not measured in the studies: time to restoration failure or retreatment, patient satisfaction and costs. Crowns versus fillingsAll studies in this comparison used PMCs. One study reported outcomes in the short term and found no reports of major failure or pain in either group. There was moderate quality evidence that the risk of major failure was lower in the crowns group in the long term (risk ratio (RR) 0.18, 95% confidence interval (CI) 0.06 to 0.56; 346 teeth in three studies, one conventional and two using Hall Technique). Similarly, there was moderate quality evidence that the risk of pain was lower in the long term for the crown group (RR 0.15, 95% CI 0.04 to 0.67; 312 teeth in two studies).Discomfort associated with the procedure was lower for crowns fitted using the Hall Technique than for fillings (RR 0.56, 95% CI 0.36 to 0.87; 381 teeth) (moderate quality evidence).It is uncertain whether there is a clinically important difference in the risk of gingival bleeding when using crowns rather than fillings, either in the short term (RR 1.69, 95% CI 0.61 to 4.66; 226 teeth) or long term (RR 1.74, 95% CI 0.99 to 3.06; 195 teeth, two studies using PMCs with conventional technique at 12 months) (low quality evidence). Crowns versus non-restorative caries treatmentOnly one study compared PMCs (fitted with the Hall Technique) with non-restorative caries treatment; the evidence quality was very low and we are therefore we are uncertain about the estimates. Metal crowns versus aesthetic crownsOne split-mouth study (11 participants) compared PMCs versus aesthetic crowns (stainless steel with white veneers). It provided very low quality evidence so no conclusions could be drawn. AUTHORS' CONCLUSIONS: Crowns placed on primary molar teeth with carious lesions, or following pulp treatment, are likely to reduce the risk of major failure or pain in the long term compared to fillings. Crowns fitted using the Hall Technique may reduce discomfort at the time of treatment compared to fillings. The amount and quality of evidence for crowns compared to non-restorative caries, and for metal compared with aesthetic crowns, is very low. There are no RCTs comparing crowns fitted conventionally versus using the Hall Technique.

Referral patterns and general anesthesia in a specialized paediatric dental service.

OBJECTIVES: The caries patterns of child populations in Germany have changed during the last 20 years. This affects the referrals and provision of specialist dental care for children. This study has two aims: first, to investigate referrals received by a specialized pediatric dental institution in 1995 and 2008, and second, to assess the treatments performed during full oral rehabilitations under general anesthesia in this institution from 2007 to 2008. METHODS: All data of referred patients were evaluated for 1995 and 2008 separately. Comparisons were carried out for different socio-demographic, medical, and dental parameters. All patients treated under general anesthesia (GA) between March/2007 and December/2008 were examined retrospectively and their data were analyzed. RESULTS: In 1995 (n = 191), significantly older children were referred to specialized pediatric dental care compared to 2008 (n = 179). In addition, a shift of surgical referrals to very young children with high caries levels was clearly noticed, resulting in considerably more oral rehabilitation performed under GA in 2008 (n = 73). Thus, the mean values of 6.4 fillings and 2.7 extractions per child were quite high. CONCLUSIONS: Preventive treatment approaches for primary dentition in Germany need further improvement by focusing on high caries-risk groups, as specialized pediatric dentistry bears the great burden of providing oral rehabilitations under GA in young children.

Prosthetic Oral Rehabilitation of a Child With S-ECC: A Case Report with Histopathologic Analysis.

The aim of this case report is to describe the treatment planning of a young child with severe early childhood caries (S-ECC) as well as the prosthetic rehabilitation technique. A 3-year-old female child was referred to the pediatric dentistry clinic with the chief complaint of tooth pain, difficulty in eating and recurrent hospitalizations caused by dental infections. The mother reported intermittent episodes of fever and recurrent swelling of child's face. The girl presented angular cheilitis and was referred to a dietitian. The treatment plain consisted on a behavior changes in oral hygiene habits, exodontias of all primary teeth and oral rehabilitation with a prosthesis. The extracted teeth with periapical lesions were submitted to histopathologic analysis (hematoxilin and eosin staining) and revealed an inflammatory infiltrate. The aesthetic requirement of children with S-ECC has been a challenge to pediatric dentists. In the present case, the oral rehabilitation provided for the children better aesthetic, nutrition, phonation, and functional conditions.

[NONSURGICAL RECONSTRUCTION METHOD INTERDENTALLY PAPILLAE IN THE RESTATION OF APROXIMAL CAVITIES AS ONE OF THE STAGES OF REHABILITATION OF PATIENTS WITH GENERALIZAD PERIODONTITIS].

Reconstruction of missing papilla--the basis of modern concepts of objective treatment of dental diseases. Interproximal spaces are important anatomical structures, as are bulky in the mouth and repeated many times. Violation of relations between different structural elements increases the risk of inflammation in periodontitis. Patients with approximal caries posteriors and generalized periodontitis studied anthropometric parameters of the structures of the interdental spaces and their impact on the volume papilla before and after restoration, carried out with move a contact point to the apex. The results showed that the relationship between anthropometric data interdental had certain patterns in all groups surveyed. Important was a clear relationship between anthropometric indicators of basic elements of interdental spaces. In the absence of the interproximal papilla length (IPL) was on average 7.2 mm, the distance from the gingival margin to the proximal contact--3.9 mm and the horizontal distance between the roots at the enamel--cement border (HDR) reached 3.2 mm. Following the restoration with move a contact point to the apex to an average of 4.5 mm IPL, there was a significant increase in the interdental papillae. In the case of patients prior to treatment was determined by a thin biotype, the small width of attached gingival significant HDR--volume papilla week after restorations movement of the contact point to the root apex contact point is not increased. The results obtained require long-term studies for the possibility of forecasting the success of the restoration or preservation of the interdental papillae in the restoration of approximal cavities on the stages of rehabilitation of patients with generalized periodontitis.

Oral rehabilitation of a 4-year-old child with early childhood caries under general anaesthesia: a case report on long-term outcome.

BACKGROUND: Young patients with early childhood caries (ECC) commonly undergo oral rehabilitation under general anaesthesia (GA), often because of problems with behaviour management. Children with a history of ECC are highly susceptible to the development of new caries, even after comprehensive oral rehabilitation. CASE REPORT: The present paper reports the case of a female patient, aged 4.1 years, with ECC who was referred for treatment to the Department of Paediatric Dentistry of the Universitat Internacional de Catalunya. On account of the requirement for extensive dental treatment, and because of behaviour management problems, her dentition was restored under GA. A combination of restorative approaches and techniques was used, including the placement of composite resins, preformed metal crown restorations, extractions, and space maintainers. The patient was followed for 24 months, both clinically and radiographically. Conclusion This case reflects the need to provide adequate support to children at high risk for ECC, together with their families by developing more acceptable and effective biological and behavioural interventions in order to reduce caries relapse after oral rehabilitation under GA.

[Complete attendance of a caries risk patient]. / Caries rizikópáciens komplex ellátása. Esetismertetés.

An adult caries high risk patient reported to the clinic with acute complaint. After an adequate pain control patient was motivated to participate in the required periodontal, oral surgical, conservative dental and prosthodontic treatment. Based on her DMF-index scores, periodontal and plaque indexes, and high rates for Streptococcus mutans (CRT-test), and also her inappropriate diet deriving from her financial and social standing, the 38-year-old female patient was considered as a caries high risk patient. After oral hygienic instruction, motivation, supra and subgingival scaling, and extraction fillings and root canal treatments (including revisions as well) were carried out. Finally complete functional and esthetic rehabilitation have been fulfilled by fixed restorations. Caries is a widespread disease in Hungary, affecting 98,8% of the adult population. According to recent statistics despite an improving tendency, the application of many patients with the need of an entire dental rehabilitation is expected. Besides the importance of prevention and regular controls the treatment planning and the execution of a complete dental treatment remain a rather complex task even without the presence of any systemic diseases. The patients' co-operation may be obtained after a comprehensive medical history and by means of different methods (bacterial tests, plaque indexes etc.) which demonstrate the results, to assure a sufficient and longterm outcome.

Porcelain laminate veneers: restorative management.

This article presents the case of a young adult woman who presented with esthetic complaints years after conventional orthodontics. The treatment plan the patient ultimately selected was the placement of 10 indirect porcelain laminate veneers.

[Dissertations 25 years after date 30. Oral hygiene and dental hygienists]. / Proefschriften 25 jaar na dato 30. Mondzorg en mondhygiënisten.

In 1986 the thesis entitled 'Choosing for dental hygienists' was published in The Netherlands. It provided the scientific basis for the further development of the profession of dental hygienists in The Netherlands. Since then, the profession has developed very strongly. In the intervening years, qualified dental hygienists have come to be considered capable of taking over simple restorative treatments from dentists. As a result, treatment, especially in children, can largely be carried out by one person. Nevertheless, recent developments, such as the sharp increase in the number of new dental students, suggest that the re-allocation of responsibilities is proceeding slowly. This suggests that policy makers have not yet unambiguously opted for dental hygienists and prevention.

[System of therapy and prophylaxis of hard tooth tissues pathology in the group of pilots].

Survey of 77 males aged 22 to 55 including 43 pilots (main group), 24 non-flying employees (comparison group) and 10 essentially healthy men with sanitized oral cavity (control group) revealed caries in 100% members of groups 1 and 2. Prevalence of other than caries pathologies was higher in the group of pilots. Analysis of mixed unstimulated saliva showed calcium and phosphates reduction by half in 50% and 30% of pilots, respectively. Investigation of hair elemental composition displayed also deficiency of Ca and P in pilots. The authors recommend methods for dental rehabilitation as an indispensable part of medical care for flying personnel.

Antibacterial and Antimicrobial Effects of Xanthorrhizol in the Prevention of Dental Caries: A Systematic Review.

BACKGROUND: Xanthorrhizol is one of the numerous phytochemicals whose pharmacological benefits have been explored for its antibacterial and antimicrobial effects. In light of the role bacteria play for initiating tooth decay, this present systematic review assessed xanthorrhizol's effect against dental caries. METHODS: The electronic databases including Pubmed, Scopus and Embase were searched up to September 2020, Studies examining the antibacterial and antimicrobial effects of xanthorrhizol in the prevention and treatment of dental caries. RESULTS: Eleven studies met the criteria for final inclusion. Findings from these studies showed that xanthorrhizol showed significant inhibition of notable caries causing bacteria including Streptococcus mutans, Streptococcus sanguinis, Enterococcus faecalis and Bacillus cereus. Furthermore, there was no reported toxicity. However, it could not selectively target the growth of cariogenic bacteria. CONCLUSION: So far, studies exploring the use of xanthorrhizol as a potential drug for the prevention and treatment of dental caries have shown promising outcomes. However, more work needs to be done especially in areas such as optimal dose or concentration, in addition, in vitro, in vivo and clinical studies and selective targeting of cariogenic bacteria has been performed.

Early childhood caries and oral rehabilitation. A treatment quandary.

BACKGROUND: Early childhood caries (ECC) is a virulent form of dental caries that can destroy the primary dentition of toddlers and preschool children. It occurs worldwide, afflicting predominantly disadvantaged children. Although Streptococcus mutans is the most likely causative agent, diet also plays a critical role in the acquisition and clinical expression of this infection. Early acquisition of S. mutans via vertical or horizontal transmission is a key event in the natural history of the disease that coupled with caries promoting feeding behaviours results in accumulation of these organisms to levels exceeding 30% of the total cultivable plaque flora, which in turn leads to rapid demineralization of the tooth structure. Inflicted children may also have other associated health problems, ranging from local infections to oral pain that manifest as difficulty in eating and sleeping, reduced growth and altered behaviour. Oral rehabilitation usually consists of restoration or surgical removal of carious teeth along with recommendations regarding feeding habits. Although treatment can be instituted in the dental clinic, it becomes costly sometimes when cooperative capacity of babies and preschool children necessitates the use of general anaesthesia. Primary prevention of ECC has largely been restricted to counselling parents regarding proper feeding behaviour, oral hygiene measures and new strategies that address the infectious component through use of topical antimicrobial therapy in order to defeat this common oral affliction.

Comprehensive oral rehabilitation with general anesthesia and prosthetic care in the primary dentition: a case report.

This case report describes the oral rehabilitation of a 5-year-old male referred by a general dentist to a pediatric dentist due to acute psychological stress to dental treatment and extensive dental caries. The patient's dental restorations and extractions were completed under general anesthesia. Maxillary and mandibular prostheses were completed in the outpatient clinical setting. The treatment plan for this child provided options to improve appearance, self-image and oral function.

The Monitor Practice Program: implications for dentistry and dental education.

The restorative model of care, known colloquially as drilling and filling, has been challenged on the basis of its inappropriateness. The Caries Management System protocol was developed as an evidence-based strategy for non-surgical treatment of caries lesions and the Monitor Practice Program was designed to test the hypothesis that use of the protocol would reduce risk of dental caries experience. After 7 years, patients attending intervention practices, compared with those attending control practices, needed: 30%-50% fewer restorative interventions; 55% fewer first time restorative interventions; 32% fewer repeat restorative interventions; and were only 23% as likely to be classified as high risk. The outcome was cost-effective and patients attending intervention practices highly valued non-invasive care, and intervention dentists derived professional satisfaction from non-surgical caries management. The implications of the program are that the general public will likely embrace the benefits of non-invasive caries management, as will many current and future dental practitioners. This calls for dental practice reform including: the establishment of a clinical discipline in cariology; cariology curriculum development; revised accreditation regulations for cariology programs in dental schools; advanced training in clinical cariology leading to a specialty; support from the dental profession; and public health advocacy.

Salivary antioxidant capacity of children with severe early childhood caries before and after complete dental rehabilitation.

OBJECTIVE: There is a need to determine whether total antioxidant capacity (TAC) in severe early childhood caries (S-ECC) is an indicator of inflammatory response to the lesion or a marker of the disease. This study compared TAC levels in children with ECC before and after dental treatment and compared the results with those of caries-free children. DESIGN: Prospective study. SETTING: A teaching hospital. PATIENT SELECTION: Salivary samples were obtained from 20 children aged 5 years and diagnosed with S-ECC, and 20 age- and sex-matched controls. INTERVENTION DETAILS: Complete dental rehabilitation under general anesthesia was performed on the children with S-ECC, and follow-up salivary samples were obtained one week and three months postoperatively. TAC was measured using a commercially available Oxygen Radical Absorbance Antioxidant Assay measurement kit (Zen-Bio ORAC™, AMS Biotechnology, Abington, UK). OUTCOME MEASURES: Differences between children with and without dental caries were tested using the Mann-Whitney U test; differences before and after dental treatment were analyzed using Friedman test followed by Wilcoxon sign-rank test with Bonferroni correction to compensate for multiple comparisons. RESULTS: Median TAC (1.54 mcg/L, CI 1.15-1.92) of the control group was significantly lower than that of the treated group prior to treatment (p = 0.003). Treatment of the dental lesions significantly reduced TAC of the treated group, and no significant differences were observed between the test and control groups at either one week (p = 0.076) recall or three-month recall (p = 0.096). TAC in children posttreatment was significantly reduced compared to their pretreatment values (p < 0.001). CONCLUSION: Total antioxidant capacity in the saliva of children with severe early childhood caries undergoes significant reduction following treatment of the carious lesions.

Oral Health Status of 12-year-olds from Regions with and without Coverage of the National Oral Health Comprehensive Intervention Program for Children in China.

OBJECTIVE: To investigate the oral health status and related factors of 12-year-olds from regions with and without coverage of the National Oral Health Comprehensive Intervention Program in China by means of analysing national data from the 4th National Oral Health Survey. METHODS: Data of 12-year-olds participating in the 4th National Oral Health Survey of China were used for statistical analysis. Children who were recruited in the survey completed a dental examination and filled in a questionnaire. Oral health status, pit-and-fissure sealant history, oral hygiene behaviours, sugar consumption habits, status of dental service utilisation, and oral health knowledge were compared between children from regions with and without coverage of the national programme. For the number of decayed, missing and filled permanent teeth (DMFT) and its components, as well as the number of teeth with pit-and-fissure sealants, mean values were statistically tested to see if significance existed between regions covered by the national programme and uncovered regions, whereas caries prevalence and percentage of pit-and-fissure sealants presented were also compared. RESULTS: Data from 27,821 12-year-old children were analysed, among whom 7,726 were from regions covered by the national programme and 20,095 were from uncovered regions. Statistical significance was found in caries experience and activity, pit-and-fissure sealant history, sugar consumption habits, utilisation of dental services and oral health knowledge when compared between the covered and uncovered regions. Prevalence of dental caries and indices for caries experience and activity was lower in regions covered by the national programme than those not covered, while the percentage of pit-and-fissure sealants presented and the number of teeth with pit-and-fissure sealants exhibited higher in the covered regions. This remained the same even if we focused only on the first molars instead of the full dentition. CONCLUSION: The National Oral Health Comprehensive Intervention Program for Children in China potentially contributed to better oral health status, behaviour and knowledge in 12-year-old children. The expansion and extension of coverage of the national programme was expected to be beneficial for improving oral health status in children, as well as constructing teams of oral and dental workforce and working mechanisms in some underdeveloped regions.

Remineralizing potential of CPP-ACP in white spot lesions - A systematic review.

OBJECTIVE: The aim of this systematic review was to assess the long term remineralizing potential of casein phosphopeptide-amorphous calcium phosphate (CPP-ACP) only in paste form compared with fluoride varnish, and or placebo in both naturally occurring and post-orthodontic white spot lesions in vivo. DATA SOURCES: The literature search covered the electronic databases: PubMed and Google scholar from 2005-2016. Only articles published in English were included. Randomized control trials in which CPP-ACP delivered by paste form were included. All studies which met inclusion criteria underwent two independent reviews. STUDY SELECTION: Two ninety five articles were identified from the search after excluding duplications. Abstracts of forty one articles were reviewed independently. Twenty nine articles were excluded after reading abstract. Full text articles were retrieved for fifteen relevant studies. After reviewing articles independently, three articles were excluded after full text reading. Finally twelve studies were selected based on the eligibility criteria. The remineralizing effect of CPP-ACP were compared with placebo and fluoridated toothpaste and fluoride varnish in randomized control trial. CONCLUSION: A high level evidence of remineralizing potential of CPP-ACP on naturally occurring white spot lesion and WSL post orthodontic treatment was found in comparison with placebo/fluoridated toothpaste and fluoride varnish without any statistically significant difference. Well-designed RCTs are, therefore, required to improve the level of evidence in this area.