Search Results (72)

Background: Dental caries is a prevalent dental problem affecting primary and permanent teeth. Early demineralization of enamel lesions can be reversed through remineralization. Many studies have focused on caries prevention and disease progression arrest using silver diamine fluoride (SDF). No in vitro studies have compared the remineralization effects of different 38% SDF solutions on artificially demineralized enamel lesions. This study aimed to compare the remineralization potential of three commercial 38% silver diamine fluoride formulations on artificial enamel lesions in primary teeth using a pH cycling model. The hypothesis was as follows: different commercial SDF formulations would exhibit varying remineralization effects, as measured by surface microhardness, due to potential differences in their compositions. Materials and Methods: In this study, 75 primary molars were randomized into five groups (N = 15): I: baseline, II: SDF Riva Star Aqua^® 38%, III: Riva Star^® 38%, IV: SDF Advantage Arrest^® 38%, and V: control. Artificial caries were created by submerging teeth in 10 mL of demineralization solution (pH 4.5) for three days in a light-resistant container, ensuring distinct visual changes in the enamel as per the International Caries Detection and Assessment System (ICDAS level 2). After pH cycling, all samples underwent a standardized Vickers microhardness test (VMHT) with a 50 g load for 15 s. Data were analyzed using one-way ANOVA and Tukey’s post hoc test, with a significance level set at p ≤ 0.05. Results: The one-way ANOVA test indicated a significant difference in microhardness among the groups (SDF Riva Star Aqua, SDF Riva Star, and SDF Advantage Arrest), with an F-value of 167.73 and p < 0.001. The post hoc Scheffé test showed that SDF Riva Star Aqua and SDF Riva Star were not significantly different (p = 0.388). However, SDF Advantage Arrest had a significantly higher mean microhardness compared to both groups (p < 0.001). Overall, these results show that SDF Advantage Arrest leads to greater microhardness than SDF Riva Star Aqua or SDF Riva Star. Conclusions: SDF Advantage Arrest showed superior performance among the SDF-treated groups, significantly increasing microhardness compared to SDF Riva Star Aqua and SDF Riva Star. This suggests that SDF Advantage Arrest offers enhanced remineralization and structural strengthening, making it the most effective option for managing demineralized primary teeth. Future research should investigate the long-term performance and mechanisms of these treatments to optimize clinical protocols for preserving primary tooth integrity. Full article

Background: Due to limitations of fluoride (F) treatment as a main caries preventive measure, it is important to consider the use of other dental caries preventive measures to reduce caries prevalence, especially in its early stages. Recently, new remineralizing agents appeared on the market, with their commercial availability in a variety of oral care products. Objectives: The purposes include providing a scoping review that represents caries remineralizing efficacies of only commercially available products and their existing adverse effects (if it is presented) and ensuring that only evidence-based approved products are included. Methods: The following databases were used in searching scientific literature on 28 October 2024: PubMed, PubMed Advanced Search, MeSH database, and PubMed Clinical Queries. The study selection criteria were as follows: for laboratory, in vitro, and/or in situ—remineralization of enamel-scanning electron microscopy, spectroscopy, microhardness test, light microscopy, profilometry, transverse microhardness microradiography, integrated mineral loss, light microscopy, photothermal radiometry; if it was a randomized controlled trial—CONSORT protocol, ICDAS system (to detect dental caries), diagnostic additional devices; antibacterial ability-colony forming units, DNA-based sequencing, scanning electron microscopy, crystal violet staining, and confocal laser scanning microscopy. Results: This review includes 98 papers: 14 of them describing the current status of caries patterns in the world, 60 studies (45 laboratory studies and 15 RCTs), and 24 systematic reviews were analyzed in order to detect whether new remineralizing agents can replace fluoride in further caries prevention. Conclusions: All reviewed new remineralization agents could be used without additives to treat early caries lesions, but the combination with F promotes better remineralization. Only HAP demonstrated its potential to serve as an alternative to fluoride in oral care products. However, further clinical studies are needed to prove its role in the remineralizing process of initial caries lesions. One also needs to ensure that both the clinical trials and in vitro lab studies use the best gold standards to validate any changes in the tooth structure, both remineralization and demineralization. Full article

Childhood dental caries remains a critical public health issue in rural areas, where caregivers’ knowledge, attitudes, and practices (KAP) significantly influence oral health outcomes. This study assessed the association between parental KAP and the prevalence and severity of caries in children aged 5–9 years in Cayambe, Ecuador. Methods: A cross-sectional study was conducted with 229 schoolchildren and their caregivers, using a validated questionnaire and clinical examinations (ICDAS criteria). Caries severity was categorized as “obvious decay” (ICDAS 4–6) or “no obvious decay” (ICDAS 0–3). Results: Advanced dental caries affected 73.4% of children (ICDAS 4–6). While parental knowledge and attitudes showed no significant association, brushing teeth ≥2 times/day significantly reduced caries severity (p < 0.05). Sociodemographic factors, such as parental education, were not significant predictors. Conclusion: Oral hygiene practices—particularly frequent toothbrushing—were the key protective factor against severe caries, highlighting the need for behavior-focused interventions promoting daily habits. Future research should evaluate long-term preventive strategies. Full article

This study aimed to assess dental caries status of 3- to 6-year-old preschool children in the Republic of Serbia. Stratified cluster sampling was implemented. Children were examined in four administrative regions of Serbia. Dental caries indices (decayed, missing, and filled) for deciduous teeth and the first permanent molar were recorded at the tooth level (dmft, DMFT) and surface level (dfs, DFS). In addition to cavitated caries lesions (ICDAS 3-6), visual changes in enamel (ICDAS 1-2) were recorded. This study included 1060 3-year-old and 1820 6-year-old children in Serbia. Fifty-six percent of 3-year-olds and 21% of 6-year-olds were caries-free. The mean dmft was 2.11 ± 3.45 for 3-year-olds and 4.46 ± 3.69 for 6-year-olds. The mean dfs was 2.62 ± 5.56 for 3-year-olds and 6.06 ± 6.33 for 6-year-olds. The decayed component was dominant in dmft/dfs. The prevalence of surfaces with initial lesion was 8% for 3-year-olds and 13% for 6-year-olds. Among children diagnosed with early childhood caries, 54% of 3-year-olds and 37% of 6-year-olds had a severe form. The mean DMFT was 0.15 ± 0.55, with only the first permanent molars being affected. Dental caries remains a significant public dental health issue among preschool children in Serbia. There is a noticeable trend of increasing numbers of decayed teeth as children progress through their preschool years. It is imperative to take corrective action enhance the existing oral health prevention program in Serbia with the aim of achieving better dental health among preschool children. Full article

Background and Objectives: To evaluate the impact of impacted mandibular third molars on temporomandibular joint dysfunction using the Modified Helkimo Index, analyzing symptom severity across age groups. Materials and Methods: A cohort of 140 patients (70 with impacted molars, 70 without) was assessed using the Modified Helkimo Index. Patients were categorized by age (<25, 26–30, 31–35, >36 years), and statistical comparisons between Icdⁱ (with impacted molars) and Icd^a (without impacted molars) were performed. Key parameters included mandibular movement limitation, joint noises, and pain scores. Data were analyzed using descriptive statistics and statistical tests, with significance set at p < 0.05. Results: TMJ dysfunction was significantly more prevalent in patients under 25 years (Icdⁱ = 13.5, Icd^a = 11.0; p = 0.045), with a progressive decrease in severity in older groups (>36 years: Icdⁱ = 3.5, Icd^a = 4.5; p = 0.072). Women exhibited a higher prevalence across all age categories (female-to-male ratio: <25 years = 2.7, >36 years = 3.0). The most frequent symptoms were mandibular movement restriction (42.5%), joint noises (38.2%), and pain (35.7%). Conclusions: Impacted third molars may significantly exacerbate TMJ dysfunctions, particularly in younger individuals and females, with a strong association between impacted molars and increased Modified Helkimo Index scores. Early extraction might mitigate symptoms, emphasizing the need for proactive clinical management. Full article

Improving children’s oral health is a national priority. Parental knowledge and self-efficacy influence children’s health behaviors; however, the relationship between parental oral health-related knowledge, self-efficacy, child oral health-related quality of life (OHQoL), and dental caries remains unclear, especially among low-income, ethnically diverse U.S. families. This study assesses the relationship between parental oral health-related knowledge, self-efficacy, child dental caries, and OHQoL. This cross-sectional seco ndary analysis uses baseline data from a school-based cluster-randomized controlled trial among children (kindergarten–second grade). Dental assessments were conducted using the International Caries Detection and Assessment System (ICDAS) on site in schools at baseline (n = 34 schools, n = 1084 consenting parent–child dyads). Child OHQoL, parental knowledge, and self-efficacy were measured using validated self-report surveys. Associations between exposures and outcomes (child dental caries prevalence, child OHQoL) were evaluated by univariate and multivariable logistic and linear regressions, respectively. After adjusting for covariates, higher parental self-efficacy was associated with lower child OHQoL (lower score indicates higher quality of life) [beta = −0.16, 95% CI: −0.24, −0.09, p < 0.01] and lower odds of active dental caries [Adj OR: 0.95, 95% CI: 0.9, 0.99, p = 0.02]. No significant associations were noted for parental knowledge. These findings can inform future research, understanding how parental psychosocial factors influence dental caries prevention behaviors and risk, and inform interventions for children. Full article

Background: Primary molars with deep carious lesions often require a treatment with pulpotomy and restoration with a crown. Aim: This study aims to compare the survival rates of stainless steel (SSC) and zirconium oxide (ZOC) crowns carried out on pulpotomized primary molars using the International Caries Detection and Assessment System (ICDAS) 4 to 6 lesions. Materials and Methods: The data of 100 patients (mean age 5.3 ± 2.1 years, mean decayed, missing or filled primary teeth (dmft) 7.1 ± 3.2) with 272 primary molars (40, 225, 7 with ICDAS 4, 5, 6, respectively) were collected retrospectively from a specialized private pediatric dental office after ethical approval was obtained and each participant agreed to participation in the study. Primary molars were treated between 2019 and 2021 with pulpotomy (15.5% ferrous sulfate solution for hemostasis and zinc oxide eugenol as a wound dressing) followed by a crown (203 SSC and 69 ZOC) with a minimum follow-up period of 6 months and a mean follow-up time of 28.2 (±11.0) months. Results: Failure occurred significantly less often in SSC (n = 13 out of 203) than in ZOC (n = 20 out of 69; p < 0.001). Major failure was attributed to swelling and abscess (n = 13, 39.4%) followed by the occurrence of fistula (n = 15, 45.4%) and fracture of the crown and abutment (n = 5, 15.2%). Minor failure due to cement dissolution occurred significantly less often in SSC than in ZOC (n = 10 out of 203 vs. n = 9 out of 69; p < 0.005. A Kaplan–Meier survival analysis showed an overall estimated survival time of 38.25 (Confidence interval (CI): 37.0–39.4) months for both types of crowns. A Log-Rank (Mantel–Cox) analysis showed a statistically significant difference (p < 0.05) in the estimated mean survival time of SSC (39.75; CI: 38.5–40.9 months) and ZOC (33.4; CI: 30.5–36.3 months). Survival probability drops just below 80% for ZOC and stays a little over 90% for SCC around the 20th month. Conclusions: SSC showed an advantage over its ZOC counterpart when placed after pulpotomy for the management of primary molars with deep carious lesions. A higher necessity for re-intervention in the more aesthetic ZOC should be considered in clinical decision taking. Full article

Objective: To investigate the predictive value of nutritional status in heart failure (HF) patients with an implantable cardioverter defibrillator (ICD), and to identify factors associated with ICD discharge and mortality. Methods: This retrospective study was conducted by analyzing data from 2017 to 2021. HF patients who underwent ICD implantation for primary prevention were included. Follow-up visits were continued until December 2022. Patients were examined based on ICD shock occurrence (ICD-A: appropriate shock), ICD non-discharge (ICD-X), and mortality. Nutritional status was assessed by the Prognostic Nutritional Index (PNI) and the Controlling Nutritional Status (CONUT) scores. Results: A total of 221 patients were included in the study, 86 of whom were in the ICD-A group (135 in the ICD-X group). Age and sex distribution were similar in these groups. The all-cause mortality rate was 20.36%. A PNI with a cut-off value of <47.25 and a CONUT score with a cut-off value of >2.5 were able to significantly predict all-cause mortality. The PNI had a greater area under the curve compared to the CONUT. Non-ischemic cardiomyopathy and high left-ventricle end-systolic diameter (ESD) were independently associated with appropriate ICD shock. Low systolic blood pressure, high ESD, low sodium, low total cholesterol, low (<47.25) PNI, and ICD shock were independently associated with all-cause mortality. Conclusions: Malnutrition appears to be associated with mortality in patients with primary-prevention ICDs, and the PNI appears to be a more useful indicator than the CONUT for determining the risk of mortality in these patients. Full article

The aim of this randomized clinical trial was to evaluate the efficacy of two different remineralising toothpastes in preventing dental caries and promoting oral health. Patients aged 6–18 years old with healthy and fully erupted first permanent molars (C1 and C2 DIAGNOdent scores) were enrolled and randomized into two groups according to the home-hydroxyapatite-based remineralising treatment used: the Trial group used zinc carbonate hydroxyapatite-based treatment (Biorepair Total Protective Repair), while the Control group used magnesium strontium carbonate hydroxyapatite conjugated with chitosan toothpaste (Curasept Biosmalto Caries Abrasion & Erosion). Dental and periodontal parameters were measured over a six-month period, including the DIAGNOdent Pen Index (primary outcome), BEWE Index, Plaque Index, Bleeding Score, Schiff Air Index, and ICDAS assessed with DIAGNOcam. A total of 40 patients were equally allocated in the two groups and finally analyzed. A significant reduction in the DIAGNOdent Pen score was reported in the Trial group after 1 month of treatment, while in the Control group, no significant change was found. The Trial group also showed a significant reduction in plaque levels after 3 months of treatment, while in the Control group, it occurred after 1 month. However, the Bleeding Score and Schiff Air Index showed no significant differences between the groups, suggesting that additional measures may be required to address gingival inflammation and hypersensitivity. The ICDAS index also showed no statistically significant changes, due to the limited duration of this study. Overall, zinc-hydroxyapatite-based toothpaste was more effective than magnesium strontium carbonate hydroxyapatite toothpaste in enhancing enamel remineralisation in the short-term period. The assigned treatments did not result in significant improvements in the oral indexes assessed in this study. Full article

Background/Objectives: this study aimed to study the association of dental caries and erosion in athletes with dietary and oral health habits. Methods: An observational cross-sectional study was conducted at the Sports Dentistry department of a university clinic. Intraoral examination included the International Caries Detection and Assessment System (ICDAS II) index and the Basic Erosive Wear Examination (BEWE). A questionnaire was completed with sociodemographic data, and dietary and oral hygiene habits. An inferential and multivariable regression analysis was performed to study the association of dental caries and erosion with confounding variables. Results: A total of 80 athletes were included. The prevalence of dental caries and erosion was 50.0% and 40%, respectively. Significant associations were observed between self-perceived oral health and caries lesions, with “Good” (−5.01, p < 0.001) and “Very good” (−5.46, p < 0.001) perceptions linked to fewer lesions. BEWE scores revealed significant associations with meal frequency uncertainty (−12.56, p = 0.014) and uncertainty about the last dental visit (8.82, p = 0.014). Self-perceived oral health as “Good” or “Very good” was associated with lower dental erosion (p < 0.010). Other demographic and behavioral factors were not significantly associated with caries or erosion. Conclusions: this cohort of athletes exhibited a high prevalence of dental caries and erosion, with associated dietary and oral hygiene habits. These results highlight the need for targeted dietary counseling and oral health education for athletes, whose nutritional needs may lead to increased consumption of sugar-rich diets. Full article

Background/Objectives: Contact areas between first and second primary molars, shaped by concave/convex proximal surface morphology, are associated with proximal caries with concave surfaces linked to biofilm stagnation. This study aimed to evaluate the accuracy and clinical feasibility of a scoring system for classifying contact types (concave–concave, concave–convex, convex–convex, convex–concave) for dental practitioners. Methods: Following ethical approval and informed consent, 116 4–5-year-old children were enrolled. A calibrated examiner assessed caries on the distal of first molars and mesial of second molars using ICDAS-merged criteria and scored 464 proximal contacts clinically and radiographically. Stone models from silicone impressions were also scored by 17 trained practitioners, who repeated scoring a week later and assessed contacts clinically in six children. Practitioners completed a feasibility and satisfaction questionnaire. Results: Convex–convex contacts were most prevalent (58.6%), followed by convex–concave (32.6%). Contact type significantly correlated with caries (OR = 13.5; 95% CI: 6.4–28.3). Inter- and intra-examiner reproducibility ranged from 0.71 to 0.82. Most practitioners felt very (64.7%) or moderately (35.3%) capable of applying the system, found it low in difficulty (70.6%), and expressed high satisfaction (82.4%). Conclusions: The study indicated that it is possible for dental practitioners to classify the proximal contact types between primary molars both in an accurate and clinically feasible way. The system exhibited high reproducibility and practitioner satisfaction, indicating its potential as a valuable tool for identifying caries-prone surfaces and supporting evidence-based caries management. Full article

Background: Dental caries remains one of the most widespread chronic diseases that also affects first permanent molars (FPMs). In this study, we analyzed the prevalence of carious lesions using a standardized evaluation system, while following the analysis of the influence of favoring factors represented by the type and frequency of snacks and the frequency of tooth brushing. Method: A clinical–statistical study was carried out on a group of 311 children from both urban and rural environments, aged between 6 and 19 years old. As a diagnostic system and assessment of the depth of carious processes, we used the ICDAS system. The following parameters were recorded: odontal status of the 4 FPMs, age, gender, residence, frequency of dental brushing, and frequency of between-meal snacks and their type. The ICDAS system was used as a diagnostic system and assessment of the depth of carious processes. The data were statistically analyzed with SPSS, using the Kruskal–Wallis H and Chi-Square tests. Results: The occlusal surface was the most interesting in the presence of odontal lesions. Sweet snacks were the most frequent snacks consumed by the subjects. The age group of 13–19 years presented fewer healthy FPMs, compared to the age group of 6–12 years. The higher involvement of older subjects was found for all four molars, both in the case of identified carious lesions and the presence of root debris and edentations. Brushing twice a day was more frequent in the 6–12 age group. In analyzing the status of the first molars in relation to the gender of the subjects, in the present study, no statistically significant differences were recorded between the status of the molars relative to gender, except for molar 1.6 (p > 0.05). Regarding the other types of snacks, children from rural areas consume more fruits than those from urban areas. Conclusions: The frequency of tooth brushing and the type and frequency of snacks between meals influence the prevalence of carious lesions at the level of the first permanent molars. Full article

Background/Objectives: Dental caries remains a significant public health challenge in Romania, with recent studies reporting a prevalence of 40% in children’s permanent teeth, with 90% of cases untreated. This study aimed to evaluate the dental status of the first permanent molars in children aged 11–12 years. Methods: This cross-sectional study was conducted over 12 months at the Integrated Center for Dental Medicine in Târgu Mureș and two private clinics in Transylvania. A total of 516 children, aged 11–12 years, were examined using the ICDAS II classification. Data on carious lesions and dental treatments performed were collected. Results: Of the 2064 first permanent molars examined, 57.99% had carious lesions, fillings, or extractions, while 41.28% were free from caries. Among the affected molars, 41.71% had untreated caries, 9.30% were filled, and 6.25% were sealed. Boys showed a significantly higher prevalence of advanced lesions (ICDAS 4–6) compared to girls. Caries predominantly affected the pits and fissures (87.46%). Conclusions: This study reveals a high prevalence of carious lesions in first permanent molars and a low rate of treatment. The findings emphasize the need for improved oral health education, increased access to dental care, and the development of national strategies to prevent and treat dental caries in children. Full article

Research with nanoparticles for the treatment and prevention of dental caries is of special interest given the high prevalence of the disease worldwide. Several studies support the use of nanoparticles associated with materials given their antimicrobial properties and potential demineralization reduction. This study aimed to evaluate the impact of the application of silver nanoparticles (AgNPs) and chitosan gel in combination with commercial fluoride varnish on the remineralization of dental enamel. Ninety-six tooth blocks were macroscopically evaluated via stereomicroscopy, ICDAS II, and laser fluorescence. Enamel blocks were subjected to artificial demineralization and divided into four exposure groups (24, 48, 120, and 168 h), and five different remineralizing agents were applied, namely, FV (fluoride varnish), FV + CG (fluoride varnish + chitosan gel), FV + AgNPs (fluoride varnish + AgNPs), FV + AgNPs + CG (fluoride varnish + AgNPs + chitosan gel), and AgNPs + CG (AgNPs + chitosan gel). Enamel surface changes were evaluated via laser fluorescence, X-ray diffraction, scanning electron microscopy, and energy-dispersive X-ray spectroscopy. Laser fluorescence results obtained from demineralized blocks and subsequently exposed to remineralizing treatment indicate significant differences. After exposure to remineralizing agents, hydroxyapatite and modified apatite phases were identified mainly in the samples treated with FV + AgNPs + CG in the groups exposed for 24, 48, and 120 h. The FV + AgNPs + CG and AgNPs + CG indicate good performance in terms of the Ca/P ratio in in vitro demineralization compared to the group treated with fluorine varnish. Full article

Background: Along with the long-term sequelae of preterm birth for general health, oral health is potentially influenced by prematurity due to developmental and behavioral peculiarities. Objectives: This study aimed to compare oral health parameters in the mixed dentition of prematurely and full-term born children. Methods: Dental caries, developmental defects of enamel (DDE), and gingival inflammation were assessed in 7-to-9-year-old children (n = 38) born preterm (PT) compared to a matched control group born full-term (FT) in Germany. Dental caries was recorded using the International Caries Detection and Assessment System (ICDAS II) and DMFT/dmft-criteria. DDE was scored with modified DDE-Index and periodontal health by Periodontal Screening Index (PSI). Statistical analysis included McNemar’s test and Poisson regression. The significance level was p ≤ 0.05. Results: Caries prevalence was 47.4% in PT and 57.9% in FT. In the primary dentition, FT children were significantly more affected than PT children (1.6 dmft vs. 2.7 dmft; p = 0.035). PT children with extremely low birthweight (ELBW) had the highest caries experience (3.2 dmft; 1.0 DMFT). Prevalence of DDE in primary teeth was significantly higher in PT (55.3%) than in FT children (28.9%; p = 0.008). PSI was 3.8 in PT and 3.3 in FT children, but significantly higher in PT children with ELBW (7.4; p = 0.125). Conclusions: PT children are at higher risk for DDE in primary teeth and compromised periodontal health than FT children. Children with ELBW are most susceptible for dental caries and gingivitis. Full article