Search Results (477)

Background: Breakfast habits in Mediterranean countries often include processed products with hidden sugars, which may compromise children’s oral and general health. Objectives: This study assessed the sugar content of breakfast foods commonly consumed by children using °Brix refractometry and examined its implications for dental caries and obesity. Methods: Forty-nine breakfast food samples (processed products, homemade alternatives, and fresh fruits) were analysed using a digital °Brix refractometer to quantify soluble sugar concentrations. Comparative statistical analyses were performed to evaluate differences among food categories. Results: Processed foods consistently exhibited significantly higher °Brix values (mean ± SD: 14.1 ± 4.9), reflecting greater levels of extrinsic sugars, compared with homemade preparations (10.9 ± 1.1) and fresh fruits (10.7 ± 5.2) (p < 0.01). Processed items contained on average 25% more sugar than the other categories. Fresh fruits and homemade options demonstrated moderate °Brix levels, with no added sugars, whereas processed products—despite some being marketed as “no added sugars”—frequently contained substantial sugar content. Conclusions: The findings highlight the urgent need for educational strategies and clearer labelling to reduce sugar intake during childhood breakfasts. Promoting natural and homemade alternatives could be a key preventive approach to lowering the risk of dental caries, obesity, and other diet-related conditions. Full article

Background/Objectives: Sugar added to pediatric oral medications may increase the risk of dental caries and erosion. Parental awareness and practices play a crucial role in minimizing the oral health risks associated with such medications. Therefore, the aim was to assess parents’ knowledge, attitudes, and practices regarding the cariogenic potential of pediatric oral medications in the Kingdom of Saudi Arabia. Methods: A cross-sectional study was conducted using an online questionnaire. Parents who had at least one child between 2 and 12 years old were included. Participants were categorized into three groups based on the long-term intake of medications and their child’s health status. Group 1: Parents of children with chronic diseases on long-term medications. Group 2: Parents of healthy children on long-term medications. Group 3: Parents of healthy children not on long-term medications. Results: A total of 2195 responses were collected. The majority of parents were aged 31–40 years. More than half of the mothers and fathers had a diploma or a university degree (59% and 54.3%, respectively). Although a high proportion of the parents (78–83%) were aware that medications often contained sugar, only 46–50% were aware of their cariogenic potential, while 27–38% speculated about their erosive potential. In terms of practices, most parents encouraged their children to drink water (70–71%) or rinse their mouths (14–20%) after medication intake. Conclusions: While most parents were aware that pediatric oral medications may contain sugar, there was a lack of proactive measures to mitigate their negative impact on oral health. Further studies are still needed to evaluate and improve public awareness and practices regarding the oral health risks associated with pediatric medications. Full article

X-linked hypophosphatemic rickets (XLH) is a rare genetic disorder with a frequency of 1:20,000, caused by mutations in the PHEX gene, resulting in impaired phosphate metabolism and bone mineralization. There is an association between hypophosphatemia and dental issues, though this link is not definitively established. This study aims to evaluate the dental status, including oral hygiene, caries prevalence, and malocclusions, as well as parental awareness of dental complications, in children with XLH in Bulgaria, particularly those receiving or about to begin burosumab treatment, and to compare their oral health status with that of healthy children. Eleven children with XLH (seven girls, four boys, aged 2.5–17 years), nine receiving burosumab, were assessed and compared with eleven age- and gender-matched healthy children (seven girls, four boys, aged 2.5–17 years) without XLH or systemic conditions affecting dental health. Parental awareness of dental implications was assessed via a questionnaire, revealing no awareness of potential complications. Oral hygiene, measured using the Oral Hygiene Index-Simplified (OHI-s), was poor in 66.67% of children, with an average of 6.45 ± 5.80 carious lesions per child, and was highest in the 11–16 age group. Malocclusions were observed in 63.64% of children, and spontaneous endodontic infections occurred in 18.18%. Compared with healthy children, patients with XLH had significantly worse oral hygiene (p = 0.013) and a higher caries prevalence (p = 0.001). Children with XLH exhibit poor oral hygiene, a high caries burden, and frequent malocclusions, compounded by a lack of parental awareness of dental risks. These findings underscore the need for targeted dental interventions and education in XLH management, including the integration of routine dental assessments and structured parental education programs into existing clinical protocols to improve oral health outcomes. Full article

Background/Objectives: Self-adhesive flowable resins (SAFR) entered the market, eliminating the adhesive system application due to their self-adhesive technology. Guided by the PICO framework (Population, Intervention, Comparison, Outcome), the aim was to conduct a systematic review of clinical studies to compare the clinical performance of Self Adhesive Flowable Resin (SAFRs) with conventional flowable resins used for direct restorations. Methods: The protocol of this systematic review was registered in the International Prospective Register of Systematic Reviews (CRD42023394297) and followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guideline. Five databases (PubMed, Embase, Web of Science, Scopus, and Cochrane Library) were searched from inception to July 2025. Nine randomized clinical trials were included, totaling 493 restorations in 232 patients. Clinical performance was assessed using USPHS or FDI criteria, with follow-up periods ranging from 6 months to 5 years. Data were pooled using a random-effects meta-analysis to calculate risk differences (RD) and 95% confidence intervals (CI) for marginal adaptation, retention, marginal staining, post-operative sensitivity, color stability, surface roughness, secondary caries, and anatomical form. Results: Meta-analysis showed no significant differences between SAFRs and CFRCs for in terms of: marginal adaptation (RD = 0.01; 95% CI: −0.02 to 0.04; p = 0.53; I² = 0%), retention (RD = 0.00; 95% CI: −0.02 to 0.03; p = 0.81; I² = 0%), marginal staining (RD = 0.01; 95% CI: −0.01 to 0.02; p = 0.51; I² = 0%), and post-operative sensitivity (RD = −0.01; 95% CI: −0.03 to 0.02; p = 0.62; I² = 0%). The certainty of the evidence for all outcomes was rated as moderate to high according to the GRADE assessment. Conclusions: SAFR restorations demonstrated comparable clinical performance to conventional resins; however, heterogeneity in follow-up duration and the scarcity of long-term data (>5 years) warrant caution. Full article

The infant oral microbiome is a complex and dynamic microbial community that undergoes various transformations during human development. From birth, these microorganisms are modulated by factors such as birth type, nutrition, oral hygiene, hormonal changes, and environmental and socioeconomic conditions. These elements interact continuously, shaping the diversity and stability of the oral microbiome and consequently influencing the oral and general health of individuals. The main objective of this study was to review the literature on the evolution of the oral microbiome at different stages of growth, with special emphasis on the maintenance of dental homeostasis and prevention of pathologies such as caries and periodontitis. A bibliographic review of scientific databases was conducted, focusing on the last decade. In general, oral microbiome dysbiosis increases the risk of oral diseases and systemic conditions. Diet, parental practices, and horizontal transmission of bacteria from caregivers have been shown to modulate and influence the composition and functioning of the infant oral microbiome. Despite these advances, gaps remain in our understanding of the impact of the pediatric oral microbiome on long-term comprehensive health. Therefore, longitudinal research is needed to understand the development of the oral microbiome and its potential role in early prediction, prevention, and treatment of oral and systemic diseases. Full article

Background/Objectives: Official data on the oral health of young children in Romania are limited, especially concerning the societal shifts following the COVID-19 pandemic. This study aimed to compare the oral health status, hygiene habits, diet, and dental care patterns of 6-year-old children in a rural Romanian region before and after the pandemic. Methods: A cross-sectional survey studied two groups of 6-year-olds from rural Transylvania: Group 1 (n = 77), assessed 2018–2020 pre-pandemic, and Group 2 (n = 136), assessed in 2024 post-pandemic. Clinical data used the Decayed, Missing, and Filled Teeth (DMFT) index. Parents completed questionnaires on oral hygiene, diet, dental visits, and pandemic-related topics for Group 2. Chi-square, Student’s t-tests, and a multiple linear regression were used to analyze the data. Results: Post-pandemic, 70% of children brushed twice daily, up from 26%. Despite this, negative outcomes increased: the number of affected teeth rose from 6.8% to 29.6% (p < 0.001), sugar intake increased, and dental visits became more reactive, with pain being the main reason for 61% of post-pandemic visits, compared to 17% pre-pandemic. Conclusions: This study reveals a significant oral health paradox: despite a three-fold increase in recommended toothbrushing, caries experience in permanent teeth increased four-fold. This outcome was driven by a high-risk environment of more cariogenic diets and reduced preventive care, with lower maternal education also identified as a key independent risk factor. These findings show that promoting hygiene alone is insufficient, underscoring the urgent need for public health programs that integrate nutritional counseling, improve access to preventive care, and address underlying socioeconomic disparities. Full article

Dental caries is now recognised as a multifactorial disease shaped by complex interactions among genetic, epigenetic, microbiological, environmental, and social factors. This narrative review synthesises recent findings on the influence of genetic and epigenetic factors on caries susceptibility, exploring implications for personalised prevention strategies, including novel vaccine approaches. Numerous gene polymorphisms in pathways related to enamel formation, saliva composition, immune response, and taste perception have been linked to increased caries risk, with some effects modulated by sex and tooth-specific factors. Early-life environmental exposures (diet, tobacco, and antibiotic use) have been demonstrated to further alter risk through epigenetic modifications such as DNA methylation, microRNA regulation, and histone changes. The recognition of this landscape of inherited and acquired vulnerabilities has given rise to interest in innovative preventive measures. In particular, anti-caries vaccines targeting Streptococcus mutans are being developed using protein subunits, DNA constructs, and even plant-based antigen production. Notwithstanding the challenges that still need to be overcome—chiefly the achievement of robust mucosal immunity, the assurance of safety, and the enhancement of production—these vaccines are proving to be a promising addition to traditional oral hygiene and fluoride measures. The integration of genetic and epigenetic insights with immunological advances has the potential to facilitate the development of more effective, personalised interventions to prevent dental caries. Full article

This study evaluated the physicochemical and morphological properties of tooth enamel in patients with caries-predisposing SNPs (rs4694075 in AMBN and rs2337359 in TUFT1 genes), based on the DMFT index. We included 40 of 120 individuals (aged 19–43), collecting stimulated saliva and 58 healthy teeth extracted for orthodontic/surgical reasons. Saliva DNA was genotyped. Enamel properties were assessed using Vickers microhardness, deposition thickness, and calcium content. Genotype and allele frequencies aligned with the literature. The TUFT1C/C genotype subgroup showed a significantly higher DMFT index (p = 0.03) compared to the T/T genotype, while AMBN showed no such correlation. Calcium content, microhardness, and enamel thickness were similar across all polymorphic variants of both genes. A statistically significant correlation (p = 0.003) was found between reduced enamel calcium content and a higher DMFT index. Despite existing literature on the subject, the studied SNPs did not reflect any correlation with morphological or physicochemical changes in enamel. The above results suggest that genetic variability identifies patients classified by dentists as being at higher risk of caries, even though these patients follow a non-cariogenic diet and adhere to a hygiene regime. As no structural or physicochemical changes in the enamel of this group were observed, the potential cause may be disturbances in the remineralisation mechanisms or enamel surface properties that promote biofilm adhesion in polymorphic patients. Intensive tooth calcification control algorithms using LIF and RVG, as well as remineralisation cycles to increase hydroxyapatite saturation with calcium phosphates and bioadhesive fluoride delivery systems for long-term biofilm control, are used to more effectively prevent or slow down the progression of caries. Full article

Background/Objectives: Pacifier use in infants has both beneficial and harmful implications, and dipping pacifiers in sweeteners is used by some parents to soothe infants. This study aimed to assess pacifier usage among mothers in Jeddah, Saudi Arabia, and to examine its association with child demographics, maternal socioeconomic status (SES), and maternal knowledge of the risks associated with dipping pacifiers in sweeteners. Methods: A cross-sectional study was conducted among mothers of healthy children aged 2 to 4 years during community-awareness events in Jeddah. Participants completed a validated Arabic questionnaire covering pacifier use patterns, feeding practices, SES background, and knowledge regarding the adverse effects of pacifier sweetening. Results: A total of 1438 mothers participated. The mean age of children was 34.3 ± 10.7 months, with 441 children (30.7%) reported as pacifier users. Among them, 202 (45.8%) used pacifiers both during the day and at night. Most children (35.6%) discontinued use between 4 and 6 months of age. Only 6.1% of mothers reported adding sweeteners to pacifiers. Pacifier usage was significantly higher among first-born children (37.6%, p < 0.001), those who received both bottle- and breastfeeding (65.5%, p < 0.001), and children enrolled in nursery (62.1%, p = 0.007). Most mothers (75.6%) were aware of the link between sweetened pacifiers and dental caries, and 69.4% of those who had this knowledge avoided giving their child a pacifier (p = 0.077). Conclusions: Birth order, feeding practices, and nursery attendance are key predictors of pacifier use. Enhancing parental awareness and education may support early interventions to promote healthier oral and feeding habits in young children. Full article

Background/Objectives: Educational background is an aspect of socio-economic status, that may be associated with higher caries risk. This study aimed to investigate differences in caries prevalence between different school types for older adolescents in Greifswald, Germany. Methods: Cross-sectional data were collected as part of compulsory dental school examinations between 2020 and 2023. Oral health status was assessed according to WHO criteria by six calibrated examiners and reported as mean D₃MFT (D₃: dentin caries, M: missing, F: filled, SD/±: standard deviation). To compare educational backgrounds, the adolescents were divided into two groups according to their age and type of school (11–15 and 16–18 years old). Results: The study included 5816 adolescents (48.7% females) with a mean D₃MFT of 0.65 (Q1–Q3: 0–1); 73.8% were clinically caries-free, having D₃MFT = 0, confirming the polarization in caries experience with 2.5 ± 2.13 SaC index. The logistic regression model showed a significantly increased Odds Ratio for having caries in relation to age, being male, having plaque or gingivitis (p < 0.005). There were significant differences in caries experience and prevalence between school types, where high schools had the lowest D₃MFT values in both age groups (0.39 ± 1.17 and 0.64 ± 1.49, respectively). The highest D₃MFT values were in schools for special educational needs in younger adolescents (1.12 ± 1.9) and in vocational schools in older adolescents (1.63 ± 2.55). Conclusions: In a low-caries-risk population, there were significant differences in caries experience and prevalence among adolescents in different school types. Prevention strategies should aim to reduce the polarization in caries across different educational backgrounds in late adolescence. Full article

Background/Objectives: Caries risk assessment is essential for the management of dental caries. There are different assessment methods with the most commonly used being CAMBRA, the Cariogram, and Caries Risk Semaphore (CRS). The aim of this study was to determine the diagnostic agreement between the three different caries risk assessment methods mentioned above. Methods: This study was conducted in the Dental Clinic of the University of Valencia by Preventive and Community Dentistry II students on patients examined during clinical practices (n = 672). Patients were evaluated to determine their caries risk using the three methods named above. A descriptive analysis of the sample was performed, and diagnostic agreement was assessed using the Kappa coefficient. Results: According to CRS, 321 patients (48%) showed high risk, 96 patients (14%) moderate risk, and 255 (38%) low risk. The highest diagnostic agreement was found between CRS and CAMBRA, with an unweighted Kappa of 0.36. Regarding risk severity assessments, the highest Kappa was also observed between CRS and CAMBRA, with a Kappa of 0.46 for low risk, 0.14 for moderate risk, and 0.40 for high risk. Conclusions: There is an important heterogeneity in the obtained results. This highlights the need to further study different caries risk assessment methods and determine their predictive capacity to choose the one that yields the best outcome. Full article

Introduction: Dental caries and molar–incisor hypomineralisation (MIH) are prevalent conditions affecting children’s oral health, with functional, aesthetic, and psychosocial implications. In Spain, previous studies have highlighted geographic and sociodemographic disparities in their distribution, particularly among rural and migrant populations. Objective: To characterise oral health status, in terms of caries and MIH, among 6–7-year-old children from the towns of Palos de la Frontera, Mazagón, and San Bartolomé. Methods: A cross-sectional study was conducted involving 229 children recruited from public primary schools. Sociodemographic, anthropometric, and behavioural data were collected through clinical examination and interview. Statistical analysis included univariate and multivariate logistic regression. The study protocol was approved by the Ethics Committee of Huelva. Results: The prevalence of caries (DMFT ≥ 1) was 53.3%, with mean DMFT and dft indices of 1.78 and 0.31, respectively. MIH affected 32.8% of the cohort, with a predominance in the first permanent molars (teeth 36 and 26). Multivariate analysis identified independent predictors of caries: African (OR = 7.47; 95% CI: 2.84–23.8) and European (OR = 4.56; 95% CI: 1.26–22.3) parental origin, poor oral hygiene (OR = 3.07; 95% CI: 1.60–6.03), and the presence of MIH (OR = 3.20; 95% CI: 1.64–6.42). The municipality of San Bartolomé was associated with a higher risk of MIH (OR = 2.90; 95% CI: 1.21–7.45). Conclusions: The high prevalence of caries and MIH in the Condado-Campiña district, exceeding national averages, reflects oral health inequities linked to social determinants (migrant origin, locality) and clinical factors (MIH, oral hygiene). Targeted preventive interventions are urgently needed in high-risk populations, including culturally tailored education and policies ensuring equitable access to dental care services. Full article

The involvement of oral bacteria in the pathogenesis of distant organs, such as the heart, lungs, brain, liver, and intestine, has been shown. We analyzed the distribution of bacterial species in the resected aortic valve by 16S rRNA metagenomic analysis and directly compared their gene sequences with those in the oral cavity. Thirty-two patients with aortic stenosis or aortic regurgitation who underwent aortic valve replacement were enrolled in this study. Antibody titer against periodontal pathogenic bacteria in the patient’s serum was analyzed. The genetic background and distribution of bacterial species on subgingival plaque, the dorsal surface of the tongue, and the resected aortic valve were analyzed. Patients with aortic valve disease were shown to have more severe periodontal disease by the detection of antibodies against Socransky’s red-complex bacteria of periodontitis. Bacterial DNA was detected in the aortic valves of 12 out of 32 patients. The genomic sequences of the V3-V4 region of the 16S rRNA in some bacteria isolated from the aortic valves of six patients who underwent metagenomic analysis were identical to those found in the oral cavity. The findings indicate that bacteria detected in the aortic valve may be introduced through oral dysbiosis, a condition characterized by an imbalance in the oral microbiota that increases the risk of periodontal disease and dental caries. Oral dysbiosis and the resulting potential bacteremia are associated with the pathogenesis of aortic valve diseases. Full article

Background and Objectives: This is the first systematic review to focus exclusively on in vivo randomized controlled trials that compare bulk-fill and conventional incremental composite restorations in primary teeth. Our aim was to synthesize current evidence on their clinical performance, including retention, two-year survival rates, marginal integrity, and procedural efficiency. Methods: A comprehensive literature search was conducted in PubMed, Scopus, and the Elicit AI platform up to March 2025. Eligible studies were in vivo randomized controlled trials involving children aged 3–12 years with carious primary teeth, directly comparing bulk-fill and incremental composite restorations. Primary outcomes included retention rates, two-year survival, and marginal integrity, while secondary outcomes were postoperative sensitivity, secondary caries, and aesthetic outcomes. Two reviewers independently performed study selection, data extraction, and risk-of-bias assessments using the Cochrane RoB 2.0 tool. A narrative synthesis was undertaken due to substantial heterogeneity in study design and outcome reporting. The review protocol was registered in PROSPERO (CRD420251021433). Results: Thirteen randomized controlled trials met the inclusion criteria. Both restoration techniques demonstrated high short-term retention rates (>90%) and comparable two-year survival (85–90%). Marginal integrity was generally equivalent, though incremental techniques showed modest advantages in complex cavities. Secondary outcomes were inconsistently reported, with no significant group differences. Bulk-fill restorations consistently reduced the procedural time by 2–4 min per restoration, representing a meaningful advantage in pediatric clinical settings. Conclusions: Bulk-fill composites offer a clinically effective and time-efficient alternative to incremental layering in the restoration of primary teeth. This focused synthesis addresses a gap in existing reviews by concentrating solely on primary dentition and in vivo evidence. Despite similar clinical outcomes, the time savings associated with bulk-fill techniques may enhance their utility in pediatric dentistry. Further standardized and long-term trials are warranted to confirm these findings and inform clinical guidelines. Full article

Background/Objectives: Children with an oral presence of Candida spp. have an elevated prevalence of dental caries. As an alternative to conventional antifungal drugs, the use of biofilm-modulating strategies, such as probiotic bacteria, may be a sustainable option. Probiotics are live microorganisms that have beneficial health effects, while prebiotics are compounds in food that foster the growth or activity of the beneficial microorganisms. The aim of this paper was to review current clinical findings regarding the antifungal effects of pre- and probiotic supplements, including syn- and postbiotics, in children. Methods: We searched two databases (PubMed and Google Scholar) for controlled clinical trials published in English up to 20 April 2025, and two authors scanned the abstracts independently for relevance. The selected full-text papers were reviewed and assessed for risk of bias. Results: Four articles published between 2013 and 2025 were included in this review, covering a total number of 208 caries-active children between 3 and 14 years of age. Study designs were heterogeneous, and we observed conflicting results: two studies with probiotic streptococci failed to demonstrate any beneficial effects on the counts of salivary C. albicans, while interventions with L. plantarum and L. rhamnosus significantly reduced C. albicans compared with controls. None of the included reports displayed a low risk of bias. No clinical studies utilizing prebiotics, synbiotics, or postbiotics were retrieved. Conclusions: We found insufficient evidence concerning the antifungal effects of probiotic supplements in children. Therefore, we recommend future clinical trials to explore the ability of pre-, pro-, and postbiotic interventions to affect cross-kingdom biofilms in order to support a balanced and health-associated composition of the dental biofilm in children. Full article