Background: The assessment of dental anxiety in pediatric patients is essential for achieving successful dental treatment as it may negatively impact oral health-related quality of life (OHRQoL). This cross-sectional clinical observational study aimed to compare dental anxiety levels, assessed using the Child Drawing: Hospital (CD:H) scale, and OHRQoL between children diagnosed with Familial Mediterranean Fever (FMF) at an early stage and healthy controls. Methods: This study included 37 children aged 8-12 years diagnosed with FMF and 37 healthy children as controls. Their behavior during dental examination was evaluated using the Frankl Behavior Rating Scale, and their anxiety was assessed at the end of the examination using drawings interpreted with the CD:H scale. Dental anxiety and fear were measured with the Dental Anxiety and Fear Scale (IDAF-4C), and OHRQoL was assessed using the Child Oral Health Impact Profile-Short Form 19 (COHIP-SF19). Decayed, missing, filled teeth (DMFT/dmft) indices of all children were recorded. Disease severity in children with FMF was determined using the Modified Pras Severity Score based on symptoms reported in the patient history. Data were analyzed using Jamovi, and statistical significance was defined asp < 0.05. Results: There were no statistically significant differences between children with FMF and healthy controls in CD:H, COHIP-SF19, IDAF-4C, DMFT/dmft, or Frankl scores (all p > 0.05). Frankl scores were negatively correlated with IDAF-4C scores (rho = -0.355, p = 0.002). CD:H scores were negatively correlated with COHIP-SF19 scores (rho = -0.241, p = 0.039). Among children with FMF, Pras severity scores were negatively correlated with Frankl scores (rho = -0.341, p = 0.039). Conclusions: Children diagnosed with FMF showed similar levels of dental anxiety, stress, behavior, and OHRQoL compared with healthy controls. This study offers a novel perspective for future research on psychological and behavioral aspects of chronic pediatric conditions in dentistry.
Background: Biofilm removal plays a key role in the long-term success of root canal therapy. This ex-vivo study aimed to compare the antibacterial efficacy of two rotary instrumentation systems (ProTaper Ultimate and Pro AF Baby Gold) and an irrigation-based non-instrumentation endodontic treatment (NIET) in eliminating Enterococcus faecalis (E. faecalis) biofilms from extracted mandibular second primary molars. Methods: A total of 45 extracted mandibular second primary molars were used. Only teeth with at least two-thirds of the root length intact and without structural anomalies were included. Five teeth served as a negative control group, while the remaining 40 were contaminated with E. faecalis and randomly assigned to four groups (n = 10) based on the preparation technique. Group 1: irrigation-only NIET; Group 2: ProTaper Ultimate; Group 3: Pro AF Baby Gold; and a positive control group (no instrumentation or irrigation) comprised the study groups. After treatment, biofilm samples were collected, and bacterial load was quantified by colony-forming unit (CFU) counting. Data were analyzed with the Kruskal-Wallis H test with Dunn's multiple comparisons for post hoc pairwise testing and the Mann-Whitney U test. Statistical significance level was set at 0.05. Results: The median bacterial counts were 7.99 in the control group, 6.81 in Group 1, 4.73 in Group 2, and 0.00 in Group 3. Group 1 showed no significant difference from the control group (p = 0.3985), but differed significantly from Group 2 (p = 0.0031) and Group 3 (p < 0.0001). Both rotary systems effectively reduced E. faecalis biofilms, with the highest efficacy observed in Group 3. In contrast, NIET provided limited bacterial reduction. Conclusions: While NIET may be useful in pediatric patients, its limited antibacterial efficacy highlights the need for further improvement before it can be considered a reliable clinical alternative.
Background: Premature exfoliation of primary teeth without trauma is an unusual finding that raises suspicion of an underlying systemic disorder. Among the possible causes, hypophosphatasia (HPP) is a rare inherited metabolic disease characterized by deficient alkaline phosphatase (ALP) activity, leading to impaired skeletal and dental mineralization. Pediatric dentists are frequently the first professionals to identify the initial signs of this condition. Case: This report describes the 6-year follow-up of a male patient who first presented at 22 months of age with premature loss of four anterior primary teeth, short stature, and balance issues. No traumatic events were reported by the parents. Clinical examination revealed further mobility of the primary incisors and confirmed short stature and unstable gait. Laboratory tests revealed persistently low ALP levels, hypercalciuria, and high urinary phosphoethanolamine (PEA) levels. Radiography revealed subtle metaphyseal radiolucency. Genetic analysis confirmed a heterozygous mutation in the liver/bone/kidney alkaline phosphatase (ALPL) gene, establishing the diagnosis of HPP. Management was performed by a multidisciplinary team, including pediatric endocrinologists, geneticists, orthopedists, orthodontists, and pediatric dentists. Dental care focused on prevention, professional hygiene sessions, topical fluoride applications, and monitoring occlusal development. Orthodontic assessments were performed when the permanent teeth erupted. Over the years, the child lost additional primary teeth with intact roots but maintained masticatory efficiency, vertical dimension, and good oral function. Growth parameters and skeletal phenotype remained stable, and enzyme replacement therapy (ERT) was not considered necessary. Conclusions: This case illustrates the key role of early dental signs in timely HPP diagnosis, the potential significance of a rare haplotype, and the effectiveness of interceptive orthodontic management over six years.
Background: Pediatric sleep-disordered breathing (SDB) is highly prevalent and associated with craniofacial risk factors, including malformations of the maxilla, mandible, and other features not routinely assessed clinically. This study evaluated craniofacial risk factors associated with SDB symptoms in children presenting for routine dental care. Methods: Children aged 5-12 years were recruited from pediatric dental practices in nine U.S. cities. The primary outcome was SDB as defined by the Pediatric Sleep Questionnaire-Sleep-Related Breathing Disorder (PSQ-SRBD) questionnaire. Regression analyses modeled the association between PSQ-SRBD, the 21 individual craniofacial features, as well as the total number of craniofacial risk factors. A subset of participants underwent a blinded duplicate craniofacial assessment to evaluate inter-rater reliability. Results: The sample included 141 children (75% Non-Hispanic-White, 12% Hispanic, 9% Non-Hispanic-Black, 4% other; 50% female), with a mean age (standard deviation) of 8.6 (2.3) years, presenting for routine dental care. PSQ-SRBD scores were >= 0.33, signifying increased SDB risk in 28 (20%) children. Increased risk for SDB was associated with the total number of craniofacial risk factors, odds ratio (OR) of 1.16 (95% confidence interval (CI): 1.01-1.35, p = 0.035); as well as with specific individual features including a narrow palate: 3.47 (1.34-9.07, p = 0.010), open bite: 5.61 (1.36-23.63, p = 0.016), tongue thrust: 11.33 (1.98-75.19, p = 0.007), and a heartshaped tongue: 7.41 (1.48-39.38, p = 0.014) after adjustment for age, sex, race, and ethnicity. There was moderate inter-rater reliability (kappa statistic: 0.76, 95% CI: 0.63- 0.89) in the subset of 54 subjects with duplicate craniofacial assessments. Conclusions: Multiple craniofacial features assessed during routine dental visits were associated with an increased risk for pediatric SDB. This study supports the utility and feasibility of systematic craniofacial screening by dental providers to identify children at risk for SDB and facilitate timely referral and intervention.
Background: Reliable bonding between resin composite restorations and deciduous dentin is clinically challenging. Theaflavins (TFs), black tea-derived natural polyphenols with collagen cross-linking, matrix metalloproteinase (MMP)-inhibiting and antibacterial activities, have not been studied as a deciduous dentin pretreatment agent. This study evaluated 2% (w/v) TFs for improving bond strength and marginal sealing, with 2% chlorhexidine (CHX) and distilled water (DW) as controls. Methods: Forty-eight caries-free primary molars were randomly assigned to micro-tensile bond strength (& micro;TBS, 30 teeth) or microleakage (18 teeth) testing. Each group was subdivided into TFs, CHX, and DW subgroups, and these were further split into immediate/aged testing. After pretreatment and adhesive/resin application, & micro;TBS measurement, fracture mode observation, interface morphology analysis, and International Organization for Standardization (ISO)-standard microleakage assessment were conducted; data were analyzed via SPSS 26.0 (alpha = 0.05). Results: & micro;TBS: In both immediate and aged groups, TFs group depicted the highest strength, followed by CHX and DW (p < 0.05). Fracture mode: After aging, the DW group showed predominantly type I interfacial failure, while the CHX and TFs groups displayed fracture mode III-a mode not observed in the DW group. Interface morphology: TFs group had the most and longest resin tags, while the thickest and most intact hybrid layer were observed in both immediate and aged groups. Microleakage: In both immediate and aged groups, the TFs group was lower than DW (p <0.05) but showed no significant difference from CHX group (p > 0.05). TFs group had no significant change in microleakage after aging (p > 0.05). Conclusions: The 2% TFs pretreatment significantly improved bond strength and reduced microleakage in deciduous dentin, as compared with those with 2% CHX.
Background: Orthodontic appliances increase the difficulty of maintaining oral hygiene due to their size and complexity. This study aimed to evaluate salivary pH and buffer capacity in pediatric patients aged 6-14 years using the Saliva-Check Buffer test comparing two groups: patients who have completed dental treatments but have not yet started the orthodontic treatment (control group), and those who have been undergoing orthodontic treatment with rapid palatal expander (RPE) for at least six months (trial group). Methods: Clinical assessments included the recording of Decayed, Missing, Filled Teeth (DMFT + dmft), Decayed, Missing, Filled Surfaces (DMFS + dmfs), plaque control record (PCR) and Frankl behavioural scale. Salivary pH and buffering capacity were measured using the Saliva-Check Buffer kit which consisted of five different tests. Data were statistically analyzed, assessing data normality of distributions with Kolmogorov-Smirnov test, and subsequently performing Mann-Whitney test and linear regressions analyses (significance threshold: p < 0.05). Results: Orthodontic patients exhibited significantly higher PCR scores and lower salivary buffering capacity compared to the pre-orthodontic group (p < 0.05). No significant differences were observed in DMFT + dmft and DMFS + dmfs scores between the groups (p> 0.05), but DMFS + dmfs significantly influenced salivary consistency, pH and buffering capacity (p <0.05). Salivary consistency significantly influenced by age, while salivary pH seemed influenced by PCR and group. Sex and group significantly influenced saliva quantity (p < 0.05), and finally PCR significantly influenced salivary buffering capacity (p < 0.05). Conclusions: The findings suggest that orthodontic treatment may contribute to increased plaque accumulation and reduced salivary buffering capacity, potentially elevating caries risk. Enhanced oral hygiene measures and preventive strategies are recommended for orthodontic patients. Clinical Trial Registration: the study was registered on clinicaltrials.gov (NCT06922799).
Background: The choice of crown material following endodontic treatment in primary molars is critical for biocompatibility and long-term clinical success. This study aimed to compare the stress distribution patterns caused by stainless steel crowns (SSC), pediatric zirconia crowns (PZC), and Bioflx crowns-placed on pulpotomized primary molars- in combination with different luting cements, under maximum bite force using threedimensional finite element analysis (3D-FEA). Methods: A 3D model of a caries-free, anatomically intact maxillary primary molar was created from micro-computed tomography (micro-CT) images. A virtual pulpotomy was simulated using mineral trioxide aggregate (MTA) and conventional glass ionomer cement (GIC). SSC, PZC, and Bioflx crowns were modeled in various combinations with either GIC or resin-modified glass ionomer cement (RMGIC). Based on the mechanical properties reported in the literature, a total load of 245 N was applied at angles of 0 degrees, 45 degrees, and 90 degrees, and stress distributions and maximum von Mises stress values were evaluated in the luting cement layer, dentin, and pulp tissues. Results: In the Bioflx crown models, von Mises stress values in both the dentin and cement layers were higher compared with those in the SSC and PZC models. The lowest stress values were observed in the PZC models. Stress levels within the radicular pulp were similar across all models and remained below the thresholds for biological damage. The healthy tooth model showed intermediate stress values between those of the SSC and PZC models. Models utilizing RMGIC exhibited lower stress levels in the cement layer but higher stress in dentin and pulp; however, these differences did not represent a relevant variation. Conclusions: The findings indicate that the directionally applied 245 N masticatory force has a direct impact on the biomechanical performance of both the crown material and the luting cement. Notably, the Bioflx crown models' elevated stress levels indicate that a thorough clinical assessment is necessary before using it.
Background: The present randomized clinical trial aimed to evaluate the potential effects of an orthodontic smartphone application (Ortodontika) in addition to verbal instructions for the improvement of pediatric patients' oral health and the reduction of orthodontic urgencies in the first 6 months of hyrax rapid palatal expander (RPE) treatment. Methods: Patients aged 6-14 years old were enrolled and modified gingival index (MGI), bleeding index (BI), and plaque index (PI) were recorded at the baseline (T0) and at follow-ups. Hyrax rapid palatal expander was cemented and patients were randomly divided into the Control group, in which instructions were given to patients for RPE activations and daily oral hygiene, and in the Trial group, in which Ortodontika application was delivered as additional aid to verbal instructions. The RPE questionnaire was delivered to all patients to evaluate their perceptions and knowledge on their orthodontic treatment. The APP questionnaire was delivered to Trial group only to assess the experience with Ortodontika application. The number of orthodontic urgencies and the number of accesses to the application for the Trial group were recorded in the time frames between follow-up appointments. Results: No significant between-group differences were found for MGI, BI and PI (p > 0.05), while significant within-group differences were found for BI and PI (p <0.05). A significantly higher number of the cumulative orthodontic urgencies was found in the Control group (p < 0.05). The number of accesses to the application was higher in T0-T1 and T1-T2 time frames, even though with no withi-group differences (p > 0.05). No significant differences were found for the RPE and APP questionnaires (p> 0.05). Conclusions: Ortodontika application as an adjunct to verbal instruction could be useful for the reduction of RPE urgencies and as a reinforce for daily oral hygiene.
Background: Although pulpectomy is recognized as the standard treatment for severe pulp pathologies, objective and quantifiable measures to predict primary molar survival after pulpectomy are limited. The aim of this study was to develop a predictive model for the long-term survival of primary molars after Vitapex pulpectomy using machine learning. Methods: This retrospective cohort study analyzed data from 212 pulpectomized primary molars. The DeepHit prediction model was developed based on significant prognostic factors identified through univariate Cox regression analysis. Calibration of the prediction model was evaluated, and further external validation was performed on 101 pulpectomized primary molars from multicenter cohorts. Results: Age at initial treatment, Frankl behavior score, arch type, presence of mucosal fistula, periapical lesion, and single-visit pulp treatment were significantly associated with survival rates. The weighted mean Brier score was 0.20, and an overall concordance index (C-index) was 0.73, indicating strong predictive accuracy. Conclusions: The DeepHit prediction model for primary molar pulpectomy in children under 9 years of age was successfully developed and showed clinical potential for predicting pulpectomy outcomes.
Background: Parafunctional habits, such as bruxism, mouth breathing, and nail or lip biting, are common in children and may disturb the neuromuscular balance of the stomatognathic system, contributing to malocclusion and temporomandibular joint (TMJ) dysfunction. This study aimed to describe the prevalence and clinical correlates of TMJ symptoms in children and adolescents, with particular focus on their associations with parafunctional habits, malocclusion, and mandibular asymmetry. Methods: This retrospective cross-sectional study analyzed 190 orthodontic examination records from patients aged 6-18 years (mean = 12.34 +/- 2.76 years), collected between January 2022 and March 2024. Data on parafunctional habits, TMJ symptoms, and clinical variables were extracted from standardized forms. Chi-square tests assessed associations between categorical variables, and Spearman's rho examined correlations with age. Binary logistic regression was used to explore variables associated with the presence of TMJ symptoms. Statistical significance was set at p < 0.05. Results: Mouth breathing was the most common parafunctional habit (34.7%), followed by nail biting (17.4%) and bruxism (14.2%). TMJ symptoms were present in 39.5% of participants, and mandibular asymmetry in 11%. Bruxism was associated with higher odds of TMJ symptoms (beta = 1.03, p = 0.020, Odds Ratio (OR) = 2.79), whereas mouth breathing showed an inverse association (beta = -0.75, p = 0.028, OR = 0.47). Thumb-sucking decreased with age (rho = -0.147, p = 0.043), while lip-biting increased (rho = 0.170, p = 0.019). Patients with mandibular asymmetry were more likely to have TMJ symptoms (chi 2 = 28.16, p < 0.001). Conclusions: Parafunctional habits and TMJ symptoms were prevalent in this orthodontic population. Bruxism showed a significant association with TMJ symptoms, whereas mouth breathing was negatively associated. Incorporating systematic screening for parafunctional habits and functional deviations into orthodontic evaluations may contribute to earlier recognition of patients who could benefit from closer functional monitoring.
Background: Diet is a key risk factor in the development of dental caries, and parents' nutritional attitudes can shape children's eating behaviors. This study aimed to evaluate the association between parental eating behaviors, feeding styles, and dental caries in preschool children. Methods: The study included 376 children aged 3-6 years. Participants were classified into four groups according to their maximum Caries Assessment Spectrum and Treatment (CAST) score: healthy/pre-morbidity (scores 0-3), morbidity (scores 4-5), severe morbidity (scores 6-7), and mortality (score 8). Parents completed the Child Eating Behavior Questionnaire (CEBQ) and the Parental Feeding Style Questionnaire (PFSQ). Socioeconomic status was assessed using the Family Affluence Scale. Results: Higher CAST scores were significantly associated with lower socioeconomic status and parental education levels (p < 0.001). The proportion of children in the mortality stage increased with more frequent junk food consumption (p <0.001). Significant differences across dental caries stages were observed in the CEBQ subscales of Desire to Drink (p = 0.002), Slow Eating (p = 0.001), Emotional Undereating (p = 0.008), and Food Fussiness (p = 0.001). Comparisons between morbidity stages showed statistically significant differences in instrumental (p = 0.005) and emotional feeding styles (p = 0.003), with the highest values observed in the mortality group. Linear regression analysis evaluating the effects of CEBQ and PFSQ subscales on the maximum CAST score demonstrated a statistically significant model (F = 7.437; p < 0.001). Conclusions: Children's eating behaviors and parental feeding styles appear to influence both the presence and severity of dental caries during the preschool period. Evaluation of dietary behaviors may enhance understanding of the multifactorial etiology of dental caries and support the promotion of healthy eating habits in early childhood.
Background: This study aimed to identify factors associated with dental caries in Chinese children and develop a validated risk prediction nomogram for this condition. Methods: A total of 450 pediatric outpatients from the Stomatology Department of the General Hospital of Northern Theater Command were enrolled and stratified into a caries group (n = 340) and a non-caries group (n = 110) based on clinical caries status. Univariable and multivariable logistic regression analyses, combined with Least Absolute Shrinkage and Selection Operator (LASSO) regression, were applied to screen independent predictors of dental caries, and a nomogram model was constructed based on the identified key factors, with internal validation using the original dataset. The discriminative power was measured by the receiver operating characteristic (ROC) curve's area under the curve (AUC), whereas calibration was assessed using calibration plots and the Hosmer-Lemeshow test. Clinical applicability was examined through decision curve analysis (DCA) and clinical impact curves (CIC). Results: The following three factors contribute to the occurrence of dental caries: liking to eat snacks (p < 0.001), Undesirable Behavioral Habits (p = 0.039), and brushing teeth for less than 2 minutes (p < 0.001). The nomogram showed excellent discrimination, with an AUC of 0.939 (95% Confidence Interval: 0.911-0.967) confirmed by bootstrapping, and good calibration (Hosmer-Lemeshow test, p = 0.922). DCA indicated that using the model to guide targeted interventions provided superior net benefit across a wide probability threshold range (0.02-0.98), compared to strategies of intervening in all or no children. CIC displayed good predictive ability and clinical application value for the model. Conclusions: Prediction nomograms identified frequent snacking, undesirable behavioral habits, and brushing time <2 minutes as key predictors of childhood dental caries. Both clinical and online dynamic nomograms can screen high-risk children, enabling dentists to deliver individualized management and timely, effective interventions for them.
Background: Despite being entirely preventable, dental caries remains highly prevalent in children, often beginning as early enamel demineralization (white spot lesions). Fluoride-based products are the mainstay for prevention and remineralization, with 5% Sodium Fluoride Varnish (FV) and 38% Silver Diamine Fluoride (SDF) being the most commonly used. However, evidence on SDF's remineralization potential in early primary tooth enamel caries is limited. Methods: This in vitro study evaluated the effectiveness of SDF and FV in remineralizing artificial enamel caries by measuring enamel microhardness (EMH). Sixty primary teeth were randomized into four groups (n = 15): sound enamel (healthy enamel), SDF, FV, and demineralized untreated control. Artificial caries was induced via an 8-day exposure to a pH 4.4 demineralizing solution. EMH was measured using a Vickers Microhardness tester. Data were analyzed via one-way analysis of variance (ANOVA) and Tukey's post-hoc test (p <= 0.05). Results: Results showed significant differences among groups (p < 0.001). FV produced the greatest increase in EMH, significantly outperforming SDF and control. SDF also improved EMH compared to untreated teeth, but was less effective than FV. Conclusions: Under these in vitro conditions, FV demonstrated superior remineralization capacity compared to SDF for early enamel lesions in primary teeth. However, these findings should be interpreted within the context of a chemically-induced lesion model without biofilm, and clinical decision-making should consider that FV and SDF have different indications and may serve complementary roles depending on lesion type, substrate, and clinical circumstances.
Background: Apical periodontitis develops when bacterial infection occurs within the root canal system or periapical tissues. In adolescents, immature permanent teeth often exhibit incomplete canal division and insufficient calcification, which may compromise root canal preparation and obturation. Moreover, when the infection originates from extraradicular biofilms rather than intracanal bacteria, nonsurgical endodontic treatment alone may not be sufficient. In such cases, intentional replantation can provide access for root-end management and removal of extraradicular biofilms, serving as a feasible treatment option when conventional retreatment fails. This report aims to present the clinical rationale, procedure, and long-term outcome of intentional replantation as a conservative management approach for refractory apical periodontitis in an adolescent mandibular molar. Case: A 13-year-old male was referred with a persistent sinus tract on the mandibular right first molar following root canal treatment. Retreatment revealed incomplete canal development with a middle distal canal communicating with the distobuccal and distolingual canals. The previously placed calcium hydroxide with iodoform paste was removed, and the canals were refilled with mineral trioxide aggregate (MTA) based materials. Despite initial resolution, recurrence of the apical lesion, accompanied by sinus tract formation, was confirmed at 9 months. Intentional replantation was then performed with extraoral root-end resection and MTA retrofilling. At the 4-year follow-up, clinical and radiographic evaluations demonstrated complete periapical healing, normal mobility and function, and no evidence of root resorption or ankylosis. Conclusions: Endodontic management of immature adolescent teeth requires particular caution due to anatomical complexities. When apical periodontitis persists despite conventional retreatment, intentional replantation may be considered a predictable and viable treatment option in selected adolescent patients.
Background: With the emergence of U-shaped manual toothbrushes, it has become necessary to evaluate their effectiveness in preschool children when used independently. Accordingly, this cross-over randomized controlled trial aimed to evaluate the effectiveness of a manual U-shaped toothbrush for dental plaque removal among preschool children, compared with a manual traditional toothbrush, and to assess the ease of use of both toothbrushes and children's preferences. Methods: Thirty children aged 4-5 years were randomly divided into two groups: Group 1 (n = 15), in which children used a manual traditional toothbrush for 21 days followed by a manual Ushaped toothbrush for another 21 days, and Group 2 (n = 15), in which children used a manual U-shaped toothbrush for 21 days followed by a manual traditional toothbrush for 21 days. Plaque accumulation was evaluated by two blinded examiners using Turesky modification of the Quigley-Hein plaque index (TMQHPI) at seven-time points; pre-brushing (T0), immediately after using the first toothbrush (T1), 7 days after using the first toothbrush (T2), 21 days after using the first toothbrush (T3), immediately after using the second toothbrush (T4), 7 days after using the second toothbrush (T5), and 21 days after using the second toothbrush (T6) to determine which toothbrush achieved better plaque removal. At T3 and T6, children were asked about the ease of use of both toothbrushes, while at T6, they were asked about their preferred toothbrush. Results: At T2, T3, T5, and T6, plaque accumulation was significantly lower with the use of the U-shaped toothbrush. Both toothbrushes were reported to be easy or moderately easy to use by the children. Most children preferred the U-shaped toothbrush. Conclusions: Ushaped toothbrushes significantly improved preschool children's plaque control ability. Clinical Trial Registration: NCT06288581.
Background: Effective measurement of working length is essential for successful endodontic treatment. Electronic Apex Locators (EAL) and Digital Radiography (DR) are commonly used methods, yet their comparative impact on post-operative pain remains unclear. This study aimed to compare post-operative pain intensity and pain dissipation duration following working length determination using EAL and DR in pediatric endodontic patients. Methods: A total of 130 patients aged 10-15 years were randomly assigned to the EAL group (n = 65) or the DR group (n = 65). Pain intensity was assessed using the Visual Analogue Scale (VAS) at pre-operative, and at 6, 12, 24, 48 hours, and 7 days post-operatively. Pain scores were further analyzed by age and gender. Independent and paired t-tests and Analysis of Variance were applied for statistical analysis. Results: No statistically significant difference was observed between the EAL and DR groups in VAS scores at any time point (p > 0.05). Female participants consistently reported higher mean pre- and post-operative pain scores compared with males, with significant differences observed in both groups (EAL: p = 0.031; DR: p < 0.001 for pre-op scores). Overall, while both groups showed comparable pain reduction trends over time, gender influenced pain perception and pain relief duration significantly in both treatment modalities. Conclusions: Both EAL and DR are effective for working length determination, showing no significant difference in post-operative pain. Pain perception and relief duration, however, vary with gender and age and should be considered during endodontic treatment planning. Clinical Trial Registration: The trial was retrospectively registered with ClinicalTrials.gov (Identifier: NCT07181252, Retrospective registration).
Background: Gingivitis is the most common periodontal disease in children and adolescents, characterized by reversible inflammation caused by plaque accumulation. Because traditional clinical indices, such as gingival and plaque scores, detect inflammation only after visible tissue changes occur, identifying early biomarkers of subclinical inflammation is essential. Gingival crevicular fluid (GCF), a serum-derived exudate enriched with host inflammatory mediators, has emerged as a valuable non-invasive diagnostic medium. This study aimed to compare GCF concentrations of interleukin-1 beta (IL-1 beta), tumor necrosis factor-alpha (TNF-alpha), interleukin-6 (IL-6), and interleukin-8 (IL-8) between children with clinically healthy gingiva and those with plaque-induced gingivitis, and to evaluate correlations between cytokine levels and clinical periodontal parameters. Methods: A cross-sectional study was conducted in 58 children aged 10-13 years, classified as healthy (n = 30) or with gingivitis (n = 28). Clinical parameters-including plaque index, gingival index, probing depth, bleeding on probing, and GCF volume were recorded. GCF samples were collected from the mesiobuccal sites of the upper incisors and analyzed using enzyme-linked immunosorbent assay (ELISA). Statistical tests included Mann-Whitney U, Spearman correlation, and receiver operating characteristic (ROC) curve analysis (p < 0.05). Results: All clinical parameters were significantly higher in the gingivitis group (p < 0.001). IL-1 beta and IL-8 levels were significantly elevated in gingivitis (p = 0.001 and p = 0.035, respectively), whereas IL-6 and TNF-alpha showed no significant differences. IL-1 beta correlated with bleeding on probing (r = 0.47) and pocket depth (r = 0.34). IL-1 beta demonstrated the highest diagnostic accuracy, with an area under the curve (AUC) = 0.76. Conclusions: IL-1 beta appears to be a sensitive and reliable biomarker of gingival inflammation in children, reflecting local immune activation before irreversible tissue damage.
Background: The concept of oral-health-related quality of life (OHRQoL) encompasses patients' subjective perceptions of their oral health status and emotional well-being. Several factors have been reported that can influence the adolescents' OHRQoL, including dental caries, malocclusion, and the parental educational and socioeconomic levels. Parents significantly influence their children's oral health and development. However, the relationship between parents' and adolescents' OHRQoL remains unclear. This study aimed to investigate the possible relationship between the OHRQoL of parents and their adolescent children in a population from Salamanca, Spain. Methods: This cross-sectional study was conducted at the Dental Clinic of the University of Salamanca (Spain) between 2023 and 2025. A total of 130 adolescents (aged (11-14) years) who had never attended a dental consultation and their parents were recruited. Parents completed the Spanish version of the Oral Health Impact Profile (OHIP-14), while adolescents completed the Spanish version of the Child Perceptions Questionnaire (CPQ-Esp(11-14)). Correlations between parents' and adolescents' OHRQoL scores were assessed using Spearman's correlation coefficient (rho). Results: The mean age of the participating adolescents was 12.55 +/- 1.43 years (girls: 50%; boys: 50%), and the mean age of the was 43.2 +/- 3.32 years. The mean score for the individual domains of the CPQ-Esp(11-14) was 17.4 +/- 3.6. Higher scores in the psychological discomfort dimension of the OHIP-14 were significantly correlated with more negative OHRQoL outcomes in the functional limitation (rho = 0.16), emotional well-being (rho = 0.16) and social well-being (rho = 0.17) dimensions of the CPQ-Esp(11-14) (p <0.05). Conclusions: This study observed a significant relationship between the psychological discomfort dimension of the OHIP-14 in parents and the OHRQoL of their adolescent children.
Background: The integration of artificial intelligence (AI) into dentistry holds immense potential to enhance diagnostic accuracy, treatment planning, and patient outcomes, particularly in pediatric care. Despite its promise, the adoption of AI in routine dental practice remains slow, with challenges such as ethical concerns, lack of training, and high costs hindering progress. This study explores the awareness, attitudes, and current adoption of AI in pediatric prosthodontics and oral medicine among dental professionals in Saudi Arabia (SA), Malaysia (MY), and Pakistan (PK), aiming to identify barriers and opportunities for AI integration in child-focused dental care. Methods: A crosssectional survey was conducted among 655 pediatric dentists (SA: 231, MY: 181, PK: 243) using a structured online questionnaire. The survey assessed demographics, knowledge of AI applications, attitudes toward AI integration, current clinical practices, and perceived barriers. Data were analyzed using descriptive statistics, chi-square tests, and logistic regression to evaluate regional differences and predictors of AI adoption. Results: Awareness of AI applications was highest in MY (95.6%), followed by PK (85.6%) and SA (78.8%). While most respondents viewed AI positively-believing it could improve treatment outcomes (92.6-97.1%)-actual usage was low (SA: 16.5%, MY: 37.6%, PK: 9.9%). Key barriers included cost, lack of training, and resistance to change. Logistic regression revealed significant regional disparities, with MY showing higher adoption rates than SA and PK (rho < 0.001). Despite enthusiasm, over 90% of dentists emphasized the need for human oversight in AI-based diagnoses. Conclusions: Pediatric dentists acknowledge the potential of AI; however, its practical implementation is hindered by systemic and regional challenges. It is crucial to implement targeted interventions, including the development of affordable AI tools, the establishment of specialised training programs, and the formulation of ethical guidelines. Collaborative efforts involving policymakers, educators, and practitioners can facilitate the responsible integration of AI, enhancing precision and patient care.
Background: Traumatic dental injuries are a significant public health issue, yet intelligent chatbots offering potential solutions may broaden both patients and clinicians' horizons. This study aimed to evaluate the accuracy, temporal reliability, and reference reliability of the diagnosis and treatment responses provided by artificial intelligence (AI) chatbots to created dental trauma. Methods: 45 dental trauma scenarios based on the International Association of Dental Traumatology (IADT) guidelines were presented to four generative large language models (LLMs): ChatGPT-4o, Claude Sonnet 3.7, Gemini Advance, and DeepSeek R1. Three questions (diagnosis, treatment, and references) were asked for each scenario, and the responses were scored using a modified Global Quality Scale (mGQS) developed by the authors, allowing quantitative comparison of the results. The obtained data were analyzed using IBM SPSS Statistics version 27.0. Differences between diagnosis and treatment scores were evaluated using the Analysis of Variance (ANOVA) test, and the temporal reliability of chatbots was evaluated using the intraclass correlation coefficient (ICC). The sources provided by the LLMs were cross-checked via Google Scholar and PubMed and classified as real or fake references. Results: No significant differences were found among LLMs in diagnosis and treatment scores (p > 0.05). In the overall evaluation, DeepSeek R1 received the highest scores, while Claude Sonnet 3.7 showed the lowest average scores. When temporal reliability was assessed, ChatGPT-4o demonstrated good, clinically acceptable temporal reliability (ICC = 0.80). In contrast, Claude Sonnet showed poor reliability, while Gemini Advance and DeepSeek R1 exhibited moderate reliability. In terms of reference reliability, the highest true source rate was observed in DeepSeek R1 (84.78%), while the lowest rate was seen in Claude Sonnet 3.7 (52.57%). Conclusions: Although LLMs provided partially accurate and consistent responses for simple dental trauma cases, they are not yet suitable for clinical use, particularly in terms of treatment recommendations and source reliability.
