Clinical guidelines for the diagnosis and treatment of pulpitis and apical periodontitis – what do we know about regenerative pulp therapy Introduction and purpose: This is the fifth article from a series of articles on the clinical recommendations of the European Society of Endodontology S3-level clinical practice guideline for the management of pulpitis and apical periodontitis. Regenerative endodontic treatment of immature permanent teeth with pulp necrosis and apical periodontitis is discussed. Material and methods: The development of this S3-level clinical guideline was based on a robust and transparent process described in the previous articles. Here, two systematic literature reviews were conducted to describe and analyse existing research on the different treatment modalities for the management of immature permanent teeth with pulp necrosis and apical periodontitis, regenerative endodontic treatment and apexification techniques. Results and conclusion: For patients with immature permanent teeth and pulp necrosis with or without apical periodontitis, both regenerative endodontic procedures and apexification may be considered. At present, we do not know whether endodontic tissue engineering represents a valid treatment option as further clinical evidence and research is required. Keywords: regenerative endodontic treatment, apexification, immature permanent teeth, pulp necrosi, apical periodontitis
Diagnosis of pulpitis and apical periodontitis. Recommendations from ESE S3 clinical guidelines AIM: Correct choice of treatment strategy is dependent upon a correct diagnosis. The aim of this article is to give an overview of an evidence-based approach to diagnosis of pulpitis and apical periodontitis based on the consensus-based clinical S3-guidelines by European Society of Endodontology. Methodology: The clinical recommendations in a S3-level guideline are based on systematic reviews of the current literature combined with clinical experience, pros and cons of the investigated diagnostic measures and considerations to costs for the patient (cost-benefit). Results: For the diagnosis of pulpitis, clinical examination combined with pain history, assessment of pulp vitality, and results of relevant supplementary clinical tests, clinical observations are recommended. In patients suspected of having apical periodontitis, clinical examination in combination with periapical radiography is regarded as the standard diagnostic method. CBCT may be considered as an additional diagnostic measure in cases where there is doubt about the diagnosis after standard measures have been applied. Correct periapical diagnostics on CBCT depends on whether the tooth is root-filled or not, and artifacts from metals and movement may influence the diagnostic accuracy negatively. Conclusion: S3-guidelines provide evidence-based recommendations of the clinical strategy for diagnosis of pulpitis and apical periodontitis. Keywords: pulpitis, apical periodontitis, diagnosis, diagnostic accuracy, evidence-based clinical recommendations
Communication climate in the dental clinic This article examines the communication climate in dental clinics and demonstrates its impact on patient safety. We present critical quality moments, five hallmarks of a healthy communication climate, and strategies for incremental improvements. The article describes so-called critical quality moments, concrete situations where the communication climate in the clinic is put to the test. Five features of an excellent communication climate are presented: (i) Friendly friction, (ii) tolerance for active speech mistakes, (iii) psychological safety, (iv) agency climate, and (v) pushing plus buttons. The article discusses how improvements in the communication climate can arise from small steps and minor changes to clinical routines and habits. A revolution is not needed to strengthen how colleagues in the dental clinic communicate at work. Keywords: communication climate, psychological safety, friction, ethics, dental health
Vital pulp treatments Introduction: Epidemiological studies indicate that root filled teeth exhibit higher rates of apical periodontitis and extraction compared to non-root filled teeth, underscoring the importance of vital pulp treatment (VPT) when feasible in teeth with pulpitis. The European Society of Endodontology has established guidelines for treatment of pulpitis, which this article evaluates from a Scandinavian perspective. Review of available scientific literature: The guidelines are based on three systematic reviews on pulpitis management. For teeth with pulpitis without spontaneous pain, evidence is insufficient to favour direct pulp capping over pulpotomy or selective/stepwise caries removal. In teeth with pulp exposure due to caries, direct pulp capping and pulpotomy show comparable short-term outcomes. For teeth diagnosed with pulpitis, with or without spontaneous pain, pulpotomy and root canal treatment demonstrate similar short-term effectiveness. Root canal treatment is suggested to be performed on teeth as soon as the diagnosis necrosis is confirmed to prevent apical periodontitis. Discussion: VPT offers advantages, though concerns persist regarding long-term pulp survival and undetected disease progression. ESE’s guidelines are in line with the Scandinavian’s, though evidence is weak concerning balancing short-term benefits against long-term outcomes, emphasizing the need for careful clinical judgment and further research. Keywords: dental caries, dental pulp capping, dental pulp exposure, pulpectomy, pulpotomy
Description of method for development of a s3 level clinical guideline Purpose: To describe the development of a methodologically sound, evidence-based guideline for the diagnosis and treatment of pulpal and apical disease. The guideline was developed to improve patient care by creating conditions that promote endodontic health and the preservation of natural teeth, while also ensuring oral quality of life (QoL) (1). Method: The development of this S3-level guideline followed the recommendations of an independent organization specializing in guideline development, which ensured a robust and transparent process, the Association of Scientific Medical Societies in Germany (AWMF) (2). Fourteen systematic literature reviews were conducted to describe and analyze existing research, comparing various methods for the diagnosis and treatment of pulpitis and apical periodontitis. The quality of evidence in the individual literature reviews was assessed using the Grading of Recommendations Assessment, Development and Evaluation (GRADE) (3,4). The strength of the individual recommendations was assessed based on AWMF recommendations. Finally, a structured consensus process was held with the participation of a broad panel of internationally recognized researchers and endodontic specialists, representatives from other dental specialties, and patients. This ensured that evidence, clinical experience, and patient preferences were integrated into the recommendations. Result: This S3 clinical guideline provides clinical recommendations on, among other things, the diagnosis and treatment of pulpitis and apical periodontitis, management of deep caries lesions, aseptic treatment, choice of instrumentation, irrigation, root canal filling materials, and highlights the importance of clinical follow-up and continuing education. Conclusion: This guideline is the result of a robust, transparent, and evidence-based process designed to guide clinicians, patients, healthcare systems and decision-makers in the best possible diagnosis and treatment of pulpal and periapical disease. Keywords: endodontology, clinical guidelines, method
Nor Tannlegeforen Tid. 2026;136: Mass disasters, whether natural, manmade, or a combination, often result in numerous fatalities and present complex challenges for victim identification. Disaster Victim Identification (DVI) is a structured, multidisciplinary process that aims to recover, identify, and repatriate deceased individuals. Globally accepted standards, such as the Interpol DVI guidelines, form the foundation of modern DVI operations and are actively applied across the Nordic countries. Key identification methods include dental records, dna analysis, and fingerprint comparison. Dental identification plays a vital role, especially when remains are fragmented or degraded. Effective DVI requires collaboration between police, forensic experts, and healthcare professionals. This paper outlines the organisation, protocols, and identification techniques used in mass fatality incidents, with a focus on the Nordic context. It also addresses current challenges, such as loss of ante-mortem data, dna contamination, technological limitations, and emphasizes the importance of preparedness, training, and high-quality dental record keeping. As future mass disasters are inevitable, the dental profession must remain ready to contribute to DVI efforts by ensuring accurate and accessible documentation and engaging in forensic odontology networks.
Forensic odontology is a special discipline in dentistry. Forensic odontologists primarily work on assignment from authorities or closely related disciplines as forensic medicine. Examples of main tasks for forensic odontologists are personal identifications by means of the teeth, age assessments, and examination of evidence objects suspected to be of dental/ odontological origin or objects /tissue with suspected dental impact. This paper provides an appetizer in the form of an overview of the most important issues in forensic odontology which are covered in the present Nordic Theme issue.
Dental tissues and dental restorations can withstand extreme conditions. For dental identification accurate odontological details recorded on deceased individuals are compared to dental records on missing persons. Forensic dental identification and profiling are common tasks for forensic odontologists. Dental identification can be essential when unknown bodies are found. It may be relevant in single cases as well as following mass disasters, when bodies are decomposed beyond recognition, severely mutilated or skeletal remains exist. Forensic dental identification is recognized internationally as one of three so-called “primary identifiers” together with fingerprints and DNA.
Around 1 out of 5, or 150 million children, under the age of 5 worldwide are unregistered or lack a birth certificate. Unaccompanied minor migrants have many benefits that are inaccessible to adults. It is evident that the age of migrants is one of the key variables that must be ascertained. Equally, it is important that juveniles are housed under safe conditions, including not with adults who are professing to be children. In contrast to teeth, bone growth is dependent on nutrition and external factors. Teeth and bone develop independently and, consequently, it might be a good argument for using both dental and bone development in medical age estimation. The Nordic countries use dental development to estimate the age especially by staging wisdom teeth from radiographs. All countries also estimate age based on skeletal maturity. In addition, Finland and Denmark use physical maturity criteria and Denmark uses sexual maturity. Various recognised scientific methods are used by the different countries. All EU + countries, except Ireland, approve some form of medical age assessment. 21 use dental radiograph analysis and 16 dental observations. 23 countries use carpal (hand/wrist) radiographs, 14 collarbone radiographs and 2 knee MRIs and 8 sexual maturity observations.
In forensic sciences, age estimation is applied mostly when the age of the asylum seekers is unclear especially in cases of the unaccompanied children and in victim identification in reconciling the identity of the deceased. In young individuals the maturation status of teeth as well as eruption of teeth are inspected, and in older individuals degenerative changes like secondary dentine deposits can be evaluated. From a deceased individual, tooth specimens can be extracted for age estimation purposes, which is obviously not possible from a living individual. Age estimation methods by means of the teeth are reviewed.
Gorlin syndrome, also known as nevoid basal cell carcinoma syndrome, is a rare autosomal dominant condition, where clinical features include basal cell carcinomas and odontogenic keratocysts. Radiological examination is necessary to detect the keratocysts, but this represents a diagnostic dilemma due to the patient's increased sensitivity to radiation. The purpose of this article is to describe guidelines for radiological examination and follow-up of Gorlin syndrome. Panoramic imaging and cone beam computed tomography (CBCT) are modalities used for examinations and follow-up of odontogenic keratocysts in the jaws. By using a low-dose CBCT protocol, the image quality will be reduced, but good enough to diagnose keratocysts. The dentist can detect multiple odontogenic keratocysts, especially in children, and can therefore be central to the diagnosis of Gorlin syndrome. CBCT examination with a low-dose protocol can increase the diagnostic value, at the cost of a small rise in radiation dose, compared to panoramic imaging.
Teeth have been described as the body's flight recorder because they can reflect a range of genetic changes, autoimmune conditions, dental trauma, systemic disorders, and environmental influences. These factors can impact amelogenesis and dentinogenesis, leading to dental developmental disorders in the hard tissue of teeth. Thorough investigation of these disorders is essential, as they may be linked to broader diseases and syndromes. Disorders that affect dental tissue, such as enamel and dentin, can have either genetic or non-genetic causes. Identifying potential connections between dental developmental disorders and extra-oral symptoms is crucial for dental health professionals, as it may aid in the diagnosis of underlying syndromes. A holistic approach that considers the “whole individual” is key to recognizing these associations. Highlighted examples include autoimmune polyendocrine syndrome type 1 and coeliac disease (APS1), tricho-dento-osseous syndrome, and hypophosphatasia. The importance of systematic diagnosis, interdisciplinary collaboration, and the potential role of genetic testing are emphasized. Many patients will require personalized follow-up and treatment throughout their lives, making early diagnosis essential to ensuring the best possible care both in the short and long term.
Nor Tannlegeforen Tid. 2025; 135: Complex inherited rare diseases that manifest in the oral cavity often require diagnosis, counselling, and potentially highly specialized treatment. In the Nordic countries, competence centres have existed for several decades, providing diagnostic services, counselling, and highly specialized dental treatment for patients with inherited rare diseases. This article takes the reader through a description of the important collaboration that, since the establishment of the centers, has formed the foundation for meeting the specific needs of this patient group. Internally, we refer to ourselves as the "rare family". The historical perspective is exactly the foundation for future visions of dental perspectives in rare diseases.
Orofacial function refers to the ability to eat through the mouth (chewing, swallowing, and handling bolus in different consistencies), swallow saliva, use facial muscles for communication, perform oral clearance, and to produce speech sounds. Orofacial dysfunctions are common in rare health conditions because many genes are involved in the development of the nervous system and brain, as well as in the growth of craniofacial structures and tooth development. Both oral health and general health can be affected by orofacial dysfunctions, and quality of life can be negatively impacted. This review article aims to examine how causal diagnoses, such as rare health conditions, affect orofacial form and function, and the types of orofacial dysfunction that can arise. The need for a structured assessment is emphasized, and various available assessment methods for oral motor and sensory functions are presented. To promote a holistic approach in healthcare and dentistry, extensive interdisciplinary collaboration is needed. By assessing structure, sensory, and motor function across disciplines, while considering the individual’s causal diagnosis and general functions, a personalized care approach for impaired orofacial function is made possible. The benefits of a holistic and multidisciplinary approach can include a reduced number of healthcare visits, improved general health, improved oral health, and enhanced perceived quality of life.
This article presents Unique Teeth (uniqueteeth.net) – a web portal for rare disorders with oral manifestations. Global estimates suggest that up to half a billion people are affected by a rare disorder. Increasingly, many are living longer with their conditions. Many of these disorders present with oral manifestations or medical conditions necessitating adjustments in dental management. Unique Teeth was created to support dental professionals when treating individuals with known rare disorders – or undiagnosed individuals with unusual oral clinical findings.
The article discusses personalised dental care for individuals with rare diagnoses, who often have an increased risk of oral health problems and may have various disabilities that complicate oral care. Barriers such as dental anxiety and inadequate accommodation contribute to a lack of necessary treatment, which can negatively impact function and quality of life. The article emphasises the importance of a thorough medical history and assessing the patient’s needs before treatment. Preparation, tailored communication, and patient stabilisation can be crucial for safe treatment. Collaboration with relatives and healthcare professionals is also central to ensuring a holistic approach. The article presents specific techniques such as visual support, stabilisation with cushions, and questionnaires for assessing accommodation needs. Additionally, it includes resources that can assist with information and treatment suggestions. The presented elements can improve dental care for individuals with rare diagnoses.
One to two per 1,000 newborns have cleft lip and palate (CLP), and in the vast majority it is the only congenital defect. In a small proportion of individuals with CLP, however, this occurs as part of a syndrome. This is called syndromic CLP. In syndromic CLP, the cleft is treated in the same way as in non-syndromic patients. However, they have a number of other anomalies that also need to be treated, therefore the overall course of treatment is more extensive. Since patients with syndromic CLP (just like with non-syndromic CLP) have their regular examination, check-up and dental treatment at their own municipal dentist/dentist like all other patients, it is important as a dentist to have knowledge of this patient group.
A 46-year-old male patient was referred for evaluation of a suspected cystic lesion that was discovered incidentally during sleep apnea treatment planning. CBCT imaging revealed a large cyst in the left maxilla associated with an impacted third molar displaced against the orbital floor. Following biopsy and infection management, complete surgical removal of the cyst and associated teeth were performed. The buccal fat pad was mobilized and used for wound closure in areas where the surrounding mucosa was insufficient to achieve primary wound closure. Histological examination confirmed a cystic lesion consistent with a dentigerous cyst. The patient had an uncomplicated postoperative recovery.
