Purpose: This study quantified age-specific differences in organ and effective doses during intraoral radiography in pediatric patients, with emphasis on identifying developmental stages associated with increased radiation exposure to critical organs. Methods: Monte Carlo simulations were performed using PCXMC 2.0 software for 3 pediatric age groups (5, 10, and 15 years), representing key developmental stages. Simulated full-mouth intraoral radiographic series used 4 exposure combinations: 60 kilovolt peak (kVp)/3 milliampere (mA), 60 kVp/6 mA, 70 kVp/3 mA, and 70 kVp/6 mA. Organ dose distributions and total effective doses were calculated according to the 2007 recommendations of the International Commission on Radiological Protection. One-way analysis of variance with post hoc tests assessed differences between groups. Results: Clear age-dependent variations in organ and effective radiation doses were observed. The 5-year-old group showed the highest effective doses (62.4 to 129.6 microsieverts [μSv]), despite fewer exposures. The 10-year-olds had the lowest doses (37.2 to 76.8 μSv). Thyroid doses in 5-year-olds were 3.2 times higher than in older groups (P<0.001), due to anatomical proximity. Bone surface doses were similar in 5 and 15-year-olds but lower in 10-year-olds. These trends persisted across exposure combinations, though optimized settings (60 kVp/3 mA) reduced doses by over 50%. Conclusions: Age significantly influences radiation dose in pediatric dental imaging, with 5-year-olds receiving higher organ doses, especially to the thyroid. These findings stress the importance of age-specific protection strategies beyond adjusting exposure settings, emphasizing the developmental stage in radiation safety.
Purpose: To evaluate the effectiveness of artificial intelligence (AI)-powered chatbots in providing reliable guidance for the management of acute pediatric dental trauma. Methods: A comparative analysis was conducted between August 2024 and April 2025 using 5 prominent AI chatbots: ChatGPT-4, Google Gemini, Perplexity, Claude-2, and Llama, assessing 23 frequently asked questions on pediatric dental trauma. Responses were evaluated on accuracy across 4 domains: dental diagnosis, treatment, follow-up, and medical follow-up. The study simulated clinical scenarios without involving human participants. Results: Chatbot performance in dental diagnosis and treatment was consistent with no significant variation. However, significant differences were noted in dental follow-up (P=0.036), and medical follow-up had low validity. Conclusions: Chatbots can be reliable tools for preliminary parental guidance in pediatric dental trauma. However, inconsistencies in follow-up recommendations and medical guidance limit their use as independent tools. They should be considered as supportive aids rather than replacements for clinical expertise.
Purpose: This study evaluated associations among breastfeeding duration and combined breast/formula feeding on childhood dental caries. Methods: This was a cross-sectional study of 3- to 6-year-old children (n =1,256) in the National Health and Nutrition Examination Survey, 2015-2018. Duration of breastfeeding and breast/formula feeding were assessed through structured interviews. Caries experience was assessed as having at least 1 decayed and filled tooth. Survey-weighted logistic regression adjusted for confounders evaluated associations. Results: The average maternal age at delivery was 28 years (standard error=0.28). About half (49.7%) of the children were girls. Thirty-eight percent of the children were breastfed for no more than 6 months, 20% for more than 6 to 12 months, and approximately 9% were breastfed for more than 12 to 18 months and over 18 months, while 24% were exclusively formula-fed. Relative to children breastfed for no more than 6 months, those breastfed for longer than 18 months had a nonsignificant covariate-adjusted caries experience odds (odds ratio [OR]=1.55, 95 percent confidence interval [95% CI]=0.80 to 3.01). Relative to children who were exclusively breastfed, those who were nonconcurrently breastfed/formula-fed (ie, there was no overlap in breastfeeding and formula feeding) had higher covariate-adjusted caries experience odds (OR=3.01, 95% CI=1.18 to 7.67). Conclusions: Nonconcurrent breast/formula feeding was associated with increased dental caries prevalence. Additional studies are needed to confirm these results and evaluate underlying mechanisms.
Purpose: To investigate associations between feeding practices and the prevalence of oral Rothia, at the species and genus level, with early childhood caries (ECC). Methods: A total of 438 children were included in this cross-sectional study. A questionnaire was completed by the parent of each participant. Based on the feeding history, participants were classified as exclusively breastfed, exclusively bottle-fed, or mixed (both feeding). Supragingival plaque samples were collected, and 16S rRNA sequencing was used to assess Rothia genus and species' relative abundances. The association between feeding practices and Rothia prevalence with ECC was analyzed using multivariable logistic regression. Results: Low relative abundance of Rothia aeria was significantly associated with ECC, whereas there were no significant associations between the relative abundance of Rothia dentocariosa or Rothia mucilaginosa with caries status. Feeding practices were not associated with ECC. However, bedtime bottle use, bedtime snacking, living in a rural area, older age, use of fluoridated toothpaste, and having less-educated guardians were significantly associated. Conclusions: The findings suggest that low relative abundances of Rothia aeria and Rothia (genus) are associated with early childhood caries. Social environment and bedtime habits were also associated with ECC; however, feeding practices were not. Prospective studies examining Rothia and feeding practices with ECC would be beneficial to understand the relationship between Rothia and ECC and to help reach a consensus on the effect of different feeding practices on ECC risk.
Purpose: To assess California pediatric dentists' perspectives on Senate Bill 501 (SB 501) and its impact on sedation practice in pediatric dentistry. Methods: An electronic survey was delivered to all 818 members of the California Society of Pediatric Dentistry. The 18-question survey inquired about the participants' demographic information, sedation experience, and insights about the changes made by SB 501. Data were anal- yzed using frequency distribution and chi-squared analyses (P<0.05). Results: A total of 124 pediatric dentists responded to the survey (15.2% response; 78.7% had previously applied for a sedation permit, while 21.3% did not. Among the 96 respondents with a previous sedation permit, 83% reported that SB 501 impacted their practices. Additionally, 72.9% of the respondents with previous sedation experience hold an active permit, and 53.1% are currently using oral sedation in-office. The top barriers linked to SB 501 were the cost of hiring a second Pediatric Advanced Life Support (PALS)-certified support personnel dedicated to patient monitoring (34.5%), the requirement to complete 20 sedation cases for each age category to obtain pediatric endorsements (26.2%), other reasons (18.2%), application fees (15.5%), and continuing education requirements (3.6%). Conclusions: Based on these findings, new sedation permit regulations in California in 2022 have significantly impacted pediatric sedation practices. A marked decrease in sedation permit holders may lead to diminished access to care for pediatric patients. Many respondents urged the revision of this legislation to better support offering safe and effective sedation care.
Purpose: To evaluate the physical and mechanical properties of 3 types of preformed crowns used in pediatric dentistry. Methods: Thirty crowns each were used for 3 study groups: Group 1-BioFlx® Crowns (BFCs); Group 2-stainless steel crowns (SSCs); and Group 3-preformed zirconia crowns (PZCs). The crowns (mandibular right second molar, size 4) were cemented on identical 3D printed teeth models. These were then mounted in acrylic blocks for the assessment of wear, compressive strength, and microhardness. Results: A significant difference (P ≤ 0.05) was observed in the compressive strength of the crowns evaluated. The highest compressive strength was seen in SSCs, followed by BFCs, and the lowest with PZCs. The difference in the microhardness of the 3 crowns was significant (P ≤ 0.001), with the highest demonstrated by PZCs, followed by SSCs, and the lowest with BFCs. The wear rate was found to be highest with SSCs, followed by PZCs, and lowest with BFCs. Conclusion: Stainless steel crowns and preformed zirconia crowns demonstrate high compressive strength and microhardness respectively, while BioFlx® Crowns showed the highest wear resistance of the 3 crowns tested.
Purpose: This study investigated whether the age of permanent tooth emergence in US adolescents has shifted over the past 40 years and whether these changes vary by gender or race. Methods: A retrospective review of clinical records from 751 patients aged 9 to 16 years was conducted across three cohorts: 1978 to 1982, 1998 to 2002, and 2018 to 2022. Intraoral photographs were analyzed to assess the presence of maxillary and mandibular canines, premolars, and second molars at half-year intervals. Logistic regression modeled the probability of tooth presence based on age, cohort, gender, and race. Results: Median age of tooth emergence was found to be earlier by 0.5 to 0.9 years for most teeth. Compared to 1980, the odds of tooth presence were significantly higher in 2000 (odds ratio [OR]=1.75) and 2020 (OR=3.01), indicating a consistent trend toward earlier emergence. Females demonstrated significantly earlier emergence than males (OR equals 0.63), and Black children exhibited higher odds of tooth presence compared to White and Hispanic peers. Conclusions: This study provides evidence of a trend toward earlier emergence of permanent dentition in a US adolescent population. Gender and racial differences suggest that emergence timing is influenced by both biological and environmental factors.
Purpose: This study investigated the associations between parental and child mental health (MH) impairment on child dental care utilization. Methods: This study used US nationally representative data from the 2017 to 2021 Medical Expenditure Panel Survey (n =13,762). The associations were assessed using Pearson's chi-squared test and logistic regressions. Regressions controlled for age, sex, race/ethnicity, family income, year, geographic region, dental insurance, parental age, single-parent household, and number of children in the household. Results: Parental MH impairment was associated with lower odds of overall dental care, with an odds ratio (OR) of 0.87 (95% confidence interval [95% CI]=0.77 to 0.99, P=0.04), preventive care (OR=0.86, 95% CI=0.76 to 0.98, P=0.02), higher odds of restorative care use (OR=1.39, 95% CI=1.15 to 1.67, P=0.001). These associations were most significant in children with parental MH impairment but no MH care: overall dental care (OR=0.85, 95% CI=0.73 to 0.98; P=0.03), preventive care (OR=0.84, 95% CI=0.72 to 0.97; P=0.02), restorative care (OR=1.46, 95% CI=1.18 to 1.8, P<0.001). Conclusions: Parental mental health impairment was associated with lowered odds of preventive care use but increased odds of restorative care use in children. Parental MH care is a potential protective factor in promoting oral health care in children. Further investigation is needed to develop interventions to promote parental MH and child oral health.
Purpose: To investigate the association between pregnant women receiving oral health guidance from health care professionals and their children visiting a dentist before 12 months of age. Methods: Data were drawn from multiple follow-ups of the 2015 Pelotas Birth Cohort. The main outcome was whether the child had a dental visit in the first year of life, either for preventive care or treatment of dental problems. The primary exposure was the mother's receipt of oral health guidance from a health care professional during pregnancy. Potential confounders included socioeconomic and demographic characteristics, maternal experience of dental caries, and dental visits during pregnancy. Multinomial logistic regression was used for the analysis, comprising 3,938 mother-child dyads. Results: Children whose mothers received oral health guidance during pregnancy had a 60% higher prevalence of preventive dental visits compared to those whose mothers did not receive such guidance (prevalence ratio=1.60; 95% confidence interval [CI]=1.19 to 2.15). Conclusion: This study found that professional oral health guidance provided to mothers during pregnancy was positively associated with a higher likelihood of their children receiving preventive dental care during the first year of life.
Purpose: This study investigated whether the position of the maxillary frenum is associated with the presence and severity of anterior tooth caries in children aged 6 to 36 months. Methods: Five dentists from the South Texas Oral Health Network (STOHN) assessed 319 children using the International Caries Detection and Assessment System (ICDAS) and classed frenum attachment. Results: Of 319 patient children, 170 (53.9%) exhibited no anterior caries, while 149 (46.1%) demonstrated varying levels of decay with higher caries grades observed in older children (P<0.001). Most participants (79%) were enrolled in Medicaid. Frenum attachment was classified as Class III or IV in 57% of cases. Statistical analysis revealed no significant association between caries grade and frenum attachment (P=0.32), nor between caries and insurance status (P=0.31). Conclusion: In the population studied, maxillary frenum attachment classification does not significantly correlate with the severity of anterior caries in children aged 6 to 36 months.
Purpose: To compare the monomer leaching of 3D-printed denture base materials (NextDent® Denture 3D+ [D3D]) and orthodontic base material (NextDent® Ortho Flex [OF]) with conventional poly-methyl methacrylate (PMMA) resins at 5 time points. Methods: Fifteen standardized samples (N=5 /group) of D3D, OF, and PMMA materials were submerged in artificial saliva for 48 hours. The solutions were extracted, and the monomer release rate and amount were measured using high-performance liquid chromatography (HPLC) at 0, 8, 16, 24, and 48 hours. One-way analysis of variance, independent t-tests, and post-hoc least significant difference tests were used to compare monomer release rates and amounts across different time intervals and materials. Results: Methyl methacrylate was detected in the PMMA group at 0.0034 wt%, which is below the ISO threshold (<4.5 wt%). Significant differences were observed in monomer release rates and patterns among the groups (P<0.001). The highest monomer release occurred within the first 8 hours and decreased drastically over time (P<0.001). Among 3D printing groups, the OF group exhibited a higher release rate than the D3D group at all time points (0, 8, 16, 24, and 48 hours; P <0.001). The D3D group maintained a consistently low release rate. Conclusions: The levels of monomer release in this in vitro study would be considered safe for use in pediatric dentistry. Due to the highest monomer release occurring within the first 8 hours, it is recommended that appliances be delivered at least 8 hours after fabrication to minimize initial exposure.
Purpose: To evaluate the burden of managing permanent first molars (PFMs) in children with molar hypomineralization (MH). Methods: Retrospective data on the cost of treatment of PFMs in children with MH in a university-based pediatric clinic were collected. Data included demographics, health status, zip code, treatment type, number of visits, behavioral guidance (BG), and retreatment. The cost was calculated based on the billing codes for operative treatment and BG. Results: A total of 199 MH patient charts were included. The mean age was 8.07 years (±1.46 standard deviation). Over 25% had behavioral and medical conditions and lived more than 25 miles from the clinic. Operative treatment costs differed significantly by age (P<0.001). Male patients, patients travelling more than 25 miles, and patients with behavioral conditions had significantly higher BG and total treatment costs (P<0.05). Conclusion: Gender, distance from the clinic, and health status were related to higher treatment burden of permanent first molars in children with molar hypomineralization.
Purpose: This study compares the accuracy of dental students in diagnosing different breathing sounds using traditional versus artificial intelligence-assisted precordial stethoscopes (AIPS). Methods: The study involved 45 3rd- and 4th-year dental students who completed a pre-test to assess their baseline knowledge of breathing sounds. After watching a learning video, participants were randomized into 3 groups: conventional stethoscopes (Group A), AIPS (Group B) with audio, and AIPS with audio and video (Group C). Participants were evaluated in their diagnosis ability by listening to 10 recorded episodes of specific breathing sounds and then took post-tests to evaluate their learning. A post-survey was administered to evaluate the confidence and satisfaction of the participants with diagnostic responses, and to collect demographic information. Statistical significance was evaluated using a 1-way analysis of variance and paired sample t-test (P<0.05). Results: Significant improvements were observed in diagnostic accuracy (P<0.001) and knowledge (P=0.047) across all groups. AI groups demonstrated higher diagnostic accuracy for specific sounds (normal breathing, partial airway obstruction, and apnea). The confidence and satisfaction of the participants were strongly correlated with diagnostic accuracy (P<0.001), with those in Groups B and C reporting higher satisfaction. Group C responded fastest for apnea (P=0.021) and Group A for normal breathing (P=0.005), while Group A had the highest missing diagnosis proportion (53.3%). Conclusions: Artificial intelligence-assisted precordial stethoscopes enhance diagnostic accuracy and learning outcomes, particularly for students with lower baseline knowledge. These findings suggest that integrating artificial intelligence tools can improve the detection of respiratory complications during sedation, enhancing patient safety.
Purpose: This retrospective study assessed the presence of adverse events during moderate sedation for pediatric dental procedures performed in a dental clinic. Methods: Dental treatment completed with sedation between June 2014 to November 2024 was assessed for the presence of any adverse events (AEs). AEs were classified by the modified Tracking and Reporting Outcomes of Procedural Sedation (TROOPS) scale and an adverse event list from the Pediatric Sedation Research Consortium (PSRC). Results: There were 923 completed patient sedation records between the ages of 2 and 16 years from 9 different sedation regimens within the dental clinic included in this study. Overall, the proportion of adverse events was low (4.55%) with an increase in AE with the intranasal dexmedetomidine/orally administered midazolam (odds ratio [OR]=4.7, P<0.01) and a decrease in AE with triazolam (OR equals 0.2, P<0.01). No adverse events required medical intervention. Conclusions: Overall, adverse event proportions were low with pediatric dental moderate sedation supporting the safety of this modality of treatment. More studies are needed to assess adverse events and adverse event scales in pediatric dental sedation.
Purpose: The purpose of this study was to examine for differences in mean oxygenation levels of healthy pediatric patients and pediatric patients with sickle cell disease (SCD) receiving nitrous oxide (N₂O) for dental procedures and to determine if N₂O decreases oxygen saturation levels for SCD patients. Methods: Patients aged 2 to 17 years with SCD and healthy age-matched patients were recruited at their preventive or restorative dental visits between 2019 and 2023. Up to 50% N₂O was administered during routine restorative treatment. Oxygen saturation was measured via a pulse oximeter before starting nitrous, at 10-minute intervals throughout treatment, and after nitrous oxide termination. Descriptive and bivariate analyses were conducted using statistical software with statistical significance set at P<0.05. Results: There was a significant difference in average oxygen saturation at baseline between cases and controls; however, there was no significant difference at 10, 20, or 30 minutes. There was no significant difference in oxygen saturation between cases and controls after terminating N₂O. Conclusions: Use of up to 50% nitrous oxide for dental treatment was found to be safe in this cohort of sickle cell disease patients. The oxygen saturation of healthy patients and patients with SCD increases with the use of N₂O. In addition, N₂O use in patients with SCD may alleviate anxiety and increase the pain threshold, decreasing the risk for vaso-occlusive crisis.
Purpose: This systematic review and meta-analysis aimed to assess and compare dental caries among adolescents aged 12 to 15 years worldwide residing in rural and urban areas. Methods: A systematic search was conducted in PubMed, Scopus, Web of Science, EMBASE, and Google Scholar. Studies reporting decayed, missing, filled teeth (DMFT) and decayed, missing, filled surfaces (DMFS) for permanent teeth scores for both urban and rural adolescents aged 12 to 15 years were included. Risk of bias was assessed using the Newcastle-Ottawa Scale. Meta-analysis was performed using Review Manager 5.3 software using a random-effects model, with standardized mean differences (SMD) and 95 percent confidence intervals (95% CI) calculated. Heterogeneity was assessed using the I² statistic, and certainty of evidence was evaluated using GRADE. Results: Fifty-four cross-sectional studies were included. Pooled analysis revealed significantly higher DMFT/DMFS scores in urban adolescents (SMD equals 0.34, 95% CI equals 0.22 to 0.46; P<0.001), with considerable heterogeneity (I² equals 99%). Subgroup analyses were conducted by geographical region, age group, and study publication period (past decade). Adolescents residing in urban areas exhibited higher dental caries in comparison to their rural counterparts, although regional variations were evident. Conclusions: Based on these findings, there is a need for context-specific oral health policies and tailored preventive strategies to address inequalities in both urban and rural populations aged 12 to 15 years.
Purpose: To describe the clinical needs and care rendered to children participating in a virtual dental home (VDH) program at a rural school in Tuolumne County, CA, USA, from 2021 to 2023. Methods: The VDH pilot program, operated at a public elementary school in rural northern California and provided dental care using teledentistry for students from kindergarten through eighth grade. Data collection included an exported report of all data elements from the electronic health record. A single study clinician reviewed clinical notes and procedure codes to ensure accuracy in data exports for data collected in academic years 2021 to 2023. Descriptive statistics were generated for demographic characteristics, clinical needs, referrals, and care rendered. Results: A total of 53 patients were enrolled, with the majority classified as high caries risk. The program recorded 160 visits for 35 unique patients in the first academic year and 173 visits for 46 in the second. Over 87% of procedures completed were for examinations and preventive services. The program achieved several Healthy People 2030 oral health targets, including a high incidence of preventive dental visits and sealants. However, it underperformed in reducing the prevalence of untreated caries. Conclusions: The school-based virtual dental home program effectively provided preventive dental treatment, minimized barriers to care, and improved access to services in a Dental Health Provider Shortage Area. Teledentistry proved effective for pediatric dentistry in preventive treatment, minimally invasive care, and referrals, highlighting the potential of VDH models in reducing dental care gaps in underserved areas.
Purpose: To compare the effectiveness and report on oral sedation-related events using three different multiagent regimens in pediatric patients up to 24 hours post-discharge. Methods: Sixty healthy 3- to 7-year-old patients were randomly allocated to 1 of 3 groups. Group 1 received midazolam, meperidine, and hydroxyzine (MZ/M/H; n equals 20). Group 2 received meperidine and hydroxyzine (M/H; n equals 20). Group 3 received midazolam and hydroxyzine (MZ/H; n equals 20). Nitrous oxide inhalation was concurrently used in all groups. After completion of sedation, the treating dentist answered survey 1 regarding the preoperative period until discharge. Parents completed 2 phone interviews at 8 and 24 hours post-discharge (surveys 2 and 3). Data analysis included chi-square, 1-way analysis of variance, and post-hoc tests (P<0.05). Results: Over-all, the 3 regimes were effective (90%). Group 1 showed a significant increase in slurring/difficulty speaking post-operatively and up to discharge (P=0.04). Groups 1 and 3 exhibited significantly greater difficulty walking on their own at discharge (P=0.02). Groups 1 and 2 experienced significantly increased lethargy (P=0.02) within 8 hours post-discharge. Overall musculoskeletal effects were significantly less prior to discharge in Group 2 (P=0.02), while gastrointestinal upset was significantly more in Group 1 at 24 hours post-discharge (P=0.01). Conclusions: This randomized clinical trial demonstrated that oral sedation regimens containing different combinations of midazolam, meperidine, and hydroxyzine are effective and relatively safe. Postoperative monitoring remains essential up to 24 hours. Longer postoperative monitoring may be required when a 3-medication regimen is used.
