Purpose: To evaluate Portuguese parents' knowledge about ankyloglossia, examine how it may affect child development, and describe diagnostic and treatment practices of the condition. Methods: During March 2025, a 6-section multiple-choice questionnaire, based on an Australian study, assessed Portuguese parents' knowledge of ankyloglossia both in person at a university pediatric dental clinic and online. The data were analyzed with descriptive statistics, using Fisher's exact tests with Monte Carlo simulations. Results: This study collected 259 valid responses, predominantly from the central region of Portugal (76.1%). More than half of the participants (58.7%) were familiar with the term "ankyloglossia", primarily associating it with issues in speech (91.4%), chewing (70.8%) and breastfeeding (66.1%). The main source of information about ankyloglossia was healthcare professionals (77.9%). Approximately one-fifth of participants (20.1%) had a child diagnosed with ankyloglossia. Diagnoses were typically based on professional opinion, breastfeeding difficulties and tongue appearance, with physicians, dentists, speech therapists and lactation consultants being the primary diagnosticians. Surgical treatment, mainly laser frenectomy, was performed in 88.5% of cases, with significant involvement from dentists and speech therapists. Parents reported high satisfaction with treatment outcomes and the information provided. Conclusion: This study found a moderate level of awareness about ankyloglossia among Portuguese parents and caregivers. Clearer diagnosis and treatment protocols and further research are essential to improve care and enhance parental knowledge.
Purpose: To evaluate the effectiveness of positive pre-visit imagery in reducing dental anxiety (DA) in children undergoing procedures requiring local anesthesia. Methods: A triple-blind, randomized controlled clinical trial was conducted with 69 children aged 7 to 12 years of age at a university pediatric dental clinic in Brazil. Participants were randomly assigned to either an experimental group (positive dental images) or a control group (neutral nature images). Images were shown 2 minutes prior to receiving local anesthesia. DA was assessed before and after treatment using the Venham picture test (VPT). Statistical analyses included the Mann-Whitney U test, Wilcoxon signed-rank test and ordinal logistic regression to identify predictors of post-procedure anxiety. Results: No significant differences in VPT scores were found within or between groups before and after treatment (P>0.05). Baseline anxiety, age, sex and group allocation did not predict post-treatment anxiety. Conclusion: Positive pre-visit imagery was not effective in reducing DA when measured by the VPT.
Purpose: To analyze electronic health records from pediatric patients at a university hospital to evaluate the association between vitamin D deficiency and dental caries in hospitalized children from birth to 9 years of age. Methods: Electronic health records from 124,091 pediatric patients between the years 2011 and 2025 were analyzed. International Classification of Diseases-10 codes identified diagnoses of vitamin D deficiency and dental caries. Odds ratios (ORs) with 95% confidence intervals (CIs) were calculated. Secondary analyses included stratification by race to account for potential demographic confounders. Results: Dental caries was diagnosed in 8% of children with vitamin D deficiency versus 2.6% of those without it. The unadjusted odds ratio for caries in vitamin D-deficient children was 3.17 (95% CI=2.20 to 4.54; P<0.0001). After adjustment for African American ethnicity, the association remained significant (OR=4.581; 95% CI=2.52 to 8.33; P<0.0001). Conclusions: Vitamin D deficiency was associated with increased odds of dental caries in the 0 to 9 years age group. Further research is needed to explore the influence of race/ethnicity and nutritional factors on pediatric caries risk.
Vitamin C is crucial for normal physiology and function. Severely insufficient levels of vitamin C can disrupt these processes, resulting in scurvy, a condition characterized by compromised collagen production and tissue degradation. The purpose of this report is to present a complex case of a pediatric patient with autism spectrum disorder exhibiting nonspecific oral lesions. Histopathological examination of the lesions revealed granulomatous inflammation, suggesting an initial diagnosis of orofacial granulomatosis, with a recommendation to rule out Crohn's disease. Further investigation confirmed the presence of vitamin C deficiency, with the oral lesions responding positively to vitamin C supplementation, indicating that the oral lesions were a manifestation of scurvy. In the United States, scurvy is rare and usually associated with underlying conditions and restrictive diets; if left untreated, severe complications affecting patients' life expectancy may occur. Understanding the clinical manifestations of vitamin C deficiency is crucial for timely diagnosis and effective management.
Purpose: To evaluate and compare the efficacy of physics forceps versus conventional forceps in primary mandibular second molar extractions among children aged 7 to 10 years of age. Methods: A randomized split-mouth trial was conducted with children requiring bilateral primary mandibular second molar extractions. Outcomes assessed included extraction time, tooth fracture, anxiety, and complications. Results: Fifty children participated. Physics forceps significantly reduced extraction time (mean difference=7.7 seconds, 95 percent confidence interval= -11.5 to -3.9; P<0.001) and anxiety reduction was greater (-1.94 versus -0.56; P<0.001). Tooth fractures were less frequent with physics forceps (12% versus 32%; P=0.05). No post-operative complications occurred. Conclusions: Physics forceps shortened extraction time, reduced anxiety and lowered fracture incidence, making them advantageous for pediatric dental extractions.
Purpose: To determine the prevalence of 3-rooted mandibular molars (3RMMs) in pediatric patients and evaluate associations between their occurrences across different teeth. Methods: A retrospective analysis of digital bitewing and panoramic radiographs from children 4 to 12 years of age was performed. Prevalence was calculated at both the patient and tooth levels. Associations examined included bilateral versus unilateral occurrence, sex and side differences, and correlations between adjacent primary molars as well as between primary and permanent molars. Results: Radiographs of 998 children were evaluated. Of 5,988 mandibular molars assessed, 52 exhibited an additional root (0.9%). At the patient level, 32 children (3.2%) had at least one 3RMM. Prevalence was 1.2% in primary first molars, 1.3% in primary second molars and 1.3% in permanent first molars. Bilateral involvement (43.8%) was significantly more frequent than in unilateral cases (P=0.035). A left-side predominance was noted for primary second molars (P=0.049), while no sex differences were observed. The presence of a primary 3RMM increased the likelihood of a permanent 3RMM (13.6% vs 1.3%; P=0.002). When the first primary molar was 3-rooted, the prevalence of a 3-rooted primary second molar was higher (25% vs 1% in children without a 3-rooted first primary molar, P<0.001), as was the prevalence of a 3-rooted permanent first molar (23.1% vs 1% in children without a 3-rooted first primary molar, P<0.001). Conclusions: Although rare, 3RMMs demonstrate consistent associations between adjacent and successive teeth, supporting a developmental link. Early radiographic recognition in primary molars may help anticipate similar anatomy in permanent molars and reduce the risk of procedural complications.
Purpose: To explore parents' perceptions, acceptance and concerns regarding the use of silver diammine fluordie (SDF) to manage early childhood caries (ECC). Methods: The authors conducted interviews with 39 parents whose children had participated in a randomized clinical trial using SDF to manage ECC. A mixed-methods design was employed: thematic analysis for open-ended responses and descriptive analysis for closed-ended questions. Results: Parental acceptance of SDF was strongly linked to trust in the dentist (100%), its painless application (97.4%), absence of anesthesia, needles or drilling (92.3%), and its ability to reduce pain (97.4%). Most parents appreciated the fast treatment (89.7%) and limited alternatives during the pandemic (89.7%). Nearly all participants (94.9%) reported they would choose SDF again, with higher acceptance for posterior teeth (87.2% vs. 69.2% for anterior teeth). Additionally, 74.4% preferred SDF over restorations. Thematic analysis highlighted 4 key areas: (1) acceptance of SDF, (2) pain and comfort, (3) reactions to color change and (4) concerns and uncertainties. Conclusions: Parents valued SDF as a safe, effective and non-invasive option for managing ECC, particularly given its ability to avoid drilling, needles and anesthesia. However, esthetic concerns about staining underscored the need for clear provider-parent communication and ongoing education about treatment limitations and the importance of follow-up applications for successful caries arrest.
Purpose: To investigate through a meta-analysis and systematic review the influence of the combined use of silver diammine fluoride (SDF) and potassium iodide (KI) on the bonding of adhesive materials to sound and carious dentin. Methods: The PubMed/MEDLINE, Scopus, Embase, LILACS, Web of Science databases and grey literature were searched. In vitro studies comparing the bond strength of adhesive systems (AD) or glass ionomer cements (GIC) to SDF+KI and SDF-treated dentin were included. Mean differences were estimated, separately by dentin condition (sound or carious dentin) and tooth type (primary or permanent), considering the adhesive material as a subgroup. Results: Of 1,689 potentially eligible studies, 45 were selected for full-text analysis and 14 were included. There was no significant difference in the bond strength to permanent carious dentin pre-treated with SDF or SDF+KI (P=0.17; I²=97%), regardless of the adhesive material (GIC: P=0.32; AD: P=0.25). Subgroup analyses for primary carious dentin pre-treated with SDF or SDF+KI, performed separately for GIC and AD, also showed no significant differences (GIC: P=0.13; AD: P=0.28). However, when pooling all datasets, a statistically significant difference was observed (P=0.005; I²=94%), indicating that SDF+KI improved bond strength. No difference in the bond strength of GIC to permanent sound dentin pre-treated with SDF and SDF+KI was found (P=0.80; I²=0%). Conclusion: Pooled in vitro data suggest that SDF + KI do not affect bond strength to permanent carious or sound dentin and may enhance bond strength in primary carious dentin.
Root fractures in adolescents present unique esthetic and prosthodontic challenges, especially when complicated by oblique or vertical fracture lines that preclude traditional root submergence. A 15-year-old female sustained multiple traumatic dental injuries, including a complex root fracture of the maxillary left central incisor, following a motor vehicle accident. Polytrauma management included pulpal therapy, splinting and interim prosthesis fabrication, but the incisor demonstrated both horizontal and vertical fracture components, contraindicating conventional root submergence therapy. Socket shield therapy (SST) ridge preservation enabled buccal bone retention while minimizing the patient's surgical burden, thereby facilitating immediate removable prosthesis fabrication and esthetic rehabilitation. The preserved shield will facilitate future implant placement during adulthood without requiring grafting. This case highlights SST as a conservative pediatric trauma management strategy, providing immediate esthetic reassurance for the adolescent patient and reducing trauma-related distress during a critical developmental stage.
Purpose: To evaluate pairwise associations between 4 self-reported and 1 biological stress measure (hair cortisol) and assess the associations between stress and untreated dental caries in adolescents enrolled in public insurance (Medicaid) in the United States. Methods: This pilot cross-sectional study used survey, hair and dental screening data collected from Oregon Medicaid-enrolled adolescents ages 12 to 18 years (n=268). Self-reported stress measures included the Perceived Stress Scale-10 (PSS) and adapted versions of the Stressful Life Events Screening Questionnaire, the Psychosocial Index and Things I Have Seen and Heard (TISH) questionnaire. The biological stress measure was hair cortisol concentration (HCC). Untreated caries was defined as the number of decayed primary and permanent tooth surfaces. Spearman's rank-order correlation test was used to report correlations (r) and 95 percent confidence intervals (α=0.05). Results: The four self-reported stress measures were significantly and positively correlated. PSS was the only self-reported stress measure that was significantly associated with HCC (r=-0.16; P=0.008). Most stress measures showed very weak, statistically insignificant associations with untreated caries, except for a significant but negative correlation between untreated caries and the TISH questionnaire (r=-0.13; P=0.04). Conclusions: Self-reported and biological stress measures may not be interchangeable. Most of the evaluated stress measures demonstrated an insignificant association with untreated caries. Additional work is needed to elucidate the relationship between different types of stress and oral health outcomes in low-income adolescents.
Purpose: To evaluate the prevalence of teething problems throughout the period of primary tooth eruption. Methods: This birth cohort study was conducted in two phases: Phase one (evaluation of teething symptoms among newly recruited infants) and Phase two (evaluation of teething symptoms among newly recruited infants and follow-up evaluation among infants recruited in Phase one). The study included an evaluation of infants born in a tertiary health care hospital using a hybrid design of telephonic conversation/video calling and clinical examination. The data were collected by one trained and calibrated evaluator and recorded in a self-designed form with validated measures of teething problems. Results: A total of 525 infants and parents participated. Teething problems were most prevalent at nine months of age (67.1 percent), followed by 12 months (50.1 percent) and 15 months (43.6 percent). Finger-sucking was the most common teething problem at six months (14 percent), nine months (81 percent), and 12 months (61.1 percent) of age. Incisor eruption was most associated with teething problems (72.5 percent), followed by canines (39.4 percent), first molars (36.9 percent) and second molars (24.9 percent). A significant correlation was seen between maternal education and maternal occupation and the parent-reported prevalence of teething problems (P<0.05). Conclusions: Almost two-thirds of the parents reported one or more teething problems at nine months coinciding with incisor eruption, whereas half also reported teething problems at 12 months. A significant correlation was seen between maternal education, maternal occupation and the prevalence of teething problems.
Purpose: To assess the fracture resistance of prefabricated esthetic crowns for primary molars. Methods: Seventy-two human mandibular second primary molars were divided into three groups: preveneered stainless steel crowns (VSS), prefabricated zirconia crowns (PZ) and BioFlx crowns (BF). Crowns were cemented with glass ionomer cement; for each group, 12 samples were tested for fracture resistance and 12 samples underwent 5,000 thermocycles before testing. The fracture mode was assessed for all the samples. Differences in the fracture resistance values between the groups were tested using analysis of variance (ANOVA), followed by Tukey's post hoc test, while the distribution of fracture modes was tested using Fisher's exact test. Statistical significance was set at P =0.05 and analyses were conducted using SPSS version 25.0 software. Results: ANOVA tests indicated a significant difference in fracture resistance among the test groups (P <0.001). The groups were ranked as follows: before thermocycling- (1) PZ group (3,327±1497), (2) BF group (1,694±163) and (3) VSS group (536±12); and after thermocycling-(1) PZ group (3,308±162), (2) BF group (1,579±77) and (3) VSS group (413±16). Tukey's post hoc analysis indicated that the PZ group exhibited a significantly higher fracture resistance than the BF and VSS groups (P <0.001). The VSS group showed a predominance of minimal cracks (5.6 percent) and loss of less than half of the crown (11.1 percent). Conclusions: PZ yielded the highest resistance, followed by BF crowns. VSS may require caution in high-stress areas due to their susceptibility to esthetic component failure, although the underlying crown remains functional.
Purpose: The maxillary labial frenulum (MLF) has been implicated in clinical concerns, including breastfeeding difficulties, midline diastema and oral hygiene challenges. Despite multiple classification systems, a lack of consensus persists regarding the clinical significance of MLF variations and indications for surgical intervention. This review evaluates existing classification systems, diagnostic approaches and treatment considerations to provide an evidence-based framework for clinical decision-making. Methods: A literature search was conducted using PubMed, Scopus and EMBASE. Studies were screened through a multi-phase process and their quality was assessed using the Critical Appraisal Skills Program. Results: Sixteen studies met the inclusion criteria. Classification systems varied widely, with limited clinical applicability. Midline diastema often resolves naturally, questioning the necessity of early frenectomy. Surgical intervention is only advised when MLF impedes oral hygiene or contributes to orthodontic relapse. Conclusions: Variability in the classification and management of the MLF may contribute to inconsistent clinical decisions. Evidence-based guidelines are needed to support appropriate intervention and reduce the risk of unnecessary procedures.
Purpose: To understand mandatory educational requirements for child abuse and neglect (CAN) recognition and mandated reporting for dentists to obtain and renew dental licensure in the United States (US).Methods: Publicly available state websites, dental board documents and the American Academy of Pediatric Dentistry's website outlining requirements for dental licensure in the US were reviewed for specifically designated mandated reporting or CAN educational requirements as prerequisites to obtain either initial or renewal of licensure to practice dentistry within the jurisdiction. For inclusion in the study, CAN education had to be listed as a requirement specific to obtaining and renewing dental licensure, not just a general mandated reporting education suggested or required by the state.Results: Four of 50 states (Illinois, Iowa, New York and Pennsylvania) and the District of Columbia require a mandatory educational course on CAN and reporting to obtain a dental license. Four states (Illinois, Iowa, Maryland and Pennsylvania) and the District of Columbia require a mandatory educational course on CAN to renew a license.Conclusions: This study suggests that more US states should implement a requirement for dental professionals to take a mandatory educational course on CAN recognition and reporting to obtain and renew dental licensure. This education should be specific to dentistry and dental practice settings to best prepare professionals to report suspected abuse and/or neglect.
Purpose: To measure the fluoride release and enamel fluoride uptake from a new dimethicone-based fluoride varnish (Profisil) and Duraphat fluoride varnish, and determine if the varnishes occlude dentin tubules. Methods: The fluoride release of both varnishes was measured from specimens with a constant surface area to volume ratio in a water bath. The fluoride uptake of demineralized enamel cores treated with both varnishes was studied over 24 hours using ion-specific electrodes to determine fluoride content and atomic absorption spectroscopy to determine calcium content. Scanning electron microscopy (SEM) was used to examine the occlusion of dentin tubules and the surface of enamel after treatment with varnish. Results: Duraphat varnish released 68±7.1 ppm of fluoride per gram of varnish after 24 hours. Profisil varnish released 65±6.3 ppm of fluoride per gram of varnish after 24 hours. Duraphat varnish specimens had a fluoride content of 2.5±1.8 mg F/g enamel before application of the varnish, which increased to 285±62 mg F/g enamel after 24 hours. Profisil varnish specimens had a fluoride content of 2.4±2.1 mg F/genamel before application of the varnish, which increased to 272±74 mg F/g enamel after 24 hours. SEM images depicted that both varnishes occluded open dentin tubules and left mineral deposits on the surface of the enamel. Conclusions: Both varnishes released significant amounts of fluoride and significantly increased the fluoride uptake of demineralized enamel. Moreover, the new varnish induced occlusion of the tubules and induced mineral growth on the surface of the enamel.
Purpose: To assess the direct and indirect effects of oral conditions, family income, child's sex, history of toothache and dental visits on oral health-related quality of life (OHRQoL) of children, according to parents. Methods: A cross-sectional study was conducted with 843 pairs of parents and children aged three to five years of age, in Campina Grande, Paraíba, Brazil. Parents answered a questionnaire with sociodemographic and socioeconomic questions, and their children's use of services and experience of toothache, as well as the Brazilian Scale of Impact on Oral Health in Early Childhood. Three researchers examined for the presence of dental caries, dental trauma and malocclusion. Descriptive and confirmatory factor analyses were conducted to validate the measurement models and constructs. The analysis accounted for confounding factors to ensure precise estimates of the relationships among variables. Structural equation modeling was employed to examine both direct and indirect associations between variables. Results: Absence of dental visits (β =-0.332; 95 percent confidence interval [95% CI]:- 0.471 to -0.193; P <0.001) and toothache (β =-0.748; 95% CI:0.588 to 0.883; P <0.001) directly impacted OHRQoL negatively. Family income (β =0.689; 95% CI: 0.518 to 0.859; P <0.001) and anterior open bite (β =-0.339; 95% CI:-0.613 to -0.184; P <0.001) had indirect effects mediated by dental caries (β =0.748; 95% CI: 0.748 to 0.883; P <0.001). Conclusion: Both direct and indirect factors affect the OHRQoL of preschoolers, emphasizing the importance of considering oral health conditions and socioeconomic factors to evaluate and improve their quality of life.
Diamond-Blackfan anemia is a rare inherited bone marrow failure syndrome. It is part of a group of genetic disorders characterized by a decrease in red blood cells due to bone marrow malfunction. It affects five to seven live births per million per year. Pediatric patients are typically diagnosed within the first year of life; however, clinical manifestations can present at any age. Advances in molecular testing have increased the ability to identify Diamond-Blackfan anemia variants in adults. Patients with the disease have a wide range of features, including distinct physical characteristics; however, there is limited literature highlighting the dental manifestations and implications of the disease. Therefore, the purpose of this case report is to review the literature on Diamond-Blackfan anemia and highlight the unique challenges that dental practitioners may face in the delivery of dental care.
The purpose of this report is to describe a seven year-old boy diagnosed with hypohidrotic ectodermal dysplasia who was rehabilitated with dental implants and partial removal prosthesis. The patient had only three dental elements: primary maxillary right first molar and primary maxillary right and left canines. The patient underwent treatment under general anesthesia in a hospital setting. Two dental implants were placed in the mandibular arch to support a dental prosthesis. Due to the COVID-19 pandemic, there was a prolonged period before continuing with the rehabilitative phase. Upon resumption, peri-implant mucositis was observed. Through professional and home plaque control measures, peri-implant tissue health was restored. A removable prosthesis was fabricated for the maxillary arch and O-ring attachments were used for the mandibular prosthesis. Given the patient's growth, prostheses may need to be replaced approximately every six months until growth is complete.
This case describes an emergency situation with a 10-month-old infant who presented with a sizable, smooth-surfaced, dome-shaped oral lesion. Upon examination, the pediatric dentist discovered a piece of a toy, embedded in the alveolar ridge. The purpose of this case report is to raise awareness about intraoral foreign body embedment in infants, highlighting the potential risks associated with popular toys that can break, adhere to the alveolar ridge and pose choking hazards. Pediatric dentists should advise parents to prevent infants from chewing on toys due to safety concerns.
Purpose: To evaluate the influence of commonly used restorative materials, including zinc oxide eugenol (ZOE), resin-modified glass ionomer cement (RMGIC) and stainless steel crowns (SSC), on the setting reaction (measured by microhardness) of Endo-Cem Premix Mineral Trioxide Aggregate (PMTA) when used as a pulpotomy agent. Methods: Fifty extracted primary molars had a pulpotomy with a three-millimeter layer of EndoCem PMTA applied to the pulpal floor. Specimens were divided into five groups: group one (control), EndoCem with a moistened cotton pellet; group two, EndoCem with RMGIC; group three, EndoCem with ZOE; group four, EndoCem with RMGIC and SSC; and group five, EndoCem with ZOE and SSC. Teeth were incubated at 37 degrees Celsius and 100 percent humidity for 24 hours. Microhardness was measured at depths of one, two and three millimeters using a Knoop hardness tester. Statistical analyses included analysis of variance and Tukey's post hoc tests (significance at P<0.05). Results: EndoCem PMTA demonstrated effective setting across all experimental groups, with an overall mean Knoop hardness number (KHN) of 65.71±9.98. Group four showed the highest mean KHN (72.66±6.34 at three mm), while the control had the lowest KHN (58.42±11.26 at one mm). Groups three and four had significantly higher KHN than the control group (P<0.01). Microhardness values remained consistent across depths, with the highest values observed at three millimeters. Conclusions: EndoCem PMTA sets reliably, regardless of the restorative material, supporting its application in single-visit pulpotomy procedures. The use of ZOE or RMGIC with SSC further enhanced its mechanical properties.
