This systematic review aimed to evaluate the level and pattern of dental fear and anxiety (DFA) amongst children and adolescents with traumatic dental injuries (TDI) and, where available, to compare these outcomes with non-traumatised controls. An a priori protocol was developed and registered in PROSPERO (CRD420261329946). A comprehensive literature search was conducted in PubMed, EMBASE, Web of Science, and Scopus on 3 March 2026, with additional grey literature, citation, and reference searching. No language or time restrictions were applied. Observational clinical studies assessing DFA in individuals with TDI using validated tools were included. Two reviewers independently screened studies, extracted data, and assessed risk of bias using the Joanna Briggs Institute checklist. Certainty of evidence was evaluated using the GRADE approach. A total of 2885 records were identified, of which 4 cross-sectional studies met the inclusion criteria after screening. Studies were conducted in Croatia and Kosovo and included paediatric populations. Sample sizes ranged from 147 to 505 participants. Different validated scales (CFSS-DS, CDAS, S-DAI) were used to assess DFA. Overall, children with TDI demonstrated predominantly low levels of dental fear and anxiety across assessment tools. However, findings were inconsistent, with some studies reporting lower or similar anxiety levels in TDI patients compared to controls. Risk of bias was moderate or high in three of the four studies, and the overall certainty of evidence was rated as low to very low due to methodological limitations, heterogeneity, and imprecision. The limited available evidence suggests that children and adolescents with TDI do not consistently present with higher levels of dental fear and anxiety than non-traumatised controls. These findings indicate that TDI does not inherently cause DFA, underscoring the critical role of empathetic behaviour support in mitigating post-traumatic dental fear. However, the evidence is based on a small number of regionally concentrated cross-sectional studies with low to very low certainty. Future prospective studies using standardised TDI classifications, validated DFA instruments, and clearly defined assessment time points are needed.
Molar incisor hypomineralisation (MIH) is an enamel defect that impacts at least one first permanent molar, frequently involving the incisors. Managing MIH-affected teeth is challenging due to inflammation, sensitivity, rapid caries development and difficulty achieving anaesthesia. Local anaesthesia, linked to pain, is a key factor in fear and discomfort in children. The objective of this study was to evaluate and compare the effectiveness of intraosseous (IO) and intraligamentary anaesthesia in providing analgesia during restorative procedures for MIH-affected molars in children aged 6 to 14 years. In a split-mouth study, 25 healthy patients (aged 6–14 years) with confirmed MIH on the lower first permanent molars participated. Each child underwent two restorative procedures: one with intraligamentary anaesthesia on the first visit, and second with intraosseous anaesthesia using the QuickSleeper™ computerised system on the subsequent visit. The teeth were restored with glass ionomer fillings in both sessions. Parameters evaluated included onset time, pain during administration, repeat anaesthesia needs, anaesthetic efficacy, heart rate and postoperative complications. Statistical analysis was performed. IO anaesthesia provided significantly faster onset and lower pain during administration compared to intraligamentary anaesthesia. Heart rate was significantly lower during restorative procedures with IO anaesthesia. Intraligamentary anaesthesia achieved profound analgesia in 24
Molar incisor hypomineralisation (MIH) is frequently associated with hypersensitivity, dental anxiety and reduced efficacy of local anaesthesia, complicating pain control during dental treatment in children. To evaluate, based exclusively on randomised controlled trials (RCTs), the effectiveness of different local anaesthetic techniques, agents and adjunctive interventions in reducing pain during dental treatment of MIH-affected teeth in children. A systematic review was conducted following PRISMA 2020 guidelines and registered in PROSPERO (CRD420251150485). MEDLINE, Cochrane Central, ScienceDirect, SCOPUS, EBSCO, and LILACS were searched up to September 2025. Eligible studies were RCTs involving children and adolescents (6 – 18 years-of-age) with MIH, assessing pain outcomes during dental procedures. Risk of bias was assessed using the Cochrane RoB 2 tool, and certainty of evidence was evaluated using the GRADE approach. Eight RCTs were included. Low-certainty evidence suggested that intraosseous anaesthesia and 4
To assess the association between extrinsic black tooth stain and dental caries experience in the primary dentition of preschool children in Hue, Vietnam. A cross-sectional study was conducted among preschool children aged 3-5 years in Hue, Vietnam. Black stain was diagnosed using standardised clinical criteria and classified as mild, moderate, or severe. Dental caries experience was assessed using the decayed, missing and filled primary teeth (dmft) index. The dmft scores were compared between children with and without black stain using the Mann–Whitney U test. An exploratory Spearman correlation examined dmft in relation to an ordinal black-stain score ranging from absence to increasing severity. Black stain was observed in a relatively small proportion of the participating preschool children during the clinical examination. Median (interquartile range) dmft was lower in children with black stain than in those without [3 (0–6) vs 5 (2–10); p < 0.001], with a small effect size (r = 0.11). The ordinal black-stain score showed a weak inverse correlation with dmft (Spearman’s ρ = − 0.108, p < 0.001). Because the score incorporated both black-stain presence and severity, this correlation did not demonstrate an independent severity-related gradient. The presence of black stain was associated with lower caries experience in preschool children, although the magnitude of the difference was small. The cross-sectional findings should not be interpreted as evidence of a protective effect of black stain against dental caries and require confirmation in longitudinal studies with adjustment for relevant confounders.
Early childhood caries (ECC) is a prevalent condition affecting preschool children worldwide. Although preformed metal crowns (PMCs) are considered the gold standard for restoring primary teeth, their poor aesthetics remain a concern. Hybrid resin polymer crowns (HRPCs; BioFlx, Kids-e-Dental LLP), have been developed to address this limitation. The present study aimed to compare the clinical effectiveness of HRPCs and PMCs in children aged 3–7 years. This prospective parallel-group clinical study included 60 children divided into two parallel groups receiving either PMCs or HRPCs. Clinical parameters assessed were retention, marginal integrity, gingival inflammation, plaque accumulation, occlusal wear, proximal contact, resistance to displacement, and parental satisfaction. Evaluations were conducted at 3, 6, and 9 months, and data were analysed using the chi-square test (p < 0.05). No statistically significant differences were observed between groups in retention, marginal integrity, secondary caries, resistance to displacement, or proximal contact (p > 0.05). However, gingival inflammation and plaque accumulation were significantly higher in the HRPC group at 6 and 9 months. Additionally, crown wear and anatomical form were better preserved in the PMC group. Parental satisfaction was slightly higher for HRPCs, though not statistically significant. Both crown types showed acceptable clinical performance. While PMCs demonstrated superior durability and periodontal outcomes, HRPCs offered better aesthetics and greater parental preference. HRPCs may serve as a suitable alternative when aesthetics are prioritized. Further long-term studies with larger sample sizes are recommended.
Treatment decision between pulp therapy and extraction for compromised teeth in paediatric patients remains a topic of debate. While both approaches address the associated pain, their long-term impact on children’s well-being remains unclear. This systematic review aimed to analyse and compare the impact of pulp therapy and extraction on OHRQoL in paediatric patients. This review was conducted in accordance with PRISMA guidelines. A comprehensive search was performed in multiple electronic databases. Methodological quality and risk of bias were evaluated using the RoB 2 tool for randomised controlled trials, ROBINS-I tool for non-randomised trials, and the Newcastle–Ottawa Scale for observational studies. Seven studies comprising a total of 1367 participants met the inclusion criteria. The results indicated that pulp therapy was associated with superior OHRQoL outcomes compared to extraction. Children who underwent pulp therapy reported lower anxiety, better emotional well-being, and higher parental satisfaction. Given the heterogeneity among the studies, a narrative synthesis was performed. Pulp therapy may offer better OHRQoL outcomes than extractions in paediatric patients by preserving function, reducing anxiety, and minimising long-term complications. However, these findings should be interpreted cautiously since the available evidence was limited and of low to very low certainty. Further well-designed randomised controlled trials are required.
Intraligamentary anaesthesia (ILA) has emerged as a promising alternative to the conventional inferior alveolar nerve block (IANB) in dental procedures, particularly among children with primary mandibular molars. This study aims to comprehensively assess the efficacy, safety, and patient-related outcomes of ILA compared with conventional IANB. A systematic search of PubMed, MEDLINE, Scopus, Web of Science (WOS), and Cochrane CENTRAL was conducted from inception to September 2025 for randomised controlled trials (RCTs) comparing ILA and IANB in paediatric patients undergoing dental procedures on mandibular molars. The primary outcome was postoperative pain. Secondary outcomes includedd lip biting, success rates, postoperative complications, and mean changes in pain scores assessed by the Sound–Eye–Motor (SEM) scale and Visual Analogue Scale (VAS). Pooled analyses were performed using risk ratios (RR) and standardised mean differences (SMD) with corresponding 95
This outcome-selected retrospective descriptive study aimed to describe the clinical characteristics, complications and care pathways of permanent teeth with traumatic dental injuries that resulted in tooth loss or were assessed as having inevitable tooth loss within Danish municipal dental care. This outcome-selected retrospective descriptive study included 65 patients with 80 permanent teeth of which 55 teeth had already been lost when data were collected, and 25 teeth were expected to be lost later. The material included dental records, radiographs and clinical photographs. Thirty variables were obtained and analysed using descriptive statistics including general patient data, trauma diagnosis, complications, number of visits, number of clinicians and follow-up duration in order to analyse tooth loss or inevitable tooth loss in the near future. Forty-five teeth (56
Early childhood caries (ECC) remains a major public health problem worldwide. Infant feeding practices, particularly bottle-feeding duration and nocturnal bottle use, have been implicated as potential risk factors; however, evidence regarding duration-specific effects remains inconsistent. The aim was to systematically evaluate whether prolonged bottle-feeding and nocturnal bottle use are associated with increased prevalence of ECC. This systematic review followed PRISMA guidelines and was registered in PROSPERO (CRD420251186608). MEDLINE, Cochrane Central, ScienceDirect and Scopus were searched up to May 2026. Observational studies involving children ≤ 71 months that reported ECC outcomes (dmft/dmfs/dft/deft) in relation to bottle-feeding duration and/or night-time bottle use were included. Risk of bias was assessed using ROBINS-E, and certainty of evidence was evaluated using GRADE. Twelve studies (two prospective cohorts and ten cross-sectional; 6,955 children) were included. Bottle-feeding limited to the first year of life was not associated with increased caries severity. Continuation beyond 12 months was associated with a gradual increase in ECC, whilst bottle-feeding beyond 24 months showed a consistent and clinically relevant increase in caries severity. Nocturnal bottle-feeding further amplified risk, particularly beyond 24 months, with evidence of dose–response relationships. Overall certainty of evidence was low to very low, limited primarily by observational study design, heterogeneity in exposure definitions and residual confounding. Evidence suggests a duration-dependent association between prolonged bottle-feeding and ECC severity, particularly beyond 24 months and during night-time. These findings support current recommendations for timely cessation of bottle use and avoidance of night-time bottle-feeding to reduce ECC burden.
Pierre Robin Sequence (PRS) is characterised by micrognathia, glossoptosis and upper airway obstruction, often necessitating early intervention to ensure airway stability and adequate feeding. This case series highlights the role of the Tübingen Palatal Plate (TPP), a functional approach in the multidisciplinary management of infants with PRS. This retrospective case series describes seven infants with PRS managed using the TPP within a multidisciplinary tertiary care setting. Clinical outcomes were assessed in terms of airway patency, feeding ability, growth status and caregiver-reported compliance. All infants demonstrated improvement in airway patency reflected by reduced dependence on adjunct airway support, along with enhanced feeding. Longitudinal assessment using WHO Weight-for-Age Z-scores (WAZ) demonstrated progressive improvement in nutritional status and satisfactory weight gain during follow-up. High caregiver compliance and satisfaction were observed, with no reported complications. This series highlights the feasibility and clinical effectiveness of TPP as a simple, non-invasive intervention and underscores the pivotal role of paediatric dentists in the multidisciplinary management of PRS.
Effective pain control during local anaesthetic administration is essential in paediatric dentistry. Although topical anaesthetic gels are widely used, concerns remain about dosage control. Cryoanaesthesia has emerged as a non-pharmacological alternative. This randomised controlled trial aimed to evaluate the non-inferiority of cryoanaesthesia compared with 20 https://ensaiosclinicos.gov.br/rg/RBR-74w5bt4 , registered on March 12th, 2025.
To assess clinical decision-making patterns in pulp therapy of primary teeth among Tunisian dental practitioners and explore the influence of diagnostic uncertainty on treatment selection. A cross-sectional, scenario-based survey was conducted among 263 dental practitioners in Tunisia (March–August 2025), including general dentists and specialists involved in paediatric care. A structured questionnaire based on the American Academy of Pediatric Dentistry (AAPD) guidelines presented three standardised clinical scenarios with increasing diagnostic complexity: asymptomatic deep caries, mechanical pulp exposure, and progressive pulpal disease. Participants selected treatment options which were compared to guideline-recommended management. Most participants were early-career practitioners (85
To provide an updated review of the literature and systematically estimate the global prevalence of hypomineralised second primary molars (HSPM). A comprehensive literature search was conducted across PubMed, Web of Science, Scopus, Embase, SciELO and LILACS electronic databases following PRISMA guidelines. The grey literature search was conducted on Google Scholar. Observational studies reporting prevalence data of HSPM were included. Risk of bias was assessed using the Joanna Briggs Institute Checklist for Prevalence Studies. A random-effects meta-analysis was performed to estimate the pooled prevalence. Subgroup analyses were performed to explore potential sources of heterogeneity. Sixty-one studies were included in the quantitative synthesis, comprising 52,874 participants and 127,841 primary molars. The pooled prevalence of HSPM was 10.7
Haematopoietic stem cell transplantation (HSCT) is a curative treatment for haematological malignancies and non-malignant haematological and immunological disorders. The oral cavity, which serves as a reservoir for infection, poses additional risks for patients undergoing HSCT. This study aimed to assess the oral disease burden among children and adolescents undergoing allogeneic HSCT (aHSCT) and to evaluate the oral healthcare they received before transplantation. This prospective, longitudinal, multicentre cohort study included 91 children and adolescents under 18 years of age who were scheduled for an aHSCT. The mean age of the cohort was 11.2 ± 4.6 years, with acute leukaemia the most common diagnosis (47
To assess periodontal and oral health status in Moroccan children and evaluate asthma-related factors, including treatment characteristics and oral conditions. A cross-sectional analytical study was conducted among 228 children aged 3–15 years, including asthmatic and non-asthmatic participants recruited at a tertiary university hospital. The groups were matched for age and sex. Data collection included sociodemographic characteristics, asthma-related variables (severity and treatment), and oral hygiene practices. Periodontal status was assessed using the Plaque Index (PI) and Gingival Index (GI), along with the evaluation of salivary flow and oral mucosal conditions. Univariate and multivariate linear regression analyses were performed to identify factors associated with periodontal outcomes. Asthmatic children showed significantly higher mean PI and GI scores compared with nonasthmatic children (p < 0.001). Gingival inflammation and oral candidiasis were significantly more prevalent in asthmatic children. In multivariate analysis, reduced salivary flow remained independently associated with higher PI scores, while longer treatment duration remained independently associated with increased GI scores among asthmatic children. Childhood asthma and prolonged asthma treatment may be associated with poorer periodontal and oral health status. Reduced salivary flow may contribute to plaque accumulation among asthmatic children. These findings highlight the need for increased awareness and preventive oral health care in pediatric patients with asthma.
This study aimed to evaluate parents’ knowledge and attitudes regarding endodontic treatment of primary teeth. This cross-sectional questionnaire-based study was conducted amongst parents. The questionnaire included sociodemographic and clinical variables, knowledge items regarding endodontic treatment of primary teeth, and attitude items evaluated on a five-point Likert scale. Knowledge scores ranged from 0 to 16 and were categorised as low (0–5), medium (6–10) and high (11–16). Mann–Whitney U, Kruskal–Wallis and Spearman correlation tests were used. The significance level was set at p < 0.05. The mean knowledge score was 7.80 ± 3.94, and the mean attitude score was 31.48 ± 6.22. Knowledge scores differed significantly according to gender, education level, income level, number of children, and previous root canal treatment experience (p < 0.05). Attitude scores differed significantly according to education level, income level, number of children, and age group (p < 0.05). A moderate positive correlation was found between knowledge and attitude scores (rho = 0.543; p < 0.001). Parents’ knowledge about endodontic treatment of primary teeth is positively correlated with their attitudes towards these treatments. Higher education and income levels are associated with higher knowledge and more positive attitudes. These findings suggest that parent-centred education strategies can increase awareness and support more positive attitudes towards endodontic treatment of primary teeth.
To investigate the association between MIH and occlusal alterations in children with mixed dentition. Orthodontic records of children aged 8 to 12 years were evaluated in this cross-sectional study. Patients with craniofacial syndromes or anomalies and records with insufficient image quality were excluded. MIH was diagnosed according to the European Academy of Paediatric Dentistry (EAPD) criteria. Occlusal alterations were assessed using criteria adapted from the Dental Aesthetic Index (DAI). Intra-examiner reliability was assessed. Associations were analysed using Chi-square or Fisher’s exact tests, and crude prevalence ratios (PR) with 95
The objective of this systematic review was to identify and evaluate the quality of the available evidence on the orthodontic aspects and implications when treating patients with MIH, before, during and after orthodontic treatment. Six electronic bibliographic databases were searched up to 26.05.2026. All studies assessing orthodontic interventions and outcomes in 5–18-year old patients with MIH were considered as eligible for inclusion. Qualitative and quantitative synthesis of results were performed and reported according to the PRISMA guidelines. Out of 243 records identified, 5 studies were included: a prospective, split-mouth trial, a prospective cohort, a cross-sectional study, and 2 retrospective studies. The included studies evaluated the relationship between MIH, extraction timing, space closure outcomes, adjacent teeth eruption and angulation, and orthodontic outcomes in paediatric populations. The relationship between MIH and orthodontic treatment was primarily therapeutic, rather than aetiological. Maxillary extractions yielded more favourable spontaneous space closure compared to mandibular extractions. This was confirmed after pooling the estimates for complete space closure after first molar extraction of 3 studies (no orthodontic treatment need versus orthodontic treatment need) in the maxilla: RR 4.12, 95
To investigate how dental clinicians worldwide manage primary molars with irreversible pulpitis and pulp necrosis and to identify factors associated with variability in the use of coronal pulpotomy, non-vital pulp therapy (NVPT), and extraction. An online questionnaire was distributed via international and regional paediatric dentistry associations to dental clinicians who treat children. Standardised clinical scenarios were developed for irreversibly inflamed and necrotic primary molars. Participants selected their most likely treatment. Demographic data and reasons for not performing coronal pulpotomy or NVPT were collected. Data were analysed using multivariable Generalized Estimating Equations (GEE) logistic regression to evaluate treatment choices and modified Poisson regression to calculate paired risk ratios (α = 0.05). A total of 374 clinicians responded, the majority of whom were paediatric dentists (82.9
This study directly compared the enamel matrix proteomes of HSPM and MIH using label-free quantitative proteomics to identify differentially abundant proteins and understand condition-specific pathogenic mechanisms. Enamel samples from 10 HSPM and 10 MIH samples were subjected to label-free quantitative LC–MS/MS analysis (final comparative analysis: n = 6 per group). 120 proteins common to both groups were identified through secondary proteomic analysis; 90 met a ≥ 50
