In the final part of this two part article on artificial intelligence (AI) in dentistry we review its transformative role, focusing on AI in dental education, patient communications, challenges of integration, strategies to overcome barriers, ethical considerations, and finally, the recently released International Dental Federation (FDI) Communique (white paper) on AI in Dentistry. AI in dental education is highlighted for its potential in enhancing theoretical and practical dimensions, including patient telemonitoring and virtual training ecosystems. Challenges of AI integration in dentistry are outlined, such as data availability, bias, and human accountability. Strategies to overcome these challenges include promoting AI literacy, establishing regulations, and focusing on specific AI implementations. Ethical considerations in AI integration within dentistry, such as patient privacy and algorithm bias, are emphasized. The need for clear guidelines and ongoing evaluation of AI systems is crucial. The FDI White Paper on AI in Dentistry provides insights into the significance of AI in oral care, dental education, and research, along with standards for governance. It discusses AI's impact on individual patients, community health, dental education, and research. The paper addresses biases, limited generalizability, accessibility, and regulatory requirements for AI in dental practice. In conclusion, AI plays a significant role in modern dental care, offering benefits in diagnosis, treatment planning, and decision-making. While facing challenges, strategic initiatives focusing on AI literacy, regulations, and targeted implementations can help overcome barriers and maximize the potential of AI in dentistry. Ethical considerations and ongoing evaluation are essential for ensuring responsible, effective and efficacious deployment of AI technologies in dental ecosystem.

Periapical abscesses, radicular cysts, and periapical granulomas are among the most frequently identified pathological lesions in the alveolar bone. Although many studies have investigated bacterial metagenomics in periapical abscesses, little is known about the genome mining of abundant bacteria in periapical lesions and its correlation to human transcriptome. This study aims to explore the enriched metabolic environment of periapical lesions associated with microbial diversity and their role in lesion progression. Bacterial DNA and human RNA were isolated from periapical lesions and healthy pulp tissue and sequenced using next-generation sequencing (NGS). The sequences of the most abundant bacteria were then analyzed to identify secondary metabolites, pathogenic proteins, and their associated metabolic pathways. The results revealed that Fusobacterium nucleatum was the predominant bacterium in periapical abscesses and radicular cysts, whereas Porphyromonas endodontalis was the most abundant in periapical granulomas. Integrated bacterial and human metabolic pathways indicated that the augmentation of similar pathways is important in lesions pathogenesis. In periapical abscesses, inflammatory response, humoral immune response, positive regulation of cell migration, and hemopoiesis were enriched. In radicular cysts, pathways linked to NABA matrisome associated, inflammatory response, immune response-regulating signaling pathway, neutrophil degranulation, and P73 pathway were enriched. Meanwhile, periapical granulomas exhibited significant enrichment of pathways related to response to bacterium, regulation of immune effector process, and positive regulation of cell migration. In conclusion, this study is the first to elucidate the interplay between microbial and human metabolic activity associated with inflammation in abscesses, apoptosis in cysts, and inflammatory regulation in granulomas. These findings have significant clinical implications for the early diagnosis, prevention, and treatment of periapical lesions.

Objective This study aimed to compare the effectiveness of semi-annual application of 38% silver diamine fluoride (SDF) with and without light curing in arresting dentine caries in primary teeth. Methods Children aged 5-7 years with at least 1 active dentine carious lesion were randomly allocated into: Group 1 (38% SDF with light curing: applied SDF for 10 seconds and exposed to LED light for 20 seconds) and Group 2 (38% SDF without light curing: applied SDF for 10 seconds and isolated for 20 seconds). Both interventions were repeated every 6 months. At the baseline, demographic data, oral health-related behaviors and clinical parameters of the children were collected. The activity of carious lesion was assessed using the visual-tactile method and adverse effects, if any, were recorded at both 6-month and 12-month follow-up periods by the same examiner. Intention-to-treat analysis was employed to analyze the data. Results At baseline, 40 children (218 lesions) and 37 children (261 lesions) were recruited into Group 1 and Group 2. There were no significant differences between the 2 groups in terms of demographic data, oral health-related behaviors, and clinical parameters of the children at baseline (P > .05). After 12 months, 66 out of 77 children (85.74%) remained in the study. There was no significant difference in caries arrest rate between Group 1 (74.8%) and Group 2 (69.0%) with P = .161. Conclusion The semi-annual application of 38% SDF with or without light curing is equally effective in arresting dentine carious lesions in primary teeth. The addition of light curing to SDF-treated teeth has no significant effect in arresting dental caries in primary teeth.

Aim: Mucormycosis is a rare human infection associated with Mucorales, a group of filamentous moulds found in different environmental niches. Its oral manifestations may occur in the mandible and tongue despite being rare. We aimed to systematically review the data on clinical manifestations, risk factors, diagnostic approaches, treatment options, and outcomes of mandibular and tongue mucormycosis. Methods: An electronic search of articles published between January 1975 and November 2022 in PubMed, Web of Science, and EMBASE databases was performed. A total of 22 articles met the inclusion criteria and reported 27 cases of oral mucormycosis in total. Results: Fourteen patients had mandibular mucormycosis signs unrelated to COVID-19 infection, 6 had SARS-CoV-2 -related mandibular mucormycosis, and 6 had manifestations in the tongue. All published case reports during the COVID-19 pandemic were from India. Patient ages ranged from 4 months old to 82 years, and most patients had important comorbidities, such as blood dyscrasias related to immune deficiency and uncontrolled type 2 diabetes mellitus. The signs and symptoms of mandibular and tongue mucormycosis varied from dental pain, loose teeth, and nonhealing sockets to dysphagia and paraesthesia of the lip. Some patients also reported trismus, draining sinus tract, and facial pain. The diagnosis of oral mucormycosis was based on a combination of clinical, radiographic, and histopathologic findings by demonstrating fungal hyphae in tissue specimens. In most cases, mucormycosis was managed with systemic amphotericin B, strict glycaemic control, and aggressive surgical debridement of infected tissue, minimising the progression of the fungal infection and thus improving the survival rate. In some cases, combined antifungal therapy, antibiotic therapy, and chlorhexidine mouthwashes were used successfully. Conclusions: Recognition of the signs and symptoms by oral care providers is pertinent for the early diagnosis and treatment of tongue and mandibular mucormycosis, and providers should be aware of the possibility of this opportunistic fungal infection in patients with COVID-19. A multidisciplinary approach is recommended for the management of this lethal infection. (c) 2023 The Authors. Published by Elsevier Inc. on behalf of FDI World Dental Federation. This is an open access article under the CC BY -NC -ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/)

Objectives This article reappraises the accuracy and factors associated with the detection of the cementoenamel junction (CEJ) using the tactile method. Materials and Methods A total of 111 tooth sites of 7 patients scheduled for flap surgery were selected for the study. The CEJ was detected in a blind manner using the conventional tactile method with a standard periodontal probe by a single, trained examiner. A custom-made stent was prepared to standardize the measurements and the distance from a fixed reference point on the stent to the CEJ was measured before (apparent CEJ) and after (real CEJ) opening a gingival flap. To evaluate the effect of local anesthesia (LA) on the measurement error, assessment with and without LA given prior to the measurement was also evaluated. The bone crest-CEJ distance at each site was also recorded in all sites. Statistical Analysis The measurement error of apparent versus real distance, if any, was compared using Cohen's weighted kappa coefficient (WKC) (+/- 1 mm). Results A weak WKC (WKC = 0.539) was found between the apparent and real CEJ distance. Higher WKCs were noted at posterior and proximal sites than the anterior and buccal/lingual sites, respectively (0.840 and 0.545 vs. 0.475 and 0.488). A higher confluence of the agreements was noted when CEJ distance was measured in anesthetized sites (WKC = 0.703). Sites without bone loss showed more coronal deviation of CEJ detection, as opposed to apical deviation seen at sites with bone loss. Conclusion The conventional CEJ detection using the tactile method was relatively imprecise depending on the anatomical location of the tooth and the bone loss at the site of measurement. However, the detection accuracy improved when the sites were anesthetized. In clinical terms, our data, reported here for the first time imply that, in the absence of visual cues, posterior tooth site measurements of periodontal attachment loss were more reliable in comparison to the other sites. The bone crest level also impacted the measurement deviation to some extent, implying that, possible overestimate of clinical attachment loss may occur at sites without bone loss.

Collagen X is an extracellular matrix protein, usually found in the hypertrophic cartilage destined to be mineralized. It is intimately associated with the mineralization process of the mammalian hard tissues, and particularly, regulating the compartmentalization of matrix components. Despite the fact that the dentine of the tooth is highly mineralized, there are no previous reports to indicate the presence of collagen X in this connective tissue. Here we report, for the first time, its presence in mammalian dentine based on micromorphological and immunohistochemical data. We hypothesize that the collagen X in dentine may in the long term arrest the progression of the mineralization front towards the soft tissue components of the pulp that are not destined to be mineralized.

Fungi present in Dental Unit Water (DUW) can pose a health hazard to patients and dental personnel. Yet, the issue of fungal contamination of DUW and their conduits, DUW Lines (DUWLs) has been poorly addressed despite a growing body of data on the subject. In this comprehensive review, we aim to address this gap by examining the diverse fungal contaminants found in DUW, the challenges associated with controlling their growth within waterline biofilms, and the various measures employed for fungal decontamination. The review underscores the intricate fungal ecosystems that exist within DUWLs and emphasizes the importance of implementing targeted antimicrobial strategies to uphold waterline hygiene. However, it is important to note that complete eradication of fungi in DUWLs has proven elusive, even with the application of disinfectants at varying concentrations, types, and frequencies. This highlights the pressing need for continued research efforts to develop new and optimized treatment protocols that are specifically tailored to eradicate fungi from DUWLs. Finally, it was notable that there are currently no specific regulations by any dental authority on permissible levels of fungi, as opposed to bacteria, in DUWLs. Legislation developed based on our findings can contribute to the standardization of practices and the formulation of effective control strategies for fungal contamination in DUWLs. It can also guide dental professionals in implementing regular monitoring, proper maintenance, and targeted disinfection protocols to minimize fungal contamination and ensure optimal water quality for patient safety.

Betaine, known as trimethylglycine, is a non-toxic natural substance reported to affect cancer cell responses. This study delves into the impact of betaine on the survival, proliferation, and invasion of oral squamous cell carcinoma (OSCC) cells in vitro. Human OSCC cells (HSC-4 and HSC-7) were subjected to varying concentrations of betaine, and their viability and proliferation were assessed through colourimetric MTT and colony-forming unit assays. Cell cycle progression and cell apoptosis were also investigated using flow cytometry, while cell migration and invasion were examined using a transwell migration assay, and the mRNA expression was evaluated by a quantitative polymerase chain reaction. Finally, proteomic analysis was conducted through liquid chromatography-tandem mass spectrometry on the extracted protein component of the cells. Results indicate that betaine effectively suppressed OSCC proliferation and colony formation. It triggered early apoptosis without disrupting cell cycle progression, reduced cell migration, and inhibited invasion. Betaine exposure led to significantly decreased mRNA levels of MMP1, MMP2, and MMP9 while downregulating FN1, a gene linked to epithelial-to-mesenchymal transition. Proteomic analysis revealed 9240 differentially expressed up/downregulated proteins in cells treated with betaine. The significantly upregulated proteins were associated with ATP-binding cassette (ABC) transporters, while the down-regulated proteins were associated with G protein-coupled receptors (GPCR) ligand binding. In conclusion, betaine exhibits potent anti-cancer properties by attenuating OSCC cell proliferation and mitigating invasion. Exploring this natural product as an adjunct for managing oral squamous cell carcinoma shows promise, although further investigations are needed to fully elucidate its functionality.

The human oral cavity is a sanctuary for a perplexing array of resident microbes. Lurking among them are opportunist fungal commensals such as Candida , which create dysbiotic states when local or systemic adverse conditions supervene. This account attempts to describe the work of the author and his international team on extensive studies on the conversion of oral Candida from commensalism to parasitism. The data comprise novel discoveries on the clinical epidemiology, etiopathogenesis, and clinical management of oral candidiasis. Candidal biofilm lifestyle is now considered a crucial factor in its pathogenesis. A multitude of studies have illustrated 1) the impact of dietary carbohydrates on biofilms; 2) the conflicting roles of saliva, serum, and sub -therapeutic concentrations of antifungals biofilms; 3) the drug resistance of candidal biofilms due to intrinsic anti -oxidative capacities; and 4) the interkingdom interactions of indigenous bacteria in both inhibiting and fostering yeast colonization. With the advent of the HIV epidemic, novel variants of oral candidiasis were described, and a new, improved classification of oral candidiasis was proposed. An extensive inquiry into the oral manifestations of HIV -infected highlights the global sub -types of oral C. albicans, increased Sap expression, and the enhanced avidity of Candida to the buccal epithelium of HIV carriers. This presentation redefines the complex behavioral features of Candida within the human oralome, which may lead to a deeper understanding of oral and systemic candidiasis. (Oral Surg Oral Med Oral Pathol Oral Radiol 2024;137:402-407)

OBJECTIVES:To investigate the role of Keratinocyte Differentiation Factor 1 (KDF1) in ectodermal dysplasia (ED) and nonsyndromic tooth agenesis (NSTA) and perform a literature review. METHODS:Genome sequencing was used to identify genetic variants in a Thai, NSTA proband and validated through Sanger sequencing. Pathogenicity was assessed using ACMG guidelines, MetaRNN and AlphaMissense. A comprehensive review of KDF1/NSTA cases informed genotype-phenotype analysis of the proband. RESULTS:The proband revealed multiple missing teeth, caries and extensive periodontal disease. Deep phenotyping showed no signs of ED beyond tooth agenesis. The identified novel KDF1 variant, p.Ile243Leu, was classified as 'likely pathogenic' by ACMG and predicted as 'detrimental' by MetaRNN and AlphaMissense analyses. A total of 14 reviewed KDF1 cases revealed ED-associated variants (3 variants in 8 patients) clustering in the region of amino acids 251-275, within the DUF4656 domain, while NSTA-causing variants (4 variants in 6 patients) were typically found in amino- or carboxy-termini to this region. KDF1/NSTA cases exhibited an average of 15 missing teeth, with a higher prevalence in the mandible. CONCLUSION:This study identifies a novel KDF1 variant-related NSTA in Thai people. The genotype-phenotype correlates suggest a distinctive pattern and tooth agenesis of KDF1-related NSTA.

OBJECTIVE:Endodontic microbiota appears to undergo evolutionary changes during disease progression from inflammation to necrosis and post-treatment. The aim of this study was to compare microbiome composition and diversity in primary and post-treatment endodontic infections from a cohort of patients from the UAE. DESIGN:Intracanal samples were collected from primarily infected (n = 10) and post-treatment infected (n = 10) root canals of human teeth using sterile paper points. Bacterial DNA was amplified from seven hypervariable regions (V2-V4 and V6-V9) of the 16S rRNA gene, then sequenced using next-generation sequencing technology. The data was analyzed using appropriate bioinformatic tools. RESULTS:Analyses of all the samples revealed eight major bacterial phyla, 112 genera and 260 species. Firmicutes was the most representative phylum in both groups and was significantly more abundant in the post-treatment (54.4%) than in primary (32.2%) infections (p>0.05). A total of 260 operational taxonomic units (OTUs) were identified, of which 126 (48.5%) were shared between the groups, while 83 (31.9%) and 51 (19.6%) disparate species were isolated from primary and post-treatment infections, respectively. A significant difference in beta, but not alpha diversity was noted using several different indices (p< 0.05). Differential abundance analysis indicated that, Prevotella maculosa, Streptococcus constellatus, Novosphigobium sediminicola and Anaerococcus octavius were more abundant in primary infections while Enterrococcus faecalis, Bifidobacterium dentium, Olsenella profusa and Actinomyces dentalis were more abundant in post-treatment infections (p <0.05). CONCLUSION:Significant differences in the microbiome composition and diversity in primary and post-treatment endodontic infections were noted in our UAE cohort. Such compositional differences of microbiota at various stages of infection could be due to both intrinsic and extrinsic factors impacting the root canal ecosystem during disease progression, as well as during their therapeutic management. Identification of the key microbiota in primarily and secondarily infected root canals can guide in the management of these infections.

Denture plaque, a biofilm that develops on denture surfaces, could contribute to many oral and systemic afflictions. Hence, a quantitative assessment of denture plaque is important to evaluate the denture hygiene of denture wearers, particularly to prevent plaque biofilm-associated diseases. The aim of this systematic review, therefore, was to review and summarize the visual denture hygiene assessment methods using denture plaque indices and with planimetries published in the literature. English language studies published up to March 2022 in four electronic databases, PubMed, Medline, Embase, and Cochrane Library, were searched, followed by a manual search of Google Scholar by two assessors. The review followed Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) whenever possible. Details of the visual assessment methods, including the types of denture assessed, its materials and its surfaces, as well as the use of a disclosing agent, were the main outcomes. Of 492 screened studies, 74 were included per the inclusion and exclusion criteria. Of these, 60 studies utilized various denture plaque indices while 18 used planimetries. 43 out of 60 studies with indices and 17 out of 18 studies with planimetries used disclosing agents for visual evaluation of plaque. A total of 21 indices were described in the included studies, of which seven graded a divided denture surface, while the remainder graded entire denture surface. Of the 18 planimetric assessments, one study quantified squares of the disclosed plaques on denture images, 16 studies quantified such pixels with computer programs, and a single study quantified points, pixels, and contour of plaque areas. In summary, denture plaque indices appear to be popular in denture plaque assessment due to their simplicity. Computerized planimetric assessment, though more time-consuming, provides a more accurate assessment of plaque load as it is less prone to subjectivity and assessor errors.

The proper closure of the access cavity between appointments during endodontic treatment is paramount and relies on temporary fillings. This systematic review evaluates the effectiveness of zinc oxide-based materials and glass-ionomer cement (GIC) as temporary coronal sealers after root canal treatment in extracted human teeth. Three databases were searched to identify randomized clinical trials that examined the sealing properties of various temporary sealing materials using dyes or stains as indicators. A total of seven in vitro studies that fulfilled the eligibility criteria were critically analyzed. These indicated significant variations in the relative sealing ability of the coronal breach of endodontically treated teeth, either by zinc oxide or GIC-based materials. While GIC-based material (e.g., Fuji IX and Fuji II) exhibited superior sealing of single-rooted teeth, zinc oxide-based material (e.g., Cavit, Coltosol, Caviton) also showed promising attributes. Resin-modified GIC formulations displayed enhanced physical properties, yet challenges related to adhesive failure and shrinkage during polymerization were observed. Zinc oxide-based materials have demonstrated superior coronal sealing effectiveness over certain GIC in controlled settings. Their premixed nature ensures consistent application and hygroscopic properties improve cavity sealing. However, the focus on dye penetration tests for microleakage in vitro may not fully represent the risk of bacterial infiltration. Thus, in vivo studies are crucial for validating these findings in clinical contexts.

AIM:As data are sparse on the long-term association between periodontal diseases and development of metabolic syndrome (MetS), we investigated their relationship in a Thai cohort over a 10-year observational period. METHODS:Medical records and data on periodontal assessments of 2161 employees of the Electricity Generating Authority of Thailand collected at two time points, 2003 and 2013, were used. Experienced periodontists used standard national and international criteria to define periodontitis and MetS. The impact of baseline periodontitis on subsequent MetS incidence and its components was evaluated using regression analyses. RESULTS:The severity and extent of periodontitis significantly predicted MetS incidence over a decade, with a higher incidence of MetS in individuals with poorer periodontal health. A single percentage increase in the periodontitis extent raised the risk of MetS incidence by 0.4% and the risk of developing individual components of MetS by 0.2%. Independent of periodontal health, age of an individual emerged as a factor impacting MetS development. CONCLUSION:This study highlights the potential effect of the severity and extent of periodontitis on the increased incidence and progression of MetS. Hyperglycaemia and hypertension were the two MetS components most significantly affected by the existence of periodontitis.

Dental unit waterlines (DUWLs) are the conduits within the dental chair through which water derived from the municipal or other peripheral supply systems flows through the dental chair to reach the dental patient. The quality of the water so delivered must have a low pathogenic microbial burden so as to be safe for the patient and the dental personnel. Regulatory bodies have therefore set minimum standards for the quality of water that exits from DUWLs as part of routine infection control. Adopting a comprehensive approach that combines physical, chemical, and automated methodologies is recommended to effectively decontaminate DUWLs. This review discusses the complexities of DUWL decontamination in terms of (1) Best Practice Guidelines in dental healthcare settings to mitigate DUWL contamination, (2) origins of DUWL contamination and biofilm formation and the associated infectious risks, (3) contemporary approaches for minimizing DUWL contamination, and (4) constraints in combating biofilms in DUWLs. Compliance with regional and national regulations on DUWL decontamination is a legal obligation for all dental practitioners and fundamental to protecting public health.

Plaque biofilm is a major etiologic factor of periodontitis, and its effective removal prevents or ameliorates the disease. However, toothbrushing alone does not sufficiently clean the interdental area, and additional interdental cleaning is required to completely remove the plaque from this locale. This cross-sectional study aimed to assess the association of interdental cleaning on the prevalence of periodontitis in a large urban Thai adult cohort. Interdental cleaning data were retrieved from a dental survey of 1,743 employees of the Electricity Generating Authority of Thailand (EGAT) in 2019. The Centers for Disease Control and Prevention/American Association of Periodontology (CDC/AAP) periodontal case definitions were applied. The participants were subdivided into two groups as those with or without periodontitis depending on their oral health status assessed by calibrated professional examiners. The proportion of subjects who performed interdental cleaning was assessed through a self-reported questionnaire by frequency (daily/ ≥ 1 per week/ none) and profile (correct/ incorrect) of interdental cleaning. Then, the association between interdental cleaning and periodontitis was calculated using logistic regression analysis controlling for the common risk factors of periodontitis such as age, sex, education, smoking, and diabetes. Participants who performed interdental cleaning on a daily basis and ≥ 1 per week were 27.5 https://www.thaiclinicaltrials.org ).

OBJECTIVES:The study explored the expression profile of miRNAs in Notch-activated periodontal ligament stem cells (PDLSCs) and examined their potential cellular targets.METHODS:PDLSCs were cultured and treated with indirect immobilized Jagged1. The miRNA expression profile was examined using NanoString analysis. Bioinformatic analysis was performed together with enrichment, and miRNA expression was evaluated and validated using a quantitative polymerase chain reaction (qPCR).RESULTS:A total of 26 miRNAs were differentially expressed in Jagged1 treated PDLSCs compared with the controls. Pathway analysis revealed that altered miRNAs were significantly associated with the transforming growth factor β (TGF-β) signaling pathway. Target prediction analysis demonstrated that 11,170 genes as predictable targets of these altered miRNAs. Enrichment of predicted target genes revealed that they were related to ErbB, Ras and MAPK signaling pathways and small GTPase transduction.CONCLUSIONS:The research concludes that several miRNAs are differentially expressed in jagged-1 treated PDLSCs. In translational terms the differential functionality of these miRNAs offer promise for the development of targeted regenerative materials that are necessary for managing lost tissue replacement in periodontal diseases.

Objectives To compare, in vitro, the efficacy of three proprietary silver diamine fluoride (SDF) products in mitigating progression of dentinal caries induced by an inter-kingdom, dual-species, bacterial-yeast biofilm. Methods Human dentin blocks were demineralized to create artificial caries lesions and randomized into three SDF test groups: Saforide, Topamine, T-SDF, and an aqueous control (n = 26 per group). After application of foregoing SDF variants, the blocks were incubated with Streptococcus mutans and Candida albicans for 24 h for biofilm development, and subsequently subjected to a microbe-induced, pH-cycling process for 7 days, to mimic the oral eco-system. The biofilm cell viability and surface topography were assessed by colony-forming units (CFUs) and scanning electron microscopy respectively. The lesion depth and mineral density were evaluated by micro-computer tomography. SDF precipitate and matrix-to-mineral ratio were evaluated by X-ray diffraction and Fourier transform infrared spectroscopy, respectively. Standard, accepted methodology was used for all these evaluations and procedures. Results After pH cycling, the SDF groups demonstrated comparable inhibition of the biofilm relative to the control. the log CFU of S. mutans for Saforide, Topamine, T-SDF, and control were 6.69±0.73, 6.48±0.56, 6.63±0.66, and 8.01±0.45, respectively. For C. albicans, the log CFU were 4.86±0.44, 4.72±0.53, 4.92±0.29, and 5.60±0.27, respectively. The log CFU of S. mutans and C. albicans in the SDF groups were significantly lower than the control group (p<0.001). Further, the lesion depth decreased by approximately 14.79±7.00% in the SDF groups, while it increased by 11.07±8.61% in the control (p<0.001), and the mineral density increased by 16.36±4.58% in the SDF group, as opposed to a 5.59±2.64% reduction in the control (p<0.001) implying their caries mitigating effect. These findings were corroborated by SEM images of the lesions. Conclusion SDF significantly mitigated dentin caries due to an assault by a polymicrobial plaque biofilm whilst arresting mineral loss and lesion growth. There was no difference in the caries-arresting efficacy of the compared SDF variants.

AIM:To investigate the effect of periodontitis on the long-term changes of the cardio-ankle vascular index (CAVI). MATERIALS AND METHODS:A 10-year retrospective cohort study of 3842 Thai participants (range 25-76 years) with normal CAVI at the study initiation was undertaken. Full-mouth periodontal examination was performed by calibrated periodontists, and the extent and severity of periodontitis were determined at 5-year intervals. Serial CAVI measurements were used to examine the incidence of high CAVI (≥ 9.0) and changes in CAVI over time (ΔCAVI). RESULTS:Participants with a higher extent or severity of periodontitis were found to have a significantly higher mean ΔCAVI. The incidence of high CAVI was also observed to be higher in those with periodontitis compared to those without it. The adjusted risk ratios for developing high CAVI were 1.309 and 1.513 for localized and generalized periodontitis, respectively. Participants with severe periodontitis had a 37% higher likelihood of developing CAVI ≥ 9.0 compared to individuals with no/mild periodontitis. This risk was consistent with a significant change in ΔCAVI of 0.054-0.140. CONCLUSIONS:Periodontitis, both in terms of extent and severity, was found to have a significant dose-dependent effect on the risk of developing high CAVI over a 10-year period, suggesting a causal relationship between these two parameters.

Objective: To evaluate the gingival phenotypes of healthy young adult Pakistanis attending a dental institution. Methods: A cross-sectional study of gingival phenotype, probing depth (PD), papilla height (PH), gingival width (GW), gingival thickness (GT), crown width (CW) and crown length (CL) of maxillary central incisors was conducted in 510 healthy, Pakistani young adults, aged 20-35 years, attending a regional dental hospital in Pakistan. The K-means clustering technique was employed to delineate clusters based on the characteristics of the periodontal phenotypes. The resultant data was compared with the available international findings. Results: Three quarters (76 %) of the 510 patients examined exhibited a thick gingival phenotype, and the remainder a thin phenotype. The K-means clustering deployed the individual into three different clusters 1, 2 and 3, with varying ratios of PD, GW, CW/CL, with significant variations across the three clusters (p < 0.05). Our data where a vast majority of the cohort exhibited a thick gingival phenotype is comparable to most of the populations sampled in other regions of the world. Conclusion: Taken together the current data, a first for a Pakistani population, indicate that healthy, young adult Pakistanis had differing gingival phenotypes and crown forms, with the thick gingival phenotype predominating. These results are similar to reports from most other regions of the world. However, a larger study with a broader swathe of the Pakistani population is required to derive country specific data on the subject.