Twice daily toothbrushing with fluoride toothpaste is of undisputed importance for oral health, but the type of toothbrush is a subject of discussion. The aim of this narrative update was to examine the efficacy of powered (electric) toothbrushes (PTB) versus manual toothbrushes (MTB) for dental biofilm (plaque) removal and reduction of gingival inflammation in children up to 18 years. PubMed, The Cochrane Library, and Google Scholar were searched for relevant systematic reviews and/or meta-analyses based on randomized controlled trials, published in English between 2020 and 31 October 2025. Six systematic reviews and one comprehensive review were included and scrutinized. In healthy children, PTBs were 4–17

Dental caries is the world's most common non-communicable disease with a complex etiology including social, behavioral, medical, biological and economical elements. The distribution among populations and age groups is skewed, which calls for validated clinical tools to identify those with increased caries risk. The aim of this article was therefore to review risk factors for caries development in children, based on global prospective birth cohorts, genetic proceedings and data from validated risk assessment tools. The genetic elements involve four main categories comprising enamel quality, salivary composition, dental biofilm function and taste preferences. Recent studies suggest that genes may account for 35-55% of the variation in caries scores in the young permanent dentition. Prospective birth cohorts have pointed out poverty, socioeconomic level, early introduction and excessive sugar intake as significant factors for a child's dental caries trajectory up into adulthood. Moreover, prolonged breastfeeding, child obesity and maternal oral conditions are linked to the caries burden later in life. In the clinic, the strongest predictors are past caries history and selected behavioral and social factors. The performance of the validated caries risk assessment models is far from perfect, but still acceptable in terms of reliability during childhood. These tools are the best clinical practice since they add objectivity, consistency and documentation to the clinical routines. In addition, the dental staff has the advantage of using the outcome of the assessment for a structured risk communication with the caregivers. The protocol should also form the basis for a personalized intervention program addressing the entire family, with particular focus on maternal oral health and sugar reduction.

BACKGROUND:The objectives of this Focused Workshop were to update the epidemiology, aetiology, risk factors, diagnosis and management of gingival and periodontal diseases and conditions in children and adolescents, and to explore the applicability of the 2018 Classification in children and adolescents. METHODS:The Workshop discussions were informed by three specifically commissioned systematic reviews covering gingival and periodontal diseases and conditions, in systemically healthy children and adolescents, or in children and adolescents with systemic conditions. RESULTS:Over 70 genetic, congenital and acquired systemic conditions that impact the periodontal tissues were identified, with levels of evidence graded as very low, low or moderate. Gingival diseases and conditions in systemically healthy children and adolescents were identified, alongside local predisposing and systemic modifying factors. Periodontitis and other periodontal conditions in the 2018 Classification System also apply to children and adolescents; however, there are challenges with periodontal probing in the primary and mixed dentition. CONCLUSIONS:Periodontal tissues in children and adolescents differ from those in adults and require special consideration, accounting for their stage of development and predisposing and modifying factors unique to younger patients, which may confound accurate diagnosis, prognostication and management. Specific approaches to screening, examination and treatment are necessary for safe and effective management in this patient group.

Klinisk relevans I tilgængelige systematiske oversigter har vi fundet beskedent belæg for en cariesforebyggende effekt af overvåget tandbørstning blandt børn i skoleregi. Selvom vi ikke anbefaler overvåget tandbørstning som generel foranstaltning, er der dog eksempler på omkostningseffektive programmer, som er udført i socioøkonomisk belastede områder og har udjævnet sociale uligheder i oral sundhed blandt førskolebørn.

In paediatric dentistry, the implementation of interdental cleaning measures, particularly the use of dental floss, is a commonly recommended procedure to prevent caries. How-ever, there is only limited evidence of a caries-preventive effect. A narrative review was conducted to update the knowledge on the effect of interdental tooth cleaning on caries development in children and adolescents. A literature search in databases revealed no new randomized controlled studies on the topic. There is still a lack of long-term studies on the effect of self-performed dental flossing and the use of interdental brushes on dental caries development in children. Thus, there is no evidence whether interdental cleaning aids to reduce caries, when compared with toothbrushing alone. However, some population-based cross-sectional studies, most of which were conducted with adults, show correlations between interdental hygiene and caries prevalence and/or increment. In conclusion, our findings do not support a general recommendation of interdental cleaning devices in children but individual indications for interdental cleaning devices may exist based on special needs, abilities, and family conditions. Thus, parents and children should be thoroughly instructed and trained to avoid traumatic side-effects of the procedure.

Artikkeli on tiivistelmä pohjoismaisissa hammaslääkärilehdissä keväällä 2025 julkaistuista 11 artikkelista, jotka käsittelivät suuhygienian merkitystä suunterveyden ylläpidossa. Artikkeleissa todetaan, että kariesta, ientulehdusta ja parodontiittia voidaan hallita kiinnittämällä huomiota yleisiin riskitekijöihin.Parodontaalisairauksien ehkäisyssä ja hoidossa tulisi noudattaa European Federation of Periodontologyn suosituksia. Olennaisia keinoja ehkäistä kariesta ovat sokerin välttäminen ja fluoridin käyttö. Myös hampaiden harjaus kahdesti päivässä ikäryhmälle sopivalla määrällä fluorihammastahnaa on suositeltavaa. Fluoridia sisältäviä suuhuuhteita ja muita paikallisvalmisteita suositellaan niille henkilöille, joilla on suurentunut kariesriski, kun taas fluoritonta hammastahnaa ei voida suositella nykytiedon valossa. Kouluissa tapahtuvan, suunterveyttä edistävän toiminnan mahdollisuuksia kannattaaartikkelien kirjoittajien mukaan pohtia. Tämänhetkisen tutkimustiedon perusteella biofilmin poistamisessa hammasväliharjat ovat tehokkaampia kuin hammaslanka, ja antibakteerisia valmisteita tulisi harkita vain lyhytaikaiseen käyttöön. Näyttö suuhuuhteiden tehosta halitoosiin on heikko. Myös näyttö sähköhammasharjan paremmuudesta verrattuna manuaaliseen hammasharjaan pitkällä aikavälillä on artikkelien mukaan vähäistä. Heikkokuntoisten ikäihmisten kohdalla on olennaista, että suun terveydenhuollon ammattilaisten ja hoitohenkilökunnan välinen yhteistyö on aktiivisempaa, jotta ikäihmisten suunterveyttä voidaan parantaa. Mekaanisen biofilmin poiston tulisi olla yhtä aikaa sekä tehokasta että hellävaraista, jotta haittavaikutuksilta vältytään. Etähammaslääketieteen sovellukset voivat puolestaan tulevaisuudessa tarjota vaihtoehtoisia menetelmiä hallita kariesta ja parodontaalisairauksia.

Vitamin D deficiency is associated with a variety of oral health disorders. The aim of the present cross-sectional study was investigate the association between parental-reported vitamin D supplementation and oral health in 6- and 10-year-old children living in Poland. The study population consisted of 2019 6- and 10-year old children from 10 out of 16 provinces in Poland. Parents answered a structured questionnaire covering information on socio-economic and dietary factors as well as data on the oral hygiene behavior. The children underwent a clinical examination and the prevalence of dental caries and frequency (dmft/DMFT) and gingival bleeding on probing (BOP) was recorded. We used Spearman’s correlation and logistic regressions to calculate associations between vitamin D supplementation and the collected data. According to the parents, 44.3

Background/Objective: With a prevalence linked to modern lifestyle, erosive tooth wear (ETW) is a growing clinical problem among children and adolescents. The aim of this cross-sectional study was to record the awareness and knowledge of ETW among Greek dentists and to explore their preferred treatment decisions. Methods: A case-based digital questionnaire was distributed to a stratified sample of dentists practising in Athens (n = 218). We collected data regarding clinical scoring, possible aetiological factors, and clinical management of ETW and used descriptive statistics, chi-square tests, and odds ratio calculations to process the outcome. Results: The response rate was 92%. The majority (71%) recorded ETW among their patients, but only 5% used an established and validated scoring system. Almost 1/3 registered only the location of the lesions. Over 70% disclosed the possible causes of ETW, with frequent consumption of fizzy soft drinks (67%) and acidic foods (56%) being the most common. Most respondents managed the ETW patients in their own clinic, while 23% referred them to another dentist or a university clinic. The respondents focused on secondary prevention (dietary advice, oral hygiene, and fluoride exposure) and preferred less invasive options for anterior teeth, with restorative care restricted to the lower molars. Conclusions: The majority of the dentists participating in this survey registered ETW and its possible causes and seem to have adopted a preventive and minimally invasive approach for the management in children and adolescents. For the case documentation, a minority took advantage of standardised scoring systems for lesions and dietary habits, and very few performed salivary diagnostics. The findings underscore the need of continuing education to offer updates on the most current guidelines and focusing on patients’ needs and expectations.

Background/Objectives: Children with an oral presence of Candida spp. have an elevated prevalence of dental caries. As an alternative to conventional antifungal drugs, the use of biofilm-modulating strategies, such as probiotic bacteria, may be a sustainable option. Probiotics are live microorganisms that have beneficial health effects, while prebiotics are compounds in food that foster the growth or activity of the beneficial microorganisms. The aim of this paper was to review current clinical findings regarding the antifungal effects of pre- and probiotic supplements, including syn- and postbiotics, in children. Methods: We searched two databases (PubMed and Google Scholar) for controlled clinical trials published in English up to 20 April 2025, and two authors scanned the abstracts independently for relevance. The selected full-text papers were reviewed and assessed for risk of bias. Results: Four articles published between 2013 and 2025 were included in this review, covering a total number of 208 caries-active children between 3 and 14 years of age. Study designs were heterogeneous, and we observed conflicting results: two studies with probiotic streptococci failed to demonstrate any beneficial effects on the counts of salivary C. albicans, while interventions with L. plantarum and L. rhamnosus significantly reduced C. albicans compared with controls. None of the included reports displayed a low risk of bias. No clinical studies utilizing prebiotics, synbiotics, or postbiotics were retrieved. Conclusions: We found insufficient evidence concerning the antifungal effects of probiotic supplements in children. Therefore, we recommend future clinical trials to explore the ability of pre-, pro-, and postbiotic interventions to affect cross-kingdom biofilms in order to support a balanced and health-associated composition of the dental biofilm in children.

Orthodontic patients are often instructed to use fluoride mouthrinses (FMR) to prevent caries during treatment with fixed orthodontic appliances (FOA). The aim of this study was to examine the caries preventive effect of FMR during FOA treatment based on randomized controlled trials. An information specialist searched five databases up to September 30, 2024. We included trials with parallel groups (intervention vs. control) and a minimum duration of six months. Based on the abstracts, the authors independently selected and reviewed full text papers, extracted key outcome data, and assessed the risk of bias. The primary outcome was incidence of enamel caries on subject level. We conducted a narrative synthesis and pooled comparable data in a random effects model. We identified 22 studies of which seven, involving 704 patients, met the inclusion criteria. Five and two studies had moderate and high risk of bias, respectively. In all studies, FMR was additive to daily use of fluoride toothpaste. The intervention varied from twice daily to twice weekly and the duration ranged from six to 26 months. Five studies were included in a meta-analysis. The aggregated data showed a small risk difference of − 0.07 (95

Klinisk relevans Tandbørstning med fluoridtandpasta er og bliver et umådeligt vigtigt redskab til forebyggelse af caries.

Klinisk relevans Dette nordiske tema fokuserer på forskellige aspekter af mundhygiejnens betydning for opretholdelse af oral sundhed. Caries, gingivitis og parodontitis kan kontrolleres ved tiltag over for fælles risikofaktorer. Inden for tandplejen er motiverende samtale den mest anvendte model til adfærdsændring på individniveau. Desuden kan teletandpleje på sigt blive en supplerende strategi til kontrol af caries og parodontale sygdomme. Følgende tiltag kan bidrage til bedre mundhygiejne gennem plakreduktion: grundig tandbørstning med elektrisk eller manuel tandbørste, interdental rengøring med mellemrumsbørster fremfor tandtråd. Fluorid i diverse udgaver modvirker caries ved at reducere progressionshastigheden.

Caries and periodontitis affect a significant part of the global population. Regular oral hygiene, sugar restriction, and fluoride exposure are the main avenues for the maintenance of oral health, but the adjunctive use of prebiotics and probiotic bacteria has gained attention over the past decades. The microbial and clinical effects of these biological interventions have been thoroughly covered in systematic reviews. However, the combination of prebiotics and probiotics (synbiotics) may boost the clinical benefits, and postbiotics, being inanimate microorganisms, can, when added to oral hygiene products, offer a sustainable option. The aim of this narrative review was to summarize clinical trials on the adjunctive use of synbiotics and postbiotics in the prevention and management of dental caries, gingivitis, and periodontitis. We searched two databases (PubMed and Google Scholar) for relevant literature, and we identified 17 relevant papers, five on dental caries and 12 with periodontal endpoints. We found emerging evidence of low certainty that lozenges/tablets containing synbiotics or postbiotics could reduce caries incidence in preschool and schoolchildren in comparison with standard preventive care. The effect on adult patients with plaque-induced gingivitis was less consistent. For adults with periodontitis, the adjunctive use of synbiotic and postbiotic products seemed to enhance the outcome of conventional scaling and root planning. In conclusion, both dental caries and periodontitis are non-communicable diseases, closely associated with an unbalanced oral biofilm, and the application of microbial modulators, including synbiotics and postbiotics, display promising beneficial effects and warrant further research.

Data from systematic reviews and meta-analyses show that probiotics positively impact clinical parameters of oral diseases such as gingivitis, dental caries, and periodontitis. However, the working mechanism of probiotics is not fully understood, but is hypothesized to be mediated by direct and indirect interactions with the oral microbiota and the human host. In the present narrative review, we focused on the microbiological effect of probiotic supplements based on data retrieved from randomized clinical trials (RCTs). In addition, we assessed to what extent contemporary molecular methods have been employed in clinical trials in the field of oral probiotics. Multiple RCTs have been performed studying the potential effect of probiotics on gingivitis, dental caries, and periodontitis, as evaluated by microbial endpoints. In general, results are conflicting, with some studies reporting a positive effect, whereas others are not able to record any effect. Major differences in terms of study designs and sample size, as well as delivery route, frequency, and duration of probiotic consumption, hamper comparison across studies. In addition, most RCTs have been performed with a limited sample size using relatively simple methods for microbial identification, such as culturing, qPCR, and DNA–DNA checkerboard, while high-throughput methods such as 16S sequencing have only been employed in a few studies. Currently, state-of-the-art molecular methods such as metagenomics, metatranscriptomics, and metaproteomics have not yet been used in RCTs in the field of probiotics. The present narrative review revealed that the effect of probiotic supplements on the oral microbiota remains largely uncovered. One important reason is that most RCTs are performed without studying the microbiological effect. To facilitate future systematic reviews and meta-analyses, an internationally agreed core outcome set for the reporting of microbial endpoints in clinical trials would be desirable. Such a standardized collection of outcomes would most likely improve the quality of probiotic research in the oral context.

Caries is among the most common non-communicable diseases worldwide, yet it is commonly described as preventable. Caries prevention is, however, difficult and complex, since the disease has strong social, parental, behavioral, political, medical/genetic, and psychological elements, and the payment models are targeted at traditional conservative care. The aim of this paper is to discuss some key issues that make caries prevention in children be perceived as “difficult”: i) the communication gap between researchers and clinicians, creating unrealistic expectations of intervention efficacy; ii) the skewed distribution of caries and the problem of reaching children with the highest need; iii) limited access to care, which is a threat to oral health, in particular in low-socioeconomic-status, underserviced, and remote communities; and iv) the need to adopt behavior change models to affect the modifiable risk factors that are shared with other non-communicable diseases. Dentists cannot simply rely on fluoride exposure; proper education and training in caries risk assessment, behavior change models targeted at oral hygiene and sugar intake, and collaboration with primary healthcare and local school authorities are avenues that aid in caries prevention and reduce the uneven burden of the disease. Online education and mobile apps may help to promote oral health in areas with shortages of dental work force.

Background. Pre- and probiotics may help restore a dysbiotic oral ecosystem. The first years of life provide a window of opportunity to modulate the composition of the oral microbiota and prevent disease. Objectives. The aim of the present study was to investigate the effect of a tablet containing inactivated Ligilactobacillus salivarius CECT 5317 and the cranberry extract on the development of caries in cariesactive preschool children. Material and methods. The study employed a randomized, placebo-controlled, double-blind design. Preschool children (N = 73) with at least one active carious lesion were enrolled and randomly assigned to the test group or the placebo group. The intervention period was 3 months. Caries was assessed according to the International Caries Detection and Assessment System (ICDAS) II criteria at baseline and after 9 months, and oral hygiene was evaluated with the simplified oral hygiene index (OHI-S). The salivary counts of Streptococcus mutans and Lactobacillus spp. were determined at baseline, and then after 3 and 9 months through the conventional cultivation on TYCSB and MRS agar, respectively. Results. Sixty children completed the trial (a dropout rate of 19%). The baseline caries prevalence was high in both groups (similar to 71%) and there were no major differences between the groups with regard to background variables. The 9-month incidence of initial carious lesions (ICDAS 1+2) was significantly lower in the test group as compared to the placebo group (p < 0.05). The plaque levels, and the salivary counts of S. mutans and Lactobacillus spp. remained unchanged in both groups throughout the study. Conclusions. A daily intake of a tablet containing a paraprobiotic and the cranberry extract reduced the 9-month incidence of initial non-cavitated carious lesions in caries-active preschool children. The present study is one of the first to show the impact of synbiotics on the development of caries in children.

Objective:To compare the reliability of two scoring systems for detecting white spot lesions (WSLs) from clinical photographs captured during debonding of fixed orthodontic appliances. Methods:Digital images of 58 healthy adolescents (34 females and 24 males) were examined, depicting 384 buccal surfaces of maxillary incisors, canines, and first premolars. Three trained examiners (E1, E2 and E3) independently evaluated the fully anonymized photos in a randomized order using the Gorelick index (GI) and the modified International Caries Detection and Assessment System (ICDAS II). A 1-2-week interval separated the scorings. Spearman's rank correlation coefficient, Fisher's z-test, and the interclass correlation coefficient (ICC) were applied to compare the scoring methods and express examiner agreement. Results:The two scoring systems showed a moderate to strong positive relationship, but inter-examiner variations were significant (p<0.05). We found moderate to good reliability (ICC 0.60 to 0.84) with the ICDAS II system and good to excellent values with the GI (ICC 0.72 to 0.94), depending on the examiner. The agreement concerning the sound surfaces and the most severe WSLs was perfect, whereas the scoring of the milder lesion stages appeared more uncertain. Conclusion:A moderate to strong positive relationship was demonstrated between the two methods when scoring the presence and severity of WSLs from digital images. Significant inter-examiner variations affected reliability.

Purpose : To investigate the impact of giving children younger than 2 years foods and beverages with free sugars on the prevalence of early childhood caries at 5 years. Materials and methods : The study group consisted of 208 children (105 boys and 103 girls) with a complete set of data on nursing, diet and caries from birth to 5 years. We collected feeding habits and dietary data through structured questionnaires at 6, 12, 18 and 24 months and the presence of decayed (d), missed (m) and filled (f) teeth was scored according to the WHO criteria at 5 years of age. We processed data with chi-square tests and expressed as relative risk (RR) with 95 % confidence intervals. Results : At the age of 5 years, 22% of the children had caries. Intake of fruit juice with meals (RR 2.3) and cookies or biscuits at 24 months of age (RR 2.4), as well as fast food consumption at least once every week (RR 2.9), more than doubled the risk for early childhood caries (p < 0.05). Conclusions : Within the limitations of the present study, we found a relationship between consumption of free sugars early in life and dental caries prevalence at 5 years. It therefore seems important to embrace and emphasise the current sugar recommendations in primary and dental care to educate caregivers to avoid serving free sugars to their children before the age of 2 years.