Optimal outcomes of pulpotomy in young patients: Long-term prospects for permanent molars with signs and symptoms indicative of irreversible pulpitis.

OBJECTIVES: Limited literature addresses the long-term success of complete pulpotomy in permanent molars with signs of irreversible pulpitis in young patients. The aim of this observational study was to prospectively evaluate the long-term outcomes of complete pulpotomy using mineral trioxide aggregate (MTA) over an average period exceeding 11 years. METHODS: Out of 27 molars displaying signs suggestive of irreversible pulpitis which underwent MTA pulpotomy, 24 molars were followed-up for a mean duration of 11.0 ± 2.2 years (range 8.2 to 14.8 years). Clinical and radiographic assessments were periodically conducted, tailored to each patient's specific circumstances. Treatment failure criteria included clinical signs and symptoms and radiographic evidence suggesting a lack of pulpal or periapical healing. RESULTS: 83 % of molars had signs and symptoms of symptomatic irreversible pulpitis, with 83 % displaying apical periodontitis. Clinically and radiographically, all pulpotomies (100 %) were considered successful. A hard tissue barrier was observed in 71 % of teeth, and continued root maturation was evident in all molars with open apices. Complete pulp canal obliteration (PCO) was present in 21 % of the molars. All radiographic apical radiolucencies completely resolved. CONCLUSIONS: This study demonstrates a 100 % success rate over an average 11-year follow-up for complete pulpotomy in managing permanent molars with signs and symptoms of irreversible pulpitis in young patients. It offers evidence for its long-term efficacy in promoting healing of pulp and periapical tissues. CLINICAL SIGNIFICANCE: This study showed high long-term success for complete pulpotomy in young permanent molars with irreversible pulpitis, with clinical and radiographic success over 11 years. Despite initial symptoms of pulpitis and apical periodontitis, the treatment resulted in tissue healing, root maturation, and resolution of periapical radiolucencies, suggesting it as an alternative to root canal therapy.

Relationship Between Clinical Outcomes and Nerve Conduction Studies Before and After Viral Infections in Healthy Individuals: Case Series.

BACKGROUND: The neurological effect of viral respiratory infections has been acknowledged in many studies. However, patients who recovered from this infection show neurological manifestations and are not being routinely transferred for electrodiagnostic evaluation. AIM: This study aimed to examine the neurological effect of viral respiratory infections on the nerve function using electrophysiology in patients fully recovered from viral respiratory infections. METHODS: To limit bias in the results, the authors decided to choose patients who recovered from one virus in all participants (coronavirus). Medical records were screened for patients who performed nerve conduction studies (NCSs) before the coronavirus pandemic. Thirty patients met our inclusion criteria, and only 10 showed up to perform NCS. Data of the NCS was compared before and after the coronavirus infection for motor and sensory NCS parameters. RESULTS: An increase in both the median and ulnar sensory nerve latencies and a decrease in the sensory nerve amplitude was observed. Also, there was a decrease in the motor conduction velocity (MCV) of the ulnar nerves and motor amplitude in the median nerve. In the lower limbs, there was a decrease in the sural nerve latency, increased MCV in the tibial nerves, and decreased MCV in the peroneal nerves. The proximal amplitudes of the tibial and peroneal nerves were increased, but the distal amplitude was increased only in the peroneal nerves and decreased in the tibial nerves. CONCLUSION: There is a significant impact of viral infections on the peripheral nerves. Large-scale prospective studies are required to investigate the pathogenesis of the neuropathy and myopathy after viral infections.

Management Thresholds for Molars With Occlusal Noncavitated Caries Lesions.

AIM: There is sparse research on the effect of factors related to the dentist and patient in the caries management decision-making process. This in vitro study explored the influence of factors related to dentists and patients on the management decision of occlusal noncavitated caries lesions in children. MATERIALS AND METHODS: Five investigators in the specialties of dental public health (DPH), paediatric, prosthetic, and operative dentistry and a general dentist (GDP) participated in this study. Initially, the investigators were asked to independently assess the occlusal surfaces of 175 noncavitated permanent molars and choose a management recommendation using 2 caries risk patients' scenarios. After 1 month, investigators were trained and calibrated to use the International Caries Detection and Assessment System (ICDAS) scoring system. Then, they examined the same teeth, recorded the highest/worst ICDAS score, and chose a management recommendation. Two weeks later, the investigators repeated the teeth examination using magnification loupes and again chose a management recommendation. The teeth were sectioned to study the relationship between the presence of caries and the management recommendations. RESULTS: For the low- and the high-caries risk scenarios, ICDAS training increased the operative intervention by 20% to 27% and 14% to 22%, respectively, for both the GDP and the paediatric dentist (P < .0001). For the low-caries risk scenario, using the magnifying loupes increased the operative recommendations for the DPH, GDP, and the operative dentist by 5% to 23% (P < .05). Compared to the low-caries risk scenario, teeth for patients with high caries risk received more surgical interventions (9%-30%) at all examination conditions for the GDP and the paediatric and operative dentists (P < .0001). CONCLUSIONS: For occlusal noncavitated caries lesions, enhancing dentists' caries detection skills had a significant impact on decisions of surgical intervention. This also influenced the appropriateness of the treatment recommended for the different caries risk groups.

Three-dimensional characterization of naturally developed early caries lesions using high-resolution micro-computed tomography.

OBJECTIVES: The goal of this micro-Computed-Tomography (µCT) study was to characterize the structural parameters of natural, early proximal enamel caries lesions and correlate them with two-dimensional radiographic findings. METHODS: Extracted human premolar teeth with ICDAS score 2 proximal lesions were examined using visual-tactile, µCT and simulated bitewing radiographs (BTX). Sound enamel and caries-lesions' structural and mineral density (MD) parameters were analyzed which included surface layer (SL) status and thickness, depth of lesion, and MD. RESULTS: Thirty-six extracted premolars with 54 proximal early enamel caries lesions were analyzed. Lesions varied notably in lesion depth and MD. SL thickness ranged between 20 and 139µm. Three teeth (5.6%) had micro-cavitations upon the µCT examination despite being "clinically" non-cavitated. Cavitation status had no significant association with µCT nor BTX radiographic depth. Depth of lesions correlated weakly but statistically significantly with mineral loss (ML) at body of lesion (r=0.301, p=0.027). SL thickness also correlated negatively with ML at SL (r=-0.501, p<0.001). CONCLUSIONS: Early proximal enamel lesions with ICDAS 2 score as determined by visual-tactile examination exhibited a wide range of lesion parameters and cavitation status when examined by µCT. Visual-tactile examination may fail to detect micro-cavitations in enamel surface that are detectable by µCT. CLINICAL SIGNIFICANCE: Clinicians have direct access to early proximal enamel lesions during orthodontic separation, exfoliation, extraction or restoration of adjacent teeth. This study invites the clinician to consider more decisive management options in high risk individuals (e.g. micro-invasive techniques), given the finding of vast structural variability of such lesions.

The role of progranulin in ischemic heart disease and its related risk factors.

Cardiovascular disease, in particular, ischemic heart disease, is the leading cause of mortality worldwide. Obesity and its related disorders are linked to cardiovascular events. Adipose tissue is an active endocrine organ that secretes bioactive molecules termed adipokines, which play an important role in heart function. Progranulin, one of the adipokines, plays a crucial role in health and disease. In relation to heart disease, progranulin has shown anti-inflammatory activity in the vascular endothelium and its deletion has exacerbated the atherosclerotic process. Progranulin binds to apo-lipoprotein A-1 and forms a complex attenuating pro-inflammatory activity of progranulin and stabilizing atherosclerotic plaques. The adipokine may have an athero-protective role by increasing nitric oxide level in the vascular endothelium by enhancing endothelial nitric oxide synthase phosphorylation, enhancing reverse cholesterol transport, and exerting an antithrombotic effect. Furthermore, PGRN exhibits protective properties in an acute ischemia-reperfusion injury. However, Progranulin has a pro-inflammatory action linked with cardiovascular risk factors, such as metabolic syndrome and type two diabetes. The review at hand sheds light on the interesting role that progranulin plays in ischemic heart disease and its related risk factors.

Salivary fluoride concentration following toothbrushing with and without rinsing: a randomised controlled trial.

BACKGROUND: Caries prevalence has declined significantly since the introduction of fluoridated toothpaste. There have been several developments regarding specific active fluoride ingredients but not enough evidence to support one over the other. The purpose of this double-blind randomized controlled trial was to compare salivary fluoride concentrations of different fluoride formulations in the form of toothpaste with and without post-brushing water rinsing in adults. METHODS: The study included 120 participants who were randomly assigned to one of 12 groups (10 participants/group). The toothpaste formulas investigated included (1) fluoride-free (0 ppmF); (2) sodium fluoride (1450 ppmF); (3) sodium monofluorophosphate (1450 ppmF); (4) sodium fluoride and monofluorophosphate combined (1450 ppmF); (5) stannous fluoride and sodium fluoride combined (1450 ppmF); and (6) amine fluoride (1400 ppmF). Block randomisation was used to assign each participant to one of the 12 groups. Participants brushed with 1.0 g of one of the six different toothpaste formulations either with or without post-brushing water rinsing. Saliva was collected at six different times (baseline and at 1, 15, 30, 60, and 90 min/s post-brushing). Samples were analysed using a fluoride ion-specific sensitive electrode connected to an ion analyser. RESULTS: The demographic characteristics of the participants were not significantly different among the groups (P > 0.05). Time, toothpaste formulation, and post-brushing rinsing routines had significant effects on saliva fluoride retention (P < 0.05). Amine fluoride-containing toothpaste was the only formula that showed statistically significantly higher concentrations of salivary fluoride at 90 min in both the rinsing and non-rinsing groups. Sodium monofluorophosphate toothpaste did not result in a significant difference compared to the control group at any time point, in both rinsing and non-rinsing groups. CONCLUSIONS: Based on the results from this study, no rinsing after toothbrushing in adults can be recommended when sodium monofluorophosphate containing toothpaste formula is used. It also concludes that amine fluoride resulted in a significantly higher saliva fluoride concentration at 90 min in both the rinsing and non-rinsing groups compared to other fluoride toothpaste formulations. Registry: Protocol Registration and Results System (ClinicalTrials.gov). CLINICAL TRIAL REGISTRATION NUMBER: NCT02740803 (15/04/2016).

Dental plaque microbiota profiles of children with caries-free and caries-active dentition.

OBJECTIVE: Microbiota comparisons between healthy and diseased dental tissues have accentuated the importance of cultivating and identifying bacterial species that play a role in the initiation and progression of dental caries. The objective of this study was to evaluate the bacterial community composition in caries-active and caries-free children. METHODS: Supragingival plaque samples were collected from 64 caries-active and 64 caries-free Middle Eastern children. The hypervariable V3-V4 of the bacterial 16S rRNA gene was sequenced with Human Oral Microbe Identification using Next Generation Sequencing. Microbial community structure and composition analyses were performed by processing operational taxonomic units. Bioinformatic analyses, including analysis of similarity, alpha and beta diversities, and principal coordinate analysis, were carried out. RESULTS: Diversity indices did not find differences between the caries-active and caries-free groups (p > 0.05). Similarity analysis demonstrated that the microbiota composition did not differ between the two groups. Comparative analysis at the species level revealed a significantly higher relative abundance of Leptotrichia shahii, Prevotella melaninogenica, Veillonella dispar, Leptotrichia HOT 498, and Streptococcus mutans in caries-active children (p < 0.05). Corynebacterium matruchotii, Lautropia mirabilis, Neisseria elongata, and Corynebacterium durum were relatively more abundant in the caries-free group (p < 0.05). Species belonging to the Leptotrichia, Prevotella, and Veillonella genera were significantly predominant in the caries-active subjects. CONCLUSION: In view of the lack of a clear association between Corynebacterium spp. and dental caries status in the literature, the predominance of these species in caries-free children warrants further research to understand their possible role in a health-associated microbial community. CLINICAL SIGNIFICANCE: Understanding the relationship between specific bacteria present in dental biofilms and health and disease is essential for preventing and combating dental caries. Using advanced next generation sequencing techniques, the present study demonstrated the complexity of the caries microbiome and identified species/genera whose virulence or protective properties should be further explored.

The Effects of Progranulin in a Rat Model of Acute Myocardial Ischemia/Reperfusion are Mediated by Activation of the P13K/Akt Signaling Pathway.

BACKGROUND Progranulin is an adipokine, encoded by the progranulin (GRN) gene. Progranulin is expressed in atherosclerosis, but its effects in cardiac ischemia and reperfusion injury are unknown. Therefore, this study aimed to investigate the effects of progranulin in a rat model of acute myocardial ischemia/reperfusion (MI/R) injury in vivo. MATERIAL AND METHODS The model of acute MI/R injury was established in male Wistar rats by ligation of the left anterior descending (LAD) coronary artery for 30 minutes and reperfusion for 60 minutes. Before modeling, one group was treated with progranulin (0.03 µg/kg), and one group was treated with the P13K/Akt inhibitor, LY294002 (3 mg/kg). Left ventricular function (LV) was monitored, including the LV systolic pressure (LVSP), LV end-diastolic pressure (LVEDP), and changes in LV pressure. At the end of the study, blood and myocardial tissue were examined. Cardiac biochemical markers, histopathology, gene expression, and apoptosis were analyzed. RESULTS Progranulin improved cardiac function following acute MI/R injury and significantly improved recovery of cardiac contractility and LVSP. Progranulin significantly reduced myocyte apoptosis, inflammation, and tissue edema, and was highly expressed in cardiac tissue following MI/R injury. The cardioprotective effect of progranulin was reduced by blocking the P13K/Akt signaling pathway. CONCLUSIONS In the rat model of acute MI/R injury, progranulin had a protective effect on cardiac function and morphology, associated with activation of the P13K/Akt signaling pathway. The mechanisms of the anti-apoptotic, anti-inflammatory, and inotropic effects of progranulin in the setting of acute MI/R injury require further in vivo studies.

Efficacy of Chewing Gum to Reduce Orthodontic Pain Compared to Placebo: A Blinded, Parallel-Group, Preliminary Clinical Trial.

AIMS: To quantify the pain experienced by orthodontic patients during the first 10 days of appliance placement, to determine whether chewing gum reduces orthodontic pain compared to placebo, and to examine patients' overall perceptions of the impact of orthodontic pain. METHODS: Patients bonded with fixed appliances were randomly assigned to one of two groups (gum group [GG] or placebo group [PG]) and then followed for 10 days. The main outcome was a visual analog scale (VAS) pain score, and the secondary outcomes included patients' subjective assessments of overall pain level, the impact of pain on hygiene habits and treatment decision, and the frequency of analgesics consumption. Eighty kits (40 for GG and 40 for PG) were pre-randomized and concealed before patient enrollment using a computer-generated random sequence. Operators and patients were blinded. Data were analyzed using generalized linear models and Mann-Whitney U, chi-square, and Fisher exact tests. RESULTS: A total of 75 patients were allocated to intervention groups; 37 participated and completed diaries (20 in GG and 17 in PG). No statistically significant differences were detected between the GG and PG groups in any tested variable. Pain negatively affected some patients' oral hygiene practices. A mismatch existed between patient expectations and actual pain experiences. Female patients used analgesics more frequently than male patients (P = .046). CONCLUSION: Chewing gum three times per day does not seem to significantly reduce orthodontic pain compared to placebo. Orthodontists should manage their patients' pain expectations.

Microcomputed Tomography Calibration Using Polymers and Minerals for Enamel Mineral Content Quantitation.

OBJECTIVE: The aim of this paper was to develop calibration standards (CSs) that are readily available for clinical researchers for the quantitation of enamel mineral content. METHOD: Polyethylene terephthalate (PET), acetal, polyphenylene sulfide (PPS), selenite, Egyptian alabaster, aragonite, and fluorite were fashioned into discs, and their densities were measured and stacked for microcomputed tomography examination. Frame averaging, flat-field correction, pre-filtration, and beam-hardening correction were applied. CSs were checked for homogeneity. The linear relationship between the mean greyscale value (GSV) of each disc and its physically calculated density was explored, and reproducibility was tested. A calibration function was established and then validated using a bovine enamel disc and sound enamel of extracted human premolar teeth. RESULTS: Measured densities were PET (ρ = 1.38 g/cm3), acetal (ρ = 1.41 g/cm3), PPS (ρ = 1.64 g/cm3), selenite (ρ = 2.24 g/cm3), Egyptian alabaster (ρ = 2.7 g/cm3), aragonite (ρ = 2.72 g/cm3), and fluorite (ρ = 3.11 g/cm3). Examination of the profile sections of CSs confirmed the uniformity of GSVs with minimal beam-hardening effect. A squared Pearson correlation coefficient of R2 = 0.994 was determined between the mean GSV of each CS and its calculated density and was reproduced at different settings with R2 >0.99. A linear regression equation of density (y) versus GSV (x) was established using the least squares regression equation method. The estimated density of the bovine enamel disc (2.48 g/cm3) showed high accuracy when compared to the physically measured value (2.45 g/cm3). The -relative error was 1.2%. Densities of sound enamel in the extracted human premolar teeth were 2.6-3.1 g/cm3. CONCLUSIONS: This is a simple, valid, and reproducible method to quantitate enamel mineral content. This simple, yet accurate system could be used to expand knowledge in the field of enamel caries research.

Knowledge and Sociodemographic Determinants of Emergency Management of Dental Avulsion among Parents in Kuwait: A Cross-Sectional Study.

OBJECTIVES: The aim of this study was to evaluate the knowledge of first aid measures for a permanent tooth avulsion among parents in Kuwait and to assess the effect of different sociodemographic characteristics. MATERIALS AND METHODS: A cross-sectional study was conducted among 554 parents who visited 5 dental specialty centers in Kuwait. Parent sociodemographic data and responses to avulsion management questions were collected through a self-administered questionnaire. Descriptive and binary logistic regression analyses were used for data analysis. RESULTS: In the 554 responses from patients, gaps were identified in the following areas: replantation (199, 35.9%), cleaning of the tooth (182, 32.9%), and transport media (84, 15.2%). Most parents demonstrated satisfactory knowledge levels regarding the urgency to seek professional help (391, 70.6%) and the first place of contact after the injury (525, 94.8%). Having previous information on emergency management of dental avulsion was a significant predictor of good knowledge (OR 2.138, 95% CI 1.347-3.395, p = 0.001). Of the 544 parents, 99 (17.8%) had received information on dental avulsion management: 30 (30.3%) from the Internet, 19 (19.2%) from books, 12 (12.1%) from television, 6 (6%) from smart phone applications, 2 (2%) from newspapers, and 30 (30.3%) from other sources. CONCLUSION: In this study, parents in Kuwait did not have adequate knowledge of emergency management for dental avulsion. Future educational campaigns on dental avulsion are urgently needed to educate parents.

Does the Removal of Cementum Facilitate Bacterial Penetration into Dentinal Tubules In Vitro?

INTRODUCTION: The importance of an intact layer of cementum on the root surface in preventing bacterial penetration into radicular dentin has not been sufficiently investigated. The aim of this in vitro study was to determine the effect of the absence of cementum from the root surface and the length of the infection period (2 or 4 weeks) on the maximum depth of bacterial penetration and the percentage of sectors lined with bacteria. METHODS: Sound, single-rooted extracted teeth with closed apices were randomly assigned to either a control group (cementum present [CP]) or an experimental group (cementum removed [CR]). Each group was further divided randomly into 2 subgroups: 2-week infection (CP2 and CR2) and 4-week infection (CP4 and CR4). Teeth were then artificially infected with Enterococcus faecalis and prepared for histology. RESULTS: A total of 107 teeth were available for histologic examination, 25 teeth in CP2, 31 teeth in CP4, 27 teeth in CR2, and 24 teeth in CR4. Pairwise comparisons revealed statistically significant differences in the maximum depth of bacterial penetration for the following combinations: CP2-CR2, CP2-CR4, CP4-CR2, and CP4-CR4 (P < .001). Pairwise comparisons also revealed a statistically significant difference in the percentage of sectors lined with bacteria for CP2-CR2, CP2-CP4, and CP2-CR4 (P < .001). CONCLUSIONS: The results support the hypothesis that the absence of cementum facilitates bacterial penetration into dentinal tubules. Results also suggest that the process of radicular dentin infection is time dependent and highlight the importance of early treatment of infected teeth, especially in situations in which cementum discontinuity is suspected.

The effect of clove and benzocaine versus placebo as topical anesthetics.

OBJECTIVES: The purpose of this study was to examine whether the natural herb clove can replace benzocaine as a topical anesthetic. METHODS: Topical agents were applied to the maxillary canine buccal mucosa of 73 adult volunteers. Four substances were tested in the study: (1) homemade clove gel, (2) benzocaine 20% gel, (3) placebo that resembles clove and (4) a placebo that resembled benzocaine. After 5 min of material application in a randomized, subject-blinded manner, each participant received two needle sticks. Pain response was registered using a 100 mm visual analogue pain scale. RESULTS: Both clove and benzocaine gels had significantly lower mean pain scores than placebos (p=0.005). No significant difference was observed between clove and benzocaine regarding pain scores. CONCLUSION: Clove gel might possess a potential to replace benzocaine as a topical agent before needle insertion.