Development of 'OXIS Classification' calibration website for dental researchers.

PURPOSE: The variations in interproximal contact areas have been categorised open (O), point (X), straight (I), and curved contact (S). This is based on their shapes and termed as OXIS classification. The interactive OXIS calibration website was developed to assist researchers seeking appropriate knowledge, minimise the overload of material, optimise efficiency in calibration and, to provide repositories for clinicians, healthcare workers, and policymakers. METHODS: The website was developed in two phases. The first phase of development included expert group discussion, Focus Group Discussion (FGD), and the implementation of FGD recommendations. The second phase emphasised registration and development of the interactive web portal on OXIS classification. The developed website was subjected to user experience testing, functional testing, performance testing, security testing, device, platform testing, and then hosted. Calibrated students and faculties evaluated it with the help of Suitability Assessment of Materials (SAM) and System Usability Scale (SUS). Finally, after amendments, the website was evaluated by non-calibrated researchers and multidisciplinary experts. RESULTS: The total agreement was 74% for overall SAM category. Pooled mean total score of SUS was 52.7 (SD 7.17; range 45-67.5), indicating an average score. CONCLUSION: The content of the developed website has been evaluated as "satisfactory" and its technical quality as "of higher standards".

Bleaching techniques in primary teeth: a systematic review.

OBJECTIVE: Discolouration of primary teeth, often attributed to trauma and pulpal infection, is a prevalent concern that can significantly impact the esthetics and self-esteem of children. To address this issue, bleaching techniques have emerged as a viable treatment option. This systematic review aims to provide a comprehensive summary of the effectiveness of bleaching agents in managing discoloured primary teeth. METHODS: Two reviewers independently conducted an electronic database search using PubMed, EMBASE, LILACS, CINAHL via EBSCO, Scopus, and Web of Science until September 26,2023. In vitro studies and case reports that assessed the quantifiable success were included. The present review utilized Distiller SR software for data extraction. The protocol of this study was registered in PROSPERO (International Prospective Register of Systematic Reviews) (CRD42022329831). The quality of studies was analysed with Cochrane tool and the JBI checklist. RESULTS: The search retrieved 1845 references of which 14 studies were included for qualitative analysis. There were 8 in vitro studies and 6 case reports included in this systematic review. There were 299 teeth samples in the in vitro studies and 18 teeth were assessed in the case reports. All the 18 teeth (6 case reports) showed considerable shade improvement within 7-14 days. However, only 3 teeth were followed up for a period of 12-24 months. Substantial shade improvement was also observed in samples in the in vitro studies. CONCLUSION: This systematic review has comprehensively examined the various bleaching agents and methods for the management of discoloured primary teeth. However, it is crucial to recognize that the available evidence is from case reports and is insufficient to make a clinical recommendation.

A systematic search, heuristic evaluation and analysis of dental trauma mobile applications.

BACKGROUND: Despite the exponential growth of mobile device applications in promoting awareness on traumatic dental injuries (TDIs), the overall validity of existing applications in content, engagement, usability, functionality, esthetics, and user perception remains largely uncertain. AIMS: The primary aim was to systematically search and assess the quality, functionality, perceived impact and usability of available applications related to TDIs using the User Version of the Mobile Application Rating Scale (uMARS) and the Coventry, Aberdeen, and London-Revised (CA-LO-RE) scale. A heuristic evaluation was additionally performed. The secondary aim was to categorize existing mobile applications according to their target users, including general population, dentists, dental students, medical healthcare professionals, and researchers. METHODS: A systematic search for dental trauma applications (free and paid) was conducted using the AppStore and Google Play store. Two reviewers independently performed data extraction and quality assessment for all the included applications using uMARS and CA-LO-RE. A user experience architect conducted a heuristic evaluation. RESULTS: Only 6 of the 3061 initially screened applications were eligible for qualitative and quantitative assessments. These applications' average star uMARS rating was 12.5 (standard deviation [SD] 2.6). The mean and SD for the uMARS objective items were as follows: A-engagement (mean 12.1 [SD 3.3]), B-functionality (mean 15.5 [SD 1.4]), C-esthetics (mean 9.5 [SD 2.5]), and D-information (mean 13 [SD 4.5]). The severity rating for the heuristic evaluation criteria was low to moderate for all the included applications, excluding tooth emergencies with a high severity score. CONCLUSION: Despite moderate quality, functionality, user perception, behavioural impact and usability scores, the inclusion of advanced features to "engagement" and "usability" in existing trauma based apps will enhance their purpose. A design-thinking approach coupled with interactive features is recommended for future mobile applications on TDIs.

Minor physical anomalies including palatal rugae pattern and palatal dimensions in children with sickle cell disease: A cross-sectional analytical study.

Background: Sickle cell disease (SCD) is the most common hereditary hemoglobinopathy, which delays growth leading to an altered skeleton and craniofacial pattern. Palatal rugae patterning has been considered the regulator of the development of the palate. The purpose of the research work was to study the morphology of the palate, rugae pattern, and its dimensions in SCD children and compare them with healthy normal children, and to evaluate its role as minor physical anomalies (MPAs). Methods: A cross-sectional case-control study was designed as per STROBE guidelines. The sample comprised 50 children diagnosed with sickle cell disease (Group SCD) and 50 normal healthy children as control (Group C) belonging to the same age group (10-18 years). Dental impressions were made, followed by the pouring of dental casts. The length of the palatal rugae was measured and categorized into primary (>5 mm), secondary (3 mm-5 mm), and fragmentary rugae (<3 mm). The shape of each primary palatal rugae was identified and categorized as curved, wavy, straight, circular and non-specific. Linear and angular measurements of the palatal rugae patterns and palatal dimensions (width, height, area) were measured and recorded. Results: The total number of palatal rugae and fragmentary rugae was lesser in Group SCD than in Group C (p < 0.05). The depth of the palate was significantly increased, whereas the area of the palate significantly decreased in Group SCD. Conclusions: The children with SCD showed distinctive palatal rugae patterns and dimensions when compared with normal healthy children that can be attributed as potential MPAs for sickle cell disease. Children with SCD had an under-developed palatal rugae pattern with a deep, narrow and small palate when compared to healthy children.The dimensions of the palatal rugae pattern in SCD showed reduced distance between the incisive papilla and the first and last rugae, indicating a further decrease in the anteroposterior dimensions of the palate. These findings may aid in the early diagnosis and prevention of malocclusion in children with SCD by appropriate interceptive orthodontic treatment.

Enhancing elementary school teachers' knowledge in managing traumatic dental injuries: The effectiveness of educational sessions.

BACKGROUND/AIMS: This study aims to evaluate the short- and long-term effects of educational intervention on elementary school teachers' knowledge of traumatic dental injuries (TDI). MATERIALS AND METHODS: The study included all of the elementary schools (29) in the emirate of Ras Al Khaimah, United Arab Emirates. Of the initial 538 participants, 497 teachers completed the full-length study. The first assessment (T0) was performed prior to intervention using a four-part validated questionnaire that evaluated demographics, knowledge, attitudes, and self-assessment in relation to TDIs. The questionnaire was followed by a 30-min lecture presentation featuring various dental trauma scenarios. Each teacher's knowledge was reassessed immediately after the intervention (T1) and 3 months after the intervention (T2). The data were analyzed using the Cochran test, Wilcoxon signed-rank test, and chi-squared test. RESULTS: Half of the participants had witnessed dental trauma at least once; however, 96.6% of the participants had not attended any training related to dental trauma prior to the educational intervention. Knowledge regarding first aid management of broken teeth and avulsions was disappointing pre-intervention but was significantly higher post-intervention (p < .001). Following the workshop, participant self-assessments indicated improvement in the ability to appropriately respond to cases of dental trauma as necessary (p < .001). CONCLUSIONS: Inadequate knowledge of emergency management of TDI was demonstrated initially. There was a remarkable improvement in the overall knowledge of TDI after the educational sessions. Raising the awareness in dental trauma field by conducting educational sessions is crucial for achieving a better outcome.

Systematic review of clinical practice guidelines for traumatic dental injuries.

BACKGROUND/AIMS: Traumatic dental injuries (TDI) are considered a public health problem due to their high prevalence and associated physical, economic, psychological and social consequences. Hence, good Clinical Practice Guidelines are essential to achieving a favourable prognosis. The aim of this review was to appraise the existing Clinical Practice Guidelines (CPGs) on TDI using AGREE II and AGREE-REX. MATERIALS AND METHODS: A systematic search for existing guidelines on TDI was performed on PubMed, EMBASE, CINAHL, Cochrane Library, ProQuest, National Institute for Health Care Excellence, BMJ Best Practice, Trip database, Guideline International Network, Scottish Intercollegiate Guidelines Network, World Health Organisation, Web of Science and 'Ministry of Health worldwide' databases. Four appraisers independently appraised the included CPGs. The AGREE II tool was applied to assess the methodological quality, while AGREE REX assessed the quality of recommendations of the included guidelines. RESULTS: Of the 7736 titles screened, three guidelines, namely the International Association of Dental Traumatology Guidelines (IADT), and the Italian and Malaysian guidelines, were included for the final analysis. These guidelines were published between 2019 and 2020. The AGREE II analysis demonstrated scores above 80% for the IADT and Italian guidelines for the scope and purpose domain. Overall, the Malaysian guidelines achieved the highest score for all domains. The AGREE REX analysis indicated variability in implementation across the nine items, with five that scored above the midpoint of 4.0 on the response scale. Both the Italian and the IADT guidelines had a similar score for the values and preference domains (36.36%). CONCLUSIONS: Several deficiencies exist in the methodological quality of existing CPGs on TDI. Future guidelines should consider improvements for domains such as 'rigour of development', 'stakeholder involvement' and 'applicability' to overcome the existing limitations.

Evaluation of the Clinical Performance of NuSmile Pedodontics Zirconia Crowns in Pulp-Treated Primary Teeth-2 Years Follow-Up Study.

OBJECTIVES: There is a lack of information regarding the longevity of prefabricated crowns on primary teeth. Therefore, the objective of the present study was to evaluate the clinical success rate of NuSmile pediatric Zirconia crowns in both primary anterior and posterior teeth up to 2 years in terms of gingival health, levels of plaque, restoration failure, and marginal integrity. MATERIALS AND METHODS: This interventional study evaluated the clinical performance of NuSmile primary Zirconia crowns on 232 (172 primary incisors and 60 primary molars) pulp-treated primary teeth. Statistical analysis included independent t-test and Kaplan-Meier survival method for which the level of significance was set up at p < 0.05. RESULTS: Gingival and plaque index of the teeth restored with NuSmile Zirconia crowns (test tooth) compared with adjacent and antagonist teeth (control tooth) showed no statistically significant difference at all time intervals (p > 0.05). The Kaplan-Meier survival graph indicated that only 34% of NuSmile Zirconia incisor crowns and 86% of NuSmile Zirconia molar crowns have survived at the end of 24 months. Of the 172 NuSmile Zirconia incisor crowns placed, only 82 teeth survived at the end of 2 years and the majority of the crowns completely lost the Zirconia crown. The Kaplan-Meier graph also indicated that more than two-thirds of crowns, i.e., 90% incisor crowns and 76% of molar crowns, had good marginal integrity at the end of 24 months. CONCLUSIONS: Zirconia pediatric crowns preserve and maintain gingival health and have long-term survival rates with good retention and marginal integrity, indirectly preventing secondary caries. Hence, Zirconia pediatric crowns are a well-suited restoration of choice for primary teeth rehabilitation.

Parents' and Children's Acceptance of Silver Diamine Fluoride Application on Primary Teeth in the United Arab Emirates.

PURPOSE: To assess the acceptance of silver diamine fluoride (SDF) application on children's teeth among parents and children in the United Arab Emirates (UAE). MATERIALS AND METHODS: A pre-tested questionnaire and clinical photographs of SDF-treated teeth were employed to determine preferences among 370 parents for its use in managing dental caries in their children's teeth. A similar number of children ages 4 to 8 years were also interviewed, and their reaction to SDF was assessed through a facial image scale after showing pictures of pre- and post-SDF treated primary teeth. RESULTS: 265 mothers and 105 fathers participated in this study. The Χ2 test was used to test for the statistically significant differences between parental perceptions. Almost all parents responded that SDF was either unacceptable or extremely unacceptable for their children's anterior teeth in comparison to 63% for posterior teeth (p = 0.009). Fathers were more comfortable with SDF treatment for posterior teeth on a scale of 3.1 out of 4, in comparison to 1.8 for mothers (p = 0.007). Parents with limited education (up to primary school) showed greater SDF acceptance in comparison to college-graduate parents (p = 0.000). The level of parental SDF acceptance increased with the children's behavioural barriers. The older children had a lower acceptance rate, at 1.2 and 2.5 for anterior and posterior teeth, respectively (p = 0.000). CONCLUSIONS: SDF was acceptable to UAE-based parents for posterior teeth; however, they preferred it for anterior teeth only when advanced behavioural management (e.g., sedation) was advocated. Socioeconomic factors moderated their SDF preference regarding the location of tooth and treatment difficulty. Younger children were relatively more receptive to SDF use than were older children.

Sustainable development goals and ending ECC as a public health crisis.

Early Childhood Caries (ECC) remains a global issue despite numerous advancements in research and interventional approaches. Nearly, 530 million children suffer from untreated dental caries of primary teeth. The consequences of such untreated dental caries not only limit the child's chewing and eating abilities but also, significantly impact the child's overall growth. Research has demonstrated that ECC is associated with nearly 123 risk factors. ECC has also been associated with local pain, infections, abscesses, and sleep pattern. Furthermore, it can affect the child's emotional status and decrease their ability to learn or perform their usual activities. In high-income countries, dental care continues to endorse a "current treatment-based approach" that involves high-technology, interventionist, and specialized approaches. While such approaches provide immediate benefit at an individual level, it fails to intercept the underlying causes of the disease at large. In low-income and middle-income countries (LMICs), the "current treatment approach" often remains limited, unaffordable, and unsuitable for the majority of the population. Rather, dentistry needs to focus on "sustainable goals" and integrate dental care with the mainstream healthcare system and primary care services. Dental care systems should promote "early first dental visits," when the child is 1 year of age or when the first tooth arrives. The serious shortages of appropriately trained oral healthcare personnel in certain regions of the world, lack of appropriate technologies and isolation of oral health services from the health system, and limited adoption of prevention and oral health promotion can pose as critical barriers. The oral health care systems must focus on three major keystones to combat the burden of ECC-1. Essential oral health services are integrated into healthcare in every country ensuring the availability of appropriate healthcare accessible and available globally, 2. Integrating oral and general healthcare to effectively prevent and manage oral disease and improve oral health, 3. Collaborating with a wide range of health workers to deliver sustainable oral health care tailored to cater to the oral health care needs of local communities.

Authors submission guidelines, a survey of pediatric dentistry journals regarding ethical issues.

OBJECTIVE: To assess the pattern of instructions regarding the ethical requirements given to authors in various Pediatric Dental Journals. MATERIAL & METHODS: A cross-sectional survey of 'instructions for authors,' for analysis of guidelines on ethical processes, was done. Instructions to authors in journals of pediatric dentistry across the globe were reviewed for guidelines with regards to fourteen key ethical issues. Descriptive statistics were used, and results were expressed in percentages as well as numbers. RESULTS: Of the 18journals of pediatric dentistry, all 14 ethical issues were covered by the instructions to authors in only three journals with only 50% of these providing clarity about authorship using ICMJE guidelines. Furthermore, COI declaration was found to be present as mandatory in about 44% of the journals. 38.9% of the sampled journals mentioned guidelines on research misconduct, publication issues such as plagiarism, overlapping/fragmented publications, and availability of raw research data from authors. Guidelines on handling of complaints about editorial team was provided to authors by slightly over 33% of the selected pediatric dentistry titles while handling of complaints about authors and reviewers were mentioned in 16.7%and 55.6% of the journals respectively. CONCLUSION: A significant proportion of Journals of Pediatric Dentistry did not provide adequate instructions to authors regarding ethical issues.

Pulpal dressing condensation methods in pulpotomy for primary molars: An in-vitro comparative study.

PURPOSE: To compare three condensation techniques of zinc oxide eugenol (ZOE) as a pulpal dressing material during pulpotomy in extracted primary molars. MATERIAL AND METHODS: Sixty primary first and second molars were embedded in individual wax casts and divided into three groups consisting of 20 teeth each. In group I, the ZOE base was condensed by an amalgam condenser, while a moist cotton pellet was used in group II. A combination of an amalgam condenser and a wet cotton pellet tested the condensation mentod in group III. The condensation quality of the three techniques was evaluated through two digital periapical radiographs taken in a lateral and anterior-posterior direction. RESULTS: Non-parametric Kruskal-Wallis test showed that there was no significant difference between the technique and quality of ZOE compaction. However, a significant difference was observed on condensation assessment for combined three groups on lateral radiographs vs the appearance on antero-posterior radiographs with the p-value set at < 0.05. CONCLUSION: Voids appeared with all three techniques. A combination of an amalgam condenser and the wet cotton wool pellet was the least effective method of condensation. Lateral radiographs revealed much fewer spaces between the ZOE and pulpal floor in comparison to antero-posterior images.

Retention Force of Glass Ionomer Based Luting Cements with Posterior Primary Zirconium Crowns - A Comparative in Vitro Study.

OBJECTIVE: To determine the retentive force of three glass-ionomer luting cements used with prefabricated primary zirconium crowns (PPZCs) and to assess whether the retentive force was dependent on cementation material or different PPZCs brands. STUDY DESIGN: Four mandibular right second molar PPZCs were selected, one each from four manufacturers-NuSmile®ZR, Sprig Crowns, Cheng Crowns and Kinder Krowns. Silicone impressions of the outer surface of crowns were taken; stone dies prepared and reduced to fit the corresponding brand. 24 alginate impressions of each die obtained and filled with core buildup flowable composite. 96 composite tooth-replicas thus achieved were divided into four groups and further categorized into three subgroups of eight samples based on luting cements used - BioCem, FujiCEM®2 and KetacCem. Samples were thermocycled, placed in artificial saliva for one week followed by assessment of retentive force for crown dislodgment and failure mode. RESULTS: Data was statistically evaluated using two-way ANOVA, HSD (P <0.05). KetacCem had the lowest retentive force while BioCem showed comparatively higher value to FujiCEM®2. Adhesive failure modes were predominant with cement mainly adhering to crown's internal surface. CONCLUSIONS: Resin-based GI cements offered superior retention than conventional GI cements for PPZCs and retentive force was dependent on cement type.

Interproximal contact areas of primary molars based on OXIS classification - a two centre cross sectional study.

Background: Contact areas in primary teeth are known to be broader, flatter and situated farther gingivally than permanent teeth. The purpose of this study was to assess the prevalence of OXIS contact areas between primary molars using die models of children from two different ethnic populations. The research question of the present study is "What is the prevalence OXIS contact areas of primary molars in the populations studied?". Methods: A cross-sectional study was planned in a representative sample of 200 caries-free contact areas among children aged 3-6 years in two centers, Ajman and Puducherry. Data collection was performed from sectional or full-arch die stone models. The contacts were assessed according to OXIS classification by a single calibrated examiner at Center 2. Prevalence was expressed as numbers and percentages. The Chi-square test was applied to determine the association of OXIS contacts across genders and arches. Results: The prevalence of O, X, I, and S contacts were 19%, 22.5%, 53%, and 5.5% in Center 1 and 6%, 1.5%, 75.5%, and 17% in Center 2, respectively. Significant results (p=0.005) were obtained in Center 1 when inter-arch comparison was performed and between the centers with respect to type of contact. No significant difference was obtained with respect to gender and OXIS contact areas. Conclusions: The present study confirmed OXIS contacts in both the centers. The 'O' and 'X' types of contacts were observed more in Center 1, whereas 'I' and 'S' contacts were observed more in Center 2.

Long-term management of an ankylosed young permanent incisor replanted within 2 h of avulsion: A case report with a 10-year follow-up.

Tooth avulsion is a severe form of luxation injury that involves damage to both the pulp and the periodontal ligament. Avulsed teeth need to be replanted immediately in order to restore esthetics and function. Delayed replantation often results in ankylosis of the tooth which is a common sequela following avulsion injuries. An ankylosed tooth with a necrotic periodontal membrane does not move along with a growing alveolus leading to an arrest in height and width of the alveolar bone causing the tooth to be infraoccluded in a growing individual. This case report describes the multidisciplinary treatment and long-term management of an avulsed permanent central incisor in an 8-year-old child with delayed replantation.

Effect of Fruit Juices and Other Beverages on Loss of Tooth Structure

Objective: To determine the effect of seven different beverages on tooth enamel. Material and Methods: Human teeth samples were immersed in each beverage (Pepsi, Red Bull, Orange juice, Apple juice, Lemon juice, Coffee and Green tea). Specimens were divided into seven groups by beverage type (n = 5 per group). Weight of the enamel was measured before and after immersion in different beverages daily for at periodic intervals of 24hrs, 7 days, 15 days and 30 days. The data were recorded after weighing the teeth at each time. The beverages were replaced daily. Anova and Tukey post hoc test was performed to compare the differences in percent weight loss. The significance level was set at 5%. Results: There was change in the mean percent weight loss amongst the different beverages with orange juice showing a high reduction in comparison to green tea and coffee. The mean weight reduction of orange juice was by 21% followed by Red Bull (13%), Pepsi (11%), Lemon juice (16%), Apple juice (16%), coffee (3%) and green tea (3%). Conclusion: This study shows that different beverages have erosive potential on teeth depending on the duration of the exposure.

Estimation of fluoride concentration in drinking water and common beverages in United Arab Emirates (UAE).

OBJECTIVE: To assess fluoride concentration in drinking water which include tap water of 4 emirates - Abu Dhabi, Dubai, Sharjah and Ajman plus bottled water, commonly available soft drinks & juices in United Arab Emirates. METHODS: Five different samples of tap water collected from each of the four emirates of UAE: Ajman, Sharjah, Abu Dhabi and Dubai; twenty-two brands of bottled water and fifteen brands of popular cold beverages, purchased from different supermarkets in U.A.E were tested using ion selective electrode method and the fluoride concentration was determined. RESULTS: The mean fluoride content of tap water samples was 0.14 mg F/L with a range of 0.04-0.3 mg F/L; with Ajman tap water samples showing the highest mean fluoride content of 0.3 mg F/L. The mean fluoride content for both bottled drinking water and beverages was 0.07 mg F/L with a range of 0.02-0.50 mg F/L and 0.04-0.1 mg F/L respectively. Majority (68.2%) of the bottled water are produced locally within U.A.E while a few (31.8%) are imported. CONCLUSIONS: The tap water, bottled water and beverages available in U.A.E show varying concentrations of fluoride, however none showed the optimal level necessary to prevent dental caries. Dental professionals in U.A.E should be aware of the fluoride concentrations before prescribing fluoride supplements to children.

Pulpectomy in hyperemic pulp and accelerated root resorption in primary teeth: a review with associated case report.

Persistent hemorrhage after complete amputation of coronal pulp is a common clinical finding during pulpotomy procedure in primary teeth. These teeth are best managed with pulpectomy, but they have hyperemic pulp with some remaining vital tissue. Good chemico-biomechanical preparation of primary canals cannot guarantee complete removal of this vital tissue from inaccessible areas. Use of Ca(OH) 2 containing root filling pastes in vital pulp tissue can cause accelerated resorption of primary roots. The possible mechanism behind such extensive root resorption is discussed with review of literature. A case report of a child with 30 months follow-up is presented and discussed.