Rectal Sedation With Ketamine and Midazolam in the Management of Uncooperative Children During Dental Treatment: A Case Series and Method Description.

Background In pediatric dentistry, sedation aims to eliminate anxiety to facilitate the completion of dental procedures. Sedation in children is a multidimensional field that includes the child, parents/guardians, and the health care team. The rectal route is generally painless, making it suitable for children who are afraid of needles. This route has several advantages over the oral route, including reduced patient cooperation requirements, a faster and more predictable onset, and less physical trauma than the intravenous and intramuscular routes. This case series aimed to evaluate the effectiveness and success rate of rectal sedation with ketamine and midazolam in the management of uncooperative children during dental treatment. Case presentation Ten healthy children with definitely negative behavior were enrolled in this study. Each child was given 7 mg/kg of ketamine in combination with midazolam 0.1 mg/kg by the rectal route. The mean onset sedation time was 9.5 minutes, and pulpotomy procedures were done. Behavioral response was monitored throughout treatment using the Ohio State University Behavioral Rating Scale (OSUBRS), and the depth of sedation was measured using the University of Michigan Sedation Scale (UMSS). The Houpt General Behavior Scale was used to estimate the treatment success rate based on the overall behavior rating. All 10 cases showed good anxiolysis and cooperation following rectal administration, with no side effects observed. Conclusions Rectal administration of ketamine in combination with midazolam may be considered a reliable method in the management of uncooperative children during dental treatment. No adverse effects were observed during or after the sedation procedure.

Evaluation of the effect of high-intensity light-curing device on micro-leakage of pits and fissure sealants.

Reducing treatment time is one of the most important trends in modern dentistry. This study aimed to compare the micro-leakage around the resin sealants when using both high and conventional intensity light-curing systems. The study sample consisted of 30 extracted human maxillary premolar teeth that were divided into two equal groups according to the light-curing system used: Group 1, High-Intensity Light-Curing System and Group 2, Conventional Light-Curing System. Light-curing by Woodpecker I-LED device with two intensities (high and conventional) has been used. All teeth were subjected to 500 cycles of thermocycling. Then, a methylene blue dye microleakage test was performed, and the teeth were sectioned longitudinally and studied under a stereo microscope. The mean of micro-leakage in the high-intensity group (1.33 ± 1.29) was less than in the conventional intensity group (1.63 ± 1.29) without any statistically significant differences (p = 0.320). The high-intensity light-curing system mode may be a good and acceptable alternative to conventional intensity light-curing system mode in polymerization of pits and fissure sealants.

The effect of secondhand smoke exposure on dental caries and gingival health among schoolchildren in Damascus, Syria: a cross-sectional study.

OBJECTIVE: This study aimed to evaluate the effect of secondhand smoke on dental caries and gingival health among schoolchildren in Damascus, Syria. MATERIALS AND METHODS: This was a cross-sectional study. It was carried out at government schools in Damascus, Syria. This study included healthy children aged 10 to 13 years old. Schoolchildren were interviewed to answer the researcher-administered questionnaire to obtain answers regarding demographic information and family smoking behavior. A dental examination was performed by a dentist, and the number of decayed (D), missing (M), and filled (F) permanent teeth (DMFT) was scored based on the World Health Organization (WHO) 1997. A gingival examination was performed using the modified gingival index (MGI) and Silness-Leo plaque index (PI) to assess gingival inflammation and plaque accumulation, respectively. RESULTS: A total of 284 schoolchildren participated. More than half (61.26%) of them were exposed to secondhand smoke (SHS), and about half of them (52.11%) resided in a house with at least one cigarette smoked in a day. About one-third of the passive smokers (33.30%) had poor plaque control, with a statistically significant difference from non-passive smokers (p < 0.05). The multivariate regression model showed that the number of smokers at home was significantly associated with the DMFT score, dental plaque accumulation, and gingival inflammation (p < 0.1). However, the number of cigarettes smoked at home in a day was not a predictor for dental caries and gingival status (p = 1.000). CONCLUSIONS: Within the limitations of this study, the number of smokers at home appears to have more adverse effects on children's oral health compared to the quantity of smoke inhaled. In addition, SHSe was associated with more dental plaque accumulation among schoolchildren.

Effect of various types of milk on salivary pH among children: a pilot randomized controlled crossover trial.

OBJECTIVE: This study aimed to evaluate salivary pH changes after consuming three types of milk in children aged 3-5 years. The null hypothesis was that no statistically significant difference would be noted in the salivary pH between high-protein, full-fat, and sweetened milk groups at different time points. MATERIALS AND METHODS: This was a double-blind, pilot randomized controlled crossover trial. 30 Children have undergone three experimental sessions with a 1-week washout period. Each child was given 250 mL of one of the following types of milk: high-protein, full-fat, or sweetened milk. The salivary pH was measured at the baseline (t0) after 5 (t1), 10 (t2), 15 (t3), 30 (t4), and 60 (t5) minutes of milk consumption, using a pH saliva indicator strip. RESULTS: There is a sharp drop in salivary pH after 5 min of sweetened (P < 0.05) and full-fat milk consumption (p < 0.05). However, the initial drop in the salivary pH was found to remain above the critical level. For the high-protein milk group, salivary pH decreased slightly after 5 min but was similar to that at the baseline (p = 0.573). In the high-protein milk group (p < 0.05), the salivary pH was slightly greater than the baseline value at t5. CONCLUSIONS: The study shows an initial suggestion that milk is a non-cariogenic beverage, even when sugar is added. Furthermore, high-protein milk has a protective effect from dental caries.

The efficacy of the dental Water Jet, orthodontic, and conventional toothbrushes in plaque removal around orthodontic braces in adolescents: A randomized controlled trial.

OBJECTIVES: Orthodontic treatment improves both masticatory function and the aspects of facial esthetics through the correct alignment of the teeth. If oral hygiene is neglected during fixed orthodontic treatment, it may lead to plaque accumulation and gingivitis. The aim of this randomized controlled trial was to evaluate the effectiveness of the dental Water Jet (DWJ), and orthodontic toothbrush (O-TH) in removing dental plaque around the orthodontic braces compared to conventional toothbrush (C-TH) in adolescents. MATERIALS AND METHODS: This was a three-arm, double-blind, and parallel-group randomized active-controlled trial. Forty-five patients were randomly allocated into three groups: DWJ, the O-TH, and the C-TH (control group). The primary outcome measure was dental plaque accumulation change from the baseline (t0 ) to post-cleaning (t1 ), and plaque scores were recorded using the Orthodontic Plaque Index (OPI). The current clinical trial was registered and approved by Australian New Zealand Clinical Trials Registry (ACTRN12623000524695). RESULTS: A statistically significant difference was noted in the OPI scores between different time points in the DWJ group, the O-TH group, and the C-TH group (p < .05). However, no significant difference was noted between the groups after the cleaning procedure (p > .05). CONCLUSION: The level of oral hygiene was not satisfactory in patients undergoing fixed orthodontic treatment. In addition, the efficacy of the DWJ was not superior to O-TH nor to C-TH in plaque removal.

Comparative efficacy of topical povidone-iodine and chlorhexidine gel on dental plaque regrowth in toddlers: A randomized controlled trial.

OBJECTIVES: This study aimed to compare and evaluate the efficacy of topical use of povidone-iodine (PVP-I) solution and chlorhexidine (CHX) gel on dental plaque regrowth after 3 and 7 days in toddlers aged 24-36 months. MATERIALS AND METHODS: A randomized controlled trial that included 45 healthy toddlers aged 24-36 months, who were randomly assigned to three groups. The first group received a placebo (distilled water (DW)) (negative control). The second group received topical CHX gel (0.2% w/v) (positive control). The third group received topical PVP-I solution (10% w/v). Plaque accumulation was measured at the baseline (t0 ), after 3 days (t1 ) and after 7 days (t2 ) using the Turesky-modified Quigley-Hein plaque index (TMQHPI). Oral hygiene practices were prohibited during the trial period. The trial ID is ACTRN12623000567628. RESULTS: In the DW group, the mean of the TMQHPI score was 1.89 ± 0.67 at t0 and decreased to 1.45 ± 0.66 at t1 (p = .028). Similarly, in the CHX group, the mean of the TMQHPI score was 1.83 ± 1.06 at t0 and decreased to 1.02 ± 0.99 at t1 (p = .033). Regarding the PVP-I group, the mean of the TMQHPI score went from 1.84 ± 0.85 to 1.01 ± 0.61 at t1 and then increased to 1.57 ± 0.74 at t2 . Those changes were statistically significant (p = .001) and (p = .002), respectively. No statistically significant difference was noted between TMQHPI scores at t0 (p = .789). Regarding t1 and t2 , no statistically significant difference was found between the three groups (p > .05). CONCLUSION: CHX and PVP-I efficacy lasted only for 3 days, and PVP-I was not superior to CHX in terms of plaque control in toddlers. However, further studies are needed to determine the long-term efficacy of these antiplaque agents in toddlers.

Vital Pulpotomy on immature lower first permanent molars using Portland cement, a case of failure and success-case report with 2 years follow-up.

Key clinical message: While the importance of vital pulp therapy comes from its ability to promote pulp healing allowing the tooth to continue its development and giving the patient a more convenient treatment, dental practitioners should be more aware of the minor mistakes which they might commit during treatment procedures that could reflect negatively on the treatment's outcome. Developing behavior management skills as well as learning from reported mistakes are beneficial to practitioners to provide a more precise and successful treatment. Abstract: Vital pulp therapies are known to preserve tooth development and give pulp tissues a chance to heal. Despite the progress of biocompatible materials used in this field, these treatments are still facing some failure for several known and unknown reasons that might not only be related to the material used. This case report presents and discusses the possible reasons for the success of one vital pulpotomy procedure and the failure of another, both conducted on two immature lower first permanent molars of the same patient, in an attempt to conclude what led to both results.

Knowledge, perceptions, and behavior regarding children's oral health among Syrian pediatricians: a cross-sectional study.

BACKGROUND: Oral health has a direct impact on health-related quality of life (HRQoL). Hence, general health and oral health cannot be separated. Pediatricians play a pivotal role in providing primary care for infants and are the first to interact with them since birth. Therefore, the aim of this study was to evaluate the knowledge, perceptions, and behavior of Syrian pediatricians regarding children's oral health. METHODS: This was a cross-sectional study. The questionnaire consisted of six main sections and required answers regarding demographic characteristics, knowledge, behavior, perceptions, and training received in oral health. The association between categorical variables was tested with Pearson's chi-square tests and Fishers exact tests using SPSS ver. 23. RESULTS: The response rate was 43.12% (229/531). Most of the participants (64.02%) got a poor level of knowledge and no significant association was found between knowledge level and years of experience (p = 0.270). The majority of the participants (99.13%) perceived that diet, bacteria, and sugar exposure time are the etiological factors of dental caries. The overwhelming majority of the participants (98.25%) acknowledged the need for further oral health training during residency. CONCLUSIONS: Most pediatricians reported a poor level of knowledge. It is recommended to update the postgraduate and residency curriculum to equip pediatricians with adequate knowledge regarding children's oral health.

Evaluation of Self-Adhesive Composite Restorations Bond on Primary Canines: An In Vitro Study.

Background and purpose The aesthetic requirements for the restoration of the primary anterior teeth of both the child and his parents increased recently, especially with the presence of materials with good mechanical properties capable of giving a good aesthetic shape. However, the challenge remains in the possibility of applying these materials to primary teeth, where the child's cooperation and ability to keep their mouth open during the completion of the restoration is an important challenge for the dentist. Therefore, this study aimed to evaluate the bonding of self-adhesive composite by studying the microleakage in primary canines. Materials and methods The studied sample consisted of 60 extracted primary canines that were divided into three equal groups (n=20) according to the type of restoration: group 1 (experimental) - self-adhesive composite alone, group 2 (experimental) - self-adhesive composite with selective enamel etching, and group 3 (control) - conventional composite with the self-etching bond and selective enamel etching. A Class V cavity was prepared at the cementoenamel junction, 2 mm deep and 1 mm in diameter. In this way, the gingival wall is dentine, while the incisal wall is enamel-dentine. Restorations were placed according to the group to which the tooth belongs. After that, all teeth were subjected to 500 cycles of thermocycling. Then, a methylene blue dye microleakage test was performed, and longitudinal sections of the teeth were made and studied under x20 magnification using a stereo microscope. Results In the gingival wall, the scores of microleakage in the conventional composite group after selective etching were lower than those of the self-adhesive composite groups, with a statistically significant difference. While in the incisal wall, there were no statistically significant differences in the frequencies of the scores of microleakage between the three groups. Conclusions Within the limitations of this study, the conventional composite bonded better to enamel and dentine than self-adhesive composite resin applied alone or after selective enamel etching. The bonding of the self-adhesive composite was lower than that of the conventional composite, and it is not recommended to use it in Class V restorations of primary anterior teeth.

Assessing an active distracting technique during primary mandibular molar pulpotomy (randomized controlled trial).

OBJECTIVES: This study aims to evaluate the effectiveness of two different distraction techniques (Audio Video Distraction/Video Game Distraction) in the management of anxious pediatric patients during dental treatment. MATERIALS AND METHODS: One hundred and five children were randomly divided into three groups; Group A: active distraction using video games on a tablet device and wireless joystick (VG). Group B: passive distraction using video on tablet, and wireless headphones (AV). Group C (Control group): basic behavior guidance technique Tell Show Do was used (C). The children were selected from the department of pediatric dentistry at the Faculty of Dentistry, Damascus University, who required pulpotomy in primary mandibular molars. All children were assessed by: Simplified Wong-Baker FACES for pain scale (self-report), and "HOUPT" Behavior Rating Scale for Overall Behavior (non-self-report), at the end of treatment. RESULTS: One hundred and five children completed the study (57 boys and 48 girls) aged between 6 and 10 years (mean age of 7.4 years). The active distraction (VG) group was superior to the passive distraction (AV) group and the control group (C) on the pain scale with statistically significant differences as appeared in Simplified Wong-Baker Scale (p = .000), The active distraction (VG) group was superior to the control group (C) in overall behavior as appeared in HOUPT scale (p = .041), but it was no statistically significant differences between (VG) group and (AV) group in overall behavior (p = .605). With the use of Bluetooth technology and wireless devices, the workspace was comfortable for the dentist and did not interfere with the movement of his hands. CONCLUSION: Positive distraction with video games by wireless joystick displayed on the portable tablet on the dental chair was the best technique for reducing dental anxiety and reported pain in school children (6-10 years) and was better than negative distraction by video cartoons on the tablet device.

Molar-incisor hypomineralisation: Knowledge and perception of Syrian undergraduate and postgraduate dental students.

INTRODUCTION: Dentists' knowledge and expertise, especially in their early career, are primarily shaped during undergraduate studies. This cross-sectional study aimed to assess the knowledge and perception of Syrian under- and postgraduate students regarding diagnosing and managing molar-incisor hypomineralisation (MIH)-affected teeth. MATERIALS AND METHODS: Final-year dental students (FY-students), postgraduates in paediatric dentistry (PD-postgraduates) and postgraduates in other lines of specialty (OS-postgraduates) in all Syrian dental schools were invited to participate in an established web-based survey covering the knowledge and attitudes regarding the prevalence, aetiology, diagnosis and management of MIH. Data were analysed with descriptive statistics and Fisher's exact/chi-squared tests at 5%. RESULTS: In total, 1142 post- and undergraduate students from six public and five private dental schools in Syria participated in this study (867 FY-students, 74 PD-postgraduates and 201 OS-postgraduates). PD-postgraduates were found to present statistically significantly better knowledge regarding MIH compared with the two other groups. Only 19% of FY-students and 54% of OS-postgraduates reported themselves familiar with MIH (compared with 97% of PD-postgraduates). Similarly, 18% of FY-students and 27% of OS-postgraduates were capable of diagnosing MIH (compared with 81% of PD-postgraduates). Stainless-steel crowns and direct composite fillings were chosen as most suitable for treating MIH-affected molars from all responders. CONCLUSIONS: FY-students and even OS-postgraduates in Syria lack knowledge and confidence when confronted with MIH. The university curricula need to include more educational materials to equip the students with the necessary tools to manage MIH clinically.

Knowledge, perceptions, attitudes, and clinical experiences on molar incisor hypomineralization among Syrian pediatric dentists and general dental practitioners: a cross-sectional study.

BACKGROUND: Molar incisor hypomineralization (MIH) is a widespread oral health problem. Dentists encounter several challenges regarding MIH management worldwide. The aim of this study was to evaluate and compare the knowledge, perceptions, attitudes, and clinical experiences on MIH among general dental practitioners and pediatric dentists in Syria. METHODS: All general dental practitioners and pediatric dentists belonging to the Syrian Dental Syndicate of Damascus were invited to complete a cross-sectional structured questionnaire (n = 1936). The questionnaire consisted of four sections and required responses regarding demographic data, knowledge, perceptions, attitudes, and experiences on MIH. Data were analyzed with Pearson's chi-square test and multivariate regression models using SPSS Ver. 23.0. RESULTS: The overall response rate was 36.31% (703/1936). Pediatric dentists were significantly more familiar with MIH (p < 0.001) and more confident when diagnosing it (p < 0.001). Most participants (43.95%) perceived an increase in MIH prevalence in Syria. Stainless steel crowns were the most favorable restorative material for molars with post-eruptive breakdown (51.38%). As for molars and incisors with opacities, composite resin was preferred with (41.82%), and (67.51%) respectively. General dental practitioners requested further training regarding MIH treatment (p < 0.001). CONCLUSIONS: Pediatric dentists were equipped with further knowledge regarding MIH, and were more confident when diagnosing it. There is a need for additional training and education for general dental practitioners. Most respondents perceived an increase in the prevalence of MIH. There is a dearth of data regarding MIH prevalence in Syria. The materials of choice for restoring teeth with MIH were stainless steel crowns and composite resin.

Histopathological evaluation of pulp response to portland cement compared to MTA after primary canines pulpotomy (in vivo study).

INTRODUCTION: ECC (Early childhood caries) is very common in children. Because of the small size of primary anterior teeth, endodontic exposures occur early. Pulp tissue response after pulpotomy of primary anterior teeth by both MTA and Portland Cement is very important when pulp exposures occur in these teeth. AIM: This study aimed to evaluate in vivo pulp tissue responses after the primary canines pulpotomy with either White Portland Cement (WPC) or White Mineral Trioxide Aggregate (WMTA), by histopathological analysis. MATERIALS AND METHODS: The study included 30 primary canines in 21 healthy children aged 6-9 years old and it was classified into 2 groups according to the material. Group 1: included 15 teeth capped by White Portland Cement, and Group 2: included 15 teeth capped by white MTA. The dentine bridge formation, soft Tissue Organization, tissue fibrosis, formed dentin bridge thickness, pulp calcifications, hemorrhage in the pulp tissue, and deposition of new dentin on the inner surface of the dentin at 3 months periods were recorded. RESULTS: Data were analyzed statistically; the Mann-Whitney U test was performed for the assessment of histopathological criteria. Descriptive statistics were performed for the analysis of participant properties. Histopathological analysis showed complete dentin bridge formation and normal soft tissue organization for both materials. Statistical analysis showed no significant differences in dentine bridge formation (P value = 0.213), soft Tissue Organization (P value = 0.339), tissue fibrosis (P value = 0.079), formed dentin bridge thickness (P value = 0.139), pulp calcifications (P value = 0.581), hemorrhage in the pulp tissue (P value = 0.117), and deposition of new dentin (P value = 0.097), during the observation period. CONCLUSIONS: Within the limitation of the current study WPC was similar to WMTA in terms of histological criteria so PC may serve as a good alternative to MTA in primary teeth pulpotomy.

Evaluation of a Novel Tool for Apical Plug Formation during Apexification of Immature Teeth.

The purpose of this study was to compare the sealing ability and time required for the formation of Biodentine and mineral trioxide aggregation (MTA) apical plugs, using three different delivery methods: an amalgam carrier (AC), the Micro Apical Placement (MAP) System or a novel tool using a modified cannula (MC). Materials and Methods: A total of 60 uniformed molar roots were divided into three main groups, according to the technique of apical plug formation: AC, MAP, and MC. Each group was divided into two subgroups, according to the filling material used: MTA and Biodentine. A timer was used to calculate the required time for apical plug formation. After setting the filling materials, the apical microleakage of the formed plugs was quantified using the dye extraction method and spectrophotometry. The differences between the groups were analyzed using the one-way ANOVA and LSD post hoc tests. The significance level was set at 0.05. Results: No significant differences were reported in the time required to form the apical plugs in all groups (p > 0.05). However, the apical plugs formed by the AC method had significantly higher microleakage than those formed using the MAP and MC methods (p < 0.05). Conclusion: Within the limitations of this study, the sealing ability of the apical plugs formed by the MC method is comparable to the MAP method and better than the AC method.

COMPARATIVE ASSESSMENT OF NOVEL 3D PRINTED RESIN CROWNS VERSUS DIRECT CELLULOID CROWNS IN RESTORING PULP TREATED PRIMARY MOLARS.

PURPOSE: The primary objective of this randomized controlled trial is to compare the clinical impact of using crowns manufactured by 3D printing and direct composite celluloid crowns as a final restoration for primary molars after pulpotomy procedures. MATERIAL AND METHODS: Fifty primary molars selected from the children needing treatment at the Pediatric Dentistry Clinic at Damascus University Faculty of Dentistry were randomized by using SPSS and divided into 2 groups based on fabricating methods: Group A: 3D-printed crowns with the utilization of biocompatible light-curing composite, and Group B: Crowns were made directly using composite carried out by prefabricated celluloid crown. The evaluation team assessed the crowns in each group using the United States Public Health Service (USPHS) criteria for retention, marginal integrity, and gingival health at baseline, followed by 3 follow-up sessions at 3, 6, and 12 months. RESULTS: Chi-Square statistical testing was accomplished using SPSS software to compare crown failure among the experimental group. At the 12-month follow-up, no statistically significant differences were noted between groups (P = .157). For gingival health assessment, the Mann-Whitney test was used. No statistically significant differences were recorded between the 2 groups in the third follow-up month (P = .058); However, a significant difference was noted in the 6th and 12th follow-up months (P = .023, P = .000). For marginal integrity comparison, Mann-Whitney statistical Test was used for the third, sixth, and twelfth-month follow-up sessions. A significant difference was noted in all follow-up periods (3-6-12 months) between the direct and indirect crowns (P = .025, P = .025, P = .002, respectively). CONCLUSION: The 2 types of experimental crowns (direct composite celluloid crowns and the resin crowns manufactured via 3D printer) were suitable esthetic alternatives for restoring pulp-treated primary molars with a notably higher rate of retention with direct composite crowns. 3D-printed resin crowns, however, portrayed superior gingival health in addition to greater marginal integrity.

Clinical Performance of Two Types of Primary Molar Indirect Crowns Fabricated by 3D Printer and CAD/CAM for Rehabilitation of Large Carious Primary Molars.

OBJECTIVES: This randomized clinical trial aimed to evaluate clinical outcomes of two types of esthetic crowns fabricated using a three-dimensional (3D) dental printer and computer-aided design and manufacturing (CAD/CAM) system as an alternative full-coronal restoration for extensively carious pulp-treated primary molars. MATERIALS AND METHODS: Randomization was done for 50 lower primary molars in 50 child patients, split into two groups based on the fabrication method used: Group A: CAD/CAM crowns using polymethyl methacrylate (PMMA) blocks and Group B: 3D dental printed crowns using GC photopolymer resin. All crowns were evaluated at baseline and at 3rd, 6th, and 12th months using the U.S. Public Health Service criteria for gingival health, retention, and marginal integrity for both groups. STATISTICAL ANALYSIS: The survival rate of 3D-printable crowns was 84% compared with 80% survival rate using CAD/CAM fabricated crowns at the end of the 12th-month follow-up. No statistically significant differences were noted in restoration failure. In the evaluation of gingival health between the two groups' follow-up times, no statistically significant differences were noted at the 3rd- and 6th-month follow-ups, yet at the 12th month, statistically significant differences were noted (p = 0.022) when comparing gingival health. No statistically significant differences were noted between the two groups when comparing marginal integrity scores in all the follow-up periods. CONCLUSION: Resin crowns fabricated via 3D dental printer and PMMA crowns fabricated using CAD/CAM are acceptable esthetic choices in restoring pulp-treated primary molars with great marginal integrity and crowns retention. 3D-printed resin crowns showed less cementing failure and performed better regarding gingival response compared with PMMA crowns.

Comparing the efficacies of two chemo-mechanical caries removal agents (2.25% sodium hypochlorite gel and brix 3000), in caries removal and patient cooperation: A randomized controlled clinical trial.

INTRODUCTION: This study compared and evaluated the effectiveness of Brix 3000 and 2.25 % sodium hypochlorite (NaOCl) gel with conventional rotary instrumentation method in caries excavation of primary molars. The null hypothesis: no difference between the two tested chemo-mechanical caries removal (CMCR) agents used in this trial. MATERIALS AND METHODS: a randomized controlled clinical trial conducted with 32 children suffering from proximal caries of primary maxillary molars, age ranging between 6 and 9 years old. Subjects were randomly assigned into three groups: Brix 3000, NaOCl gel, and conventional with 10, 12, and 10 teeth in each group, respectively. After isolation of selected teeth, either CMCR agent were applied for two minutes. The application was repeated as needed until a caries-free surface was obtained. The conventional group used low-speed burs to excavate all carious lesions. The time required to obtain a caries-free result for each testing method was recorded. Wong-Baker FACES pain rating scale was used to assess the acceptance of the technique used by the child. RESULTS: Conventional treatment required significantly less time for caries removal compared to Brix 3000 (P = .002) and NaOCl gel (P = .000). No significant difference observed between Brix 3000 and NaOCl gel (P = .679). Statistically higher pain scores were observed with conventional treatment compared to both Brix 3000 (P = .000) and NaOCl gel (P = .005). Pain scores were lower with Brix 3000, and NaOCl gel with no significant difference observed between the CMCR agents (p = .690). CONCLUSIONS: CMCR agents that are effective in removing the carious dentine of primary teeth without negatively affecting the cooperation of children. CLINICAL SIGNIFICANCE: The use of a 2.25 % sodium hypochlorite gel can be an effective and well-tolerated method of removing decay from primary teeth and reduce the trauma associated with conventional rotary caries removal.

Evaluation of the apical extrusion of sodium hypochlorite gel in immature permanent teeth: An in vitro study.

BACKGROUND: Sodium hypochlorite (NaOCl) gel has been suggested as a safer substitute in open apices as compared to solution, with the same antimicrobial effect. OBJECTIVES: This study aimed to compare the amount of the apical extrusion of NaOCl gel and solution in immature permanent teeth. MATERIAL AND METHODS: A crossover in vitro study was conducted at the Department of Pediatric Dentistry, Faculty of Dentistry of Damascus University, Syria. Thirty freshly extracted immature single-rooted human premolars were decoronated and the cavity was then accessed. The teeth were radiographed to determine the mesiodistal dimension of the apex. In addition, the surface area of the apical foramen was calculated with Adobe Photoshop® to evaluate the amount of extrusion from the whole surface of the apex. The teeth were divided into 2 groups according to the size of the apex: ≤2.5 mm (group A) and >2.5 mm (group B); each group was irrigated with 5 mL of NaOCl solution and 2 different commercial types of NaOCl gel for 60 s, and then the extruded irrigant was measured in a plastic vial. RESULTS: The data was analyzed using the Kruskal-Wallis analysis. Based on the observed results, a statistically significant difference was noted (p = 0) between NaOCl solution and gel when the apical diameter was ≤2.5 mm, while there was no significant difference between the 2 types of NaOCl gel. No statistically significant difference was observed (p = 0.2) between NaOCl solution and gel when the apical diameter was >2.5 mm. CONCLUSIONS: Sodium hypochlorite gel is safer than solution when irrigating immature teeth with the apical diameter ≤2.5 mm.

Retention and remineralization effect of moisture tolerant resin-based sealant and glass ionomer sealant on non-cavitated pit and fissure caries: Randomized controlled clinical trial.

INTRODUCTION/OBJECTIVES: Pit and fissure sealants are an essential part of preventive dentistry and should be adopted as a crucial part of the minimally invasive dentistry due to their profound benefit to our patients. METHODS: The study design is a single-blind, split-mouth, randomized controlled clinical trial. Forty patients between age 6-9 were selected. First permanent molars' occlusal surfaces with scores of 1, or 2 according to the International Caries Detection and Assessment System II (ICDAS II) and with scores between 14-30 by using DIAGNOdent device (Kavo®, Biberach, Germany) were selected and readings recorded. One side of the mouth was randomly chosen to have either the moisture tolerant resin sealant or the glass ionomer sealant placed, and then the second material was placed on the other side. The retention of these materials was analyzed at 3 and 6 months. The sealants were then removed and DIAGNOdent readings were subsequently taken. RESULTS: After three months, full retention was found in 38/40 (95%) teeth in Group A (Embrace™ WetBond™) and 35/40 (87.5%) teeth in Group B (Fuji TRIAGE®). Additionally, no sealant suffered a total loss in group A, whereas, three sealants were totally lost (7.5%) in group B. The difference in sealant retention in two groups in this period was not found to be statistically significant (P >  0.05). At six months, full retention was found in Group A 34/40 (85%) and 25/40 (62.5%) in Group B. Also, the partial loss in Group A was 2/40 (5%) whereas in Group B 7/40 (17.5%). Also, the total loss was 4/40 (10%) and 8/40 (20%) in Group A and B, respectively. The difference in sealant retention in two groups after six months follow-up was found statistically significant (P < 0.05). The initial mean values of DIAGNOdent readings were 22.42 and 22.8 in Group A and Group B, respectively. After six months, DIAGNOdent mean values revealed a drop in both groups, and this difference was statistically significant. Nevertheless, when Group A was compared to Group B in terms of remineralization effect, the differences were found not to be statistically significant (p > 0.05). CONCLUSIONS: Within the limitation of this study, we affirmed that occlusal caries lesions, which is restrictive to enamel and in need of surgical intervention, can be arrested clinically by sealing the lesion with both a hydrophilic resin sealant and glass ionomer sealant materials. Embrace™ WetBond™ showed superiority over the glass ionomer sealant tested in retention after six months follow up.

Effect of dietary combinations on plaque pH recovery after the intake of pediatric liquid analgesics.

OBJECTIVES: To study the effect of water, halloumi cheese and sugar-free (SF) chewing gum on plaque pH recovery after the intake of sweetened PLAs. SETTINGS AND DESIGN: A randomized clinical trial was conducted on 17 children (10 females, 7 males) aged 11-12 years with DFT/dft of more than 3. MATERIALS AND METHODS: Each volunteer tested paracetamol and ibuprofen suspension alone or followed with water, halloumi cheese or SF gum, as well as 10% sucrose and 10% sorbitol as controls. Plaque pH was measured using the sampling method before and after 5, 10, 15, 20, 30 min of ingestion. STATISTICAL ANALYSIS: Statistical analysis was performed using analysis of variance followed by least significant difference test to assess minimum pH (min pH), maximum pH drop (ΔpH), and the area under baseline pH, and P value was set as 0.05. RESULTS: Both ibuprofen and paracetamol were not significantly different from 10% sucrose in terms of min pH, ΔpH, and area under baseline pH except for min pH of ibuprofen (P = 0.034). Water and halloumi cheese did not have a significant effect on plaque pH recovery after the intake of both analgesics as min pH, ΔpH, and area under baseline pH were similar to 10% sucrose except for min pH of ibuprofen + water (P = 0.048). However, plaque pH variables after chewing SF gum for 20 min were similar to 10% sorbitol. CONCLUSION: Chewing SF gum immediately after the intake of sweetened PLAs for 20 min restores plaque pH and could be recommended as a complementary aid in caries prevention.