Silver modified atraumatic restorative treatment: a paradigm shift in dental caries management.

Silver diamine fluoride (SDF) and atraumatic restorative treatment (ART) are treatment modalities that are minimally invasive and used for the prevention and control of dental caries. The amalgamation of these two techniques has led to the development of silver modified atraumatic restorative treatment (SMART). In this approach the carious lesion is restored with glass-ionomer cement (GIC) after SDF application. SMART effectively arrests caries without removing additional tooth structure, making it a promising option for caries management in children who lack cooperative ability.This article reviews the literature on SMART, the evidence regarding its applications in dental practice, its advantages, drawbacks, the scope for research, and clinical use.

Organic antibacterial modifications of high-viscosity glass ionomer cement for atraumatic restorative treatment: A review.

High viscosity glass ionomer cement (HVGIC) has been employed as a restorative material for Atraumatic Restorative Treatment (ART). As residual caries persist after caries removal in ART, the antibacterial activity of HVGIC gains importance. Organic and inorganic substances with antibacterial properties have been incorporated into HVGIC over the years, and their effects on the antibacterial and physical properties have been studied. The objective of this paper is to review the various alterations made to HVGIC using organic compounds, their effect on the antibacterial activity, and the physical properties of the cement. Various in vitro investigations have been conducted by adding antiseptics, antibiotics, and naturally occurring antibacterial substances. Most of these compounds render superior antibacterial properties to HVGIC, but higher concentrations affect physical properties in a dose-dependent manner. However, some naturally occurring antibacterial substances, such as chitosan, improve the physical properties of HVGIC, as they enhance cross-linking and polysalt bridging. There is potential for clinical benefits to be gained from the addition of organic antibacterial compounds to HVGIC. In-depth research is required to determine the optimum concentration at which the antibacterial effect is maximum without affecting the physical properties of the cement.

Preventing Early Childhood Caries through Oral Health Promotion and a Basic Package for Oral Care: A Pragmatic Trial.

Introduction: Untreated caries in mothers is one of the common risk factors for early childhood caries (ECC). Aim: The aim of the study was to investigate the impact of an oral health promotion program on ECC. Methodology: We conducted a pragmatic trial at 12 primary health centers in a rural community of India with 311 pregnant women using fluoride toothpaste, oral health information through pamphlets, and referral to urgent dental care or atraumatic dental treatment as the test intervention. Data were collected through structured interviews at baseline and oral examination of the children at 2 years of age. Results: Of the 311 women who participated, 274 children were followed up with at 2 years of age. ECC was low and comparable in both groups. When compared with the control group, significantly, more children from the intervention group were breastfed for over 6 months of age (P = 0.012) and consumed less sugar (P < 0.001). The number of mothers' decayed teeth (P = 0.01), children's sweet scores (P < 0.001), and the age at which brushing commenced for children (P = 0.04) increased the likelihood of tooth decay in children. Conclusion: The oral health promotion program had some beneficial effects in preventing caries in children when provided to pregnant women.

Clinical effectiveness of resin-modified glass ionomer-based fluoride varnish for preventing occlusal caries lesions in partially erupted permanent molars: A randomised active-controlled trial.

BACKGROUND: Deep pits and fissures in partially erupted permanent molars are vulnerable to dental caries. AIM: To assess the clinical effectiveness of resin-modified glass ionomer-based fluoride varnish (RMGI-F varnish: Clinpro XT™ varnish) in preventing occlusal caries lesions in partially erupted permanent first molars. DESIGN: In this randomised active-controlled superiority trial with a single-blind parallel design, 74 children with 182 partially erupted first permanent molars were allocated into two groups: Group 1: RMGI-F varnish; and Group 2: GI sealant (active control), with an application of 0.1% sodium fluoride varnish for all other teeth. The primary outcome was ICDAS score ≥1 at 12 months of follow-up. Data were analysed using adjusted Chi-square test and GEE regression for binary outcomes. RESULTS: Group 1 (15.7%) and Group 2 (13.8%) did not differ significantly in ICDAS ≥1 scores at 12 months of follow-up (adjusted χ2  = 0.373, p = .541). There was no significant difference in retention between Group 1 (48.3%) and Group 2 (20.7%) at 12 months of follow-up (adjusted χ2  = 0.1, p = .752). Mean application time per tooth (16 ± 5.9 vs 20.2 ± 5.4 min) was significantly different (t = 5.26, p = .014). CONCLUSIONS: RMGI-F varnish was not superior to GI sealant in preventing occlusal caries lesions in partially erupted molars.

Comparative Evaluation of Surface Roughness and Wettability of an Alkasite with Nano Bulk-Fill and Nanofilled Resin Composite Restorative Materials: In vitro Study.

Context: Surface characteristics of resin-based composites (RBCs) can change with polishing and over time. Aim: The aim of the study was to compare the surface roughness and wettability of three different posterior RBCs after polishing and the change in these surface characteristics over time, after aqueous aging. Settings and Design: Experimental in vitro study. Materials and Methods: Eleven disc-shaped RBC specimens were fabricated. The RBCs used were, alkasite composite, bulk-fill nanocomposite, conventional nanofilled composite. All the specimens underwent polishing with Soflex Diamond Polishing System and then analyzed for roughness and wettability at baseline and after aqueous aging for 3 months with the help of an atomic force microscope and a contact angle goniometer respectively. Statistical Analysis: One-way ANOVA and Tamhane test were used for the multiple comparisons. Results: Alkasite composite showed significantly higher surface roughness (P = 0.028 and P < 0.001, respectively) and lower wettability (P = 0.023 and P = 0.020, respectively) than conventional nanofilled composite at baseline and 3 months. Surface roughness of alkasite composite was also significantly higher than bulk-fill nanocomposite (P = 0.009 and P < 0.001, respectively) at both the time points. Conclusions: Alkasite has higher surface roughness in comparison to conventional nanocomposite and bulk-fill nanocomposite and lower wettability than conventional nanocomposite after polishing and aqueous aging over a 3-month period. In terms of surface characteristics, alkasite composite may be advantageous in preventing initial plaque adhesion to the material surface, but the lower surface roughness of nano-filled composites may be more advantageous in terms of plaque retention prevention.

Teledentistry and its applications in paediatric dentistry: A literature review.

BACKGROUND: During the unfortunate event of the COVID-19 pandemic, restrictions were placed on face-to-face interactions in dentistry to promote social distancing and reduce spread of virus. In order to provide dental services teledentistry was employed. OBJECTIVE: This article aims to review the literature and information available on the provision and utilization of teledentistry as a method to address oral health needs of paediatric patients. RESULTS: Teledentistry has been utilised in paediatric population for the purpose of oral health education and promotion, remote diagnosis and monitoring, and behaviour guidance. Studies involving paediatric population for aforementioned applications have shown that this practice strategy is beneficial to provide dental treatment in remote locations with little access to paediatric dental specialists, monitor patients between appointments, conduct remote diagnosis and screening programmes, promote oral health of children through dental education, and in pre-appointment behaviour guidance. This method was particularly useful during the current COVID-19 pandemic where dentists use their mobile phones, computer webcams for patient appointments while maintaining safe distance and avoid exposing themselves as well as patient to the virus. CONCLUSION: Teledentistry can be a supplement to face-to-face methods of paediatric dental care, ultimately leading to better patient management. This technology can make a significant contribution in reducing the supply-demand gap of paediatric dental specialists in places where healthcare facilities are limited and ensure safety during the pandemic whilst providing dental care to paediatric patients. Further research is required for safe, effective and evidence-based use of teledentistry in the field of paediatric dentistry.

Early childhood caries and parents' challenges in implementing oral hygiene practices: a qualitative study.

BACKGROUND: Early childhood caries (ECC) is highly prevalent with significant long-term consequences. Parents are primarily responsible for the oral health practices of their children. Parents' health beliefs, attitudes, and cultural factors influence oral health practices. AIM: To explore and understand the perceptions and challenges faced by the parents of the children with ECC in performing routine oral hygiene practices for their children. DESIGN: We conducted a qualitative description study with the parents of children with ECC. Data were collected through five focus groups using culturally appropriate, semi-structured, open-ended questions and probes. Focus groups were audiotaped, and field notes were taken, which were transcribed verbatim after each focus group session. Data were analyzed using content analyses. RESULTS: A vast majority of the participants were aware of the significance of oral hygiene. However, they faced challenges in implementing proper home hygiene practices at home and lacked knowledge about the type of toothpaste and toothbrush to be used for their children. CONCLUSION: The parents of the children with ECC face a severe knowledge gap, which is interfering with the selection of proper oral hygiene aids for their children. They also face barriers in implementing oral hygiene routines for their children, in spite of awareness that tooth brushing is important.

Association of Streptococcus Mutans, Candida Albicans and Oral Health Practices with Activity Status of Caries Lesions Among 5-Year-Old Children with Early Childhood Caries.

PURPOSE: Candida albicans is frequently detected together with Streptococcus mutans in the plaque or biofilms of children with early childhood caries (ECC). The aim of this study was to examine the association of the microbial counts of C. albicans and S. mutans in the supragingival plaque with the activity status of carious lesions and oral health practices in children with ECC. MATERIALS AND METHODS: 66 children aged 5 years were examined and their caries status recorded as per the ICDAS-II and the Lesion Activity Assessment (LAA) criteria. A questionnaire covering oral health practices was administered to parents. Plaque samples were collected and cultured on mitis salivarus bacitracin (MSB) agar and CHROMagar. Data was analysed using Spearman's rank correlation and Mann-Whitney U test. RESULTS: There was a statistically significant positive correlation between the levels of S. mutans and C. albicans (rs = 0.702, p <0.001). A positive correlation was seen between the percentage of active carious lesions with the colony counts of S. mutans (rs = 0.884, p <0.001) and C. albicans (rs = 0.785, p <0.001). Improper toothbrushing practices, dietary and feeding practices were statistically significantly associated with activity of caries lesions, S. mutans and C. albicans count. CONCLUSION: The total count of C. albicans and S. mutans in the supragingival dental plaque of children with ECC increases with an increase in the percentage of active carious lesions and the severity of dental caries. Improper oral health practices can lead to increased number of active carious lesions, as well as increased microbial load of both S. mutans and C. albicans.

Effect of three silver diamine fluoride application protocols on the microtensile bond strength of resin-modified glass ionomer cement to carious dentin in primary teeth.

BACKGROUND: Use of silver diamine fluoride (SDF) after selective caries excavation can arrest the further progress of the carious lesion. Application of potassium iodide (KI) can reduce the staining due to SDF. AIM: The aim of the study was to evaluate the effect of the application of SDF, with and without acid etching and KI on the bond strength of resin-modified glass ionomer cement (RMGIC) to the carious dentin of primary teeth. MATERIALS AND METHODS: In thisin vitro study, caries was induced on the occlusal surface by inoculating Streptococcus mutans strain in 36 extracted primary molars. The teeth were divided into four groups (n = 9), and the following treatments were done to the carious dentin prior to final restoration with RMGIC: Group I: 10% polyacrylic acid conditioner, Group II: 38% SDF, Group III: 37% phosphoric acid etchant followed by 38% SDF, and Group IV: 37% phosphoric acid etchant followed by 38% SDF and 10% potassium iodide solution. The microtensile bond strength was measured using universal testing machine. Failure modes were recorded using a scanning electron microscope. RESULTS: There was no significant difference in microtensile bond strengths between the groups (P = 0.665), with the highest value seen in Group III. CONCLUSIONS: Application of SDF with or without acid etching and KI does not affect the bond strength of RMGIC to carious dentin of primary teeth.

Remineralising Effectiveness of Two Fluoride Varnishes Containing Additives: An In Vitro Study.

PURPOSE: To assess the remineralising efficacy of fluoride varnish containing additives and conventional sodium fluoride varnish. MATERIALS AND METHODS: 72 extracted upper central incisors specimens were randomly allocated to four groups after demineralisation: control; 5% sodium fluoride varnish (FV) (Fluoritop-SR); resin modified glass ionomer-based calcium phosphate containing fluoride varnish (CV) (Clinpro XT); fluoride varnish with xylitol coated calcium phosphate (cXp) (Embrace). Change in surface morphology, calcium phosphorous ratio and fluoride content of enamel were evaluated using scanning electron microscope and energy dispersive X-ray analysis (SEM-EDAX). Change in surface roughness was evaluated using profilometer analysis. All readings were taken at baseline, after demineralisation, at 2 weeks and 4 weeks of remineralisation. RESULTS: At 4 weeks of remineralisation surface roughness values were ranked as follows: control > FV = cXp > CV. Calcium phosphorus ratios were in the order: CV > FV = cXp > control and fluoride content (for treatment groups): CV = cXp > FV. Scanning electron microscopy images showed mineral deposition on the surfaces of the treatment groups with different deposition pattern of minerals. CONCLUSION: Fluoride varnishes with or without additives are effective in remineralisation of early enamel lesions. Glass ionomer-based fluoride varnish results in better remineralisation than xylitol coated calcium phosphate containing fluoride varnish and 5% sodium fluoride varnish.

Effect of a relaxation training exercise on behaviour, anxiety, and pain during buccal infiltration anaesthesia in children: Randomized clinical trial.

BACKGROUND: Cognitive behavioural techniques can decrease procedural pain and anxiety in children. Bubble breath exercise, a play therapy technique, may be used as a relaxation strategy to manage anxiety and pain. The objective of the study was to evaluate the effect of bubble breath exercise on dental anxiety, dental behaviour, and pain intensity during buccal infiltration of local anaesthetic in children. STUDY DESIGN: This randomized controlled trial involved 66 children aged 7-11 years, randomly allocated to two groups: Group 1 (control) and Group 2 (intervention group). Group 2 was trained in bubble breath exercise. The reaction during buccal infiltration anaesthesia was recorded in terms of behaviour (Frankl's behaviour rating scale), anxiety (Facial Image Scale and pulse rate), and pain perception (Wong-Baker FACES pain rating scale and the Faces, Leg, Activity, Cry, and Consolability scale). RESULTS: The bubble breath exercise significantly reduced the pain perceived, as measured by both the Wong-Baker FACES pain rating scale (P < 0.001) and the FLACC scale (P < 0.001). There was no statistically significant difference in dental anxiety and behaviour among the groups. CONCLUSION: Use of bubble breath exercise may be beneficial in decreasing the pain perceived during maxillary buccal infiltration anaesthesia in 7- to 11-year-old children.

Association of temperament with dental anxiety and behaviour of the preschool child during the initial dental visit.

The aim of this study was to investigate whether there is an association between temperament characteristics of preschool children, dental anxiety, and their dental behaviour. A total of 100 children, aged 3-5 yr, who were attending their initial dental visit accompanied by a parent, were included in this cross-sectional study. Dental anxiety of children was measured using the Facial Image Scale. The behaviour of children during the initial oral examination and oral prophylaxis was assessed using Frankl's behaviour rating scale. Temperament was assessed using Emotionality, Activity, Shyness Temperament Survey for Children (parental ratings). Statistically significant weak linear positive correlations were seen between the following: the percentage duration of definitely negative behaviour and shyness scores (rs  = 0.28); anxiety level and emotionality scores (rs  = 0.28); and anxiety level and shyness scores (rs  = 0.26). Multinomial logistic regression analysis revealed that children with higher anxiety had higher odds of showing definitely negative behaviour, which decreased with increasing age of the child. Emotionality and shyness temperaments may be weakly associated with dental anxiety, and shyness may be weakly associated with the dental behaviour of the preschool child. Definitely negative dental behaviour is associated with dental anxiety and age of the child.

Evaluation of conventional, protaper hand and protaper rotary instrumentation system for apical extrusion of debris, irrigants and bacteria- An in vitro randomized trial.

BACKGROUND: Endodontic instrumentation carries the risk of over extrusion of debris and bacteria. The technique used and the type of instrumentation influences this risk. AIM: The purpose of this study was to evaluate and compare the K-file, ProTaper hand and ProTaper rotary instrumentation systems for the amount of apically extruded debris, irrigant solution and intracanal bacteria. DESIGN: Experimental single blinded randomized type of in vitro study with sample of 30 single rooted teeth. Endodontic access cavities were prepared and the root canals were filled with the suspension of E. faecalis. Myers and Montogomery Model was used to collect apically extruded debris and irrigant. Canals were prepared using K files, Hand protapers and Protaper rotary files. STATISTICAL ANALYSIS: Non Parametric test like Kruskal-Wallis and Mann-Whitney U test were applied to determine the significant differences among the group. RESULTS: Tests revealed statistically significant difference between the amount of debris and number of bacteria extruded by the ProTaper hand and the K-files. No statistically significant difference was observed between the amounts of irrigant extruded by the ProTaper hand and the K-file system. Statistically significant differences were observed between the amounts of bacteria and irrigant extruded by the ProTaper rotary and the Protaper hand. No statistically significant difference was observed between the amounts of debris extruded by the ProTaper hand and the K-file system. CONCLUSIONS: Amount of apical extrusion of irrigant solution, bacteria and debris are significantly greater with K File instruments and least with Protaper rotary instruments. Key words:Protaper, rotary, periapical extrusion.

Evaluation of pit-and-fissure sealants placed with four different bonding protocols: a randomized clinical trial.

BACKGROUND: Application of adhesive after acid etching may increase the retention of pit-and-fissure sealants and improve clinical effectiveness. AIMS: To clinically evaluate the retention, marginal discoloration and caries incidence of pit-and-fissure sealants applied using four bonding protocols: conventional acid etching, etch-and-rinse adhesive, multimode universal adhesive and self-etch adhesive used after acid etching. DESIGN: In this split-mouth design study, the four adhesive protocols were randomly assigned to the four erupted, non-carious first permanent molars and involved 52 patients between 6 and 10 years of age. The sealants were evaluated at 3-, 6- and 12-month intervals. Statistical analysis was carried out using Friedman test and Kruskal-Wallis test. RESULTS: At 12 months, the retention rate was maximum in etch-and-rinse and universal adhesive groups (77.1%) followed by self-etch adhesive (58.3%) and conventional acid etching group (45.8%). Dental caries was observed only in one tooth, and marginal discoloration was found to be the highest in conventional group and least in etch-and-rinse group. CONCLUSIONS: Use of adhesives during pit-and-fissure sealant application does not significantly enhance sealant retention nor decrease marginal discoloration. Etch-and-rinse adhesive is advantageous only at short term.

Utility of knowledge, attitude, and practice survey, and prevalence of dental caries among 11- to 13-year-old children in an urban community in India.

BACKGROUND: The school oral health education program is believed to be a cost-effective method for promoting oral health. The KAP (knowledge-attitude-practice) model of oral health education is often the foundation of most health education programs. OBJECTIVES: To assess the existing knowledge, attitude, and oral health care practices among 11- to 13-year-old children and the association of knowledge with attitude, oral health care practices, and dental caries prevalence. DESIGN: Cross-sectional design, involving 858 children studying in class seven at various schools in the city of Mangalore, India. The children were selected using stratified random sampling method. Prevalence of dental caries was determined using decayed, missing, and filled permanent teeth (DMFT) index. A self-administered questionnaire on self-care practices in oral health, knowledge, and attitude toward oral health care was filled by children. The association of different variables with knowledge was analyzed using binary logistic regression analysis. RESULTS: The dental caries prevalence was 59.4%, and 54.5% had low knowledge. They lacked knowledge regarding use of fluoridated toothpaste and did not use them. Children with low knowledge had significantly higher odds of having DMFT ≥ 1, not using fluoridated toothpaste, and being afraid of going to the dentist due to possible pain. There was no association of other oral health care practices and attitudes with knowledge. CONCLUSION: Oral health care practices and attitudes are not fully explained by knowledge, and other models of health education need to be considered.