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Traumatic dental injuries (TDIs) in the primary dentition may result in tooth discolouration and fractures. The aim of this child-centred study was to explore the differences between preschool children's eye movement patterns and visual attention to typical outcomes following TDIs to primary teeth.An eye-tracker recorded 155 healthy preschool children's eye movements when they viewed clinical images of healthy teeth, tooth fractures and discolourations. The visual search pattern was analysed using the eye movement analysis with the Hidden Markov Models (EMHMM) approach and preference for the various regions of interest (ROIs).Two different eye movement patterns (distributed and selective) were identified (p .05). Children with the distributed pattern shifted their fixations between the presented images, while those with the selective pattern remained focused on the same image they first saw.Preschool children noticed teeth. However, most of them did not have an attentional bias, implying that they did not interpret these TDI outcomes negatively. Only a few children avoided looking at images with TDIs indicating a potential negative impact. The EMHMM approach is appropriate for assessing inter-individual differences in children's visual attention to TDI outcomes.

Visual attention is a significant gateway to a child’s mind, and looking is one of the first behaviors young children develop. Untreated caries and the resulting poor dental aesthetics can have adverse emotional and social impacts on children’s oral health-related quality of life due to its detrimental effects on self-esteem and self-concept. Therefore, we explored preschool children’s eye movement patterns and visual attention to images with and without dental caries via eye movement analysis using hidden Markov models (EMHMM). We calibrated a convenience sample of 157 preschool children to the eye-tracker (Tobii Nano Pro) to ensure standardization. Consequently, each participant viewed the same standardized pictures with and without dental caries while an eye-tracking device tracked their eye movements. Subsequently, based on the sequence of viewed regions of interest (ROIs), a transition matrix was developed where the participants’ previously viewed ROI informed their subsequently considered ROI. Hence, an individual’s HMM was estimated from their eye movement data using a variational Bayesian approach to determine the optimal number of ROIs automatically. Consequently, this data-driven approach generated the visual task participants' most representative eye movement patterns. Preschool children exhibited two different eye movement patterns, distributed (78%) and selective (21%), which was statistically significant. Children switched between images with more similar probabilities in the distributed pattern while children remained looking at the same ROI than switching to the other ROI in the selective pattern. Nevertheless, all children exhibited an equal starting fixation on the right or left image and noticed teeth. The study findings reveal that most preschool children did not have an attentional bias to images with and without dental caries. Furthermore, only a few children selectively fixated on images with dental caries. Therefore, selective eye-movement patterns may strongly predict preschool children’s sustained visual attention to dental caries. Nevertheless, future studies are essential to fully understand the developmental origins of differences in visual attention to common oral health presentations in children. Finally, EMHMM is appropriate for assessing inter-individual differences in children’s visual attention.

Objectives: To determine different combinations of marginal ridge shape (MRS) and contact extents in nature of the contact between primary molars and its correlation with the presence of carious lesions on radiographic examination of approximal surfaces. Study design: Retrospective study of 347 clinical records, including photographs and bitewing radiographs, were assessed for intact MRS and caries extent. The carious lesions were scored (0–5, Mejàre scoring system) radiographically and correlated to the intact MRS on clinical photographs, and strength of associations quantified using logistic regression analysis and chi-square tests. Results: Primary molars, 848(contact extent), and 757(MRS) were analyzed. Combination of straight-convex(35.4%) MRS was more common (p

To determine, using eye-tracking technology, (i) what children notice the most when they look at images of dental operatories and (ii) the effect of distractors on gaze pattern. Forty-one children aged 4–12 years (21 girls, 19 boys) viewed 13 images of dental operatories taken from different perspectives on a computer screen. One child was excluded due to calibration issues with the eye-tracking equipment. Areas of interest (AOI’s) were pre-defined on each image, then a Tobii X2-60 eye-tracking camera was used to track the location of participant’s gaze. Count of participants to fixate and mean length of fixation (LOF) for each AOI were measured. Significant differences in the mean LOF was noticed for bracket tables, handpieces, and the dental chair. Significantly differences in mean LOF between different areas of the images were noted where distractors (cartoons) were added. When viewing images of dental operatories on a computer screen, children fixated most on the bracket tables, handpieces, and dental chairs. The addition of distractors was able to change where they looked. Eye-tracking was able to effectively assess where the children looked. The findings demonstrate that children have inherent preferences for where they fixate when viewing images of a dental operatory. This has not previously been known and will allow customization of dental operatories where children will be treated.

Although usually considered to be of developmental origin, dentigerous cysts (DCs) have been reported to form in response to chronic periapical inflammation associated with primary teeth that have necrotic, infected pulps. This article describes the management of a DC associated with tooth 21 in a seven-year-old Caucasian child with a history of multiple TDIs to the primary maxillary incisors. Chronic periapical inflammation associated with a necrotic pulp in tooth 61 was identified as the likely cause of the lesion. Initial conservative management involved marsupialization of the lesion by extracting the necrotic tooth 61. Following significant decompression of the cyst, surgical enucleation was carried out under general anaesthesia and an orthodontic attachment was bonded to the crown of the unerupted tooth 21 to facilitate traction. Histopathological assessment of the enucleated tissue confirmed it to be a DC. Two years after the initial presentation, teeth 21 and 22 had erupted into the oral cavity, improving patient aesthetics. However, the root of tooth 22 was transposed with the crown of the unerupted tooth 23. This case highlights the undesirable sequelae that may occur following delayed and inappropriate management of TDIs.

To evaluate the correlation between spacing in the primary dentition and caries experience. One hundred seventy-four clinical records, including photographs during 2017–2019 were assessed for primate, generalised and interdental spaces. The mean of decayed, missing or filled teeth and surfaces (dmft and dmfs) were recorded to quantify the caries experience. Linear regression analyses were used to ascertain correlations between spacing and dental caries. The strength of the associations was quantified using odds ratio (OR) and 95% confidence interval (CI). Ninety-seven boys and 77 girls were included in the final analysis. Approximately 41% of children had primate space in all four quadrants, and 15% of children had no primate spaces in all four quadrants. 50% of children did not exhibit generalised spacing, while 39% of children showed interdental spacing. Children with no primate space had approximately five surfaces higher dmfs score compared to those with primate space in all four quadrants (95% CI − 9.27 to − 1.23; p

While eye-tracking technology is a validated tool in the field of education it is still in its infancy in the field of Pediatric Dentistry. The primary aim of this study was to determine dental undergraduates' search patterns and visual fixations while viewing panoramic radiographs (PR) using an eye-tracker. The secondary aim was to decide on the potential opportunities to enhance teaching-learning strategies when studying these radiographs.Sixty-five dental undergraduates in the final year of their dental education consented to and participated in this study. A Tobii Pro Nano screen-based eye-tracking camera was mounted to the lower edge of a laptop with five different PR uploaded onto the Tobii Studio software. Regions of Interest (ROIs) were pre-determined for the five PR. The participants (17 males and 48 females) viewed all the PR images with no time restrictions and a "think-aloud" protocol was exercised.The average view time for the PR was 245.58 ± 106.7 s. Participants spent significantly less time examining the surrounding structures (14.85 s) than the dentitions (primary: 97.58 s and permanent: 37.58 s). Males demonstrated a slightly higher view time (290.88 ± 97.7 s) than females (229.53 ± 106.05 s).The results revealed that though the participants focused on the ROI, most of them failed to make the correct diagnosis. In addition, the search patterns of the participants unveiled no sequential viewing of PR. Hence the need to revise the teaching-learning strategies for the systematic interpretation of PR images in the dental curriculum is warranted.

No previous studies have investigated eye-movement patterns to show children’s information processing while viewing clinical images. Therefore, this study aimed to explore children and their educators’ perception of a midline diastema by applying eye-movement analysis using the hidden Markov models (EMHMM). A total of 155 children between 2.5 and 5.5 years of age and their educators (n = 34) viewed pictures with and without a midline diastema while Tobii Pro Nano eye-tracker followed their eye movements. Fixation data were analysed using data-driven, and fixed regions of interest (ROIs) approaches with EMHMM. Two different eye-movement patterns were identified: explorative pattern (76%), where the children’s ROIs were predominantly around the nose and mouth, and focused pattern (26%), where children’s ROIs were precise, locating on the teeth with and without a diastema, and fixations transited among the ROIs with similar frequencies. Females had a significantly higher eye-movement preference for without diastema image than males. Comparisons between the different age groups showed a statistically significant difference for overall entropies. The 3.6–4.5y age groups exhibited higher entropies, indicating lower eye-movement consistency. In addition, children and their educators exhibited two specific eye-movement patterns. Children in the explorative pattern saw the midline diastema more often while their educators focussed on the image without diastema. Thus, EMHMMs are valuable in analysing eye-movement patterns in children and adults.

Over the last decade there has been a renewed interest in the use of Silver Diamine Fluoride (SDF) as an adjunctive modality in the management of caries among high-risk populations. This review presents the current evidence behind the use of SDF and recommendations for its use in caries management dental practice. CPD/Clinical Relevance: Silver diamine fluoride is an effective, evidence-based modality that can contribute towards arresting carious lesions among high-risk children and disadvantaged populations.

Supernumerary teeth are reported to occur in both primary and permanent dentitions, but their exact aetiology remains unclear. To date, there have been no documented reports of supernumerary teeth formation subsequent to traumatic dental injuries (TDIs) to the primary incisors. This case report illustrates such an unusual consequence where a supernumerary tooth developed subsequent to a subluxation injury to teeth 51 and 61 in a 4-year-old Caucasian girl. This emphasizes the importance of reviewing TDIs, as well as providing parents with sufficient information about possible sequelae at the time of trauma. Nevertheless, it also provides an excellent basis for future investigations, which are essential to establish this correlation and to prove causation.

Background: Calcium phosphate and fluoride (F) delivery systems claim to facilitate enamel remineralization. Aim: To evaluate and compare (i) the remineralizing potential of Clinpro® Tooth Crème(CTC) and Tooth Mousse Plus®(TMP) on artificial carious lesions, and (ii) the benefit of 1000ppm F dentifrice prior to the application of CTC and TMP. Study design: Carious lesions, 200–300μm deep were produced by placing molars in demineralizing solution for 96h, sections 100–150μm thick were then randomly assigned to six groups(n=150). Specimens were treated thrice daily with a non-fluoridated(Group A), or fluoridated dentifrice[1000ppm, (Group B)], or CTC(Group C), TMP(Group D), fluoridated dentifrice followed by CTC(Group E), or a fluoridated dentifrice followed by TMP(Group F), and then subjected to a 10-day pH cycling model. Lesion evaluation involved polarizing light microscopy and microradiography. Results: Posttreatment maximum mineral content at the surface zone(Vmax) was significantly increased in Groups B, C, and D compared to the other groups. The lesion depth(LD) decreased in Group D>Group C>Group E, and the net mineral content gain(ΔZ) in Group C>Group D, which did not reach statistical significance. Conclusions: CTC and TMP exhibited similar efficacy in remineralizing artificial carious lesions. Nevertheless, the net mineral gain or lesion consolidation following CTC use was higher than TMP.

BACKGROUND The influence of parental education, choice of child dentifrice, and its impact on their children's dental caries experience remain unclear. AIM To investigate (a) dentifrice types used by Australian pre-school children, (b) demographic factors that influence parents' dentifrice choice, and (c) whether dentifrice type is related to pre-schooler's caries experience. DESIGN 155 parent-child dyads were recruited from five random metropolitan childcare centres. Parents completed a questionnaire recording relevant demographics and child dietary preferences, oral hygiene practice, and dental visits. One calibrated operator performed a clinical examination of their pre-schooler for evidence of carious lesions. Data were analysed, and comparisons between variables made using chi-square tests and regression models. RESULTS 50% of pre-schoolers used

Objectives To determine, using eye-tracking technology, what children notice the most when they look at the dentist. Methods A total of 41 children viewed 10 images of dentists of different genders and ethnicities, and wearing different attires, on a computer screen. Due to calibration issues with the eye tracking equipment, data from one child was excluded thus resulting in a final sample of 40 children (21 females; 19 males). Participants were aged 4–12 years. A Tobii X2-60 eye-tracking camera was used, which follows the location of participants’ gaze as they look at images on a screen. Areas of interest (AOI’s) were pre-defined on each image (e.g. eyes, mouth, shirt). Other images were displayed between dentist images with no consecutive dentist images displayed. Number of participants to fixate and mean length of fixation for each AOI were measured. Results Visual assessment illustrated that the dentist’s face had the highest concentration of fixations, followed by attire. The circum-oral area has significantly more fixations than the eyes. The number of fixations and the mean length of fixation were both longer for the face than for the attire, and for the circum-oral area compared to the eyes. Distractors such as pens and ties exhibited more and longer fixations compared to images without distractors. Conclusions Children fixated most on the dentist’s face particularly the circum-oral area, followed by attire. Distractors were able to draw the children’s gaze. Importantly, eye-tracking was an effective tool in assessing where children look on dentists’ images. Clinical significance This research will provide an understanding of where children focus when they look at a dentist. This has not previously been known and will allow dentists to modify how they present themselves and interact with child patients.

Development of human dentition has been used as a predictor for evaluating the growth and maturity of an individual. It is fairly identical in a specific population, but the effect of development on subjects with dental anomalies had not been fully explored, particularly on subjects with supernumerary teeth (ST). This study hence aims to evaluate the dental development of children with and without ST. Sample size calculation was conducted and 320 radiographs of subjects with and without supernumerary teeth (ST) were obtained from the archives of a teaching hospital. The subjects in both groups were age and sex matched. All the subjects belong to southern Chinese ethnicity aged 2 to 14 years. The left-side dentition was scored, and dental age (DA) was estimated by obtaining scores from the southern Chinese dental reference dataset. Paired t test was used to calculate the difference between chronological age and dental age (CA-DA) for boys and girls with and without ST and further based on the number and position of ST. The difference between chronological age and dental age (CA-DA) was 0.10 years for boys and 0.19 years for girls with ST whilst 0.01 and 0.05 years for boys and girls without ST (p > 0.05). The boys with bilateral ST showed significant delay in dental development of 0.23 years (p

BACKGROUND Silver diamine fluoride (SDF) is a cariostatic agent used to adjunctively manage dental caries in high-risk groups. However, black staining is a frequently reported side effect following SDF application and influences the acceptability of this treatment. AIM To evaluate the staining potential of SDF and the influence of the potassium Iodide (KI) application on the degree of black staining over time. DESIGN Extracted carious primary molars were collected and sorted into pairs matched by tooth type, size and location of the carious lesion (n = 35). Teeth were stratified to receive either 38% SDF, KI immediately after SDF application, or 12% SDF. Standardised timelapse photography and image processing software was used to evaluate staining over a period of 7 days. RESULTS Following SDF application, the onset of black staining occurred within 2 min and increased in value for up to 6 h post-application. The use of KI immediately after SDF application resulted in no noticeable staining of the carious dentine or surrounding enamel. No significant differences were evident in the staining potential between the different SDF concentrations (38% and 12%). Furthermore, root surface and cementum was found to stain darker and more readily when compared with the coronal enamel surface. CONCLUSION SDF has the ability to visibly stain dental hard tissues and its staining potential may be modified by application of KI.

AIM To investigate the root canal morphology of hypomineralised second primary molars(HSPM) using micro-CT(μCT) compared with non-hypomineralised second primary molars (non-HSPM). METHODOLOGY Ten HSPM and 10 non-HSPM were divided into Group 1(maxillary HSPM), Group 2 (mandibular HSPM), Group 3(maxillary non-HSPM), and Group 4 (mandibular non-HSPM). All teeth were scanned using μCT to assess the following parameters: (i) root canal configuration, (ii) pulp volumes, and (iii) the influence of the root canal system landmarks on access cavity outline forms and canal curvature. Two-way ANOVA was employed for descriptive analysis (P

To conduct a meta-analysis of studies that have employed the Early Childhood Oral Health Impact Scale (ECOHIS) and Child Oral Health-Related Quality of Life (COHRQoL) instruments, to evaluate the oral health-related quality of life (OHRQoL) changes in children following dental treatment under general anaesthesia (DGA). A systematic search of 5 databases was conducted in accordance with the PRISMA guidelines. The inclusion criteria were use of ECOHIS and COHRQoL, pre-and post-operative assessments, patients aged between 0 and 16 years, no restrictions on the follow-up period and DGA. The primary outcome measure was changes in quality of life for both the children, which was based on mean difference (MD). Twenty-two articles were included in the meta-analysis. A favourable outcome in OHRQoL was identified in all studies. The combined MD for ECOHIS and COHRQoL were 1.62 [95% CI 1.52–1.71; P

Hypodontia and hyperdontia are considered to be at opposite ends of the dental development spectrum. Nevertheless, these anomalies may occur concomitantly (hypohyperdontia). This clinical report describes two case of hypohyperdontia occurring exclusively in the premaxillary region, and the difficulties associated with its diagnosis and management. Following 24 months of follow-up examinations, Case 1 developed a sequential supernumerary tooth in the tooth 35 region. Cases of hypohyperdontia can occur exclusively in the premaxillary region and may be difficult to diagnose. Multidisciplinary treatment planning is essential to facilitate appropriate management, and long-term follow-up is necessary as sequential supernumerary teeth may develop.

Hypophosphatasia has a wide clinical spectrum ranging from premature loss of primary teeth to neonatal death. The premature loss of primary teeth in a child with an otherwise unremarkable history may be the first sign of a more significant underlying disease. This report illustrates the role of the dental practitioner in facilitating the diagnosis of hypophosphatasia. CPD/Clinical Relevance: This report outlines the signs and symptoms essential to facilitate the diagnosis of hypophosphatasia by the dental practitioner.

Primate spaces are diastemata consistent with an inherent physiological pattern rather than functional adaptation. This article presents an atypically increased primate space only in the right mandibular arch. CPD/Clinical Relevance: Differential diagnoses that can be considered for an asymmetrically enlarged primate space include individual variation, tooth size, arch length discrepancy, infection, traumatic dental injury or an obstructive pathology, such as a malignant neoplasm, developmental cyst, odontoma or supernumerary tooth.

This study sought to evaluate the tooth mineral density (TMD) for the different lesion types in hypomineralised first permanent molars (FPMs) and compare them to unaffected enamel in clinically sound FPMs. Eighteen FPMs with varying degrees of hypomineralised enamel were grouped into brown, yellow/creamy and white lesion types. Micro-CT was used to determine the TMD for each lesion type, and for unaffected enamel at different locations in the outer, middle, and inner-third of the enamel. The average TMD for brown, yellow/creamy, white and unaffected enamel was 1.79, 2.21, 2.43 and 2.46 g/cm3, respectively. Brown and yellow/creamy lesions exhibited a statistically significant difference when compared to white lesions and unaffected enamel. However, no statistical difference was evident in TMD between white lesions and unaffected enamel. The TMD increased from the outer-third to inner-third for brown and yellow/creamy lesions (p

An odontoma is described as a hamartoma, which is usually classified as a benign tumour. This clinical report will describe an unusual presentation of an odontoma in the mandibular primary molar region and highlight the importance of a comprehensive clinical and radiographic examination. A systematic approach to reading bitewing radiographs will also be described. CPD/Clinical Relevance: This clinical report serves as a good example to highlight the importance of thorough radiographic examination to enable detection of tooth abnormalities and facilitate timely interventions; thus preventing or reducing the severity of the potential complications.

To evaluate whether the literature contains evidence, of an appropriate quality, to support the fundamental belief that there is an “optimal time” for extraction of FPMs with a poor prognosis. A comprehensive search, limited to human studies, was performed using five databases. PICO based inclusion and exclusion criteria were employed to facilitate article selection. Three independent reviewers assessed the quality of included studies using STROBE and GRADE criteria. Initially, 56 articles were selected, of which 9 were included for final assessments. None of the included studies obtained moderate or high GRADE level rating and neither did they meet all of the STROBE requirements with only one study satisfying 95%, and another study satisfying 73%, of the requirements. The inter-observer agreement was excellent. There is no scientific evidence, of an appropriate quality, to support the “optimal time” for extraction of FPMs with a poor prognosis.

Purpose: To determine the three-dimensional (3D) tooth morphology of all primary molars and to identify and consolidate positional factors that could potentially have an effect on tooth preparation. Study design: Thirty-one non-carious primary molars were scanned using micro-CT and reconstructed using 3D analysis software. Each pulp horn to its respective cusp tip distance (PHCD) was measured as well as the distances from the pulp chamber to the mesial, distal, lingual and buccal surfaces. One-way ANOVA and post-hoc t-tests were used for data analysis. Results: The mesio-buccal and disto-buccal PHCD was significantly shorter than the mesio-lingual and disto-lingual PHCDs in maxillary second primary molars (P < 0.05). Mesial, distal and lingual walls were thinner than the buccal walls of mandibular molars while in maxillary molars; the mesial and distal walls were thinner than the palatal and buccal walls (P < 0.05). Conclusions: First primary molars have thinner tooth structure surrounding the pulp than second primary molars in the same arch with the exception of the buccal walls of all molars and lingual walls of maxillary molars. The mesial and distal walls are thinner than the buccal walls of all molars and lingual walls in maxillary molars.

AIM To outline the current literature surrounding natal teeth, and then, in a pilot study, to evaluate natal teeth using micro-computed tomography (micro-CT) to determine their anatomical profile, and compare and contrast different analytical methods to assess natal teeth. METHODS 2 extracted natal teeth (mandibular central incisors) and 1 exfoliated mandibular primary central incisor were subjected to micro-CT analysis. RESULTS Within natal teeth, there were no statistical differences in tooth mineral density (TMD) of both enamel and dentine (P > .05), whereas mandibular primary central incisors had a significantly higher TMD of both enamel and dentine in comparison with both natal tooth 1 and natal tooth 2 (P

To assess the health-related quality of life (HrQoL) and oral health-related quality of life (OHrQoL) of preschool children with autism spectrum disorders (ASD) and to determine the associated factors. A case–control study of preschool children with and without ASD was undertaken. H&OHrQoL were assessed employing Pediatric Quality-of-Life Inventory Version 4.0 (PedsQL™ 4.0) and Early Childhood Oral Health Impact Scale (ECOHIS). Differences in PedsQL and ECOHIS scores were determined between groups and correlation between PedsQL and ECOHIS was explored. Regression analyses were conducted to determine key factors associated with H&OHrQoL. Parents of 510 children (253 cases and 257 controls) completed the H&OHrQoL questionnaire assessments. Significant difference in PedsQL (p

Reporting guidelines can improve the quality of reports of research findings. Some specialities in health care however require guidance on areas that are not captured within the existing guidelines, and this is the case for Paediatric Dentistry where no such standards are available to guide the reporting of different types of study designs. The ‘Reporting stAndards for research in PedIatric Dentistry’ (RAPID) group aims to address this need by developing guidelines on reporting elements of research of particular relevance to Paediatric Dentistry. The development of RAPID guidelines will involve a five‐phase process including a Delphi study, which is an explicit consensus development method designed and implemented in accordance with the Guidance on Conducting and REporting DElphi Studies. The guideline development process will be overseen by an Executive Group. Themes specific to areas in Paediatric Dentistry will be selected, and items to be included under each theme will be identified by members of the Executive Group reviewing at least five reports of experimental and analytical study types using existing reporting guidelines. For the Delphi study, the Executive Group will identify an international multidisciplinary RAPID Delphi Group (RDG) of approximately 60 participants including academics, Paediatric Dentists, parents, and other stakeholders. Each item will be evaluated by RDG on clarity using a dichotomous scale (‘well phrased’ or ‘needs revision’) and on suitability for inclusion in the Delphi study using a 9‐point Likert scale (1 = ‘definitely not include’ to 9 = ‘definitely include’). The items will then be included in an online Delphi study of up to four rounds, with participants invited from stakeholder groups across Paediatric Dentistry. Items scored 7 or above by at least 80% of respondents will be included in the checklist and further discussed in a face‐to‐face Delphi consensus meeting. Following this, the Executive Group will finalize the RAPID guidelines. The guidelines will be published in peer‐reviewed scientific journals and disseminated at scientific meetings and conferences. All the outputs from this project will be made freely available on the RAPID website: www.rapid-statement.org.

A 3 year and 8 months old Chinese boy was referred for a consultation regarding his missing maxillary anterior teeth. He had a history of trauma to his primary maxillary anterior teeth due to a fall at the age of 16 months. Clinical examination of the patient indicated multiple carious lesions and inadequate oral hygiene. Radiographic examination revealed intrusion of the primary left lateral incisor, with evidence of damage to the permanent tooth germ. Subsequently, the patient was followed-up for almost six years during which his permanent maxillary left lateral incisor erupted exhibiting an unusual morphology. Clinically enamel hypoplasia and radiographically dens invaginatus were evident in affected tooth.

Calcium phosphate and fluoride (F) delivery systems claim to facilitate enamel remineralization.To evaluate and compare (i) the remineralizing potential of ClinproCarious lesions, 200-300μm deep were produced by placing molars in demineralizing solution for 96h, sections 100-150μm thick were then randomly assigned to six groups(n=150). Specimens were treated thrice daily with a non-fluoridated(Group A), or fluoridated dentifrice[1000ppm, (Group B)], or CTC(Group C), TMP(Group D), fluoridated dentifrice followed by CTC(Group E), or a fluoridated dentifrice followed by TMP(Group F), and then subjected to a 10-day pH cycling model. Lesion evaluation involved polarizing light microscopy and microradiography.Posttreatment maximum mineral content at the surface zone(VCTC and TMP exhibited similar efficacy in remineralizing artificial carious lesions. Nevertheless, the net mineral gain or lesion consolidation following CTC use was higher than TMP.

Many oral and dental manifestations have been observed in Noonan syndrome (NS), which occur together or separately along with the general manifestations. Here, we describe the oral and dental manifestations of NS, highlighting the potential dental treatment modalities. The most commonly reported manifestations include, but are not limited to, maxillio-mandibular discrepancies, high-arched palate, micrognathia, malocclusion, anterior open-bite, posterior cross-bite, eruption disturbances, enamel defects, dental caries, eruption cysts, dilacerations, benign multiple giant cell lesions of hard and/or soft tissues, and odontogenic keratocysts and dental anomalies such as hypodontia, hyperdontia, taurodontism, microdontia, double-tooth. Therefore, it is essential that clinicians understand the nature and extent of these variations in the clinical presentation of NS patients so as to be proficient in diagnosis and the appropriate management. Furthermore, an interdisciplinary management is essential to achieve favorable treatment outcomes.

To assess the reliability of the vertical tube shift technique (VTST) and horizontal tube shift technique (HTST) for the localisation of unerupted supernumerary teeth (ST) in the anterior region of the maxilla. A convenience sample of 83 patients who attended a major teaching hospital because of unerupted ST was selected. Only non-syndromic patients with ST and who had complete clinical and radiographic and surgical records were included in the study. Ten examiners independently rated the paired set of radiographs for each technique. Chi-square test, paired t test and kappa statistics were employed to assess the intra- and inter-examiner reliability. Paired sets of 1660 radiographs (830 pairs for each technique) were available for the analysis. The overall sensitivity for VTST and HTST was 80.6 and 72.1% respectively, with slight inter-examiner and good intra-examiner reliability. Statistically significant differences were evident between the two localisation techniques (p

Objectives: To determine the F concentration of bottled waters that was available in Hong Kong and Qatar. Study design: The F concentrations of bottled waters collected from Hong Kong (n=81) and Qatar (n=32) were analysed. The F ion selective electrode method was used to measure the F concentration in the samples. Three measurements were obtained for every sample to ensure reproducibility and appropriate statistical analyses were employed. Results: Qatar group: F concentrations ranged from 0.06ppm to 3.0ppm with a mean value of 0.8ppm. The F concentrations displayed on the labels of the samples (60%) were significantly lower than the measured F concentration (p < 0.0001). Hong Kong group: F concentrations ranged from 0.04ppm to 2.52ppm with a mean value of 0.44ppm. The F concentrations displayed on the samples (16%) were significantly lower than the measured F concentration (p< 0.0001). Conclusion: Wide variations exist in the F concentration among the different brands of bottled water available in Hong Kong and Qatar. The F concentrations displayed on the labels were not consistent with the measured F concentrations.

Background No published studies exist on the remineralizing potential of Tooth Mousse Plus® (TMP) when applied for less than 3 min. Aim To evaluate (i) the remineralizing potential of TMP on artificial carious lesions, when applied thrice daily for 60 s, and (ii) the benefit of using a fluoridated dentifrice prior to TMP application. Design Carious lesions, 120–200 μm deep, were produced by placing molars in demineralizing solution for 96 h, and sections 100–150 μm thick were then randomly assigned to four groups. Specimens were treated thrice daily with a non-fluoridated (Group A), or 1000 ppm F dentifrice (Group B), or TMP (Group C), or a 1000 ppm F dentifrice followed by TMP application (Group D), and then subjected to a 10-day pH cycling model. Lesion evaluation involved polarizing light microscopy and microradiography. Results Post-treatment maximum mineral content at the surface zone (Vmax) was significantly increased and lesion depth (LD) significantly decreased in Group C, while only the Vmax increased in Group D. Increase in LD was observed in Group B; however, no significant differences were noted in percentage LD changes between groups B, C, and D (P > 0.05). Conclusions TMP applied for 60 s significantly remineralized the artificial carious lesions. No additional benefit was evident when TMP was preceded by treatment with 1000 ppm F dentifrice.

Objectives To assess the changes in the oral health-related quality of life (OHRQoL) of 221 preschool children who presented to the emergency department with the consequences of untreated dental caries requiring dental extractions under general anaesthesia (DEGA). Methods Two hundred and twenty-one healthy preschool children, who required emergency DEGA, were recruited over a period of 12 months. The same parent or caregiver completed the Early Childhood Oral Health Impact Scale (ECOHIS) questionnaire; both, prior to the DEGA and at the 2-week post-treatment visit. Data were analysed using repeated anova with adjustments for multiple comparisons using the Bonferroni tests with the significance level set at 5%. Results One hundred and twenty-six participants, with a mean age of 4.02 and a mean dmft score of 8.27 (SD = 4.13), completed the 2-week post-treatment questionnaires. The overall ECOHIS, CIS, and FIS scores decreased significantly (P < 0.001) after emergency DEGA, demonstrating large effect sizes. The biggest decrease in prevalence after emergency DEGA was observed for the items of pain in teeth, trouble sleeping, being irritated or frustrated, difficulty drinking food, and parents being upset. Conclusions The OHRQoL of preschool children, who presented to the emergency department with the consequences of untreated dental caries, was significantly improved following emergency DEGA.

To evaluate (1) the remineralizing potential of Tooth Mousse® (TM) on artificial carious lesions, when applied for 1 min, and (2) the benefit of a fluoridated dentifrice prior to TM application. Demineralisation caries-like lesions 120–200 μm deep were produced by placing molars in demineralizing solution for 96 h, sections 100–150 μm thick were then randomly assigned to four groups. Specimens were treated thrice daily with a non-fluoridated (Group A), or fluoridated dentifrice (1000 ppm) (Group B), or TM (Group C), or a fluoridated dentifrice followed by TM (Group D) then subjected to a 10-day pH cycling model. Lesion evaluation involved polarizing light microscopy and microradiography. Application of TM in isolation (Group C) for 1 min resulted in significant increase in lesion depth (LD), however, an increase in mineral content deposition (V max) was not significant. Post treatment LD increases were greatest in Group A, then Group C and Group B respectively. A decrease in LD (by 19.9 %) was noted only after fluoridated dentifrice and TM (Group D) were applied consecutively for 1 min each (p

Fluoridation of drinking water has been recognized as one of the most effective ways of achieving community-wide exposure to the caries prevention effects of fluoride (F). A vast majority of people in Qatar use bottled water for drinking. Use of bottled water without knowing the F level may expose children to dental caries risk if the F level is lower than optimal or to dental fluorosis if the F level is too high. The aim of this study was to determine the F concentration of bottled water available in Qatar. A total of 32 brands of bottled water were evaluated. The F concentrations displayed on the labels were recorded. The F ion-selective electrode method was used to measure the F concentration in water samples, and three measurements were taken for every sample to ensure reproducibility. The p value was set at 0.05. The F concentration ranged from 0.06 to 3.0 ppm with a mean value of 0.8 ppm (±0.88). The F levels were provided by the manufacturers on the labels of 60 % of the samples, but this was significantly lower than the measured F levels (p

BACKGROUND The health and well-being of children are intimately linked to their parents' physical, emotional, and social health and social circumstances. AIM To conduct a meta-analysis of studies that have used the Early Childhood Oral Health Impact Scale (ECOHIS) and Child Oral Health-Related Quality of Life (COHRQoL) instruments, to evaluate the family impact scale (FIS) changes following their children's dental treatment under general anaesthesia (DGA). METHODOLOGY A systematic search was undertaken using the PRISMA guidelines. The inclusion criteria consisted of patients below 16 years of age, DGA, pre- and post-operative assessments, and the use of ECOHIS and COHRQoL. FIS changes were the primary outcome measure, where the mean difference (MD) was calculated. RESULTS After initial search of 105 studies in the database, twenty-one articles were included in the analysis. A positive outcome in the FIS changes was identified in all studies. The combined MD for FIS using ECOHIS and COHRQoL was 1.52 [95% CI: 1.15-1.89; P

Background There is relatively little literature on the oral health experiences of individuals with Rett syndrome. This study described the incidence of dental extractions and restorations in a population-based cohort, according to a range of demographic and clinical factors. The association between bruxism and age was also investigated. Methods Existing questionnaire data in the population-based Australian Rett Syndrome Database for the years 2004, 2006, 2009 or 2011 on genetically confirmed female cases (n = 242) were analysed. Results The incidence rate of restorations and extractions were 6.8 per 100 person years (py) and 9.3 per 100 py respectively. The incidence of extractions decreased with increasing levels of income. Compared to those with a C-terminal mutation, the incidence rate of extraction was higher for those with large deletions (Incidence Rate Ratio (IRR) 4.93; 95% CI 1.46–16.7, p = 0.01). There was a 5% decrease in the risk of frequent bruxism for every one-year increase in age (Risk Ratio 0.95; 95% CI 0.94–0.97). Conclusions Social advantage may provide some protection for dental health in individuals with Rett syndrome. Those with more severe genotypes seemed to have poorer oral health outcomes.

To determine, using eye-tracking technology, (i) what children notice the most when they look at images of dental operatories and (ii) the effect of distractors on gaze pattern.Forty-one children aged 4-12 years (21 girls, 19 boys) viewed 13 images of dental operatories taken from different perspectives on a computer screen. One child was excluded due to calibration issues with the eye-tracking equipment. Areas of interest (AOI's) were pre-defined on each image, then a Tobii X2-60 eye-tracking camera was used to track the location of participant's gaze. Count of participants to fixate and mean length of fixation (LOF) for each AOI were measured.Significant differences in the mean LOF was noticed for bracket tables, handpieces, and the dental chair. Significantly differences in mean LOF between different areas of the images were noted where distractors (cartoons) were added.When viewing images of dental operatories on a computer screen, children fixated most on the bracket tables, handpieces, and dental chairs. The addition of distractors was able to change where they looked. Eye-tracking was able to effectively assess where the children looked.The findings demonstrate that children have inherent preferences for where they fixate when viewing images of a dental operatory. This has not previously been known and will allow customization of dental operatories where children will be treated.

This study compared oral health behaviours and barriers to dental care among preschool children with and without ASD, and evaluated dental knowledge and attitudes of their parents. 257 preschoolers with ASD and an age- and gender-matched control sample were recruited. Children with ASD had less frequently performed tooth-brushing and used toothpaste, but more often required parental assistance in tooth-brushing (p

Background The accuracy of estimated age should depend on the reference data sets (RDS) from which the maturity scores or Ages of Attainment (AoA) were obtained. This study aimed to test the accuracy of age estimation from three different population specific dental reference datasets (RDS). Methods Two hundred and sixty six dental panoramic radiographs of subjects belonging to southern Chinese ethnicity were scored and dental age (DA) was estimated from three reference datasets: French-Canadian, United Kingdom (UK) Caucasian and southern Chinese. Statistical significance was set at p 0.05). The southern Chinese RDS estimated the age of 80% of subjects within ±12 months range, and 90% of subjects within ±18 months range (p

Accurate measurement of the mechanical properties of the oral mineralized tissues is important for assessing and understanding the clinical performance of these tissues. Nanoindentation has found vast range of applications in the mechanical characterization of synthetic materials at the nano- and microscale. However, direct application of this technique to biological tissues often leads to erroneous results because some of the characteristics of these biological materials, such as viscoelasticity and moisture content are significant but are not addressed in the conventional data analysis protocol developed for nanoindentation on hard materials. For accurate measurement of their mechanical properties, the choice of appropriate indentation parameters, hardware and analysis methods are critical. This chapter provides a brief insight into some of the practical issues which need attention when using nanoindentation to characterize the mineralized tissues found in the oral cavity.

Assessment of age is a common procedure routinely conducted in many countries following birth date disputes, particularly following asylum claims and criminal offenses. UNICEF reports that only 65% of children in the world were registered, and the numbers of children who possess an authentic birth certificate were significantly lower than those registered. Legally important ages can be categorized into defined age ranges that vary among different countries. Recently, following an increase in the number of age-specific crimes, many countries have revised their legally important ages. This article is intended to report the most recent data on the ages of legal importance in the major countries of the world and implicate its relevance to birth registration and age assessment practices.

SUMMARY Objectives The aim of this review was to assess the methodologies used in previously published prospective randomized clinical trials on chemomechanical caries removal and to conduct a meta-analysis to quantify the differences in the excavation time between chemomechanical and conventional caries removal methods. Methods An electronic search was performed using Scopus, PubMed, EBSCO host, and Cochrane Library databases. The following categories were excluded during the assessment process: non-English studies published before 2000, animal studies, review articles, laboratory studies, case reports, and nonrandomized or retrospective clinical trials. The methodologies of the selected clinical trials were assessed. Furthermore, the reviewed clinical trials were subjected to meta-analysis for quantifying the differences in excavation time between the chemomechanical and the conventional caries removal techniques. Results Only 19 randomized clinical trials fit the inclusion criteria of this systematic review. None of the 19 reviewed trials completely fulfilled Delphi's ideal criteria for quality assessment of randomized clinical trials. The meta-analysis results revealed that the shortest mean excavation time was recorded for rotary caries excavation (2.99±0.001 minutes), followed by the enzyme-based chemomechanical caries removal method (6.36±0.08 minutes) and the the hand excavation method (atraumatic restorative technique; 6.98±0.17 minutes). The longest caries excavation time was recorded for the sodium hypochlorite-based chemomechanical caries removal method (8.12±0.02 minutes). Conclusions It was found that none of the current reviewed trials fulfilled all the ideal requirements of clinical trials. Furthermore, the current scientific evidence shows that the sodium hypochlorite-based (Carisolv) chemomechanical caries removal method was more time consuming when compared to the enzyme-based (Papacarie) chemomechanical and the conventional caries removal methods. Further prospective randomized controlled clinical trials evaluating the long-term follow-up of papain-treated permanent teeth are needed.

Several hypotheses have been proposed to explain hypodontia of the various tooth types with evolutionary and anatomic models. Hypodontia of all primary canines in a healthy individual is exceptionally rare and has not been previously reported in the dental literature. This clinical report describes a 4-year-old southern Chinese female with the congenital absence of the primary canines in all quadrants. Furthermore, all of the permanent tooth germs excluding the third molars were evident on a panoramic radiograph and were developing consistent with the subject’s chronological age. This case serves as an excellent example to refute the conventional wisdom that “all primary canines can never go missing” and that all of the currently proposed hypotheses to explain hypodontia have limitations.

Aim: To assess and compare the oral health status of preschool children with and without autism spectrum disorders. Methods: A random sample of 347 preschool children with autism spectrum disorder was recruited from 19 Special Child Care Centres in Hong Kong. An age- and gender-matched sample was recruited from mainstream preschools as the control group. Dental caries status, gingival health status, tooth wear, malocclusion, dental trauma and oral mucosal health were assessed and compared between the two groups. Results: It was feasible to conduct a comprehensive oral health screening among 74.1% (257) of the children with autism spectrum disorder. The mean age was 59 ± 10 months (range from 32 to 77 months), of whom 84.4% were males. Children with autism spectrum disorder had better gingival health than children without autism spectrum disorder (mean plaque score and gingival score p 0.05). Conclusion: Differences in oral health status exist among preschool children with and without autism spectrum disorder. Preschool children with autism spectrum disorder exhibited lower caries experiences and better gingival health than children without autism spectrum disorder.