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AIMS To compare the dental caries prevalence using the International Caries Detection and Assessment System (ICDAS) and the caries risk by Caries Management by Risk Assessment (CAMBRA) in individuals with cerebral palsy (CP) and normoactives (NAs). METHODS AND RESULTS Sixty children and adolescents aged 6-12 years (30 CP/30 NA) were clinically evaluated by one calibrated examiner using two-digit ICDAS criteria and converted into components of dmf/DMF indices: d2mf2/D2MF2 (enamel and dentin lesions) and d3mf3/D3MF3 (dentin lesions). An adapted CAMBRA was used for risk classification. The mean d2mf2s/d2mf2t and D2MF2S/D2MF2T for CP were 17.0 �� 16.8/7.5 �� 4.3 and 10.7 �� 17.6/5.3 �� 5.8, respectively, and for NA were 17.2 �� 16.9 /6.9 �� 4.8 and 11.1 �� 11.7/5.5 �� 4.7, respectively. The mean d3mf3s/d3mf3t and D3MF3S/D3MF3T for CP were 10.1���� 16.7/3.0 �� 4.1 and 4.9 �� 15.6/0.2 �� 0.4, respectively, while for NA the mean values were 9.8 �� 13.0/3.5 �� 3.8 and 2.1 �� 5.7/0.9 �� 2.0, respectively. There were no statistically differences for caries prevalence and risk in both groups (p��>��0.05). CONCLUSIONS Dental caries was highly prevalent in CP and NA children and adolescents. Enamel and dentin lesions and high caries risk were the most common condition.

Aim This systematic review and meta-analysis aimed to assess the diagnostic performance of commonly used methods for occlusal caries diagnostics, such as visual examination (VE), bitewing radiography (BW) and laser fluorescence (LF), in relation to their ability to detect (dentin) caries under clinical and laboratory conditions. Materials and methods A systematic search of the literature was performed to identify studies meeting the inclusion criteria using the PIRDS concept (N = 1090). A risk of bias (RoB) assessment tool was used for quality evaluation. Reports with low/moderate RoB, well-matching thresholds for index and reference tests and appropriate reporting were included in the meta-analysis (N = 37; 29 in vivo/8 in vitro). The pooled sensitivity (SE), specificity (SP), diagnostic odds ratio (DOR) and areas under ROC curves (AUCs) were computed. Results SP ranged from 0.50 (fibre-optic transillumination/caries detection level) to 0.97 (conventional BW/dentine detection level) in vitro. AUCs were typically higher for BW or LF than for VE. The highest AUC of 0.89 was observed for VE at the 1/3 dentin caries detection level; SE (0.70) was registered to be higher than SP (0.47) for VE at the caries detection level in vivo. Conclusion The number of included studies was found to be low. This underlines the need for high-quality caries diagnostic studies that further provide data in relation to multiple caries thresholds. Clinical relevance VE, BW and LF provide acceptable measures for their diagnostic performance on occlusal surfaces, but the results should be interpreted with caution due to the limited data in many categories.

Immigration in Italy is a constant call to hospitality, no less than to openness to build a physical and symbolic space for all people and groups, cultural and religious, in which immigrants come together for both linguistic and spiritual affinity. These groups and communities represent a challenge and an opportunity for the Italian church. With the aim of knowing in order to enhance and make known in the Italian local church a little of the experience of Christian and ecclesial life of Brazilians in Italy, in the first semester of 2017 a research was conducted among immigrants from Brazil. The article presents the main results of an interactive listening with dozens of people, in fifteen cities, where believers of Brazilian origin actively participate in the local Christian community, in parishes or in ethnic communities.

Objectives Biallelic variants in solute carrier family 24 member 4 (SLC24A4) have been previously reported to cause non-syndromic autosomal recessive amelogenesis imperfecta (AI) of the pigmented hypomaturation type (MIM #615887). We here describe a novel variant in SLC24A4 causing mild enamel hypomaturation defects also in heterozygous individuals. Materials and methods In the present pedigree analysis, a large consanguineous Syrian family with AI of the hypomaturation type was investigated by clinical and dental evaluation, and exome and Sanger sequencing. Dental histological investigations of seven primary and two permanent teeth were performed. Results Homozygous variants in SLC24A4 (c.1604G>A; p.Gly535Asp) were identified in five individuals with brown discolorations and irregular pits and grooves of the teeth. Severe attritions, occlusal abfractions, and the radiological lack of contrast between enamel and dentin point out a mineralization defect. Histological dental investigations confirmed the clinical diagnosis of AI of the hypomaturation type. In two heterozygous individuals, a mild hypomaturation defect was present with white and light brown enamel discolorations. Conclusions This is the first report of heterozygous SLC24A4 variants causing mild hypomaturation defects, providing confirmatory evidence that the function of SLC24A4 in calcium transport has a crucial role in the maturation stage of amelogenesis. Clinical relevance The present report is expanding the clinical phenotype of SLC24A4 variants to more severe forms of amelogenesis imperfecta. An autosomal-dominant inheritance pattern with mild clinical phenotypes in heterozygotes has to be considered.

Background: Specular reflection can be used to quantify dental erosion, and might also provide similar results for caries. This study assessed the possibility of using specular reflection intensity (SRI; quantitative lesion activity assessment) to measure the progression of initial enamel caries lesions. Methods: Two hundred native enamel specimens and flat ground enamel specimens (n=100 each) were subjected to a 4-species biofilm caries model during 2, 4, 6, 8, and 10 weeks (n=20 each), to induce ‘active’ enamel caries lesions. Afterwards, to induce ‘inactive’ lesions, all specimens were continuously remineralized and brushed twice daily for 2, 4, 6, 8, and 10 weeks. Change in specular reflection intensity (%SRI), visual caries detection (ICDAS) and visual caries severity assessment were performed for all active lesions and during the remineralization phase. Scanning electron microscopy (SEM) images were taken for qualitative analysis. Results: For active lesions, %SRI dropped from 100% to about 80% in native enamel, and to about 15% in polished enamel. Remineralization/brushing increased %SRI in native enamel, but not in polished enamel. The comparison with visual caries scores yielded a better linear relationship of %SRI with early enamel lesion where caries was induced for up to 6 weeks. Conclusion: The use of the optical reflectometer for the assessment of caries lesion activity seemed to work better for early caries lesions and for polished specimens.

Contains fulltext : 154871.pdf (Publisher’s version ) (Closed access) OBJECTIVE: Due to an increased focus on erosive tooth wear (ETW), the European Federation of Conservative Dentistry (EFCD) considered ETW as a relevant topic for generating this consensus report. MATERIALS AND METHODS: This report is based on a compilation of the scientific literature, an expert conference, and the approval by the General Assembly of EFCD. RESULTS: ETW is a chemical-mechanical process resulting in a cumulative loss of hard dental tissue not caused by bacteria, and it is characterized by loss of the natural surface morphology and contour of the teeth. A suitable index for classification of ETW is the basic erosive wear examination (BEWE). Regarding the etiology, patient-related factors include the pre-disposition to erosion, reflux, vomiting, drinking and eating habits, as well as medications and dietary supplements. Nutritional factors relate to the composition of foods and beverages, e.g., with low pH and high buffer capacity (major risk factors), and calcium concentration (major protective factor). Occupational factors are exposition of workers to acidic liquids or vapors. Preventive management of ETW aims at reducing or stopping the progression of the lesions. Restorative management aims at reducing symptoms of pain and dentine hypersensitivity, or to restore esthetic and function, but it should only be used in conjunction with preventive strategies. CONCLUSIONS: Effective management of ETW includes screening for early signs of ETW and evaluating all etiological factors. CLINICAL RELEVANCE: ETW is a clinical condition, which calls for the increased attention of the dental community and is a challenge for the cooperation with other medical specialities.

Objectives To provide consensus recommendations on how to intervene in the caries process in adults, specifically proximal and secondary carious lesions. Methods Based on two systematic reviews, a consensus conference and followed by an e-Delphi consensus process were held with EFCD/ORCA/DGZ delegates. Results Managing an individual’s caries risk using non-invasive means (oral hygiene measures including flossing/interdental brushes, fluoride application) is recommended, as both proximal and secondary carious lesions may be prevented or their activity reduced. For proximal lesions, only cavitated lesions (confirmed by visual-tactile, or radiographically extending into the middle/inner dentine third) should be treated invasively/restoratively. Non-cavitated lesions may be successfully arrested using non-invasive measures in low-risk individuals or if radiographically confined to the enamel. In high-risk individuals or if radiographically extended into dentine, for these lesions, additional micro-invasive (lesion sealing and infiltration) treatment should be considered. For restoring proximal lesions, adhesive direct restorations allow minimally invasive, tooth-preserving preparations. Amalgams come with a lower risk of secondary lesions and may be preferable in more clinically complex scenarios, dependent on specific national guidelines. In structurally compromised (especially endodontically treated) teeth, indirect cuspal coverage restorations may be indicated. Detection methods for secondary lesions should be tailored according to the individual’s caries risk. Avoiding false positive detection and over-treatment is a priority. Bitewing radiographs should be combined with visual-tactile assessment to confirm secondary caries detections. Review/refurbishing/resealing/repairing instead of replacing partially defective restorations should be considered for managing secondary caries, if possible. Conclusions An individualized and lesion-specific approach is recommended for intervening in the caries process in adults. Clinical significance Dental clinicians have an increasing number of interventions available for the management of dental caries. Many of them are grounded in the growing understanding of the disease. The best evidence, patients’ expectations, clinicians’ expertise, and the individual clinical scenario all need to be considered during the decision-making process.

This paper provides recommendations for dentists for the treatment of dental caries in children, with an emphasis on early childhood caries (ECC), primary teeth, and occlusal surfaces in permanent teeth. A consensus workshop followed by an e-Delphi consensus process was conducted with an expert panel nominated by the European Organization for Caries Research (ORCA) and European Federation of Conservative Dentistry (EFCD)/German Association of Conservative Dentistry (DGZ) boards. Based on 3 systematic reviews and a nonsystematic literature search, recommendations were developed. The caries decline has led to a more polarized disease distribution in children and adolescents along social gradients which should be taken into account when managing the caries process at all levels, such as the individual, the group, or a population. The control or reduction of caries activity is the basis for successful caries management. In children, caries management requires adequate daily oral hygiene and fluoride application via toothpaste, ensured by caregivers, and especially for ECC prevention an emphasis on sugar intake reduction is needed. These noninvasive interventions are also suitable to arrest or control initial or even cavitated dentine caries lesions in the absence of irreversible pulpitis. Fluoride varnish or silver diammine fluoride can be added as supplementary agents. In pits and fissures, composite resin materials can be used as preventive sealants and for defect-oriented minimally invasive restorations. In primary molars, preformed metal crowns are more successful than multisurface fillings, especially in caries-active patients. With persisting high caries activity, multiple lesions, and limited cooperation, caries control should consist of robust measures with high success rates, even including extraction in selected cases. This applies especially to treatments performed under general anesthesia., info:eu-repo/semantics/published

Background: The first clinically detectable stage of caries lesion is a non-cavitated white spot lesion (WSL). The detection of early stages of caries lesions allows non-invasive management by fluoride usage, oral hygiene and diet control. There is a lack of information in the literature regarding the prevalence of these caries lesions in preschool children, which is important especially for public health strategies. Objective: The aim of this study was to conduct a systematic review with meta-analysis to verify the WSLs prevalence in primary teeth of preschool children. Methods: A literature search with MEDLINE/PubMed, Scopus, Web of Science, and Open Gray databases was conducted. Included studies fulfilled the eligibility criteria. Meta-analyses were performed using random effects model, for prevalence of pooled WSLs and subgroups analyses. Results: The search strategy identified 4922 potentially relevant articles, with final inclusion of 16 studies. The pooled prevalence of WSLs in primary teeth was 14.0% (95% CI: 8.0-24.0), without publication bias (p=0.2668). For subgroup analyses, an increase in WSLs prevalence for children of low-income economy (24.0%; 95% CI: 20.0-28.0), for age >31 months (22.0%; 95% CI: 12.0-37.0), for validated visual criteria assessment (20.0%; 95% CI: 11.0-33.0), and for tactile assessment with ball-ended probe (26.0%; 95% CI: 11-50.0) were detected. Conclusion: It is suggested that the prevalence of WSLs in primary teeth of preschool children increases in countries with low income economy, with age greater than 31 months or texture assessment with visual validated criteria or ball-ended probe. PROSPERO Registration: Protocol number #CDR42017078434.

To investigate the effect of toothpastes on dentine surface loss and tubule occlusion, and the association of toothpaste-related factors to each of the outcomes. One hundred and sixty human dentine specimens were randomly distributed into 10 groups, according to different toothpastes. The specimens were submitted to artificial saliva (60 min), citric acid (3 min), and brushing abrasion (25 s; totalizing 2 min in toothpaste slurries). This was repeated five times and two outcome variables were analyzed: dentine surface loss (dSL; μm) and tubule occlusion by measurement of the total area of open tubules (Area-OT; μm2). Data were analyzed with Kruskal-Wallis and Mann-Whitney tests (α = 0.05); bivariate and multivariate regressions were used to model the association of the chemical (pH, concentration of F−, Ca2+, and PO43− and presence of Sn2+) and physical (% weight of solid particles, particle size, and wettability) factors of the toothpastes to both outcome variables. Toothpastes caused different degrees of dSL and did not differ in Area-OT. All chemical and physical factors, except the presence of Sn2+, were associated with dSL (p

Reversible data hiding with automatic contrast enhancement methods provide an interoperable way to reduce the storage requirement for automatic image enhancement applications: original image can be recovered from the enhanced image without any additional information. Unlike the previous work, where the goal was to maximize the contrast, the proposed method increases the contrast to an appropriate level using an idea called brightness preservation. This is achieved by using an adaptive bin selection process based on the original brightness. Extensive experimental results verify that the enhanced images produced using the proposed method are visually and quantitatively superior than the existing work.

Aim This systematic review and meta-analysis aimed to assess the diagnostic accuracy and reliability of commonly used caries detection methods for proximal caries diagnostics. Visual examination (VE), bitewing radiography (BWR), laser fluorescence (LF), and fibre-optic transillumination (FOTI) were considered in detail. Material and methods PRISMA guidelines for the reporting of systematic reviews and meta-analyses were applied. The mnemonic PIRDS (problem, index test, reference test, diagnostic and study type) concept was used to guide the literature search. Next, studies that met the inclusion criteria were stepwise selected and evaluated for their quality with a risk of bias (RoB) assessment tool. Studies with low/moderate bias and sufficient reporting were considered for meta-analysis. The pooled sensitivity (SE), specificity (SP), diagnostic odds ratio (DOR), and area under the ROC curve (AUC) were calculated. Results From 129 studies meeting the selection criteria, 31 in vitro studies and five clinical studies were finally included in the meta-analysis. The AUC values for in vitro VE amounted to 0.84 (caries detection) and 0.85 (dentin caries detection). BWR ranged in vitro from 0.55 to 0.82 (caries detection) and 0.81–0.92 (dentin caries detection). LF showed higher AUC values for overall caries detection (0.91) and dentin caries detection (0.83) than did other methods. Clinical data are limited. Conclusion The number of diagnostic studies with low/moderate RoB was found to be low and indicates a need for high-quality, well-designed caries diagnostic studies. Clinical relevance BWR and LF showed good diagnostic performance on proximal surfaces. However, because of the low number of includable clinical studies, these data should be interpreted with caution.

The formation of a physiological biofilm cannot be avoided under normal circumstances. However, the consequences of a supragingivally located biofilm, such as caries, gingivitis and, as a further effect, periodontitis, are relatively easy to avoid. The simplest and most common method used worldwide for the elimination of biofilm is periodic mechanical removal using a toothbrush or similar tools, such as chewing sticks or woods. This method was already used in ancient Egypt, and is still being used today, albeit advanced and improved with the help of toothpastes. Here we give a summary of the most common toothbrushes, highlighting their advantages and disadvantages. Furthermore, we provide an overview of the most common toothpastes, their ingredients, and functions. In addition, the ingredients will be critically evaluated and recommendations given for the use or non-use of certain ingredients for different target groups, such as children, healthy adults, or patients with special needs.

Following the publication in 2005 of the ‘Profiles and Competences of a European Dentist’ by the Association for Dental Education in Europe (ADEE), curricula have been developed and published for undergraduate dental studies in several disciplines. To date, no attempt has been made to develop a curriculum in the field of Conservative Dentistry (Operative/Restorative Dentistry) based on updated ADEE recommendations. A European Federation of Conservative Dentistry (EFCD) Curriculum Workshop, which adopted the ADEE learning outcomes-based approach ,was held in July 2018 for the purpose of developing expert consensus from across Europe and beyond on a curriculum for Integrated Conservative Oral Healthcare. The proposed curriculum is considered to underpin general oral healthcare provision, and to complement curricula in associated subject areas (e.g. cariology) and other closely related dental disciplines (e.g. endodontology and periodontology). This concept, referred to as ‘ConsCare’ for convenience, is about teaching undergraduate dental students to counsel and manage patients to achieve and maintain optimal oral health throughout life. The expert group of authors developed a curriculum to prepare new graduates to deliver integrated conservative oral healthcare, and thereby make a major, fit-for-future purpose contribution to life-long oral health. Dental schools across Europe and elsewhere in the world are encouraged to adopt the proposed curriculum and give ConsCare a central position in the teaching of general oral healthcare provision to undergraduate dental students.

The third and last volume of the collection Social and Solidarity Economy in Higher Education: A Space for Innovation presents curricular experiences in universities in Colombia, Brazil, Argentina, Portugal, and Spain. It begins with the systematization of an experience that emerged in the late 1970s in Colombia, which has inspired the creation of subsequent formal and non-formal programs to strengthen the theory and practice of solidarity economy in the territories. Then, the training activities of the SSE in the classroom were linked to mathematics and its contributions to the popular economy. In the line of curriculum development, its two chapters show the innovative contribution of the teaching of the social economy in a master’s degree in Portugal and of the production of knowledge through undergraduate projects and projects in Colombian universities. The following chapters explore the aesthetic experiences in the solidarity economy, as well as the role that virtual education plays in the development of entrepreneurial skills. Finally, Brazil once again provides an example of the capacity of universities for solidarity entrepreneurship and innovation (the LabEcosol experience and its impacts on the territory).

Objectives The aim of this in vivo prospective clinical study was to validate a near-infrared light transillumination (NILT) device for the detection of proximal caries lesions and compare it to the established diagnostic method of bitewing radiography (BWR). Materials and methods A total of 116 interproximal posterior teeth/surfaces without gross cavitation were included and assessed with BWR and NILT. After clinical examination, the teeth with sound surfaces or non-cavitated caries lesions were separated with the use of an orthodontic separation rubber for 24 h. Upon removal of the separator a silicon impression was obtained and the teeth surfaces were directly investigated. Intra- and inter-examiner reproducibility, sensitivities (SE) and specificities (SP) as well as the area under ROC curves (AUC) were calculated. Results The SE of NILT was 0.92 in D1 lesions and 1.00 in D2 and D3 lesions, respectively. BWR showed SE values of 0.81 in D1 lesions, 0.74 in D2 and 1.00 in D3 lesions, respectively. However, NILT showed lower values of SP (D1 0.38, D2 0.42 and D3 0.99) compared to BWR (D1 0.65, D2 0.88, D3 1.00). Intra-examiner reproducibility increased for both examiners from the initial examination (0.68 and 0.62) to the recall appointment (0.89 and 0.76) respectively. Conclusion The performance of NILT in detection of enamel caries was comparable to BWR. NILT could be considered as a useful and reliable tool in clinical practice. However, monitoring of enamel lesions might not be accurate, since a low specificity of NILT at D1,2 level and a tendency to false positive ratings have been shown. Therefore, it is recommended that treatment decisions should not be based on NILT alone. Clinical relevance This study might indicate that NILT can be used for routine patient screening but the use of BWR is still important for treatment decisions.

Resumo Introdução A economia solidária se apresenta como estratégia de inclusão social pelo trabalho para pessoas com sofrimento psíquico. No Brasil, até 2005 não havia um levantamento sistematizado de Empreendimentos Econômicos Solidários (EES) que permitisse análises sobre esta realidade, ainda que informações desta natureza sejam reconhecidamente fundamentais para a avaliação e avanço de estratégias de sustentação destas ações. A Secretaria Nacional de Economia Solidária (SENAES) investiu no mapeamento nacional dos EES desde 2005 e, entre os anos de 2010 a 2013, foi realizado o segundo e último levantamento relativo aos EES no país, que alimentou o Sistema Nacional de Informações em Economia Solidária (SIES). Objetivo Caracterizar os empreendimentos econômicos solidários do campo da saúde mental cadastrados no banco de dados do SIES, oriundo do segundo mapeamento nacional. Método Trata-se de um estudo documental que analisou descritivamente os dados constantes no SIES. Resultados Foram identificados 140 empreendimentos compostos predominantemente por pessoas com transtornos mentais, inclusive quando decorrentes do uso de álcool e outras drogas, totalizando 19.708 empreendimentos cadastrados em todo território nacional. Os resultados apontam que há muitas semelhanças nas características dos EES do campo da saúde mental com os demais EES, como o tipo de organização, a atividade econômica desenvolvida, os espaços de comercialização, as conquistas e os desafios, por exemplo. Conclusão Entre as especificidades dos empreendimentos do campo da saúde mental, é possível apontar de maneira mais significativa a distribuição regional e área de atuação. Discute-se sobre as conquistas reveladas pelo mapeamento e sobre os desafios colocados para o avanço. Abstract Introduction The solidarity economy is a strategy of social inclusion through work for people with psychic suffering. In Brazil, until 2005 there was no systematized survey of Solidary Economical Enterprises (SEE) that allowed analyzes on this reality, even though information of this nature is recognized as fundamental for the evaluation and advancement of strategies to sustain these actions. The National Secretary for Solidarity Economy (SENAES) has invested in the national mapping of the SEE since 2005, and between 2010 and 2013, the second and last survey on the SEE was carried out in the country, which fed the National Information System in Solidarity Economy (SIES). Objective To characterize the solidary economical enterprises of the field of mental health registered in the database of SIES from the second national mapping. Method This is a documentary study that analyzed descriptively the data contained in SIES. Results One hundred and forty enterprises were identified, predominantly composed of people with mental disorders, including those resulting from the use of alcohol and other drugs in a total of 19,708 enterprises registered in Brazil. The results point out that there are many similarities in the characteristics of SEE in the field of mental health with other SEE, such as the type of organization, economic activity developed, marketing spaces, achievements and challenges. Conclusion Among the specificities of the mental health field, we can point more significantly to the regional distribution and area of action. It discusses the achievements revealed by the mapping and the challenges posed for the advancement.

Contains fulltext : 218124.pdf (Publisher’s version ) (Closed access) Our understanding of erosive tooth wear and its contributing factors has evolved considerably over the last decades. New terms have been continuously introduced, which frequently describe the same aspects of this condition, whereas other terms are being used inappropriately. This has led to unnecessary confusion and miscommunication between patients, professionals, and researchers. A group of 15 experts, selected by the European Organization for Caries Research (ORCA) and the Cariology Research Group of the International Association for Dental Research (IADR), participated in a 2-day workshop to define the most commonly used terms in erosive tooth wear. A modified Delphi method was utilized to reach consensus. At least 80% agreement was achieved for all terms discussed and their definitions related to clinical conditions and processes, basic concepts, diagnosis, risk, and prevention and management of erosive tooth wear. Use of the terms agreed on will provide a better understanding of erosive tooth wear and intends to enable improved communication on this topic.

Objective: Saliva is the most important biological factor to protect against erosive tooth wear (ETW). Gastroesophageal reflux disease (GERD) patients have an increased risk of ETW due to the frequent presence of intrinsic acids in the oral cavity. Remarkably, not all GERD patients suffer from ETW, which might be due to differences in the composition of the saliva. Methods: This study compared the proteomic profile of saliva in patients (1) with GERD and ETW (basic erosive wear examination, BEWE, score ≥9; GE group) and (2) with GERD without ETW (BEWE = 0; GNE group) using shotgun label-free quantitative proteomic analysis nLC-ESI-MS/MS. The ability of hemoglobin (Hb) to protect against initial enamel erosion caused by a daily 10-s immersion of enamel specimens in 0.01 M HCl (pH 2.3) for 3 days was evaluated in vitro for proof of concept. Surface hardness change was used as response variable. Results: The differential expression of Hb subunits was significantly increased in the GNE group versus the GE group, in particular the Hb α-subunit that showed a >22-fold increase. Expressions of serum albumin (4.5-fold) and isoforms of cytoskeletal keratin type II (>3-fold) were also increased in the GNE group. Proteinase inhibitors, such as α1-antitrypsin and α2-macroglobulin, were only identified in the GNE group. In vitro, Hb (1.0 and 4.0 mg/mL) significantly reduced initial enamel erosion compared to a negative control after 3 days. Conclusions: Our results indicate that many proteins, with special emphasis on Hb, may be involved in the resistance of GERD patients to the occurrence of ETW. These proteins may be candidates for inclusion in dental products to protect against ETW.

While a consensus exists that advanced digital and mechatronic technology is on the cusp of profoundly impacting virtually every manufacturing and industry sector, there are some industries that seem to have profited far less from this ongoing ‘revolution’. One prominent example of this is the construction sector and, in particular, building construction. In this paper, we aim at discussing some of the reasons for this apparent lack, and some reasons why this might change in the near future. We introduce the problem of digital in situ fabrication as both a significant challenge and a huge opportunity. We support the discussion with an example of a robotically-fabricated digital concrete wall. Overall, we find that solving in situ fabrication constitutes an inherently multidisciplinary challenge.

SUMMARYObjectives: To evaluate the impact of magnification aids on the precision of tooth preparation under simulated clinical conditions.Methods and Materials: Two plastic blocks marked with a geometric shape were fixed in a dental phantom head: a circle as the distal surface of tooth 16 (UNS 3) and a y-shaped figure as the occlusal surface of tooth 36 (UNS 19). Sixteen dentists (mean age: 39 years; range: 26-67 years) prepared the geometric shapes from the inside to the boundary line with a cylindrical bur and water-cooling. The boundary line had to be touched but not erased. Chair-side assistance was provided to simulate the clinical situation. Tooth 16 was prepared under indirect vision via a dental mirror. Tooth 36 was prepared under direct vision A) without magnification aids, B) with Galilean loupes, 2.5× and light-emitting diode light, and C) with a microscope, 6.4× and coaxial light. The preparation procedure was performed three times in different sequences of the magnification devices and with a break of at least 1 week between each procedure. The correctly prepared contour and the incorrectly prepared areas were evaluated in relation to the whole circumference of the geometric shapes.Results: For both values the precision was significantly higher when a microscope was used, followed by preparation using loupes; precision was lowest without magnification aids (pConclusions: Magnification devices improved the precision of tooth preparation under simulated clinical conditions.

Erosive tooth wear is defined as irreversible loss of dental tissues due to intrinsic or extrinsic acids, exacerbated by mechanical forces. Recent studies have suggested a higher prevalence of erosive tooth wear in males, as well as a genetic contribution to susceptibility to erosive tooth wear. Our aim was to examine erosive tooth wear by performing a genome-wide association study (GWAS) in a sample of the Northern Finland Birth Cohort 1966 (n = 1,962). Erosive tooth wear was assessed clinically using the basic erosive wear examination. A GWAS was performed for the whole sample as well as separately for males and females. We identified one genome-wide significant signal (rs11681214) in the GWAS of the whole sample near the genes PXDN and MYT1L. When the sample was stratified by sex, the strongest genome-wide significant signals were observed in or near the genes FGFR1, C8orf86, CDH4, SCD5, F2R, and ING1. Additionally, multiple suggestive association signals were detected in all GWASs performed. Many of the signals were in or near the genes putatively related to oral environment or tooth development, and some were near the regions considered to be associated with dental caries, such as 2p24, 4q21, and 13q33. Replications of these associations in other samples, as well as experimental studies to determine the biological functions of associated genetic variants, are needed.

Peritoneal dialysis (PD) performed with transmembrane pH-gradient liposomes was reported to efficiently remove ammonia from the body, representing a promising alternative to current standard-of-care for patients with severe hepatic encephalopathy. In this study, we further characterized the properties of liposome-supported peritoneal dialysis (LSPD) by 1) assessing its in-use stability in the presence of ascitic fluids from liver-disease patients; 2) investigating its interactions with drugs that are commonly administered to acute-on-chronic liver failure patients; and 3) analyzing the in vivo extraction profile of LSPD. We found that LSPD fluid maintained its in vitro ammonia uptake capability when combined with ascitic fluids. The co-incubation of selected drugs (e.g., beta-blockers, antibiotics, diuretics) with LSPD fluids and ammonia resulted in limited interaction effects for most compounds except for two fluoroquinolones and propranolol. However, considering the experimental set-up, these results should be interpreted with caution and confirmatory drug-drug interaction studies in a clinical setting will be required. Finally, metabolite-mapping analysis on dialysates of LSPD-treated rats revealed that the liposomes did not remove important metabolites more than a conventional PD fluid. Overall, these findings confirm that LSPD is a potentially safe and effective approach for treating hyperammonemic crises in the context of acute-on-chronic liver failure.

OBJECTIVES The aim of this study was (i) to evaluate the visual performance of dental hygienists in their clinical environment and (ii) to analyse the relationship between self-assessed and objectively measured visual acuity. METHODS The near visual acuity of 191 dental hygienists and dental hygiene students was self-assessed with a visual analogue scale and objectively measured with miniaturized visual tests in a simulated clinical setting. The visual acuity was also measured with magnification aids if they were part of the individual clinical equipment. The influence of age and magnification on the near visual acuity was analysed. RESULTS The visual performance with respect to dental working distance showed a variability of 300% in the dimension of the smallest recognized structure. A weak positive correlation between the self-assessed and objectively measured visual performance (Spearman's rank correlation = 0.27) and a highly significant impact of the test person's age and the use of loupes (both P

Variable Stiffness Catheter In article number 2101290 by Quentin Boehler, Bradley J. Nelson, and co‐workers, a magnetically controlled catheter that is able to continuously change its stiffness is presented. Soft, magnetic tools that are enhanced with the capability to apply and control forces during surgical intervention can significantly improve outcome of the procedure. The capabilities are demonstrated by performing a fully robotic surgery for a challenging ophthalmic intervention. Image designed by Adrián Bago González. [Image: see text]

Journal of Clinical Medicine 10(15), 3223 (2021). doi:10.3390/jcm10153223 special issue: "Special Issue "Recent Advances in the Management of Dental Caries" / Special Issue Editor: Prof. Dr. Rainer Haak, Guest Editor", Published by MDPI, Basel

Retrospective chart review. To describe (i) the nutritional blood parameters (NBP) and the nutritional risk screening (NRS) in patients with spinal cord injury (SCI) and pressure ulcers (PU) III and IV according to the EPUAP classification, and (ii) the relationship between both NBP and NRS. SCI acute care and rehabilitation clinic in Switzerland. The NBPs were measured upon the admission of patients treated for PU III and IV between 11/2011 and 12/2014. Descriptive analyses and group comparisons were done. A total of 170 patients, including 42 (25%) women, 19 (12%) people with paraplegia and 104 (61%) people with traumatic SCI, were admitted and analyzed. Pathologic blood values and NBP were found for c-reactive protein (83%), vitamin D (73%), protein (41%), erythrocyte sedimentation rate (ESR) (41%), albumin (34%), hemoglobin (34%), zinc (29%), folic acid (22%), transferrin (15.3%), and copper (1.2%). Overall, the NRS was >3 in 39% of the patients, wherefrom 28% in patients with PU III and 44% with PU IV (p=0.07). No statistical significant differences were found between patients with PU III and IV in terms of NBP and NRS. We found abnormal values in NBP and in NRS in a significant number of patients with SCI and PU of both III and IV. Both laboratory examinations and nutritional assessments at admission can help to detect and correct the nutritional deficits in patients at risk. Neither the grade of the PUs, nor the NBP or the NRS can replace one another.

Item does not contain fulltext BACKGROUND: Kohlschutter-Tonz syndrome (KTZS) is a rare autosomal-recessive disease characterised by epileptic encephalopathy, intellectual disability and amelogenesis imperfecta (AI). It is frequently caused by biallelic mutations in ROGDI. Here, we report on individuals with ROGDI-negative KTZS carrying biallelic SLC13A5 mutations. METHODS: In the present cohort study, nine individuals from four families with the clinical diagnosis of KTZS and absence of ROGDI mutations as well as one patient with unexplained epileptic encephalopathy were investigated by clinical and dental evaluation, parametric linkage analysis (one family), and exome and/or Sanger sequencing. Dental histological investigations were performed on teeth from individuals with SLC13A5-associated and ROGDI-associated KTZS. RESULTS: Biallelic mutations in SLC13A5 were identified in 10 affected individuals. Epileptic encephalopathy usually presents in the neonatal and (less frequently) early infantile period. Yellowish to orange discolouration of both deciduous and permanent teeth, as well as wide interdental spaces and abnormal crown forms are major clinical signs of individuals with biallelic SLC13A5 mutations. Histological dental investigations confirmed the clinical diagnosis of hypoplastic AI. In comparison, the histological evaluation of a molar assessed from an individual with ROGDI-associated KTZS revealed hypocalcified AI. CONCLUSIONS: We conclude that SLC13A5 is the second major gene associated with the clinical diagnosis of KTZS, characterised by neonatal epileptic encephalopathy and hypoplastic AI. Careful clinical and dental delineation provides clues whether ROGDI or SLC13A5 is the causative gene. Hypersensitivity of teeth as well as high caries risk requires individual dental prophylaxis and attentive dental management.

Background Dental caries morbidity stages and their impact on oral health-related quality of life (OHRQoL) have not yet been established. Aim To compare the association of dental caries morbidity stages with OHRQoL in children and adolescents from public schools of Patos-PB, Brazil. Design A cross-sectional study was performed on 461 students at 8-10 years and 454 at 11-14 years. Caries was evaluated by Caries Assessment Spectrum and Treatment (CAST) instrument. The maximum CAST code per individual was registered. OHRQoL was assessed using the Child Perceptions Questionnaires for children (CPQ8-10 ) and adolescents (CPQ11-14 ). Results Morbidity stage was the most prevalent caries condition in children (40.8%) and adolescents (38.1%). Factors associated with higher CPQ8-10 scores in the multivariate regression analysis after adjustments were age [9 years, prevalence ratio (PR): 1.24; 95% confidence interval (CI): 1.06-1.45; and 10 years, PR: 1.32, CI: 1.13-1.55] and dental caries status [morbidity, PR: 1.23, CI: 1.03-1.48; and severe morbidity, PR: 1.30, CI: 1.04-1.61]. The factor associated with higher CPQ11-14 scores was dental caries status [morbidity, PR: 1.20, CI: 1.00-1.44]. Conclusions The OHRQoL of children was negatively associated with morbidity and severe morbidity stages of dental caries, while for adolescents, only morbidity had a negative association with their OHRQoL.

Objectives To determine the prevalence, severity and distribution of erosive tooth wear lesions in adult patients at the Universidad de los Andes Health Center in the San Bernardo Metropolitan Region, Chile, during a period of 4 months in 2016. Methods A cross-sectional study was conducted. A consecutive sample of patients from 18 to 46 years old who were receiving care at the Universidad de los Andes Health Center during a period from September 2016 to January 2017 was analysed. Basic erosive wear examinations (BEWEs) were performed by two calibrated examiners. Results A total of 535 adults were included in this study. An erosive tooth wear prevalence of 97.9% was found in which at least one surface had a BEWE score of 2 or 3 as the highest score (98.56% for females and 95.8% for males). In the sample, 75.70% and 74.77% of individuals had at least one surface with a BEWE score of 3 at the second and fifth sextant, respectively. The median of cumulative BEWE scores was 12. The median by individual of the affected percentage of tooth surfaces with BEWE scores 2 or 3 was 19.70%. Conclusions We found a high prevalence of erosive tooth wear, mainly in the anterior group of teeth. No differences were found between the sexes, but a positive correlation with age was found. The percentage of surfaces affected was low or moderate.

The detection of exposed dentine caused by erosive tooth wear is difficult. To the authors’ knowledge, there are no studies available on the impact of magnification and/or dye on the detection of erosive lesions. Therefore, the aim of this study was to investigate if the accuracy of assessing exposed dentine by the naked eye could be improved by using a microscope, dyeing, or a combination of both. The collected data were compared with the assessment of histological sections, which was considered the gold standard. A total of 70 teeth (24 teeth with slight erosion and 46 teeth with dentine involvement) showing different grades of erosive tooth wear were assessed 4 times by 17 examiners (9 aged Knowledge Transfer Statement: Clinicians can use the results of this study when they assess erosive tooth wear. It will help clinicians to detect erosive tooth wear correctly, particularly the involvement of dentine. Using a microscope in the diagnostic process has a direct impact on the right assessment and consequently on prevention and/or minimally invasive treatment.

OBJECTIVE To assess the association between erosive tooth wear (ETW) and consumption of different kinds of beverages in a group of schoolchildren 11-14 years old in Mexico City. METHODS Cross-sectional study in a sample of students (n = 512) in Mexico City. The Basic Erosive Wear Examination (BEWE) was used to quantify ETW. Beverage consumption (BC) was determined using a frequency questionnaire; beverages included pure water, natural fruit juices, milk, hot beverages, and soft drinks. Ordinal logistic regression model was used to evaluate the association between the presence of ETW and BC. RESULTS In total, 45.7% of the schoolchildren showed an initial loss of surface texture (BEWE = 1) and 18.2% a distinct defect involving loss of dental tissue (BEWE ≥ 2) in at least one tooth. For each glass (350 ml) of milk/week, the odds of not having erosive wear (BEWE = 0) versus having an initial loss of surface texture (BEWE = 1) or of having an initial loss of surface texture versus the presence of a defect involving the loss of dental tissue (BEWE ≥ 2) decreased 4% (OR = 0.96, 95% CI 0.93-0.99, p = 0.008); for each portion of sweet carbonated beverage consumed (350 ml), the odds increased 3% (OR = 1.03, 95% CI 1.001-1.07, p = 0.046). CONCLUSION The intake of milk and milk-based products could be a dietary means of helping prevent ETW, especially if their consumption could replace sweet carbonated drink consumption. CLINICAL RELEVANCE Knowing the impact of beverage consumption on ETW helps to provide suitable recommendations for the prevention and control of ETW in order to promote tooth longevity.

This study aimed to assess the prevalence of erosive tooth wear among 3- to 5-year-old children in Hong Kong and to determine the effect of socio-economic factors, dental habits, and oral hygiene on their dental erosive wear status.Stratified random sampling was adopted. Their parents were asked to complete a questionnaire regarding their children's backgrounds. A single examiner evaluated the children for erosive tooth wear using Basic Erosive Wear Examination (BEWE) criteria. Multiple logistic regression was used to determine the relationship between erosive wear and the children's socio-economic factors, dental habits, and oral hygiene.1204 children participated in this study. Prevalence of erosive tooth wear (BEWE score 0) was 14.9%. Among these, 153 children (12.8%) had initial wear, 21 children (1.8%) had distinct tooth loss, and five (0.4%) had severe erosive wear. Prevalence of erosive wear among the 3-, 4-, and 5-year-old children was 10.7%, 15.0%, and 17.7%, respectively. Increasing age, the low education of mother and high plaque scores were risk factors of erosive wear (P 0.05).Prevalence of erosive tooth wear is low among preschool children in Hong Kong. The erosive tooth wear prevalence increased with increasing age, lower education of mother, and poorer oral hygiene.

Background: There is a need for analytical techniques for measuring Erosive Tooth Wear (ETW) on natural surfaces in clinical studies. The purpose was to investigate the use of two instruments aimed to assess initial to more advanced stages of ETW. Methods: Human premolar enamel samples (2x3mm) (n = 24), were polished flat and mounted in resin cylinders (4 cylinders, 6 samples in each). Part 1: Baseline analyses by White Light Interferometer (WLI), Surface Reflection Intensity (SRI: TableTop and OptiPen) and Surface Hardness (SH). Erosion (1% citric acid (pH 3.6) for 1, 2, 4, 6, 8, 10 min. SRI and SH analyses after every erosion episode and by WLI after 10 min. New indentations were made and enamel loss; was measured by change in indentation depths from toothbrush abrasion (200 g, 60 strokes, 30 s). Another series of 2 × 5 min erosion (totally15 min and 20 min) was analysed with SH and SRI after each erosion, and by WLI (on samples and impressions of samples) after 20 min. Part 2 investigated WLI performance in the interface where initial erosion increases in severity and substance loss occurs. The samples were repolished. Baseline analyses by WLI, SRI (TableTop and OptiPen) and SH. Four cylinders were etched for 1, 2, 4, 8 min respectively and analysed by SRI, SH on samples, and WLI on samples and impressions). Results: Part1: SRI decreased from baseline to ~ 6 min etch and increased slightly after abrasion, the two devices correlated well (ICC 0.98 p < 0.001, Spearmans rs 0.91 p < 0.001). SH decreased nearly linearly to 10min etch, but increased distinctly after abrasion. Mean enamel loss from abrasion alone was 0.2 μm (change in indentation depths). After 10 min etch, it was 0.27 μm (WLI) and after 20 min etch, it was 2.2 μm measured on samples vs 2.4 μm on impressions of samples (7% higher). Part 2: From baseline to 8 min etch; SRI and SH decreased whereas WLI presented increasing etch depths. Conclusions: With some adjustments, the use of SRI and WLI in combination seems to be a promising strategy for monitoring ETW in clinical studies. Keywords: Erosive tooth wear, Clinical studies, Measurements

BACKGROUND Little is known about fluoride toothpastes effect on deciduous teeth submitted to erosive tooth wear OBJECTIVES: To evaluate the preventive effect of different toothpastes on surface loss (SL) after severe erosion/abrasion model and to compare this effect between permanent (PT) and deciduous teeth (dt). DESIGN Enamel samples were randomly divided according toothpastes groups (n=17). G1: placebo; G2: NaF; G3: AmF-NaF-SnCl anti-erosion; G4: SnF ; and G5: NaF anti-erosion for children. Samples were incubated in artificial saliva (1h), submitted to erosive challenge (3min; 1% citric acid; pH3.6; at 25°C) and to toothbrush abrasion (2min slurry immersion; 50 strokes; 200g) during 30 cycles. Surface loss (μm; mean±SD) was quantified by contactless profilometry. The effects of the two covariables "tooth" and "toothpaste" were analyzed by non-parametric ANOVA, variables with significant effects were tested by Wilcoxon tests. RESULTS dt showed significantly higher surface loss than PT in all groups (p

OBJECTIVES: The aim of this study is to examine morphological changes of dentin surfaces following air polishing or amino acid buffered hypochlorite solution application and to assess their influence on periodontal ligament (PDL) cell survival, attachment, and spreading to dentin discs in vitro. MATERIALS AND METHODS: Bovine dentin discs were treated with either (i) Classic, (ii) Plus, or (iii) Perio powder (EMS). Furthermore, Perisolv® a hypochlorite solution buffered with various amino acids was investigated. Untreated dentin discs served as controls. Morphological changes to dentin discs were assessed using scanning electron microscopy (SEM). Human PDL cells were seeded onto the respectively treated discs, and samples were then investigated for PDL cell survival, attachment, and spreading using a live/dead assay, adhesion assay, and SEM imaging, respectively. RESULTS: Both control and Perisolv®-rinsed dentin discs demonstrated smooth surfaces at low and high magnifications. The Classic powders demonstrated the thickest coating followed by the Powder Plus. The Perio powder demonstrated marked alterations of dentin discs by revealing the potential to open dentinal tubules even before rinsing. Seeding of PDL cells demonstrated an almost 100 % survival rate on all samples demonstrating very high biocompatibility for all materials. Significantly higher PDL cell numbers were observed on samples treated with the Perio powder and the Perisolv® solution (approximately 40 % more cells; p < 0.05). SEM imaging revealed the potential for PDL cells to attach and spread on all surfaces. CONCLUSION: The results from the present study demonstrate that cell survival and spreading of PDL cells on root surfaces is possible following either air polishing or application with Perisolv®. Future in vitro and animal testing is necessary to further characterize the beneficial effects of either system in a clinical setting. CLINICAL RELEVANCE: The use of air polishing or application with Perisolv amino acid buffered hypochlorite solution was effective in treating root surfaces and allowed for near 100 % PDL cell survival, attachment, and spreading onto all root surfaces. KEYWORDS: Air-Flow; Dentin discs; Dentinal tubules; Periodontal regeneration; Powder spraying

OBJECTIVES: Hyaluronic acid (HA) is a natural constituent of connective tissues and plays an important role in their development, maintenance, and regeneration. Recently, HA has been shown to improve wound healing. However, no basic in vitro study to date has investigated its mode of action. Therefore, the purpose of this study was to examine morphological changes of dentin surfaces following HA coating and thereafter investigate the influence of periodontal ligament (PDL) cell survival, attachment, and spreading to dentin discs. MATERIALS AND METHODS: HA was coated onto dentin discs utilizing either non-cross-linked (HA) or cross-linked (HA cl) delivery systems. Morphological changes to dentin discs were then assessed using scanning electron microscopy (SEM). Thereafter, human PDL cells were seeded under three in vitro conditions including (1) dilution of HA (1:100), (2) dilution of HA (1:10), and (3) HA coated directly to dentin discs. Samples were then investigated for PDL cell survival, attachment, and spreading using a live/dead assay, cell adhesion assay, and SEM imaging, respectively. RESULTS: While control dentin discs demonstrated smooth surfaces both at low and high magnification, the coating of HA altered surface texture of dentin discs by increasing surface roughness. HA cl further revealed greater surface texture/roughness likely due to the cross-linking carrier system. Thereafter, PDL cells were seeded on control and HA coated dentin discs and demonstrated a near 100 % survival rate for all samples demonstrating high biocompatibility of HA at dilutions of both 1:100 and 1:10. Interestingly, non-cross-linked HA significantly increased cell numbers at 8 h, whereas cross-linked HA improved cell spreading as qualitatively assessed by SEM. CONCLUSIONS: The results from the present study demonstrate that both carrier systems for HA were extremely biocompatible and demonstrated either improved cell numbers or cell spreading onto dentin discs. Future in vitro and animal research is necessary to further characterize the optimal delivery system of HA for improved clinical use. CLINICAL RELEVANCE: HA is a highly biocompatible material that may improve PDL cell attachment or spreading on dentin. KEYWORDS: Connective tissue regeneration; Growth factors; Hyaluronan; Periodontal regeneration; Soft tissue regeneration; Wound healing

PURPOSE To assess the visual performance of Swiss hand surgeons in an environment similar to their workplace. The influence of Galilean (lenses only) and Keplerian loupes (lenses and prisms), the surgeon's age, and the credibility of a self-assessment of his or her own optical performance were evaluated. METHODS Sixty-three hand surgeons between 29 and 68 years of age with 70 loupes were included in the study (Galilean n = 35, Keplerian n = 35). The visual performance as surgeons was self-assessed on a modified visual analog scale and objectively measured with miniaturized visual tests in a simulated clinical setting. We evaluated the influence of the optical device by comparing Galilean and Keplerian loupes and the influence of the surgeon's age by comparing 2 subgroups: < 40 years and ≥ 40 years. RESULTS The correlation between self-assessment and objective visual performance was weak, with a Spearman rank correlation coefficient of 0.25. The near visual acuity with habitual optical aids showed considerable variability, with a range of 300% in the dimension of the smallest detected structure. The near visual acuity was significantly lower in the older group ≥ 40 years than in the younger group < 40 years with both Galilean and Keplerian loupes. Keplerian loupes allowed a significantly higher visual performance than Galilean loupes. Surgeons 40 years or older using Keplerian loupes had a similar visual acuity to surgeons younger than 40 years with Galilean loupes. CONCLUSIONS The magnified near vision of hand surgeons showed an important individual variability. Self-assessment was not a valuable instrument for surgeons to estimate their own near vision. Hand surgeons older than 40 years should use higher magnification loupes. TYPE OF STUDY/LEVEL OF EVIDENCE Diagnostic III.

There is no standard for testing anti-erosive/anti-abrasive agents, making the assessment and comparison of study results difficult. Factors which are varied in study designs are amongst others the erosive medium regarding concentration and pH or movement type of acid. The present study therefore investigated the impact of these factors on dimension of tissue loss and on efficacy of active agents used as anti-erosive/anti-abrasive therapeutics. In 8 experiments, consisting of 8 groups each (n = 20 each), resulting in a total of 64 groups, enamel specimens were demineralised (10 days, 6 × 2 min/day) using different acids (1, 0.5 and 0.3% citric acid at native pH 2.3, 2.5 and 2.8, respectively, and 0.3% citric acid adjusted to pH 3.6) with two different movement types (jerky or smooth). Specimens were immersed (2 × 2 min/day) in slurries of 1,450 ppm F- toothpaste (NaF), 1,450 ppm F- and 3,436 ppm Sn2+ toothpaste (NaF/SnF2), 970 ppm F- and 3,000 ppm Sn2+ gel (SnF2) or placebo, or were additionally brushed during immersion (15 s, 200 g). All groups were in between stored in a mineral salt solution. Tissue loss was determined profilometrically. Movement type, pH and concentration of acid had a substantial impact on study outcome. The combination of jerky movement and concentrated acid masked, to some extent, differences between erosive and erosive-abrasive tissue loss. The acid at low concentration (0.3%), independent of pH, was too mild to produce any tissue loss. The model with the best ability to demonstrate effects of abrasive impacts and active agents used the 1% acid concentration combined with smooth acid movements.

The aim was to investigate dentin bond strength of two resin-ceramic materials and five cements after 24 h and six months storage. Cylinders (n=15/group) of Lava Ultimate (3M ESPE) and VITA ENAMIC (VITA Zahnfabrik) were cemented to mid-coronal dentin of 300 extracted human molars with RelyX Ultimate (3M ESPE), PANAVIA F2.0 (Kuraray), Variolink II (Ivoclar Vivadent), els cem (Saremco Dental), or Ketac Cem Plus (3M ESPE). Shear bond strength (SBS) was measured after 24 h or six months storage (37°C, 100% humidity) and statistically analyzed (significance level: α=0.05). SBS varied markedly between Lava Ultimate and VITA ENAMIC, between the five cements, and between storage of either 24 h or six months. After six months, SBS was highest when Lava Ultimate was cemented with RelyX Ultimate and when VITA ENAMIC was cemented with RelyX Ultimate or with Variolink II. Lava Ultimate was somewhat more sensitive to storage than was VITA ENAMIC.

Objectives The aim of this in vitro study was to examine the effect of different levels of magnification on the accuracy and reliability of visual caries detection using ICDAS criteria. Methods Occlusal surfaces of 100 extracted molars were assessed by 14 examiners (3rd and the 4th year dental students and dentists) using no magnification aids, a 2.5× Galilean loupe, a 4.5× Keplerian loupe, or a surgical microscope with 10× magnification. The assessments were repeated on a different day. Sensitivity, specificity, AUC and reliabilities were calculated according to the gold standard of histology. Results We found that with increasing magnification, the number of surfaces rated as “sound” (ICDAS code 0) decreased, while the number of surfaces with a localized enamel breakdown (ICDAS code 3) increased. While the sensitivities increased, the values of the specificities decreased to an unacceptably low level irrespective of the clinical experience of the examiners. Conclusions ICDAS seems to be optimized for natural vision up to 2.0× magnification and not for high magnifications. The use of powerful magnification in visual caries detection involves the risk of unnecessary and premature invasive treatment. Clinical significance This paper discusses when it does and does not make sense to use magnification devices for visual caries detection using ICDAS criteria. Strong magnifications should be refrained from for this purpose.

A unique, multidisciplinary manual for the treatment of pediatric dental emergencies for general practitioners and non-pediatric specialists. Management of Dental Emergencies in Children and Adolescents presents the diagnostic skills, treatment options, and management strategies necessary to provide effective and appropriate dental care for children and adolescents. This authoritative manual helps dental practitioners manage potentially stressful situations with children and adolescents while improving their competence in a wide range of urgent pediatric situations. An emphasis on managing the therapeutic demands of both younger patients and their parents enables readers to have greater confidence in handling demanding emergency situations in daily practice. An expert team of contributors explain how to manage tooth substance loss, endodontic problems in deciduous teeth, the long‐term consequences of early tooth loss, the dental issues related to oral health, and more. Guiding practitioners through the unique challenges of pediatric dental emergencies, this book: - Explains the differences in treating and managing dental emergencies in children compared to adults - Covers all types of pediatric dental emergencies including open pulp in permanent and deciduous teeth, missing teeth, and non-infective dental conditions - Offers clinical vignettes and photographs to highlight clinical relevance - Includes chapters by experts in multiple disciplines such as endodontics, restorative dentistry, pediatric dentistry, prosthodontics, and orthodontics The first textbook to focus exclusively on young patients in need of acute dental care, Management of Dental Emergencies in Children and Adolescents is a much-needed resource for general and specialist dentists as well as trainee and specialist pediatric dentists.

The study conducted in a bacterial-based in vitro caries model aimed to determine whether typical inner secondary caries lesions can be detected at cavity walls of restorations with selected gap widths when the development of outer lesions is inhibited. Sixty bovine tooth specimens were randomly assigned to the following groups: test group 50 (TG50; gap, 50 microm), test group 100 (TG100; gap, 100 microm), test group 250 (TG250; gap, 250 microm) and a control group (CG; gap, 250 microm). The outer tooth surface of the test group specimens was covered with an acid-resistant varnish to inhibit the development of an outer caries lesion. After incubation in the caries model, the area of demineralization at the cavity wall was determined by confocal laser scanning microscopy. All test group specimens demonstrated only wall lesions. The CG specimens developed outer and wall lesions. The TG250 specimens showed significantly less wall lesion area compared to the CG (p < 0.05). In the test groups, a statistically significant increase (p < 0.05) in lesion area could be detected in enamel between TG50 and TG250 and in dentine between TG50 and TG100. In conclusion, the inner wall lesions of secondary caries can develop without the presence of outer lesions and therefore can be regarded as an entity on their own. The extent of independently developed wall lesions increased with gap width in the present setting.

OBJECTIVE The aim of this study was to investigate whether patients with diagnosed erosive gastroesophageal reflux disease (ERD) have an increased probability of halitosis and tongue coating compared to patients with nonerosive gastroesophageal reflux disease (NERD). MATERIALS AND METHODS Sixty-six patients (33 males and 33 females) were recruited for the study and received an upper gastrointestinal endoscopy. The presence of ERD (n = 31) and NERD (n = 35) was classified based on the Los Angeles classification for erosive changes in the esophagus. Additionally, the patients filled in a questionnaire regarding their subjective assessment of halitosis, and an organoleptic assessment of halitosis, a measurement of oral volatile sulfur compounds (VSC) with the Halimeter, and a tongue coating index were performed. ERD and NERD subjects were compared with regard to Halitosis-related clinical and anamnestic findings. RESULTS No statistically significant difference could be found between ERD and NERD patients regarding tongue coating index, organoleptic scores, and VSC values as well as self-perceived bad taste, tongue coating, and bad breath. CONCLUSIONS These data suggest that halitosis is not typically associated with erosive gastroesophageal reflux disease and the presence of esophageal mucosal damage (ERD patients). CLINICAL RELEVANCE The data of this investigation support the findings of interdisciplinary bad breath clinics that gastroesophageal reflux disease is not a leading cause for halitosis.

The difference between carious lesion diagnosis and carious lesion detection is discussed here. Concerning carious lesions, 3 diagnostic requirements should be fulfilled: to detect lesions, to assess surface integrity, and to assess lesion activity to support clinical decision making. The first and most important diagnostic method is meticulous visual-tactile inspection. This is the only method that potentially contributes to all 3 diagnostic requirements. All other methods that are presented in this chapter, i.e., bitewing radiography, fluorescence-based technologies, and transillumination methods, are limited to assessing lesion depth in surfaces that are not visible to the eye and thus contribute to lesion detection only. At the end of the chapter, recent developments in objective lesion activity assessment are presented.

Objective: To evaluate the effect of erosive challenges on the tooth- restoration interface of deciduous teeth treated with different adhesive protocols. Material and Methods: Deciduous molars were cut mesiodistally, then embedded, abraded and polished (n=80). Samples were randomly divided according to the adhesive system used into: G1 (Adper Single Bond2®, etch-and-rinse), G2 (Universal Single Bond®, self-etching), G3 (OptibondFL®, etch-and-rinse with Fluoride) and G4 (BondForce®, self-etching with Fluoride). After standardized cavity preparation (2 mm diameter x 2 mm depth), adhesive systems were applied and samples were restored (composite resin Z350®). Half of the samples were exposed to erosive/abrasive cycles (n = 10, each adhesive group), and the other half (control group; n = 10) remained immersed in artificial saliva. For microleakage analysis, samples were submersed in methylene blue and analyzed at 40x magnifications. Cross-sectional microhardness (CSMH) was carried out (50 g/5 s) at 25 μm, 50 μm, and 100 μm from the eroded surface and at 25 μm, 75 μm, and 125 μm from the enamel bond interface. Results: Regarding microleakage, 7.5% of the samples showed no dye infiltration, 30% showed dye infiltration only at the enamel interface, and 62.5% showed dye infiltration through the dentin-enamel junction, with no difference between groups (p≥0.05). No significant difference was observed in CSMH at different depths (two-way ANOVA, p≥0.05). Conclusions: We did not observe significant changes in microleakage or CSMH after erosive/abrasive challenges in deciduous teeth treated with different adhesive protocols (etch-and-rinse and self-etching adhesives, with and without fluoride).