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Brenda S Bohaty,1,2 Qiang Ye,3 Anil Misra,3,4 Fabio Sene,6 Paulette Spencer3,51Department of Pediatric Dentistry, University of Missouri-Kansas City School of Dentistry, Kansas City, MO, USA; 2Department of Pediatric Dentistry, Children's Mercy Hospital, Kansas City, MO, USA; 3Bioengineering Research Center, 4Department of Civil, Environmental, and Architectural Engineering, 5Department of Mechanical Engineering, University of Kansas, Lawrence, KS, USA; 6Department of Restorative Dentistry, State University of Londrina, School of Dentistry, Londrina, BrazilAbstract: Restoring posterior teeth with resin-based composite materials continues to gain popularity among clinicians, and the demand for such aesthetic restorations is increasing. Indeed, the most common aesthetic alternative to dental amalgam is resin composite. Moderate to large posterior composite restorations, however, have higher failure rates, more recurrent caries, and increased frequency of replacement. Investigators across the globe are researching new materials and techniques that will improve the clinical performance, handling characteristics, and mechanical and physical properties of composite resin restorative materials. Despite such attention, large to moderate posterior composite restorations continue to have a clinical lifetime that is approximately one-half that of the dental amalgam. While there are numerous recommendations regarding preparation design, restoration placement, and polymerization technique, current research indicates that restoration longevity depends on several variables that may be difficult for the dentist to control. These variables include the patient's caries risk, tooth position, patient habits, number of restored surfaces, the quality of the tooth–restoration bond, and the ability of the restorative material to produce a sealed tooth–restoration interface. Although clinicians tend to focus on tooth form when evaluating the success and failure of posterior composite restorations, the emphasis must remain on advancing our understanding of the clinical variables that impact the formation of a durable seal at the restoration–tooth interface. This paper presents an update of existing technology and underscores the mechanisms that negatively impact the durability of posterior composite restorations in permanent teeth.Keywords: composites, bonding, dental restorations

Introduction: It is critical for dentists to identify and differentiate primary and permanent teeth, fillings, dental restorations and areas with pathological findings when reviewing dental radiographs to ensure that an accurate diagnosis is made and the optimal treatment can be planned. Unfortunately, dental radiographs are sometimes read incorrectly due to human error or low-quality images. While secondary or group review can help catch errors, many dentists work in practice alone and/or do not have time to review all of their patients' radiographs with another dentist. Artificial intelligence may facilitate the accurate interpretation of radiographs. To help support the review of panoramic radiographs, we developed a novel collaborative learning model that simultaneously identifies and differentiates primary and permanent teeth and detects fillings., Methods: We used publicly accessible dental panoramic radiographic images and images obtained from the University of Missouri-Kansas City, School of Dentistry to develop and optimize two high-performance classifiers: (1) a system for tooth segmentation that can differentiate primary and permanent teeth and (2) a system to detect dental fillings., Results: By utilizing these high-performance classifiers, we created models that can identify primary and permanent teeth (mean average precision [mAP] 95.32 % and performance [F-1] 92.50 %), as well as their associated dental fillings (mAP 91.53 % and F-1 91.00 %). We also designed a novel method for collaborative learning that utilizes these two classifiers to enhance recognition performance (mAP 94.09 % and F-1 93.41 %)., Conclusions: Our model improves upon the existing machine learning models to simultaneously identify and differentiate primary and permanent teeth, and to identify any associated fillings., Clinical Significance: Human error can lead to incorrect readings of panoramic radiographs. By developing artificial intelligence and machine learning methods to analyze panoramic radiographs, dentists can use this information to support their radiograph interpretations, help communicate the information to patients, and assist dental students learning to read radiographs., Competing Interests: Declaration of Competing Interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2023. Published by Elsevier Ltd.)

Objectives: A cleansing body wash containing diluted sodium hypochlorite (0.006% NaOCl) was evaluated for management of moderate-to-severe Staphylococcus aureus-colonized, atopic dermatitis in children., Methods: A 6-week, prospective, open-label study was conducted with 50 evaluable participants (ages 6 months to 17 years) who had moderate-to-severe atopic dermatitis with S aureus skin colonization documented by culture. Participants were instructed to continue using their current medications while using the study product, 0.006% NaOCl body wash, once daily to affected areas for 6 weeks. Primary outcome measures were Investigator's Global Assessment, Eczema Area and Severity Index, and Body Surface Area scores. Secondary outcome measures were the Visual Analog Scale for pruritus, Family Dermatology Life Quality Index, and Patient Satisfaction Questionnaire for Problem Areas. A subject daily diary and a six-item subject questionnaire that provided information on preferences for bleach bath vs body wash were secondary outcome measures., Results: Daily use of the 0.006% NaOCl body wash led to improvement for all outcome measures comparing baseline to 2-week and to 6-week evaluations. Of the 50 skin S aureus-positive subjects, 32/50 (64%) were still positive at 2 weeks. A 36.5% decrease in subject's daily record of topical corticosteroid application at end of study compared to baseline was found. Participant surveys indicated preferences for the body wash over bleach baths., Conclusions: Sodium hypochlorite (NaOCl) body wash improved all outcome measures for moderate-to-severe S aureus-colonized AD in infants, children, and adolescents. The limited reduction in S aureus further suggests that sodium hypochlorite has ameliorative effects other than antimicrobial actions., (© 2019 The Authors. Pediatric Dermatology Published by Wiley Periodicals, Inc.)

Familial adenomatous polyposis patients often present with non-malignant extra-intestinal manifestations which include dental anomalies that may be evident prior to the appearance of the colonic adenomas. The aims of this study were to describe the prevalence and type of dental anomalies and the relationships between gene mutations and dental anomalies in these patients. Twenty-two pediatric familial adenomatous polyposis patients and 46 controls, who were age and gender matched participated. Familial adenomatous polyposis patient's had a dental examination with panoramic radiograph and medical record review for age at diagnosis, the presence of the adenomatous polyposis coli gene mutation, and determination of other extra-intestinal manifestations on the body. The control group was identified from a retrospective chart review and selected if there was a current panoramic radiograph. The only significant difference between familial adenomatous polyposis patients and controls were the presence of jaw osteomas and sclerosis (p = .0001). Patients with a mutation in, or upstream of codon 1309 had a higher frequency of osteomas (77.8%) and jaw-bone sclerosis (44.4%), and 77% of these had at least one dental anomaly. This preliminary study showed an association between a genetic variant at, or upstream of codon 1309, and radiographic dental anomalies.

Background: Gastroesophageal reflux disease (GERD) affects 15-25% of children and adolescents in the United States. The diagnosis of GERD in children is complex as reported symptoms or symptom profiles have been found to be unreliable. Frequently, the diagnosis must be confirmed by objective tests such as pH monitoring or histological evidence of esophagitis on an esophageal biopsy. Dental erosion has been shown to be associated with GERD as an atypical complication and has the potential to be a marker of GERD. The purposes of this study were to compare the frequency and patterns of dental erosion in children and adolescents with and without histologic esophagitis., Methods: Twenty-five subjects were recruited from patients scheduled for an upper gastrointestinal endoscopy. Information regarding potential GERD symptoms, food habits, and dental hygiene habits were obtained. Intra-oral photographs were taken, and a dental exam for erosion was performed. The results of a standard biopsy taken from the lower third of the esophagus during an endoscopy were used to divide subjects into either the control group or the GERD group (i.e. those with histologic esophagitis)., Results: Twenty-two subjects yielded 586 evaluable teeth. No significant difference was found between frequency or erosion patterns of those with and without histologic esophagitis. Dental erosions were more frequent in primary teeth., Conclusions: Dental erosions do not appear to be associated with histologic esophagitis indicative of GERD.

CME EDUCATIONAL OBJECTIVES: 1.Understand the clinical presentation of a Becker nevus.2.Describe the differential diagnosis for Becker nevus.3.Be able to discuss the appropriate management for a Becker nevus. A 9-year-old healthy male presented to the dermatology clinic for evaluation of lesions on his chest. The lesions were unilateral and had been present for at least 1 year. No lesion had been previously noted in the affected area. No treatments had been tried prior to presentation. The patient denied pruritus or pain. Review of systems, medical history, and family history were unremarkable., (Copyright 2013, SLACK Incorporated.)

Background: Quaternary ammonium compounds (Quats), such as benzalkonium chloride (BAC) and benzethonium chloride (BEC), are widely used as antibacterial active ingredients and preservatives in personal care products, disinfectants, and ophthalmic preparations. BAC is known to be a marginal irritant when patch tested at 0.15% aq. Data on BEC are limited., Objective: To differentiate irritant from allergic patch test reactions to quaternary ammonium compounds., Methods: Eight subjects who were considered likely to react based on history of rash after exposure to disinfectants or a history of prior positive patch test to BAC were recruited, as well as two patients undergoing routine patch testing. BAC (0.15% aq), BAC (0.15% pet), BEC (0.05% aq), BEC (0.15% pet), BEC (0.15% aq), BEC (0.5% aq), sodium lauryl sulfate (2.0%), and deionized water were applied under Finn chambers for 48 h. Four days and 7 days after application, the sites were examined visually and then by in vivo reflectance confocal microscopy (RCM) which was interpreted by blinded experts., Results: Two patients with definite allergic reactions according to visual patch test reads and RCM were clinically relevant. Cross-reaction between BEC and BAC was demonstrated in one patient. RCM imaging correlated well with clinical scoring and interpretation of patch test reactions in terms of irritancy vs. allergy for BEC and BAC., Conclusion: Relevant allergic reactions to quats occur in humans. Possible cross-reaction was noted to occur between BAC and BEC. RCM appears to be a useful tool in distinguishing between irritancy and sensitization during patch testing to BAC and BEC. Further study of prevalence and best test concentration and vehicle is needed., (© 2011 John Wiley & Sons A/S.)

Microscale elastic moduli, composition and density have rarely been determined at the same location for biological materials. In this paper, we have performed homotopic measurements to determine the physico-mechanical properties of a second primary molar specimen exhibiting sound and caries-affected regions. A microscale acoustic impedance map of a section through this sample was acquired using scanning acoustic microscopy (SAM). Scanning electron microscopy was then used to obtain mineral mass fraction of the same section using backscattered images. Careful calibration of each method was performed to reduce system effects and obtain accurate data. Resorption, demineralization and hypermineralization mechanisms were considered in order to derive relationships between measured mineral mass fraction and material mass density. As a result, microscale mass density was determined at the same lateral resolution and location as the SAM data. The mass density and the acoustic impedance were combined to find the microscale elastic modulus and study the relationship between microscale composition and mechanical properties.

With wet bonding techniques, the channels between the demineralized dentin collagen fibrils are filled with debris, solvent, and water. Commercial adhesives include solvents such as ethanol or acetone to facilitate resin-infiltration into this wet substrate. Under in vivo conditions, the solvent may be diluted because of repeated exposure of the material to the atmosphere, or concentrated because of separation of the bonding liquids into layers within the bottle. The purpose of this study was to investigate the effect of different concentrations of ethanol (10-50%) on infiltration of the adhesive resin and collagen fibril encapsulation in the adhesive/dentin interface using light microscopy, micro-Raman spectroscopy, and scanning electron microscopy. The results indicated that under wet bonding conditions the hybridization process was highly sensitive to the initial solvent concentration in the adhesive system. The staining and scanning electron microscopy results showed that the quality of the interfacial hybrid layer was poor at the lower (10%) or higher (50%) ethanol content. Micro-Raman analysis indicated that there was a distinct difference in the degree of adhesive penetration among adhesives containing different concentrations of ethanol. Adhesives containing 10 or 50% ethanol did not realize effective penetration; the penetration of the adhesive monomers increased dramatically when the initial ethanol content was 30%. The amount of solvents are essential for achieving effective bonding to dentin., (Copyright 2007 Wiley Periodicals, Inc.)

Under in vivo conditions, the adhesive/dentin bond at the gingival margin of class II composite restorations can be the first defense against substances that may penetrate and ultimately undermine the composite restoration. Deterioration of this bond during aqueous aging is an area of intense investigation, but to date, the majority of our techniques have provided only an indirect assessment of the degrading components. The purpose of this study was to analyze the in situ molecular structure of adhesive/dentin interfaces in class II composite restorations, following aging in aqueous solutions. Class II preparations were cut from 12 unerupted human third molars, with a water-cooled, high-speed, dental handpiece. The prepared teeth were randomly selected for restoration with single bond (SB) and Z100 (3M). Teeth were restored, as per the manufacturer's directions, under environmental conditions that simulated humidity and temperature characteristics of the oral cavity. Restored teeth were kept in sterile Delbecco's phosphate saline for 48 h or 90 days. The samples were sectioned occlusogingivally and micro-Raman spectra were acquired at approximately 1.5 microm spatial resolution across the composite/adhesive/dentin interfaces at the gingival margins. Samples were wet throughout spectral acquisition. The relative intensity of bands associated with the adhesive in the interfacial region decreased dramatically after aqueous storage. This decrease in concert with the similar depth of dentin demineralization provides direct spectroscopic evidence of leaching of adhesive monomer from the interface during the 90 days of storage. SB adhesive infiltrated 4-5 microm of 12-microm demineralized dentin at the gingival margin. After 90 days of aqueous storage, SB adhesive infiltration was reduced to approximately 2 microm, leaving approximately 10 microm of demineralized dentin collagen exposed at the gingival margin. The unprotected collagen at the gingival margin of the aged class II composite restorations was disorganized, suggesting hydrolysis of the collagen, with 90 days of aqueous storage., ((c) 2005 Wiley Periodicals, Inc.)

Objectives: A primary reason for premature failure of Class II composite restorations is recurrent decay at the gingival margin. The integrity of the gingival margin depends on the bond formed with dentine. Using scanning electron microscopy (SEM) and histomorphologic technique, the purpose of this study was to characterise the adhesive/dentine (a/d) bond in dentine sections from the dentinoenamel junction (DEJ) and the cementoenamel junction (CEJ) with commercial adhesives of varying hydrophobic/hydrophilic composition., Materials and Methods: The occlusal 1/3 of the crown was removed from 20 human third molars, this exposed the surface used for the DEJ sections. The teeth were sectioned occluso-gingivally into equal halves: one-half representing the DEJ; the remaining half was sectioned 4mm deep to the exposed surface (CEJ). Each half was treated with the same adhesive. The teeth were randomly selected for treatment with Single Bond (SB, 3M) or Dentastic UNO (UNO, Pulpdent) using wet bonding technique as per manufacturers' instructions. Thin (3-5mum) sections of native a/d interfaces were cut and stained with Goldner's trichrome for light microscopic (LM) examination. Companion slabs were polished and acid-bleach treated, then analysed with SEM., Results: DEJ sections: SB/dentine specimens had approximately 4mum exposed protein at the interface, UNO infiltrated the depth of the demineralised dentine and encapsulated exposed protein. CEJ sections: SB/dentine specimens had highly variable interface structure with localized exposed protein, UNO/dentine exhibited 3-5mum exposed protein at the interface. The quality of the interface was exaggerated and the above differences were not revealed based on SEM characterisation., Conclusions: As a result of adhesive phase separation, SB does not form structurally integrated a/d bonds at the DEJ or CEJ. The increased hydrophilic composition of UNO contributes to the formation of an integrated a/d bond at the DEJ, but structural differences and increased moisture leads to unprotected protein at the a/d interface in the CEJ sections. The inability of the SEM technique to reveal the complexity of the interface could be related to the modifications of the a/d interface caused by polishing and acid-bleach treatment.

The purpose of this study was to determine the adequacy of the alternate forms reliability of three versions of the Oucher pain scale. Because the original large-sized posters were unwieldy for use by nurses with children in clinical settings, it became necessary to reduce it in size. To determine whether the resulting tools were psychometrically equivalent to the original versions of the Oucher, this study was undertaken. In a group of 3- to 12-year-old children who underwent surgical or dental procedures ( n = 137), scores were obtained after the procedure on small and large versions of the Oucher. The order of presentation of the two different Ouchers was randomized. Findings revealed that correlation coefficients between the scores provided for the small and large versions of the Oucher were strong, positive, and significant for the Caucasian, African-American, and Hispanic versions in 3- to 12-year-old children. These results provided evidence of the adequacy of the alternate forms reliability of these scales.

Epidermolysis bullosa is a unique group of disorders that have blister formation as the common feature. Although there are many variants of this disorder, the subtypes are classified into three groups based upon the level of tissue separation that occurs after mechanical trauma is sustained by the skin. Specific subtypes of EB may have substantial involvement of extracutaneous areas such as the oral cavity and dentition. This case report demonstrates the importance of a dental examination at an early age in order to facilitate the correct subtyping of EB. For the very young patient, correct classification of the subtype of EB may be very important in identifying the severity of clinical features associated with the disorder, and with this information the patient and family may become better aware of potential complications of the disorder such as the dental defects described in this report.

The purpose of this study was to evaluate and compare in vitro fluoride release from and weight and volume changes of Photac-Fil, a light-curing polymaleinate restorative glass ionomer, with Ketac-Fil, a self-curing glass ionomer, and Ketac-Silver, a metal reinforced glass ionomer. Five discs of each material, measuring 2 mm height and 5 mm diameter, were suspended in separate vials of distilled water and laboratory artificial saliva. Fluoride release into the solutions was measured using a calibrated fluoride-sensitive ion meter initially at 24 hr and then weekly from 1 to 9 weeks. These results were evaluated statistically using repeated measures analysis of variance. Volumes and weights were recorded at the start and end of the experiment and analyzed using the paired t-test. Photac-Fil released similar amounts of fluoride to Ketac-Silver, but significantly less than Ketac-Fil in distilled water (P < or = 0.05). In artificial saliva, Photac-Fil released similar amounts to Ketac-Fil, but significantly more than Ketac-Silver (P < or = 0.05). Photac-Fil volume increased in distilled water and artificial saliva (P < or = 0.05) as did Ketac-Fil and Ketac-Silver in artificial saliva (P < or = 0.05). The only material that demonstrated significant net weight increase was Ketac-Silver in artificial saliva (P < or = 0.05). In summary, differences in fluoride release between these three glass ionomer materials varied as a function of the media in which they were stored. Whereas Ketac-Fil exhibited significantly greater fluoride release than the other materials in distilled water, in artificial saliva Ketac-Fil and Photac-Fil exhibited comparable fluoride release. Dimensional change, as evaluated by volume and weight differences, was also affected by storage media.

Dental educators nationwide have expressed concern regarding the decreasing pediatric clinical experience available to undergraduate dental students. Some educators have suggested that dental programs should utilize extramural clinics and rotations to enhance current patient pools. This paper presents a successful clinical program that is designed to 1) augment the dental education of predoctoral dental students, and 2) provide dental care for an underserved pediatric dental population in an urban community.

Conventional outbred rats were fed Streptococcus sobrinus for 24 weeks and ELISA was used to identify isotypes of antibodies against bacteria in saliva and serum. Quantities of antibodies from experimental rats were compared with values derived from the control population. Saliva IgM and IgA anti-S. sobrinus from experimental rats were greater than controls at week 3, were much less at week 9, but normal levels were found by week 13. IgG antibodies in saliva peaked at weeks 5 and 9 but fell to control levels by week 13. Relative levels of antibodies in saliva of experimental animals continued to cycle during weeks 13-24 but did not differ greatly from controls. Serum IgM and IgG antibodies to S. sobrinus were essentially like controls throughout the experiment. Serum IgA increased briefly during the first 12 weeks then returned to normal levels. The results suggest that prolonged peroral exposure to cariogenic bacteria ultimately leads to modulation of antibody around unimmunized control levels even though antigenic stimulation persists.

Decreasing caries activity in children has adversely affected the education programs in clinical pediatric dentistry. This paper presents a program designed to facilitate the educational requirements of undergraduate dental students as it meets the dental needs of an urban pediatric population in Kansas City, MO. Changes in dental treatment needs that have occurred in this population over the past decade are evaluated. Dental records of 760 children from four urban schools were examined; data from the dental records were categorized according to the type and number of operative procedures completed. Results indicated a significant decrease in the percentage of patients requiring simple or complex amalgams from 1977 to 1987. Similar decreases were noted in other operative procedures. However, comparisons between the proportion of patients requiring multiple operative procedures indicate less changes during the ten-year period. These results suggest that there is still a percentage of patients requiring substantial dental care as a result of dental caries.

The frequency of using self-applied (over-the-counter) fluoride products and prescribed supplemental fluorides, and the prevalence of fluorosis-like enamel lesions in the permanent dentitions of children living in an optimally fluoridated urban community were investigated. Subjects were selected randomly, and consent forms and questionnaires concerning fluoride usage and residency status were provided to guardians prior to examination. After a supervised tooth brushing event, 300 consenting subjects were examined by the principal investigator using Dean's index to assess levels of fluorosis-like lesions. The principal investigator was standardized with another investigator prior to the examinations to obtain an interexaminer agreement level of 97%, and an intraexaminer agreement level of 96%. Portable dental equipment was used during all examinations. Chi-square analysis indicated no statistically significant difference between the frequency of tooth brushing with a fluoridated dentifrice at an early age and the prevalence of fluorosis-like enamel lesions. However, there was a significant difference (P less than 0.05) between the prevalence of fluorosis-like lesions, and the frequency of using prescribed fluoride supplements and gels, and over-the-counter rinses.