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Background and objectives: Patient education and health literacy are crucial in dentistry, prior to complex procedures like root canal treatment (RCT), that are often associated with anxiety. This mixed-methods pilot study explored the effectiveness of educational material on patients' understanding and experiences of RCT, and dentists' feedback on using a new resource. Methods: Before RCT, patients were provided with an existing New Zealand Dental Association (NZDA) education pamphlet or an enhanced educational resource (EER) in pamphlet or online format, and surveys were conducted to evaluate their helpfulness. Dentists were interviewed to gather insights on the use and value of the resources. Quantitative data and variable relationships were compared using Chi square tests and qualitative data was thematically analysed. Results: The patients valued their dentist as an 'educator' but appreciated the clarity, simple language and visual aids in the resources, which answered questions, enhanced understanding, and reduced anxiety. Those who had received the EER (pamphlet and online) better understood the stages of RCT, reported significantly lower levels of anxiety after RCT (p=.04) and had positive overall experiences. The EER improved and supported dentists in consent processes and enhanced patient-dentist communication. Conclusions: The findings from this study highlight the value of providing patients supplementary educational material to enhance their health literacy and experience of RCT. Dentists have an important role in educating their patients and clear and informative resources are valuable adjuncts. Further validation of these findings in broader clinical settings is warranted. [ABSTRACT FROM AUTHOR]

Aim: This ex vivo study aimed to compare protein expression of advanced glycation end‐products (AGE) and receptor (RAGE), and the levels of selected genes associated with inflammation and collagen within dental pulp tissue from patients with type 2 (T2D) diabetes and non‐T2D. Methodology: Noncarious extracted permanent molar teeth from patients with well‐controlled T2D (n = 19) and non‐T2D (controls) (n = 19) were collected and compared. The coronal pulp was examined using immunohistochemistry (IHC) (n = 10 per group) for anti‐AGE and anti‐RAGE. Quantitative PCR (n = 9 per group) was used to analyse the gene expression levels of NFKB, S100A12 and COLIA1. Data analyses were performed between the groups using GraphPad Prism using Pearson correlation, Shapiro–Wilk and Mann–Whitney U‐tests, and multiple regression using SPSS. Results: AGEs were distributed diffusely throughout the pulp extracellular matrix associated with collagen fibres and were present on several cell types. RAGE was expressed at the pulp–dentine interface and was observed on odontoblasts, immune cells, endothelial cells and fibroblasts. Semi‐quantitative analysis of IHC samples showed significantly increased expression of AGE (p <.0001) and RAGE (p =.02) in T2D samples compared with controls. The expression of NFKB (p <.0001), S100A12 (p <.0001) and COLIA1 (p =.01) genes were significantly higher in the T2D pulp, and multivariate logistic regression analysis showed that these findings were not affected by age. Conclusion: T2D may exert a similar glycation response in the dental pulp to other body sites. This could occur through activation of NF‐κB pathways with a concomitant increase in genes associated with inflammation and collagen. [ABSTRACT FROM AUTHOR]

Aim: The aim of this study was to investigate the effect of type 2 diabetes (T2D) on clinically normal dental pulp tissue by using special stains and immunohistochemistry (IHC) to determine the morphology of the coronal pulp and distribution of immune markers in non‐T2D and T2D groups. Methodology: Ethics approval for this in vitro pilot study was obtained from the University of Otago Human Ethics Committee (16/069). Twenty extracted permanent molar teeth diagnosed as having clinically normal pulp status were collected. Ten teeth were from participants with well‐controlled T2D and ten from participants without diabetes (non‐T2D). Each tooth was sectioned transversely at the cemento‐enamel junction before the crowns were decalcified and embedded in paraffin. Sections were stained with haematoxylin and eosin, Massons trichrome, and van Gieson stains for histological and morphological evaluation. IHC using anti‐CD4, anti‐CD68 and anti‐CD83 and anti‐IL1β, anti‐IL6, anti‐IL17, anti‐TNF‐α, anti‐TLR2, anti‐TLR4 and anti‐FOXP3 identified proteins of interest. Qualitative and semi‐quantitative analyses evaluated the morphology of the dental pulp and protein expression. Data analyses were performed with GraphPad Prism, using Student's t‐test and multiple regression using SPSS at p <.05. Results: Special stains demonstrated morphological differences in the T2D dental pulp compared with non‐T2D. Qualitative analysis indicated that the pulp in the T2D samples was consistently less cellular, less vascular, showed evidence of thickened blood vessel walls, increased pulp calcification and collagen deposition. Semi‐quantitative analysis of IHC samples showed the T2D pulp had significantly increased expression of macrophage and dendritic cell markers CD68 (p <.001) and CD83 (p =.04), and there was significantly greater expression of inflammatory cytokines IL1β (p =.01), IL6 (p <.0001), IL17 (p <.0001) and TNF‐α (p =.01). T2D samples showed a significant increase in markers of innate inflammation, TLR2 (p <.001) and TLR4 (p <.001) and decreased expression of regulatory T‐cell marker, FOXP3 (p =.01). Multiple regression showed that age‐corrected differences were statistically significant. Conclusion: Preliminary findings suggest that T2D may exert a similar response in the pulp to complications in other body sites. Hyperglycaemia is associated with changes in the morphology of the clinically normal dental pulp with altered immune cell and cytokine expression. [ABSTRACT FROM AUTHOR]

Vertical root fractures (VRF) are longitudinally orientated, complete or incomplete cracks that can occur on the tooth root at any level and usually initiate from the internal root canal wall. VRFs commonly occur in root canal-filled teeth and may result in the loss of the affected tooth. A PubMed search to April 2017 was completed using the key words "vertical root fractures", "endodontic treatment" and "root-filled teeth". Abstracts were read to identify relevant articles before retrieval. A search of reference lists identified further studies and 62 articles were selected. Diagnosis of VRFs can often be challenging. The combined use of history taking, periodontal probing and periapical radiographs is essential. The aetiology is multifaceted and includes predisposing factors such as tooth type, root canal morphology, and iatrogenic factors involving materials and devices used in root canal treatment and for post space preparation. Emerging risk factors such as implant-associated VRF have recently been identified. Prevention of VRF includes conservation of dentine during root canal instrumentation, appropriate choices of materials for preparation, irrigation and disinfection and avoiding excessive forces during lateral and vertical condensation of gutta-percha (GP). Cracks formed during root-end preparations in apical surgery may also lead to VRF, and teeth with the "butterfly effect" seem to be more at risk. Traditionally, treatment of VRFs has been tooth extraction. Alternative treatments such as bonding of separated root fragments followed by intentional replantation have gained some momentum. [ABSTRACT FROM AUTHOR]

Objectives: This study explored the attitudes of New Zealand (NZ) general dental practitioners (GDPs) towards older adults living within the community and the barriers and difficulties caring for their oral health needs., Background: Adults are living longer and retaining teeth. Their dentitions are complex and alongside their dental needs, older adults often experience age-related systemic disease or decline. Ageism and stereotypical views of older adults impedes access to dental care. While there is some understanding of older adults and ageism from the perspective of dental students, there is a paucity of knowledge about dentists' management of this patient demographic., Materials and Methods: A mixed-methods survey questionnaire collected quantitative and qualitative data. Quantitative data were analysed descriptively followed by bivariate analysis. Qualitative data responses to open-ended questions were analysed thematically., Results: A total of 382 GDPs participated (response rate of 24%) and demonstrated positive attitudes and low levels of ageism towards older adults who they enjoyed treating. Confidence was positively related to clinical experience, and most dentists had engaged in gerodontology updates. Barriers to care for older adults were perceived to be beyond their control and mostly related to cost, chronic disease or age-related change. Consent processes could create difficulty and so collaboration with family or caregivers was important., Conclusion: The GDPs displayed positive attitudes and confidence towards older adults who are a rewarding patient cohort. Gerodontology education during training and following graduation is critical to enhance oral health outcomes for older patients., (© 2024 Gerodontology Association and John Wiley & Sons Ltd.)

ABSTRACT., Objective: This study aimed to examine the protein and gene expression of vascular endothelial growth factor (VEGF) and angiopoietins-1 and 2 in tissue from healthy and inflamed dental pulps., Methods: Permanent teeth with pulps diagnosed as healthy or reversible pulpitis were used for immunohistochemistry (IHC) and gene expression experiments. For IHC, a whole pulp tissue was excavated from the pulp chamber, and it was formalin-fixed and processed for routine IHC with angiogenic markers anti-VEGF, anti-Ang1, and anti-Ang2. Staining was visualized with diaminobenzidine (DAB), and examined using light microscopy. The distribution of markers in healthy and inflamed pulps was qualitatively and quantitatively analyzed. Real-time quantitative polymerase chain reaction (RT qPCR) was used to ascertain the gene expression levels of ANGPT1 , ANGPT2 , and TEK in the presence of inflammation. Statistical analysis was performed using the Mann-Whitney test with the statistical significance level set at 0.05., Results: There was increased protein and mRNA expression of VEGF and Ang-1 markers in inflamed pulp samples as compared with that in the healthy pulp tissue. IHC demonstrated intense expression of the VEGF protein on endothelial cells (EC) and some non-ECs, and there was significantly more staining on ECs associated with inflamed tissue (P<0.001). Ang-1 and Ang-2 were significantly expressed on ECs and non-ECs (P<0.05). RT qPCR did not show significant differences in gene expression between healthy and inflamed samples although similar trends were observed to IHC., Conclusion: The presence of Ang-1, Ang-2, VEGF, and TEK gene in healthy and mildly inflamed pulp tissue associated with reversible pulpitis indicates that these angiogenic factors may participate in physiological and pathological angiogenesis and healing. The inflammatory process may regulate Ang-1/Ang2/Tie2 signaling; and together with VEGF, these growth factors have an important role in modulating pulp angiogenesis., Competing Interests: Disclosures Conflict of interest: The Authors declare no conflict of interest., (Copyright: © 2019 European Endodontic Journal.)

Objective: To investigate apical cracks in roots that exhibit the butterfly effect and that have undergone apical resection and ultrasonic root-end cavity preparation. The effect of the obturation material was also studied., Methods: Forty extracted single-rooted teeth were decoronated at the cemento-enamel junction. Roots were viewed under a light microscope and coded according to the presence or absence of the butterfly effect. Canals were prepared using ProTaper Next instruments to size X3 and assigned to two obturation groups (gutta-percha and AH Plus, and ProRoot MTA alone). Each contained twenty roots (10 with the butterfly effect and 10 without the butterfly effect). Roots were resected perpendicular to their long axis, 3 mm from the apex, and cavities were cut using ultrasonic retrotips. Resin replicas were used for crack imaging from scanning electron micrographs. Statistical analyses were performed using Stata 13.1 (StataCorp, College Station, TX, USA)., Results: Cracks occurred more frequently in teeth with the butterfly effect (80%), with this difference being significant (P=0.001). Most cracks (73%) ran buccolingually. Teeth obturated with MTA developed fewer cracks compared to those obturated with GP and sealer., Conclusion: Root-ends with the butterfly effect had a significantly higher number of buccolingual cracks following resection and ultrasonic root-end preparation. This might explain the development of some vertical root fractures, which usually run buccolingually. Canal obturation with MTA may be protective., Competing Interests: Conflict of interest: No conflict of interest was declared by the authors., (Copyright: © 2018 European Endodontic Journal.)