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PURPOSE: To evaluate the effectiveness of all radioprotective measures in underage patients who undergo a dental radiodiagnostic examination. METHODS: A systematic review was performed including randomised controlled trials (RCTs), or cluster trials, cohort studies, cross-sectional studies, case-control studies and comparative in vitro research. These studies examined the healthy underage human population (below 18 years) undergoing a dental radiodiagnostic examination. All radioprotective measures were included except for justification as an intervention. The primary outcomes were in vivo mortality and morbidity. Some surrogate or indirect outcomes such as in vitro effective dose and organ absorbed doses were also accepted. Secondary outcomes with regards to image quality and therapeutic value were also analysed. RESULTS: Eighteen papers were eligible for implementation. Fifteen studies underwent narrative synthesis. Regression analysis was performed on three studies. CONCLUSION: The following radioprotective measures can reduce the exposure dose. For lateral cephalometry: collimation, filtration, the fastest receptor type and circumstantial thyroid shielding. For oblique lateral radiographs: the shortest exposure time, a smaller horizontal angulation, a longer focus to skin distance. For intraoral radiography: rectangular collimation, the fastest image receptor speed and thyroid shielding when the thyroid gland is in line of or very close to the primary beam. For panoramic radiographs: collimation, the fastest receptor type and the use of automatic exposure control (AEC) or manual adjustment of intensity. For cone-beam computed tomography: collimation, the largest voxels size in relation to the treatment need, change in image settings such as ultra-low dose settings, shorter exposure time, a lower amount of projections, lower beam intensity, reduction of the potential, use of a thyroid shield except in two situations and the use of AEC. All of the changes in exposure parameters should be performed while maintaining a sufficient therapeutic value on an individual and indication-based level.

A longitudinal oral health promotion project on caries experience and oral cleanliness was performed in a remote village in Nepal. The aim of this 6-month prospective survey was to investigate the impact of an oral health promotion project on caries experience, oral health-related behaviour, and general knowledge about oral health in Kerung, a remote village in Nepal.A prospective study was conducted in a convenience sample of children from the local school in Kerung. At baseline and after six months, dental plaque scores and caries experience scores were measured by calibrated examiners. Validated questionnaires on oral health habits and knowledge on oral health were taken. In addition, an oral health promotion program was developed.At baseline, 359 children were included, of which 266 could be surveyed after six months. A statistically significant decrease in the mean plaque score was found at after six months with a higher reduction for boys. A significant decrease in caries prevalence, as well as a significant increase in knowledge about oral health, was observed. Furthermore, after six months there were significantly more children reporting that they brushed their teeth for at least two minutes.Dental screenings and a comprehensive educational program resulted in a significant improvement of oral health.

This systematic review aimed to assess (1) whether systemic antibiotics are beneficial or harmful in healthy children who present with an odontogenic abscess in the primary dentition with or without systemic involvement and (2) if antibiotics are beneficial, which type, dosage and duration are the most effective. Electronic databases (Medline, Embase, and the Cochrane Library) were screened from 1948 up to August 2020. No filters with respect to study design were applied. Outcomes of interest included pain, swelling, pain relief, adverse effects, signs of infection, quality-of-life measurements and medication required for pain relief. Altogether, 352 titles and abstracts were screened for eligibility; of these, 19 were selected for full text assessment. All were excluded because none of them fulfilled the inclusion criteria and addressed the (adjunctive) use of antibiotics in children who present with an odontogenic abscess in the primary dentition. At present, there is no single randomised or non-randomised clinical study evaluating the effectiveness and harms of systemic antibiotics administered in children who present with an odontogenic abscess in the primary dentition. There is no clinical evidence to support nor to refute the use of antibiotics in children who present with an odontogenic abscess in the primary dentition without signs of local spread or systemic involvement. Given this lack of scientific evidence, the use of antibiotics cannot be recommended in these children. Well-designed clinical trials are indicated to fully understand the impact and necessity of antibiotics in these situations.

This was primarily to perform a retrospective analysis of 1000 emergency dental visits in order to characterize the nature of the dental emergency and the treatment provided and secondly to define a guideline for dental emergency treatment in children including pain management. A retrospective review was conducted of 1000 patients (aged 0–16 years) who visited the dental emergency service of the paediatric dental clinic at the Ghent University Hospital, Belgium over a period of 3 years. Data regarding age, gender, reason for visit, year of visit, consequent appointments and treatment provided were collected. Statistical analysis was carried out using descriptive statistics (frequency distribution) and Chi-square test, with significance level set as P

Objectives: Analgesics are one of the most frequently used medicines. Self-medication and misuse have been described in the literature. The purpose of this study was to document analgesic (mis)use in a population seeking emergency dental treatment. Material and methods: Patients consulting a dental emergency service were randomly asked to complete a questionnaire on analgesic use, knowledge and information on the analgesics and on their pain history. A photobook was used as an aid to identify products used. Descriptive statistics were combined with chi-square and Mann-Whitney U testing. Results: Ninety-eight patients were included. Acetaminophen (69.4%) and ibuprofen (65.3%) were the most frequently used products. Nearly half of the subjects (43.9%) combined at least two analgesics. Although 42.9% of subjects were aware of the maximum daily dose, 62.2% of the subjects exceeded this limit, specifically 76.6% of subjects using ibuprofen and 32.4% of subjects using acetaminophen overdosing. Females overdosed significantly more than males. Ingestion on medical advice did not affect the overdose rates significantly. No significant relation was found between the absence of knowledge on the maximum daily dose and actual overdosing. No higher pain reduction was found in patients overdosing analgesics. The average number of days patients experienced pain before consulting the emergency unit was 12. A significant relation was found between the lag time and overdosing. Conclusions: A large portion of the patients overdosed analgesics. Even prior medical advice did not reduce significantly overdose rates. Clinical relevance: Dentists treating emergency cases clearly need to be aware of the high risk and high rates of overdosing analgesics in their patients.

Aim To compare the clinical and radiographic efficacy of Biodentine™, ProRoot® White Mineral Trioxide Aggregate (WMTA) and Tempophore™ as pulpotomy medicaments in the treatment of carious primary molars. Methodology A parallel-design, randomized controlled trial was developed. Patients above 3 years of age with carious primary teeth with vital pulps without spontaneous pain or history of swelling were included. Fifty-eight patients (82 teeth) with a mean age of 4.79 ± 1.23 years were included. The teeth were randomized, blinded and allocated to one of the three groups (Biodentine™, ProRoot® WMTA or Tempophore™) for pulpotomy treatment. All teeth were followed up clinically and radiographically (after 6, 12 and 18 months) by two blinded calibrated investigators. A generalized estimating equation (GEE), Wald chi-square test and an intention-to-treat analysis (ITT) with ‘last carried forward’ approach were performed using Statistical Package for Social Sciences v 21.0 (IBM Corp., Armonk, NK, USA). Results Forty-six patients and 69 teeth were available for follow-up after 18 months. Clinical success (radiographic success in parenthesis) was 95.24% (94.4%), 100% (90.9%) and 95.65% (82.4%) in the Biodentine™, ProRoot® WMTA and Tempophore™ groups, respectively, but the difference was not significant. Pulp canal obliteration was significantly different amongst the experimental groups as the Biodentine™ group exhibited significantly more pulp canal obliteration when compared to the ProRoot® WMTA group at 6 months (P = 0.008) and 18 months (P = 0.003). Conclusions After 18-month follow-up, there was no significant difference between Biodentine™ in comparison with ProRoot® WMTA or Tempophore™.

Age 18 years is considered as the age of majority by most countries. To ascertain the age of interest, both third molar development (TMD) and eruption (TME) staging scores are beneficial without needing multiple imaging modalities. This study aimed to assess the chronological course of TMD and TME in a Malay sub-adult population and evaluate predictions when specific stage(s) of TMD and TME have been attained that are pertinent to the age group of interest (

Biodentine™ has frequently been acknowledged in the literature as a promising material and serves as an important representative of tricalcium silicate based cements used in dentistry. To provide an update on the physical and biological properties of Biodentine™ and to compare these properties with those of other tricalcium silicate cements namely, different variants of mineral trioxide aggregate (MTA) such as ProRoot MTA, MTA Angelus, Micro Mega MTA (MM-MTA), Retro MTA, Ortho MTA, MTA Plus, GCMTA, MTA HP and calcium enriched mixture (CEM), Endosequence and Bioaggregate™. A comprehensive literature search for publications from November 20, 2013 to November 20, 2016 was performed by two independent reviewers on Medline (PubMed), Embase, Web of Science, CENTRAL (Cochrane), SIGLE, SciELO, Scopus, Lilacs and clinicaltrials.gov. Electronic and hand search was carried out to identify randomised control trials (RCTs), case control studies, case series, case reports, as well as in vitro and animal studies published in the English language. The enhanced physical and biologic properties of Biodentine™ could be attributed to the presence of finer particle size, use of zirconium oxide as radiopacifier, purity of tricalcium silicate, absence of dicalcium silicate, and the addition of calcium chloride and hydrosoluble polymer. Furthermore, as Biodentine™ overcomes the major drawbacks of MTA it has great potential to revolutionise the different treatment modalities in paediatric dentistry and endodontics especially after traumatic injuries. Nevertheless, high quality long-term clinical studies are required to facilitate definitive conclusions.

Objectives: To test the fracture strength of weakened bovine incisors endodontically treated with mineral trioxide aggregate (MTA), cal- cium phosphate bone cement (CPBC) or fibre reinforced composite (FRC) posts, and to evaluate the fracture mode. Methods: Weakened bovine incisors (n = 75), standardized according to the dentinal wall thickness at the cervical area, were randomly assigned to one control group and three experimental groups. Unfilled teeth were assigned to group 1 (n = 20) and served as control group. Group 2 (n = 17) consisted of teeth filled with MTA. In group 3 (n = 18), the incisors were filled with CPBC and in group 4 (n = 20) with FRC posts. All specimens were subjected to load at a cross-head speed of 60 mm min 1 until fracture occurred. The initial (IL) and final fracture (FL) loads (N) were recorded, and the failure mode among the different groups was evaluated. Results: ANOVA showed a sta- tistically significant difference in fracture load among the groups. Tukey's test revealed a significant difference for the IL between the control group and the experimental groups with exception of the MTA group. The FL was not significantly different among the experimental groups. A high per- centage of favourable fractures was seen in the FRC and CPBC groups. Conclusion: FRC posts and CPBC could be promising materials to strengthen non-vital structurally compromised teeth.

Aim To evaluate the strengthening effect of two different types of fibre-reinforced composite (FRC) posts in an ex vivo experimental model. Methodology Compact and hollow bone samples from bovine femurs were used as standardized samples. A total of 80 hollow samples were divided into two groups and filled either with a prefabricated FRC post or with individually adapted FRC posts. For each group, half of the samples were subjected to thermocycling (5–55 °C, 5000×). The remaining samples were kept for 24 h at 37 °C at 100% relative humidity. All samples were loaded diametrically until fracture. The null hypothesis tested was that the fracture resistance of standardized bone samples is not influenced by the type of FRC post, independently of the exposure to thermocycling. Results were evaluated by anova, and subsequent multiple comparisons were performed. Results The samples filled with the individually adapted FRC posts were more resistant to fracture than the prefabricated ones (P

Background. Optimal pit and fissure sealing is determined by surface preparation techniques and choice of materials. Aim. This study aimed (i) to compare the microleakage and penetration depth of a hydrophilic sealant and a conventional resin-based sealant using one of the following preparation techniques: acid etching (AE) only, a diamond bur + AE, and Er:YAG laser combined with AE, and (ii) to evaluate the microleakage and penetration depth of the hydrophilic pit and fissure sealant on different surface conditions. Design. Eighty recently extracted 3rd molars were randomly assigned to eight groups of ten teeth according to the material, preparation technique, and surface condition. For saliva contamination, 0.1 mL of fresh whole human saliva was used. All samples were submitted to 1000 thermal cycles and immersed in 2% methylene blue dye for 4 h. Sections were examined by a light microscope and analysed using image analysis software (Sigmascan (R)). Results. The combination of Er:YAG + AE + conventional sealant showed the least microleakage. The sealing ability of the hydrophilic sealant was influenced by the surface condition. Conclusion. Er:YAG ablation significantly decreased the microleakage at the toothsealant interface compared to the non-invasive technique. The hydrophilic sealant applied on different surface conditions showed.

International Journal of Paediatric Dentistry 2011; 21: 13–22 Introduction. The aim of the study was to investigate caries experience and dental care index in diabetic children and to determine if correlation exists between caries experience and metabolic control, insulin treatment, and the duration of diabetes. Materials and methods. The study group consisted of 52 children and adolescents, 3–16 years of age with type 1 diabetes attending the outpatient diabetic clinic at Ghent University Hospital, Belgium. Fifty healthy subjects recruited from the paediatric dental clinic served as the control group. Caries lesions were assessed using DMF-index both at cavity and non-cavity levels. Participants and/or their guardians provided information about oral hygiene habits and dietary habits. Diabetes-related data (type, duration, insulin regimen) were collected from medical records and completed with the lab data on HbAlc. Conclusion. It became clear that, although children with type 1 diabetes mellitus could be expected to run a potential high caries risk taking into account the diabetes-associated biological and behavioural alterations, no significant differences were observed regarding caries experience and dental care between diabetic children and healthy controls. The level of untreated dental decay among the diabetic children is, however, considerably high, which was reflected by a significant lower dental attendance.

Endodontic treatment of immature teeth is often complicated because of flaring root canals and open apices for which apexification is needed. Long-term prognosis for these teeth is surprisingly low because of cervical root fractures occurring after an impact of weak forces. In this study, an experimental model was developed to determine the fracture resistance of immature teeth and to test the hypothesis that endodontic materials succeed in reinforcing them. Compact and hollow bone cylinders from bovine femurs were used as standardized samples. In order to evaluate the experimental model, fracture resistance in both groups was evaluated by determining the ultimate force to fracture (UFF) under diametral tensile stress. Analysis of variance (ANOVA) revealed a statistically significant difference between the mean values of UFF for both groups, independently of the sampling location or subject. In a following setting, the hypothesis that obturation with gutta percha (GP), mineral trioxide aggregate (MTA), or calcium phosphate bone cement (CPBC) reinforces the hollow bone samples was investigated. Obturation resulted in a significant reinforcement for all materials, but the degree of reinforcement depended on the material. The experimental model appeared to be suitable for in vitro investigation of reinforcement and fracture resistance in a standardized way.

Owing to a misunderstanding on the part of the authors, the name of the last author, Prof. R. M. H. Verbeeck, was omitted from this article.

The third molar development (TMD) has been widely utilized as one of the radiographic method for dental age estimation. By using the same radiograph of the same individual, third molar eruption (TME) information can be incorporated to the TMD regression model. This study aims to evaluate the performance of dental age estimation in individual method models and the combined model (TMD and TME) based on the classic regressions of multiple linear and principal component analysis. A sample of 705 digital panoramic radiographs of Malay sub-adults aged between 14.1 and 23.8 years was collected. The techniques described by Gleiser and Hunt (modified by Kohler) and Olze were employed to stage the TMD and TME, respectively. The data was divided to develop three respective models based on the two regressions of multiple linear and principal component analysis. The trained models were then validated on the test sample and the accuracy of age prediction was compared between each model. The coefficient of determination (R²) and root mean square error (RMSE) were calculated. In both genders, adjusted R² yielded an increment in the linear regressions of combined model as compared to the individual models. The overall decrease in RMSE was detected in combined model as compared to TMD (0.03-0.06) and TME (0.2-0.8). In principal component regression, low value of adjusted R(2) and high RMSE except in male were exhibited in combined model. Dental age estimation is better predicted using combined model in multiple linear regression models.

Biodentine™, een nieuw anorganisch restauratief cement gebaseerd op tricalciumsilicaat (Ca3SiO5) cement, wordt op de markt gebracht als een ‘bioactief dentinesubstituut’. De auteurs geven in dit hoofdstuk een samenvatting van de bestaande literatuur om zo na te gaan of het een geschikt alternatief vormt voor andere tricalciumsilicaat cementen in de endodontie en traumatologie. Een uitgebreid literatuur onderzoek werd uitgevoerd voor publicaties tussen 1980 en januari 2015. Rekening houdend met de fysische (hogere druksterkte, push-out hechtsterkte, densiteit en porositeit), biologische (vorming van calciumhydroxide, hogere afgifte en incorporatie van calciumionen) en verwerkingseigenschappen (snellere uitharding) van Biodentine™, zou dit bioactief tricalciumsilicaatcement een waardig alternatief kunnen betekenen voor mineraal trioxide aggregaat (MTA) in het kader van endodontie, dentale traumatologie, restauratieve tandheelkunde en kindertandheelkunde.

Introduction Biodentine TM is a new version of calcium silicate-based inorganic cement. Aim The aim of this review is to provide a detailed analysis of the physical and biological properties of Biodentine TM and to compare these properties with those of other tricalcium silicate cements viz. mineral trioxide aggregate (MTA) and Bioaggregate TM (Bioaggregate). Study design A comprehensive systematic literature search for all publications to date was performed on 20th November 2013 by two independent reviewers in Medline (PubMed), Embase, Web of Science, CENTRAL (Cochrane), SIGLE, SciELO, Scopus, Lilacs and clinicaltrials.gov using the search terms Biodentine, ‘‘tricalcium silicate’’, Ca3SiO5, ‘‘dentine substitute’’, ‘‘dentin substitute’’ and RD 94. In addition to the electronic search, hand searches and reference searches were performed to include articles published in journals that were not indexed in Medline. Randomised control trials (RCT), case control studies, case series, case reports, in vitro studies, animal studies and short communications in English language were considered for this review. Conclusions Considering the superior physical and biologic properties, Biodentine TM could be an efficient alternative to MTA to be used in a variety of clinical applications. There appears to be a wide range of clinical applications where Biodentine TM could be used in the field of endodontics, dental traumatology, restorative dentistry and pediatric dentistry. Although it seems to be good clinical practice, currently there is little clinical evidence to support all potential indications.

Aim The aim of this study was to analyze whether any correlation existed between Flemish dental practitioner's educational background and their perceptions of their knowledge regarding emergency treatment for crown fractures and their actual expertise. Methods A questionnaire was distributed among 336 dental practitioners at six different locations in the country and completed prior to a lecture on dental traumatology. The response rate was 100%. The questionnaire consisted of three parts: the first part enquired about personal background, the second part requested a self-assessment of the practitioner's dental trauma education and treatment experience, and the third part tested the knowledge of the practitioner by asking for responses to different options for emergency treatment for dental trauma. Results Nearly 63% of the participants had more than 20 years of experience. Satisfaction about adequacy in basic education in dental traumatology was significantly related to the years as graduation to older graduates being less satisfied. This observation was not related to the additional education taken. Most frequently, uncomplicated crown fractures (42%) were seen more frequently than severe injuries. Concerning knowledge, a high result (67%) of incorrect answers was given for the treatment for injured immature permanent incisors. However, a high correlation was found between good knowledge of treatment and young professionals who graduated

Optimal pit and fissure sealing is determined by surface preparation techniques and choice of materials.This study aimed (i) to compare the microleakage and penetration depth of a hydrophilic sealant and a conventional resin-based sealant using one of the following preparation techniques: acid etching (AE) only, a diamond bur + AE, and Er:YAG laser combined with AE, and (ii) to evaluate the microleakage and penetration depth of the hydrophilic pit and fissure sealant on different surface conditions.Eighty recently extracted 3rd molars were randomly assigned to eight groups of ten teeth according to the material, preparation technique, and surface condition. For saliva contamination, 0.1 mL of fresh whole human saliva was used. All samples were submitted to 1000 thermal cycles and immersed in 2% methylene blue dye for 4 h. Sections were examined by a light microscope and analysed using image analysis software (Sigmascan(®)).The combination of Er:YAG + AE + conventional sealant showed the least microleakage. The sealing ability of the hydrophilic sealant was influenced by the surface condition.Er:YAG ablation significantly decreased the microleakage at the tooth-sealant interface compared to the non-invasive technique. The hydrophilic sealant applied on different surface conditions showed comparable result to the conventional resin-based sealant.

Oral health is an essential component of children's general health. The aim of this study is to evaluate the training, knowledge, attitudes and practices of primary care paediatricians in oral health in Europe. Paediatricians were invited to complete a survey on the web. There was a 54.3% response rate. The oral health education of the responders was received mainly through continuing medical education and practical experience (51%) rather than in medical school or during paediatric residency training (33%). Twenty-four percent of the responders did not know that the first signs of caries were white spots on the surfaces of teeth. Although 98.8% of paediatricians check the oral health status of children, only 52% feel confident enough to identify dental caries. A large proportion of the paediatricians (43%) recommended a first dental visit for children above the age of 3 years and only 7% under 1 year of age.Paediatricians are familiar with some aspects of the oral health but are not confident in identifying the risk factors. The current postgraduate curriculum in Paediatrics should incorporate training on basic oral healthcare. In addition, continuous educational programmes are needed to keep the knowledge of the paediatrician up to date. What is Known: • Oral health is an essential component of general health that influences the functional, psychological and social dimensions of a child's well-being. • Paediatricians are the leading providers of primary healthcare for children. What is New: • Paediatricians are familiar with some aspects of the oral health of children but are not confident in identifying the risk factors responsible for oral disease. • The current postgraduate curriculum in Paediatrics should incorporate training on basic oral healthcare in children.