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Children and adolescents with autism spectrum disorder are thought to be more vulnerable to oral diseases than typically developing individuals due to cariogenic dietary habits, self-injurious behaviors, and increased barriers to dental care services. This review aimed to summarize current evidence comparing the oral health status of people diagnosed with and without autism spectrum disorder. Study selection and screening, data extraction, risk of bias assessment, and quality-of-evidence evaluation was conducted using the Grading of Recommendations Assessment Development and Evaluation approach and performed independently by two reviewers. A total of 16 studies were found eligible for qualitative synthesis and 15 were included in quantitative analysis. When comparing children and adolescents diagnosed with and without autism spectrum disorder, significantly higher prevalence of bruxism was identified. Individuals diagnosed with autism spectrum disorder were also found to have significantly lower salivary pH. However, no statistically significant differences in terms of caries prevalence and severity, oral hygiene and periodontal status, prevalence of malocclusion, dental traumatic injuries, as well as salivary flow rate and buffering capacity were found. The quality of evidence of each outcome was graded as very low mainly due to the overall high risk of bias, considerable heterogeneity, and imprecision.

This study compared oral health behaviours and barriers to dental care among preschool children with and without ASD, and evaluated dental knowledge and attitudes of their parents. 257 preschoolers with ASD and an age- and gender-matched control sample were recruited. Children with ASD had less frequently performed tooth-brushing and used toothpaste, but more often required parental assistance in tooth-brushing (p < 0.05). Barriers to dental care were more frequently reported among children with ASD (p < 0.001). Parents of children with ASD had higher scores in dental knowledge and attitudes than those without ASD. Differences in oral health behaviours and barriers to dental care existed between preschool children with and without ASD. Parents of children with ASD had better dental knowledge and attitudes.

Background: This cross-sectional study aimed to identify the prevalence of Candida albicans and Malassezia globosa in children with severe early childhood caries and caries-free children in Hong Kong. Methods: This study first recruited a total of 80 children aged between 48 and 72 months old, 40 children with severe early childhood caries, and 40 caries-free children. The children were then further divided into four groups, with 20 children in each group: Group 1: Severe early childhood caries—C. albicans, Group 2: Severe early childhood caries—M. globosa, Group 3: Caries-free—C. albicans and Group 4: Caries-free—M. globosa. Saliva, plaque, and caries lesion samples were collected from participants with severe early childhood caries, while only saliva and plaque samples were collected from caries-free participants. Caries status of the primary molars was assessed using WHO's decayed, missing, and filled tooth index, and the severity of cavitated lesions was determined based on International Caries Diagnosis and Assessment System criteria as caries code 5 or 6. The samples were analyzed using an Internal Transcribed Space and Quantitative Real-Time Polymerase Chain Reaction. Results:C. albicans was more prevalent in saliva and plaque samples of severe early childhood caries than in the caries-free group. Proportion of C. albicans in both saliva and plaque samples differed significantly between severe early childhood caries and caries-free groups (p < 0.05). Within the severe early childhood caries group, the proportion of children with C. albicans varied between 6 and 46%. No significant difference in M. globosa load was found between plaque samples of the severe early childhood caries and caries-free groups (p = 0.159). Conversely, no significant difference in M. globosa load was observed between saliva samples of severe early childhood caries and caries-free groups (p = 0.051). Conclusions: This study demonstrated a strong association between C. albicans and severe early childhood caries. M. globosa was detected in both the caries-free and severe early childhood caries groups, albeit at low levels. [ABSTRACT FROM AUTHOR]

Aim: To assess and compare the oral health status of preschool children with and without autism spectrum disorders. Methods: A random sample of 347 preschool children with autism spectrum disorder was recruited from 19 Special Child Care Centres in Hong Kong. An age- and gender-matched sample was recruited from mainstream preschools as the control group. Dental caries status, gingival health status, tooth wear, malocclusion, dental trauma and oral mucosal health were assessed and compared between the two groups. Results: It was feasible to conduct a comprehensive oral health screening among 74.1% (257) of the children with autism spectrum disorder. The mean age was 59 ± 10 months (range from 32 to 77 months), of whom 84.4% were males. Children with autism spectrum disorder had better gingival health than children without autism spectrum disorder (mean plaque score and gingival score p < 0.001). Children with autism spectrum disorder had less caries experiences than children without autism spectrum disorder (mean decayed, missing and filled surfaces and decayed surfaces, p < 0.05). Children with and without autism spectrum disorder had similar prevalence of tooth wear, malocclusion, dental trauma experience and oral mucosal lesions (p > 0.05). Conclusion: Differences in oral health status exist among preschool children with and without autism spectrum disorder. Preschool children with autism spectrum disorder exhibited lower caries experiences and better gingival health than children without autism spectrum disorder.

Background: Patients with multi‐bracketed fixed orthodontic appliances are at a higher risk of developing enamel demineralisation. Aim: To compare the efficacy of the quarterly application of two varnishes in preventing white spot lesions (WSLs) during multi‐bracketed fixed orthodontic treatment. Design: Ninety‐nine patients were randomly allocated into three intervention groups: Group A—standard oral hygiene instructions (OHI); Group B—5% sodium fluoride (NaF) varnish with standard OHI; and Group C—NaF plus tricalcium phosphate varnish with standard OHI. The outcome was assessed at 6‐monthly intervals using a quantitative laser fluorescence device, clinical evaluation and photographic evaluation on six maxillary anterior teeth. A logistic regression model using generalised estimating equations with the intervention group, time and their interaction was used to compare the occurrence of WSLs, whereas the independent‐samples Kruskal–Wallis test was used to compare the means of fluorescent values among different groups at p =.05. Results: Generalised estimating equations (with intervention and time as predictors) showed that only the effect of time was found to be significant (p <.001), whereas there was no significant difference among the three intervention groups (p =.305) using clinical assessment or photographic assessment (p =.599). At the 18‐month follow‐up, sodium fluoride (NaF) varnish with standard OHI was shown to reduce the odds of WSLs by 55% (p =.200), and NaF plus tricalcium phosphate varnish with standard OHI by 42% (p =.327). Conclusion: The study failed to demonstrate that the quarterly application of both the study varnishes with OHI provided additional benefits compared with standard OHI alone in preventing WSLs, taking the effect of time of follow‐up into consideration. There were higher odds of developing WSLs with an increased duration of orthodontic treatment. [ABSTRACT FROM AUTHOR]

Background: Demineralization during multi‐bracketed fixed orthodontic treatment is a well‐known problem. Aim: To systematically evaluate the evidence for the prevention of enamel demineralization during multi‐bracketed fixed orthodontic treatment. Design: Systematic reviews (with or without meta‐analysis) that have appraised the primary studies on the prevention of demineralization during multi‐bracketed fixed orthodontic treatment were searched systematically and included as per pre‐defined eligibility criteria. The risk of bias of the included reviews was assessed by two authors using the ROBIS tool and AMSTAR‐2 tool. Results: Twenty‐nine reviews conducted on 128 exclusive primary studies were included for the present overview; 23 of these reviews were assessed to be of a high risk of overall bias, 5 were of low risk, and 1 review was of unclear risk of bias. Conclusions: Predominantly, the published reviews have focused on fluorides, whereas some reviews have also studied the role of casein phosphopeptide‐amorphous calcium phosphate (CPP‐ACP), reminder therapy, lasers, and sealants. Professional fluorides, sealants, reminder therapy, and lasers might be valuable interventions to prevent demineralization during orthodontic treatment based on the conclusions of reviews with high quality; however, further studies are required to elucidate the role of CPP‐ACP, chlorhexidine varnish, and powered toothbrushes. [ABSTRACT FROM AUTHOR]

Purpose: Along with calcium and phosphate ions, fluoride ions promote remineralisation of noncavitated carious lesions to form fluorapatite. However, the supply of calcium and phosphate ions from saliva may not be adequate for effective remineralisation in patients with high caries risk. Therefore, an additional supply of calcium and phosphate ions is mandatory to enhance effective remineralisation with fluoride ions. Several calcium- and phosphatebased remineralisation agents are available for clinical use. However, the nature of the incorporated calcium and phosphate ions and the method of their stabilisation are not similar. Therefore, this review summarises research findings on the enamel remineralisation potential of calcium- and phosphate-based remineralisation agents. Materials and Methods: Appropriate key words were used and the Pubmed electronic database was searched to retrieve articles. Screening through titles and abstracts identified relevant articles. Full text review of the identified relevant articles was performed and the significant findings were summarised and presented in this review. Results: Several studies including laboratory-based studies, in situ and randomised controlled clinical trials showed casein phosphopeptide amorphous calcium phosphate (CPP-ACP)-containing remineralisation agents to have superior remineralisation potential compared to other forms of calcium- and phosphate-based remineralisation agents, such as functionalised tri-calcium phosphate (fTCP) and amorphous calcium phosphate (ACP). Conclusions: More long-term clinical studies are necessary to compare the enamel remineralisation potential of calcium- and phosphate-based agents that contain fTCP and ACP with those containing CPP-ACP. Additional well-designed randomised controlled clinical trials are also necessary to justify long-term clinical supplemental use of products containing CPP-ACP. [ABSTRACT FROM AUTHOR]

Background: Increasingly, mobile apps are being used to promote oral care. Many of them are aimed at children. Objective: This study aimed to systematically search and evaluate apps that promote oral care and hygiene for children. Methods: A broad search strategy (13 keywords) was developed to identify apps from Apple’s App Store and the Google Play Store in April 2019. After reviewing the apps’ titles and summaries, potentially relevant apps were downloaded for viewing. The quality of the apps that met the inclusion criteria was assessed by the Health on the Net Foundation Code of Conduct (HONcode) criteria for medical and health websites and the Scientific Basis of Oral Self-care (SBOSC). Results: More than 3000 Apps were identified and 54 relevant apps informed the review. The quality of the apps according to the HONcode criteria was generally low. The mean HONcode score was 1.8/8.0. One-quarter of the apps had a HONcode score of 0 (14/54, 26%). The SBOSC score of the apps was evaluated based on a 6-point scale. The mean SBOSC score was 1.5/6.0; 19% (10/54) of the apps had a score of 0. There was a significant and positive correlation between HONcode and SBOSC scores (r=0.37; P<.01). More recently uploaded apps had significantly higher HONcode scores (P<.05). Conclusions: There are many apps aiming to promote oral self-care among children. The quality and scientific basis of these apps are low. Newer apps are of higher quality in terms of scientific basis. There is a need to ensure high-quality and evidence-based apps are available. The effectiveness of apps in terms of oral care and clinical outcomes among children needs to be evaluated. [ABSTRACT FROM AUTHOR]

Purpose: To identify and review the psychometric properties of instruments available for measuring oral health literacy. Materials and Methods: A comprehensive computerised search was carried out using six databases. The final papers were rated for level of evidence and scientific quality. Results: A total of 621 potentially relevant articles were retrieved in the primary search. Twenty-nine studies using 13 oral health literacy instruments were included in the final analysis. After applying an international standards framework, all included studies were categorised as evidence level '2c'. Qualities of evidence were rated with STROBE guidelines. Psychometric analysis indicated various levels of validity and reliability across the instruments. Conclusions: As an emerging field, the number and reliability of oral health literacy instruments is rapidly growing, although many are in preliminary stages of testing. The majority of these focus on functional literacy and were developed in English for North American contexts. Further work is indicated to measure oral health literacy as a wider construct across diverse populations. [ABSTRACT FROM AUTHOR]

Purpose: This work describes a new method using polarized light microscopy to determine the failure modes of fractured beams following microtensile bond strength testing. The outcomes were validated using SEM and EDX elemental analysis. Materials and Methods: Resin adhesives and resin composites bonded to caries-free dentin samples as well as disks of adhesive and composite were observed with reflected polarized light microscopy (PLM) to obtain standard images. A set of beams fractured in the microtensile bond test were observed with PLM and compared with the standard images to determine failure mode through PLM color matching with the standard dentin, adhesive, or composite images. Samples were analyzed by EDX under SEM and compared with the PLM outcomes. Results: Reflected PLM images showed that the fractured surfaces covered with resin-based materials (adhesives or composite) appeared pink in color, in contrast to dentin surfaces, which appeared yellow. EDX mapping together with SEM observation confirmed the results obtained by PLM. Conclusion: The results of EDX mapping and SEM observation showed that the use of polarized light microscopy is a simple, viable method for differentiation between the resin-covered dentin surfaces for determining fracture pattern analysis after bond testing. [ABSTRACT FROM AUTHOR]

Objective: This systematic review investigated the oral health of children with ADHD. Method: A structured search strategy was performed on five electronic databases: SCOPUS, Web of Science, COCHRANE, PubMed, and PsychInfo. Studies were included in the review if they reported clinical oral health outcomes on a population diagnosed with ADHD under the age of 18 years old. Qualitative and quantitative analysis was performed on pooled prevalence and mean/median values for caries, trauma, periodontal problems, and tooth wear. Results: Twenty-seven effective articles were reviewed by two calibrated assessors. Meta-analysis of the results found higher mean number of decayed surfaces, plaque index, and trauma prevalence among children with ADHD. Conclusion: Children with ADHD show increased risk for caries and traumatic dental injuries, and may have poorer oral hygiene compared with children without ADHD. More awareness among clinicians would promote better caries- and trauma-preventive advice and management. [ABSTRACT FROM AUTHOR]

Purpose: This study evaluated the effect of chlorhexidine (CHX) incorporation into experimental dentin adhesives with different hydrophilicities on the microtensile bond strength (µTBS) to dentin. Materials and Methods: Flat, deep dentin surfaces were prepared from 60 extracted human third molars. Three ethanol-solvated (50 wt% ethanol/50 wt% comonomers) experimental adhesives with varying degrees of hydrophilicity were prepared for the CHX-free groups. For the CHX-containing groups, chlorhexidine diacetate was further added to the ethanol-solvated adhesives to form a concentration of 2.0 wt% CHX. Dentin surfaces were etched with 37% phosphoric acid for 15 s, rinsed and blot dried before bonding. The adhesives were generously applied to dentin with a microbrush for 15 s. A second application of fresh adhesive was made and light cured for 20 s (600 mW/cm²) after solvent evaporation. Composite buildups were made using Filtek Z250 (3M ESPE). The bonded teeth were sectioned into 0.9 mm x 0.9 mm beams and stressed to failure at a crosshead speed of 1 mm/min. Testing was performed 24 h after specimen preparation and 12 months after storage in artificial saliva. The µTBS data were analyzed using three-way ANOVA and Tukey's multiple comparison tests. Fractographic analysis was performed by SEM. Results: Significant differences were observed for the three factors "adhesive hydrophilicity" (p < 0.001), "CHX incorporation" (p = 0.001), and "storage time" (p < 0.001). Interaction among these three factors was also significant (p < 0.001). Incorporation of CHX had no effect on the immediate bond strength of the three experimental adhesives (p > 0.05). After storage in artificial saliva, significant reduction in bond strength was observed in all adhesive groups, except for CHX-containing adhesive I (p < 0.001). The µTBS of the CHX-containing experimental adhesive III was significantly higher than the corresponding CHX-free adhesive (p < 0.001) after aging. Conclusion: When incorporated into hydrophilic dental adhesives, chlorhexidine can partially reduce the degradation of the resin-dentin bonds. [ABSTRACT FROM AUTHOR]

Purpose: This study examined the effects of cutting dentin with different burs at various speeds on the microtensile bond strength (μTBS) of two self-etching adhesive systems. Materials and Methods: Flat deep dentin surfaces from 50 extracted human third molars were divided into 5 groups (n ≤ 10) according to bur type and speed of rotation: (I) high-speed diamond bur, (II) low-speed diamond bur, (III) highspeed tungsten carbide bur, (IV) low-speed tungsten carbide bur. Controls were abraded with 600-grit SiC paper. A two-step self-etching adhesive, Clearfil SE Bond (SE, Kuraray) and a one-step self-etching adhesive, Clearfil S3 Bond (S3, Kuraray) were applied to dentin surfaces and light cured. Composite buildups were performed using Filtek Z250 (3M ESPE). For μTBS evaluation, composite-dentin beams of 0.8 mm2 were stressed to failure at a crosshead speed of 1 mm/min. The μTBS data were analyzed using two-way ANOVA and Tukey's multiple comparison tests. Representative fractured beams from each group were prepared for fractographic analysis under SEM. Results: Two-way ANOVA showed that the effects of dentin surface preparations, adhesive systems, and their interaction were statistically significant (p < 0.001). The μTBS was the highest when bonding SE to dentin surface prepared with 600-grit SiC abrasive paper (47.3 ± 7.4 MPa), followed by high-speed tungsten carbide burs (40.8 ± 6.1 MPa), and the lowest when bonding S3 to dentin surfaces prepared with a high-speed diamond bur (15.2 ± 6.2 MPa). SEM observation of the fractured surfaces revealed mixed and adhesive failures for SE groups, while in the S3 groups, adhesive failures predominated with numerous inclusion droplets. Conclusion: Higher bond strengths are achieved with SE bond when applied on dentin surfaces prepared with tungsten carbide burs. Proper bur and adhesive selection are essential to optimize dentin adhesion of self-etching adhesives. [ABSTRACT FROM AUTHOR]

Purpose: To determine if adverse chemical interaction and adhesive permeability are both responsible for the incompatibility between a single-step, self-etching adhesive and chemically-cured or dual-cured composites. Materials and Methods: Bonding was performed with Xeno CF Bond (Dentsply-Sankin), on either hydrated (H) or dehydrated (DH) human dentin. For microtensile bond strength evaluation, a dual-cured hybrid composite (Bis-Core) was activated using: (1) the light-cured (L) mode (base syringe only), (2) delayed light activation (DL) (base syringe left on top of cured adhesive in the dark for 20 min before activation), and 3) the chemically-cured (C) mode (base and catalyst syringes in the dark). A chemical co-initiator (B; BondLink) was also applied to the cured adhesive before coupling with the composite in chemically-cured mode. This resulted in seven experimental groups: (1) L-H (control); (2) DL-H; (3) DL-DH; (4) C-H; (5) C-DH; (6) C-B-H; and (7) C-B-DH. For transmission electron microscopy, the dual-cured composite in the seven groups was replaced with a light-cured microfilled composite (Metafil CX) and an experimental chemically- cured microfilled composite of the same composition. Specimens were immersed in ammoniacal silver nitrate for 24 h. After reduction of the diamine silver ions to silver, undemineralized and unstained sections were examined for nanoleakage within the resin-dentin interfaces of the seven groups. Results: For the light-cured modes, bond strengths fell substantially in DL-H but not in DL-DH. For the chemically-cured modes, bond strengths were lowest in C-H and only increased slightly in C-DH. The use of a chemical co-initiator with the adhesive further improved the bond strength in C-B-H. Only C-B-DH was not significantly different from the control light-cured mode L-H. Two abnormal modes of silver deposition were observed in resin-dentin interfaces. A continuous layer of silver was observed when the chemically- cured composite was applied to the cured adhesive in the absence of the chemical co-initiator (C-H; C-DH). Silver-impregnated water blisters were identified when the chemically-cured composite was coupled to bonded hydrated dentin (C-H; C-B-H). Similar water blisters were seen in DL-H in which adverse chemical interaction should not occur. Conclusion: Adverse chemical interaction between catalytic components of chemically-cured composite and the tested single-step, self-etching adhesive was the major cause of reductions in bond strength, while adhesive permeability was a minor cause of bond strength reduction. The combination of these two factors accounts for the substantial reduction in bond strength when chemically-cured or dual-cured composites were coupled to bonded hydrated dentin. [ABSTRACT FROM AUTHOR]

Several dentifrices are available in the market for tile control of calculus, plaque, and gingivitis. The anticalculus activity of the pyrophosphate dentifrice formulation has been convincingly demonstrated. Recently, dentifrices containing 0.3% triclosan and 2.0% Gantrez have been shown to possess some anticalculus activity, in addition to their antiplaque and antigingivitis properties. Similarly, sequential application of sanguinarine-containing dentifrice with a brash, followed by a rinse of 30 to 60 seconds, also provides sustained antiplaque and antigingivitis effects. However, other dentifrices have had much less convincing clinical results. It is therefore important for dentists to interpret the therapeutic claims of various antiplaque and antigingivitis dentifrices cautiously before recommending these products to patients. [ABSTRACT FROM AUTHOR]

Ten patients with skeletal Class III malocclusion in the early mixed dentition who were treated with maxillary expansion appliance and protraction headgear were compared with reasonably matched controls. Significant orthopedic effects were found after as little as 6 months of treatment. Cephalometric analysis revealed that the correction of Class III malocclusion was primarily a result of forward and downward movement of the maxilla and backward rotation of the mandible. The clinical result of one patient treated with this appliance is used to demonstrate the importance of force magnitudes and directions, as well as the design of the appliance, to the success of the treatment. [ABSTRACT FROM AUTHOR]

Because research has resulted in a better understanding of the etiology of dental caries as well as the introduction of new techniques and materials in the practice of dentistry, approaches toward the management of rampant caries should be reevaluated. The development of the acid-etching technique and the improvements in the physical properties and clinical performance of composite resins and glass-ionomer cements have completely changed the concepts of prevention, conservative dentistry, and dental esthetics. Several methods for the treatment of rampant caries are described and management of two cases is documented. [ABSTRACT FROM AUTHOR]