Oral Health and Preventive Dentistry

Purpose: To describe the use of work process modelling to optimise the organisation of the demand for oral health treatment in primary care units in Brazil. Materials and Methods: The oral health care routine was at first described as the “AS IS” model, which was evaluated by the oral team professionals, rearranged, and further described as the “TO BE” model described using a business process management modelling tool. The significant increase in the demand of patients due to restrictions offered by the dental service in addition to non-urgent treatments being avoided by patients during COVID-19 pandemic was also considered. Results: Structuring the work processes in a visual way using modelling tools was useful to picture the entire treatment process and adjust when needed. The use of the managerial tool was useful to understand and reorganise the workflow of organising the demand and ultimately improve the efficiency of the resources. The use of such managerial tools helped oral health professionals to efficiently rearrange their tasks and set priorities to meet their needs. Conclusions: With the use of management tools, each unit can readjust its structures and ways of working, aiming to improve the quality of public health care services provided to patients. Keywords: demand, primary health care, oral health, workflow

Purpose: To identify the relationship between periodontal health knowledge and oral health-related quality of life among Caribbean adults. Materials and Methods: A cross-sectional study was conducted in a representative sample from 3 Caribbean cities (weighted N = 1805). Participants completed a questionnaire on oral health knowledge, hygiene habits, and other practices, as well as the Oral Health Impact Profile-14 (OHIP-14) questionnaire. The associations between knowledge and habits and OHIP-14 score and its tertiles were evaluated using negative binomial and multinomial logistic regression models, respectively, adjusting for confounders. Odds ratios and regression coefficients were reported. Results: Participants reporting none, little, and adequate knowledge about gum health had higher odds of being in the worst tertile for OHRQoL, compared to those reporting “good knowledge” (ORnone vs good = 2.38, 95% CI: 1.59–3.54; ORlittle vs good = 1.82, 95% CI: 1.19–2.78; ORadequate vs good = 1.68, 95% CI: 1.11–2.57). Participants reporting toothbrushing ≥ twice/day were less likely to be in the worst tertile for OHRQoL, compared to those brushing less often (OR = 0.67, 95% CI: 0.48–0.92). Self-reported gum bleeding was associated with double the odds of being in the worse tertile (OR = 2.03, 95% CI: 1.60–2.58). Conclusion: According to the findings of this study, periodontal health knowledge is associated with reduced OHRQoL in Caribbean Adults. In addition, the frequency of brushing and the self-reported gum bleeding was related to a worse quality of life (QoL) level. Keywords: Caribbean adults, OHIP-14 questionnaire, oral health, patient education, quality of life

Purpose: To evaluate the peri-implant parameters of immediately placed and loaded mandibular overdentures over a 5-year follow-up period. Materials and Methods: All subjects who had been advised and planned for two-implant mandibular overdenture treatment were included in this study. The peri-implant parameters –including plaque index (PI), bleeding index (BI) and peri-implant pocket depth (PIPD) as well as marginal bone loss (MBL) – were assessed. In addition, prosthodontic parameters including abutment-, implant- and denture-related complications were assessed. Patients were evaluated at follow-up visits, scheduled at 1, 12, 24, 36, 48, and 60 months. The data distribution was analysed with the Shapiro-Wilk test. Data within follow-up categories were compared using ANOVA and the Tukey-Kramer test. A p-value < 0.05 was considered statistically significant. Results: Among the 32 participants, 19 were males and 13 were females, with a mean age of 60.5 ± 7.33. The mean plaque index (PI), bleeding index (BI) and peri-implant pocket depth (PIPD) varied over time. However, no statistically significant difference was observed in the plaque index, bleeding index and peri-implant pocket depth over time (p > 0.05). The mean value at baseline was found to be -0.9 ± 0.3. The values increased over time, with the highest value observed at 60 months 2.6 ± 0.7, which was statistically significant (p < 0.001). Conclusion: Immediately placed and loaded mandibular implant overdentures using two un-splinted implants with locator attachments showed acceptable PI, BI and PIPD at the 5-year follow-up. Statistically significantly greater marginal bone loss was observed from baseline to follow-up, but it was within acceptable limits. A moderate number of restorative and abutment complications were observed during the follow-up of IODs. Keywords: dental implants, immediate dental implant loading, overdentures, peri-implantitis

Purpose: To examine the relationship between socioeconomic inequalities and oral health among adults in the Guangxi province of China. Materials and Methods: The present work was designed as a cross-sectional study, and comprises a secondary analysis of the Fourth National Oral Health Survey from 2015–2016. A multistage cluster sampling method was adopted for this survey, conducted in three urban and three rural districts Guangxi province. Dental examinations were conducted to determine oral health indicators: decayed teeth (DT), clinical attachment loss (CAL) and missing teeth (MT). The outcome measures were DT, CAL and MT. A structured questionnaire was used to collect data on demographic characteristics and socioeconomic status (SES). Multiple logistic regression models were used to analyse the relationship between SES and oral health by adjusting covariates. Results: The sample consisted of 651 participants aged 35–74 years. Logisitic analysis showed a statistically significant association between SES and oral health indicators. In the fully adjusted model, participants with primary education were more likely to suffer more DT (OR = 2.67, 95% CI: 1.17–6.10), teeth with CAL ≥ 4 mm (OR = 2.15, 95% CI: 1.25–3.67) and MT (OR = 3.04, 95% CI: 1.65–5.60) compared to the higher education group. Participants with secondary education exhibited a higher likelihood of experiencing increased MT compared to those in the higher education group in the fully adjusted model (OR = 3.21, 95% CI: 1.78–5.76). Household income was associated with DT and MT in the unadjusted model only. Conclusions: There was strong relationship between SES and oral health of adults. The survey suggested a relationship between low educational attainment and oral health. Keywords: oral health, socioeconomic inequalities, socioeconomic status

Purpose: To screen for the cisplatin resistance-related prognostic signature in oral squamous cell carcinoma (OSCC) and assess its correlation with the immune microenvironment. Materials and Methods: The gene expression data associated with OSCC and cisplatin-resistance were downloaded from TCGA and GEO databases. Cisplatin-resistant genes were selected through taking the intersection of differentially expressed genes (DEGs) between tumor and control groups as well as between cisplatin-resistant samples and parental samples. Then, prognosis-related cisplatin-resistant genes were further selected by univariate Cox regression and LASSO regression analyses to construct a survival prognosis model. A GSEA (gene set enrichment analysis) between two risk groups was conducted with the MSigDB v7.1 database. Finally, the immune landscape of the sample was studied using CIBERSORT. The IC50 values of 57 drugs were predicted using pRRophetic 0.5. Results: A total 230 candidate genes were obtained. Then 7 drug-resistant genes were selected for prognostic risk-score (RS) signature construction using LASSO regression analysis, including STC2, TBC1D2, ADM, NDRG1, OLR1, PDGFA and ANO1. RS was an independent prognostic factor. Additionally, a nomogram model was established to predict the 1-, 2-, and 3-year survival rates of samples. The GSEA identified several differential pathways between two risk groups, such as EMT, hypoxia, and oxidative phosphorylation. Fifteen immune cells were statistically significantly different in infiltration level between the two groups, such as macrophages M2, and resting NK cells. A total of 57 drugs had statistically significantly different IC50 values between two risk groups. Conclusion: These model genes and immune cells may play a role in predicting the prognosis and chemoresistance in OSCC. Keywords: cisplatin, gene, oral squamous cell carcinoma, prognosis, resistance

Purpose: To compare the effectiveness of an interproximal brush, a water flosser, and dental floss in removing plaque and reducing inflammation around implant-supported crowns. Materials and Methods: A randomised controlled trial was conducted involving 45 participants with implant-supported single crowns. The participants were randomly assigned to three groups: interproximal brush, water flosser, and dental floss. Plaque index scores, gingival index scores, and interleukin-6 (IL-6) levels were assessed at baseline and after a two-week period. Statistical analysis was performed to compare the outcomes among the groups. Results: Following the second visit, improvements in plaque control were observed across all three interdental cleaning methods. The water flosser demonstrated a slight reduction in IL-6 levels (60.17 ± 3.07 vs 58.79 ± 4.04) compared to the initial visit, although this decrease was not statistically significant. Conversely, both the interdental brush and dental floss exhibited a slight increase in IL-6 levels at the second visit (60.73 ± 2.93 and 55.7 ± 10.64, respectively) compared to the mean at the first visit (58.38 ± 3.24 and 54.6 ± 2.22, respectively). Among the groups, only the interproximal brush demonstrated a statistically significant difference in IL-6 levels (p=0.008), while no statistically significant differences were observed in the dental floss and water flosser groups. Conclusion: Within the study’s limitations, our findings suggest that all three methods of interdental cleaning effectively improve plaque control and reduce gingival inflammation. However, using a water flosser appears to reduce inflammation more effectively, highlighting its potential advantage over the other two methods. Further research is needed to evaluate the long-term efficacy and impact of these methods on implant survival. Keywords: dental implant, interdental aid, oral hygiene, single crowns, water floss

Purpose: The relationship between the number of chronic diseases and oral health problems is unclear. We sought to determine whether the number of chronic diseases and multimorbidity have an association with oral health problems in Korean adults. Materials and Methods: Data from 23,246 adults aged ≥ 19 years, who participated in the Korea National Health and Nutrition Examination Survey from 2016 to 2019, were considered for our analyses. Participants with either masticatory or speech problems were defined as the oral health problems group. Individuals who reported having had dental treatment in the last year were defined as the dental treatment group. We used multivariable logistic regression analyses to calculate odds ratios (ORs) and 95% confidence intervals (CIs). Results: The proportions of oral health problems and dental treatment were higher in participants with multimorbidity than in those without multimorbidity (all p < 0.001). Moreover, ORs of oral health problems demonstrated a tendency to increase with the number of chronic diseases, even after adjustment (p for trend < 0.001). Compared to the participants without multimorbidity, the risk of having oral health problems increased by 25% (OR: 1.25, 95% CI: 1.12–1.39), and that of receiving dental treatment increased by 23% (OR: 1.23, 95% CI: 1.13–1.34) in patients with multimorbidity. Conclusion: The risk of oral health problems and dental treatment increased in association with the number of chronic diseases in Korean adults. The authors emphasise the risks and importance of oral health in a large population affected by multiple chronic diseases. Keywords: chronic diseases, dental treatment, Korea, multimorbidity, oral health problems

Purpose: Previous surveys have reported that children with vitamin D deficiency were likely to suffer from early childhood caries (ECC). The aim of this systematic review and meta-analysis was to determine 1. whether the status of vitamin D is intrinsically related to the occurrence of ECC and 2. the optimal level of vitamin D for the prevention of ECC. Materials and Methods: The database of PubMed, Web of Science, Cochrane, Embase and Google scholar were searched for targeted literature. The eligibility criteria were observational studies in which children with ECC were compared to children without ECC in terms of their vitamin D status. Applying the Newcastle-Ottawa tool, study selection, data extraction, and risk of bias assessment were performed by 2 reviewers independently. Meta-analysis was performed using the Cochrane Collaboration’s Review Manager 5.4 software. Results: 501 articles were retrieved from the electronic databases; 11 studies were finally included in systematic review, 10 studies of which were submitted to meta-analysis. The 25(OH)D levels in the ECC group were statistically significantly lower compared with that in the caries-free group (WMD = -13.96, 95% CI: [-19.88,-8.03], p < 0.001), especially in regard to the association between S-ECC and vitamin D (WMD = -18.64, 95% CI: [-20.06,-17.22], p < 0.001). The subgroup analyses in terms of geographical region demonstrated that children with a level of 25(OH)D of 50–75 nmol/l were more likely to have ECC than those with over 75 nmol/l (OR = 1.42, 95% CI: [1.26,1.60], p < 0.001), with data from Asia and Europe combined for analysis Conclusions: The level of vitamin D was lower in children with ECC than in caries-free children, and the correlation between S-ECC and vitamin D was even stronger. The optimal 25(OH)D level for preventing occurrence and development of ECC was ≥ 75 nmol/l. Thus, clinicians should view the development of early caries also from a systemic perspective. Keywords: early childhood caries, vitamin D, 25(OH)D

Purpose: This study aimed to investigate the inhibitory effect of a PRG Barrier Coat on biofilm formation and structure by Streptococcus mutans and propose an effective method for preventing dental caries. Materials and Methods: Streptococcus mutans MT8148 biofilms were obtained from hydroxyapatite disks with and with- out a PRG Barrier Coat. Scanning electron microscopy (SEM) was used to observe the 12- and 24-h-cultured biofilms, while reverse-transcription polymerase chain reaction (qRT-PCR) was used to quantify caries-related genes. Biofilm adhe- sion assessments were performed on glass. Statistical analysis was performed using a two-sample t-test. Results: A statistically significant difference in Streptococcus mutans biofilm adhesion rate was observed between the con- trol and PRG Barrier Coat-coated samples (p < 0.01). However, there was no statistically significant difference in total bacter- ial count or biofilm volume (p > 0.05). SEM revealed that the PRG Barrier Coat inhibited biofilm formation by Streptococcus mutans. Real-time RT-PCR revealed that the material restricted the expression of genes associated with caries-related bio- film formation. However, the suppression of gtfD and dexB differed from that of other genes. Conclusion: PRG Barrier Coat suppressed biofilm formation by Streptococcus mutans by inhibiting the expression of in- soluble glucan synthase, which is associated with primary biofilm formation. The material also affected gene expression and altered the biofilm structure. Tooth surface-coating materials, such as PRG Barrier Coat, may improve caries preven- tion in dental practice. Keywords: biofilm, PRG Barrier Coat, reverse-transcription polymerase chain reaction (RT-PCR), scanning electron mi-croscopy (SEM), Streptococcus mutans

Purpose: Environmental factors modulate oral-health-related quality of life (OHRQoL). The aim of this study was to analyse sociodemographic and behavioural factors affecting the OHRQoL in Spanish adolescents, by using the Child-OIDP (Child-Oral Impacts on Daily Performances) index. Materials and Methods: A cross-sectional study was conducted in 337 adolescent schoolchildren aged 13–15 years. A questionnaire on sociodemographic, behavioural and oral self-perception factors was administered with the Child-OIDP questionnaire. Descriptive statistics, Kruskal-Wallis and Mann-Whitney U-tests, as well as a regression model were used in the data analysis. Results: The overall mean Child-OIDP index was 3.28±6.55. It was statistically significantly higher in females than in males (p 0.001). Mothers having a managerial job showed statistical association with worse OHRQoL (p 0.001). Caries experience and history of dental trauma were not associated with the oral-health-related quality of life (p > 0.05). Halitosis statistically significantly affected the activities of daily living (p 0.001). Perceived dental problems, dental treatment needs, self-assessment of oral health status and satisfaction with oral health were associated with the impact index (p 0.05). Conclusion: Mothers who were managers, female sex, presence of halitosis, and perceived dental treatment needs were the most important predictors of the impact index, while dietary habits, oral hygiene, and dental visits did not affect it. Knowledge of these factors will help dental professionals to apply adequate preventive and therapeutic measures. Keywords: adolescent, behavioural factors, oral health, quality of life, sociodemographic factors

Purpose: To collect and evaluate the available evidence on existing tools used in research and clinical practice to assess and analyse the diet of children and adolescents for its cariogenicity. Materials and Methods: Multiple databases were searched up to October 2022, with no date, publication, or language restrictions, followed by a manual search. Study screening, data extraction, and risk of bias assessment were performed in duplicate. Dietary assessment tools and dental clinical parameters tested were retrieved for qualitative assessment and synthesis. Results: Of the 2896 papers identified, 9 cohort and 23 cross-sectional studies fulfilled the inclusion criteria. To assess dietary data, 13 studies used a 24-h recall, 11 used a food diary, and 7 used a food frequency questionnaire. For analysis, five studies reported using the Healthy Eating Index, ten used a score based on consumption of sugars, and the remaining analysed cariogenic diet based on the weight and frequency of sugars consumed, or the daily caloric intake from free sugars. Risk of bias assessment suggested that 65.7% of the studies were of moderate and 31.5% of high quality. Conclusion: Inconsistency exists regarding methods used for the assessment and analysis of dietary cariogenicity. Although every dietary assessment tool has different strengths and limitations, the 24-h recall was the most commonly used method for the assessment of dietary cariogenicity and the most consistent in detecting a positive relationship between sugary diet and carious lesions. A standardised method for cariogenic analysis of dietary data needs to be determined. Keywords: cariogenic diet, dietary assessment tools, food diary, 24-h recall

Purpose: This study aimed to assess the impact of photodynamic therapy (PDT) on the oral health-related quality of life (OHRQoL) among denture stomatitis patients with implant overdenture prostheses (IODs). Materials and Methods: The patients were recruited from a specialist dental practice according to selection criteria. The Candida spp. were identified and confirmed by the microbiological culture technique. Candida counts were estimated as colony-forming units (CFU/ml) at baseline, 15, 30, and 60 days. PDT was carried out twice a week with 72 h intervals for a period of 4 weeks. A structured questionnaire was used for data collection. It included the demographic details of the patients, including age, gender, education, marital and socioeconomic status (SES), oral habits, and smoking status. In addition, the Oral Health Impact Profile-EDENT (OHIP-EDENT) scale was added to assess the OHRQoL of all patients before and after PDT treatment. The data were analysed using descriptive statistics, the t-test and the Shapiro-Wilk test; statistical signifcance was set at p < 0.05. Results: At baseline, the overall mean Candida CFU/ml were quite high in the implant overdenture (IODs) samples, 37.12 ± 15.8, as compared to palatal mucosa samples with 5.1 ± 2.3. After PDT treatment, a statistically significant reduction was noted in the mean Candida CFU/ml on both surfaces at all follow-up visits. It was observed that all domains of OHIP-EDENT except for physical disability and handicap showed statistically significant improvement in mean scores after PDT treatment. FL, P1, P2, D2, and D3 had statistically significant mean score improvements of 2.2, 3.1, 2.2, 1.4, and 0.7, respectively. Furthermore, after PDT treatment, the total OHIP-EDENT score showed a statistically significant improvement of 11.6. Conclusion: PDT treatment has a positive impact on the OHRQoL for patients with denture stomatitis. It can be used as an effective treatment option for the treatment of denture stomatitis in IOD patients. Keywords: dental implant, patient-centered outcome, patient satisfaction, photo-disinfection, quality of life, removable denture

Purpose: Dental students learn knowledge and practical skills to provide oral health care to the population. Practical skills must be maintained or continuously developed throughout a professional career. This cross-sectional survey aimed to evaluate the perception of practical skills of dental students and dental-school graduates by national dental associations (NDAs) in international comparison in the European Regional Organization of the FDI World Dental Federation (ERO-FDI) zone. Materials and Methods: A questionnaire of 14 items collected information on pre-/postgraduate areas. Results: A total of 25 countries participated (response rate: 69.4%), with 80.0% having minimum requirements for practical skills acquisition and 64.0% starting practical training in the 3rd year of study. In countries where clinical practical work on patients begins in the 2nd year of study, practical skills of graduates are perceived as average, starting in the 3rd year of study as mainly good, starting in the 4th as varying widely from poor to very good. In total, 76.0% of respondents feel that improvements are needed before entering dental practice. Improvements could be reached by treating more patients in dental school (32.0%), increasing the quantity of clinical training (20.0%), or having more clinical instructors (12.0%). In 56.0% of the countries, it is possible to open one’s own dental practice immediately after graduation, and in 16.0%, prior vocational training is mandatory. Conclusions: All participating countries in the ERO-FDI zone reported practical training in dental school, most starting in the 3rd year of study. The perception of practical skills of dental students and dental-school graduates among NDAs is very heterogeneous. Reasons for the perceived deficiencies should be further explored. Keywords: dental association, graduate, international, practical skills, student

Purpose: When carrying out prosthetic rehabilitation of edentulous and partially edentulous patients, great attention is paid to the personal attitude of the patients, their satisfaction with oral health and psychosocial interaction due to tooth loss, as well as the treatment of the resulting disorders. This attention has led to the development of various instruments for examining the quality of life related to oral health. The aim of this study was to develop and validate a reliable instrument in the Serbian language suitable for measuring oral health-related quality of life in patients who have been rehabilitated with complete or partial dentures. Мaterials and Methods: The study was unicentric and cross-sectional, and assessed the reliability and validity of a newly developed instrument for measuring the oral health-related quality of life in denture wearers (OHRQoL-DW). It was conducted on a sample of 200 adults from Serbia, wearers of various types of dentures, with a mean age 66.9 ± 10.3 years and male/female ratio of 86/114 (43%/57%). Results: The definitive version of the OHRQoL-DW scale with 28 items showed very good reliability, with Cronbach’s alpha = 0.938. Good temporal stability of the questionnaire was demonstrated, and satisfactory results were obtained for divergent and convergent validity tests. Exploratory factorial analysis revealed four domains of oral health-related quality of life in denture wearers: physical, psychosocial, environmental and aesthetic. Conclusions: The OHRQoL-DW scale is a reliable and valid generic instrument for measuring the oral health-related quality of life in patients wearing dentures, which is one of the most important outcomes of oral health in prosthetic treatment. Keywords: complete denture, oral health, partial denture, quality of life

Purpose: To assess the antioxidant and antineoplastic effects of Hibiscus sabdariffa Linn. on oral squamous cell carcinoma cells. Materials and Methods: Human squamous cell carcinoma HSCC cells were tested for cytotoxicity by a methanol extract of Hibiscus sabdariffa (MEHSP). After 24, 48, and 72 h, the MTT assay and Trypan blue exclusion test were used to determine cell survival and death. 2, 2-diphenyl-1-picrylhydrazyl (DPPH), DNA Protection Assay (DPA), and ferric reducing antioxidant power assay (FRAPA) measured the antioxidant activity of MEHSP. Results: The antioxidant activity (%) ranged from 47.92-82.24 in the DPPH test, 11.61-73.65 in the DPA, and 4.97-52.09 in the FRAPA. The HSCC in-vitro cytotoxicity assay showed dose- and time-dependent cell viability. MEHSP at 5 μg/ml inhibited viable cells, while increasing MEHSP doses decreased cell viability. The Trypan blue exclusion test showed that MEHSP significantly reduced cell viability at 24, 48, and 72 h. Conclusion:Hibiscus sabdariffa contains antioxidant and HSCC-cytotoxic properties. Keywords: DPPH, Hibiscus sabdariffa, methanol, natural anticancer compound, squamous cell carcinoma

Purpose: To examine the clinical efficacy of a chlorhexidine gargle combined with recombinant bovine basic fibroblast growth factor (rb-bFGF) gel in the treatment of recurrent oral ulcers and its effects on inflammatory factors, immune function, and recurrence rate. Materials and Methods: Ninety-six patients with recurrent oral ulcers were randomly assigned to two groups: experimental (treatment with chlorhexidine gargle plus rb-bFGF gel) and control (treatment with chlorhexidine gargle alone) (n = 48 cases). The therapeutic efficacy, clinical improvement of symptoms, and recurrence rate within 3 months were compared between the two groups. Serum inflammatory factor and immune factor levels of patients in the two groups were measured before and after treatment. Results: A statistically significantly higher total effective rate was found in patients of the experimental group (95.83%) versus the control group (81.25%) (p < 0.05). The time to onset of pain relief was shortened, the duration of pain relief was prolonged, and VAS scores for pain level were lower in the experimental than the control group (p < 0.05). Among patients in the experimental group, the number of oral ulcers and ulcer area decreased, and faster onset of pain relief and time until normal eating improved in comparison to the control group (p < 0.05). Reduced levels of IL-2, IL-6, IL-8, and TNF-α were observed in the experimental vs the control group (p < 0.05). Elevated levels of CD3+, CD4+, and NKT and reduced levels of CD8+ were found in the experimental group compared to the control group (p < 0.05). The ulcer recurrence rate of patients in the experimental group (8.33%) was notably lower in comparison to the control group (29.17%). Conclusion: Chlorhexidine gargle plus rb-bFGF gel can improve the clinical outcome of patients with recurrent oral ulcers. It can reduce the levels of inflammatory factors, improve immune function, and reduce the recurrence rate. Keywords: chlorhexidine gargle, clinical efficacy, immune function, inflammatory factors, recombinant bovine basic fibroblast growth factor gel, recurrence rate, recurrent oral ulcers

Purpose: To determine the caries status in children’s deciduous teeth and examine the influence of family oral health behaviours on the caries status. Materials and Methods: This cross-sectional study included 329 children aged 3–6 years in rural Heishanzui Township, Hebei Province, China, and used a completely random sampling method. These children underwent physical and oral health examinations. The questionnaires were given to the parents and caregivers of the examined children. Results: The prevalence of caries in the deciduous dentition among children aged 3–6 years was 80.55%, with a dmft index of 4.93. Children in the caries group ate sweets, chocolates, and carbonated drinks more frequently than did children in the caries-free group (p < 0.05). Children in the caries-free group brushed their teeth more frequently, with parents helping their children brush, more often than did those in the caries-affected group (p < 0.05). The level of parental education and annual household income also had statistically significant effects on the prevalence of caries in the two groups (p < 0.05). Logistic regression analysis revealed that the frequency of eating sweets was a risk factor for caries in deciduous teeth (odds ratio = 2.20; p < 0.05). Conclusion: The prevalence of caries in deciduous teeth among children aged 3–6 years in rural Heishanzui Township was high. Compared to children in the caries-affected group, the families and children in the caries-free group had better oral hygiene behaviours. Moreover, the frequency of eating sweets was shown to be a risk factor for caries in deciduous teeth in children aged 3–6 years. Keywords: caries, children, deciduous dentition, oral health behaviours, rural areas

Purpose: To investigate the effect of full-mouth disinfection on the sizes of the periodontal wound and periodontal inflammatory burden and whether it leads to a decrease in C-reactive protein (CRP) levels. Materials and Methods: The study included 20 systemically healthy subjects (11 women and 9 men) 30 to 68 years old with localised or generalised periodontitis (stage III, grade C). The sizes of the periodontal wound and periodontal inflammatory burden were measured with the web application “Periodontalwound”, which is based on measurements of average tooth cervices, as well as probing depths and bleeding on probing assessed at six sites around each tooth present in the oral cavity. The levels of hsCRP (high-sensitivity CRP) were measured with an immunochemical method. All three parameters were measured before initial treatment and 3 months after therapy. Full-mouth disinfection included removal of plaque and calculus with ultrasonic and hand instruments in one session. Results: The results showed a statistically significant decrease in the size of the periodontal wound (p < 0.001), a statistically significant decrease in the size of periodontal inflammatory burden (p < 0.001), and a decrease in hsCRP levels 3 months after therapy. Conclusion: Full-mouth disinfection leads to a decrease in the periodontal wound and periodontal inflammatory burden size, as well as a decrease in the levels of hsCRP in patients with localised or generalised periodontitis (stage III, grade C). Keywords: C-reactive protein, full-mouth disinfection, periodontal inflammatory burden, periodontal wound

Purpose: To study the therapeutic effect of hemagglutinin-2 and fimbrial (HA2-FimA) vaccine on experimental periodontitis in rats. Materials and Methods: The first batch of rats was divided into two groups and immunised with pure water or pVAX1-HA2-FimA at the age of 6, 7, and 9 weeks. After sacrificing the animals, total RNA was extracted from the spleens for RNA high-throughput sequencing (RNA-Seq) analysis. The second batch of rats was divided into four groups (A, B, C, D), and an experimental periodontitis rat model was established by suturing silk thread around the maxillary second molars of rats in groups B, C, and D for 4 weeks. The rats were immunised with pure water, pVAX1-HA2-FimA vaccine, empty pVAX1 vector, and pure water at 10, 11, and 13 weeks of age, respectively. Secretory immunoglobulin A (SIgA) antibodies and cathelicidin antimicrobial peptide (CAMP) levels in saliva were measured by enzyme-linked immunosorbent assay (ELISA). All rats were euthanised at 17 weeks of age, and alveolar bone loss was examined using micro-computed tomography (Micro-CT). Results: Through sequencing analysis, six key genes, including Camp, were identified. Compared with the other three groups, the rats in the periodontitis+pVAX1-HA2-FimA vaccine group showed higher levels of SIgA and CAMP (p < 0.05). Micro-CT results showed significantly less alveolar bone loss in the periodontitis+pVAX1-HA2-FimA vaccine group compared to the periodontitis+pVAX1 group and periodontitis+pure water group (p < 0.05). Conclusion: HA2-FimA DNA vaccine can increase the levels of SIgA and CAMP in the saliva of experimental periodontitis model rats and reduce alveolar bone loss. Keywords: CAMP, DNA vaccine, SIgA

Purpose: To investigate the microbiological outcomes obtained with either subgingival debridement (SD) in conjunction with a gel containing sodium hypochlorite and amino acids followed by subsequent application of a cross-linked hyaluronic acid gel (xHyA) gel, or with SD alone. Materials and Methods: Forty-eight patients diagnosed with stages II-III (grades A/B) generalised periodontitis were randomly treated with either SD (control) or SD plus adjunctive sodium hypochlorite/amino acids and xHyA gel (test). Subgingival plaque samples were collected from the deepest site per quadrant in each patient at baseline and after 3 and 6 months. Pooled sample analysis was performed using a multiplex polymerase chain reaction (PCR)-based method for the identification of detection frequencies and changes in numbers of the following bacteria: Aggregatibacter actinomycetemcomitans (A.a), Porphyromonas gingivalis (P.g), Tannerella forsythia (T.f), Treponema denticola (T.d), and Prevotella intermedia (P.i). Results: In terms of detection frequency, in the test group, statistically significant reductions were found for P.g, T.f, T.d and P.i (p < 0.05) after 6 months. In the control group, the detection frequencies of all investigated bacterial species at 6 months were comparable to the baseline values (p > 0.05). The comparison of the test and control groups revealed statistically significant differences in detection frequency for P.g (p = 0.034), T.d (p < 0.01) and P.i (p = 0.02) after 6 months, favouring the test group. Regarding reduction in detection frequency scores, at 6 months, statistically significant differences in favour of the test group were observed for all investigated bacterial species: A.a (p = 0.028), P.g (p = 0.028), T.f (p = 0.004), T.d (p <0.001), and P.i (p = 0.003). Conclusions: The present microbiological results, which are related to short-term outcomes up to 6 months post-treatment, support the adjunctive subgingival application of sodium hypochlorite/amino acids and xHyA to subgingival debridement in the treatment of periodontitis. Keywords: cross-linked hyaluronic acid, microbiology, non-surgical periodontal therapy, periodontitis, periopathogenic bacteria, sodium hypochlorite/amino acids

Purpose: The objective of the present systematic review and meta-analysis was to assess randomised controlled trials (RCTs) which assessed the efficacy of mini dental implants (MDIs) and standard-diameter implants (SDIs) in retaining mandibular overdentures (MO). Materials and Methods: The focused question was “Is there a difference in the mechanical stability between MDIs and SDIs in retaining MO?” Indexed databases were searched up to and including November 2023 using different keywords. Boolean operators were used during the search. The literature was searched in accordance with the PRISMA guidelines. The PICO characteristics were: patients (P) = individuals with complete mandibular dentures requiring dental implants; Intervention (I) = placement of MDIs under mandibular dentures; Control (C) = placement of SDIs under mandibular dentures; Outcome (O) = comparison of stability between MDIs and SDIs in supporting mandibular dentures. Only RCTs were included. Risk of bias (RoB) was assessed using the Cochrane RoB tool. Results: Five RCTs were included. The numbers of participants ranged between 45 and 120 edentulous individuals wearing complete mandibular dentures. The mean age of patients ranged between 59.5 ± 8.5 and 68.3 ± 8.5 years. The number of MDIs and SDIs ranged between 22 and 152 and 10 and 80 implants, respectively. The follow-up duration ranged between one week and 12 months. Three RCTs reported an improvement in the quality of life (QoL) of all patients after stabilisation of mandibular dentures using MDIs or SDIs. In one RCT, peri-implant soft tissue profiles were comparable between MDIs and SDIs at the 1-year follow-up. The implant survival rate was reported in two RCTs, which were from 89% to 98% and 99% to 100% for MDIs and SDIs, respectively. All RCTs had a low RoB. Conclusion: Mini dental implants represent a viable alternative to traditional standard-diameter implants when seeking optimal retention for mandibular overdentures. Keywords: edentulous, implant survival rate, mandible, mini dental implants, overdenture, standard-diameter implants

Purpose: To investigate the causality between periodontitis and non-alcoholic fatty liver disease (NAFLD) using a two-sample bidirectional Mendelian randomisation (MR) analysis. Materials and Methods: Genetic variations in periodontitis and NAFLD were acquired from genome-wide association studies (GWAS) using the Gene-Lifestyle Interaction in Dental Endpoints, a large-scale meta-analysis, and FinnGen consortia. Data from the first two databases were used to explore the causal relationship between periodontitis and NAFLD (“discovery stage”), and the data from FinnGen was used to validate our results (“validation stage”). We initially performed MR analysis using 5 single nucleotide polymorphisms (SNPs) in the discovery samples and 18 in the replicate samples as genetic instruments for periodontitis to investigate the causative impact of periodontitis on NAFLD. We then conducted a reverse MR analysis using 6 SNPs in the discovery samples and 4 in the replicate samples as genetic instruments for NAFLD to assess the causative impact of NAFLD on periodontitis. We further implemented heterogeneity and sensitivity analyses to assess the reliability of the MR results. Results: Periodontitis was not causally related to NAFLD (odds ratio [OR] = 1.036, 95% CI: 0.914–1.175, p = 0.578 in the discovery stage; OR = 1.070, 95% CI: 0.935–1.224, p = 0.327 in the validation stage), and NAFLD was not causally linked with periodontitis (OR = 1.059, 95% CI: 0.916–1.225, p = 0.439 in the discovery stage; OR = 0.993, 95% CI: 0.896–1.102, p = 0.901 in the validation stage). No heterogeneity was observed among the selected SNPs. Sensitivity analyses demonstrated the absence of pleiotropy and the reliability of our MR results. Conclusion: The present MR analysis showed no genetic evidence for a cause-and-effect relationship between periodontitis and NAFLD. Periodontitis may not directly influence the development of NAFLD and vice versa. Keywords: causality, Mendelian randomisation (MR), non-alcoholic fatty liver disease (NAFLD), periodontitis

Purpose: This study aimed to investigate the usefulness of a newly developed oral simulator for nursing students’ oral assessment education on oral diseases and symptoms. Materials and Methods: The participants were first-year students (n=105) at a nursing school in Japan. Ten identical oral simulators with angular cheilitis, missing teeth, dental caries, calculus, periodontitis, hypoglossal induration, food debris, and crust formation were created by a team of dentists. After a 45-minute lecture programme for oral assessment performance with the Oral Health Assessment Tool (OHAT), the ability test with the simulators and the OHAT as well as test feedback were conducted in a 30-minute practical programme. To evaluate the effectiveness of the programmes, questionnaires and ability tests with slides of oral images were conducted at baseline and after the programme. Results: Ninety-nine students (94.3%) participated in this study. The results of the ability test with the simulators and the OHAT in the practical programme showed that the correct answer rates of assessing tongue, gingiva, present teeth, and oral pain were less than 40%. Their levels of confidence, perception, and oral assessment performance were statistically significantly higher after the programmes than they were at baseline. Their level of confidence in assessing the need for dental referral had the largest increase in scores compared to the lowest scores at baseline in the nine post-programme assessment categories. Conclusions: This study identified several problems with nursing students’ oral assessment skills and improvements of their oral assessment confidence, perceptions and performance. Keywords: collaborative education, nursing student, oral assessment, Oral Health Assessment Tool, oral simulator

Purpose: To evaluate the efficacy of the adjunctive use of tea tree oil (TTO) for dental plaque control and nonsurgical periodontal treatment (NSPT). Materials and Methods: Three electronic databases were searched from 2003. The reference lists of the included articles and relevant reviews were also manually searched. Randomised controlled trials reporting the clinical outcomes of the topical use of TTO as an adjunct to daily oral hygiene or scaling and root planing (SRP) were included. Regarding the use of TTO as an adjunctive to daily oral hygiene, the primary outcome was plaque index (PI) reduction. Regarding the use of TTO as an adjunctive to SRP, probing pocket depth (PPD) reduction and clinical attachment level (CAL) gain were the primary outcomes. The secondary outcomes were adverse events. Results: Eleven studies were included for qualitative analysis, 9 studies were included for quantitative analysis, and 6 studies were included to examine the application of TTO mouthwash as an adjunctive to daily oral hygiene. In addition, three studies were included to analyse the subgingival use of TTO adjunctive to SRP at selected sites. The results indicated a nonsignificant improvement in PI reduction in the TTO mouthwash group compared with placebo. The incidence of adverse events was statistically significantly greater in the CHX group than in the TTO group. For subgingival use of TTO adjunctive to SRP, beneficial effects were observed in the TTO group compared with SRP alone in terms of PPD and CAL at both three and six months post-treatment. However, an unpleasant taste was reported in three out of four studies. Conclusion: There is a lack of strong evidence to support the beneficial effects of TTO. Studies with larger sample sizes and standardised evaluation criteria are needed to further demonstrate the clinical relevance of TTO. Keywords: dental plaque, meta-analysis, scaling and root planing, tea tree oil

Purpose: This study investigated the magnitude, direction, and temporal aspects of the force applied during instrumentation with a piezoelectric ultrasonic periodontal scaler, compared this force with recommendations in the literature, and assessed the influence of the profession (dentist or dental hygienist) and calculus hardness. Materials and Methods: The force applied by ten dental hygienists and six dentists during debridement of comparatively soft and hard artificial dental calculus with a piezoelectric ultrasonic scaler was recorded in-vitro. The total force and its components in three axes were statistically analysed. Results: During debridement of soft artificial dental calculus, the mean total force applied by dental hygienists was 0.34 N (± 0.18 N, range: 0.13 N to 0.59 N) and by dentists 0.28 N (± 0.33 N, range: 0.06 N to 0.95 N), and the total force exceeded 0.5 N approximately 23% and 14% of the time for dental hygienists and dentists, respectively. During debridement of hard artificial dental calculus, the mean total force applied by dental hygienists was 0.63 N (± 0.40 N, range: 0.28 N to 1.64 N) and by dentists 0.57 N (± 0.17 N, range: 0.34 N to 0.76 N); the total force exceeded 0.5 N more than half of the time for both professions. On average, dental hygienists applied 1.85x (p = 0.04) and dentists 2.04x (p = 0.06) higher force on hard than on soft artificial calculus. However, dental hygienists and dentists used similar forces during the debridement of both hard (p = 1.00) and soft (p = 0.26) calculus. Conclusion: The force applied during the debridement of hard artificial dental calculus was statistically significantly higher than during the debridement of soft artificial dental calculus. No statistically significant difference between dentists and dental hygienists was found. The force applied by both groups on soft and hard artificial dental calculus frequently exceeded recommended values. Keywords: calculus, debridement, periodontal, piezoelectric, ultrasonic

Purpose: To investigate parental perceptions of comprehensive dental care under general anesthesia for their children. Materials and Methods: The study included parents of children who underwent comprehensive dental care under general anesthesia. Only parents who could communicate in English were included. They were invited to participate in a telephone interview within four weeks of their children’s dental treatment under general anesthesia. The interviews were designed to gather information on three main domains: problems experienced before the operation, children’s well-being after the operation, and satisfaction. Results: A total of 45 parents participated in the study; 91.1% identified as women and 8.8% as men. Most parents resided in areas categorised as either more deprived (51%) or most deprived (24.4%), based on deprivation indices. Prior to surgery, 66.7% of children suffered from dental pain, 44.4% were affected by dental abscesses or facial swelling, 42.2% experienced difficulties with eating and drinking, while 37.8% experienced sleeping difficulties. Painkillers were used for a short duration to manage post-operative pain (48.9%). Four weeks after the operation, many parents reported improvements in their children’s mouth comfort. They observed positive changes in their children’s ability to eat (40%), sleep habits (33.3%), and overall health and well-being (82.2%). Overall, most parents expressed high levels of satisfaction with the care their children received (95.5%). Conclusion: Parents observed improvements in their children’s oral health and reported high level of satisfaction with the procedures. Keywords: dental treatment, general anaesthesia, paediatric, parental

Purpose: To assess adherence to follow-up maintenance visits among patients who had previously undergone crown-lengthening surgery and investigate the different factors impacting their compliance. Materials and Methods: A total of 314 patients were identified for follow-up appointments. Based on their responses, participants were categorised into four groups: attendees, non-attendees, refusals, and unreachable. Furthermore, data on sociodemographic factors (age, sex, nationality, marital status, education, occupation, and residential area), medical history, dental history (including missing teeth, implants, or orthodontic treatment history), and past appointment attendance (average yearly appointments, missed appointment percentage, and last appointment date) were collected and analysed to understand their influence on patient compliance. Results: In a sample of 314 patients, 102 (32.5%) attended the appointments successfully. Improved attendance rates were significantly associated with being female, Saudi Arabian, married, and employed (p < 0.05). Moreover, patients with a high frequency of annual appointments and a recent history of appointments exhibited better compliance. None of the analysed dental factors affected the attendance rates. Conclusion: About one-third of patients who had undergone crown lengthening surgery were compliant with the follow-up visits. Different factors influenced this compliance pattern to varying extents, with more efforts needed to enhance patients’ commitment to these visits. Keywords: adherence, compliance, crown lengthening surgery, periodontal maintenance

Purpose: This cross-sectional longitudinal observational study aimed to clarify the question of whether painful temporomandibular disorders (TMD) in psychiatrically confirmed patients hospitalised for post-traumatic stress disorder (PTSD) therapy after using splint therapy (ST) show long-term therapeutic effects in the case of functional disorders. Materials and Methods: One hundred fifty-three (153) inpatients (123 male and 20 female soldiers, age 35.8 ± 9.2 years, 26.6 ± 2.2 teeth) with confirmed PTSD (Impact of Event Scale – Revised ≥33), grade 3 to 4 chronic pain according to von Korff’s Chronic Pain Scale and the research diagnostic criteria of painful TMD (RDC-TMD) were recorded. All participants received a maxillary occlusal splint that was worn at night. Control check-ups of the therapeutic effect of the splint were conducted for up to 9 years during psychiatric follow-ups. Results: TMD pain worsened in 22 (14.4%) patients within the first 6 weeks and led to the removal of the splint. The pain intensity (PI) at BL was reported to be a mean of VAS 7.7 ± 1.1. Six weeks after ST (n = 131), the average PI was recorded as VAS 2.6 ± 1.3. Based on the last examination date of all subjects, the average PI was recorded as 0.7 ± 0.9. Seventy-two (72) patients used a second stabilisation splint in the maxilla after 14.4 ± 15.7 months, and 38 patients used between 3 and 8 splints during their psychiatric and dental treatment time (33.7 ± 29.8 months). Conclusion: The presented data shows that therapeutic pain reduction remained valid in the long term despite continued PTSD. The lifespan of a splint seems to be dependent on individual factors. Long-term splint therapy appears to be accepted by the majority of patients with PTSD and painful TMD. Keywords: bruxism, PTSD, splint therapy, TMD

Purpose: To compare the regenerative clinical and radiographic effects of cross-linked hyaluronic acid (xHyA) with enamel matrix proteins (EMD) at six months after regenerative treatment of periodontal intrabony defects. Materials and Methods: Sixty patients presenting one intrabony defect each were randomly assigned into control (EMD) and test (xHyA) groups. Clinical attachment level (CAL) gain was the primary outcome, while pocket probing depth (PPD), gingival recession (REC), bleeding on probing (BOP), full-mouth plaque score (FMPS), full-mouth bleeding score (FMBS), and radiographic parameters such as defect depth (BC-BD), and defect width (DW) were considered secondary outcome variables. Parameters were recorded at baseline and after 6 months. Results: At the 6-month follow-up, 54 patients were available for statistical analysis. In the control and test groups, the mean CAL gain was statistically significant in the intragroup comparison (p < 0.001). 48.1% of test sites showed a CAL gain ≤ 2 mm compared with 33.3% of control sites. The mean PPD reduction was statistically significant in the intragroup comparison in both groups (p < 0.001). The mean REC increase was similar in the two groups: 1.04 ± 1.29 mm vs 1.11 ± 1.22 mm (test vs control). The mean BC-BD, DW, FMPS, FMBS, and BOP changed statistically significantly only in the intragroup comparison, not in the intergroup comparison. Conclusion: Both treatments, EMD and xHyA, produced similar statistically significant clinical and radiographical improvements after six months when compared with baseline. Keywords: cross-linked hyaluronic acid, enamel matrix derivative, intrabony defects, periodontal pocket, periodontal regeneration

Purpose: To study the clinical and pathological characteristics of oral lichen planus (OLP) in a large sample. Materials and Methods: A comprehensive analysis was conducted on 105 patients with oral lichen planus (OLP), considering various factors including sex, age, disease site, lesion type, lesion area, morphological characteristics, self-reported symptoms, and history of systemic diseases. Histopathological examination was performed for each patient, and the pathology results were analysed according to sex and age group. Results: 70.5% of the OLP patients were female, and OLP was most likely to occur in the cheek, followed by the tongue, lips, gums and palate. The patients with moderate pain according to the VAS score accounted for 60%. Thirty-nine percent of the OLP patients had a systemic disease, and the most common clinical type of OLP was nonerosive. Most of the pathological results showed liquefaction degeneration of basal cells and infiltration of lamina propria lymphocytes. There was no statistically significant difference in pathological manifestations between male and female patients, and there were statistically significant differences in pathological manifestations among different ages patients. Conclusion: This study analysed the sociodemographic data and clinical manifestations of 105 OLP patients to guide follow-up treatment planning and disease monitoring. Moreover, pathological manifestations should be analysed to avoid delayed treatment and to monitor for carcinogenesis. Furthermore, the correlation of pathological manifestations among OLP patients with different sexes and ages is conducive to further research on the specific differential manifestations and possible underlying mechanisms involved. Keywords: clinical features, demographic characteristics, histopathology, oral lichen planus

Purpose: This in-vitro study aimed to investigate the cleaning efficacy of 18 different manual children’s toothbrushes applying horizontal, vertical, and rotational movements, as well as to evaluate the rounding of their filament ends. Materials and methods: Models equipped with artificial teeth (coated with titanium dioxide) were brushed using a brushing machine with clamped manual children’s toothbrushes. The machine carried out horizontal, vertical, and rotational movements for 1 min with a constant contact pressure of 100 g. The percentage of the area of titanium dioxide removed from the buccal, mesial, distal and total surfaces of the artificial teeth corresponded to the cleaning efficacy. To assess the filament design, a scanning electron microscope was used to check the morphology of the filaments which was scored with Silverstone and Featherstone scale. SPSS 22 was used for data analysis. Results: The rotational and the vertical movements achieved the best cleaning efficacy with all tested toothbrushes. The vast majority of the tested toothbrushes had their poorest cleaning efficacy in the horizontal movement. Only a small part of the children’s toothbrushes (3 out of 18) had a correct and acceptable proportion of rounded bristle ends. Conclusions: Based on the present results, it could be concluded that the cleaning efficacy of different manual children’s toothbrushes varied considerably. The best cleaning efficacy was almost always observed for rotational and vertical movements. Keywords: children’s toothbrushes, cleaning, efficacy, filament end rounding, pediatric dentistry

Purpose: To assess children’s OHRQoL and associated factors among a sample of children with special needs in Riyadh, Saudi Arabia. Materials and Methods: A sample of 6- to 12-year-old children was obtained using convenience sampling from rehabilitation centers. Data were collected through a questionnaire and dental examination. The questionnaire included items related to the children’s and their families’ characteristics, oral health-related quality of life scales (Parental-Caregivers Perceptions Questionnaire [P-CPQ] and Family Impact Scale [FIS]), perceived health status, and dental care utilisation. Clinical examination was performed by a trained and calibrated dentist. The data were analysed using SPSS; descriptive and inferential data analyses were also performed using SPSS. Results: The mean P-CPQ was 1.10 ± 0.74, and the mean FIS was 1.39 ± 0.88. There was a statistically significant correlation between P-CPQ and caries (r = 0.36, p = 0.02). After controlling for confounders, caries was associated with poor P-CPQ (B = 0.06, p = 0.024). Compared to low-income families, higher-income families had better P-CPQ (4000-8000 SAR: B = -1.36, p = 0.001). Conclusion: Poor oral health-related quality of life in Saudi children is associated with caries and low income. Preventive measures addressing social determinants are vital to control caries and promote oral health in children with special health-care needs. Keywords: dental care for children, health-related quality of life, oral health, perception

Purpose: To investigate the association of low renal function and overweight with poor periodontal condition in community-dwelling older Japanese women. Materials and Methods: In total, 359 older women (age range: 55–74 years) participated in this study. Two periodontal parameters – the number of teeth with a probing pocket depth (PPD) or clinical attachment level (CAL) ≥ 4 mm – were used as the dependent variables. The principal independent variables were low renal function as defined by the estimated glomerular filtration rate (eGFR) and overweight as defined by the body mass index. Poisson regression analysis was used to calculate the ratio of means (RM). Results: The RMs of the number of teeth with a PPD or CAL ≥ 4 mm in an adjusted model without an interaction term were 1.21- or 1.27-fold higher among those with an eGFR < 60, while those among the participants with an eGFR < 60 in the adjusted model with interaction terms for the number of teeth with a PPD or CAL ≥ 4 mm were 1.43- or 1.36-fold higher. In addition, increments of periodontal risk with low renal function and overweight showed a slightly smaller to negative trend. Conclusion: The present findings suggest a connection between unfavourable periodontal health and both renal function and being overweight among older Japanese women. A weak negative interaction was also found between poor renal condition and overweight in relation to periodontal condition. Keywords: excess weight, kidney function, periodontal health

Purpose: To assess the prevalence and configuration of bifid (BMC) and trifid (TMC) mandibular canals using computed tomography (CT), describing the anatomical characteristics of the accessory canals, especially of the retromolar type. Materials and Methods: CT scans of 123 patients were analysed. BMCs were identified and the patterns of bifurcation were classified, including trifid canals. The width of accessory canals was measured. Retromolar canals were further classified according to their course and morphology, while their position and width were evaluated using linear measurements on CT images. Results: The majority of patients (53.6%) presented at least one BMC or TMC. 36.2% of mandibular canals were bifid, while 4.5% were trifid. The forward canals (12.6%) and retromolar canals (10.2%) were the most common among BMCs. In relation to the retromolar canals, 60% were vertical and 40% curved, with a mean width of 1.03 ± 0.28mm. Conclusion: BMCs and TMCs are common 3D radiographic findings, so that they should be considered as anatomical variations, not anomalies. Preoperative CT or CBCT evaluation should aid in identifying these variations and analysing their position and course in surgical planning. Keywords: anatomical variations, cone-beam computed tomography, mandibular canal, mandibular nerve, oral surgery, third molar

Purpose: Gingivitis and periodontitis are oral disorders characterised by chronic inflammation, impacting the supportive structures around teeth due to bacterial accumulation. While the role of inflammation in both periodontitis and dry eye disease (DED) has been established individually, their potential association remains unclear. This study aimed to investigate the association between periodontitis and the manifestation of signs and symptoms related to DED in patients aged 18–40. Materials and Methods: A cross-sectional study was conducted involving healthy controls, DED patients with or without periodontitis, and patients with periodontitis without DED. Ophthalmic and oral examinations were performed, and demographic, ocular, and systemic disease data were collected. Statistical analysis was conducted using ANOVA and chi-squared tests. Results: A total of 684 participants were included in the study. Significant elevations in tear osmolarity levels, increased Ocular Surface Disease Index scores (OSDI), and decreased tear break-up time (TBUT) and Schirmer (ST-I) values were observed in DED patients with periodontitis compared to individuals with DED but without periodontitis, as well as control and periodontitis groups. Furthermore, higher neutrophil-to-lymphocyte ratios (NLR) were found in DED patients with periodontitis. Conclusion: The findings suggest an association between periodontitis and the severity of signs and symptoms related to DED. The study highlights the importance of interdisciplinary approaches in understanding the systemic implications of periodontal disease and its potential impact on ocular health. Keywords: dry eye disease, inflammation, ocular surface, periodontitis, tear osmolarity

Purpose: To examine the anti-caries effect of mouthwashes containing Cibotium barometz J. Smith (CB), a natural substance, and compare it with chlorhexidine and saline solution. Materials and Methods: A randomised, blinded clinical trial was conducted on 76 study participants. The differences between the 3 gargle groups (saline gargle: SAL; chlorhexidine gargle: CHX; CB gargle group: CB) and the differences over time (baseline, after 1 week, after 2 weeks) were compared. To this end, ANOVA was performed on caries-related clinical indicators (e.g. O’Leary plaque index, caries activity, and satisfaction). Results: The O’Leary index, caries activity, and saliva tests, gradually improved in group CB at one and two weeks. In the case of bacterial tests, unlike SAL and CHX, only in group CB did the decrease occur one and two weeks later. The caries-related indicators decreased significantly over time in group CB compared to SAL and CHX groups, and there was also a statistically significant difference in interaction between groups and time (p<0.05). Conclusions: The mouthwash containing CB extract showed statistically significant improvement in biofilm adhesion as well as the saliva and bacterial tests compared to SAL and CHX. However, since there were differences in the initial oral conditions of the three groups, additional long-term research is needed through crossover clinical trials to supplement these. Keywords: biofilms, Cibotium barometz J. Smith, chlorhexidine, dental caries, mouthwashes

Purpose: With the increasing use of artificial intelligence (AI) in dentistry, it is feasible to self-monitor oral health using Oral Health AI Advisors (OHAI Advisors). This technological advancement offers the potential for early detection of oral diseases and facilitates early prevention. This systematic review aimed to evaluate the effectiveness of OHAI Advisors as a tool in preventive dentistry for the general population. Materials and Methods: Standardised searches were performed and screened across four electronic databases. The primary outcomes were changes in clinical and behavioural measures, and evidence was synthesised. The quality of the included studies was assessed. Results: The initial search identified 1639 articles, 64 full texts were reviewed, and four studies were included in the analyses. Qualitative synthesis revealed that short-term use of OHAI Advisors, for up to 6 months, statistically significantly reduced plaque and gingival index scores. Combining OHAI Advisors with verbal counseling enhanced their effectiveness. No studies investigated effects on oral health awareness, behavioural changes, or adherence to regular practice. The risk of bias in the included studies was moderate to low. Conclusion: OHAI Advisors appear to be effective for short-term oral hygiene maintenance. Further research is necessary to determine the preventive capability, focusing on assessing long-term outcomes on oral health and any changes in oral health behaviour. Keywords: artificial intelligence, dental, health education, oral health, precision dentistry, precision medicine

Purpose: The objective was to evaluate the periodontal clinicoradiographic status and whole salivary prostaglandin E2 (PgE2) levels among users of water pipe and cigarettes. Materials and Methods: Demographic data, duration of smoking (pack years), and familial history of smoking were recorded using a questionnaire. Participants were allocated into three groups based on their smoking status: group 1: self-reported cigarette smokers (CS); group 2: self-reported water-pipe-users; and group 3: non-smokers. The assessment included measurements of full-mouth plaque and gingival indices (PI and GI), as well as probing depth (PD), clinical attachment loss (CAL), and marginal bone loss (MBL). Unstimulated whole saliva samples were collected and PgE2 levels were measured. Group comparisons were done and p<0.05 was considered statistically significant. Results: Thirty-three, 34 and 33 individuals were included in groups 1, 2 and 3, respectively. Full mouth PI (p<0.05), GI (p<0.05), PD (p<0.05) and mesial (p<0.05) and distal (p<0.05) MBL were statistically significantly higher among patients in groups 1 and 2 than group 3. The scores of CAL in groups 1 and 2 were 3.45 ± 0.97 and 3.62 ± 1.2 mm, respectively. None of the individuals in the control group displayed CAL. PgE2 levels were statistically significantly higher among patients in groups 1 (231.5 ± 66.3 pg/ml) (p<0.05) and 2 (231.5 ± 66.3 pg/ml) (p<0.05) compared with group 3 (76.6 ± 10.6 pg/ml). In groups 1 and 2, a statistically significant relationship was observed between pack-years, the duration of water-pipe smoking, and the levels of PgE2 and PD. Conclusion: There is no difference in periodontal clinicoradiographic status and whole salivary PgE2 levels between CS and waterpipe-users; however, these parameters are worse in CS and water-pipe users than in non-smokers. Keywords: alveolar bone loss, cigarette smoking, periodontal inflammation, prostaglandin E2, unstimulated whole saliva, water pipe

Purpose: To investigate the prevalence, severity, oral distribution, and associated risk factors of carious lesions in the pri- mary teeth in children in Jinzhou, China, aged 7-9 years. Materials and Methods: A total of 1603 primary school students aged 7-9 years old from public and private schools in Jinzhou were recruited using multi-stage, stratified, and random sampling methods for cross-sectional studies. Carious lesions in the primary teeth of school-age children were detected and recorded according to the World Health Organiza- tion standard, and a questionnaire was collected from a parent or guardian with information on the relevant risk factors for the child. Odds ratios and 95% confidence intervals of factors related to carious lesions were estimated using binary logistic regression analysis (p<0.05). Results: The prevalence of carious lesions in the primary teeth was 74.5%, the average number of carious lesions was 3.02, and dmft was 4.08 ± 2.74. There were 655 cases (77.1%) of dental carious lesions in boys and 546 cases (72.5%) in girls, and the difference between them was statistically significant (p<0.05). Binary logistic regression analysis showed that the mother’s educational level, brushing frequency, brushing time, and consumption of soft drinks, desserts, and sweets were all associated with a higher prevalence of carious lesions (p<0.05). Conclusions: The children in our sample had a high incidence of carious lesions of the primary teeth, especially the man- dibular primary molars. Social demographic factors, oral hygiene habits, and dietary habits all play an important role in the occurrence of carious lesions. Keywords: carious lesions, children, prevalence, risk factors

Purpose: To compare short-term outcomes between membrane perforation and non-perforation patients after simultaneous external elevation with implantation. Materials and Methods: In this retrospective observational study, 60 maxillary posterior tooth-loss patients with an insufficient amount of residual bone for direct implantation were enrolled. All patients underwent simultaneous external elevation and implantation, and were divided into perforation and non-perforation groups according to the postoperative Schneiderian membrane status. Results: Of the 60 patients, 30 cases (35 implants) were assigned to the membrane perforation group, and 30 (44 implants) were allocated to the non-perforation group. There were no statistically significant differences in baseline data (p>0.05). In the perforation group, the mean vertical bone gain (VBG) at 6 and 12 months was 6.02±2.14 mm and 5.37±2.22 mm, resp., compared to 6.78±2.59 mm and 6.42±2.64 mm in the non-perforation group, resp. (both p>0.05). Preoperative median Schneiderian membrane thickness (SMT) in the perforation group was 0.77 mm, which was statistically significantly thinner than the 1.24 mm measure in the non-perforation group (p<0.05); however, there was no statistically significant difference between two groups at 12 months postoperatively (0.80 mm vs 1.25 mm, p>0.05). The marginal bone loss at 1 year after implant restoration in the perforation and non-perforation groups was 0.16±0.10 mm and 0.22±0.12 mm, resp. During postoperative follow-up, the implant survival rate was 100% in the two groups. The incidence of postoperative nasal bleeding in the perforation group was statistically significantly higher compared with that in the non-perforation group (50% vs 16.7%, p<0.05), whereas no statistically significant differences were observed in the incidence of facial swelling, intraoral bleeding, wound dehiscence and acute/chronic sinusitis between the two groups (p>0.05). Conclusions: Schneiderian membrane perforation after simultaneous external elevation and implantation do not ad- versely affect short-term clinical and radiographic outcomes. Keywords: dental implantation, implantation complication, maxillary sinus, retrospective study, Schneiderian membrane perforation

Purpose: To measure the general oral and dental health knowledge level of family medicine residents who are receiving full-time specialty training in Turkey. Primary care physicians can contribute to improving the oral and dental health of patients during general health services. Materials and Methods: The fundamentals of oral and dental health that the family medicine physicians should know about were determined, and questionnaire items on these fundamentals were prepared. The sample size was calculated as 296 individuals. The survey was conducted online. The collected data were analysed employing the following tests: chi-squared, Fisher, Kolmogorov-Smirnov, Spearman, ANOVA, Mann-Whitney U, Kruskal-Wallis, and Bonferroni. Results: 302 family medicine residents in various clinics in Turkey participated in the study. The mean age of the participants was 29.6 ± 5.1. The mean knowledge scores of the resident physicians were calculated as 65.2 ± 10.9 (lowest: 27; highest: 92). The majority of resident physicians stated that they did not receive training on oral and dental health during their residency training, and that they agreed with the idea of integrating it into the residency training curriculum. Conclusions: The general knowledge level of family medicine residents in Turkey about oral and dental health was found to be moderate. Keywords: community dental health, family medicine, oral and dental health, preventive dentistry, preventive medicine

Purpose: The relationship between body mass index (BMI) and oral disorders remains unclear. This study examined the prevalence and types of dental abnormalities and oral mucosal lesions among female students with obesity attending a Taif University sports centre. Materials and Methods: This non-interventional cross-sectional study enrolled female students with high BMI from a university sports facility using a convivence sampling method. The participants were divided into three BMI groups. Data were collected using an interview and by clinical oral examination. Prevalence and oral disorder types and possible mechanisms linking BMI and dental development were evaluated. Results: Ultimately, 86 female students with obesity were analysed. The mean BMI was 42.8 kg/m2, indicating high obesity levels. A weak although statistically significant correlation was observed between age and BMI (r=0.27), indicating that older students had higher BMI. A statistically significant association was observed between BMI and dental abnormalities (p0.05). The dental abnormality prevalence increased with BMI, ranging from 37.5% to 40.7% in the ≤40 and >45 kg/m2 groups, respectively. Most participants (66.3%) had oral mucosal lesions, with the highest prevalence among participants in the 40–45 kg/m2 group (71.4%). Conclusion: A statistically significant relationship was observed between BMI and dental abnormalities; obesity may negatively affect oral health. Keywords: body mass index, dental abnormalities, obesity, oral mucosal lesions, Saudi female

Purpose: To analyse the relative expression and diagnostic potential of lncRNA XIST (XIST) in peri-implantitis, and explore the related mechanism of XIST in peri-implantitis. Materials and Methods: XIST expression in saliva of patients with peri-implantitis was detected by qRT-PCR. The diagnostic significance of XIST in peri-implantitis was assessed by ROC curve. Clinical indicators of the included patients were collected and the correlation between XIST levels and peri-implant indicators was determined by Pearson correlation analysis. Bioinformatic prediction and luciferase reporter assay confirmed the targeting relationship of XIST with downstream factors. Results: Salivary XIST levels were obviously higher in patients with peri-implantitis than in the healthy control group, and the AUC value for identifying patients was 0.8742 with a sensitivity and specificity of 83.5% and 81.4%. Patients in the peri-implantitis group had higher levels of plaque index (PLI), sulcus bleeding index (SBI) and probing depth (PD) than those in the healthy control group, and the expression of XIST was positively correlated with PLI, SBI, and PD levels. In addition, miR-150-5p was confirmed to be a potential downstream target of XIST. Conclusion: XIST was overexpressed in the saliva of patients with peri-implantitis and correlated with the severity of the disease. XIST has high diagnostic significance for detecting peri-implantitis. Keywords: diagnosis, miR-150-5p peri-implantitis, periodontal indicators, XIST

Purpose: To investigate the prevalence and severity of erosive tooth wear (ETW) and evaluate the determinants of ETW among adolescents and adults in Poland. Materials and Methods: The study covered three age groups of patients: 15 years old, 18 years old, and adults aged 35-44 years. Calibrated examiners measured ETW according to the Basic Erosive Wear Examination (BEWE) scoring system in 6091 patients. The clinical examination of patients was preceded by a socio-medical study based on a questionnaire consisting of items identifying potential risk factors for ETW. Results: In all age groups, erosive lesions were most common in the form of initial enamel damage; more advanced lesions (BEWE 2 and 3) were rarely observed among 15-year-olds, while in the group of older adolescents and adults, the percentages were 13% and 20%, respectively. Acidic diet, gender, level of education, and medical conditions were statistically significantly associated with ETW in the examined population. The analysis showed that, depending on age, multiple and statistically significant risk factors for ETW become most apparent in the 35-44 age group, especially with regard to general health. This suggests that the long-term impact of factors and their cumulative effects are critical to the development of ETW. Conclusions: This is the first large, representative study of ETW in Central and Eastern Europe among adolescents and adults, which indicates the relatively rare occurrence and severity of erosive lesions. The present findings support other longitudinal studies supporting the use of the BEWE system as a valuable standard for assessing erosive lesions and related risk factors among different populations at different ages. Keywords: BEWE, dental erosion, epidemiological study, risk factors

Purpose: This analysis aims to evaluate the association between the time since and reason for a patient’s last dental appointment across clinical oral health outcomes. Materials and Methods: We used data from the 2017–2020 National Health and Nutrition Examination Survey (NHANES), a cross-sectional, nationally-representative survey of noninstitutionalized US adults. The predictors were the time since and the reason for the last dental appointment (routine vs. urgent). We examined the presence and number of missing teeth and teeth with untreated coronal and root caries. Multivariable regression models with interaction were used to assess the association between the time since the last dental appointment and clinical oral health outcomes among routine and urgent users separately. Results: Two-thirds of the US population had a dental appointment within a year, while nearly 44 million individuals did not visit a dentist for the last three years. The odds of having teeth with untreated coronal or root caries increased with the length of time since the last appointment, and urgent users had worse dental outcomes compared to routine users. Compared to those who had a dental appointment within a year, individuals who had their last dental appointment more than 3 years ago had 2.94 times the average number of teeth with untreated caries among routine users (95%CI=2.39, 3.62) and 1.60 times the average among urgent users (95%CI=1.05, 2.43). Conclusions: Recent, routine dental appointments are associated with improved oral health outcomes. The outcomes reiterate how social determinants of health impact access to oral health care and oral health outcomes. Keywords: dental appointments, dental attendance, dental caries, oral health disparities, routine care

Purpose: This study aimed to develop a systematic interdental brush set with size distribution based on the passage hole diameter (PHD), addressing existing gaps in size selection criteria for effective interdental cleaning. Materials and Methods: In the first step, an interdental brush set that ascends stepwise according to the PHD value was envisioned. The study was divided into three phases: (i) in-vitro determination of PHD values of a currently existing assortment on the market by 13 calibrated dental professionals, (ii) in-vitro assessment of forces during insertion, and (iii) creation and evaluation of new prototypes for missing or non-matching PHD sizes. Intra- and inter-rater reliability, assessed with the intraclass correlation coefficient (ICC), as well as insertion forces and PHD sizes at all stages were reported. Results: In the existing range, three interdental brushes fitting the desired PHD sizes were initially identified. Mean insertion forces between 0.3 and 1.7 N were documented based on raters’ PHD choices. Two additional rounds of measurements with prototypes adapted in diameter and shape were necessary, particularly for PHD values of 1.4, 2.3 and 2.6. High intra- and inter-rater reliability was observed throughout the study (ICC > 0.95), ensuring consistent evaluations. After three rounds of assessments, a prototype was successfully identified for each targeted PHD value in the systematised set, showcasing reliable sizing and insertion forces. Conclusion: Using a structured approach, a comprehensive interdental brush set was developed with reliable PHD sizing and moderate insertion forces. The verification of size reliability through measurements by dentists represents a novelty in development and underlines the importance of accurate brush size selection for optimal biofilm control. Whether a systematic set based on the PHD value offers added value for clinical practice, and at what intervals, must be demonstrated in further studies. Keywords: interdental brush, systematic set, interdental hygiene

Summary: Periodontitis is associated with numerous systemic diseases, and it has been shown that these associations are partly causal in nature. It is assumed that such interactions between periodontal and systemic diseases are also mediated via adipokines. Apelin, an adipokine about which there is little research in the dental field, is also produced together with its receptor in periodontal cells. The aim of this review was to summarize the currently available literature on the apelin-APJ system to better understand the pathomechanistic relationship between periodontitis and obesity and to determine the potential clinical relevance of apelin for diagnostics and therapy. In vitro studies suggest that apelin can enhance bacterial-induced synthesis of proinflammatory and proteolytic molecules, indicating a significant etiopathogenic role of this adipokine. Since serum levels of apelin are elevated in diabetes and/or obesity, it is possible that such systemic diseases promote the development and progression of periodontitis via apelin. On the other hand, it is also conceivable that apelin from the periodontium influences such systemic diseases. Further research is needed to better understand the role of apelin in the periodontium and the entire oral cavity, but also in the interactions between periodontal and systemic diseases. In particular, clinical intervention studies are needed to further decipher the etiopathogenic role of apelin in periodontitis. Keywords: apelin, adipocytokine, adipokine, periodontitis, periodontium

Purpose: This study aimed to evaluate the relationship between depression and social appearance anxiety in young female patients who applied for aesthetic dental treatment. Methodology: The study was conducted in a single centre and included 56 female patients aged 18–35 years. The mean age of the participants was 22.27 ± 5.62 years. Participants were informed before treatment, and the Beck Depression Inventory (BDI), Social Appearance Anxiety Scale (SAAS), and Visual Analogue Scale (VAS) were administered. Immediately after the treatment and 1 month later, the SAAS and VAS were administered again. The Kruskal–Wallis test was used for the comparison of the data obtained and the Friedman test was used for temporal comparison. Multiple comparisons were made with Dunn’s test. Results: After aesthetic dental treatment, all participants’ satisfaction with the appearance of their teeth increased, and social appearance anxiety decreased (p 0.001). The group with the lowest pretreatment satisfaction level was the group with moderate/high-level depressive symptoms. There was no correlation between the severity of depression and the increase in satisfaction after treatment (r = 0.247; p = 0.066). Satisfaction levels were similar in all depression groups after treatment. The group with the highest level of social appearance anxiety before and after treatment was the group with moderate/high-severity depressive symptoms. A moderate positive correlation was found between depression severity and social appearance anxiety (r = 0.4; p = 0.002). Conclusions: The severity of depressive symptoms seen before treatment does not affect the level of satisfaction after treatment. There is a decrease in social appearance anxiety after aesthetic dental treatment. There is a positive relationship between social appearance anxiety and depression severity. Keywords: aesthetic treatment, depression, social appearance anxiety, women

Purpose: Nonsurgical root canal therapy (NSRCT) is indicated for management of permanent teeth diagnosed with symptomatic irreversible pulpitis. However, recent research has suggested that vital pulp therapy (VPT) may be a less invasive option in these cases. The purpose of this systematic review was to evaluate the outcomes of VPT, using hydraulic calcium silicate cements (HCSCs) including complete and partial pulpotomies in permanent posterior teeth with symptomatic irreversible pulpitis. Materials and Methods: The PRISMA recommendations were adhered to. The search approach used electronic databases from PubMed, EMBASE, the Cochrane Library, and grey literature. The Newcastle-Ottawa Scale, ROBINS-I, and Cochrane Collaboration Risk of Bias tools were used to evaluate the quality of the selected studies. Results: The initial database search turned up 142 papers, of which 3 prospective cohort studies and 9 randomised controlled trials were selected for analysis. For three, seven, and two articles, the risk of bias was rated as “high” or “serious,” “fair,” and “low,” respectively. The success rates for VPT using HCSCs typically ranged from 78% to 90% one to five years following VPT. The results of the VPT and NSRCT were equivalent at one and five years, according to two articles. Although the intra-operative pulp assessment is essential for VPT treatments, most studies did not provide a thorough account of this process or the time required to achieve haemostasis. Three studies reported sample sizes that were 23 teeth. The 12 studies that were analysed revealed successful VPT procedures using HCSCs in permanent posterior teeth that had symptomatic irreversible pulpitis, with radiographic success rates ranging from 81% to 90%. Two articles claimed that the results of VPT and root canal therapy were equivalent. Conclusion: When considering VPT as an alternative to NSRCT, appropriate case selection and outcome criteria must be created. This data highlights the need for additional studies contrasting the longer-term effects of different treatment regimens. Keywords: inflammation, irreversible, symptomatic, vital pulp therapy

Purpose: To find an association between oral mucosal human papilloma- and/or Epstein–Barr (HPV, EBV) virus infection in patients with dry mouth and/or Sjögren’s syndrome (SS) compared to healthy controls and to find connections with salivary gland histopathological alterations. Materials and Methods: Ninety-two participants were divided into four groups: 1. healthy controls (n = 32); 2. xerostomia (n = 28); 3. hyposalivation (n = 22); and 4. SS groups (n = 10). To detect virus infection brush biopsy was outlined in all groups. Detections of virus-specific sequences were achieved with polymerase chain reaction (PCR). Lip biopsy and histopathological assessment was performed in groups 2, 3 and 4. Results: HPV positivity of oral mucosal cells was shown in group 1: 1 (3.12%); group 2: 3 (10.7%); group 3: 2 (8.26%); and in group 4: 0 of the samples. EBV was present in group 1: 14 (43.7%); group 2: 17 (60.7%); group 3: 6 (27.3%); and in group 4: 5 (50%) of the cases. There was no statistically significant difference between the attributes. Intact salivary gland in 28.2%, chronic sialadenitis in 28.2%, stromal fibrosis in 6.5%, lipomatous atrophy in 8.6%, fibrous atrophy in 6.5% and positive focus score (SS) in 26.1% were found in the subjects. Neither HPV nor EBV infection caused statistically significantly more histological abnormalities. Conclusion: Orofacial mucosal HPV and/or EBV DNA rates did not differ statistically significantly in patients with xerostomia or hyposalivation or SS compared to healthy controls, therefore, it cannot prove the provocative role of these viruses in dry mouth and/or SS. Neither dry mouth nor SS were accompanied by statistically significantly more salivary gland alterations in HPV- and/or EBV-positive subjects; these alterations are frequent in the virus-negative cases too. Keywords: dry mouth, Epstein–Barr virus, human papillomavirus, oral mucosa, Sjögren’s syndrome

Purpose: To evaluate the antimicrobial effect of a new active oxygen fluid (Blue®m) as a root canal irrigant against Enterococcus faecalis compared to sodium hypochlorite (NaOCl). Material and Methods: Forty-five extracted single-canaled human teeth were selected, received root canal preparation, autoclaved, and contaminated with Enterococcus faecalis. The specimens were randomly allocated into three groups: Group (A) served as the negative control, receiving irrigation with saline (n = 15); Group (B) was irrigated with 5.25% NaOCl (n = 15); and Group (C) was irrigated with 10 mL of Blue®m (n = 15). Microbial sampling from the root canals was performed before and after irrigation. The difference between the pre-irrigation and post-irrigation colony-forming units (CFU/mL) was calculated. The data was analysed using a one-way ANOVA followed by post-hoc Tukey tests. The significance level was set at 5%. Results: Blue®m statistically significantly reduced the bacterial load compared to saline (p = 0.009), but NaOCl was most effective, outperforming both (p 0.0001). Conclusion: Irrigation with Blue®m demonstrated antibacterial efficacy against Enterococcus faecalis, but it was not as effective as NaOCl. Keywords: Enterococcus faecalis, irrigant, root canal irrigation, sodium hypochlorite, oxygen

Purpose: Resins composites are widely used in modern dentistry because of their aesthetic and physical properties. However, discoloration of anterior tooth restorations is a common complaint. Understanding the factors affecting the colour stability of resin composites can lead to longer-lasting repairs. This study aimed to evaluate and compare the colour changes of nanocomposite-based bulk-fill and universal resin composites after immersion in coffee using various polishing systems. Materials and Methods: A total of 160 samples were prepared using four different composite groups, with 40 pieces for each combined group. Based on the finishing procedure, the samples were divided into four subgroups for each composite group. Three different polishing procedures were applied to the samples according to the manufacturer’s instructions. The control group was not subjected to any treatment. Initial colour measurements were performed using a VITA Easyshade V spectrophotometer. After the initial measurements, the samples were immersed in a Nescafe coffee solution for seven days, followed by colour measurements. Data were analysed using the Kolmogorov–Smirnov test and two-way analysis of variance. Tukey’s honest significant difference (HSD) test was used to determine differences between subgroups. Results: The results indicate that bulk-fill resins exhibit more discolouration than universal composites; however, this difference was not statistically significant. The resin group with the smallest discolouration was Ceram X, and the most effective polishing method was Twist polishing. Conclusion: Final surface polishing significantly reduced the composites’ discolouration. These findings support the selection of appropriate materials and polishing techniques to achieve aesthetic outcomes and colour stability in dental restorations. Keywords: bulk-fill composite, colour changes, polishing systems, universal composite

Dental caries, one of the most prevalent diseases globally, affects individuals throughout their lifetimes. Recently, researchers have increasingly focused on postbiotics for caries prevention. Postbiotics, comprising inanimate microorganisms and/or their components, confer health benefits to the host. Growing evidence suggests postbiotics’ potential anticaries effects. Specifically, numerous postbiotics have demonstrated the ability to inhibit dental caries onset and progression by modulating oral flora microecology and reducing human caries susceptibility. This review elaborates on the current research regarding postbiotics’ anticaries effects, highlights some studies’ shortcomings, and innovatively proposes that postbiotics could potentially influence tooth development and salivary characteristics through epigenetic modifications. Furthermore, it anticipates postbiotics’ future application in personalised caries treatment, given their multifaceted anticaries potential. Keywords: application, dental caries, microbiome, personalised treatment, postbiotics

Purpose: The aim of the present systematic review and meta-analysis was to assess the efficacy of non-surgical periodontal therapy (NSPT) with adjunct photodynamic therapy (aPDT) in reducing periodontal inflammation and haemoglobin A1c (HbA1c) levels in patients with diabetes mellitus (DM). Materials and Methods: The focused question was ‘Does NSPT with adjunct aPDT help reduce periodontal inflammation and HbA1c levels in patients with DM?’ The PICO (patient/population, intervention, comparison and outcomes) was formatted as follows: Patients (P): Participants diagnosed with DM; Intervention (I): NSPT with adjunct PDT for the treatment of periodontitis; Control (C): NSPT alone or NSPT with adjunct systemic antibiotic therapy; and Outcome (O): Changes in HbA1c levels. The inclusion criteria comprised RCTs specifically evaluating the impact of NSPT on HbA1c levels in diabetic patients, with a specific focus on interventions involving NSPT with and without adjunct aPDT. The literature search was performed in accordance with the Preferred reporting items for systematic reviews and meta-analysis. Indexed databases were searched without time and language restrictions using various keywords. Forest plots were created to illustrate the effects of the different studies and the global estimation. Results: Five RCTs were included and processed for data extraction. The number of participants ranged from 12 to 45 patients with medically diagnosed type-2 DM. In all RCTs, aPDT was done using a diode laser with wavelengths ranging between 660 and 810 nm. Three and two RCTs had moderate and high RoB, respectively. In two RCTs, NSPT with adjunct aPDT reported no improvement in clinical periodontal parameters. Two studies reported that NSPT with adjunct aPDT significantly reduces periodontal probing depth compared to NSPT alone. Four of the five RCTs reported that NSPT+PDT does not influence HbA1c levels. Conclusions: NSPT with or without adjunct aPDT does not affect HbA1c levels in patients with type-2 DM. Keywords: diabetes mellitus, haemoglobin A1c, non-surgical periodontal therapy, periodontal disease, photodynamic therapy

Purpose: To evaluate and compare the efficacy of seven conventional treatments and traditional Chinese medicine (TCM) combined therapies for oral lichen planus. Materials and Methods: This study employs PubMed, Web of Science, Cochrane Library, and Cnki to collect studies. After evaluating the quality and bias risk, RevMan 5.4.1 and R Gemtc package was utilised with a visual analogue scale and side effects as outcomes, to compare the efficacy of the seven treatments. Results: This study included 20 studies, with a sample size of 1669. Our results suggest that photodynamic therapy and TCM demonstrate the most significant decrease in visual analogue scale and the rank is as follows: photodynamic therapy > TCM > TCM combined with non-hormonal immunosuppressive drugs > TCM combined with glucocorticoids > chloroquine combined with glucocorticoids > non-hormonal immunosuppressive drugs > glucocorticoids. Among them, compared to glucocorticoids, photodynamic therapy (–1.55, 95% CI: (–3.09, –0.02)), TCM (–1.25, 95% CI: (–2.46, –0.06)) significantly outperform in statistics. Moreover, no side effects were reported by the photodynamic therapy treatment. In the comparison with non-hormonal immunosuppressive drugs, the result indicates TCM (–4.17, 95% CI (–8.24, –0.34)), glucocorticoids (–2.78, 95% CI (–5.69, –0.17)) and their combination (–2.83, 95% CI (–5.93, –0.05)) have a significantly lower probability of the appearance of side effects. Conclusion: This study indicates that TCM, from the perspectives of efficacy and the likelihood of side effects, outperforms all other common therapies, besides photodynamic therapy, in treating oral lichen planus. Keywords: efficacy analysis, network meta-analysis, oral lichen planus, photodynamic therapy, traditional Chinese medicine

Purpose: To examine the association between educational level and the presence of periodontal disease in adults ages ≥ 50 years in Mexico. Materials and Methods: A cross-sectional study was conducted on 2098 Mexican adults, using data from the annual reports of the Epidemiological Monitoring System for Oral Pathologies from 2019–2022. Data were collected on sociodemographic characteristics such as gender, age, educational level, oral hygiene, and diabetes. Periodontal status was evaluated using the Community Periodontal Index (CPI) and was classified into: CPI = 0 (healthy); CPI = 1 (bleeding on probing); CPI = 2 (calculus); and CPI = 3 or 4 (pocket depth ≥ 4 mm). A multinomial regression model was used to estimate the odds ratio (OR) and the 95% confidence intervals (CI), using periodontal status as the result. Results: 39.9% of subjects presented periodontal pockets of ≥ 4 mm, 20.8% presented calculus, and 12.8% presented bleeding, while only 26.4% were classified as healthy. A low level of education (≤ 9 years) (OR = 4.84; p 0.001), age ≥ 65 years (OR = 1.33; p = 0.025), poor oral hygiene (OR = 6.86; p 0.001), smoking (OR = 1.51; p = 0.025), and diabetes (OR = 1.73; p 0.001) were statistically significantly associated with the presence of periodontal pockets ≥ 4 mm. Conclusions: A low level of education is associated with worse periodontal status in adults aged 50 years or more. These findings reiterate the importance of implementing effective strategies and the incorporation of interventions for improving the access to and quality of services targeted at aging communities. Keywords: diabetes, level of education, older adults, periodontal disease, periodontal pockets

Purpose: To explore the association between the risk of dental caries and distal-less homeobox 3 (DLX3) gene in Chinese children. Materials and Methods: Based on the decayed, missing, and filled teeth (dmft) score, the children were divided into a control group (dmft = 0) and a case group (dmft ≥ 1). DLX3 gene (rs11656951 and rs2278163) polymorphisms were genotyped by polymerase chain reaction (PCR) and Sanger sequencing methods. Possible association of DLX3 gene (rs11656951 and rs2278163) polymorphisms with dental caries risk was assessed using the chi-squared test. Subgroup analysis of association was assessed by logistic regression analysis for the potential risk factors. Results: The age at which toothbrushing was started, the brushing frequency, brushing with fluoride toothpaste, and regular dental visits were statistically significantly different between case and control groups (p 0.05). The frequencies of rs11656951 TT genotype and T allele were statistically significantly higher in the control group than in the case group. The chi-squared test showed that CT genotype (p = 0.026, OR = 0.613, 95%CI = 0.398–0.944) and TT genotype (p = 0.001, OR = 0.378, 95%CI = 0.212–0.673) were negatively correlated with caries susceptibility. The T allele of rs11656951 was more frequently discovered in the control group, and was statistically significantly associated with decreased caries susceptibility (p = 0.001, OR = 0.636, 95%CI = 0.486–0.831). The G allele of rs2278163 was obviously correlated with elevated caries susceptibility (p = 0.049, OR = 1.314, 95%CI = 1.000–1.725). DLX3 gene rs11656951 TT genotype was a protective factor for caries susceptibility in the subgroups gender, sweets intake, eating before sleep, brushing frequency, brushing with fluoride toothpaste, and dental visits. The GG genotype of rs2278163 was a risk factor for caries in subgroups eating before sleep, brushing without fluoride toothpaste, and regular dental. The TT genotype of rs11656951 was dramatically correlated with reduced caries risk in low (p = 0.004, OR = 0.387, 95%CI = 0.202–0.742) and moderate/high (p = 0.016, OR = 0.360, 95%CI = 0.154–0.840) groups. Conclusion:DLX3 gene rs11656951 TT genotype is a protective factor and rs2278163 GG genotype is a risk factor for caries susceptibility, especially in low and moderate/high subgroups. Keywords: dental caries, dmft score, DLX3, polymorphisms

Purpose: This study investigates the effects of daily consumption of a probiotic ayran drink on gingival inflammation and the development of experimental gingivitis. Materials and Methods: This randomised, double-blind, placebo-controlled trial involved 54 volunteer students. The participants were randomly assigned to two groups: the control group received regular ayran for 42 days, while the test group received probiotic enriched ayran (including Lactobacillus acidophilus and Bifidobacterium bifidum) for 42 days twice a day. After 42 days, mechanical plaque control was stopped for 5 days. The plaque index (PI), gingival index (GI), probing bleeding (BOP), and probing depth (PPD) were measured at baseline, day 42, and day 47. At the same time, gingival crevicular fluid was taken for matrix metalloproteinase-8 examination. Results: The mean scores of BOP, GI, PI, and MMP-8 levels increases in both groups following the 5-day experimental gingivitis period compared to baseline and day 42. Patients using probiotic ayran had significantly less PI, GI, BOP scores and MPP-8 values (p = 0.002; p 0.001; p 0.001; p = 0.001; p = 0.001, respectively) at day 47 compared to the control group. No statistically significant differences in probing pocket depth (PPD) were observed at any time point. Conclusion: The present study suggests that daily consumption of a probiotic ayran drink containing Lactobacillus acidophilus and Bifidobacterium bifidum statistically significantly lowers clinical and immunological markers of gingival inflammation. Keywords: ayran, Bifidobacterium bifidum, dairy products, dental plaque, experimental gingivitis, Lactobacillus acidophilus, oral health, probiotics

Purpose: The objective of the present observational study was to assess the inter-examiner agreement for the diagnosis of periodontitis using the 2018 CPD among fourth and fifth year undergraduate students. It is hypothesised that there is no difference in the inter-examiner relaibility between fourth- and fifth-year undergraduate students regarding staging and grading periodontal disease using the 2018 Classification of Periodontal Diseases (CPD). Materials and Methods: All participants received training on the 2018 CPD scheme through a mandatory periodontics course conducted by a periodontist. Documentation for seven deidentified periodontitis patients, comprising medical history, dental history including tooth loss, intra-oral photographs and radiographs, periodontal charts reporting probing depth, plaque and bleeding on probing scores, furcation involvement and clinical attachment loss, was sent via e-mail to undergraduate students. The cases consisted of one sextant, and the participants were instructed to assume the sextant to be a true representation of the entire dentition. Power analysis was done on pilot data, and the level of significance was set at p0.05. Results: The percentage of undergraduate students in the fourth and fifth year that correctly identified the stage of periodontitis according to the 2018 CPD ranged between 28% and 72% and 18.5% and 77.8%, respectively. The percentage of undergraduate students in the fourth and fifth year that correctly identified the grade of periodontitis ranged between 40% and 88% and 51.8% and 92.5%, respectively. The overall staging and grading ranged between 22.8% and 74.1%, and 45.66% and 87.4%, respectively. There was no statistically significant difference between fourth- and fifth-year undergraduate students with regards to assigning the correct diagnoses to case documentation in terms of either stage or grade. Conclusion: Fourth- and fifth-year undergraduate students demonstrated high inter-examiner agreement using the 2018 CPD. Keywords: classification, diagnosis, inter-examiner agreement, periodontal disease, periodontitis, undergraduate

Background and Purpose: Despite substantial evidence supporting the role of resident bacterial communities in therapeutic fasting outcomes, research has primarily focused on gut microbiota, leaving changes in oral microbiota largely unexplored. The clinical significance of oral health changes during fasting is nonetheless underscored by the documented development of halitosis in fasting individuals. However, no scientific studies have comprehensively examined the interplay between salivary microbiota alterations, inflammatory changes in the gingival crevice, and the production of malodorous volatile compounds. We examined volatile sulphur compounds (VSC) in breath during fasting, cytokine levels in the gingival crevice, and oral microbiota composition of the saliva in a single-arm interventional study involving 36 subjects who fasted for 10 ± 3 days. Materials and Methods: Participants fasted according to Buchinger fasting guidelines. VSC were evaluated every morning before any food or drink intake using the OralChroma gas chromatography device. Saliva and gingival crevicular fluid (GCF) samples were collected at the clinical site before fasting, at the end of fasting, and at the end of food reintroduction. Follow-up saliva samples were sent to the patients after 1 and 3 months. Saliva samples were processed and analysed by targeted sequencing of 16S rRNA gene amplicons, whereas the expression of 6 inflammatory markers in the GCF were analysed using a multiplex fluorescent bead-based immunoassay. Results: The quantification of volatile compounds in the breath demonstrated a statistically significant increase in dimethylsulfide levels during fasting, which corroborates the occurrence of bad breath as a common side effect of fasting. Salivary microbiota profiling showed a shift in microbial composition, including reduction in the levels of Neisseria, Gemella and Porphyromonas spp., concomitant with an increase in the levels of Megasphaera, Dialister, Prevotella, Veillonella, Bifidobacteria, Leptotrichia, Selenomonas, Alloprevotella, and Atopobium. We further demonstrated a reduction in the levels of the pro-inflammatory cytokine interleukin-8 in the GCF. Conclusion: Dimethylsulfide concentrations in the breath increased during fasting, and this was correlated to changes in the oral microbiota. Future studies are needed to illuminate the possible impact of these changes on oral and general health status. Keywords: bad breath, gingival crevicular fluid, inflammatory markers, prolonged fasting, saliva microbiota

Purpose: This study aimed to investigate the association between vitamin D levels and periodontitis according to sleep duration in a representative sample of Korean adults. Materials and Methods: A total of 3535 subjects who participated in the sixth (2013–2014) Korea National Health and Nutrition Examination Survey were examined. Vitamin D deficiency was defined as a 25-hydroxyvitamin D serum concentration of 20 ng/ml. Periodontal status was assessed with the community periodontal index (CPI). A high CPI was defined as a score ≥ 3. Multivariable logistic regression analyses were adjusted for sociodemographic variables, oral and general health behaviors, and systemic health status. All analyses used a complex sampling design, and a subgroup analysis was performed to determine estimates following stratification for sleep duration (≤ 5, 6, 7–8, and ≥ 9 h per day). Results: Multivariable regression analysis indicated that among participants who slept for ≥ 9 h per day, those with vitamin D deficiency were 5.51 times (95% confidence interval = 2.04–14.89) more likely to have periodontitis than those with sufficient vitamin D levels. This association was not statistically significant in the other sleep duration groups. Conclusion: The findings of this study indicate that people with vitamin D deficiency who sleep 9 h or longer may also be statistically significantly more likely to have periodontitis. Keywords: periodontal disease, periodontitis, sleep, sleep duration, vitamin D, vitamin D deficiency

Purpose: This study evaluated the therapeutic efficacy of combining Neodymium-doped Yttrium Aluminum Garnet (Nd:YAG) laser with subgingival curettage and root planing (SRP) in generalised stage III/grade C periodontitis patients and its effects on cytokine dynamics and microbial community. Materials and Methods: Fifteen patients diagnosed with stage III/grade C periodontitis were included in the cohort. The right and left sides of the mouth were randomly assigned either the conventional SRP (control) group or the SRP supplemented with Nd:YAG laser group (experimental group, 160 mJ, 4 W) in a split-mouth design. Clinical periodontal indices were recorded at baseline and at the 6-week follow-up post-treatment. ELISA was utilised to measure IL-1β and TNF-α levels in gingival crevicular fluid. The subgingival microbiota’s composition and variations were characterised using 16S rDNA amplicon sequencing, while quantitative real-time polymerase chain reaction (qRT-PCR) was employed to analyse the changes in the red-complex bacteria in subgingival plaque. Results: The SRP+Nd group exhibited a statistically significant reduction in record probing depth (PD) and bleeding on probing (BOP) compared to the SRP group after treatment (p0.05). The SRP+Nd group showed a markedly lower IL-1β level than the SRP group (p0.05). Furthermore, there was no statistically significant difference in the dominant subgingival microbiota composition and level of the red-complex bacteria between the two groups (p>0.05). Conclusion: The adjunctive use of Nd:YAG laser with SRP demonstrates promising short-term therapeutic benefits for patients with extensive stage III/grade C periodontitis. Both SRP as a standalone treatment and its combination with Nd:YAG laser effectively facilitate a transition in the dominant bacterial community from periodontitis-associated to periodontal health-associated microbiota. Keywords: YAG laser, red complex, 16S amplicon sequencing

Purpose: Focusing on immigrant parents with children aged 0–6 months, this study assessed whether awareness of and attitudes towards restricting children’s sugar consumption vary according to family sociodemographic background and parents’ oral-health–related behaviours. Materials and Methods: A cross-sectional study was conducted including immigrant parents attending child public health centers for vaccination of their children. The study included parents born in Asia, Africa, South America, Central America and Eastern Europe. Parents from Western Europe and North America were included if they were partners of the above-mentioned participants. Cross-tabulation and multiple variable logistic regression were used to assess associations of parental knowledge and attitudes with their child’s sugar intake and sociodemographic characteristics. Results: Overall, response rate was 72.6%. A total of 345 parents completed personal, structured interviews during their visit to the health centers. Attitudes and knowledge, but not indulgence, related to children’s sugar restriction were sociodemographically unequally distributed among immigrant parents. Employed mothers, mothers with immigrant background from North America or Western Europe as well as parents with less frequent own sugar intake were more likely to confirm positive attitudes towards restricting children’s sugar snacking. The corresponding odds ratios were OR=1.8 (95% CI 1.1–3.1) and OR=6.6 (95% CI 2.3–18.9). Employed mothers and parents having received dental care information were more likely than their counterparts to possess good oral-health–related knowledge. Conclusion: Parents from sociodemographically disadvantaged backgrounds were less inclined to express positive attitudes and demonstrate sufficient knowledge regarding the limitation of their children’s sugar snacking. Culturally adapted oral health intervention programs should be implemented for immigrants, with special reference to children’s dietary habits. Keywords: attitude, children, immigrant, knowledge, sugar consumption

Purpose: To investigate the antimicrobial effects of a mouthrinse containing silver nanoparticles (AgNP) on polymicrobial biofilms in vitro. Materials and Methods: Polymicrobial biofilms were grown on glass cover slips following the method of Exterkate. Saliva collected from a healthy human was added to McBain medium (including 0.2% sucrose) to achieve a 50-fold dilution. Glass coverslips were attached to the lid of a 24-well culture plate and suspended in the medium of each well. After 24 h of cultivating, coverslips with biofilms were immersed in each of four treatment solutions or sterile deionized water for 5 min. The control and four treatment groups were as follows: 1) control: sterile deionized water; 2) nanosilver (NS): mouthrinse containing AgNP; 3) 0.05C: 0.05% chlorhexidine gluconate; 4) 0.2C: 0.2% chlorhexidine gluconate; 5) Xyl: 25% xylitol. The biofilms were further regrown for 48 h. After removing the biofilms ultrasonically, they were cultured on blood agar, viable cells were counted, and the amount of lactic acid in the biofilms was analysed using a colorimetric assay. Results: Mouthrinse containing AgNP suppressed viable cells in the biofilm to the same degree or more than with chlorhexidine gluconate. Amounts of lactic acid after 72 h cultivation of biofilms treated with 0.2C and NS showed consistently low values. Conclusion: The mouthrinse containing AgNP suppressed viable cells in polymicrobial biofilms to the same level as 0.2% chlorhexidine or higher. Keywords: chlorhexidine, dental biofilm, preventive dentistry, silver nanoparticles

Purpose: Periodontal diseases, commonly linked to dental biofilm and affecting adults, were studied using Geographic Information Systems (GIS) and Kernel Analyses with epidemiological data. This paper presents a hybrid method for use in epidemiological studies by evaluating the spatiotemporal distribution of disease prevalence. Materials and Methods: This study analy ed 47,757 patients from the Department of Periodontology out of 662,351 visitors to University Faculty of Dentistry (2012 to July 2023). The central districts of Kayseri in Turkey were selected as the study areas. Periodontitis prevalence was assessed through radiographic evidence and clinical examination. Point-based location data, including gender, age, and disease type, matched household data, creating building-based spatial data. Kernel Density (KD) and Average Nearest Neighbor (ANN) analyses examined patient concentration and disease types in specific regions. Accordingly, standard deviation ellipses were prepared by year to assess the spatial changes in the regions where patients resided. Results: The study found higher periodontitis prevalence in males, increasing with age, while gingivitis decreased. After 2017, periodontitis prevalence notably declined. Location-based data exhibited clustering in patient distribution. KD maps showed similar patient distributions over the years, with more applications from areas closer to the Faculty of Dentistry. The spatial distribution of the patients applying has remained consistent over the last 5 years. Conclusions: Through GIS, KD maps reveal the spatial-temporal distribution of periodontitis patients. This aids in identifying high-prevalence regions and guiding strategic healthcare facility placement. Implementing preventive programs in high-demand areas, particularly in family health centers (local health facilities), can reduce community-wide periodontal disease prevalence. Keywords: epidemiology, geographic mapping, gingivitis, periodontitis, spatial analysis