Oral Health and Preventive Dentistry, Volume 18/2020

Summary: Oral/dental healthcare delivery in the post-pandemic era will be different, with challenges to overcome and positive opportunities to take. Managing the needs, wants and expectations of all stakeholders must be communicated and actioned effectively, moving forwards. It is the responsibility of all stakeholders to work together to help provide high quality, evidence-based pragmatic oral healthcare delivery for the future. Patient-focused, team-delivered, minimum intervention oral healthcare (MIOC) is applicable to all patients at all stages of their lives and underpins long-term delivery of better oral and systemic health to all. Guidance, peer-support, whole-team training along with agile commissioning and suitable incentivisation will need to support the paradigm shift to prevention-based MIOC clinical practice. Keywords: Covid-19, dentistry, minimally invasive dentistry, minimum/minimal intervention, oral healthcare, pandemic

Purpose: White spot lesions (WSL) are common side-effects of orthodontic treatment with fixed multi-bracketed appliances. The aim of this review was to find all available literature and critically assess the evidence for the efficacy of bleaching as a method to treat or alleviate post-orthodontic WSLs in permanent teeth. Materials and Methods: Electronic databases were screened for relevant literature with the aid of predetermined search strategies. All types of studies, including randomised or nonrandomised controlled trials (RCTs or CCTs), prospective and retrospective studies, as well as in vitro studies were considered eligible for inclusion. The reference lists of all included articles were hand searched for additional studies. Two authors independently performed study selection, data extraction, and risk of bias assessment. Results: One RCT and 8 in vitro studies met the inclusion criteria. Seven studies were classified as having a high risk of bias while 2 in vitro studies were graded as having a moderate risk of bias. The results showed that bleaching of WSL can diminish colour disparities between carious and non-affected areas, but the certainty of the evidence was very low. The high degree of methodological heterogeneity precluded a valid interpretation of the results through pooled estimates. Conclusions: The findings from the present systematic review could not support or refute bleaching as an effective method for management of post-orthodontic WSLs. Because most of the studies in this field are in vitro and solid scientific evidence of low risk of bias is scare, further prospective in vivo studies are necessary. Keywords: bleaching, enamel demineralisation, fluoride, tooth whitening, white spot lesions

Purpose: To assess the relationship between periodontitis and nosocomial pneumonia in intensive care unit (ICU) patients. Materials and Methods: The present study was conducted in accordance with the guidelines of the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement and registered (CRD42018105124) with PROSPERO (International prospective register for systematic reviews, University of York, York, UK). A search was conducted in five databases without restrictions regarding language or date of publication. From 560 studies selected, 10 underwent full-text analysis. Five studies were eligible (five case-control studies), and all were entered in the meta-analysis. Meta-analysis was performed with tests for sensitivity and statistical heterogeneity. Summary effect measures were calculated by odds ratio (OR) and 95% confidence interval (CI). Results: There was a significant association between periodontitis and nosocomial pneumonia in the meta-analysis (OR 2.55, 95% CI 1.68 to 3.86). In this meta-analysis, I2 = 0%. Conclusions: The evidence demonstrates a positive association between periodontitis and nosocomial pneumonia. Individuals with periodontitis admitted to the ICU were more likely to present nosocomial pneumonia than individuals without periodontitis. Keywords: meta-analysis, hospitalisation, inpatient care units, periodontitis, pneumonia, ventilator associated

Purpose: Oral health is essential in everyone's daily life, and becomes particularly important for those individuals who have been previously drug addicted. The aim of this study was to assess oral health in patients almost at the end of a methadone-detoxification process due to heroin dependency, identifying their treatment needs. Materials and Methods: Seventeen patients, aged between 22 and 51 years, were admitted to the University Hospital of Verona after at least 6 months of being drug-free, except for standard methadone therapy (20 mg/day). Data concerning medical history, social status, drugs and nutritional habits were collected. Restorative conditions and periodontal status were evaluated clinically and radiographically. Results: The duration of illicit drug consumption ranged from 2 to 20 years; methadone treatment duration ranged from 1 to 17 months. A total of 392 teeth were evaluated: 2 patients were diagnosed with periodontitis, whereas dental caries was widespread, affecting most frequently interproximal surfaces of the anterior teeth. Some 185 teeth needed restorations, 15 decayed teeth endodontic treatments, 21 teeth extraction, and 84 teeth were suitable for prosthetic rehabilitations. Caries and periodontal indexes were analysed according to years of heroin consumption (HYC) and months of methadone therapy (MMT), without any statistical differences (p > 0.05) found for both phases. Social and individual factors were investigated in relation with the indexes: no correlations were demonstrated. Regarding irregular food ingestion during HYC, a statistically significant difference (p < 0.05) between the full-mouth visible bleeding on probing index (FM-VBOP) and diet was found. Conclusion: A large carbohydrate intake consequent to methadone therapy increased caries prevalence, despite a more regular diet. Keywords: oral health, drug, methadone

Purpose: Diabetes is an ever-growing health issue in the Kingdom of Saudi Arabia. It has several oral health implications and oral health in turn affects diabetes control. The primary objective of this research was to study the awareness of the effect of diabetes on oral health among the general population in the city of Jeddah, Saudi Arabia. Materials and Methods: A closed-ended, validated questionnaire was distributed to 506 randomly selected shopping-mall-goers. Responses were coded and entered into spreadsheet (SPSS, IBM) and frequency distribution of the responses was calculated. Results: The majority of the respondents were females (62.5%), non-diabetic (80.2%) and reported a positive family history of diabetes (87.9%). Most of them (63.4%) understood the importance of discussing one's diabetes status with the dentist as it affected the treatment plan, and also knew (84.4%) that diabetes affects oral health in some way. A majority also correctly responded to how diabetes affects oral health (66.3%) and to the sequelae of untreated gum disease (87.2%). The majority of the respondents had not received any tips or information regarding the connection between diabetes and oral health. Conclusion: This study reported adequate knowledge of the sample with respect to diabetes-related oral health. An important finding of this study was that the majority of the study participants did not receive information leading to diabetes-related oral health awareness or knowledge from anyone, which implies that health professionals and health media do not play the requisite role in dissemination of this important aspect of public health. Keywords: awareness, diabetes, knowledge, oral health

Purpose: To determine any associations between obesity and caries activity in the mixed dentition stage among primary school children in a low-income Mexican primary school. Materials and Methods: This cross-sectional study was performed in Mexican schoolchildren aged 8–12 years. The body mass index (BMI) was obtained, and children were classified as overweight/obese considering age and sex. The experience of caries in permanent and temporary dentition was established with the sum of decayed/missing/filled teeth (DMFT or deft index for permanent or temporal dentition); a caries index for all teeth was also considered (total decay [TD]). Mann–Whitney U-test was used to contrast the distribution between sexes of the quantitative variables and to contrast the distribution of each variable per category, the Kruskal–Wallis test was used. Spearman's Rho test was used to establish the correlation between the quantitative variables. Multiple linear regression models were performed to find the relationship between the O'Leary index and the BMI. A Multilayer Perceptron was constructed as follows: (a) dependent variables: deft, DMFT, TD and O'Leary index; (b) factor: BMI; (c) covariable: age. Results: A total of 331 children were included in the study. Dental caries prevalence was 32.4% (95% CI 29.7–35.2), while the mean DMFT was 0.64 (± SD 1.00). Through the Spearmen test, a statistically significant negative correlation was found between BMI-for-age with the total experience of carious lesions (r = –0.127, p = 0.021) and with experience of carious lesions in the deciduous dentition (deft) (r = -0.195, p ≤0.001). But when using the linear and logistic regression models to analyse the relationship with the O'Leary index, BMI was not statistically significant. With the Multilayer Perceptron there appears to be less error in the prediction of deft than the other indexes. Conclusions: This study confirms the high prevalence of obesity in primary school children. It also shows the scarce association between carious lesions and obesity. Keywords: body mass index, carious lesions, children, O'Leary index, total decay

Introduction: The aim of this study was to make a quantitative comparison of the cytotoxic potentials of four different polymerised and unpolymerised self-etching adhesives which were newly used clinically. Materials and Methods: Cytotoxic effects of both polymerised and unpolymerised forms of all test adhesives were evaluated against L929 cell line using the MTT test. The activity for unpolymerised adhesives was assessed in different doses and incubation times manner. On the other hand, cytotoxicity of the polymerised adhesives prepared at different extraction times were evaluated as dependent on incubation times. Two-Way Variance Analysis and Bonferroni post-test was used for statistical evaluation. Results: There were statistically significant differences between the groups (p < 0.05). In general, it was shown that unpolymerised and polymerised forms of each of the test compounds exhibited a time-dependent cytotoxic effect. However, the effect on polymerised forms was found to be independent of the duration of the extraction, while the effect on the unpolymerised forms increased dose-dependently. It was also determined that the most cytotoxic material in the unpolymerised form was Dentsply and in the polymerised form was Tokuyama. Conclusions: Dentsply should be preferred over Tokuyama to be able to provide clinically long-lasting restorations. Keywords: adhesive materials, cytotoxicity, polymerisation, MTT test

Purpose: To investigate dental enamel wear caused by erosion and abrasion while using a combination of anti-erosive toothbrush/-paste. Materials and Methods: A total of 60 enamel specimens from bovine incisors were randomly assigned into five groups of 12 specimens each (G1–5, n = 12): (G1) control group (no treatment), (G2) standard medium toothbrush Paro M43 and standard toothpaste Elmex Caries Protection, (G3) standard medium toothbrush Paro M43 and anti-erosive toothpaste Elmex Protection Erosion, (G4) anti-erosive toothbrush Elmex Erosion Soft and standard toothpaste Elmex Caries Protection, (G5) anti-erosive toothbrush Elmex Erosion Soft and anti-erosive toothpaste Elmex Protection Erosion. Initially, surface baseline profiles were recorded using profilometry. In a total of 60 cycles, all specimens were exposed to hydrochloric acid (pH = 3) for 1 min, rinsed with tap water to stop the erosive attack and brushed according to the specific protocol of each group (15 brushing strokes per run). Enamel loss was determined by comparing the surface profiles before and after 60 cycles and the results were statistically analysed using analysis of variance (ANOVA). Results: The significantly highest loss of enamel was observed in the control group G1(1.4 ± 0.20 µm) (p < 0.001). G2 turned out to be the most abrasive toothbrush/-paste combination (1.12 ± 0.15 µm), G3 the least invasive (0.40 ± 0.04 µm) (p < 0.001, respectively). Conclusion: All combinations of the investigated toothbrushes/-pastes reduce erosive/abrasive enamel wear. However, the highest reduction was observed for the combination of anti-erosive toothpaste and standard toothbrush (G3). Keywords: anti-erosive, dental erosion, dental abrasion, toothbrush, toothpaste

Purpose: Despite being the gold standard antiplaque agent, chlorhexidine (CHX) has many adverse effects that make scientists search for new agents to combat biofilms as effective as CHX. Hyaluronan, also known as hyaluronic acid (HA), is a natural polysaccharide with anti-inflammatory, antioxidant and bacteriostatic properties. The objectives were to evaluate the plaque inhibitory, and anti-inflammatory effects of HA mouthwash compared to CHX and distilled water (DW) in a 4-day non-brushing model together with the participants' preference to the used products. Materials and Methods: Thirty-three systemically and periodontally healthy subjects were included in this randomised, double-blinded, crossover clinical study. Subjects were randomly assigned into three treatment-sequence groups to use three mouthwashes one after another, in three different time periods. After professional prophylaxis at day 1, subjects refrained from all oral hygiene measures and used mouthwashes that were individually allocated to them. On day 5, scoring of plaque index (PI) according to Turetsky modification of Quigley Hein Index system, modified gingival index (MGI) and measurement of gingival crevice fluid (GCF) volume were performed. Treatment satisfaction questionnaire form was given at the end of each experimental period. Results: CHX showed statistically significant reduction in PI followed by HA (p = 0.048). No statistically significant differences were detected between HA and CHX in terms of MGI and GCF volume. For HA, subjects reported significantly better taste, less sensitivity, burning sensation, mouth dryness and numbness perception compared to CHX and DW. Conclusions: CHX revealed the best plaque inhibition closely followed by HA. Early gingival inflammatory changes were found similar for CHX and HA. Furthermore, HA was well accepted with better perceptions than CHX and DW. Keywords: chlorhexidine, hyaluronic acid, mouthwashes, gingivitis, taste perception

Purpose: The aim of this in vitro study was to evaluate the influence of preapplication of 2% chlorhexidine gluconate on the immediate microtensile bond strength of a universal adhesive system on dentine subjected to different bonding protocols. Materials and Methods: Twenty human molars were used in this study, and the tooth surface was abraded to expose the dentine. The teeth were randomly divided into four groups according to the surface treatment (n = 5): SBU group: Single Bond Universal without acid etching; SBUPA group: 37% phosphoric acid + Single Bond Universal; SBUCG group: 2% chlorhexidine gluconate + Single Bond Universal; and SBUPACG group: 37% phosphoric acid + 2% chlorhexidine gluconate + Single Bond Universal. The microtensile bond strengths were measured using a microtensile tester 24 h after bonding. The bond strength data were subjected to analysis of variance (ANOVA) and Sheffé's least statistically significant difference test (α = 0.05). Results: No statistically significant differences between the analysed groups were observed (p > 0.05). However, conditioning with phosphoric acid without the action of the chlorhexidine gluconate group resulted in higher numerical values of bond strengths than that for the chlorhexidine gluconate without the acid conditioning group. Conclusion: The preapplication of 2% chlorhexidine gluconate did not reduce the immediate bond strength of the Single Bond Universal adhesive system under different bonding protocols. Keywords: adhesives, dentine, microscopy electron scanning, resin composites, tensile strength

Purpose: The aim of this study was to evaluate the association between periodontitis and preterm birth in a Spanish Caucasian population, based on clinical and biochemical outcomes. Epidemiological studies have suggested that periodontitis is a potential risk factor for preterm birth. However, other studies have shown high heterogeneity in their results. Some factors such as number of evaluations during pregnancy, sample size, study population and maternal age may have an impact on the variability of the result. Methods and Materials: This cohort study enrolled 158 pregnant women, 39 with periodontitis and 119 without periodontitis. All pregnant women were evaluated in the first, second and third trimester. Results: Statistically significant differences were found in periodontal parameters between both groups, but no statistically significant differences were found in biochemical parameters during pregnancy. The duration of pregnancy in healthy patients was 38.78 ± 4.49 weeks, and in patients with periodontitis 37.81 ± 4.89 weeks, with no statistical difference (p > 0.05). This showed that periodontitis was not associated with preterm birth in a Spanish Caucasian cohort. Conclusion: In this study, periodontitis stage II, grade B, was not statistically associated with preterm birth. Pregnancy is a short period of time in order to evaluate long-term oral systemic infections. Adverse pregnancy outcomes are more difficult to occur. Thus, since pregnancy timing average cannot be changed, the stages of periodontal disease (initial, moderate, advanced) could be another factor to study. Keywords: preterm birth, periodontitis, pregnancy, risk factor

Purpose: To evaluate the relationship between decayed, missing and filled teeth (DMFT index) and body mass index (BMI) in a Turkish population of adults aged 20–30 years who did not have any chronic diseases. Materials and Methods: This study was conducted on a total of 394 patients. DMFT index was used to define the number of teeth with decays, teeth with fillings, and missing teeth. The body weight and height of the study participants were measured with a digital scale and height rod. BMI was calculated by dividing the body weight by the square root of the height. One-way analysis of variance (ANOVA) and Bonferroni tests were used to compare three or more groups and to compare two groups, respectively. The statistical significance level was evaluated at p < 0.05. Results: Differences in DMFT index among BMI groups was found to be statistically significant (p = 0.001; p < 0.01). DMFT index was significantly higher in the obese group than in the normal-weight group (p = 0.001) and overweight group (p = 0.001). No statistically significant differences were found between DMFT indices of study participants of normal weight and those who were overweight (p > 0.05). Conclusion: Positive correlation was observed between obesity and DMFT index. Coadministration of obesity prevention programmes and preventive oral health programmes can improve public health to a better point. Keywords: dental caries, DMFT, obesity

Purpose: To assess the efficacy of licorice lollipops in reducing dental caries in children. Materials and Methods: A literature search was confined to the English language using MeSH terms congruent with PICO format in 'PubMed', 'Cochrane Library' and 'Ovid', covering the period from April 1967 to December 2017. Searches in Google Scholar, grey literature and hand search of cross-references were performed to find additional data. Suitable studies were selected based on the predefined inclusion and exclusion criteria. Quality analysis and risk of bias of the selected studies were performed using the Cochrane Collaboration's tool for risk of bias. Results: Overall 519 articles were retrieved, 516 (electronic databases) and 3 (Google scholar). 516 publications were excluded due to non-availability of abstracts, or because they were unrelated studies, narrative reviews, and systematic reviews as well as letters to editors. Only three studies were included for final analysis. Quality analysis of these three studies showed that only one was of high quality, whereas the other two were rated as low. Conclusion: Licorice lollipops showed a promising effect in reducing caries by decreasing Streptococcus mutans counts in the saliva. Further research using randomised controlled clinical trial (RCT) designs with large sample size are recommended. Keywords: children, dental caries, licorice lollipops, Streptococcus mutans

Purpose: To present a review of available literature on the association of vitamin D and periodontal disease. Materials and Methods: A thorough search of articles was carried out on the databases PUBMED and MEDLINE regarding vitamin D and periodontal disease. The selected literature included cross-sectional, case-control and prospective and retrospective cohort studies. The main aspects of the association evaluated were a) the association of 25(OH)D and 1,25(OH)2D3 with periodontal disease severity, periodontal disease progression and tooth loss, b) the effect of vitamin D supplementation on periodontal health and c) the association of vitamin D receptor polymorphisms with periodontal disease. A brief overview of the biological mechanisms linking periodontal disease with vitamin D was also included. Results and Conclusions: There is conflicting evidence regarding the effects of 25(OH)D on periodontal disease severity, progression and tooth loss, with some studies reporting beneficial effects of higher 25(OH)D serum concentrations on periodontal health and tooth retention, whereas others could not find such an association. Limited evidence also supports a positive association between 1,25(OH)2D3 and periodontal health as well as a trend towards better periodontal health with vitamin D supplementation. Finally, various vitamin D polymorphisms were associated with chronic and aggressive periodontitis, with different outcomes reported for the various ethnic populations assessed. Keywords: periodontal disease, vitamin D concentration, vitamin D supplementation, vitamin D receptor, polymorphism, periodontal inflammation

In humans, ascorbic acid, better known as vitamin C, is a true vitamin because humans lack the ability to synthesise it. Vitamin C exhibits a number of enzymatic and non-enzymatic effects but all are accounted for by the ability of vitamin C to donate electrons and therefore acts as a reducing agent. It has a wide range of functions. For example, it acts as co-factor for a number of enzymes including those involved in collagen hydroxylation, prevents oxidative damage to DNA and intracellular proteins, and in plasma it increases endothelium-dependent vasodilatation, and reduces extracellular oxidants from neutrophils. Deficiency in vitamin C results in the potentially fatal disease scurvy, which can be cured only by administering vitamin C. It has been shown that in individuals with gingivitis and periodontitis, plasma vitamin C levels are lower than in healthy controls. In periodontitis, a reduced capacity to absorb vitamin C may play a role. The manner in which vitamin C data are obtained from blood significantly impacts the final value obtained and therefore data validity. Plasma vitamin C levels of 56.8 μmol/l may be regarded as the optimum plasma level. In order to achieve this level, at least 200 mg vitamin C per day should be ingested. It is advisable to obtain vitamin C through the consumption of fruit and vegetables rather than supplements. Keywords: ascorbic acid, gingivitis, periodontitis, scurvy, vitamin C

Purpose: We examined oral health behaviour and its association with school achievement among Finnish adolescents. Materials and Methods: This study is part of the Finnish national School Health Promotion study (SHP). The study population comprised a representative sample of Finnish 15-year-olds (N = 45,877). A questionnaire inquired about the respondents' school achievements and health habits (toothbrushing, smoking), background factors (age, gender, school type, family structure), and their parents' background factors (education, smoking). Chi-square tests and logistic regression models were used in the statistical analyses. Results: Better school achievements were associated with better oral health behaviour: 73.1% of students with the highest mean grades (9–10) brushed their teeth twice daily, compared to 33.8% of those with the lowest mean grade (6.9 or less). The lowest mean grade was associated with brushing less than twice daily, especially among boys (odds ratios (OR) = 4.1; 95% CI 3.6–4.7) when compared to those with the highest mean grade, but also among girls (OR = 2.3; 95% CI 2.1–2.7). Smoking among boys was associated with poor oral hygiene (OR = 1.3; 95% CI 1.2–1.4). Conclusion: School success is strongly associated with oral health behaviour among adolescents. Preventive treatment should be targeted especially at boys with poor school achievement and smoking behaviour. Keywords: adolescents, health promotion, oral health behaviour, school achievement, toothbrushing

Purpose: Increased wear of teeth may constitute a major problem in the future for the elderly. The aim of the present study was to investigate tooth wear in a sample of elderly Greeks and explore the presence and extent of severe occlusal/incisal wear in relation to the parameters of age, gender and remaining teeth. Materials and Methods: A convenience sample of 70 dentate elderly (60–92 years old) was examined. Tooth wear was assessed using a modification of the tooth wear index. The presence of severe occlusal/incisal wear was explored using the multiple correspondence analysis (MCA) and x2 tests and the extent (% of surfaces) with analysis of variance (ANOVA). Results: Increased prevalence of severe wear was observed in the occlusal/incisal and, to a lesser extent, in the cervical surfaces of the examined teeth. Seventy per cent (70%) of the participants had at least one severely worn tooth surface. Advanced age seemed to be associated with severe occlusal/incisal wear (>70 years: 79.4%; 60–70 years: 52.8%; x2 test, p = 0.024). The mean (± SD) percentage of severely worn teeth and surfaces was 34.2 ± 32.6% and 9.6 ± 9.6%, respectively. ANOVA showed that males and those with less than 20 remaining teeth exhibited more severely worn occlusal/incisal surfaces (p = 0.031 and p = 0.000, respectively). Conclusions: The presence and the extent of severe wear in the sample of the examined elderly is high compared to elderly populations in other countries. Severe wear was more prevalent with advanced age and more extensive in the occlusal/incisal surfaces in males and those having less than 20 remaining teeth. Keywords: tooth surface loss, prevalence, extent, elderly, tooth wear index

Purpose: The aim of this retrospective cross-sectional study was to detect dental health and dental treatment under general anaesthesia, as well as associations to selected parameters in a patient cohort with different disabilities. Material and Methods: Patients with disabilities, including mental, physical, combination of mental and physical as well as psychiatric disability, which received dental rehabilitation under general anaesthesia between 1 January 2002 and 31 December 2011 were included. Based on the available patients' records, findings of dental examination (Decayed-, Missing- and Filled-teeth index [DMF-T]), treatment documentation as well as further specific factors including the presence of preoperative dental examination or radiographs were analysed. Statistical analysis was conducted using Mann-Whitney U test, Kruskal–Wallis test, analysis of variance (ANOVA), chi-squared or Fisher's exact test (p <0.05). Results: A total of 464 patients were included. An overall DMF-T of 12.3 ± 7.5 (D-T of 5.8 ± 5.1) and a dmf-t of 9.2 ± 5.0 (d-t of 7.5 ± 4.5) were found. Patients with psychiatric disabilities showed worst dental health. About half of patients (56%) received a professional tooth cleaning. A tooth extraction was executed at 70% of patients, with 3.3 ± 4.5 teeth each patient. Nearly no patient received periodontal or endodontic treatment. Patients with a preoperative dental examination received statistically significantly less tooth extractions compared to patients without preoperative dental examination (2.7 ± 3.7 vs 4.5 ± 5.8). Conclusion: Patients with different disabilities show high dental treatment need and require improved dental care. Thereby, the preoperative dental examination might avoid unnecessary tooth extractions and is therefore strictly recommended. Keywords: disability, dental treatment, dental examination, general anaesthesia, dental care

Purpose: To evaluate the microtensile bond strength of dentine/self-adhesive resin cement interface after several treatments on a dentine surface. Materials and Methods: Twenty-eight human molars were selected and divided into four groups: no treatment (control (C)); 2% chlorhexidine digluconate (CHX); 25% polyacrylic acid (PA); and 23 ppm dispersive solution of silver nanoparticle (SN). Prepolymerised TPH resin composite (Dentsply) blocks were luted on the dentine surface using RelyX U200 self-adhesive resin cement (3M ESPE). Microtensile bond strength was measured (MPa) in a universal testing machine 24 h and 6 months after the bonding process. The fractured specimens were examined in an optical microscope and classified according to the fracture pattern. A representative sample of each group was observed by scanning electronic microscope. Data were submitted to analysis of variance (ANOVA) and Tukey's test to compare the mean among the groups (p <0.05). Results: The highest microtensile bond strength values after 24 h were found for the PA group (13.34 ± 6.36 MPa), with no statistically significant difference for the C group (9.76 ± 3.11 Mpa). After 6 months, the highest microtensile bond strength values were found for the C group (9.09 ± 3.27 Mpa), with statistically significant difference only for the CHX group (2.94 ± 1.66 MPa). There was statistically significant difference only for the PA group when comparing the periods studied. Regardless of the surface treatment applied, there were more adhesive failures in both periods of time. Conclusion: Dentinal pretreatment with PA, as well as use of SN before the bonding procedure of self-adhesive resin cement to dentine, may be alternative bonding protocols. Keywords: dentine-bonding agents, resin cements, tensile strength

Purpose: The air-particle-abrasion on zirconia in the gingival area of connectors and pontics in fixed partial dentures appears to increase fracture resistance. This study evaluated 'in situ' biofilm formation on the zirconia surface after different air-particle-abrasion protocols. Materials and Methods: Ninety sintered blocks (5 × 5 × 2 mm) of yttrium partially stabilised zirconia (Y-TZP) were obtained and randomised among nine groups according to the factors 'type of particle' (Alumina 50 and 110 µm; Cojet and Rocatec) and 'pressure' (2.5 and 3.5 bar) used for sandblasting for 10 s. The surface roughness (Ra/Rz) was measured before and after sandblasting. For the in-situ analyses, custom-made removable intraoral devices n = 10 with one sample of each group attached to the buccal area were used by volunteers for 8 h at night. The specimens were analysed under confocal microscopy to quantify both biovolume and thickness of the initial biofilm formed. One-way analysis of variance (ANOVA) and Dunnett's tests were performed (5%). Results: The roughness values ranged from 0.05 to 0.39 µm for Ra and from 0.35 to 2.11 µm for Rz, p = 0.00. Mean biofilm thickness ranged from 0.06 and 0.54 µm (p = 0.005), while the biovolume values were between 0.02 and 0.61 µm3/µm2 (p = 0.002). Values statistically significant for biofilm thickness and biovolume were found in groups sandblasted with Rocatec using 3.5 bar. Conclusion: In order to increase the fracture resistance of zirconia fixed partial dentures (FPDs), the air particle abrasion of zirconia with SiO2 (110 μm/3.5 bar), in the gingival area of connectors and pontics, should be avoided. Keywords: blasting, scanning electron microscopy, surface roughness, zirconia

Purpose: This randomised controlled study evaluated the effectiveness of an oral probiotic, Streptococcus salivarius M18 (SsM18), in children with black stains (BSs) in order to counteract their reformation. Materials and Methods: Fifty-eight children (aged 4–10 years) presenting with BSs were enrolled. They were randomly divided into two groups: group A (n = 29) included children who were given the test product containing SsM18 once a day for 3 months; group B (n = 29) included children who did not receive any treatment. Before beginning the study, all the children underwent professional removal of BSs. The assessment of BSs was done after 3 months (T1) and after 6 months (T2). Results: Four patients (1 belonging to group A and 3 to group B) were excluded from the study because they started antibiotic therapy. After 3 months (T1), BSs were detected in 6 of the 28 children (21.2%) from group A and in 13 out of the 26 (50%) children from group B (p < 0.05). After 6 months (T2), BSs were detected in 9 out of the 28 (32.1%) children from group A and in 14 of the 26 (53.8%) children from group B (p > 0.05). Conclusions: BSs formation in children could be prevented by administering S. salivarius M18. Keywords: child, pigmentation, probiotics, teeth

Purpose: The aim of the present study was to analyse the role of the main diagnostic signs of poor periodontal status, probing depth (PD) ≥4 mm and bleeding on probing (BOP) ≥50%, both simultaneously and individually in preterm birth (PB) and their effect on the birth weight (BW). Prematurity is a major health concern and it is the leading contributing factor to neonatal morbidity and mortality worldwide. Conflicting results exist on the relation between poor maternal, periodontal status and adverse pregnancy outcome, including preterm deliveries and low birth weight (LBW). Materials and Methods: Seventy-seven PBs and 165 deliveries at term were analysed out of 242 patients. The perinatal factors such as gestational age (GA) and BW were analysed by BOP, categorised as ≥50% (high BOP) vs <50% (non-high BOP) and PD ≥4 mm vs <4 mm, in combination or separately. Results: The obtained results suggest that maternal periodontal inflammation, represented particularly by BOP, might be a triggering factor and can be associated with PB and LBW. For women with high BOP the adjusted odds ratio (AOR) for LBW was 2.28-fold and they were likely to have PB, with a 2.02-fold higher rate. Conclusion: An increasing tendency of BOP seemed to be associated with a tendency to PB and LBW. Further investigations are necessary to underline this relationship, but the role of good oral health status in general, and particularly in case of pregnancy, is unequivocal. Keywords: birth weight, periodontal status, pregnancy, prematurity

Purpose: Periodontal disease is a chronic inflammatory disease characterised by the infiltration of inflammatory cells as well as activation of pathological angiogenesis in gingival tissues. Vascular endothelial growth factor (VEGF) plays a statistically significant role in the regulation of angiogenesis and induction of an inflammatory response in periodontal tissues. Materials and Methods: We examined the association between the VEGFA gene rs699947 polymorphism and periodontal disease. This study enrolled 200 patients with periodontal disease (130 non-smokers and 70 smokers) and 160 control subjects (126 non-smokers and 34 smokers). Results: There were no statistically significant differences in the distribution of VEGFA rs699947 genotypes and alleles between patients with periodontal disease and control subjects, also in the case when the analysis was performed in subgroups stratified according to smoking status. Conclusion: The results of this study suggest there is no association between the VEGFA gene rs699947 polymorphism and periodontal disease. Keywords: gene, polymorphism, periodontal disease, VEGFA

Purpose: Improved oral health of children is noted in most Western countries, but this coincides with a high burden of oral disease in several countries of Central and Eastern Europe. The purpose of the present study was to describe the current level of dental caries in Hungarian children aged 5, 6, and 12 years and to assess the long-term trends in caries over 30 years. In addition, the report aims to highlight the oral health habits of 12-year-old children in Hungary. Materials and Methods: A representative survey was undertaken in 2016–2017 according to the WHO Pathfinder methodology, which was also applied in previous national oral health surveys of 1985, 1991, 1996, 2001, and 2008. Children of 5–6 and 12 years were sampled systematically in all surveys over 30 years. Data were gathered through clinical examinations and a questionnaire used for 12-year-olds. Results: In 2016–2017, 42.6% of 5- to 6-year-olds were caries free, with the proportion lower in rural than urban settings. Approximately four primary teeth were affected by caries among children aged 5–6 years. Most of the disease burden consisted of untreated caries. Caries experience was higher for children living in rural areas. At age 12, about two permanent teeth suffered from caries, and the D-component of the caries index was high. The percentage of caries-free 6-year-olds grew from 9% in 1985 to 42.6% in 2016-2017. In 1985, 12-year-olds had on average 5 teeth affected by caries, and after 30 years, the level of caries declined to 2.3 DMFT in 2016–2017. The responses to the questionnaire showed that 11.9% of 12-year-olds visited the dentist because of oral pain or discomfort and 40.5% were dissatisfied by the appearance of their teeth. About 40% of children consumed soft drinks or sweets/candy, several times a day. Conclusions: Hungary has not yet achieved the WHO goals for children aged 5–6. While Hungary accomplished the WHO goal for oral health of 12-year-olds by the year 2000, it is seems unrealistic for the country to achieve the WHO goal for 12-year-olds by the year 2020. For better oral health of children, strong emphasis should be given to population-directed oral disease prevention, including the reduction of sugar consumption and implementing public health programmes for the effective use of fluoride. Keywords: dental caries, oral disease prevention, oral health behaviour, national health surveillance, children

Purpose: The first large-scale epidemiological survey on dental caries in Slovenia was conducted in 1987 and repeated in 1993, 1998, 2003, 2008, 2013 and 2017, using the same methodology. The aim of the study was to examine the trend of caries in 12-year-olds in Slovenia during a 30-year time period. The changes over time in caries experience were compared with disease trends observed in other European countries. Study Populations and Methods: The WHO National Oral Health Pathfinder Survey was applied in all seven surveys (1987–2017). The surveys were carried out in all nine geographical regions of Slovenia. For each subject, the caries experience and presence of sealants were recorded. Results: The mean DMFT of 12-year-olds decreased significantly from 5.1 in 1987 to 1.5 in 2017 (p < 0.0001). The percentage of persons with sealed teeth increased from 6% in 1987 to 94% in 2017, and the percentage of caries-free persons increased from 6% to 42%. Conclusion: The implementation of a nation-wide preventive programme was determined to significantly contribute to the effective control of caries and continuously improve the oral health of Slovenian children. In an international perspective, the Slovenian achievements in disease prevention in terms of caries prevalence reduction may be important for other countries of the region. Keywords: children, dental caries, disease prevention, epidemiology, fissure sealing

Purpose: To assess the effect of oral comprehensive healthcare on the prevalence of early childhood caries in urban areas of China. Materials and Methods: A total of 398 children aged 4–5 years from six different kindergartens in Qingdao were recruited to participate in a 1-year single-blind randomised controlled clinical trial. They were randomly assigned into either an experimental group (187 children) or a control group (211 children). The experimental group received comprehensive oral healthcare including oral health examinations, oral health education for children and their guardians, and local fluoride application and dental treatment, whereas children in the control group only received oral health examinations twice a year. The children's parents finished a comprehensive oral health questionnaire before and after the experiment. After a year, the oral health status of two groups of children was statistically analysed to determine the effect of oral comprehensive healthcare on early childhood caries. Results: After 1 year, the numbers of decayed teeth (dt), decayed tooth surfaces (ds), filled teeth (ft), and filled tooth surfaces (fs) in the experimental group were significantly lower than the control group (p <0.001). The dmft and dmfs were also significantly different between the two groups (p <0.05). Statistically significant differences were additionally shown in oral hygiene habits and eating habits of both the children and their parents in the two groups compared with 1 year before (all p <0.001). Conclusion: Implementation of comprehensive oral healthcare measures both prevents and reduces early childhood caries. Keywords: early childhood caries (ECC), child, oral hygiene behaviour, comprehensive oral healthcare, oral health education

Purpose: To examine the relationships between (1) the levels of each temperament traits and the levels of milk-feeding frequency, oral hygiene care and dental caries, and (2) the difference in mean numbers of decayed surfaces among temperament types. Materials and Methods: Four hundred and ninety-three (493) 12-month-old infants were assessed for temperaments and characteristics of child-rearing practices. The data were analysed with their dental caries status at 18 months of age. The chi-squared test, Student's t test, ANOVA and Kruskal-Wallis tests were used to assess the association between temperament traits and the following variables; dental caries, oral cleaning habits and feeding frequency. Logistic regression models were used to identify the effect of temperament traits and other factors on dental caries status. Results: The trait of adaptability was found to associate with feeding frequency at night, while those of activity and approach/withdrawal were significantly associated with regularity of oral cleaning habits by the children's caregiver. Three of the nine temperament traits – biological rhythmicity, approach/withdrawal and mood – were significantly associated with dental caries in bivariate analysis. Biological rhythmicity and approach/withdrawal traits were significantly associated with a higher chance of having caries after adjusting for regularity of oral cleaning habits and frequency of night feeding. Conclusion: Biological rhythmicity, approach/withdrawal and mood traits were related to caries in these young children. Keywords: dental caries, temperament, primary dentition, child

Purpose: To investigate recent developments in the provision of oral healthcare in Cyprus and the population's oral health, with special reference to the impact of the recent economic crisis. Research design: cross-sectional study. Materials and Methods: Data from oral health surveys in Cyprus over the last 30 years were reviewed and analysed together with policy documents. Information regarding oral health behaviour, dental visits and the consequences of the economic crisis on the latter was also obtained with the help of self-completed questionnaires by patients and dentists. Results: Although the overall level of oral health in Cyprus can be considered satisfactory, there were statistically significant variations between districts and different socioeconomic and ethnic groups. Beyond these variations, it seemed that the three-year economic crisis (2013–2016) had negatively affected the behaviour of the population in seeking dental care, reducing the frequency of visits to the dentist, and avoiding costly dental work, especially among those from the lower socioeconomic strata. This change in citizens' behaviour led to a statistically significant decrease in dentists' income in the private sector. Conclusions: The economic crisis brought about new difficulties and challenges for both the public and the private sectors of oral healthcare, and into the implementation of a new National Health System. Keywords: Cyprus, economic crisis, oral health

Purpose: Sparse data is available concerning the distribution of decayed, extracted, filled/decayed, missing, filled tooth surfaces (defs/DMFS) and the impact of influencing risk factors in Moscow. We thus aimed to measure caries experience and to estimate its associations with relevant risk factors in schoolchildren. Materials and Methods: Data was obtained from 1004 schoolchildren aged 7-17. The clinical examination included the status of dental plaque, gingival bleeding and caries experience; defs/DMFS. The questionnaire was introduced to the children/parents, in order to measure socioeconomic and behavioural variables. The Fisher Exact test and chi-squared test were used to assess statistical significance of the distribution of the variables among groups. Bivariate and general estimating equations (GEE) analyses were applied to estimate the relative effect of the independent variables on the outcomes defined as median defs and median DMFS. Results: The median defs and median DMFS varied among age groups. In the primary dentition, the bivariate analyses showed association between median defs and gender, plaque, toothache, self-satisfaction with the appearance of teeth, and intake of milk with sugar were associated (p <0.05). The multivariate analyses revealed that the median defs was lower in girls (OR = 0.9) and children with evidence of no plaque (OR = 0.7)/thin plaque (OR = 0.8), (p ≤ 0.002). In the permanent dentition, the bivariate analyses showed association between median DMFS and plaque, gingival bleeding, healthy dentition, use of toothpicks/dental floss, intake of biscuits etc, soft drinks and jam/honey, and education of the child's mother (p ≤ 0.02). Only gingival bleeding after probing (OR = 1.2) and higher education level of the mothers (OR = 0.9) were associated with the median DMFS in the multivariate analyses (p < 0.05). Conclusions: Clinical, socioeconomic and behavioural determinants were identified to influence caries in primary and permanent dentition in schoolchildren in Moscow. The findings might provide a reliable basis for improvements and education programmes in oral health promotion for children and adolescents. Keywords: caries, clinical research, epidemiology, oral health, paediatric dentistry

Purpose: This study explored the oral health of individuals with substance use disorders and examined the relationship between oral health and type and number of years of substance use disorder. Materials and Methods: This comparative cross-sectional study comprised patients with one of four groups of substance use disorders – alcohol, cannabis, central nervous system stimulants (CNSS), and opiates. All participants underwent a dental examination and were included in the study based on their clinical findings. Results: Of 95 participants, 79 (83%) were male and 37 (39%) were homeless. Statistically significant difference between the groups was observed in 6–12-mm periodontal pocket depths (p <0.05), as were differences in oral mucosal changes (p <0.001). Statistically significantly lower proportions were observed in the cannabis group for Mob G:0 and Mob G:1 and Furcation G:1 compared to the CNSS and opiate groups; the proportion of Furcation G:0 was significantly lower in the alcohol group compared to the cannabis group. Analysis of variance (ANOVA) revealed statistically significant between-group differences in age, number of years of substance use disorder, number of teeth, and decayed, missing and filled teeth (DMFT). When controlling for age and gender, substance type was found to be a statistically significant predictor of number of teeth (B = –4.4; 95% CI: –8.1 to -0.38; p = 0.03) and DMFT (B = 2.1; 95% CI: 0.86 to 3.3; p = 0.001). Conclusions: These results indicate poor oral health among individuals with substance use disorders. It seems that oral health problems are lower among abusers of cannabis than of CNSS, alcohol and opiates. Keywords: cannabis, DMFT, heroin, periodontal health, substance use disorder

Purpose: To assess the extent of differences between the oral health of people aged 50 and 70 years in a community-based setting. Materials and Methods: This research is part of the Interdisciplinary Study on Adult Development (ILSE). All participants lived in the city of Heidelberg, Germany. For the dental study, 194 participants born 1930–1932 (n = 88) or 1950–1952 (n = 106) underwent a comprehensive dental examination. For each participant the number of teeth present, the number of decayed, missing, and filled tooth surfaces (DMF-S), the Plaque Index (PI), the Gingiva Index (GI) and the Community Index of Periodontal Treatment Needs (CPITN) were determined. Depending on the structure of the data, differences between the birth cohorts were calculated by use of t tests or chi-squared tests. Multivariate analysis was also performed to assess possible effects of gender and birth cohort. Results: Oral health conditions were significantly worse among septuagenarians than among quinquagenarians. Besides poorer oral hygiene, as measured by use of PI and GI (p <0.001), periodontal conditions were worse for septuagenarians (p <0.001), who also had fewer natural teeth (p <0.002); the number of carious lesions was similar in the cohorts (p >0.05). These results were confirmed by multivariate analysis and seem to be mostly gender independent. Conclusions: Oral hygiene and health is poor for quinquagenarians and septuagenarians, with more problems associated with greater age but not with gender. Longitudinal studies are necessary to evaluate the intraindividual development of changes of oral health during ageing. Keywords: caries prevalence, periodontitis, oral health, oral hygiene, elderly people

Purpose: The aim of this study was to describe oral health knowledge, attitudes and behaviours of parents and caregivers of preschool children in order to inform an oral health promotion strategy. Materials and Methods: A sample of parents and caregivers of children attending nine randomly selected preschools in central Trinidad were invited to complete a self-administered questionnaire on early childhood oral health. Results: A total of 309 parents and caregivers participated: 88% were female, 74.4% were of Indian ethnicity, with 50.4% in manual employment, and 50.2% educated to secondary level. 59.1% felt a child's first dental visit should be when all primary teeth are present. 64% had not taken their child for a dental visit. 81.6% rated their child's oral health as good or better and 28% would want an asymptomatic, decayed primary tooth extracted rather than filled. Over 80% used fluoride toothpaste. 52.8% always supervised their child's toothbrushing, and 44% claimed to be using the recommended pea-size amount. 26.2% reported having used a sweetened feeding bottle or infant feeder at night. Conclusion: Parents and caregivers of preschool children in this sample had reasonable oral health knowledge. However, despite generally positive attitudes towards preventive oral healthcare, confusion regarding dental attendance, supervised toothbrushing, fluoride use and sugar intake suggests that these items require particular emphasis in oral health promotion programmes aimed at improving early childhood oral health. Keywords: early childhood caries, parents, caregivers, oral health promotion

Purpose: To describe oral health and hygiene in old home care clients and investigate how functional ability was associated with them. Materials and Methods: This study employed part of the baseline data of a multidisciplinary intervention study of 269 home care clients aged ≥75 years, living in Eastern and Central Finland. Structured interviews were used to measure ability to function in activities of daily living (ADL), instrumental activities of daily living (IADL), comorbidity (functional comorbidity index, FCI), depression (geriatric depression scale, GDS-15), cognitive function (mini-mental state examination, MMSE), nutritional status (mini nutritional assessment, MNA) and numbers of prescription drugs used. Clinical oral examination was included. Results: The majority of participants were at least moderately dependent on support for ADL. Of the examined, 46% were edentulous and average number of teeth was 8.4. Dental plaque in ≥ 20% of teeth present was detected in 74%, bleeding on probing in ≥ 25% of teeth examined in 75%, and caries in 30% of the dentate participants. In multivariate analyses, better functional ability (ADL) was statistically significantly associated with lower occurrence of dental plaque in ≥ 20% of teeth present. Better functional ability (ADL) and higher number of teeth were associated with lower occurrence of bleeding on probing in ≥ 25% of teeth examined and higher number of teeth with plaque with higher occurrence of bleeding on probing. Conclusion: Impaired functional ability is an important determinant of poor oral health and hygiene among old home care clients. Keywords: functional ability, oral health, oral hygiene, home care, older people

Purpose: To evaluate the clinical characteristics of dental emergency patients with special regard on gender-specific differences related to the utilisation and use of antibiotics. Materials and Methods: A retrospective analysis of all patients who presented to the emergency service of a university hospital in from 2010 to 2013 was performed. Demographic data, diagnosis, conducted treatment and the prescription of antibiotics were recorded and further analysed. Results: Altogether, 16,296 patients visited the emergency service. Of these patients, only one-fourth (25.7%; n = 4185) suffered from a diagnosis with urgent treatment needs. Gender-specific differences were found in the reason of visit. Males presented significantly more often with severe diagnoses, like abscess or trauma. Females presented significantly more often with non-urgent diagnoses, not directly connected to oral hygiene habits, like temporomandibular disorders (TMD), denture sore or dolor post extractionem. Moreover, an overuse of antibiotics was found among emergency patients, with every fifth patient (20.2%; n = 3291) being prescribed an antibiotic. Conclusion: Better public education on dental emergencies and constant updates for dentists about the use of antibiotics in dental emergency care is necessary to secure adequate medical supply for severe dental emergencies and to avoid an inappropriate use of antibiotics. Keywords: antibiotics, dental emergencies, emergency patients, gender dentistry

Purpose: The aim of this study was to assess the genetic evaluation of a three-generation consanguineous family with isolated oligodontia. Materials and Methods: A 16-year-old male patient who had been referred for orthodontic treatment due to the presence of oligodontia, and his family members who presented several missing teeth had been enrolled in the study. Clinical and radiological assessments and genetic analysis including whole-exome sequencing were performed. Results: Genetic evaluations revealed both homozygous and heterozygous mutations (c.T682A:p.F228I) in the WNT10A gene of six affected members of the family. Higher frequency of agenesis of mandibular second molar was found in homozygous relative to heterozygous WNT10A mutations. Conclusion: The present findings have provided evidence for a known variant in the WNT10A gene in a three-generation consanguineous family with isolated oligodontia, while the results confirmed that cases with homozygous mutation revealed clinical heterogeneity. Keywords: oligodontia, dental agenesis, whole-exome sequencing, WNT10A

Purpose: Ergonomics in dentistry poses some challenges to dentists and may require considerable concentration and attention to detail. This research enables early recognition and prevention of common ergonomic-related conditions, such as carpel tunnel syndrome, back pain and neck pain. The purpose of this study was to determine the prevalence of ergonomic-related problems concerning carpel tunnel syndrome (CTS) and to know the efficacy of independent and combined clinical tests used in diagnosing it. Materials and Methods: Initially the participants were instructed to complete a self-administered questionnaire regarding the severity of symptoms of their hands on a hand–wrist diagram and a visual analogue scale. The principle investigator evaluated all questionnaires independently and four clinical tests were used on both hands in a systematic (non-randomised) order for subjects who had symptoms. Those with residual symptoms that exceeded beyond 1 min interval were identified and controlled for the statistical analyses. Results: The most common symptom noted in the study group was tingling and numbness of fingers (66.46%) followed by neck pain (66.34%). 29.26% of subjects reported moderate difficulty in typing and driving vehicles, whereas 26.82% subjects felt moderate difficulty in grasping and carrying shopping bags. 61.94% of subjects with symptoms spent more than 1 h daily of their free time on mobile phones or other smart devices. Individually, in our study the Tinsel's sign stood out as ineffective in ruling out CTS when compared with Phalen's test. Combination tests like Phalen's test and compression tests are confirmatory to CTS diagnosis and 66.34 % of the research group were hence diagnosed for CTS. Conclusions: A positive criteria for CTS, neck and shoulder pain is identified in our study as being due to long-term use of mobile devices. Further, combination tests like Phalen's with pressure provocation tests proved accurate in conforming CTS. Future research is needed to confirm the diagnostic utility of these independent and combined clinical tests in less prevalent settings, including general dental practitioners and occupational worksites. Trial registration: The current study is registered in King Khalid University, College of dentistry ethical committee SRC/REG/2016-17/107. Keywords: carpel tunnel syndrome, ergonomics, Phalen's test, Tinsel's sign

Purpose: To determine the effects of sociodemographic and pregnancy-related factors on oral health attitudes during pregnancy, as well as the main predictors of proper oral practices. Materials and Methods: An electronic survey consisting of 47 (single or multiple-choice) questions was conducted in women up to 3 years after childbirth in 2017. Sociodemographic data, as well as information on the course of pregnancy and delivery, oral knowledge and basic behaviours during pregnancy were collected. The Chi-square test and Spearman's rank correlation coefficient were used for statistical analysis. Odds ratios were determined. A statistical significance level of 0.05 was used. Results: A total of 2480 questionnaires completed by women aged between 13 and 45 years who were up to 3 years after delivery, were analysed. Correct answers to all questions regarding basic oral health and oral practices were obtained by 20.8% and 19.6% of respondents, respectively. Proper health behaviours were more strongly correlated with the level of knowledge (r = 0.155; odds ratio (OR) = 2.44; CI:1.93–3.07; p <0.001) and the use of dental care before pregnancy (r = 0.187; OR = 2.88; CI:2.29–3.63; p <0.001) rather than age (r = 0.144), good or very good financial status (r = 0.110), high level of education (r = 0.081), urban residence (r = 0.058) or occupational activity (r = 0.049). Attending dental visits depended on the conviction about their safety (r = 0.195; OR = 2.47; CI: 2.09–2.93; p <0.001) as well as gynaecologist's referral in the case of general conditions in pregnancy (r = 0.052) and the risk of premature birth (r = 0.053). No effects of other parameters associated with pregnancy or delivery were confirmed. Conclusion: Health attitudes during pregnancy are modified by sociodemographic factors. The main predictors of proper health behaviours include high level of knowledge on oral health and the use of dental care before conception. Furthermore, dental attendance among pregnant women depends on the awareness of the safety of dental visits and a gynaecologist referral in case of general condition and risk of premature birth. Keywords: health behaviours, sociodemographic factors, dental visit, gynaecologist

Purpose: To review the essential characteristics of calcium sensing receptor (CaSR) and explore the hypothesis that elevated extracellular calcium ions (Ca2+) may affect the odontogenic/osteogenic differentiation and mineralisation of human dental pulp cells (hDPCs) through the CaSR signal. Materials and Methods: Based on a literature search of databases using different combinations of the key words and our previous researches, we gleaned the following important viewpoints. Results: The Ca2+ released from pulp capping materials plays an essential role in maintaining the viability and function of human dental pulp, and elevated extracellular Ca2+ concentrations can promote the odontogenic/osteogenic differentiation and mineralisation of hDPCs. Ca2+ is the primary physiological ligand of the CaSR, which has been reported to be widely expressed in a broad range of cells, including various osteoblast-like cell lines, osteoprogenitor cells, and mature osteoblasts. hDPCs consist of different subpopulations and have been shown to share phenotypical features with osteoblasts. Thus, we speculated that hDPCs also express CaSR and respond to extracellular Ca2+ via this receptor. Calcimimetics are indirect allosteric regulators of CaSR function and can increase the receptor's sensitivity to ambient Ca2+. Conclusion: The local use of calcimimetics and calcium-based pulp capping materials could create an option for promoting the Ca2+ influx of hDPCs from the extracellular space via the CaSR. Such elevated Ca2+ concentrations could enhance the odontogenic/osteogenic differentiation and mineralisation of hDPCs and eventually improve the success rate of direct pulp capping treatments in patients suffering from accidental dental pulp exposure. Keywords: calcium sensing receptor, calcimimetics, human dental pulp cells, osteogenic differentiation

Purpose: The aim of this study was to evaluate the readability and the quality of toothache-related information found in Brazilian websites. Materials and Methods: Fifty-five websites retrieved from Google Search, Baidu, Yahoo! and Bing were evaluated by two independent examiners using the DISCERN questionnaire, the Journal of American Medical Association (JAMA) benchmark criteria and the Flesch Reading Ease adapted to Brazilian Portuguese (FRE-BP). Additionally, the websites were categorised according to their information, adopting four criteria related to: (i) endodontic pain, (ii) toothache relief or treatment, (iii) the self-resolution of pain, and (iv) the promotion of home remedies usage. The statistical analysis was performed using Spearman's rank correlation coefficient, Mann–Whitney U test, hierarchical clustering analysis by Ward's minimum variance method, Kruskal–Wallis test, post-hoc Dunn's test and Chisquare test. P < 0.05 was considered statistically significant. Results: The overall means (± SD) of DISCERN and FRE-BP were, respectively, 31.02 (± 5.56) and 61.20 (± 11.79), without quality-based differences between the websites with health- and non-health-related authors, and distinct clusters. Conclusion: Therefore, the quality of toothache-related information found in this sample of Brazilian websites was classified as simple, accessible and of poor quality, which can hamper the personal decision-making process of seeking dental treatment, leading to damages caused by the non-effective self-management of toothache. Keywords: toothache, eHealth, medical informatics, consumer health information

Purpose: The aim of this study was to investigate the in vitro effect of casein phosphopeptide–amorphous calcium phosphate (CPP-ACP) and fluoride-containing varnish on prevention enamel erosive tooth wear. Materials and Methods: A total of 28 enamel samples were prepared from human molars, divided into four groups: CPP-ACPF varnish, TCP-F varnish, NaF varnish, and deionised water. For the remineralisation process stimulated human pooled saliva was used. After treatment, all enamel samples were exposed to 10 ml of Coca Cola. Ca++ release was determined by atomic absorption spectroscopy (AAS). The surface topography was evaluated by atomic force microscopy (AFM). Surface microhardness of enamel was analysed and SMHR % (surface microhardness reduction ) was calculated. Data were analysed with repeated measures analysis of variance (ANOVA). Results: Deionised water demonstrated a statistically significantly higher Ca+2 release compared to those of groups NaF > fTCP > CPP-ACPF, respectively (p <0.01). All groups measured for root-mean-square-roughness (Rrms) showed a statistically significantly difference of 6 × 6 μm2 and 12 × 12 μm2 enamel area (p <0.05) compared with a negative control group. CPP-ACPF varnish showed rougher surfaces than all remineralisation groups. SMHR % of enamels were as follows: CPP-ACPF < fTCP < NaF < deionised water (p < 0.01). Conclusion: According to the findings of this study; CPP-ACP containing agents have a statistically statistically significant effect on preventing dental erosion. Among these, CPP-ACPF-containing remineralisation agents have the most effect on the remineralisation process. Keywords: AFM, AAS, CPP-ACPF, erosion, SMH

Purpose: The aim of this paper was to compare three conventional hand mixing glass-ionomer cements (GICs) and a new mechanical mixing glass-ionomer cement. Materials and Methods: Samples were measured on days 1, 2, 6, 10, 31, 90 and 180. After 32 and 181 days of monitoring, the samples were recharged by using 1 ml of 2% sodium fluoride gel. Results: The fluoride release started in high concentration during the first day for all GICs, with a value for GIII of 32.6 ppm. From the 2nd day, a slow, steady decline, with the exception of GII, which showed a marked decline to a value of 3.2 ppm. Analysis of variance (ANOVA) test showed statistically significant differences between the amounts of fluoride of the four materials in the first 24 h. Student t test was used to compare the fluoride release between the first and second recharge in each one of the study groups. Statistically significant differences were found when we compared the fluoride release in groups I (t = –16.95, p = 0.000) and IV (t = –2.644, p = 0.26). Conclusions: A mechanical mixing was the material with the more constant fluoride release and after recharge showed the highest fluoride release which make it an important benefit for clinicians. Keywords: anticariogenic agents, fluoride, glass-ionomer cement

Purpose: The aim of this exploratory trial was to compare the 3-month effect of two antimicrobials on the salivary levels of Streptococcus mutans (SM) in children. Materials and Methods: Ninety school children aged 6–10 years participated. They were divided into two groups according to treatment used: 1% chlorhexidine gel (CHX) or 30% silver diamine fluoride (SDF). Saliva for SM colony forming unit (CFU)/ml counting was harvested in four periods: baseline (prior to antimicrobials); P1 (24 h after antimicrobial therapy); P30 (30 days after antimicrobial therapy); and P90 (90 days after antimicrobial therapy). CFU/ml data was submitted to repeated measures by analysis of variance (ANOVA). Results: Only the time factor influenced the results (p 0.05). P30 presented the lowest levels of SM and at P90, SM levels were similar to P1 but still lower than the baseline observations. SDF and CHX presented a similar effect on SM within each period of evaluation (p = 0.65). Conclusion: It was concluded that 30% SDF presents similar antimicrobial effects as 1% CHX over time. SDF might be used as an adjunctive therapy for controlling dental caries in children. Keywords: dental caries, silver diamine fluoride, Streptococcus mutans

Purpose: This study aimed to evaluate the impact of oral care and use of chlorhexidine gluconate on the prevention of ventilator-associated pneumonia (VAP) in patients admitted to an intensive care unit (ICU). Materials and Methods: An evaluation was performed on 229 patients admitted to ICU in 2012 (before implementation of oral care protocol) and 329 in 2013 (after the protocol). Oral care was based on the removal of secretions from the oral cavity with 0.12% chlorhexidine solution for brushing and sterile gauze for cleaning before a new aspiration. The cases of VAP were evaluated by observing respiratory signs, radiological changes, and culture and laboratory results. The following data were also analysed: gender, length hospital of stay, mechanical ventilation, use of antibiotics and aetiological agent of infection. Results: There was a tendency towards lower risk of development of VAP after application of oral care protocol (odds ratio = 0.64–95% CI: 0.39–1.04). There was also a reduction in the incidence of early pneumonia (up to 72 h of hospitalisation). With regard to the aetiological agent of infections, although Gram-negative bacteria predominated in the two periods studied, there was a decrease in the cases of Staphylococcus aureus infection. Conclusion: Oral care protocol has statistically significantly reduced the risk of developing early VAP in ICU patients, thus demonstrating the importance of multidisciplinary teamwork for hospitalised patients. Keywords: chlorhexidine, mechanical ventilation, oral care, pneumonia

Purpose: Low-molecular weight residuals eluting from dental materials may contribute to local and systemic adverse effects. Therefore, the aim of the present study was to compare triethylene glycol dimethacrylate (TEGDMA)-based commercial infiltrant with different conventional resin-based materials regarding their release of monomers. Materials and Methods: Cylindrical blocks (n = 10) of either two sealants (Helioseal, Delton FS+), a composite (EcuSphere), an adhesive (Teco) and an infiltrant (Icon) were prepared. Additionally, 20 artificial lesions (depths ≥100 µm) were created in bovine enamel and after etching with phosphoric acid infiltrated with the infiltrant. Except for 10 infiltrated lesions, all other specimens were polished. Each specimen was stored in 1 ml distilled water (elution medium) for 240 h. The medium was renewed in logarithmical divided time periods (4.5 min–76 h). Results: Total concentrations of eluted monomers within 240 h from the cylindrical specimens were 0.04–0.09 mg/ml (p > 0.05; Mann–Whitney test). Unpolished infiltrated specimens showed significantly higher monomer concentrations compared to all other groups, whereas polishing of specimens resulted in significantly lower concentrations (p < 0.05; Mann–Whitney test). Conclusion: It can be concluded that release of monomers was low in general, but for infiltrated lesions it was considerably reduced by surface polishing reaching similar values as for commonly used monomer-containing dental materials. Thus, adverse effects by the use of an infiltrant are not expected, but polishing of the infiltrated area should be considered. Keywords: caries, composites, elution, infiltration, TEGDMA

Purpose: Preventive dentistry aims to improve oral hygiene, including the use of interdental cleansing aids. Clear and simple classifications may positively impact patient communication and motivate oral health behaviour. To date, there is no comparative analysis of interdental brush classifications and sizes. Materials and Methods: A total of 2320 interdental brush samples by 24 manufacturers was examined regarding their passage hole diameter (PHD) according to the ISO standard for interdental brushes (ISO16409:2016), and their current classifications were evaluated. Inter- and intrarater reliability of the ISO size classification were determined based on 20 raters and 10 interdental brushes. The insertion force for these interdental brushes was analysed in vitro. Results: Excellent intra- and interrater reliability was achieved (intraclass correlation coefficient (ICC) ≥ 0.973) overall, although greater variance was observed for bigger brush sizes. Insertion forces varied depending on size and form of the brushes, amounting to 1.58 N (SD = 1.27 N) for cylindric and tapered brushes, and to 2.31 N (SD = 0.81 N) for waist-shaped brushes. The size range of commercially available products was 0.6–5.2 mm PHD, 90% presenting with a PHD ≤ 2.0 mm. Size intervals were unsystematic. The ISO size was indicated by 33% of all manufacturers, the exact PHD by 25%. Conclusions: The determination of the PHD is a reproducible instrument for most brushes currently on the market. In vitro, forces developed based on this classification are mostly moderate, thus unlikely to cause periodontal trauma. Given the discontinuous range and unclear labelling of available products, the development of a simplified classification system by usage of the PHD may benefit the practitioner and patient alike by contributing to improve oral hygiene behaviours. Keywords: dental plaque, interdental brush, oral hygiene, resistance to insertion

Purpose: C1-inhibitor (C1-INH) related hereditary angioedema (C1-INH-HAE) is a rare pathological condition caused by a deficiency or a functional alteration of serum protein C1-INH. Clinical manifestations are represented by recurrent, potentially life-threatening episodes of cutaneous or mucosal oedema. The present study analysed the effectiveness of a specific short-term prophylaxis protocol for the management of C1-INH-HAE patients requiring chronic periodontitis treatment. Materials and Methods: Ten consecutive C1-INH-HAE patients with mild to moderate chronic periodontitis were treated by non-surgical periodontal therapy with a full-mouth scaling approach (FMS) in two sessions 24 h apart. All patients underwent a short-term prophylaxis protocol of acute attacks based on the association of attenuated androgen (danazol), from 5 days before the first FMS session to 2 days after the second FMS session, and C1-INH concentrate given 1 h before the first FMS session. Patients were examined for periodontal changes over a 6-month period. Results: None of patients developed complications or oedema up to 1 week postoperatively. Compared to baseline, scaling and root planing (SRP) treatment yielded, at 6 months, a statistically significant improvement in probing depth (PD) (baseline: 5.24 mm ± 0.85 mm vs 6 months: 2.96 ± 0.31 mm), clinical attachment level (CAL) (baseline: 5.46 ± 0.81 vs 6 months: 3.89 ± 0.38 mm), full-mouth bleeding score (FMBS) (baseline: 27.6 ± 2.2% vs 6 months: 18.5 ± 2.1%) and in full-mouth plaque score (FMPS) (baseline: 28.6 ± 2.4% vs 6 months: 21.66 ± 3.3%). Conclusions: This study showed the clinical effectiveness of the reported prophylaxis protocol in preventing acute attacks in HAE patients requiring non-surgical periodontal treatment, with no complications up to 1 week after FMS. Keywords: chronic periodontitis, complement c1 inhibitor protein, dental scaling hereditary angioedema, periodontal debridement

Purpose: No information is available on the perception of the quality of care in patients treated for periodontitis. The purpose of this article was to assess how periodontitis-affected patients perceive the quality of periodontal treatment (PT) and to measure the factors which may influence it. Materials and Methods: 306 subjects who completed PT were invited to participate. Questionnaires and visual analogic scales (VAS) evaluating perception of quality of care, symptoms, and oral health related quality of life (OHRQoL) were handed out. Oral and periodontal indicators were collected before and after treatment. The impact of different factors on perception of quality was assessed with a regression model. Results: Quality evaluation was high yet unrelated for both patients and clinicians (p = 0.983). Quality was negatively influenced by the number of residual oral infections (p < 0.001), patient's age (p = 0.07) and presence of residual pain at completion of PT (p = 0.02). Professionalism, kindness of the staff and communication skills were the characteristics mostly appreciated. The OHRQoL was influenced by the number of residual teeth (p < 0.001), increasing age of patients (p = 0.08), number of residual infections (p < 0.01) and pain (p = 0.04). Conclusions: Patients' quality perception appeared to be influenced by clinical and emotional aspects. Oral care providers should be aware of the impact of non-clinical factors in patients' appreciation of quality of treatment. Keywords: oral health related quality of life, periodontitis, quality of care

Purpose: To identify the prevalence and determinants of dental trauma in permanent anterior teeth among 11- to 13-year-old schoolchildren, to compare self-reported dental trauma rates with clinical examination trauma rates, and to examine mouthguard use among children engaged in contact sports. Materials and Methods: A probability sampling scheme was used to recruit schools, with all 6th grade children in the selected schools invited to participate. A total of 2621 caregiver consent forms were sent, of which 807 were returned (31%). Caregivers were asked four trauma-related questions. Clinical examinations included assessment of dental trauma experience (trauma index with five severity codes), lip competence and incisal overjet. Child- and tooth-level analyses were performed. Results: Clinical evidence of dental trauma was found in 52% of participants, 13% self-reported dental trauma, and 7% of children did not remember the occurrence of any trauma. The two most frequently self-reported reasons of dental injury were falls or collisions with objects (63%) and sport/leisure activities (32%). Nearly half of the more severe dental injuries did not receive the necessary treatments. One-third of schoolchildren participated in contact sport activities, but only 3% always used mouthguards. There was a substantial difference between the clinical and self-reported findings. Logistic regression analyses revealed no statistically significant associations between dental trauma experience and the potential determinants studied: gender, lip coverage and overjet. Conclusion: In this study, traumatic dental injuries were observed with 52% prevalence. A substantial discrepancy between self-reported and clinical findings was observed. Keywords: dental trauma, children, mouthguards, trauma index, self-reports

Purpose: To study the dental caries experience among adolescent school children in Chennai city using the ICDAS-II scoring system. The secondary objective was to identify associated risk factors to different thresholds of dental caries defined by ICDAS. Material and Methods: Two hundred and thirty-seven children (13–17 years) from five schools across Chennai city were included using simple random sampling. After obtaining assent to participate in the study and satisfying the selection criteria, 200 children were screened for dental caries using ICDAS-II. The population was assessed for the following risk factors: sociodemographic status, habits, diet, plaque and salivary parameters. Prevalence of dental caries was estimated at the following thresholds: normal (ICDAS-0/1), mild caries (ICDAS-2), moderate caries (ICDAS-3/4) and extensive caries (ICDAS-5/6). Backward logistic regression analysis was performed to identify risk factors at different thresholds and crude odds ratio was calculated for statistically significant risk factors. Results: The overall prevalence of dental caries (ICDAS 3–6) was 57.5% (95% CI 48–62%). The proportions of children at different caries thresholds were: ICDAS-2 – 55% (95% CI:48–62%), ICDAS-3/4 – 51% (95% CI:44–58%) and ICDAS-5/6 – 25% (95% CI:19–31%). Reduced pH was statistically significant for moderate and extensive caries (OR 6.24, 95% CI 1.18–32.78 and 1.73, 95% CI 1.18–1.92, respectively) and the quantity of saliva was statistically significant for mild and moderate caries (OR 4.48, 95% CI 2.94–8.23 and 3.97, 95% CI 2.65–7.03, respectively). Low buffering capacity was associated with mild caries OR 5.71, 95% CI 2.82–18.2). Interobserver correlation was 0.91. A non-statistically significant value using Hosmer–Lemeshow Goodness of Fit test indicated that all three models predict the true estimate of the population. Conclusion: The proportions of children with mild and moderate caries were high considering their age group. The risk factors associated with mild caries were different from those associated with moderate and extensive caries. Keywords: adolescent children, dental caries, dental plaque, ICDAS, risk assessment, saliva

Purpose: To investigate if pregnancy represents a period of increased risk of non-cavitated dental caries related to changes in saliva and oral health behaviours. Materials and Methods: A non-randomised longitudinal study was performed with 27 pregnant women and 25 non-pregnant women, who were evaluated twice with the same time gap (24 weeks on average). At the first visit sociodemographic and oral health-related behaviours were assessed through a structured questionnaire. At the second visit changes related to eating sweet snacks and oral hygiene habits were also assessed. In both visits the surface-related caries status was evaluated according to ICDAS II criteria. Calculation of D0 (Sound), D1–2 (visual changes) and D3–4 (precavitated caries lesions) Index was based on data collected from clinical examination. Saliva pH and saliva flow rate were also assessed. Results: Throughout pregnancy, a statistically significant increase of eating sweet snacks between main meals was reported, with no effective adaptation of oral hygiene habits. In comparison to the non-pregnant group, pregnant women presented a lower saliva pH at both the first and second visit, p < 0.0005. During the follow-up period, a decrease in the frequency of caries-free surfaces was observed in the pregnant women (p = 0.004) and an increase in precavitated caries lesions (p = 0.011). Conclusion: The main results support the hypothesis that during pregnancy women are prone to enamel demineralisation, namely, to exhibiting additional lesions characterised by precavitated caries lesions. Keywords: pregnancy, dental caries, saliva pH, oral hygiene, diet

Purpose: Halitosis is an unpleasant breath odor which can be bothersome to individuals. Extra-oral halitosis is a type of halitosis caused by systemic conditions, bloodborne diseases, or pharmaceutical therapy. It is not related to local factors in the oral cavity. This systematic review aimed to identify the medications that can cause extra-oral halitosis. Materials and Methods: This study was conducted in accordance with the preferred reporting items for systematic reviews and meta-analyses (PRISMA). We searched online databases and also included hand searching to find relevant articles. Two authors independently performed the screening, data extraction and quality assessment of the included articles using the Cochrane Collaboration assessment tool. Results: Thirty-four studies met the eligibility criteria. The medications which can cause extra-oral halitosis were categorised into 10 groups: acid reducers, aminothiols, anticholinergics, antidepressants, antifungals, antihistamines and steroids, antispasmodics, chemotherapeutic agents, dietary supplements, and organosulfur substances. Conclusion: Pharmaceutical therapy is a potential source of extra-oral halitosis. This finding can help clinicians detect the probable causes of halitosis. Further studies are needed to definitely determine the role of various medications in causing extra-oral halitosis. Keywords: adverse drug events, adverse drug reactions, drug side effects, extra-oral halitosis, halitosis

Purpose: A growing recognition of the importance of oral health-related quality of life (OHRQoL) has led to the development of several instruments to measure their relationship with health. The objective of this review was to update the knowledge on the general and psychometric characteristics of the instruments to measure the quality of life (QoL) related to oral health that emerged after publication in 1997 of the results of the conference 'Measuring Oral Health and QoL'. Materials and Methods: A bibliographic search was carried out to identify publications published in January from 1998 to June 2018, using EMBASE, PubMed, Scopus, CINAHL and Web of Science databases. Specific criteria were established based on international reference frameworks for the inclusion, collection, and analysis of general and psychometric properties of the instruments. Results: 233 articles were identified, of which 10 met the eligibility criteria and were included. All the instruments were multidimensional, presented psychometric properties and were mostly based on prior measurement tools and the classification of impairments and disabilities. All studies presented information on the internal consistency of their instruments. Validity to discriminate was also rated positively in all of the instruments except OHRQoL-UK instrument. Among the instruments, the criterion that was found to be least was a response to change, as only three instruments met the criteria. Reliability and construct validity criteria were also present in most of the studies. Conclusion: The dental profession has shown great progress towards a more comprehensive measurement of the oral health needs of the population, it is necessary to move from focusing on sick patients and theories of disabilities to incorporating healthy patients and resource-based theories and capacities in their measurements of OHRQoL, that would improve patient safety, quality of care and risk management, and improve clinical decision making for healthcare professionals. Keywords: decision making, oral health, patient-based outcomes, patient safety, quality of life, questionnaire

Purpose: To compile the literature available about the oral health and dental care of the deaf and hard of hearing (DHH) population. Materials and Methods: The study question of this scoping review was 'What are the main findings reported in the literature about oral health and dental care of the DHH population?' The following databases were included: Web of Science, LILACS, SciELO, MEDLINE, Scopus, EMBASE, GoogleScholar and Redalyc. Full-text articles published in peer-reviewed journals, in Spanish, Portuguese, and English, from the January 2000 to January 2018 were selected with qualitative and quantitative methods. All study designs were included in the review with the exception of letters to the editor and case reports. Results: A total of fifty articles were selected for analysis. DHH population has poorer oral hygiene and a higher prevalence of caries than their non DHH peers. DHH also report significant struggles with oral health and dental access. Most dentists experienced difficulties communicating with their DHH patients. Conclusions: This scoping review is the first known that centers on DHH oral health and their dental care. Efforts to develop accessible dental health programmes are needed to address apparent oral health inequities in the DHH population. Keywords: communication aids for disabled, deaf, hard of hearing, hearing loss, persons with disabilities, special care

Purpose: To analyse the effect of information technologies on improving the frequency of the use of dental floss among adolescents. Materials and Methods: A randomised, controlled clinical trial was conducted with 291 adolescents (mean age: 16.1 years) in three phases. Phase I involved the application of a questionnaire and clinical examinations using the simplified Oral Hygiene Index and gingival bleeding index. In phase II, the adolescents were randomly allocated to four groups: oral counseling (OR) and the use of an application (App) for smartphones; OR without the app; video (VD) and app; and VD without app. Messages were set through the app for 30 days. Phase III involved the second administration of the questionnaire and clinical examination. The frequency of dental floss use was evaluated in phases I and III. The groups were categorised into the use of technology (VD and/or App) and non-use of technology (OR alone). Results: Statistically significant reductions in the clinical indices were found with all educational methods (p < 0.005) and improvements were found in the use of dental floss (p < 0.001). Moreover, information technologies were associated with an improvement in the frequency of dental floss use (p < 0.033). Conclusion: All methods were effective at improving clinical indicators. The use of information technologies can be considered an effective tool for improving dental floss use among adolescents. Keywords: adolescent, Information technology, oral health

Purpose: The effects of three preoperative mouthwashes on salivary bacterial levels were evaluated and compared between subjects with differing periodontal status. Materials and Methods: Based on periodontal parameters, periodontally healthy individuals (n = 60) and those with gingivitis (n = 60) and periodontitis (n = 60) were randomly assigned to a single preoperative dose of chlorhexidine (CHX), essential oils (EO), cetylpyridinium chloride (CPC) or negative control mouthwashes. Saliva samples were collected between 8:00 and 11:00 a.m., before and after a single-dose rinse with the respective mouthwash. Total bacterial load and levels of Porphyromonas gingivalis, Tannerella forsythia, Treponema denticola and Streptococcus oralis were determined by qPCR. Data were statistically analysed using paired t- and Student's t-tests (p < 0.05). Results: CHX, EO and CPC showed greater antimicrobial efficacy than did the negative control. CHX [1226445.53] and EO [1743639.38] provided greater reductions in comparison to both CPC [106302.96] and negative control [37852.46]). CHX provided greater reductions of simultaneous levels of Pg [106326.00], Td [3335841] and Tf [61557.47] in the healthy group, as did EO in the diseased groups. CPC provided the greatest reduction [3775319.36] in the periodontitis group. Conclusion: Periodontal status influenced the antimicrobial efficacy of preoperative mouthwashes. Therefore, periodontal status should be taken into consideration by clinicians. The antimicrobial efficacy differed among the agents tested. CHX and EO showed the greatest efficacy. The recognition of periodontal condition by clinicians is mandatory to select the most effective preoperative mouthwash. Keywords: anti-infective agents, mouthwashes, periodontal diseases, single dose

Purpose: Fluoride toothpastes are effective in caries prevention. In legislation, regular fluoride toothpaste is a cosmetic product; adolescents use it for aesthetic purposes. In dentistry, fluoride toothpaste is considered a caries preventive drug recommended to patients for that reason. Knowledge is lacking concerning what motivates adolescents to use fluoride toothpaste. Dental professionals need to understand how to motivate a risk-group for caries development to use fluoride toothpaste frequently in order to effectively motivate patients to prevent tooth decay. The purpose of this study was to investigate what motivates adolescents to use fluoride toothpaste. Materials and Methods: The study was conducted at a high school in southern Sweden. The final sample consisted of 16 adolescents age 16 to 19. This study employed a qualitative design using semi-structured interviews. The data were analysed using manifest content analysis with an occasional inductive approach. Results: Reasons for why adolescents use fluoride toothpaste were found in four different categories: oral health, economy, upbringing and habit, social influences. Conclusion: There are reasons to believe that dental professionals might have missed important arguments for why adolescents use fluoride toothpaste. The participants mentioned oral health and aesthetics as important reasons for using fluoride toothpaste, as well as other more surprising factors such as financial reasons and social environment. There are thus more arguments for using fluoride toothpaste that adolescents value than the ones we believe dental professionals use. Keywords: adolescents, fluoride toothpaste, oral health behavior, motivation, qualitative research

Purpose: To evaluate the knowledge and practices of Swiss dentists concerning oral care during pregnancy. Materials and Methods: A cross-sectional survey was conducted among 200 dentists from the German and French part of Switzerland. The survey consisted of 16 questions which assessed the knowledge, attitudes and barriers faced by dentists regarding dental care during pregnancy. Results: The majority of dentists agreed that dental care should be part of prenatal care. Overall, good agreement between the French- and German-speaking dentists was found concerning the timing of conducting various dental procedures and the administration of anesthetics and other drugs during pregnancy. Uncertainty was observed regarding the link between periodontal disease and adverse pregnancy outcomes. Conclusion: The survey reported that Swiss dentists in private practice have the knowledge to provide dental care to pregnant women. However, they all expressed the need for clear guidelines and direction on this important aspect of public health. Keywords: dentists, education, oral care, pregnancy

Purpose: Integration of genetic information into our understanding of oral diseases has fostered the hope to intervene the disease process among genetically susceptible individuals. Oral submucous fibrosis (OSF) (mainly in the Southeast Asia region) and tobacco smoking are two of the major public health problems the world is facing today. With more and more diseases being associated with alleles of the human leukocyte antigen (HLA), the objective of the study was to explore any genetic association of OSF and smoking behaviour with specific HLA Class II DQB1*0503 and HLA DRB1*0301 alleles. Materials and Methods: Genomic DNA was extracted from saliva of 64 patients divided into an OSF group, a tobacco smokers group and a control group. This was followed by polymerase chain reaction (PCR) with sequence-specific primer of HLA-DQB1*0503 and HLA DRB1*0301 allele, visualised under 2% agarose gel. Results: A statistically significant difference was observed between the OSF group and controls in presence of HLA-DQB1*0503 allele, with 84% of the patients showing the presence. Frequency of HLA DRB1*0301 allele was also found to be significantly higher (72%) among OSF patients (p < 0.001). Similar results were shown in tobacco smokers with 28% cases showing presence of HLA DRB1*0301 allele and 13 (52%) of them having DQB1*0503 allele (p < 0.001). Conclusion: HLA-DRB1*0301 and HLA-DQB1*0503 are statistically significantly associated with susceptibility to OSF and smoking behaviour. Keywords: HLA, genetics, tobacco, OSF

Purpose: Knowledge about oral health-related quality of life (OHRQoL) in adult patients with leukaemia is still limited. Accordingly, aim of this cross-sectional study was to assess OHRQoL and its associations to different parameters in adult patients with newly diagnosed acute leukaemia. Materials and Methods: Participants with first diagnosis of acute leukaemia were consecutively recruited in the Clinic of Hematology and Oncology of the University Medical Center Goettingen. OHRQoL was assessed using the German short form of oral health impact profile (OHIP-G14). Presence of oral initial symptoms, dental health (decayed- [D-T], missing- [M-T] and filled-teeth index [DMF-T]), dental behaviour and periodontal disease severity were assessed. For comparison, a healthy control group (HC) was recruited. Results: Thirty-nine patients with leukaemia and 38 HC were included. In the leukaemia group, a statistically significant and clinically relevant higher OHIP-sum score compared to HC was found (6.13 [3; 0–7] vs 0.87 [0; 0–2], p < 0.01). The different subaspects of OHRQoL (patterns) 'oral function' and 'orofacial appearance' were statistically significantly worse in the leukaemia group (p < 0.01). Time since diagnosis showed a clinically relevant association to the pattern 'psychosocial impact' (p = 0.06). Patients with oral initial symptoms had a statistically significantly worse OHIP-sum score (p < 0.04, V = 0.775). DMF-T (p = 0.03, r = 0.242) and M-T (p = 0.03, r = 0.252) showed an association to OHIP sum score. Moreover, D-T (p = 0.03, r = 0.253) and M-T (p = 0.01, r = 0.296) were associated to orofacial appearance. Additionally, M-T showed an association to pattern 'oral function' (p = 0.01, r = 0.277). Conclusion: Patients with newly diagnosed acute leukaemia show a reduced OHRQoL. This might be particularly caused by oral health situation, especially oral initial symptoms as well as missing teeth. Keywords: acute leukaemia, oral health-related quality of life, oral initial symptoms, oral health

Purpose: The objective of the present study was to investigate oral health status and treatment needs of children with disabilities in Recife, Brazil. Materials and Methods: A cross-sectional study was carried out in the six administrative districts of Recife. The sample consisted of 366 children with disabilities and age between 3 and 12 years. The oral health conditions investigated were dental caries (CPOD index and dmft index), gingival state (IPV and IGC index) and dental trauma. Data analysis involved descriptive statistics, Pearson's chi-square test, Fisher's exact test, and Poisson regression models. Results: The prevalence of caries was 65% and was associated with age (p = 0.0027) and area of residence (p = 0.020). The prevalence of need for treatment was also 65%. The mean decayed, missing and filled teeth (DMFT)/DMFT index of the study population was 3.17/1.73. Their mean number of DMFT was 2.37, 0.55 and 0.25 for the deciduous dentition, as well as 1.56, 0.05 and 0.12 for the permanent dentition. Almost the entire sample (96.7%) had visible plaque, 77.3% had gingival bleeding and 27.6% had dental traumatism. Conclusion: Children with disabilities were found to have high rates of caries and gingivitis, as well as cumulative needs for preventive and curative treatment. Keywords: children, dental care, developmental disabilities, oral health

Purpose: During biofilm formation, bacterial species do not attach directly onto the enamel surface, but rather onto the salivary pellicle. Salivary pellicle modification with casein and mucin can hinder erosive demineralisation of the enamel, but it should also not promote bacterial adhesion. The aim of our study was to assess whether salivary pellicle modification with casein, or mucin, or a mixture of both proteins (casein and mucin) influence bacterial adhesion, biofilm diversity, metabolism and composition, or enamel demineralisation, after incubation in: (a) a single bacterial model; (b) a five-species biofilm model; or (c) biofilm reformation using the five-species biofilm model after removal of initial biofilm with toothbrushing. Materials and Methods: Enamel specimens were prepared from human molars. Whole-mouth stimulated human saliva was used for pellicle formation. Four pellicle modification groups were established: control (non-modified pellicle); casein – modified with 0.5% casein; mucin – modified with 0.5% mucin; casein and mucin – modified with 0.5% casein and 0.5% mucin. Bacterial adhesion, biofilm diversity, metabolic activity, biofilm mass, and demineralisation (surface hardness) of enamel were assessed after incubation in bacterial broths after 6 h or 24 h. Results: After 24 h incubation in the five-species biofilm model, the mucin group presented significantly lower biofilm mass than the control (p = 0.028) and the casein and mucin (p = 0.030) groups. No other differences between the groups were observed in any of the other experimental procedures. Conclusion: Pellicle modification with casein and mucin does not promote in vitro bacterial biofilm formation. Keywords: biofilms, casein, demineralisation, enamel, mucin, salivary pellicle, salivary pellicle modification

Purpose: The present study aimed to assess the current situation of Chinese dental bachelor interns on HIV/AIDS-related knowledge and their attitudes towards HIV/AIDS patients. Materials and Methods: A cross-sectional, paper-based survey involving 147 dental students from three Chinese dental schools was conducted. Students were recruited to complete the questionnaire regarding their knowledge, awareness and attitudes concerning HIV/AIDS anonymously and voluntarily. Results: A total of 144 students responded to the study, generating a response rate of 98.0%. Although 97.0% of the dental students believed dentists were at high risk of HIV infection, 97.2% of students expressed no prejudice towards HIV/AIDS patients and stated their willingness to provide oral healthcare service for such patients. No statistically significant differences in the responses on attitudes and some basic knowledge were found between students who had received the relevant education about infection control and the students who had not. However, regarding most questions about oral manifestations in adult and paediatric patients living with AIDS, the students who received relevant education showed more knowledge than the students who did not (p < 0.05). The cognitive level about respecting HIV/AIDS patients' autonomy and privacy was generally low in all the students. Conclusions: Most of the dental students in this survey held positive attitudes towards HIV/AIDS patients and good grasp of some basic knowledge about HIV/AIDS. On the other hand, the questionnaire results reflected gaps in education, such as respecting HIV/AIDS patients' privacy. Keywords: attitude, dental students, HIV/AIDS, knowledge

Purpose: Nurses are the professional group who most often provide care. Studies have shown that oral healthcare is being neglected by general healthcare professionals, including nurses. With proper health-related behaviour, knowledge and attitude, they can play an important role in health education and act as a role model for patients. The aim of the study was to assess knowledge, attitude and practices related to oral health among nursing (Bsc) students in Davangere city, Karnataka, India. Materials and Methods: A cross-sectional survey was carried out among 365 BSc Nursing students at their college premises in Davangere city. Data was collected using 25 items self-administered questionnaire which was validated. One-way analysis of variance (ANOVA) and Student's unpaired t tests were used considering p ≤0.05 as statistically significant. Results: The mean knowledge scores of final and third year nursing students were significantly higher than the first and second year students (p = 0.01). The majority of the students felt the need for regular visits to dentist (72.6%) and felt that oral healthcare was an important part of nursing care (91.2%). They also felt the need to collaborate with dentists (78.1%). The majority of them brushed their teeth twice daily (74.2%) and had the habit of mouth rinsing (67.4%) and referred their patients to dentists (61.4%). Conclusion: The knowledge related to oral health among nursing students was good. The majority believed that oral healthcare was an important part of nursing care, hence the training of nursing students pertaining to oral health education and upgrade of their academic curriculum should be prioritised. Keywords: nurses, oral health, oral hygiene

Purpose: In the early stages, osteoporosis is relatively a silent disease characterised by low bone density with microarchitectural deterioration of the bone tissue leading to enhanced bone fragility. The objective of this study was to evaluate the relationship between age, body mass index, oral signs, and osteoporosis among postmenopausal women. Materials and Methods: The study included postmenopausal women who were divided into two groups of subjects. The osteoporotic group comprised 30 patients with osteoporosis who were diagnosed using dual-energy X-ray absorptiometry, and the non-osteoporotic group (control group) comprised 30 subjects with no evidence of osteoporosis. Panoramic radiography was performed, followed by the acquisition of two direct digital intraoral periapical radiographs from the mandibular premolar-molar region. Results: Chi-square test revealed a statistically significant difference (p = 0.001) in the mandibular cortical shape index between the two groups. However, a statistically non-significant difference in cortical width, the panoramic mandibular index, mandibular alveolar bone resorption degree, fractal dimension, and mean number of teeth was found between the two groups. A statistically significant difference was observed in the mean age between the osteoporotic and non-osteoporotic groups. Conclusion: The mandibular cortical index findings (MCI) on panoramic radiograph are effective indicators of osseous changes in postmenopausal osteoporosis, thereby determining early prediction of osteoporotic fracture risk and reducing its related morbidity. Keywords: bone mineral density, dual-energy X-ray absorptiometry, osteoporosis, panoramic radiography, postmenopausal women

Purpose: Bisphosphonates and non-bisphosphonate antiangiogenic and antiresorptive agents are widely used in the management of bone diseases and cancer. A subset of patients receiving these drugs can manifest with medication-related osteonecrosis of the jaw (MRONJ) and it is one of the major complications faced in dental practice. Dentoalveolar and periodontal surgery are the major risk factors associated with it. Therefore, a dentist must have adequate knowledge to promptly identify patients at risk and efficiently manage the condition. This multicentre study was designed with an aim to assess the level of knowledge and awareness regarding MRONJ among dentists from six dental schools. Methods and Materials: An online self-administered questionnaire was sent to all the dentists from six dental schools through Google forms. The results obtained were statistically analysed. The Kolmogorov-Smirnov test was performed to check for normality of data, while the Mann-Whitney U-test and chi-square test were used to compare the responses to each question. Results: The questionnaire was sent to 570 dentists, out of which 234 responses were obtained. The majority of participants were aware of the term 'MRONJ' (83.3%), clinical indications of bisphosphonates (61.5%) and its mechanism of action (72.2%). However, 68.4% and 61.5% of dentists had no knowledge about the 'drug holiday' concept and risk factors associated with MRONJ, respectively. Conclusion: Although most of the participants had knowledge regarding certain aspects of MRONJ, such as mechanism of action and clinical indications of bisphosphonates, there was a lack of awareness about the drug holiday concept and drug-associated risk factors. This emphasises the need to spread awareness among the dental community, not only in tertiary healthcare centres, but also among private dentists and dental interns to prevent cases of MRONJ. Keywords: antiangiogenic drugs, antiresorptive agents, awareness, bisphosphonates, dentists

Purpose: Atherosclerosis is a devastating disease worldwide since it is the most frequent cause of myocardial infarction, stroke, renal failure, peripheral vascular disease and perhaps dementia. There is a well-documented evidence supporting the association between clinical/subclinical atherosclerosis and periodontitis. Carotid intima media wall thickness (CIMT) is a histopathologically validated marker of atherosclerosis. This study's purpose was to assess periodontal status based on carotid artery intima media thickness. Materials and Methods: A cross-sectional study was carried out among subjects who visited the Care Hospital, Nampally Hyderabad for CIMT test. Oral hygiene status was evaluated using Simplified Oral Hygiene Index and periodontal health status was measured using modified World Health Organization (WHO) Oral Health Assessment form, 1997. The data was analysed using Statistical Package for Social Sciences (SPSS) version 21.0. The proportions and mean scores were compared using chi-square test, Mann–Whitney U test and analysis of variance (ANOVA). Logistic regression analysis determined the relationship between periodontitis, as an independent variable and other variables with CIMT. P < 0.05 was considered statistically significant. Results: A total of 600 individuals were classified based on CIMT thickness ≤ 1 mm (292; 48.6%) and CIMT > 1 mm (308; 51.3%) according to variables. Significantly higher mean scores were observed for all oral parameters among subjects with CIMT > 1 mm aged > 45 years and among males (p ≤ 0.05*). Logistic regression analysis showed that increasing age group, ie,> 45 years (OR 3.5), males (OR 2.02), university education (OR 2.99), no history of previous dental visit (OR 3.71); and visit ≥ 1 year (OR 0.76) and previous history of tobacco (OR 1.13) and alcohol use (OR 1.65), poor OHI-S (OR 8.00), Community Periodontal Index (CPI) with Code 3, 4 (OR 4.41) and loss of attachment (LOA) with Code 2 (OR 3.05) and Code 3 (OR 5.80) had significantly higher odds among individuals with subjects with CIMT > 1 mm compared to their counterparts (p ≤ 0.05*). Conclusion: The results of the study concluded that periodontal disease and poor oral hygiene were more severe among the subjects with CIMT > 1 mm. To halt the progression of increasing CIMT, preventive oral health programmes need to be integrated in the cardiac setting with established dental referral which can bring out positive health behaviours. Keywords: atherosclerosis, carotid artery intima media thickness, periodontal disease, India, oral hygiene

Purpose: The aim of this study was to evaluate one high-viscosity glass-ionomer cement (EQUIA/GC), two resin-modified glass ionomers (Fuji II LC/GC, Photac Fil Quick Aplicap/3M Oral Care), two traditional glass ionomers (Ketac Molar Easymix/3M, Fuji II/GC), and two compomers (Freedom/SDI, Dyract XP/Dentsply Sirona) through a comparison of fluoride release and antimicrobial effects. Materials and Methods: A total of 210 samples were prepared, as 10 for each of the 7 materials for fluoride release and 20 for each material for the antimicrobial effect tests. To measure fluoride release, 5 ml distilled water and 5 ml TISAB II were added to the samples, which were then incubated at 37˚C. The fluoride levels of the material were measured using the selective ion electrode on days 1, 3, 7, 14 and 28. To compare the antimicrobial effects, 20 samples were divided in two groups and implanted in culture media containing Streptococcus mutans and Lactobacillus acidophylus. Measurements were taken on days 2, 4 and 6. The diameter of the inhibition zone was recorded in millimetre (mm). Results: All the materials released fluoride and the difference between them was determined to be statistically significant (p < 0.01). The antimicrobial effect values of the materials against S. mutans and L. acidophylus were evaluated and statistically significant difference was determined between the materials on all the measurement days. Conclusions: All the materials were observed to release fluoride. With the exception of the compomers, all the other materials showed an antimicrobial effect against S. mutans and L. acidophylus. Keywords: fluoride, glass ionomer, antimicrobial, S. mutans, L. acidophylus

Purpose: To evaluate the effect of pre-treatment air abrasion of surfaces using bioactive glass 45S5 on the progression of erosion in bovine enamel induced by a common soft drink. Materials and Methods: Twelve intact bovine incisors were selected and 24 enamel samples were prepared and randomly assigned to two groups (n = 12): 1. control group, no anti-erosive treatment; 2. experimental group: samples were air abraded with bioglass 45S5 before the erosive challenge. The enamel samples were submitted to erosive cycling using a common soft drink. Enamel surface loss was evaluated using optical profilometry; surface microhardness and roughness changes were determined using Vickers method and Vertical Scanning Interferometry, respectively. In addition, SEM observations and EDS analysis were performed to detect any alterations in surface morphology and mineral content. The data were statistically analysed using one-way ANOVA and Tukey's post-hoc test at a significance level of α = 0.05. Results: The experimental group exhibited less (18.7%) surface loss than did the control group (p < 0.05), while also presenting a statistically significantly smaller decrease in surface microhardness compared to the control group after erosive cycling (p < 0.05). However, neither group showed a statistically significant change in surface roughness (p > 0.05). After the treatments, changes in surface morphology and mineral content of enamel were observed. Conclusions: Surface pre-treatment using air abrasion bioglass 45S5 may help prevent enamel erosion induced by excessive consumption of soft drinks. Further clinical trials are needed to confirm the effectiveness of this method and its clinical significance. Keywords: air abrasion, bioglass, enamel erosion, scanning electron microscopy, surface loss

Purpose: This study investigated whether selected natural products could specifically target the growth of a caries-associated bacterial species (Streptococcus mutans) without affecting the viability of a health-associated oral commensal bacterial species (Streptococcus sanguinis). Materials and Methods: Agar diffusion assays were used to screen the natural products for bacterial-growth inhibitory effects and the diameters of the inhibitory zones for the two bacterial species compared. The minimum inhibitory concentrations (MIC) of the natural products that showed growth inhibitory effects were determined using the broth microdilution method. Results: Except for the berry extracts (cranberry, wild blueberry, and strawberry), all the other selected natural products (peppermint, ginger, cinnamon, rosemary, liquorice, xanthorrrhizol, tt-farnesol, guaijaverin, and macelignan) exhibited varying degrees of bacterial growth inhibition. The MIC values ranged from as low as 4 µg/ml for xanthorrrhizol to 1000 µg/ml for guaijaverin. All the growth inhibitory natural agents tested showed similar inhibition for both S. mutans and S. sanguinis. Conclusions: Although several natural products exerted significant antibacterial effects, none had selective inhibitory action on the growth of S. mutans. Keywords: dental caries, natural products

Purpose: To assess the effects of experimental titanium tetrafluoride (TiF4) varnish and commercial sodium fluoride (NaF) varnish with CO₂ laser on enamel hardness. Materials and Methods: Ninety human enamel samples were randomly assigned to one of the following groups: 1. control (no treatment) (CO); 2. NaF varnish (2.26%) (NF); 3. TiF₄ varnish (2.45%) (TF); 4. CO₂ laser (La); 5. NaF varnish (2.26%) with CO₂ laser (NFL); 6. TiF₄ varnish (2.45%) with CO₂ laser (TFL). Enamel surface changes were determined by Vickers microhardness (VH) test with a load of 1000 g and a dwell time of 12 s. Each sample was indented three times. Data were analysed using one-way ANOVA and Tukey's test. Results: The mean surface microhardness was 245.5 VH in the CO group, 280.3 VH in group NF, 338.7 VH group TF, 277.0 VH in group La, 345.3 VH in group NFL, and 368.0 VH in group TFL. Statistical analysis showed that groups TF, NFL, and TFL had statistically significantly higher surface hardness than the control group (p < 0.05). Conclusion: The microhardness of enamel treated with TiF₄ varnish with or without laser irradiation was statistically significantly greater than that of the control group. Thus, using TiF₄ to increase enamel surface microhardness can be recommended. Keywords: CO2 laser, enamel hardness, TiF₄ varnish

Purpose: Resin infiltration may be a barrier for bleaching gels. The aim of this study was to compare dental bleaching effectiveness using low-concentration gels on heavily or mildly stained teeth that were or were not treated with resin infiltration agents. Materials and Methods: Forty bovine enamel surfaces were submitted to demineralisation, after which two staining protocols were performed. Twenty specimens were immersed in a staining broth for 24 h (Lab 1) or 7 days (Lab 2). Ten specimens of each group received resin infiltrant application following the manufacturer's recommendation. All specimens were bleached using 15% carbamide peroxide gel for 14 days (8 h daily). Colour measurement was performed using a reflectance spectrophotometer at three time points: baseline, after staining, and after bleaching. Data (CIEDE00) were analysed using Student's t-test (p < 0.05). Results: No statistically significant differences were observed in Lab 1 (p = 0.560). For Lab 2, statistically significant differences were detected (p = 0.031). Once bleaching was achieved to some degree (Lab 2), the resin infiltrant may have behaved as a semipermeable barrier to the carbamide peroxide gels. Conclusion: Bleaching treatment was effective on mildly pigmented tooth surfaces. On the other hand, in comparison to the control group, the heavily pigmented surfaces bleached less in the presence of the resin infiltrant, possibly due to the lack of free radicals penetrating into the substrate. Keywords: colour, dental caries, dental white spots, aesthetics, tooth bleaching

Purpose: This study evaluated the effect of 17% EDTA, 10% citric acid (CA), and 2% chlorhexidine (CHX) activated with a rotary microbrush (CanalBrush) on root dentin microhardness, roughness, and epoxy-based sealer bond strength. Materials and Methods: One hundred sixty single-rooted bovine incisors were instrumented and divided into 8 groups according to treatment: 1. 17% EDTA; 2. 17% EDTA+2% CHX; 3. 10% CA; 4. 10% CA+2% CHX; 5. 17% EDTA with CanalBrush; 6. 17% EDTA+2% CHX with CanalBrush; 7. 10% CA with CanalBrush; and 8. 10% CA+2% CHX with CanalBrush. Ten roots in each group were split into halves and submitted to microhardness and roughness analyses (n = 10). Following endodontic filling with AH Plus sealer, 10 roots in each group underwent push-out bond strength testing (n = 10). Data were analyzed using two-way ANOVA and Tukey's tests (α = 0.05). Results: All groups had similar microhardness values (p > 0.05) which was higher in the apical third than in the middle and cervical thirds (p < 0.05). The CanalBrush groups had higher roughness than the no-activation groups (p < 0.05), with significantly higher roughness in the cervical third than in the apical third (p < 0.05). All groups exhibited similar bond strength (p > 0.05), with the cervical third being higher, followed by the middle and apical thirds (p < 0.05). Conclusions: Microbrush activation had a direct impact on dentin roughness and did not influence the dentin microhardness or the retention of epoxy-based sealer to the root canal. Keywords: EDTA, endodontics, epoxy resin based root canal sealer, root canal irrigantsaler

Purpose: To search for useful probiotics, we characterised antimicrobial lactic acid bacteria isolated from the oral cavities of 20 healthy volunteers from Nihon Univerisity School of Dentistry. Materials and Methods: Oral lactobacilli were isolated from the saliva of 20 periodontally healthy volunteers using the Dentocult LB dip-slide method. Primary antimicrobial screening of Lactobacillus isolates was performed using the paper disk method. Each suspected antimicrobial isolate was tested against Streptococcus mutans, S. sobrinus, and Porphyromonas gingivalis. Since P. gingivalis is considered as a keystone bacterium, we further analysed lactic acid bacteria that produced extracellular soluble antimicrobial agents that created an inhibitory zone of more than 12 mm against P. gingivalis. After two rounds of antimicrobial susceptibility testing, six isolates showing strong antibacterial effects against P. gingivalis were selected and identified as facultatively anaerobic, Gram-positive, non-spore-forming, non-capsule-forming, and catalase-negative bacilli. Selected isolates were identified to the species level through 16S rDNA sequence analyses. Results: The antimicrobial substance produced by the isolated bacilli was inactivated slightly after catalase treatment, had significantly lower activity at pH levels above 9.0, and was also reduced by heat treatment above 100°C and autoclaving. The activity of the antimicrobial substance showed some resistance to lower levels of heat, as well as pepsin and proteinase K treatments. 16S rRNA sequencing identified these isolates as Lactobacillus casei, Lactobacillus fermentum, and Lactobacillus gasseri. Conclusion: These bacteria are antagonistic against potential periodontal pathogens and are good candidates for clinical application as probiotics. Keywords: antibacterial substance, lactobacilli, oral cavity

Purpose: Early childhood caries (ECC) may have a harmful impact on quality of life (QoL) of young children and parents. No oral health-related quality of life (OHRQoL) studies had been carried out among preschool children in Jordan. The aims of the study were to assess the prevalence of ECC among preschool children and to evaluate its impact on the QoL of children and families. Materials and Methods: A cross-sectional survey was conducted among preschool children aged 4 and 5 years. A two-stage random sampling design was implemented. Parents answered the Early Childhood Oral Health Impact Scale (ECOHIS) which was used to assess OHRQoL and a questionnaire addressing sociodemographic data. Clinical examination included ECC, anterior malocclusion treats (AMT) and traumatic dental injuries (TDIs). The simultaneous influence of different independent variables including gender, AMT, TDI and socioeconomic indicators (SEI) on the overall QoL was also investigated. Analysis of variance test (ANOVA), the Fisher's least statistically significant difference criteria of post hoc and simple logistic regression were used for statistical analysis. Results: Of the 2164 targeted preschool children, 1557 were included in the study. Prevalence of ECC was 72.5% and 77.2% among 4 and 5 year olds, respectively. Compared with caries-free children, ECC children (dmft 1–4 and dmft >4) had significantly higher mean scores of all the items of the ECOHIS (p < 0.05, 0.01 and 0.001) as well as mean scores of overall ECOHIS (p < 0.001). There was a significant increase in mean scores of items (p < 0.05, 0.01) and overall ECOHIS mean scores (p < 0.05) with increasing severity of dental caries. Only dental caries had a significant effect on ECOHIS (OR = 4, CI 3.179–5.972, p < 0.001) while other confounders failed to demonstrate any impact. Conclusions: Dental caries prevalence was high and the level of severity was associated with worse OHRQoL of preschool children and families. Keywords: early childhood caries, quality of life, preschool children, Jordan

Purpose: To evaluate the association of dental caries with behavioural, socioeconomic and cultural factors; and Streptococcus mutans (SM) levels in the saliva and oral hygiene index of children aged 4 and 6 years old placed in an oral health programme. Materials and Methods: This study was an analytic cross-sectional oral health survey conducted over a 9-month period. A total of 466 children aged 4 and 6 years old were included for evaluation of SM levels in saliva, simplified oral hygiene index and dental caries activity. Results: High SM levels were associated with dmft index, toothbrushing without parental assistance, deficient oral hygiene and ingestion of sweet foods. Deficient oral hygiene was found in children aged 4 years old and with three or more siblings. Dental caries was associated with low family income, deficient oral hygiene, sucrose ingestion by children younger than three years old, bottle-feeding habit and low parental compliance. Conclusions: High SM levels in saliva, deficient oral hygiene and high frequency of sucrose ingestion had association with dental caries in children. Cultural, socioeconomic and behaviour factors indirectly influenced the onset of dental caries. Keywords: dental caries, child, oral health, preventive health services

Purpose: The caries-preventive effect of pit and fissure sealant was found to be related to the incidence of caries in the population. The rate of caries in China has been very low, and a pit and fissure sealant public health programme has been widely carried out since 2005. This study aims to evaluate the caries-preventive effect of this dental public health programme in Beijing, the capital of China. Materials and Methods: A 3-year longitudinal study was conducted from 2012 to 2015. All students (n = 2973) in one district of Beijing were included. Children who received a sealant were categorised into the sealant group (n = 1648), and the other children were categorised into the no sealant group (n = 1325). Results: The dental caries risk levels in the sealant group and the no sealant group were balanced at baseline. The caries incidences of children only counting four first molars after 28 months were 18.1% and 13.6% for the sealant group and the no sealant group, respectively (Chi-square test, p = 0.001). The risk ratio in the sealant group versus the no sealant group for caries yes/no (only four molars) at 28 months was 0.73 (95% CI, 0.60–0.90; p = 0.001), based on binary logistic regression. Conclusions: The pit and fissure sealant dental public health programme implemented in Beijing was effective in preventing dental caries in the first permanent molars. Keywords: caries, prevention, programme evaluation, sealant(s)

Purpose: The purpose of this study was to perform an in vitro evaluation of the protective effects of anticavity agents applied to enamel, by themselves and in combination with Er:YAG. Materials and Methods: In this study 150 extracted third molars were used. Measurements were made using DIAGNOdent, and samples with scores of 0–13 were included in the study. These were divided into 15 groups (n = 20). Use of the agents sodium fluoride (NaF), tricalcium phosphate (Ca3PO4), titanium tetrafluoride (TiF4), Tooth Mousse (CPP-ACP), MI Paste Plus (CPP-ACP), and NovaMin (bioactive glass), individually and then in combination with Er:YAG laser, was assessed based on their effects on microhardness values. After treatment, the groups were exposed to a demineralisation solution. Statistical analyses were conducted using SPSS 20.0 package software. Results: The highest test result value was observed in the TFL (TiF4/Er:YAG laser) group. Statistically significant differences were determined among all the groups (p < 0.05). When the groups in which the agents were applied alone were compared with those involving combined use of Er:YAG laser, combined use provided significantly higher microhardness values, with the exception of the TML group (Tooth Mousse/Er:YAG laser) (p < 0.05). Conclusion: Within the limits of this study, the combined use of remineralisation agents and Er:YAG laser elicited better results than using the agents alone. The most effective remineralisation agent was TiF4/Er:YAG laser, which may be considered an alternative method for protecting the enamel against demineralisation. Keywords: bioactive glass, casein phosphopeptide amorphous calcium phosphate, demineralisation, Er:YAG laser, remineralisation, titanium tetrafluoride

Purpose: Gingival phenotype influences the outcomes of various dental procedures. The objective of the current study was to assess the agreement between various clinical and radiographic methods for evaluating gingival thickness. Materials and Methods: This ex-vivo study evaluated gingival thickness on 20 porcine cadavers. Gingival thickness was assessed at both central mandibular incisors with: a) trans-gingival probing with a standard periodontal probe (PB); b) trans-gingival probing with a stainless steel acupuncture needle (AN); c) ultrasound device (USD); and d) Cone Beam Computed Tomography (CBCT). Intra-examiner reproducibility and method error were also evaluated. Results: Trans-gingival measurements with the standard PB and the AN were found to be almost identical in gingival thickness assessment (mean GT 1.11 mm vs 1.14 mm for the left incisor and mean GT 1.12 mm vs 1.11 mm for the right incisor, respectively). USD and CBCT yielded values that were statistically significantly higher than AN. Both USD and CBCT values were higher than PB, but this difference was statistically significant only for the left central incisor. Finally, USD values exceeded CBCT measurements, but this difference was not statistically significant. There was no evidence of systematic differences between the repeated CBCT measurements (p = 0.06 for the left incisor and p = 0.55 for the right incisor). Conclusions: CBCT measurements proved to be highly repeatable and comparable to the USD measurements, while there were some indications that both CBCT and USD measurements were systematically higher than either PB or AN. Keywords: cone-beam computed tomography, gingival biotype, periodontal tissue, ultrasound

Purpose: The in-situ efficacy of an experimental stannous (Sn)-containing sodium fluoride (NaF) dentifrice against erosion and erosive tooth wear was compared with a conventional NaF dentifrice. Materials and Methods: This was a randomised, controlled, double-blind, parallel-group clinical trial. Mandibular appliances containing four enamel specimens (2 per side [L/R] of the appliance) were worn by 60 generally healthy adult subjects. Subjects were randomised to treatment based on age and gender. Treatments included a Sn-containing NaF or conventional NaF dentifrice. Conditions of erosion (dentifrice slurry treatment) and erosion/tooth wear (dentifrice slurry plus brushing) were compared. Dentifrices were used twice per day for 30 s of lingual brushing, followed by 90 s of slurry exposure. In addition, the two specimens on the left side of the mouth were brushed for 5 s each, using a power toothbrush. All specimens were exposed to four daily erosive challenges with commercial orange juice (pH 3.6). Tooth wear was measured as enamel loss using non-contact profilometry on day 10. Results: At the day 10 visit, the adjusted mean (SE) enamel loss for specimens receiving slurry (erosion) treatment was 4.7 µm (0.61) [Sn-containing NaF] and 8.73 µm (1.12) [NaF control], with results demonstrating a statistically significant benefit for the Sn-containing dentifrice (46.2% benefit; p = 0.009). For specimens exposed to erosion/tooth wear conditions, enamel loss = 6.68 µm (1.29) (Sn-containing NaF) and 10.99 µm (1.29) (NaF group), with results statistically significant (p = 0.048; 39.2% better, favouring the Sn-containing dentifrice). When data were combined, enamel loss (SE) for all specimens subjected to erosion + erosion/tooth wear was 5.61 µm (0.77) (Sn-containing NaF]) and 9.9 µm (1.3) (NaF group). The difference again was statistically significant, favouring the Sn-containing group (p = 0.022; 43.4% better). Conclusions: The Sn-containing dentifrice demonstrated significantly better protection than did NaF under erosive and erosive/tooth wear conditions. Keywords: dental erosion, dentifrice, erosive tooth wear, in situ clinical, stannous fluoride

Purpose: Currently, the prevention of periodontal diseases focuses on mechanical removal of pathogenic biofilms combined with oral antiseptics as supportive chemical antibacterial control. Due to the risk of resistance development and side effects of existing antiseptics, the interest in alternative medicine with naturopathic treatment modalities is growing in dentistry. In the present study, the antibacterial effect of the naturopathic oral care product Repha OS and some of its derivatives, based on medicinal plant extracts and essential oils, with a specific focus on added sweeteners, was investigated on periodontal pathogenic and halitosis-associated bacteria. Materials and Methods: The antibacterial efficacy was investigated by agar dilution assay. The minimum inhibitory concentration (MIC) for the bacterial species Aggregatibacter actinomycetemcomitans, Fusobacterium nucleatum, Porphyromonas gingivalis, Prevotella intermedia and Solobacterium moorei was determined. Results: A concentration-dependent antibacterial effect on oral bacterial species by Repha OS and its derivatives was demonstrated. For the original product, the maximum MIC was 10% of the calculated test solution concentration in agar for all examined bacterial species. The removal of essential oils reduced the antibacterial efficacy, whereas the displacement or replacement of sweeteners had almost no effect. Conclusion: In addition to other individual effects of the ingredients, the results of this study show that an antibacterial effect of the naturopathic oral care product on the tested oral bacterial species was achieved in vitro. In vivo, the combination of this antibacterial effect with other properties of the various ingredients may be interesting for a holistic approach in preventive dentistry. Keywords: essential oils, medicinal plant extracts, minimum inhibitory concentration (MIC), naturopathic oral care product, periodontal pathogenic or halitosis-associated bacteria

Purpose: This retrospective cohort study investigated the long-term effectiveness of one type of maxillary and 2 types of mandibular fixed lingual retainers. Materials and Methods: Eighty orthodontic patients in retention for 10-15 years were included. Irregularity index, intercanine width, overjet (OJ) and overbite (OB) were measured on plaster models at 3 occasions: (T1) pre-treatment, (T2) post-treatment and (T3) 10-15 years post-treatment. Analyses assessed the effect of the retainer type and time on mandibular irregularity, intercanine width and retainer failure. Results: In the mandible, the irregularity index increased (0.43 mm) between T2 and T3 for the 0.027" β-titanium (TMA) retainers bonded to canines only while it was stable (-0.02 mm) for the 0.016" x 0.022" braided stainless steel retainers (SS6) bonded to all six anterior teeth. The intercanine width was relatively stable in both groups during the entire observation period. In the maxilla, the irregularity index was stable between T2 and T3 (+0.07 mm). The intercanine width increased (+2.02 mm) during treatment T1-T2 and was stable (-0.02 mm) in the retention phase T2 to T3. Conclusions: In the mandible, SS6 retainers were slightly more effective in maintaining alignment compared to the TMA retainers. In the maxilla, the SS4 retainers without canine extensions were effective in maintaining alignment. All retainers were effective in maintaining the intercanine width. Keywords: adverse effects, effectiveness, efficiency, failures, fixed retainers, irregularity index, long-term retention, retention

Purpose: In the present randomised controlled trial (RCT), the authors hypothesise that herbal-based oral rinses are as effective as 0.12% chlorhexidine when used as adjuncts to non-surgical mechanical debridement (MD) in the management of peri-implant mucositis. The aim of the present RCT was to compare the efficacy of an herbal oral rinse with a 0.12% chlorhexidine-based oral rinse when used as adjuncts to non-surgical MD in the treatment of peri-implant mucositis. Materials and Methods: Adult patients with peri-implant mucositis were included. Participants were randomly allocated into 3 groups. In group 1, patients only underwent non-surgical MD. In groups 2 and 3, patients underwent non-surgical MD with adjunct rinsing with an herbal- and 0.12% CHX-based oral rinse, respectively. Peri-implant plaque index (PI) and bleeding-on-probing (BOP) and probing-depth (PD) were assessed at baseline and at 3, 6, and 12 weeks. Group comparisons were done and p < 0.01 was considered statistically significant. Results: Forty-eight patients with peri-implant mucositis (16, 16, and 16 in groups 1, 2 and 3, respectively) were included. At baseline, there was no difference in PI, PD, BOP in all groups. In group 1, there was no statistically significant difference in PI and BOP at 6, and 12 weeks of follow-up compared with baseline. In groups 2 and 3, PI (p < 0.01) and BOP (p < 0.01) were statistically significantly higher at baseline than 3, 6, and 12 weeks of follow-up. In group 1, there was no statistically significant difference in PD at all time intervals. In groups 2 and 3, PD was statistically significantly higher at baseline than 3, 6, and 12 weeks of follow-up. In groups 2 and 3, there was no statistically significant difference in PI, BOP and PD at all intervals. Conclusion: Herbal- and 0.12% CHX-based oral rinses are useful adjuncts to MD for the treatment of peri-implant mucositis. Keywords: bleeding on probing, chlorhexidine, herbal, peri-implant mucositis, probing depth

Purpose: To assess the association between low prenatal or childhood levels of 25-hydroxyvitamin D (25(OH) D) and dental caries experience in children. Materials and Methods: PubMed, B-On, Web of Science, Scopus, and Cochrane Library databases were searched. The inclusion criteria were randomised controlled trials, cohort and cross-sectional studies published between 1998 and 2019; caries outcomes expressed as prevalence or based on the decayed missing and filled index for primary and permanent teeth/surfaces; and vitamin D levels assessed by laboratory analysis. Two authors independently selected studies, collected data, and assessed risk of bias. The quality of the studies was also assessed. A narrative synthesis of the studies was performed without quantitative pooling of data due to clinical and methodological heterogeneity. Results: Out of 399 studies identified, 13 were included in the data synthesis. Even though many of the included studies had a cross-sectional design, 11 were considered high quality. The studies indicated that vitamin D has an important role in caries experience, but also revealed that vitamin D levels equal to or above 75 nmol/l seem to be more closely related to caries experience than the reference value of the Institute of Medicine. Conclusion: Evidence of an association exists between low 25(OH) D levels ( < 75 nmol/l) and caries experience in children. Hence, low vitamin D levels should be considered a potential factor associated with caries in children. Clinicians should be aware that good prenatal nutrition and early childhood diet might influence caries experience. Keywords: dental caries, vitamin D, 25-hydroxyvitamin D, children, preventive dentistry

Purpose: Regional odontodysplasia (RO) is a rare dental anomaly affecting primary and/or permanent dentition, and leads to comprehensive treatment need. The purpose of this study was to present a larger consecutive sample with RO, discuss treatment strategies for patients with RO, and review the literature. Materials and Methods: A consecutive, retrospective sample of seven children with RO (6 males, 1 female) including all patients diagnosed with RO in the eastern part of Denmark was conducted over a period of 15 years. The evaluation included gender, localisation and treatment outcome. A review of the literature and cases published within the last 15 years was conducted. Result: Referral age was 2-12 years (mean: 7.3 years). The gender ratio was 1:6 (female:male), and the right:left ratio was 3:4. 71% of the patients had RO in the mandible and 29% in the maxilla. 43% had RO in the permanent dentition, while both primary and permanent dentition were affected in 57%. Typically, RO affected incisors and canines. In some patients, RO also affected more distal tooth types. Treatment included early multiple extractions and subsequent combined orthodontics, surgery and prosthetics. A search on RO cases published within the last 15 years was conducted and included 44 cases. The review showed a male and maxillary preponderance. The most common treatment of RO is extraction. Conclusion: Treatment of RO should take place in interdisciplinary, specialised teams, and individual treatment plans should be designed. Fewer but more extensive treatment sessions under general anesthaesia may minimise the burden of care for the patients. Keywords: case report, dental anomaly, regional odontodysplasia, treatment

Purpose: This study clarified the oral factors related to swallowing function using the results of dental check-ups among community-dwelling independent elders. Materials and Methods: Data on oral and medical health check-ups from 4,676 participants aged 75 and 80 years were analysed. Swallowing function was evaluated using the repetitive saliva swallowing test (RSST), which assesses the ability to swallow saliva. Swallowing three or more times during a 30 s period was recorded as normal, while swallowing twice or less in 30 s was considered to indicate swallowing difficulty. Multivariate logistic regression analyses were performed to examine the relationship between oral factors and swallowing function. Results: In all participants, the odds ratio (OR) for swallowing difficulty was 3.42 (95% confidence interval (CI): 1.78–6.55) and 6.68 (95% CI: 1.97–22.64) among those who had 10–19 teeth without dentures and those who had 0–9 teeth without dentures, respectively, compared to individuals with ≥ 20 teeth without dentures. Those with moderate or severe dry mouth had a statistically significantly higher OR (8.01, 95% CI: 4.84–13.27) for swallowing difficulty than those without dry mouth. Among dentate participants, in addition to statistically significant variables in the analysis among all participants, those with abundant dental plaque showed a significantly higher OR (2.58, 95% CI: 1.54–4.32) for swallowing difficulty compared to those with no or slight dental plaque. Conclusion: These results suggest that oral factors such as having few teeth without dentures, dry mouth, and poor oral hygiene are related to swallowing function in elders. Keywords: swallowing function, tooth, dentures, xerostomia

Purpose: Few longitudinal studies on changes of decayed, missing, or filled teeth (DMFT) counts in a population have been reported. This study aimed to evaluate the changes in DMFT counts in Ljubljana citizens in a 30-year period. Materials and Methods: 238 dentate subjects that attended the third epidemiological study were invited. Ninety 45–95-year-old subjects (37.8%) responded to our invitation. Two (2.2%) edentulous subjects were excluded. Among the dentate subjects there were 28 men and 60 women. They were divided in six age groups with mean age of 45, 55, 65, 75, 85, and 95 years. The number of subjects in each age group was: 29, 12, 21, 18, 7, and 1, respectively. For evaluation of the state of teeth we used the DMFT index. Results: The average DMFT value for 45–95-year-old population was 19.3. Mean DMFT counts in all comparable age groups (45-, 55- and 65-years) decreased in 30 years. In 45 year olds they decreased from 17.5 to 15.7, in 55-year-olds they decreased from 20.4 to 19.2, and in 65 year olds they decreased from 22.5 to 20.7. An increase of the average number of present teeth (for 6.4 teeth in average) from the first to the fourth study in subjects of the same age was seen. Conclusion: Dental health in Slovenia has improved in 30 years. Average DMFT counts in subjects of the same age (45-, 55- and 65-years) have decreased. Ljubljana citizens have less decayed, less missing and more filled teeth than 30 years ago. Keywords: epidemiological study, teeth, DMFT counts, subjects

Purpose: To evaluate the effects of stomach and duodenal fluid on enamel surfaces, simulating the action of refluxed liquid in patients with duodenogastric reflux. Methods and Materials: Forty bovine incisors were used to obtain enamel fragments. Only half of the enamel surface was exposed to erosive challenges; the samples were then randomly divided into the following four groups (n = 10): G1: HCl; G2: HCl + pepsin; G3: HCl + ox bile + NaHCO3; and G4: HCl + pancreatin + NaHCO3. The specimens were placed in 37°C solutions, six times per day, for 20 s, over a period of 5 days and then analysed for morphology, surface roughness and the step formed on the dental enamel using confocal laser microscopy. The data were analysed using the Kruskal-Wallis and Dunn's test (p < 0.05). Results: Both analyses revealed a higher step and surface roughness for the G3 group (5.6 μm ± 1.69, 2.2 μm ± 1.61), which were statistically significant compared with the G1 and G2 groups (3.9 μm ± 1.5 μm; 1.0 μm ± 0.18; 3.7 μm ± 1.45; and 0.9 μm ± 0.12) (p < 0.05); only the step in the G4 group (4.9 μm ± 1.8 μm) was similar to that of the G3 group (p > 0.05). Morphological analysis showed greater structural loss in the G3 and G4 groups. Conclusions: Bile and pancreatin, in combination with hydrochloric acid, may promote a greater loss of structure, increased surface roughness and loss of enamel prismatic anatomy. Keywords: reflux, dental erosion, duodenogastric reflux, enamel

Purpose: Investigate dental trauma among adolescents aged 15–19 years and associated factors. Methods: The study was conducted in Recife, Brazil and the sample comprised 1485 adolescents of both sexes. The data was collected by clinical examination and interviews were conducted in-between classes by a single trained assessor. Two questionnaires (AUDIT and ASSIT 2.0) were used to investigate the involvement of adolescents with alcohol, tobacco and illicit drugs. The classification proposed by Andreasen was used to identify dental injuries. The sample size was calculated using 95% interval level. Pearson's chi-square test and Fisher's exact test were used to confirm the association between the variables. Results: The prevalence of dental injuries was 17.8%. The main causes of trauma were playing with others (20.8%) and falls (25.4%). A statistically significant percentage of adolescents reported using illicit drugs (13.9%), 15.9% used tobacco and 56.8% used alcoholic beverages. However, no statistically significant difference between the consumption of this drugs and dental injuries (p >0.005) was found. Conclusion: The prevalence of dental trauma in adolescents was high, with no association with drugs use. Keywords: dental trauma; adolescents; prevalence

Purpose: To investigate dentin abrasivity and cleaning efficacy of novel/alternative toothpastes containing diamond particles, active carbon, sea salt or organic oils. Materials and Methods: Seventy-two bovine dentin samples (for measuring abrasivity) and 60 human dentin samples (for assessing cleaning efficacy) were used in this study. Samples were divided into six groups as follows: group 1: Elmex Kariesschutz (hydrated silica); group 2: Lavera Neutral Zahngel (sea salt); group 3: Curaprox Black is White (active carbon); group 4: Swiss Smile Diamond Glow (diamond powder); group 5: Ringana Fresh Tooth Oil (hydrated silica); and group 6: artificial saliva. Samples were brushed for a total of 26 min at 120 strokes/min, replacing slurries (1 part respective toothpaste and 2 parts artificial saliva) every 2 min. Finally, abrasive dentin wear was measured profilometrically and cleaning efficacy planimetrically. Results: The highest abrasivity values were observed for Lavera Neutral Zahngel (sea salt 9.2 µm) and Elmex Kariesschutz group (hydrated silica 6.0 µm). The lowest abrasivity value was observed for Ringana Fresh Tooth Oil group (hydrated silica 1.3 µm). The highest cleaning efficacy was observed for Elmex Kariesschutz group (86.7%) and the lowest cleaning efficacy was observed for Ringana Fresh Tooth Oil group (31.3%). Conclusion: The addition of diamond powder or active carbon to toothpastes could offer high cleaning efficacy with low dentin abrasivity. The addition of sea salt to traditional abrasives might cause high abrasive dentin wear without adding further cleaning benefit. Keywords: abrasive dentin wear, active carbon, alternative toothpastes, diamond powder, toothpaste abrasivity

Purpose: This study investigated the progression of incisal tooth wear clinically for 4-years, using various diagnostic methods. Effectiveness of occlusal splints (night guards) for patients with nocturnal bruxism was also evaluated. Materials and Methods: Forty maxillary incisors from 10 patients with nocturnal bruxism were selected. Group 1 (n=5) wore occlusal splints for 6 months, whereas group 2 (n=5) didn't. Ultrasound, cast-model analysis (control), digital radiography, FluoreCam and colorimeter were used for measurements. Clinical progression of incisal wear monitored at baseline, 3, 6, 12, 24 and 48 months, respectively. Results: Ultrasound, cast-model analysis and FluoreCam readings gradually and statistically significantly decreased during the overall evaluation period for both groups (p<0.001). Regarding colorimeter, statistically significant differences in periodical measurements were observed from 24 months and 12 months, for group 1 and group 2, respectively (p<0.001). There were no statistically significant differences in readings at evaluation periods, between the groups, for ultrasound, digital radiography and cast-model analysis (p≥0.05); however, statistically significant differences were observed for colorimeter at 24 months (p=0.010) and 48 months (p<0.001), and for FluoreCam at 12, 24, 48 months (p<0.001). Annual decrease in mean crown length was determined as 20-30 µm for group 1 and 40-50 µm for group 2. The decreases in mean crown length were statistically significantly lower for group 1 compared to group 2, regarding the assessments for 1 year, 2 years and 4 years (p<0.001). Positive and good correlations were observed between ultrasound, cast-model analysis and FluoreCam measurements (p<0.001). Conclusions: Ultrasound, FluoreCam and colorimeter showed promising results for monitoring any change and progression of incisal tooth wear clinically. Ultrasound might be considered as a quantitative, reliable and repeatable method. Precision of the measurements varied among the diagnostic methods used. Occlusal splints may have a potential preventive effect for progressive tooth wear. Keywords: bruxism, colorimeter, fluorescence, occlusal splints, tooth wear, ultrasound

Purpose: To assess the current prevalence of caries, gingival bleeding, calculus, and fluorosis and to determine the risk factors for caries in permanent teeth of 12-year-old students in Guangdong Province, China. Materials and Methods: A cross-sectional survey was carried out among 1920 12-year-old students in Guangdong Province. All participants were required to undergo an oral health examination. Information concerning the subjects' family background, dietary habits, and relevant oral health behaviour were collected in a structured questionnaire. Chi-squared tests, Wilcoxon rank-sum tests, and the logistic regression model were used in the statistical analysis. Results: The prevalence rates of caries in permanent teeth, gingival bleeding, calculus, and fluorosis were 43.07%, 40.57%, 43.75%, and 5.05%, respectively; the average decayed, missing, and filled teeth (DMFT) index was 1.06±1.721. Residence (odds ratios [OR] rural=1.798, 95% CI: 1.485-2.177), sex (OR female=1.352, 95% CI: 1.121-1.631), paternal education level (OR >9 years=0.755, 95% CI: 0.608-0.936), presence of calculus (OR yes=1.279, 95% CI: 1.057-1.548), and frequency of consumption of sugary snacks (OR frequently=1.418, 95% CI: 1.064-1.890) were statistically significantly associated with the risk of permanent teeth caries. Conclusion: Oral health in 12-year-olds in Guangdong Province remains to be improved. Rural residence, female sex, the presence of calculus, and frequent consumption of sugary snacks could increase the risk of caries. The paternal educational level was negatively associated with the risk of caries, whereas we found no association between the maternal educational level and the risk of caries in this population. Keywords: caries, permanent teeth, risk factors, students

Purpose: To verify the prevalence of developmental defects of enamel (DDE) in deciduous teeth and analyse the association with adverse events that occurred during pregnancy and early childhood. Materials and Methods: In a cross-sectional study, 152 children with an average age of 3.57 ± 1.25 years were examined according to the criteria established by the DDE index. A previously validated questionnaire was given to mothers in order to obtain information regarding: calcium and vitamin D deficiency (measured in mothers); gestational diabetes; gestational undernutrition; weight at birth; neonatal hypoxia; and presence of asthma in early childhood. The clinical exam was conducted by a single examiner calibrated for visual exams (Kappa = 0.84), outdoors on patios of schools with children and examiner knee to knee. Pearson's chi-squared test and Fisher's Exact Test (p < 0.05) were used to determine statistically significant associations between the variables in study. The data were then analysed using a binary logistic regression regression. Results: 26.3% of children exhibited DDE. It was possible to verify a statistically significant association between DDE and vitamin D deficiency (p < 0.01), calcium deficiency (p = 0.01), neonatal hypoxia (p = 0.026), and gestational diabetes (p = 0.04). The regression model allowed the conclusion that children who had neonatal hypoxia during childbirth, gestational diabetes or vitamin D deficiency during their gestation were 3.54, 12.47 and 6.40 more likely to exhibit signs of DDE, respectively. Conclusion: The prevalence of DDE was considered high and was associated with vitamin D and calcium deficiency during pregnancy, gestational diabetes, and neonatal hypoxia. Keywords: child, child health, dental enamel hypoplasia, pregnancy

Purpose: This in vitro study evaluated the effectiveness of polyacrylic acid as an acid etchant similar to phosphoric acid and its effect on the microtensile bond strength of self-adhesive resin cement to enamel. Materials and Methods: Ninety Te-Econom Plus resin blocks (11 x 4 mm) were cemented onto bovine enamel and distributed into 10 groups according to the surface treatments (no surface treatment; etching with 37% phosphoric acid; etching with 20% polyacrylic acid; etching with 37% phosphoric acid + dental adhesive, and etching with 20% polyacrylic acid + dental adhesive) and the self-adhesive resin cements used (RelyX U200 and MaxCem Elite) (n = 9). After bonding, the specimens were sectioned into sticks, subjected to thermocycling (5760 cycles, 5°C and 55°C) and microtensile bond strength testing (n = 6). Images of representative specimens were obtained using a scanning electron microscope. Enamel penetration evaluation of different surface treatments was analysed by confocal laser scanning microscopy (n = 3). Data on bond strength were subjected to 2-way ANOVA and Tukey's least significant difference test (α = 0.05). Results: Both 37% phosphoric acid and 20% polyacrylic acid yielded the same microtensile bond strength between self-adhesive resin cement and enamel, independent of the application of dental adhesives (p > 0.05). MaxCem Elite showed higher bond strength values than RelyX U200 just for the 20% polyacrylic acid group (p = 0.001). Conclusion: Acid pre-conditioning of dental enamel may influence the bond strength of self-adhesive resin cement to enamel, and 20% polyacrylic acid showed efficacy similar to that of 37% phosphoric acid. Keywords: adhesives, dental enamel, microscopy, microtensile bond strength test, resin cements

Purpose: This study aimed to evaluate the experience of specific oral and dental symptoms or side effects as reported by patients following the use of nicotine replacement therapy (NRT) products. Materials and Methods: The study involved paper-based confidential survey questionnaires accessible for a period of 8 months to patients attending the School of Dentistry Dental Clinic, Griffith University, Australia. This study recorded demography, smoking history, NRT use history, and specific oral and systemic symptoms. The data was assessed and grouped into three divisions: those with no history of NRT use, current and former users of NRT, and current users of NRT. Results: Current users of NRT reported a statistically significantly higher incidence of all oral symptoms and increased incidence of systemic symptoms, as compared to those with no history of NRT use. There was no statistically significant difference between current and former users of NRT for almost all symptoms. Conclusions: A correlative relationship has been observed between the use of NRT products and patients' reported oral symptoms. This study showed a statistically significantly higher incidence of oral symptoms in current and former NRT users. The reported oral side effects and compounding risk profiles show an imperative need for further research into nicotine replacement therapy products' impact on oral health status and treatment outcomes in dental patients using NRT. Keywords: nicotine replacement products, nicotine replacement therapy, oral health symptoms, tobacco

Purpose: Oral mucositis (OM) is the most frequent side effect of radiation. Selenium deficiency leads to increased levels of free oxygen radicals and the selenium level tends to fall during radiotherapy. Hence, in this double-blind randomised controlled clinical trial, the effect of selenium was assessed in patients receiving radiation. Materials and Methods: Patients with head and neck cancer who were candidates to receive radiation were instructed to use selenium 200 mcg tablets twice daily. The grade of OM was evaluated by the World Health Organization (WHO) grading system on a weekly basis. The selenium level was measured at baseline and at the end of the radiation. Results: Seventy-one patients with head and neck cancer (37 in the selenium group, 34 in the placebo group) were enrolled in the study. The cumulative incidence of OM (grade 1–4) was 97.3% in the selenium and 100% in placebo group (p value: 0.79), and difference in the mean serum selenium level at the end of radiation was not statistically significant between the two groups (p value 0.24) Conclusion: Selenium supplementation does not appear to affect the selenium level as well as the severity and duration of OM. It is supposed that higher doses may be effective in the prevention of RT-mucositis. This trial was registered in the Iranian Registry of Clinical Trials accessible at www.irct.ir (ID No. IRCT2014072718612N1) Keywords: selenium, oral mucositis, head and neck cancer, radiation, concurrent chemotherapy, prevention

Purpose: To assess the mandibular cortical width (MCW) and morphology of the mandibular inferior cortex (MIC) on panoramic views from a large sample of males and females in various age groups by using an automated morphometric grading system for assisting osteoporosis screening. Furthermore, possible predictors and concrete cut-off values to identify the risk for osteoporosis were evaluated. Materials and Methods: MCW, MIC, tooth loss (TL), and alveolar bone loss (ABL) were retrospectively evaluated in 700 panoramic images from dental patients in Hong Kong using commercially available software. To estimate possible predictors for identifying the risk of osteoporosis, age, TL, and ABL were evaluated with the receiver operating characteristic (ROC) curves for each gender separately. Results: The age groups 60s (sixties), 70s and 80s showed statistically significant gender differences. For example, a smaller MCW and more MIC Class 3 were found in females. Furthermore, females exhibited a statistically significant increase in TL in the age groups 50 years and above. In males, age, TL or ABL did not correlate with MCW, whereas in females it statistically significantly did. Meanwhile, the correlation between ABL and MCW and MIC was weak for both genders. Concrete cut-off values to identify patients at risk of osteoporosis were 60.15 years and 3.5 missing teeth in females, and 72.55 years in males. Conclusion: Age and tooth loss were related to MCW and MIC in the population investigated. An age of ≥60 as well as more than 3.5 teeth lost seem to be indicators for a risk of osteoporosis in Chinese females based on panoramic views using artificial-intelligence-based software. Keywords: mandible, osteoporosis, panoramic radiography, radiomorphometric indices, tooth loss

Purpose: This study evaluated repair protocols of a non-aged and aged bulk-fill composite in terms of bond strength and leakage. Materials and Methods: Ninety-six bulk-fill resin specimens were constructed; half were submitted to thermocycling. Specimens were divided into six groups (n = 16) according to the repair treatments: CG: no repair (control group); Ad: adhesive; DbAd: abrasion with diamond bur + adhesive; SbAd: sandblasting + adhesive; DbSiAd: abrasion with diamond bur + silane + adhesive; and SbSiAd: sandblasting + silane + adhesive. Resin blocks were bonded to the treated surfaces to simulate repair, and the specimens were submitted to microtensile bond strength testing. The failure area was evaluated under a stereomicroscope (40X magnification), and leakage after specimen immersion in silver nitrate solution for 24 h was evaluated under a microscope (200X magnification). Three-way ANOVA (surface treatment, chemical agent, aging) and Tukey's test were performed. Results: Ad and DbAd groups showed the lowest bond strengths, while Ad was the only group negatively influenced by aging. The other groups were statistically similar to the CG in both conditions. All groups exhibited leakage, but groups without silane presented a greater percentage of leakage, mainly when diamond burs were used. Thermocycling did not influence leakage, nor did surface treatment in groups with silane. Conclusion: For composite repair, the use of silane is recommended, mainly when diamond burs are used as a mechanical surface treatment. Keywords: aging, composite resins, repair, sandblasting, silane

Purpose: To determine the prevalence of developmental defects of the enamel (DDE) in premolars whose infected predecessors were submitted to pulp therapy with antibiotic paste or extractions due to pulp necrosis. Materials and Methods: A cross-sectional study with a consecutive sample consisting of children and adolescents who presented with fully erupted premolars, was evaluated. Data were collected by dental examinations, in which the modified DDE index was applied. Dental records were evaluated and three groups of premolars were determined according to the clinical history of predecessors: GCTZ: with pulp necrosis and treated with CTZ (chloramphenicol, tetracycline, zinc oxide and eugenol) paste; GE: with pulp necrosis and treated by extraction; GH: healthy and physiologically exfoliated. Descriptive analysis and a logistic regression (p <0.05) were performed. Results: The study included 1017 premolars, DDE was present in 22.5%. Premolars belonging to the GE group presented higher odds of DDE (odds ratio (OR) = 3.52, 95% CI:2.29–5.40) than those of GCTZ group (OR = 2.43, 95% CI:1.51–3.91) and GH group (p <0.01). Enamel defects were more frequent in maxillary premolars (OR = 3.22, 95% CI:1.65–6.27, OR = 3.39, 95% CI:1.67–6.90, OR = 2.90, 95% CI:1.48–5.66 and OR = 3.10, 95% CI:1.54–6.23). Conclusions: The prevalence of enamel defects was higher in premolars whose predecessors were removed because of necrosis, followed by those treated with CTZ paste and those that were healthy by the time exfoliation occurred. Keywords: abnormalities, antibiotic paste, bicuspid, dental enamel, dental pulp necrosis, root canal therapy

Purpose: Periodontitis is characterised by inflammation of periodontium and alveolar bone loss. Gardenia jasminoides is reported to have anti-inflammatory effects. In this study, we investigated the effects of aqueous extract of G. jasminoides (GJ) on periodontitis. Materials and Methods: Male Sprague-Dawley rats aged 7 weeks were randomly placed in three groups (n = 7); non-ligatured and non-treated (NL group), ligatured and distilled water-treated (L group) and ligatured and 100 mg/kg GJ-treated (GJ group). After oral administration of GJ for 14 days, the mandibles were removed for histology. In addition, RAW 264.7 cells were treated with 100 ng/ml receptor activator of nuclear factor-κΒ ligand (RANKL) and 1, 10 and 100 μg/ml GJ for 7 days to analyse the expression of periodontitis-related factors. Results: In GJ-treated mice, the score of alveolar bone loss was statistically significantly attenuated compared with the L group. GJ treatment showed inhibition effect in the progress of cementum demineralisation. The expressions of proinflammatory cytokines in gingival tissue were statistically significantly regulated by GJ treatment. Additionally, GJ treatment showed the dose-dependent inhibition of RANKL-induced osteoclast formation. Furthermore, GJ treatment downregulated the RANKL-induced cytokine production in RAW 264.7 cells. Conclusion: In summary, GJ ameliorated periodontitis-induced alveolar bone loss via inhibiting transcription factors including nuclear factor-κB, c-fos and extracellular signal-regulated kinase signalling. Therefore, GJ might be a therapeutic option for treating periodontitis. Keywords: periodontitis, Gardenia jasminoides, alveolar bone loss, osteoclasts

Purpose: To investigate whether toothpastes with diamond powder vs those with traditional abrasives abrade dentin and enamel differently and to determine the relative dentin abrasivity (RDA) and relative enamel abrasivity (REA) values of those toothpastes. Materials and Methods: Dentin and enamel samples of bovine permanent incisors were randomly allocated into groups of eight, brushed with 20 different toothpastes (three of which contained diamond powder) and analysed for their RDA and REA values. Results: Toothpastes with diamond powder exhibit low RDA values but high REA values. Some RDA values exceeded the ones declared by the manufacturer. Conclusion: Diamond powder as an abrasive might have a mild action on dentin, but it is highly abrasive on enamel. Keywords: abrasivity, diamond powder, RDA, REA, toothpastes

Purpose: A novel acute-phase protein, YKL-40, is known as an inflammation-associated glycoprotein. YKL-40 is shown to be linked to inflammation, endothelial dysfunction and tissue remodeling secreted by various cells and is also considered to be stimulated by cytokines such as interleukin-6 (IL-6). The present study aimed to investigate YKL-40 and IL-6 levels in saliva and gingival crevicular fluid (GCF) of patients with chronic periodontitis (CP) after non-surgical periodontal therapy for the first time. Materials and Methods: Twenty-six CP patients and 26 periodontally healthy individuals were enrolled. Clinical measurements were recorded; saliva and GCF samples were obtained at baseline and 1 and 3 months after non-surgical periodontal therapy. Levels of YKL-40 and IL-6 in saliva and GCF were analysed by ELISA. Results: Salivary and GCF YKL-40 and IL-6 levels were found to be statistically significantly higher in CP patients compared to healthy controls at baseline (p < 0.001). At 1 and 3 months after the completion of treatment, both YKL-40 and IL-6 levels in saliva and GCF had statistically significantly decreased compared with baseline values in CP patients (p < 0.001). On the other hand, no statistically significant difference was observed between 1 and 3 months in terms of salivary and GCF YKL-40 and IL-6 levels or any of the clinical findings (p > 0.016). Conclusion: Salivary and GCF YKL-40 levels may be useful to evaluate resolution of periodontal inflammation. Within the limits of this study, YKL-40 acute-phase protein might be a potential biomarker for detection of periodontitis and monitoring the response to periodontal therapy. Keywords: after-treatment, gingival crevicular fluid, human, interleukin-6, saliva, YKL-40 protein

Purpose: The impact of smoking habits on periodontal treatment has not been clearly elucidated. This study aimed to specify the effects of cigarette consumption and nicotine addiction on periodontal therapy. Materials and Methods: In this retrospective case-control study, 20 moderate smokers and 20 non-smokers with severe periodontitis were examined after initial diagnosis, and non-surgical active and supportive therapies for 1-6 years (mean follow-up = 3.37 years). Fagerström's test of nicotine dependence (FTND) was evaluated at re-examination. Treatment efficacy was assessed by periodontal pocket probing depth (PPD) changes and number of teeth lost per year (TL). Bayesian multilevel and regression analyses were performed at site, tooth, and patient levels. Results: During the mean follow-up period of > 3 years including active and supportive periodontal therapies, mean PPD, PPD > 3 mm and PPD > 7 mm percentage reductions were 1.03, 1.48 and 2.57 times statistically significantly less pronounced, respectively, in smokers than in non-smokers. Multilevel analysis showed that the variability of PPD > 7 mm reduction was mainly associated with patient-level factors. Smokers presented a higher risk for periodontitis progression. In smokers, periodontal parameter improvement was less pronounced in the maxilla and molars. The mean TL was related to the FTND score, not to cigarette consumption. Regression analysis did not demonstrate other influences of demographic and periodontal treatment characteristics on treatment outcomes, except patient age. Conclusion: Smoking negatively impacted periodontal treatment outcomes at specific tooth sites (deep pockets, maxillary molars) and periodontitis progression, independent of other risk factors. Keywords: nicotine dependence, periodontitis, smoking, treatment outcomes

Purpose: To assess the prevalence and associated factors with early childhood caries (ECC) in a Polish population. Materials and Methods: A cross-sectional study was carried out involving 656 three-year-old preschool children of both sexes. Data were collected through oral examination of the children and a questionnaire self-reported by their parents. The questionnaire contained information on sociodemographic aspects, feeding and oral hygiene practices, dental care utilisation and dental health knowledge. Associations between ECC and caries-related factors were analysed with use of bivariate and multivariate logistic regression and Mann–Whitney U test. Results: ECC was diagnosed in 64.0% children from the rural area and 46.6% from the urban one, more often in boys (57.7%) compared to girls (49.5%) and S-ECC in 37.1%, 24.2%, 31.5% and 27.5%, respectively. The associations between caries experience and living in a rural area, male sex, education level and oral health-related knowledge of a parent, tooth brushing frequency, nocturnal bottle-feeding and feeding with sweet beverages at the age over 12 months, consumption of sweetened within the first 2 years of age and drinking of sweet beverages once a week at bivariate level were found. In the final model of the logistic multivariate regression analysis, seven variables were associated with ECC experience. They revealed the probability in decreasing order: living in a rural area (odds ratios (OR) = 1.90); feeding the child during the first 2 years with sweetened food (OR = 1.77); nocturnal drinking of sweet beverages by the >12-month-old child (OR = 1.73); education level of parent (OR = 1.53); gender – male (OR = 1.48); nocturnal bottle-feeding of the over-12-month child (OR = 1.44); and frequency of tooth brushing (OR = 1.41). Conclusion: The most prominent risk factors for ECC were living in a rural area, consumption of sweetened foods within the first 2 years of age and nocturnal drinking of sweet beverages by the over 12-month-old child. Keywords: early childhood caries, dmft, oral hygiene

Purpose: Currently, there is no consensus on recommendations for manual toothbrushing techniques between dentists, oral health therapists and dental companies. The aim of this systematic review is to identify and assess the quality of evidence of the effectiveness of manual toothbrushing techniques in the existing literature. Methods: A broad search was conducted on the electronic databases Medline via Ovid, PubMed and EBSCO Dentistry & Oral Sciences. Included studies examined manual toothbrushing technique efficiency. Articles were assessed utilising the Cochrane Collaboration's tool for assessing risk of bias. Thirteen studies met the inclusion criteria and were included in this review. These included five randomised controlled trials (RCT), seven experimental non-randomised control studies and one in vitro study. Results: Of the 3190 articles identified, 40 were relevant to manual toothbrushing and 13 were included in the final review. Studies indicating statistically significantly superior plaque removal for a given technique were Bass (one), modified Bass (one), Charter's (two), Fones (two), scrub (two), roll (one), modified Stillman (one), toothpick method (one). Four studies exhibited no statistically significant difference in effectiveness of plaque removal. Unfortunately, considerable variation was found between studies, making a definitive conclusion impossible in terms of an ideal manual toothbrushing technique that would promote plaque removal and reduce gingivitis. Conclusion: There is still insufficient evidence for suggesting that one toothbrushing method is more effective than another in plaque removal and reduction of gingivitis. Excessive variability in many aspects of the design and methodology of the selected studies hinder conclusions on an ideal manual toothbrushing technique. Experimental randomised controlled trials that follow the CONSORT guidelines are required to provide adequate-quality evidence and make any definitive conclusions on the relative effectiveness of manual toothbrushing techniques. Keywords: evidence-based medicine, oral hygiene, systematic review, toothbrushing

Purpose: This study examines the difference in the oral microbiome during pregnancy and the postpartum period of a Chinese population, with the focus on P. gingivalis, P. intermedia and P. nigrescens and their shift during pregnancy, in order to understand the host-microbe relationship in maintaining homeostasis during pregnancy. Materials and Methods: This cross-sectional study was carried out in a total of 117 women who underwent prenatal or regular examinations at four public hospitals, including 84 pregnant and 33 postpartum women. Women in the postpartum group were examined within 0.5-1 year after delivery, while the pregnant group was divided into early pregnancy (0-13 weeks), middle pregnancy (14–27 weeks), and late pregnancy (28–39 weeks) according to gestational age. Sociodemographic parameters were self-reported by recruited women. The study required evaluations of probing depth (PD), bleeding index (BI), clinical attachment loss (CAL), and plaque index (PlI). Unstimulated whole saliva samples were collected for the detection of P. gingivalis, P. intermedia, and P. nigrescens. Bacterial populations were evaluated using 16S rRNA-based polymerase chain reaction. Results:P. nigrescens exhibited higher prevalence in the pregnant group compared to the postpartum group (45.67% vs 12.10%, p < 0.01). P. nigrescens was more frequently detected in late than in early pregnancy (57.7% vs 48.3%, p < 0.05) and middle pregnancy (57.7% vs 31.0%, p < 0.01). Initially high prevalence of P. gingivalis in early pregnancy wanes in middle and late pregnancy (69.0%, 44.8%, 38.5%). However, the prevalence of P. gingivalis in the postpartum group (81.8%) exceeds all of the pregnant groups (p < 0.01). The change in the prevalence of P. intermedia among different groups was not statistically significant. The percentages of bleeding on probing (BOP%) sites and PD ≥4 mm sites in the postpartum group were statistically significantly higher when compared with each of the pregnant groups (p < 0.01). During pregnancy, women experienced elevated PlI, BI, PD, and BOP% (p < 0.05). The proportions of subjects in the pregnant group who agreed with the statements 'Gingival bleeding is normal', 'Can't brush teeth within 1st month postpartum', 'It's unnecessary to see a dentist if not uncomfortable' were 39.3%, 28.6%, and 35.7%, respectively. Conclusions:P. nigrescens is more related than P. gingivalis to pregnancy status. The periodontal status of Chinese women progressively deteriorates during pregnancy and persists into the postpartum period, which may result from lack of dental care knowledge. Keywords: dental care behaviours, periodontal health, periodontal pathogens, periodontal status, pregnancy

Purpose: To comparatively evaluate the effect of a 5% boric acid (BA) irrigant on periodontal condition, bacterial level and oral neutrophil numbers with a 1% povidone iodine (PVP-I) irrigant as an adjunct to scaling and root planing (SRP) in chronic periodontitis (CP) treatment. Materials and Methods: A single-masked, randomised clinical trial with 36 CP patients was conducted at the Faculty of Odonto-Stomatology, University of Medicine and Pharmacy, Ho Chi Minh City, Vietnam. Subjects were randomly divided into two treatment groups: 1) SRP plus PVP-I 0.1% irrigant and 2) SRP plus BA 0.5% irrigant. Clinical measurements, including the plaque index (PI), gingival index (GI), bleeding on probing (BOP), probing depth (PD), clinical attachment level (CAL), bacterial level in subgingival plaque (BANA test) and the quantification of oral neutrophils were evaluated at baseline, 4, 6 and 8 weeks after treatment (T0, T4, T6 and T8). Results: Whole-mouth (PI, GI, BOP, PD, CAL and PD) parameters, bacterial level in subgingival plaque and number of oral neutrophils decreased statistically significantly after treatment compared to baseline in both groups (p < 0.01). Between the two groups, whole-mouth PI, GI, BOP, PD and CAL reduction in the BA 0.5% group were higher than those in the PVP-I 0.1% group, but statistical significance was found only for GI and BOP after treatment (p < 0.05). The PD and CAL reductions for moderately deep pockets (PD ≥ 5 mm and < 7 mm) were significantly greater in group 2 compared to group 1 after treatment compared to baseline (p < 0.01). This difference was not found for deep pockets (PD ≥ 7 mm). Conclusion: The results of this study suggest that BA 0.5% could be an alternative to PVP-I 0.1%, and might be more favourable because it provided superior results regarding whole-mouth BOP, GI as well as PD and CAL reduction for moderately deep pockets after CP treatment. Keywords: boric acid, chronic periodontitis treatment, povidone-iodine, subgingival irrigation

Purpose: To assess the knowledge of postgraduate dental students about evidence-based methodology pertaining to the design, conduct, and critical appraisal of clinical trials. Materials and Methods: Senior postgraduate students were surveyed from the dental schools of three universities in Athens (Greece), Boston (USA), and Zürich (Switzerland). The proportion of students correctly answering each of the 10 questions of the survey, as well as the cumulative scores, were analysed statistically with descriptive statistics and logistic/linear regression analysis at α = 5%. Results: A total of 96 students with a mean age of 30.0 years attained an overall correct score of 45.6% ± 15.0%, with correct answers to each question ranging from 13.5% to 86.5%. The questions most frequently answered incorrectly pertained to characterising sensitivity/specificity (13.5%), the number needed to treat (14.0%), the credibility of trial synthesis in meta-analysis (23.7%), and publication bias (29.5%). The vast majority of postgraduate students could correctly identify the role of statistical power of a trial (63.8%), random allocation sequence in a randomised trial (76.0%), and blinding in a randomised trial (86.5%). Paediatric dentistry postgraduate students scored better than students from other departments (+15.1%; 95% CI: 3.0% to 27.1%; p = 0.02). Conclusions: Postgraduate students in orthodontics and other dental specialties possessed moderate knowledge on evidence-based methodology and clinical trials. Efforts should be made to integrate such subjects in university postgraduate curricula, so that future dental specialists can critically appraise such research papers. Keywords: clinical trial, educational assessment, epidemiologic research design, evidence-based dentistry, questionnaire, survey, systematic review

Purpose: To evaluate effects of the adjunctive subgingival application of sodium hypochlorite on clinical outcome following nonsurgical periodontal treatment. Materials and Methods: A search protocol was developed to answer the following focused question: 'in patients with periodontitis, does adjunctive subgingival application of sodium hypochlorite have additional clinical benefits compared to subgingival debridement alone?' Randomised controlled clinical trials (RCTs) published up to January 30, 2020, with at least 6 months of follow-up, in which sodium hypochlorite was used as an adjunct in nonsurgical periodontitis treatment were included. The search was limited to the English language. Results: Out of 355 studies retrieved, the search resulted in two publications that fulfilled the inclusion criteria. The adjunctive application of sodium hypochlorite did not provide additional beneficial effect in terms of changes in the evaluated clinical outcomes (i.e. probing depth values [PDs], clinical attachment level gain [CAL] and bleeding on probing [BOP]) when compared to mechanical instrumentation alone over the 12-month investigation period (p > 0.05). Conclusion: The available data have failed to show any additional clinical benefit following the use of sodium hypochlorite in conjunction with nonsurgical periodontal therapy. Keywords: periodontitis, review, therapy, treatment

Purpose: To evaluate the efficacy of adjunctive aids to scaling and root planing (SRP) on clinical outcomes in treating periodontal patients included in regular periodontal maintenance programs. Materials and Methods: The electronic databases MEDLINE (Pubmed), EMBASE, and the Cochrane Central Register of Controlled Trials (CENTRAL) were searched for relevant articles published up to 1st January, 2020. Randomised controlled clinical trials of SRP with or without the use of adjuncts and published in English were included. A meta-analysis using the random-effects model was performed on the selected qualifying articles. Results: Nineteen studies were included in the systematic review and sixteen in the meta-analysis. The overall effect of adjunctive aids was statistically significant for reduction in probing depth (PD) (0.376 mm, 95% CI [0.144 to 0.609]) and clinical attachment level (CAL) gain (0.207 mm, 95% CI [0.0728 to 0.340]). No statistically significant differences were observed for changes in bleeding on probing (BOP) (p > 0.05). Among the different adjuncts, statistically significant positive effects were demonstrated for adjunctive photodynamic therapy (PD reduction 0.908 mm, 95% CI [0.227 to 1.589] and CAL change (0.457 mm, 95% CI [0.133 to 0.782]) and tetracycline fibers (PD reduction 0.534 mm, 95% CI [0.290 to 0.778] and CAL gain 0.280 mm, 95% CI [0.0391 to 0.521]). Conclusions: Despite high heterogeneity of the investigated data, based on the findings of a current systematic review, adjunctive aids (in particular, photodynamic therapy and tetracycline fibers) combined with SRP provide statistically significant clinical benefits compared to SRP alone. Due to the large number of included studies with high risk of bias, future studies should be based on adequate methodological procedures to improve the overall quality of reporting and to reduce the risk of bias. Keywords: periodontal maintenance, periodontitis, residual pockets, supportive periodontal treatment

Purpose:Candida albicans is frequently detected together with Streptococcus mutans in the plaque or biofilms of children with early childhood caries (ECC). The aim of this study was to examine the association of the microbial counts of C. albicans and S. mutans in the supragingival plaque with the activity status of carious lesions and oral health practices in children with ECC. Materials and Methods: 66 children aged 5 years were examined and their caries status recorded as per the ICDAS-II and the Lesion Activity Assessment (LAA) criteria. A questionnaire covering oral health practices was administered to parents. Plaque samples were collected and cultured on mitis salivarus bacitracin (MSB) agar and CHROMagar. Data was analysed using Spearman's rank correlation and Mann-Whitney U test. Results: There was a statistically significant positive correlation between the levels of S. mutans and C. albicans (rs = 0.702, p <0.001). A positive correlation was seen between the percentage of active carious lesions with the colony counts of S. mutans (rs = 0.884, p <0.001) and C. albicans (rs = 0.785, p <0.001). Improper toothbrushing practices, dietary and feeding practices were statistically significantly associated with activity of caries lesions, S. mutans and C. albicans count. Conclusion: The total count of C. albicans and S. mutans in the supragingival dental plaque of children with ECC increases with an increase in the percentage of active carious lesions and the severity of dental caries. Improper oral health practices can lead to increased number of active carious lesions, as well as increased microbial load of both S. mutans and C. albicans. Keywords: dental caries, preschool child, candida, Streptococcus mutans

Objectives: This study investigated utilisation behaviour of the dentist compared to general practitioners (GP) and medical specialists in a German cohort under consideration of risk indicators for irregular dental attendance. Methods: Analysis of the results of the population-based LIFE-Adult-Study (Leipzig, Germany) was performed. A total of 2231 participants of the LIFE-Adult-Study were randomly selected to complete the relevant questionnaire, considering medical attendance behaviour. Associations of self-reported medical conditions, including dentaland medical attendance, sociodemographic factors, as well as self-reported general health status and oral health complaints were determined. Results: Of the 2231 participants who were included in the analysis, 14.2% reported not to have visited the dentist during the preceding 12 months. There could be shown a more selective utilisation behaviour towards medical services in smokers, men, low socioeconomic status and depression. Women were more likely to attend the dentist than men (OR = 1.8, CI = 1.4–2.3). Smoking (OR = 0.7, CI = 0.6–1.0), low socioeconomic status (OR = 0.6, CI = 0.4–0.8) and depression (OR = 0.6, CI = 0.4–0.9) were related to less dental attendance. Additionally, persons who do not visit the dentist regularly showed less attendance of the GP as well as medical specialists (p <0.05). Depression could be shown to be an additional risk factor for unfavourable utilisation behaviour towards the dentist. Conclusions: The results showed differences in dental and medical attendance, depending on different patient-related factors. Focusing attention towards high-risk groups might improve dental as well as medical utilisation behaviour, and therefore health status as well. Keywords: dental attendance, prevention, high-risk groups, cross-sectional population-based study, high-risk strategy

Purpose: To present an update the orofacial manifestations of granulomatosis with polyangiitis (GPA) and present a clinical case with the initial signs in the oral cavity. Materials and Methods: A bibliographic search was performed on Pubmed with the keywords 'Wegener's granulomatosis', 'etiology', 'oral manifestations', 'oral cavity', 'gingiva'. The inclusion criteria were papers published in English in the last 10 years that made reference to clinical cases with in which the oral cavity was affected. The quality of the results was assessed with 'The 2013 Care Checklist'. Results: Nineteen clinical cases were analysed. The average quality was 7.68/13 (range 5-10/13). 73.7% of patients were women, the most frequent area for the lesions was the gingiva and the most prevalent lesion was gingival hyperplasia. 68.4% of the patients had this lesion as a first sign, 21.1% as a progression and 10.5% as a recurrence. 68.4% of the lesions resolved once medical treatment was established. Conclusion: GPA is a multisystem disorder associated with considerable morbidity and mortality if not treated. Early diagnosis improves the prognosis. The first manifestation of the disease can be seen in the oral cavity. It is important that dentists recognise the oral manifestation in order to improve the prognosis. Key words: granulomatosis, polyangiiitis, Wegener's granulomatosis

Purpose: In periodontally healthy individuals, mean crevicular depth ranges from 1 to 3 mm. This depth threshold has been used as an indicator to differentiate a physiological dentoalveolar sulcus from a periodontal pocket needing further treatment. Because many studies have shown the important contribution of oral hygiene status to periodontal health, the purpose of this study was to explore the clinical effect of reinforced oral hygiene on the periodontal status of periodontitis-free dental students. Materials and Methods: In our longitudinal observational clinical study, we assessed the periodontal status of healthy individuals attending the dental school by measuring the periodontal pocket depth, bleeding on probing, and plaque index. The follow-up reassessment was carried out four years later at the end of the dental curriculum. Results: The study showed that oral hygiene improvement led to a slight but significant reduction in the mean sulcus depth (-0.049 mm; p < 0.0001). Conclusions: Reinforcement of oral hygiene contributes to the reduction of probing depth even in periodontally healthy patients. Keywords: bleeding on probing, oral hygiene, plaque index, probing depth, sulcus

Background: Juvenile spongiotic gingival hyperplasia (JSGH) is a benign proliferation of non-keratinised stratified squamous epithelium with evident spongiosis, exocytosis leukocytes and dilated vessels with varying numbers of inflammatory cells. Although uncertain, it has been suggested that the epithelial proliferation is probably related to trauma and local irritants. It emerges as a painless erythematous patch or papule with an irregular surface. Case reports: We present a series of eight cases and a literature review of the clinical presentation and treatment approaches for JSGH. This series includes four females and four males with a mean age of 11.6 years, all complaining of injury to the gums. All lesions were painless and not bleeding. One patient associated the lesion with the onset of trauma and another with a previous history of an eruption cyst. Periapical radiographs of the adjacent area did not show any alteration of bone or teeth. Based on these findings, the diagnostic hypotheses were a non-neoplastic proliferative process or a factitious injury. Incisional biopsy was performed and histopathologic diagnosis was conclusive for JSGH. Surgical excision was conducted in three cases, and the other five cases were supported by clinical observation and plaque control in order to prevent gingival recession defects. After a follow-up period of 11 months (mean), no recurrence was observed for surgically treated cases and mild improvement was achieved with periodontal treatment. Conclusion: This case series illustrates the importance of diagnosis and follow-up of patients with JSGH. A conservative approach consisting of basic periodontal support instead of surgical excision may be indicated because of the risk of aesthetic defects at the involved areas. Keywords: gingival diseases, hyperplasia, inflammatory gingival hyperplasia, junctional epithelium, spongiotic gingival hyperplasia

Purpose: This study aimed to estimate the prevalence, distribution, and the associated factors of tooth erosion in Turkish school children. Materials and Methods: A cross-sectional analysis was performed on a representative sample of 473 children (aged 7–14 years) from 11 public schools in Turkey. Parents were asked to fill out a questionnaire to collect sociodemographic data. A questionnaire was also given to the children, to collect data pertaining to personal demographic details and habits of consuming acidic foods and drinks. The O'Sullivan index was used to assess affected permanent teeth. The data were analysed using a chi-square test and multivariate logistic regression analysis. Results: Dental erosion was observed in 21.8% of the children. Lesions were most often observed in the enamel with less than half of the buccal surface affected. Erosion was found to be statistically significantly higher in older children and in those with an elevated body mass index (BMI) (p <0.05). The consumption of fruit juices, drinks with cola, orange soft drinks, gaseous, cocoa milk, iced tea, sodas, sports drinks, energy drinks, oranges, lemons, kiwis, grapefruits, apples, peaches, and fruit yogurts was statistically significantly higher in students with erosion (p < 0.05). There was no statistically significant relationship between students' sex, systemic disease, premature birth and low birth weight, exercise activity level, socioeconomic status, parental education level, and oral hygiene habits with erosion (p > 0.05). Conclusion: Although erosive lesions were limited to the enamel, the prevalence of erosion was high. Erosion was statistically significantly associated with older age, elevated BMI, consumption of certain beverages, and fruit. Keywords: dental erosion, aetiological, paediatric dentistry, prevalence, O'Sullivan's erosion index

Purpose: To investigate the associations between early childhood caries (ECC) and maternal factors among 18- to 36-month-old children in one rural province of Cambodia. Materials and Methods: 121 mother-child pairs (male = 67, female = 54; mean age = 25.18 ± 6.24 months) were recruited at several villages in Stueng Trang district, Kampong Cham province. ECC and maternal caries experience were recorded following WHO guidelines. Maternal factors such as literacy and socioeconomic status, as well as child-rearing behaviours, were assessed through an interview questionnaire of the mothers. Results: ECC and maternal caries prevalence were 54.5% and 84.3%, respectively. Statistically significant associations were found between ECC and: breast-feeding after 18 months; sugary food and beverage intake for the child (p < 0.05); maternal caries experience; illiteracy; night-time breastfeeding, bottle feeding, and late introduction of toothbrushing for the child (p < 0.01). A logistic regression revealed that ECC was more common in children whose mothers had DMFT > 0 (OR = 4.08; 95% CI =1.13-14.75; p = 0.032), children whose mothers were illiterate (OR = 8.21; 95% CI = 1.67-40.85; p = 0.009), children who had night-time breastfeeding after 18 months (OR = 2.76; 95% CI = 1.06-7.19; p = 0.037), and children for whom toothbrushing was introduced after 18 months (OR = 2.87; 95% CI = 1.03-7.97; p = 0.042). Conclusion: The findings of this study suggest that maternal caries experience and illiteracy, as well as a range of child-rearing behaviours including prolonged night-time breastfeeding and late introduction of toothbrushing were indicators for ECC in this population. Keywords: Cambodia, early childhood caries, maternal factors

Purpose: To analyze in vitro new formulations with Citrox and chlorhexidine digluconate (CHX) regarding their antibacterial activity against planktonic bacteria and their potential to inhibit biofilm formation or to act on existing biofilms. Materials and Methods: Five oral health care products with 0.05%–0.5% CHX formulations (four rinses and one gel) were compared with Citrox preparations and additive-free CHX solutions. The minimal inhibitory concentrations (MIC) were determined against 13 oral bacteria associated with caries or periodontitis. Further, the activity on retarding biofilm formation and on existing biofilms was analyzed; both a 'cariogenic' (5 species) and a 'periodontal' (12 species) biofilm were included. Results: The MIC values did not differ between the CHX mouthrinse/gel formulations and the respective additive-free CHX solutions. Citrox was active against selected periodontopathogens (e.g. Porphyromonas gingivalis). The CHX formulations more effectively retarded biofilm formation than did solutions with the same concentration of CHX but without additives. The anti-biofilm activities depended on the CHX concentration in the formulations. Both CHX solutions and formulations (rinse and gel) were only slightly active on an already formed biofilm. Citrox did not exert any anti-biofilm effect. Conclusion: The present in vitro data support the anti-biofilm activity of the novel CHX, Citrox, poly-L-lysine and xylitol oral health-care formulations. Further studies are warranted to confirm the present findings in various clinical settings. Keywords: biofilm, caries, chlorhexidine digluconate, mouthrinse, periodontitis

Purpose: This study aimed to explore self-reported oral hygiene practices (OHPs) among Hungarian adult e-cigarette-only (former smokers who switched completely to e-cigarette use or vaping) and dual users (smokers who use e-cigarettes and combustible tobacco cigarettes concomitantly). Materials and Methods: A cross-sectional, web-based survey of 930 adult Hungarian e-cigarette users was conducted in 2015. Participants reported 10 OHPs, which were included in analyses as separate binary variables and as a composite variable of the 10 OHP items (inadequate/adequate). Chi-square test was used to explore whether separate OHPs differ by vaping status, and to examine the relationship between inadequate OHPs and past combustible or e-cigarette use characteristics. Associations between separate OHPs and vaping status, and between inadequate OHPs and vaping status were tested by multiple logistic regression analyses. Results: More dual users reported toothbrushing twice a day or more than e-cigarette-only users (73.6% vs 65.3%, respectively, p = 0.041) and using sugar-free chewing gum (57.7% vs 45.8%, respectively, p = 0.006) while adequacy of other OHPs did not differ statistically significantly by vaping status. Inadequate OHPs were more typical in the sample (63.7%) than adequate OHPs, however, inadequate OHPs did not differ statistically significantly among dual users and e-cigarette-only users (62.0% vs 64.0%, respectively, OR = 1.20, p = 0.400), controlling for age, gender, education, past combustible and current e-cigarette use characteristics. Conclusion: In this study, both e-cigarette-only and dual users demonstrated similarly high prevalence of inadequate OHPs. Therefore dentists should educate them about effective OHPs and the role of tobacco and e-cigarette use in the development of oral diseases. Keywords: e-cigarettes, oral hygiene, tobacco smoking, vaping

Purpose: This study investigated the effect of long-term daily chemical disinfection on the topographic and Candida albicans biofilm formation on a denture base resin and a reline acrylic resin. Material and Methods: Circular samples (14 × 1.2 mm) were fabricated from a denture base (Vipi Wave) and reline acrylic resins (Tokuyama Rebase Fast II). Samples were kept in 50 ml of distilled water (48 h at 37°C). Subsequently, the samples were immersed in five different solutions: 0.5% sodium hypochlorite; 3.8% sodium perborate; 2% chlorhexidine gluconate; apple vinegar containing 4% maleic acid; and distilled water (control group). The specimen was immersed in the solutions for 8 h daily and transferred to distilled water at 37°C for more 16 h. The surface topographic and Candida albicans (ATCC 90028) biofilm formation were evaluated at baseline (before chemical disinfection) and after 1, 3 and 6 months of immersion. The surface topographic was evaluated by arithmetical roughness average (Ra) and scanning electron microscope (SEM), while the biofilm formation was evaluated by colony-forming units (CFU/ml) method and Alamar Blue assay (cell metabolism). The results were evaluated by three-way analysis of variance (ANOVAs) and post-hoc tests (α = 0.05). Results: The results showed statistically significant effects from the type of acrylic resin (p = 0.029) and time (p <0.001) on the roughness of the specimen. In general, the reline resin had higher roughness than the denture base resin. In addition, the roughness of the samples after 1, 3 and 6 months of immersion in the cleaning solutions was higher than at baseline. In relation to the microbiological assays, there were no statistically significant differences (p >0.055) in the CFU/ml values of the biofilms among the different resins, periods of time and cleaning solutions. Considering the metabolism of the cells within the biofilms, the results showed that, at baseline, it was statistically significantly higher (p <0.05) than after 1, 3 and 6 months of storage. The SEM images showed that all disinfectant solutions provided surface changes of both acrylic resins (base and reline) after 1, 3 and 6 months of immersion. Conclusions: The roughness of both acrylic resins was affected by the disinfection in all cleaning agents, increasing over time, and this effect was more evident in the reline acrylic resin group. This surface change was also observed in the SEM images. While the number of cells within the biofilms was not affected by immersion in the cleaning agents, their metabolism was lower after 1, 3 and 6 months of immersion. Keywords: biofilm, acrylic base resin, hard relines, roughness, denture cleansers

Mucormycosis is a rare fungal infection with high morbidity and mortality and a very poor prognosis. However, aggressive medical and surgical management can result in survival rates exceeding 80%. The most common sites involved in mucormycosis infection are the sinus, lung, skin and soft tissues, gastrointestinal system, central nervous system, and rarely the mandible. Systemic risk factors for mucormycosis are diabetes mellitus (DM), neutropenia, corticosteroid use, hematologic malignancies, organ transplantation, metabolic acidosis, deferoxamine use, and advanced age. Local risk factors are a history of trauma, burns, surgery. We report on two patients with mucormycosis of the jaw. While one case presented as mucormycois involving the maxillary sinus in a patient with uncontrolled DM, the other was a rare case of mandibular mucormycosis in a patient with acute myeloid leukemia. Keywords: jaw, mucormycosis, necrosis, zygomycosis

Purpose: To investigate the oral colonisation potential after four weeks' administration of Lactobacillus reuteri and to examine the short-term effect of probiotics on salivary Streptococcus mutans and lactobacilli. Materials and Methods: The study group comprised 13 young adults who volunteered after receiving verbal and written information. The short-term prospective clinical trial lasted 9 weeks, consisting of a 4-week intervention period with administration twice daily and a 5-week post-administration follow-up period with no probiotic consumption. Saliva and dental biofilm samples were obtained immediately before probiotic administration, after 2 weeks and after 4 weeks of L. reuteri administration. Follow-up samples were collected once every week on a regular basis after administration was terminated. The numbers of salivary S. mutans and lactobacilli were assessed by regular plating, while the presence of the two L. reuteri strains in saliva and dental biofilm was evaluated using quantitative polymerase chain reaction (qPCR). Results: The occurrence of L. reuteri in the oral cavity increased gradually during the intervention period and reached the maximum level after four weeks of probiotic administration (p < 0.0001). The 4-week samples of stimulated whole saliva showed a statistically significant decrease in the number of S. mutans and a statistically significant increase in the salivary lactobacilli level in comparison to baseline. qPCR showed that the DSM 17938 strain has better colonisation for both saliva and dental biofilm than the ATCC PTA 5289 strain at the nine-week follow-up. Conclusion: Probiotics have the ability to colonise the oral cavity during usage, but it gradually disappears after the completion of intake. It also has ability to decrease the number of salivary S. mutans. Keywords: dental biofilm, dental plaque, Lactobacillus reuteri, probiotics, qPCR, saliva, Streptococcus mutans (S. mutans)

Purpose: Evidence has shown that silver diamine fluoride (SDF) at 30–38% has the potential to control and revert caries lesions. However, SDF can be found at lower concentrations on the market. In this study, we evaluated the effect of different commercially available SDF products on the progression of non-cavitated caries lesion in primary teeth assessed by a pH-cycling model. Materials and Methods: Subsuperficial caries lesions were formed in primary teeth using a demineralising solution for 96 h. Demineralised samples were randomly allocated to the following groups (n = 12/group): (G1) Negative Control, deionised water; (G2) Cariostatic, Inodon; 10%* SDF; (G3) Cariestop, Biodynamics, 12%* SDF; (G4) Cariostal, Iodontec, 16%* SDF; (G5) Cariestop, Biodynamics, 30%* SDF (*concentrations declared in the label). Products were applied according to the manufacturer’s recommendation and reapplied after 7 days. Samples were exposed to a pH-cycling model for 14 days. After the cycle was completed, samples were sectioned, analysed by polarised light microscopy, and lesion depth was estimated as indicator of caries lesion progression. Groups were compared by multiple comparisons test (p < 0.05). Results: The negative control group exhibited the greatest lesion depth. All SDF products reduced the caries lesions depth and differed from the negative control. It was a trend observed (G1>G2>G3>G4), but no statistical differences among G3, and G5, and between G4 and G5 were observed for lesion depth. Conclusion: The tested SDF products reduced the depth of non-cavitated carious lesions in primary enamel. Although SDF products with declared concentrations between 12% and 30% (G3, G4, and G5) demonstrated a similar lesion depth in primary enamel, the effect of the concentration remains unclear. Keywords: dental caries, primary teeth, remineralisation

Purpose: Some authors have highlighted the danger of intraoral use of rotating instruments which can produce droplets and aerosols. During the Covid lockdown phase, dental operators were limited to providing emergency treatment that could not be postponed. Therefore, it is necessary for the dental team to restart safely to treat neglected oral diseases that may also affect systemic health. The role of the dental hygienist has apparently changed for procedures performed close to the patient’s oral cavity, particularly in terms of the droplets and aerosols produced during oral hygiene practices. Through an analysis of the most recent literature on the use of dedicated PPE and changed post-Covid 19 work processes, and a review of the differences between manual causal therapy and mechanical therapy in terms of outcome after oral hygiene treatment, we define how the role of the dental hygienist can change positively. Materials and Methods: Narrative reviews of the literature in terms of PPE adopted and oral hygiene procedures performed were carried out in Pubmed. Results: 188 articles from February 2020 to May 2020 using the search terms ‘dentistry’ and ‘covid-19’ were examined. 10 reviews of the literature were performed using the search terms ‘mechanical procedures’ and ‘manual hygiene’. Conclusion: Only continuous update of evidence-based literature on the new standards in oral hygiene procedures and the different results yielded by different procedures can ensure a safe working environment for the dental hygienist while supporting the dentist in this phase of the pandemic. Keywords: Covid-19, manual hygiene, mechanical procedures, post-lockdown, role of hygienist

Purpose: Previous studies have shown that haemodialysis (HD) patients frequently suffer from xerostomia. This problem is associated with difficulties in oral functions, increased risk of oral diseases and interdialytic weight gain (IDWG). The aims of this preliminary study are to evaluate the efficacy and safety of topical dry mouth products in treating xerostomia in HD patients and their impact in reducing IDWG. Materials and Methods: We included 25 HD patients that suffered from xerostomia and complied with inclusion criteria. Subjects received toothpaste, mouthwash and mouth gel for dry mouth. The duration of treatment was 4 weeks. Patients filled out a visual analogue scale (VAS) for xerostomia and Oral Heath Impact Profile (OHIP)-14 questionnaires. Clinical data and IDWG were collected of the medical history of HD patients. Questionnaires and IDWG were collected at baseline, 2 and 4 weeks post-treatment. Results: Twenty-five patients completed the study (56% male and 44% female). The mean age was 63.52 ± 12.50 years. The topical treatment statistically significantly (p = 0.0001) alleviated the symptoms of xerostomia and improved their quality of life (OHIP-14 scores) (p = 0.0001). We observed a statistically significantly IDWG (kg) and IDWG% reduction (p = 0.03) after the use of topical treatment for xerostomia. None of the patients reported side effects. Conclusions: Xerostomia might affect the quality of life and increase the IDWG of these patients. The daily use of topical treatment for xerostomia could decrease thirst and IDWG, improving the quality of life of HD patients. Future randomised studies are needed to confirm these results. Keywords: haemodialysis patients, xerostomia treatment, topical treatment, interdialytic weight gain, oral health-related quality of life

Purpose: Three commercial restorative glass-ionomer cements (GICs) were modified with 5% and 10wt/wt% nanodiamond (ND) particles incorporated into the powder of the GICs. The aim of the study was to assess the percentage of surface fluoride increase on different materials, following 2% neutral sodium fluoride gel application (2% NSF). Materials and Methods: The commercial GICs were: FN, Fuji IX GP (GC); KU, Ketac Universal (3M Oral Care); and RSC: Riva Self Cure (SDI). Grade 1 (Plasmachem) nanodiamond was used. Six specimens of each material were prepared using precise powder:liquid ratios. After a 10-min setting time, the GICs were polished. The specimens were randomly divided into two groups: control (group A) and test (group B). The samples were blot dried and group B received the 2% NSF gel for 2 min. The excess was wiped off with gauze and both groups were analyzed with SEM-EDS. Results: Data analysis revealed that all the GICs and their respective ND modifications had a statistically significant surface fluoride percentage increase (p < 0.0001) on the GICs in group B. The addition of ND10% w/w to FN (p < 0.001) and RSC (p = 0.029) resulted in statistically significant increase of surface fluoride percentage. KU remained consistent with no statistically significant increase noted between ND-modified KU and KU in group A or B. Conclusion: The ability of GICs to absorb the 2% NSF gel immediately after finishing of the restoration statistically significantly increases the fluoride percentage of the surface layer. Keywords: elemental analysis, glass-ionomer cement, nanodiamonds, neutral sodium fluoride gel, SEM-EDS

Purpose: The present study analysed the association between anaemia and dental caries in adolescents on the basis of predisposing factors and presence of severely decayed teeth. Materials and Methods: This observational study included a complex probabilistic sample of adolescents (17–18 years old) enrolled at public schools in São Luís, Brazil (n = 363). Two hypothesis models were tested: (1) anaemia and dental caries are associated given that they share predisposing factors, such as socioeconomic and high sugar consumption, and (2) the presence of severely decayed teeth may increase the susceptibility of patients to anaemia. In the first model, the association between anaemia and the history of dental caries (the outcome number of affected teeth) was analysed by Poisson regression. In the second model, the association between the presence of severely decayed teeth with pulp exposure/necrosis and the outcome anaemia was analysed by logistic regression. Bivariate and multivariate analyses after adjusting for socioeconomic factors and sugar consumption were performed, considering 5% of statistical significance level and using STATA 115.0. Results: Anaemia was associated with a higher number of affected teeth with a history of dental caries in bivariate (means ratio [MR]: 1.30; 95% confidence intervals [CI95%]: 1.10–1.52; p = 0.001) and multivariate (MR: 1.18; CI95%: 1.01–1.39; p = 0.046) analyses. Severely decayed teeth with pulp exposure/necrosis were associated with anaemia in bivariate (odds ratios [OR]: 5.75; CI95%: 1.97–16.8; p = 0.001)] and multivariate (OR 5.51; CI95%: 1.71–17.74; p = 0.004) analyses. Conclusion: This study suggests that anaemia and dental caries are associated in a population-based sample of adolescents and that predisposing factors and severely decayed teeth seem to be involved in this association. Keywords: iron-deficiency anaemia, dental caries, adolescents

Purpose: In a cross-sectional population-based study of 888 5-year-old preschoolers from Teresina, Brazil, to determine the prevalence and factors associated with erosive tooth wear (ETW). Materials and Methods: In a questionnaire, parents provided information on sociodemographic factors, their children’s eating/drinking habits, and oral health. Dental examination was performed at the schools by two calibrated examiners for the diagnosis of ETW, following the criteria of the modified O’Brien Index. Results: The prevalence of ETW was 3.3%. The maxillary incisors were the most highly affected teeth, followed by the mandibular and maxillary molars. The majority of the lesions reached only the enamel (72.1%) and up to 1/3 of the dental surface (63.1%). The occlusal surface was the most affected (47.8%). Preschoolers who had an acidic food-consumption profile had a 2.74 times (95% CI = 1.03–7.30) higher chance of having ETW than children without this profile. Conclusion: The prevalence of erosive tooth wear on the deciduous teeth was low and associated with the consumption of acidic beverages. Keywords: child, preschool, prevalence, tooth erosion

Purpose: The use of a mouthwash as an adjunct to mechanical plaque removal may be useful to improve oral hygiene. In this study, cetylpyridinium chloride (CPC)-based mouthwashes containing sodium fluoride and xylitol (X-PUR Opti-Rinse 0.05% NaF and X-PUR Opti-Rinse 0.2% NaF) were evaluated for their antimicrobial activity against important oral pathogens associated with dental caries, periodontal disease, and candidiasis. Moreover, their biocompatibility and anti-inflammatory properties were assessed.Materials and Methods: Antimicrobial activity was determined using a disk-diffusion assay, a microplate dilution assay, and the European standard protocols for antiseptics. Microbicidal properties were assessed against both planktonic and biofilm cultures. An oral epithelial cell model was used to evaluate the biocompatibility of mouthwashes and their ability to attenuate cytokine secretion.Results: Using three different antimicrobial assays, the CPC-based mouthwashes were found to be highly active against the tested microorganisms. More specifically, the mouthwashes met the European Standard NF EN 1040 and NF EN 1275 defined as a log10 reduction ≥ 5 (≥ 99.999% killing) for bacteria and log10 reduction ≥ 4 (≥ 99.99% killing) for fungi, respectively. The CPC-based mouthwashes were also bactericidal against biofilms of S. mutans, S. sobrinus, and P. gingivalis. Using an oral epithelial cell model, the CPC-based mouthwashes were found to be less cytotoxic than a chlorhexidine-containing mouthwash used as control. Lastly, the CPC-based mouthwashes decreased the secretion of interleukin-6 and interleukin-8 by lipopolysaccharide-stimulated oral epithelial cells. Conclusion: The CPC-based mouthwashes supplemented with sodium fluoride (0.05% or 0.2%) and xylitol (10%) were highly active against important oral pathogens. Moreover, using an oral epithelial cell model, these mouthwashes were found to be biocompatible and to exhibit anti-inflammatory activity. Keywords: anti-inflammatory, antimicrobial, biofilm, cetylpyridinium chloride, mouthwash, xylitol

Purpose: To assess the prevalence of dentin hypersensitivity (DH) in an adult population and explore its association with sociodemographic variables, dietary habits and oral health behaviours as there is very little data on this from the Caribbean. Materials and Methods: A cross-sectional survey was conducted of consecutive dental patients (18 years and over) attending the UWI School of Dentistry polyclinic. Following informed consent, dental examinations were performed and the presence of DH was assessed clinically by sensitivity to an air blast on individual teeth. Patients were also given a questionnaire. Their answers were processed using statistical software (SPSS version 24). Associations between variables were analysed using the chi-squared test. Results: 300 patients participated, with an age range of 18–81 years and a mean age of 44.7 years (SD 15.7). 68.8% were female and the main ethnic groups were African (45.8%), Indian (29.8%) and mixed (24.4%). Over half of the participants (54.9%) reported a history of sensitive teeth and 52% reported sensitivity to the air syringe on one or more teeth. Based on multivariate logistic regression, a history of sensitive teeth was significantly associated with Indo-Trinidadian ethnicity (OR 2.24, 95% CI: 1.23, 4.45), a history of tooth grinding or jaw clenching (OR 0.38, 95% CI: 0.19, 0.76) and consumption of citrus fruits one to two times daily (OR 0.22, 95% CI: 0.06, 0.85). Those who experienced vomiting irregularly were more likely (OR 2.31, 95% CI: 0.96, 5.54) to have DH. Conclusion: Prevalence of dentin hypersensitivity was high among this sample of dental patients and was associated with ethnicity, tooth grinding and dietary practices. Keywords: dentin hypersensitivity, pain, prevalence