This study aimed to investigate the associations between glycemic outcomes and a range of clinical and demographic factors, including treatment modality, sex, age, diabetes duration, and body mass index, in youth with type 1 diabetes in an international registry. This observational, cross-sectional cohort study included youth <21 years from 23 countries. Proportions of individuals using different treatment modalities (continuous glucose monitoring [CGM] with injections, CGM with pump, automated insulin delivery [AID]) and achieving recommended time in tight range (TITR >50%), time in range (TIR >70%), and glycated hemoglobin (HbA1c) (≤6.5% [48 mmol/mol] and ≤7% [53 mmol/mol]) were assessed using mixed-effects fractional logistic and linear regression models. Sex, age (categorized), diabetes duration (categorized), body mass index standard deviation score (categorized), and treatment modality were included as covariates. Data of 7691 individuals (mean [standard deviation] age of 13.7 [4.3] years, diabetes duration 6.3 [4.2] years, 47.8% female) were included. AID users were the most likely to achieve TITR target (adjusted mean [standard error of the mean] 41.2% [2.9]), followed by CGM with insulin pump (25.2% [2.3]) and CGM with injections (13.7% [1.5], P < 0.001). A similar association was observed for proportions of individuals achieving TIR and HbA1c targets (P < 0.001). Age <6 years was associated with a higher coefficient of variation (CV) (P < 0.001) and a lower probability of achieving both TITR and TIR targets compared with other age groups (P < 0.001). In analyses of TITR associated with mean sensor glucose stratified by CV, a higher TITR for a lower CV was observed only at mean glucose levels below 150-160 mg/dL; above this threshold, the pattern reversed, with lower CV associated with lower TITR at a given mean glucose level. Children younger than 6 years and individuals not using glucose-responsive insulin therapy were less likely to meet the recommended glycemic targets. It is imperative to minimize these disadvantages.
Dental caries is one of the most widespread chronic diseases, impacting over 2.4 billion people globally. Silver diamine fluoride (SDF) is a minimally invasive treatment known for its strong antimicrobial and remineralizing effects. However, the primary esthetic drawback of SDF is the black staining it causes on the treated tooth structure. To address this issue, adjunctive anti-staining agents such as potassium iodide (KI), glutathione (GSH), and tannic acid (TA) have been explored. These agents may not only mitigate discoloration but also affect the bonding efficiency of restorative materials applied afterward. Forty extracted permanent posterior teeth were collected, debrided, cleaned, and stored in normal saline. Each tooth was embedded in acrylic resin, and flat dentin surfaces were prepared by grinding the occlusal surface. The samples were randomly divided into four groups: Group 1 - 38% SDF only; Group 2 - SDF + 10% KI; Group 3 - SDF + 10% GSH; and Group 4 - SDF + 10% TA. Treatments were applied to dentin surfaces using a microbrush following standard protocols. A universal adhesive was then applied and light-cured, followed by the placement of composite resin. All specimens underwent shear bond strength (SBS) testing using a universal testing machine to evaluate the adhesive performance of each combination. The mean SBS values (±standard deviation) for Group 1, Group 2, Group 3, and Group 4 were 10.32 ± 0.56, 14.08 ± 0.70, 18.24 ± 0.81, and 17.05 ± 0.47 MPa, respectively. The highest bond strength was observed in Group 3 (GSH), followed by Group 4 (TA), Group 2 (KI), and Group 1 (SDF alone). Pretreatment of dentin with GSH before SDF application significantly enhanced SBS when used with universal adhesive and composite resin.
Oral squamous cell carcinoma (OSCC) is a very frequently occurring cancer type. A salivary biomarker-based noninvasive diagnostic technique helps as promising method in the early detection of cancer. This research was done to assess salivary biomarkers' diagnostic value for early OSCC identification. One hundred and twenty people participated in a hospital-based case-control study, 60 of whom were OSCC patients with histological confirmation and 60 of whom were healthy controls. Biomarkers such as interleukin-6 (IL-6), IL-8, tumor necrosis factor-alpha, IL-1β, matrix metalloproteinase-9 (MMP-9), CD44, soluble CD44, CYFRA 21-1, and lactate dehydrogenase were detected using enzyme-linked immunosorbent assay on unstimulated saliva samples. SPSS version 25.0 was used for statistical analysis. Receiver operating characteristic curve analysis was used to assess diagnostic ability and make intergroup comparisons. When compared to controls, all salivary biomarkers were considerably higher in OSCC patients (P < 0.001). Among the individual markers, IL-8 had the best diagnostic accuracy (area under the curve [AUC] =0.92), followed by MMP-9 and CYFRA 21-1. Biomarkers showed strong positive associations with OSCC, suggesting biological interdependence. With an AUC of 0.96, sensitivity of 93.3%, and specificity of 91.7%, the combined biomarker panel showed outstanding diagnostic performance. Salivary biomarkers have greater assurance for noninvasively and accurately identifying OSCC at a very early stage. The use of multiple biomarkers together can lead to better diagnosis and could help in early screening and achieve good clinical results. Résumé Introduction:Le carcinome épidermoïde de la cavité buccale (CECB) est un type de cancer très fréquent. Une technique diagnostique non invasive basée sur des biomarqueurs salivaires représente une méthode prometteuse pour le dépistage précoce du cancer. Cette recherche a été menée afin d’évaluer la valeur diagnostique des biomarqueurs salivaires pour l’identification précoce du CECB.Matériel et méthodes:Cent vingt personnes ont participé à une étude cas-témoins hospitalière, dont 60 patients atteints de CECB avec confirmation histologique et 60 témoins sains. Des biomarqueurs tels que l’interleukine-6 (IL-6), l’IL-8, le facteur de nécrose tumorale alpha (TNF-α), l’IL-1β, la métalloprotéinase matricielle-9 (MMP-9), le CD44, le CD44 soluble, le CYFRA 21-1 et la lactate déshydrogénase (LDH) ont été détectés par dosage immuno-enzymatique (ELISA) sur des échantillons de salive non stimulée. Le logiciel SPSS version 25.0 a été utilisé pour l’analyse statistique. L’analyse de la courbe ROC (Receiver Operating Characteristic) a permis d’évaluer la capacité diagnostique et d’effectuer des comparaisons intergroupes.Résultats:Comparés aux témoins, tous les biomarqueurs salivaires étaient significativement plus élevés chez les patients atteints de carcinome épidermoïde de la cavité buccale (OSCC) (P < 0,001). Parmi les marqueurs individuels, l’IL-8 présentait la meilleure précision diagnostique (aire sous la courbe [AUC] = 0,92), suivie de la MMP-9 et du CYFRA 21-1. Les biomarqueurs ont montré de fortes associations positives avec l’OSCC, suggérant une interdépendance biologique. Avec une AUC de 0,96, une sensibilité de 93,3 % et une spécificité de 91,7 %, le panel de biomarqueurs combinés a démontré d’excellentes performances diagnostiques.Conclusion:Les biomarqueurs salivaires offrent une meilleure garantie pour l’identification non invasive et précise de l’OSCC à un stade très précoce. L’utilisation conjointe de plusieurs biomarqueurs peut conduire à un meilleur diagnostic et contribuer au dépistage précoce, permettant ainsi d’obtenir de meilleurs résultats cliniques.
Ion-releasing dental varnishes vary in composition and pH responsiveness, influencing remineralization efficacy. This study aimed to compare pH-responsive multi-ion release profiles of (1) sodium fluoride (NaF) varnish, (2) casein phosphopeptide-amorphous calcium phosphate (CPP-ACP)/NaF varnish, and (3) a newly synthesized NaF/nanohydroxyapatite (nHA)‑loaded chitosan (CS) hydrogel. Seventy-two sound primary canine specimens were prepared with standardized enamel windows and allocated to eight groups (n = 9) by material and buffer pH (5.5 or 7.0). Test materials included NaF varnish, CPP-ACP/NaF varnish, and experimentally formulated NaF/nHA-loaded CS hydrogel. Samples were individually immersed in buffer solutions at pH 5.5 and pH 7.0. Solutions were renewed at 4, 24, 72, and 168 h, and analyzed by ion chromatography for fluoride, phosphate, and calcium concentrations. pH stability was monitored. Data were evaluated by 3-way repeated measures ANOVA and one-way ANOVA with Tukey's post hoc (p < 0.05). At pH 5.5, CPP-ACP/NaF varnish yielded the highest cumulative fluoride release with peak fluoride output in the first four hours (22.40 ± 0.23 ppm). NaF/nHA-loaded CS hydrogel exhibited the highest calcium release in the first four hours (11.40 ± 0.20 ppm) and sustained both calcium (30.20 ± 0.20 ppm) and phosphate (36.20 ± 0.20 ppm) through 168 h. Phosphate release peaked at 24 h for both the NaF/nHA-loaded CS hydrogel and the CPP-ACP/NaF varnish under both pH conditions. At pH 7.0, all ion releases were significantly reduced (p < 0.001), though relative material rankings remained the same. Buffer pH remained stable throughout (p > 0.05). While CPP-ACP/NaF varnish maximized early fluoride output, the NaF/nHA-loaded CS hydrogel demonstrated the most sustained multi-ion release under acidic conditions. These distinct pH-dependent kinetics suggest rapid fluoride delivery for early lesion resistance and sustained multi-ion release for extended remineralization.
This study evaluated the antibiofilm activity of experimental mouthwash containing different concentrations of cannabidiol (CBD) and the in situ effects on the physical and mechanical properties of dental enamel. Bovine enamel fragments (6 × 6 × 2 mm) were mounted in intraoral appliances worn by 14 participants in a crossover design. Mouthwash containing CBD (0%, 0.01%, 0.05%, and 0.1%) and 0.12% chlorhexidine (CHX) were tested. Each experimental phase lasted 7 days, separated by washout periods. One side of the appliance was exposed to a cariogenic challenge (20% sucrose) prior to treatment. Surface roughness (Ra), microhardness (%KHN), and color change (ΔE00) were measured before and after treatments. Biofilm and yeast counts (log10 CFU) were quantified, and enamel surfaces were analyzed by scanning electron microscopy. Data were analyzed using two-way ANOVA with Bonferroni post hoc tests and Kruskal-Wallis with Dunn's test (P < 0.05). Sucrose did not significantly affect Ra (P > 0.05), although CBD 0.1% showed higher roughness than CHX under sucrose exposure (P < 0.05). No significant differences in %KHN were observed among treatments; however, sucrose reduced microhardness in the placebo and CBD 0.01% groups (P < 0.05). CHX exhibited the highest ΔE00 values (P < 0.05). Biofilm formation was similar among CHX, CBD 0.05%, and CBD 0.1% (P > 0.05), while CHX showed lower yeast counts than CBD 0.01% and CBD 0.1% (P < 0.05). CBD 0.05% demonstrated potential for biofilm control without adversely affecting enamel properties. This study provides evidence supporting a natural compound-based mouthwash as a clinically viable alternative to chlorhexidine, showing similar efficacy and no associated adverse effects under the conditions tested.
Transverse maxillary deficiency is nearly universal in patients with cleft lip and/or palate (CLP) and represents a major determinant of occlusal function, surgical accessibility, and long-term stability. Despite established principles of rapid maxillary expansion and secondary alveolar bone grafting (SABG), considerable variability persists in appliance selection, timing, and sequencing of orthodontic and surgical interventions. To develop a standardized, evidence-informed clinical algorithm for the management of transverse discrepancies in non-syndromic CLP patients, integrating orthodontic biomechanics with surgical timing considerations. This study presents an algorithm-development framework based on structured clinical reasoning and synthesis of contemporary cleft care principles. Key variables incorporated into the decision pathway included cleft phenotype, presence of anterior segment collapse, type of posterior crossbite (relative versus absolute), dental development stage, and readiness criteria for SABG. Appliance selection (Hyrax, fan-type expander, differential opening expander), rate of activation, retention strategy, and post-graft orthodontic timing were systematically organized into a stepwise protocol designed for reproducibility across multidisciplinary cleft teams. This work is principally a structured review and synthesis of the existing literature, designed to organize established knowledge into an actionable clinical framework; no novel clinical concepts or techniques are introduced for the first time. The presented algorithm provides a structured, clinically applicable framework to harmonize orthodontic and surgical management of transverse discrepancies in CLP patients, aiming to reduce treatment variability, enhance interdisciplinary coordination, and improve graft-related and occlusal outcomes.
Odontogenic space infections can rapidly progress to severe complications, necessitating reliable biomarkers for early assessment and monitoring of treatment response. C-reactive protein (CRP) has been shown to be a sensitive indicator of systemic inflammation. To evaluate the use of serum CRP levels as a monitoring tool in patients with odontogenic space infections and correlate serial CRP changes with clinical recovery. Thirty-six patients with odontogenic space infections requiring surgical intervention were considered for this research. Serial serum CRP measurements were performed at baseline (Day 0, Day 3, Day 5, and Day 7) using an immunoturbidimetric assay. Clinical parameters, including pain (visual analog scale), swelling, and mouth opening, were recorded at the same intervals. Data were statistically analyzed. Mean CRP levels significantly decreased from 84.2 ± 20.6 mg/L on Day 0-9.6 ± 4.3 mg/L on Day 7 (P < 0.001). Pain, swelling, and mouth opening improved in parallel with CRP decline. CRP and pain were found to have strong positive relationships (r = 0.71) along with swelling (r = 0.74), and also for hospital stay (r = 0.69). There was a negative correlation noted with mouth opening (r = -0.65). Higher baseline CRP (>100 mg/L) and it was associated with prolonged hospitalization. Serial serum CRP measurements reliably reflect clinical improvement in odontogenic space infections and can serve as a practical biomarker for monitoring disease progression and treatment response. Résumé Contexte:Les infections des espaces odontogènes peuvent rapidement évoluer vers des complications graves, nécessitant des biomarqueurs fiables pour une évaluation précoce et le suivi de la réponse au traitement. La protéine C-réactive (CRP) s’est révélée être un indicateur sensible de l’inflammation systémique.Objectif:Évaluer l’utilité du dosage de la CRP sérique comme outil de suivi chez les patients atteints d’infections des espaces odontogènes et corréler les variations de la CRP avec la guérison clinique.Matériel et méthodes:Trente-six patients atteints d’infections des espaces odontogènes nécessitant une intervention chirurgicale ont été inclus dans cette étude. Des dosages sériés de la CRP sérique ont été effectués à l’inclusion (jours 0, 3, 5 et 7) par une méthode immunoturbidimétrique. Les paramètres cliniques, notamment la douleur (échelle visuelle analogique), l’œdème et l’ouverture buccale, ont été enregistrés aux mêmes intervalles. Les données ont été analysées statistiquement.Résultats:Les taux moyens de CRP ont diminué significativement, passant de 84,2 ± 20,6 mg/L au jour 0 à 9,6 ± 4,3 mg/L au jour 7 (P < 0,001). La douleur, l’œdème et l’ouverture buccale se sont améliorés parallèlement à la diminution de la CRP. Une forte corrélation positive a été observée entre la CRP et la douleur (r= 0,71), ainsi qu’avec l’œdème (r = 0,74) et la durée d’hospitalisation (r = 0,69). Une corrélation négative a été notée avec l’ouverture buccale (r = −0,65). Un taux de CRP initial élevé (> 100 mg/L) était associé à une hospitalisation prolongée.Conclusion:Les mesures sérielles de la CRP sérique reflètent de manière fiable l’amélioration clinique des infections des espaces odontogènes et peuvent servir de biomarqueur pratique pour le suivi de la progression de la maladie et de la réponse au traitement.
To comparatively evaluate the effects of fluoride varnish, casein phosphopeptide-amorphous calcium phosphate (CPP-ACP) varnish, and self-assembling peptide P11-4 on the microhardness and surface morphology of hypomineralized enamel using a porcine model simulating molar incisor hypomineralization (MIH). Eighteen hypomineralized primary canines and needle teeth (the erupted third incisors of newborn piglets) obtained from three stillborn Yorkshire piglets were included in this in vitro study. Following stereomicroscopic examination, samples were randomly allocated into three groups (n = 6): Group 1: sodium fluoride (NaF) varnish, Group 2: NaF + CPP-ACP varnish, and Group 3: P11-4. Baseline microhardness (T0) was measured using a microhardness tester under a 300 g load for 15 s. Remineralization agents were applied according to manufacturers' instructions. P11-4 application included prior sodium hypochlorite cleaning and phosphoric acid etching. Samples were stored in artificial saliva at 37 °C. Microhardness measurements were repeated at 1 week (T1) and 1 month (T2). One representative sample from each group was analyzed using scanning electron microscopy (SEM). Statistical analysis was performed using two-way repeated measures ANOVA and Bonferroni post hoc tests (p < 0.05). Microhardness values significantly increased over time in all groups (p < 0.001). Significant differences were observed between all-time points (T0-T1, T0-T2, T1-T2) within each group. At T2, the P11-4 group demonstrated the highest microhardness values, followed by NaF + CPP-ACP and NaF groups (p < 0.05). Intergroup comparisons revealed statistically significant differences, particularly between P11-4 and the other groups at T2. SEM images demonstrated an irregular surface morphology related to mineral deposit accumulation after the application of remineralization agents. Nevertheless, in the P11-4 group, the covering deposits and crack-like lines appeared less scattered and more integrated than in the other treatment groups. All remineralization agents improved enamel microhardness; however, P11-4 demonstrated superior efficacy compared to NaF + CPP-ACP and NaF varnish. Porcine enamel appears to be a reliable and biologically relevant model for simulating MIH-affected enamel in vitro.
The concomitant occurrence of hypodontia and hyperdontia is a rare clinical phenomenon. This report describes the multidisciplinary management of a non-syndromic 8-year-old patient presenting with a complex combination of gemination, bilateral missing mandibular lateral incisors, supplemental maxillary canines, ankyloglossia, and multiple hyperplastic frena. An 8-year-old female was referred for the management of ankyloglossia. Clinical and radiographic assessments, utilizing panoramic imaging and cone beam computed tomography (CBCT), identified bilateral supernumerary maxillary canines and agenesis of mandibular lateral incisors. Under general anesthesia, the supernumerary teeth were surgically extracted, and frenectomies were performed to restore tongue mobility and enhance periodontal health through improved plaque control. Furthermore, a geminated tooth (73) received prophylactic resin restoration to preserve arch integrity. Maxillary expansion was initiated using a Hyrax appliance for orthodontic interception. The patient remains under longitudinal observation for definitive interdisciplinary orthodontic treatment. Managing concurrent numerical and structural dental anomalies requires early detection via advanced imaging and a coordinated, multi-specialty approach. Clinical intervention should prioritize the restoration of physiological function and the prevention of secondary complications, such as periodontal instability or severe malocclusion, rather than isolated phenotypic corrections.
Metabolic dysfunction-associated steatotic liver disease (MASLD) is the most common reason for elevated liver enzymes in children in Europe, affecting more than 5% of all children. Since the last iteration of this position paper, there have been substantial advances in our understanding of the disease. After a detailed literature review and thorough discussion, we established consensus recommendations for the diagnosis and assessment of MASLD in children. Alanine aminotransferase (ALT) ≥ 30 IU/L is a suitable screening test for MASLD in children over 10 years of age with obesity (body mass index z-score ≥+2), or in children of any age with additional risk factors. All patients with suspected MASLD should be assessed for alternative or concomitant diagnoses, as well as comorbidities. Patients who are not overweight, under 8 years old, or have any other red flags should be promptly referred for specialist assessment. Liver biopsy remains the gold standard for diagnosis and staging of MASLD, but should be reserved for diagnostic uncertainty, to guide treatment decisions, and risk stratification (e.g., prior to transition to adult care). While there is emerging data for non-invasive tests (e.g., transient elastography), it is unclear how to routinely implement these investigations in clinical practice. Combined changes of ≥20% in both ALT and gamma-glutamyl transferase may represent a useful non-invasive tool for monitoring disease severity over time. Most patients are appropriately investigated and managed by non-specialists where the focus is on holistic management of obesity and its complications. Future research should focus on how to use non-invasive tests to risk-stratify children, in particular, how to identify those with advanced fibrosis.
Advances in three-dimensional (3D) printing have enabled the fabrication of resin crowns, including conservative designs such as endocrowns (ECs), which may improve esthetics and periodontal outcomes. However, clinical evidence comparing them with stainless steel crowns (SSCs) in primary teeth is limited. This study aimed to evaluate and compare the clinical efficiency of 3D-printed resin ECs and full coverage crowns (FCCs) with SSCs in primary molars. A randomized controlled trial was conducted on 37 children aged 4-9 years. Forty-five primary mandibular second molars were allocated into three groups ( n = 15 each): Group A (ECs), Group B (FCCs), and Group C (SSCs). Pulpectomy was performed on all the teeth. Following intraoral scanning, the resin crowns were digitally designed and 3D printed. The clinical performance of the crowns was assessed using revised FDI criteria over a 6-month follow-up period. Periodontal health was assessed using the plaque index (PI) and gingival index (GI). Kruskal-Wallis and Mann-Whitney U -tests were used. The overall success rate was ranked as follows: Group C (100%) > Group A (86%) > Group B (79%), which was not statistically significant ( P = 0.185). Periodontal health was superior in Group A, followed by Groups C and B. A statistically significant difference in GI was found between Groups A and B ( P = 0.007), as well as between Groups B and C ( P = 0.019). 3D-printed resin crowns may serve as an esthetic alternative to SSCs, with ECs preferable in children with compromised gingival health.
Full coronal restorations are essential for managing extensively cariouvarious primary molars. While stainless steel crowns (SSCs) remain the gold standard esthetic alternative, such as hybrid resin polymer (Bioflx) and nanohybrid composite (Edelweiss) crowns have been introduced. To compare the clinical performance of Bioflx, Edelweiss, and SSCs in mandibular primary second molars. This randomized controlled trial included 42 children (5-9 years), each receiving one crown following pulp therapy, randomly allocated into three groups ( n = 14 each). Outcomes assessed at 3, 6, and 12 months included retention, marginal integrity, and proximal contact (United States Public Health System) criteria, gingival health and plaque (Loe and Silness index), opposing tooth wear, parental satisfaction and chairside time. Statistical analysis included analysis of variance, Fisher's exact test, and Cochran's Q test ( P < 0.05). SSCs and Bioflx crowns showed 100% retention while Edelweiss crowns demonstrated 85.8% retention ( P = 0.37). Marginal integrity was highest in SSCs (100% at 3 and 6 months, 92% at 12 months), followed by Bioflx (85.8%) and Edelweiss (71.4%-78.5%) ( P > 0.05). Proximal contact exceeded 90% in SSC and Bioflx groups with lower values in Edelweiss ( P > 0.05). Plaque accumulation differed significantly between groups at 3 and 12 months ( P = 0.0001) with Edelweiss showing 100% plaque-free scores and SSCs the highest plaque levels. Gingival health showed a significant change overtime only in the Edelweiss group ( P = 0.02). Parental satisfaction was significantly higher for color in Edelweiss crowns ( P = 0.0001). Mean chairside time was highest for Edelweiss (1.61 ± 0.29) followed by Bioflx (0.96 ± 0.50 min) and SSCs (0.72 ± 0.20 min) with significant differences ( P = 0.0001). SSCs remain the most reliable option. Bioflx crowns offer comparable performance with improved esthetics, while Edelweiss crowns provide superior esthetics and plaque resistance but require longer chairside time and show slightly reduced retention.
Background Psychological stress is an important concern in dental education, as it may negatively affect students' well-being, academic performance, and health-related behaviors. Beyond its general impact, stress may also be associated with oral health through behavioral and physiological pathways. Methodology A descriptive cross-sectional study was conducted among fourth- and fifth-year dental students at the Faculty of Dental Medicine of Casablanca. Data were collected using an anonymous self-administered questionnaire distributed during clinical rotations. The questionnaire explored sociodemographic characteristics, sources of academic stress related to dental training, self-perceived associations between stress and oral health, coping strategies adopted by students, and proposed measures to reduce stress within the academic environment. Results A total of 323 students participated in the survey, corresponding to a response rate of 94.16%. The findings indicate that a substantial proportion of students report experiencing considerable academic stress, particularly during examination periods and within demanding clinical departments. Participants self-reported several oral health complaints, including gingival bleeding, aphthous ulcers, tooth pain, and bruxism, which they perceived as being exacerbated during periods of increased stress. Students also described a variety of coping strategies, ranging from adaptive approaches, such as social support, physical activity, planning, and spiritual practices, to less adaptive behaviors, including procrastination and avoidance. Conclusions This study aimed to identify the main sources of academic stress among dental students, explore their perceived associations with oral health, and describe coping strategies to provide recommendations for improving student well-being and the educational environment.
Submandibular gland (SMG) resection is traditionally included in level IB neck dissection for oral squamous cell carcinoma (OSCC), although isolated SMG metastases are rare. Routine removal may contribute to xerostomia and a reduced quality of life. This systematic review and meta-analysis assessed whether SMG preservation compromises oncologic outcomes or improves functional outcomes. This systematic review and meta-analysis followed PRISMA 2020 and Cochrane guidelines, with prospective registration in PROSPERO (CRD420251027851). The literature search included PubMed, Scopus, and the Cochrane Library up to March 2025. Eligible studies compared oncologic or functional outcomes after SMG preservation versus resection in OSCC. Risk of bias was evaluated using the ROBINS-I tool, and evidence certainty was assessed with the Grading of Recommendations Assessment, Development and Evaluation approach. Eight studies comprising 1,220 patients met the inclusion criteria. Preservation of the SMG did not increase locoregional recurrence (RR 1.05, p = 0.81), affect disease-specific survival (RR 0.86, p = 0.69), or alter overall survival (RR 0.80, p = 0.57) compared with gland resection. Oncologic safety was maintained in early-stage OSCC (T1-T2 N0). Xerostomia outcomes were variably reported across four studies; while some studies suggested a possible trend toward reduced postoperative dry mouth with SMG preservation, findings were inconsistent due to differences in xerostomia assessment methods and patient cohorts. Based on low-certainty evidence, SMG preservation during neck dissection appears not to compromise oncologic outcomes in selected cases. However, the impact on xerostomia remains inconclusive given the heterogeneity among studies. https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD420251027851, identifier CRD420251027851.
Individuals with Down syndrome (DS) and autism spectrum disorder (ASD) often face challenges in maintaining adequate oral hygiene due to motor, sensory, and behavioral limitations. Toothbrushes with customized handles have been proposed as assistive devices, but clinical evidence of their effectiveness remains limited. This study aimed to evaluate the effectiveness of customized-handle toothbrushes compared with conventional toothbrushes in reducing dental plaque in these populations. A non-randomized clinical trial was conducted with 28 individuals diagnosed with DS or ASD. Participants used either customized-handle or conventional toothbrushes and were followed for three weeks. Dental plaque was assessed using the modified Quigley and Hein Plaque Index at baseline, immediately after supervised brushing, and after one and three weeks. Both toothbrush types led to plaque reduction over time in both groups; however, no statistically significant differences were observed between toothbrush types at any evaluation point. Customized-handle toothbrushes showed similar effectiveness compared to conventional toothbrushes in reducing dental plaque in individuals with DS and ASD and may serve as a supportive tool for oral hygiene care, particularly when combined with supervision and caregiver assistance.
Infantile cortical hyperostosis (Caffey disease) is a rare inflammatory skeletal disorder characterized by episodic subperiosteal bone formation, commonly involving the mandible during early craniofacial development. Residual mandibular enlargement, feeding difficulty, and developmental challenges resulting from the disease may predispose affected children to early childhood caries (ECC). However, evidence guiding dental management in such patients remains limited. This report describes the dental management of a toddler with sequelae of infantile cortical hyperostosis, highlighting condition-specific considerations influencing treatment planning. A 2-year-10-month-old male with a history of infantile cortical hyperostosis, residual mandibular cortical thickening, gross motor developmental delay, and moderate acute malnutrition presented with severe ECC involving multiple cavitated dentinal lesions. Caries burden was assessed clinically using dmft criteria. Radiographic evaluation demonstrated diffuse mandibular cortical thickening without evidence of odontogenic infection. Considering high caries risk, extent of disease, limited cooperation, and systemic status, full-mouth rehabilitation under general anesthesia was undertaken. Treatment included glass ionomer restorations in posterior teeth, anterior composite restoration, extraction of a non-restorable molar, pit and fissure sealants, and topical fluoride application. Multidisciplinary preoperative assessment included evaluation of airway status and associated systemic considerations. The procedure was completed uneventfully, with satisfactory immediate postoperative recovery and short-term improvement in feeding. This case highlights the need for individualized, multidisciplinary dental management in children with sequelae of infantile cortical hyperostosis. While full-mouth rehabilitation under general anesthesia was successfully performed in this instance, findings from a single case should be interpreted cautiously. Further evidence is required to establish condition-specific dental management protocols.
Preheating resin composites can reduce viscosity and improve handling; however, resin syringes or capsules used in multiple clinical applications may undergo repeated heating and cooling. The purpose of this study was to examine the effect of repeated preheating on the polymerization shrinkage kinetics and microhardness of resin composites. Three capsule-type nanohybrid resin composites, Filtek Z350 XT (FZ), Estelite Sigma Quick (ESQ), and EsCom250 (EC), were tested under three conditions: non-heated, one-cycle preheating, and five-cycle preheating. Under the one-cycle preheating condition, the specimens were preheated once before curing. Under the five-cycle preheating condition, the specimens underwent five preheating cycles before curing, with cooling to room temperature between cycles. Preheating was performed using a composite warmer set to 55 °C. The polymerization shrinkage strain, maximum shrinkage rate, and time to maximum shrinkage rate were measured using a real-time displacement-based system. The Vickers microhardness was measured on the upper and lower specimen surfaces after 24 h of water storage. Data were analyzed using two-way analysis of variance (ANOVA) with material type and preheating conditions as fixed factors, including their interactions. Post hoc comparisons were performed for each material when appropriate. Two-way ANOVA showed significant material × preheating-condition interactions for polymerization shrinkage strain and maximum shrinkage rate, but not for time to maximum shrinkage rate or upper- or lower-surface Vickers microhardness. Within-material comparisons showed that the preheating conditions significantly affected the shrinkage strain in the FZ and EC, the maximum shrinkage rate in all three materials, and the time to maximum shrinkage rate in the ESQ and EC. Five-cycle preheating reduced the maximum shrinkage rate in all materials and delayed the time to reach the maximum shrinkage rate in ESQ and EC. Preheating did not reduce the Vickers microhardness of the upper or lower surfaces of any of the materials. Within the limitations of this in vitro study, one-cycle preheating produced limited, material-dependent changes in polymerization shrinkage kinetics and did not reduce Vickers microhardness. Five repeated preheating cycles altered the shrinkage kinetics in a material-dependent manner but did not reduce the Vickers microhardness.
Pediatric liquid medications may adversely affect the surface properties of dental tissues and restorative materials. This study assessed the effect of amoxicillin and azithromycin suspensions on the surface roughness of primary enamel, Cention N, and resin-modified glass ionomer (RMGI). A total of 90 specimens were included in this study: 30 primary enamel specimens, 30 Cention N specimens, and 30 RMGI specimens. Each substrate group was further subdivided into three subgroups (n = 10) according to the immersion medium: amoxicillin suspension, azithromycin suspension, or artificial saliva. Surface roughness (Ra) was measured using a contact profilometer at baseline and after completion of three consecutive 7-day immersion cycles separated by 2-day intervals. The cumulative exposure times were 126 min for amoxicillin and 42 min for azithromycin. Data were analyzed using IBM SPSS software. Normality was assessed using the Shapiro-Wilk test, and statistical analysis was performed using paired t-test, one-way ANOVA, and two-way ANOVA, with the level of significance set at p ≤ 0.05. Both amoxicillin and azithromycin suspensions significantly increased surface roughness compared with artificial saliva (p < 0.001 and p = 0.001, respectively), with no significant difference between the two antibiotics (p = 0.999). In all material groups, both suspensions significantly increased surface roughness, whereas artificial saliva caused no significant change. Primary enamel showed a significantly lower increase in surface roughness than both Cention N and RMGI. Both amoxicillin and azithromycin pediatric suspensions increased the surface roughness of primary enamel, Cention N, and RMGI under the conditions of this in vitro study. Although azithromycin showed an alkaline pH, the comparable roughening effects of the two antibiotics suggest that surface changes may be influenced by multiple factors, including formulation characteristics and cumulative exposure time.
This study characterized the expression profile of miR-153-3p in deciduous pulpitis in children, validated its role in regulating inflammation, oxidative stress, and apoptosis via PTEN targeting, and evaluated its biomarker and therapeutic potential. In a prospective design, pulp tissue was collected from 180 children with deciduous-tooth pulpitis (mild, moderate, or severe) and 180 caries-free controls. qRT-PCR was used to quantify miR-153-3p and PTEN expression, VAS pain scores were recorded, and ROC analysis was performed. An LPS-induced inflammatory model (5 µg/mL, 24 h) was established in human dental pulp stem cells, which were transfected with miR-153-3p mimic or PTEN overexpression plasmid. Cell viability, apoptosis, inflammatory cytokines, and oxidative stress markers were subsequently assessed, and correlations among miR-153-3p, VAS, and PTEN were evaluated. miR-153-3p was significantly downregulated in inflamed pulp and inversely correlated with disease severity and VAS score (r = - 0.323, P < 0.001), with an ROC AUC of 0.814. LPS suppressed miR-153-3p and elevated PTEN in a concentration- and time-dependent manner. miR-153-3p upregulation restored viability, reduced apoptosis, decreased cytokine release, increased SOD activity, and lowered MDA content. Dual-luciferase assays confirmed PTEN as a direct target, and PTEN overexpression reversed the protective effects of miR-153-3p. These findings indicate that miR-153-3p downregulation is associated with inflammation severity, and that miR-153-3p attenuates LPS-induced cellular responses by inhibiting PTEN. Its utility in assessing tissue inflammation and potential as a therapeutic target warrant further in vitro and in vivo validation.
To compare orthodontic bracket failure rates with and without primer in patients undergoing fixed appliances treatment. This split-mouth randomized controlled trial was conducted on 42 participants. Diagonal quadrants were randomly assigned to either the primer (control) or non-primer (experimental) group. Allocation was concealed in opaque envelopes and revealed at the time of intervention. Both genders, aged 12-30 years, and visiting for the management of malocclusion were included. Patients with dental anomalies, caries, or restorations were excluded. The direct bonding technique was used for the placement of conventional metallic brackets. Participants were followed up for six months, with monthly visits, and bracket failure within each group was recorded. Generalized estimating equation logistic regression was used to account for clustering of multiple attachments within participants and to estimate odds ratios. A total of 42 participants contributing 840 orthodontic attachments were analyzed over six months. Mean age was 17.81 ± 4.09 years, and 52.4% were female. Monthly attachment failure rates were low in both groups, ranging from 3.8% to 4.3% in the primer group and 3.6% to 6.0% in the non-primer group, with no significant unadjusted differences at any month. In multivariable generalized estimating equation analysis, bonding method was not significantly associated with attachment failure (non-primer vs primer: OR = 1.24, 95% CI = 0.72-2.13; p = 0.435). Male participants (OR = 2.31, 95% CI = 1.28-4.18; p = 0.005) and those aged ≤ 17 years (OR = 2.18, 95% CI = 1.22-3.91; p = 0.008) had significantly higher odds of failure. Failure risk declined modestly over time (OR = 0.95, 95% CI = 0.92-0.99; p = 0.028). No significant interaction effects were observed. Over a six-month follow-up period, omission of primer did not significantly increase orthodontic bracket failure rates. Male participants and younger patients showed a higher risk of bracket failure, irrespective of bonding method.