搜索结果：Pediatric dentistry

Background: For maintaining specialized dental treatment all year and in remote areas, teledentistry might offer a valuable approach. Aim: To prospectively pilot the feasibility and practicality of pediatric teledentistry during a period of restricted access during the Christmas break 2025/2026. Methods: The organizational and clinical parameters of emergency patients during the Christmas break 2025/2026 were registered for a prospective analysis. Descriptive statistics focused on the feasibility of teledentistry with categorizing treatment as only counseling without further dental contact, postponing to later regular clinic times, immediate acute pain management in-person. Results: Of the twenty-four registered patient contacts (eight female, 33%; age 1-17 years, mean 8.0 ± 3.5), 25% presented with only primary dentition and 62% of the problems addressed primary teeth. Seventy-one percent reported pain as chief complaint, leading to the diagnosis of abscess (21%), normal exfoliation or a remaining root and trauma (17% each), and simple carious defects or teeth without relevant dental pathology (13% each). These diagnoses required a timely emergency treatment in presence (46%), while the other patients could be treated with primary teledentistry consultations only (29%), while 13% received antibiotics initially and later regular treatment and in 13% the in-person diagnostics revealed no relevant dental pathology (13%). The clinical emergency treatment consisted of extractions (17%), fillings (13%) or endodontic treatment (13%). Further treatment need remained for extractions (29%) or treatment under sedation/general anesthesia (8%). Conclusions: Teledentistry was feasible for initial screening or triage during the holiday season. One third of the cases could be reduced to teledentistry as consultation only, leaving a relevant need for emergency services and also follow-up clinical visit in presence at regular practice times.

Background: Bisphenol A (BPA) release from resin-based dental materials is a growing concern due to its potential endocrine-disrupting effects, particularly in pediatric patients. This in vitro study evaluated cumulative BPA release and elution kinetics from commonly used pediatric resin-based materials, due to the limited evidence available. Methods: Three restorative materials (Clearfil Majesty ES-2, Estelite Sigma Quick, and Stela Automix) and one orthodontic material (Transbond XT) were investigated. Eighteen disk-shaped specimens (5.5 mm in diameter and 2 mm in thickness) were prepared for each material and immersed in artificial saliva (pH 6.8) at 37 &#xb0;C for 1, 7, and 28 days. BPA concentrations were quantified using liquid chromatography-tandem mass spectrometry (LC-MS/MS). BPA release kinetics were evaluated during the early (1-7 days) and late (7-28 days) release phases. Results: All investigated materials released measurable BPA concentrations, with cumulative BPA release progressively increasing up to 28 days. Clearfil Majesty ES-2 and Estelite Sigma Quick exhibited the highest cumulative BPA concentrations, whereas Stela Automix showed markedly lower values. Transbond XT also demonstrated measurable BPA release. For all materials, BPA release kinetics were significantly higher during the early phase than during the late phase (p < 0.001), indicating a non-linear release behavior over time. Conclusions: BPA release from pediatric restorative and orthodontic resin-based materials is material-dependent and characterized by progressive cumulative accumulation associated with significantly higher early-phase release rates. These findings highlight the importance of assessing the safety of resin-based materials used in pediatric dentistry.

Background and Objectives: Traumatic dentoalveolar injuries (TDI) in children often require urgent stabilization using splints. Titanium trauma splints (TTS) represent a practical option; however, pediatric evidence from hospital-based emergency settings remains limited. This study describes the clinical and contextual characteristics of children treated with TTS and explores factors associated with early complications and splint stability. Materials and Methods: A retrospective observational cohort study was conducted at a Pediatric Dentistry Service, including children with TDI managed with TTS and followed for a minimum of three months. Clinical records were reviewed to collect demographic, contextual, and clinical variables. Early complications and the need for re-splinting were recorded, and associations between selected variables and outcomes were analyzed. Results: Seventy-three patients (64.4% male; mean age 10.29 &#xb1; 2.99 years) and 127 traumatized teeth (98.4% permanent) were included. A predominance of school-based injuries was observed (52.1%). The most frequent injury types were subluxation (39.1%), avulsion (26.6%), and extrusion (16.4%). A longer interval between trauma and splint placement was associated with inflammatory root resorption (p = 0.011), although this finding should be interpreted with caution given the limited number of events. Mixed-dentition splints showed a higher likelihood of requiring re-splinting (OR = 12.23; 95% CI: 1.18-126.60); however, this estimate was imprecise and should be interpreted as an exploratory signal. Overall, 90.4% of patients completed treatment with a single splint. Conclusions: Within the limitations of this retrospective observational cohort, TTS showed satisfactory short-term clinical stability in pediatric traumatic dental injuries. Longer time between trauma and splint placement was associated with inflammatory root resorption, while mixed-dentition splints emerged as a potential signal of increased re-splinting. These findings are exploratory and hypothesis-generating and require confirmation in future studies.

Background: While region-based models have informed pain neuroscience, chronic pain is now increasingly conceptualized as a network disorder. This narrative review aimed to critically examine the conceptual evolution of chronic pain models from region-based representations toward large-scale functional network frameworks across adult and pediatric populations while exploring how emerging artificial intelligence (AI)-driven approaches may support future precision pain medicine. Methods: A structured literature search was performed in PubMed, Scopus, and Web of Science, focusing on the scientific output addressing adult and pediatric chronic pain, pain-related neuroplasticity, functional network alterations, neuromodulation, and AI-based applications in pain medicine. Results: The reviewed literature supports a progressive conceptual shift from region-based representations of pain toward network-oriented models involving dysfunctional interactions among the salience, default mode, central executive, and sensorimotor networks. Although emerging evidence suggests developmental network alterations in pediatric chronic pain, current conclusions remain limited by the relative scarcity of longitudinal neuroimaging studies. Emerging AI applications demonstrate promising potential for objective pain assessment, trajectory prediction, and personalized therapeutic decision-making. Conclusions: The transition from the pain matrix to functional network models represents one of the most important conceptual advances in contemporary pain neuroscience. A network-based perspective may accelerate AI-enabled pain biomarkers and individualized interventions.

Background and Objectives: Pediatric keratoconus may progress rapidly, and treatment decisions are often made before prolonged observation is possible. This study evaluated 24-month visual, tomographic, pachymetric, and biomechanical outcomes after conventional epithelium-off corneal collagen cross-linking (CXL) using Pentacam tomography and Corvis ST dynamic Scheimpflug analysis. Materials and Methods: This single-center observational longitudinal cohort included 28 eyes of 23 patients aged 13-18 years treated at the OCULENS Clinic, Cluj-Napoca, Romania, between 2019 and 2023. Because the study had no untreated or alternative-treatment control group, postoperative changes were interpreted as associations after CXL rather than as proof of causality. Baseline, 6-, 12-, and 24-month values were analyzed for UCVA, BCVA, Kmax, thinnest pachymetry, SP-A1, deformation amplitude (DA), first and second applanation times (A1T and A2T), highest concavity (HC) radius, and BAD-D. Repeated-measures ANOVA was used after assessment of within-eye difference normality; findings were interpreted cautiously because the analysis was eye-based, the cohort was small, and multiple outcomes were examined. Results: UCVA improved from 0.53 &#xb1; 0.16 to 0.44 &#xb1; 0.16 logMAR and BCVA from 0.31 &#xb1; 0.11 to 0.25 &#xb1; 0.11 logMAR (both p < 0.001). Mean Kmax decreased modestly from 54.36 &#xb1; 3.11 D to 53.41 &#xb1; 2.79 D, while SP-A1 increased from 84.69 &#xb1; 4.75 to 97.39 &#xb1; 5.11 (both p < 0.001). Thinnest pachymetry showed early postoperative thinning followed by partial recovery by 24 months. DA decreased, A1T increased, A2T decreased, HC radius increased, and BAD-D decreased significantly. Kmax and SP-A1 were inversely correlated at all visits (r = -0.714 to -0.773; all p < 0.001), but these correlations were considered exploratory. Post-24-month retreatment and keratoplasty-related events were recorded descriptively and were not included in the formal 24-month model. Conclusions: Within the prespecified 24-month analytic window, conventional epithelium-off CXL was associated with stabilization, modest visual and tomographic improvement, and a concordant biomechanical stiffening signal. The results should be interpreted as cautious observational findings rather than definitive evidence of long-term stability, because of the small sample, eye-level analysis, absence of a control group, limited follow-up, and lack of formal repeatability testing.

Background and Objectives: Oral health is an important component of overall health, including in children, since dental caries is the most frequent oral health condition in this demographic. It affects children's daily performance and can lead to complications ranging from moderate discomfort to highly disabling problems, which are reflected in their quality of life. Validating instruments that provide reliable information to measure how oral health impacts children's quality of life will help prioritize the management of these problems through personalized treatments. The aim of this study was to perform transcultural adaptation and Spanish validation of a POQL instrument in children aged 6 to 12 years who attended the Pediatric Dentistry Clinic at the Universidad Aut&#xf3;noma de Ciudad Ju&#xe1;rez (UACJ), and to establish an association between the presence of carious lesions and the quality of life of children. Materials and Methods: We conducted a validation study involving a sample of 379 children aged 6 to 12 years who were attending the Pediatric Dentistry Clinic at the Universidad Aut&#xf3;noma de Ciudad Ju&#xe1;rez. The instrument, adapted into Spanish, was applied to measure oral health-related quality of life, and the clinical diagnosis of caries was established using the ICDAS II system. Results: The mean age of the children was 8.51 years &#xb1; 1.64; 50.4% were boys and 49.6% girls. A total of 45.9% of the children presented caries with ICDAS II codes 5 and 6, corresponding to a severe stage with advanced tooth destruction, and 52% of the children reported their perception of their oral health-related quality of life as good. In the bivariate statistical analysis, the chi-square test showed no relationship between moderate and severe ICDAS II stages and the children's perception of their quality of life, resulting in a very low Spearman correlation. Conclusions: The findings suggest that this instrument may represent a reliable and valid tool for use in children aged 6 to 12 years. The observed association between different degrees of carious lesions and children's quality of life may reflect the close relationship between oral health and important psychosocial domains, including physical, emotional, and social development, which constitute the core dimensions evaluated by the POQL instrument.

Vitamin C deficiency also known as scurvy, can present with musculoskeletal pain, gingival bleeding, oral discomfort, and impaired mobility. Children with Autism Spectrum Disorder (ASD) are at increased risk of vitamin C and other nutritional deficiencies due to sensory sensitivity and food selectivity. This report aims to describe two pediatric patients with nonverbal ASD who presented with oral and systemic symptoms. These cases highlight the importance of obtaining a detailed dietary history and complete examination when evaluating unexplained oral bleeding, gingival inflammation, and limb pain in children with ASD. Interdisciplinary collaboration among pediatric medicine, dentistry, and specialists is essential to ensure timely diagnosis and avoid unnecessary interventions. Increased clinical awareness of nutritional deficiencies and their oral manifestations can improve outcomes and reduce diagnostic delays in this vulnerable population.

To assess whether personality styles vary across student and professional cohorts in dentistry, using psychology controls. A total of 249 dental students and 162 practicing dentists were compared with 160 psychology students and 430 psychotherapists. All participants completed the Personality-Styles-and-Disorders-Inventory (PSDI). Fourteen personality styles were analyzed across disciplines and career stages. MANOVA with post-hoc-tests showed significant differences among the four groups (dental and psychology students and professionals). Both student groups showed strong fluctuations around the normative mean, indicating higher emotional levels and peaks in stress-dependent styles. Dental students showed signs of severe stress and burnout tendencies. Their depression scores were highest, while optimism was lowest. Professionals generally showed lower values than students, often below the norm, indicating "functional adaptation" and professional stability. Psychotherapists showed the most balanced profile with the lowest values. Dentists remained moderately higher than psychotherapists, indicating higher stress. Their most distinctive characteristic was "compulsiveness", reflecting precision and perfectionism, already elevated during training and increasing in practice. While psychotherapists developed from higher stress levels during their studies to a balanced profile, dentists maintained higher stress and increased their perfectionism. Dentists demonstrate stronger tendencies towards precision and perfectionism than psychologists, who show greater flexibility and openness. Professionalization appears associated with adaptive personality style, although compulsive tendencies in dentistry remain elevated and may increase with clinical experience. These findings suggest an interplay between pre-existing dispositions and occupational socialization. Longitudinal studies are needed to clarify whether these differences are present before training or arise during professional practice. Insights into the differences in personality styles between dental students and dentists may inform dental education and prompt further research on dentist-patient relationships and treatment outcomes.

First permanent molars (FPMs) erupt early and remain exposed to the oral environment for prolonged periods, making them particularly susceptible to dental caries, molar-incisor hypomineralization (MIH), restorative failure, and repeated restorative intervention. When long-term prognosis becomes unfavorable, extraction may represent a biologically appropriate treatment option. Favorable spontaneous eruptive adaptation of the second permanent molar (SPM) has been associated with several radiographic and developmental variables. This retrospective radiographic study evaluated demographic and panoramic radiographic parameters associated with favorable eruption potential of SPMs in children with indicated FPM extraction and investigated whether established radiographic conditions were present at the time extraction decisions were made. Following ethical approval, panoramic radiographs of 500 pediatric patients presenting with extraction-indicated FPMs (n&#x2009;=&#x2009;712) were retrospectively evaluated. Demographic characteristics, dentition stage, number and location of affected FPMs, and extraction indications were recorded. Radiographic assessment included evaluation of SPM developmental stage according to Demirjian classification, SPM angulation, and presence of a third permanent molar (TPM) germ. Statistical analyses were performed using SPSS version 29.0. Descriptive statistics, chi-square tests, and multivariable logistic regression analyses were applied, with statistical significance established at p&#x2009;<&#x2009;0.05. The mean age of the study population was 128.39&#x2009;&#xb1;&#x2009;22.11 months; 54.6% were girls and 45.4% boys. Extensive carious destruction (91.4%), repeated treatment interventions, severe structural breakdown, and MIH-related defects represented the principal indications for extraction. Radiographically, 17.6% of SPMs were classified as Demirjian stage E and 27.4% as stage F. Mesial angulation was observed in 55.2% of cases, while a TPM germ was present in 74.2%. However, only 12.8% of cases (62 patients, 91 teeth) fulfilled all predefined radiographic conditions associated with favorable eruption potential following FPM extraction. Radiographic conditions associated with favorable eruption potential of SPMs were present in only a limited proportion of cases at the time FPM extraction decisions were established. These findings highlight the discrepancy between theoretically favorable developmental timing conditions and the clinical realities of pediatric dental practice, where extraction is frequently necessitated by advanced structural disease. Systematic radiographic evaluation of SPM developmental stage, angulation, and TPM germ presence should therefore be incorporated into individualized treatment planning.

Purpose: To provide an evidence-calibrated, time-bound clinical framework for using 38% silver diamine fluoride (SDF) as interim stabilization for severe early childhood caries (SECC) in young children, addressing gaps in existing guidelines regarding treatment duration, exit criteria, equity, and system accountability. Methods: This framework was developed from the American Academy of Pediatric Dentistry (AAPD) guidance (2017-2025), the 2024 Cochrane review, real-world utilization studies, and a narrative review proposing a preservation-to-precision heuristic. Recommendations are expressed using GRADE terminology. Results: The framework includes ten recommendations, a systems drift principle, explicit time thresholds (<6 months, 6-12 months, >12 months), a 12-month reassessment mandate, equity guardrails, a bridge vs. destination consent model, and a future research agenda. A clinical vignette contrasts appropriate short-term bridging with prolonged temporization due to access barriers. Conclusions: SDF is conditionally recommended for caries arrest in primary teeth. In children with SECC, SDF should be used within a documented, time-bound preservation-to-precision pathway. SDF should not become an open-ended substitute for definitive restorative care. Explicit equity implementation prevents the framework from penalizing underserved children.

Intermittent hypoxia, which is a characteristic of obstructive sleep apnea can impair mandibular growth during early development, particularly in infants. This study aimed to investigate gene expression profiles associated with mandibular cartilage growth in infant male rats exposed to IH modeling pediatric OSA. Eight-day-old male Sprague-Dawley rats were subjected to either normoxic air or IH and sacrificed after 1 week. Mandibular growth was evaluated using micro-computed tomography and histomorphometry. RNA sequencing examined differential gene expression in bone and cartilage. IH caused mandibular growth deficits, including reduced total cartilage thickness in the mid- and posterior mandibular condylar regions. Comparative measurements between IH and normoxia showed thinning of all cartilage layers in these regions under IH. In contrast, the anterior region exhibited thicker proliferative and maturative layers but a thinner hypertrophic layer under IH. RNA sequencing identified 342 upregulated and 45 downregulated genes in the IH group, including key regulators of bone and cartilage metabolism, such as gremlin-2, fibroblast growth factor 2, insulin-like growth factor binding protein 2, interleukin-1B, bone gamma-carboxyglutamate protein, wingless-related integration site 2, and SRY-box transcription factor 11. These findings suggest that IH alters expression of critical genes in mandibular cartilage development, potentially contributing to growth deficits.

Dental caries remains the most prevalent chronic disease worldwide, yet early enamel lesions are reversible if managed with appropriate remineralizing agents. This narrative review synthesizes current evidence on remineralizing agents, their mechanisms of action, and clinical applications, with a focus on dental materials used in preventive and minimally invasive dentistry. Traditional fluoride-based approaches enhance remineralization through fluorapatite formation; however, their effectiveness is limited when calcium and phosphate bioavailability is insufficient. Biomimetic agents, including casein phosphopeptide-amorphous calcium phosphate (CPP-ACP), bioactive glasses, tricalcium phosphate, and nano-hydroxyapatite, provide these bioavailable ions and demonstrate superior performance under challenging clinical conditions. Emerging therapies such as probiotics, photodynamic therapy, and laser-assisted mineralization show promise but require further clinical validation. Based on the primary mechanism of action, an original classification of remineralizing agents is proposed, grouping them into fluoride-based agents, calcium-phosphate systems, nanotechnology-based systems, biofilm modifiers, biomimetic and emerging systems, and adjunctive antimicrobial therapies. The review concludes that bioavailable calcium represents a critical limiting factor in remineralization under certain conditions, and that combination protocols incorporating multiple remineralizing agents, tailored to individual patient risk profiles, achieve superior outcomes compared to single-agent approaches. Clinicians are encouraged to adopt minimally invasive, patient-tailored remineralization strategies that arrest lesions before cavitation, preserving natural tooth structure and reducing the lifelong restorative burden.

Apexification is a widely employed procedure for managing immature permanent teeth with necrotic pulps, utilizing calcium hydroxide (Ca(OH)&#x2082;) and iodoform combinations for canal disinfection and apical barrier formation. While these medicaments are effective, prolonged placement due to missed follow-up appointments may predispose to intracanal calcification, complicating subsequent canal negotiation and obturation. This case series reports three pediatric patients who presented with pain in mandibular permanent first molars exhibiting immature apices (Cvek's stage 4) and periapical radiolucencies. All patients had previously undergone apexification with a Ca(OH)&#x2082;-iodoform medicament (Metapex, Meta Biomed Co. Ltd., Cheongju, Korea) but missed scheduled follow-up appointments, reporting after six to 10 months. At recall, clinical symptoms had subsided, and radiographs showed healing of the periapical lesions. However, during re-instrumentation, extensive intracanal calcifications and calcific barriers were observed in the apical third, obstructing complete canal negotiation and interfering with working length determination. This case series emphasizes the importance of strict follow-up compliance and cautious monitoring when employing long-term intracanal medicaments in pediatric endodontics.

Remaining Root Dentin Thickness (RRDT) after root canal instrumentation is an important parameter to be assessed with newer file systems. This study aimed to evaluate the root dentin thickness following instrumentation of primary molar root canals using manual or pediatric rotary file systems. Fifty-one extracted human primary molars were prepared with access cavity preparation and working length determination. Preliminary Cone Beam Computed Tomography (CBCT) images were obtained with specimens mounted on vinyl polysiloxane templates. Root dentin thickness was measured at three predetermined levels. 51 mesiobuccal canals were randomly divided into 3 groups of 17 each. After instrumentation using the allocated file system i.e. Group 1 - Manual K files; Group 2 - Kedo SG Blue and Group 3 - Kedo S Square rotary files, CBCT images of the specimens were obtained. The remaining root dentin thickness was obtained using measurements of pre-and post-instrumentation CBCT. Data was analysed using paired t-test for intragroup comparisons. Intergroup comparison of RRDT was done using ANOVA. The Remaining Root Dentin Thickness (RRDT) after instrumentation did not differ significantly among the three study groups at the three predetermined levels (p&#x2009;>&#x2009;0.05). Kedo S Square and Kedo SG Blue file systems showed comparable effectiveness to the manual K file system in the instrumentation of mesiobuccal canals of primary molars.

Systemic antibiotics are among the most widely prescribed therapeutic agents worldwide, and their effects on host-microbe equilibrium extend well beyond the infection for which they are intended. Periodontitis is conventionally framed as a biofilm-initiated, host-mediated inflammatory disease, although recent work has shifted this framework toward microbial homeostasis as a regulator of periodontal stability. We hypothesize that antibiotics are not direct etiologic agents of periodontitis but instead act as risk-modifying factors that lower the threshold at which plaque-mediated inflammation progresses to destructive disease. We propose that this effect may operate through several mechanisms: broad-spectrum or repeated exposure could deplete protective commensals and narrow microbial diversity, creating ecological space for opportunistic and pathogenic taxa; antibiotics may also alter host neutrophil function, cytokine profiles, and antimicrobial peptide regulation and may interfere with the osteoblastic and osteoclastic dynamics governing alveolar bone remodelling; and antibiotic-induced gut dysbiosis may propagate systemic inflammatory signals that further modulate periodontal susceptibility. To evaluate this hypothesis, we synthesize the available clinical, epidemiological, and experimental data across four converging axes-oral microbial ecology, immune regulation, alveolar bone remodelling, and the gut-oral axis-and identify the predictions the hypothesis generates and the evidence gaps it exposes. We emphasize that no clinical study has yet demonstrated a causal link between antibiotic exposure and periodontitis; the framework advanced here is therefore intended to inform antimicrobial stewardship in dentistry and to define a research agenda for determining whether antibiotic exposure constitutes a clinically meaningful modifier of periodontal disease susceptibility.

The paediatric dentistry domain requires effective management of pain in children during invasive procedures such as the inferior alveolar nerve block (IANB). This study aimed to evaluate the effectiveness of Buzzy BEETM in reducing pain perception during IANB in children. This crossover study recruited 38 children aged 6-10 years scheduled for bilateral dental procedures requiring IANB. The washout period was 7 days, and two visits were scheduled for procedures on either side. Two randomly allocated groups received the study intervention, with each group receiving it alternately at each visit. Outcomes measured were pulse rate; subjective pain assessment using the Wong-Baker FACES Rating Scale (WBS); objective pain assessment using the Sound, Eyes and Motor (SEM) scale; and parental rating of observed pain on a scale of 1-10. A statistically significant reduction in pulse rate after IANB was observed in the Buzzy BEE group at the first (p = 0.02) and second (p = 0.002) visits. At the second visit, the WBS scores (p < 0.001) and 'eye' (p = 0.004) and 'motor' (p = 0.002) scores on the SEM scale were significantly reduced in the Buzzy BEE group. The crossover analysis identified a significant treatment effect on pulse rate (p < 0.001) and significant carryover effects on WBS and SEM scores (p < 0.001). The use of Buzzy BEE reduced pulse rates during IANB, suggesting a positive impact on children's anxiety. The carryover effects in the current study limit the consistency of improvements in subjective and objective pain perceptions. Further studies with a larger sample size and an extended washout period are recommended to evaluate the effectiveness of Buzzy BEE in reducing pain perception during IANB.

Introduction Knowledge and attitudes toward oral health, shaped by personal experiences, social context, family traditions, life events, and health education programs, are fundamental determinants of oral health behaviors. This relationship is mediated by beliefs, values, and skills, whereby individuals with sufficient knowledge and positive attitudes are more likely to engage in effective self-care practices.&#xa0; Aim This study aims to assess the relationship between dental students' oral health knowledge and behaviors and their caries level. Materials and methods The study subjects in this cross-sectional study were 142 fifth-year dental students attending the College of Dentistry, Wasit University, Kut, Iraq. Their data were gathered using a questionnaire that encompassed oral health-related behaviors and validated questionnaires reported in a previous study. Furthermore, caries experience, including decayed, missing, and filled teeth and surfaces (DMFT/DMFS), was recorded for each subject based on the World Health Organization (WHO)-recommended method. The statistical analysis included an independent t-test and bivariate and multivariate Poisson regressions. Results The mean age of the study participants was 23 (&#xb1;1.41) years. Around half of the dental students had low oral health preventive knowledge, brushed their teeth &#x2265;2 times a day, and visited a dentist within the last six months. The analysis showed that there was an association between higher DMFT mean scores and a low level of oral health knowledge (adjusted RR = 1.23; 95% CI: 1.08 to 1.41) and undesirable oral health behaviors, especially among students who did not floss once a day (adjusted RR = 1.30; 95% CI: 1.07 to 1.57). Conclusion The findings of this investigation demonstrated the positive effects of oral health knowledge and desirable oral health behaviors on the caries level of dental students.

Dental anxiety represents a major challenge in paediatric dentistry and is a frequent cause of non-cooperative behaviour during dental treatment. Nitrous oxide/oxygen inhalation conscious sedation is widely used to reduce anxiety in children, while audiovisual distraction is a non-pharmacological behavioural technique aimed at diverting attention from stressful stimuli. Evidence regarding the combined effect of these two approaches during dental treatment is still limited. This randomized crossover clinical trial included 25 paediatric patients aged 4-7 years with dental anxiety and previous failed attempts at conventional dental treatment. Each child underwent two dental treatment sessions under nitrous oxide/oxygen conscious sedation, one with and one without audiovisual distraction. Anxiety and behaviour were assessed using the Modified Venham Scale and the Facial Image Scale (FIS). Vital parameters were recorded before, during, and after sedation. A significant reduction in heart rate over time was observed in both groups (p < 0.05). In children aged 4-5 years, the combined audiovisual distraction and conscious sedation approach was associated with significantly lower heart rate values compared to conscious sedation alone (p < 0.05). No significant differences were found between the two approaches for behavioural scores assessed by the Venham and FIS scales. Although behavioural scores did not differ significantly, audiovisual distraction contributed to greater physiological stability, particularly in terms of heart rate control. This no-pharmacological approach may complement the pharmacological effects of nitrous oxide sedation by enhancing the overall sense of relaxation and comfort during dental care.