Oral Health in Children: Clinical Management

Background: The treatment of cavitated lesions has evolved with minimally invasive dentistry (MID), whereby we can leave demineralized enamel that could potentially be remineralizable with the use of materials such as resin-modified glass ionomer cements (RMGICs) that allow these lesions to be repaired and remineralized while removing less tooth tissue. The aim of our study was to compare the influence of aging on adhesion to sound enamel, demineralized enamel, and the healthy dentin of five RMGICs (Vitremer^®, ACTIVA BioACTIVE Restorative, Riva LC, Ionolux^®, and GC Fuji II LC) and fluoride release. There are currently no studies on adhesion in demineralized enamel. Method: A total of 1035 bovine incisors were analyzed in 45 groups of 23 teeth each. The groups were established based on three factors: time (24 h, 1 month, and 3 months); substrate (sound enamel, demineralized enamel, and healthy dentin); and type of material. In each group, 20 samples underwent shear bond strength (SBS) and fracture type analysis. Adhesive interfaces were observed in three samples from each group using field emission scanning electron microscopy (FESEM). Daily and cumulative fluoride release rates were calculated. Results: Adhesion improved over time on both demineralized and sound enamel. ACTIVA BioACTIVE Restorative had the highest SBS values (33.63 ± 10.69 MPa), and Vitremer^® had the lowest (4.10 ± 4.63). Most fractures were adhesive. Vitremer^® and Ionolux^® showed the highest daily and cumulative fluoride release rates (Vitremer daily (24 h): 225.30 ± 26.28 ppm/g; Vitremer cumulative (30 days): 635.99 ± 305.38 ppm/g; Ionolux daily (24 h): 207.59 ± 48.43 ppm/g; Ionolux cumulative (30 days): 501.21 ± 138.71 ppm/g) and ACTIVA BioACTIVE Restorative showed the lowest (ACTIVA daily (24 h): 10.50 ± 0.85; ACTIVA cumulative (30 days): 39.10 ± 2.16). Conclusions: ACTIVA BioACTIVE Restorative was the material with the best adhesion values on all substrates and at all times, but it showed the lowest fluoride release rates. Full article

Background and Objectives: Cone Beam Computed Tomography (CBCT) offers high-resolution, three-dimensional imaging for detecting apical periodontitis (AP) and evaluating the technical quality of endodontic treatments. This study aimed to investigate the diagnostic value of CBCT in identifying endodontic failures and periapical lesions and to explore the clinical patterns associated with these findings in a Romanian patient cohort. Materials and Methods: A retrospective study was conducted on 258 patients (with 876 root canal-treated teeth), all of whom underwent CBCT imaging between October 2024 and April 2025 at a private radiology center in Craiova, Romania. Of the 876 treated teeth, 409 were diagnosed with apical periodontitis. Patients were present for endodontic treatment at the Endodontics Clinic of the Faculty of Dentistry, University of Medicine and Pharmacy of Craiova. With the patients’ consent, 3D radiological examinations were recommended for better case planning and accurate diagnosis. The periapical status and technical parameters of root canal fillings were assessed using the CBCT-PAI index and evaluated by three calibrated observers. Associations with demographic, clinical, and behavioral factors were statistically analyzed. Results: Apical periodontitis was detected in 46.69% of the teeth examined during the study period, with CBCT-PAI score 3 being the most prevalent. Poor root canal obturation quality (underfilling, overfilling, and voids) was significantly associated with periapical pathology. Chronic lesions were more common than acute ones, especially in older patients. The number of teeth with endodontic treatments and no AP, as well as the number of teeth with AP, was significantly lower for patients with acute AP, indicating the more severe impact of chronic AP on the patients’ oral health status. CBCT allowed the precise localization of missed canals and assessment of lesion severity. Conclusions: Within the limits of a retrospective, referral-based cohort, CBCT aided the detection of periapical pathology in root canal-treated teeth (46.69%). These findings do not represent population-based rates but support the selective use of CBCT, in line with current ESE guidance, for complex cases or when conventional imaging is inconclusive. Full article

Background/Objectives: Caries risk assessment is essential for the management of dental caries. There are different assessment methods with the most commonly used being CAMBRA, the Cariogram, and Caries Risk Semaphore (CRS). The aim of this study was to determine the diagnostic agreement between the three different caries risk assessment methods mentioned above. Methods: This study was conducted in the Dental Clinic of the University of Valencia by Preventive and Community Dentistry II students on patients examined during clinical practices (n = 672). Patients were evaluated to determine their caries risk using the three methods named above. A descriptive analysis of the sample was performed, and diagnostic agreement was assessed using the Kappa coefficient. Results: According to CRS, 321 patients (48%) showed high risk, 96 patients (14%) moderate risk, and 255 (38%) low risk. The highest diagnostic agreement was found between CRS and CAMBRA, with an unweighted Kappa of 0.36. Regarding risk severity assessments, the highest Kappa was also observed between CRS and CAMBRA, with a Kappa of 0.46 for low risk, 0.14 for moderate risk, and 0.40 for high risk. Conclusions: There is an important heterogeneity in the obtained results. This highlights the need to further study different caries risk assessment methods and determine their predictive capacity to choose the one that yields the best outcome. Full article

Background/Objective: The taste perception of clinical materials used in dental treatment procedures can influence the compliance of autistic children during dental visits due to their heightened anxiety and sensory processing difficulties. This study aimed to evaluate the taste acceptance of different fluoride varnish preparations among children with autism spectrum disorder (ASD) in a clinical setting. Methods: This parallel-arm single-blinded randomized clinical study included autistic children aged 6–14 years, referred to a community dental clinic unit for preventive dental care. Non-verbal behavior, as a measure of taste acceptance, was assessed using the Frankl behavior rating scale. Additionally, subjective taste responses were recorded using a 3-point facial hedonic scale. Data were analyzed using descriptive statistics and the chi-square test. Results: There was no statistically significant difference in non-verbal behavior between the three fluoride varnish groups before application (p = 0.094) or immediately after application (p = 0.718). However, when comparing pre- and post-application responses within each group, Duraphat^® showed a significant improvement in non-verbal behavior (p = 0.020), while no significant changes were observed for Profluorid^® (p = 0.196) or MI Varnish^® (p = 0.704). Subjective taste acceptance, as measured by the 3-point facial hedonic scale, showed no significant differences among the varnish groups (p = 0.406). Conclusions: Flavored fluoride varnishes may improve the compliance of autistic children with preventive oral care procedures. Although no significant differences in taste acceptance were observed among the three varnishes, Duraphat^® was associated with a significant improvement in non-verbal positive behavior, suggesting a more favorable response in autistic children. Full article

Background: Dental caries remains one of the most widespread chronic diseases that also affects first permanent molars (FPMs). In this study, we analyzed the prevalence of carious lesions using a standardized evaluation system, while following the analysis of the influence of favoring factors represented by the type and frequency of snacks and the frequency of tooth brushing. Method: A clinical–statistical study was carried out on a group of 311 children from both urban and rural environments, aged between 6 and 19 years old. As a diagnostic system and assessment of the depth of carious processes, we used the ICDAS system. The following parameters were recorded: odontal status of the 4 FPMs, age, gender, residence, frequency of dental brushing, and frequency of between-meal snacks and their type. The ICDAS system was used as a diagnostic system and assessment of the depth of carious processes. The data were statistically analyzed with SPSS, using the Kruskal–Wallis H and Chi-Square tests. Results: The occlusal surface was the most interesting in the presence of odontal lesions. Sweet snacks were the most frequent snacks consumed by the subjects. The age group of 13–19 years presented fewer healthy FPMs, compared to the age group of 6–12 years. The higher involvement of older subjects was found for all four molars, both in the case of identified carious lesions and the presence of root debris and edentations. Brushing twice a day was more frequent in the 6–12 age group. In analyzing the status of the first molars in relation to the gender of the subjects, in the present study, no statistically significant differences were recorded between the status of the molars relative to gender, except for molar 1.6 (p > 0.05). Regarding the other types of snacks, children from rural areas consume more fruits than those from urban areas. Conclusions: The frequency of tooth brushing and the type and frequency of snacks between meals influence the prevalence of carious lesions at the level of the first permanent molars. Full article

Background/Objectives: Dental caries is one of the most prevalent chronic diseases in childhood. Rotary bur handpiece excavation has been the standardised mechanical benchmark for infected dentine removal in the primary dentition, but it is associated with noise, vibration, and nociceptive triggers that influence behavioural cooperation in paediatric patients. CMCR gels have been developed for selective softening and excavation of infected primary dentine without macroscopic removal of adjacent sound tissue at the protocol-defined site. The objective of this review was to systematically synthesise the evidence on chemomechanical caries removal (CMCR) using Papacarie or Brix 3000 compared with infected dentine excavation using rotary bur handpiece instrumentation in the primary (deciduous) dentition, focusing on excavation effectiveness, paediatric procedural tolerance, anaesthetic requirement, dentine surface morphology at the excavation interface, and protocol-level operative duration per primary molar. Methods: A systematic search was performed in PubMed, Web of Science, and Scopus for English-language studies from database inception to 31 December 2023. Although no eligible paediatric dental records addressing CMCR gels for excavation of infected primary dentine were identified before 2009, the earlier literature was not intentionally excluded; rather, it did not retrieve topic-specific matches meeting the eligibility criteria. Clinical and in vitro investigations evaluating CMCR gels (Papacarie or Brix 3000) for excavation of infected primary dentine in primary molars were eligible. Outcomes were aggregated qualitatively by excavation approach and reported per primary molar at the individual study protocol level. Quantitative pooling or meta-analysis was not conducted due to heterogeneity in study designs and lack of unified denominators across the included literature. Results: Fifteen studies were included (randomised clinical trials, observational clinical investigations, clinical comparative studies, and in vitro assessments) evaluating infected dentine excavation in primary molars. CMCR gels achieved successful excavation of infected primary dentine with dentine preservation at the adjacent non-infected interface without macroscopic loss of sound tissue. Individual study protocols that reported paediatric pain outcomes during primary-molar excavation registered lower pain scores, reduced acoustic/vibratory stress, lower anaesthetic escalation cycles, and decreased local anaesthesia requirement per primary molar compared with rotary bur handpiece excavation arms. Dentine surfaces analysed under SEM protocols at the infected excavation interface described patent tubules, absence of compacted smear at the interface, preserved intertubular dentine, and no iatrogenic gouging or macrofracture of non-infected primary dentine per molar at the individual study level. Operative duration for CMCR ranged from 10 to 25 min per primary molar per tooth, while rotary bur handpiece excavation required 3–10 min per primary molar per tooth, depending on cavity extension and dentine hardness, as defined by each study protocol. Microleakage and bond-strength assays performed in vitro at the individual protocol level did not register disadvantage signals traceable to adhesive or sealing incompatibility following CMCR gel excavation per primary molar. Conclusions: CMCR with Papacarie or Brix 3000 enables protocol-level selective excavation of infected primary dentine in primary molars, reducing acoustic, vibratory, and nociceptive triggers that influence behaviour and local anaesthetic requirement per primary molar. Clinical inference should be restricted to infected dentine excavation per primary-molar denominators, avoiding extrapolation to all caries depths or all deciduous-tooth types. Standardised paediatric primary-molar infected dentine excavation trials with homogeneous denominators, bias-controlled outcome instruments, and longitudinal follow-up are required to strengthen cavity-depth indications, pulp-proximal excavation reliability, and restorative longevity guidance in the primary dentition clinical workflow. Full article

Background/Objectives: Children’s unique physiological and behavioral needs require individualized treatment planning. It seems reasonable to investigate treatment options for recurrent temporomandibular joint (TMJ) dislocation and assess their outcomes. This review was conducted with the purpose of identifying recent therapeutic approaches for TMJ dislocation in pediatric patients and evaluating their effectiveness. Methods: Searches were conducted on 21 September 2025, using BASE, PubMed, and Scopus. The review included studies with measurable outcomes, published between 2000 and 2025, that focused on patients under the age of 18 with recurrent TMJ dislocation. Studies with unclear diagnoses or undefined treatment methods were excluded. Risk of bias was evaluated using the Joanna Briggs Institute’s critical appraisal tool. The results were tabulated. Results: Based on the inclusion criteria, nine studies were included: one case-control study, three case series, and five case reports. Invasive treatment methods applied in pediatric patients were reported in two of those. Minimally invasive and conservative treatment methods were most frequently described, with botulinum toxin injections being the most commonly reported minimally invasive approach. Conclusions: Research revealed that conservative and minimally invasive methods are preferred in pediatric patients’ treatment. Due to the heterogeneity and limited number of available literature, consistent conclusions regarding the effectiveness of different treatment methods for recurrent TMJ dislocation in children could not be drawn. This study received no funding. PROSPERO ID number: CRD420251139493. Full article

Background/Objectives: Dentoalveolar ankylosis in adolescents involves a series of difficulties related to bone growth and development, especially in a vertical manner. A systematic review of studies on ankylosis in young permanent teeth treated by decoronation which considered the preservation/vertical growth of the alveolar bone as their main objective was carried out. Methods: The PRISMA 2020 guidelines were followed. Our research question was formulated using the PICO structure. Clinical cases or a series of cases of ankylosis in which a tooth had been treated with decoronation, with a minimum follow-up of one year, were included. The search was carried out in five databases. The selection of search terms was based on previous works within this framework and their most cited descriptors. The article selection and data extraction were carried out by two investigators. The JBI critical checklist of clinical cases was used for quality assessment. Results: Twelve articles were selected with a total of 23 cases that met the inclusion criteria. The mean age at the time of trauma was 9 years and the mean age at decoronation was 12.5 years. The traumatic event was avulsion in 10 out of the 14 cases. The upper right central incisor represented 62.5% of the sample compared to 25% for the contralateral tooth. The follow-up period ranged from 1 to 10 years. Vertical bone augmentation was found in all cases except in three cases where it remained stable. Conclusions: Based on the results of the present review, it can be concluded that decoronation is an effective technique for maintaining/stimulating vertical bone growth in young ankylosed permanent teeth and that complete root resorption is an important factor associated with vertical bone growth. Full article