Search Results (185)

Dental diseases have long been taught and treated as separate entities: cariology, operative dentistry, endodontics, and periodontology, each working within its own boundaries. However, increasing biological and clinical evidence suggests that this classified view does not fully reflect how disease progresses in the mouth. Instead, dental disease should be understood as a continuum within the interconnected tooth–pulp–periodontium complex. This review provides current evidence showing how dental caries can serve as the starting point of a process that can progress through pulpitis and apical periodontitis and eventually affect surrounding periodontal tissues. Caries is now widely known as a biofilm-driven and host-influenced condition shaped by ecological imbalance rather than specific pathogens alone. As lesions penetrate deeper into dentin, the structure becomes more permeable, permitting diffusion of microbial metabolites and signaling molecules toward the pulp. This initiates a multifaceted inflammatory reaction within the pulp tissue. At this stage, pulpitis becomes a critical turning point, where the outcome depends on microbial load, lesion activity, host response, and quality of clinical intervention. If the disease is not well controlled, it may lead to pulp necrosis, allowing infection to spread beyond the root canal and initiate periapical inflammation. Through anatomical pathways such as apical foramina and lateral canals, these processes can extend further, sometimes resembling or overlapping with periodontal disease. This overlap creates diagnostic challenges, as conventional tests may not always distinguish between conditions. A structured, pathway-based diagnostic approach is therefore essential. From a treatment perspective, this continuum model highlights early intervention, minimally invasive care, preservation of pulp vitality when possible, and maintenance of a strong coronal seal. Ultimately, stronger integration across dental disciplines can improve diagnosis, guide treatment decisions, support long-term tooth preservation, and promote unified dental education. This article presents a narrative review supported by a structured literature search and proposes a clinically actionable framework that extends established endodontic–periodontal concepts upstream to include caries initiation and restorative modulation. Full article

Objective: The current investigation aims to assess the clinical efficacy of intraoral photographic assessment in detecting dental caries of varying severity and to assess different variables, such as the type of dentition, examiner experience, and the type of imaging equipment, on evaluative clarity. Methods: This meta-analysis of the PRISMA-DTA systematic review and diagnostic test accuracy was conducted. They searched electronic databases such as PubMed, Web of Science, Scopus, Embase, and Cochrane Library from the beginning of time up to January 2025. The studies had to have evaluated intraoral photographic caries because they were required to have compared it with clinical intraoral examination and provide extractable tooth-level 2 × 2 data. Enamel (ICDAS 1 3), dentine (ICDAS 4 6), and any caries (ICDAS 1 6) were analyzed separately in a meta-analysis. A random-effects model was used to compute pooled sensitivity, specificity, diagnostic odds ratio (DOR), and summary receiver operating characteristic (SROC) curves. Subgroup analysis was done on a pre-specified basis according to dentition, type of examiner, and imaging device. This study has been registered in PROSPERO with reference number 2026 CRD420261330820. Results: Twenty-three studies were retrieved through a comprehensive search and were stratified by severity into three categories. In the case of enamel caries, sensitivity was 0.65 (95% CI: 0.62–0.68), specificity was 0.95 (95% CI: 0.94–0.95), DOR was 36.74 (95% CI: 12.44–108.49), and the AUC was 0.87. In the case of dentine caries, the pooled sensitivity and specificity were 0.86 (95% CI: 0.85–0.87) and 0.96 (95% CI: 0.96–0.97), respectively, which produced the DOR of 176 (95% CI: 91.2–339.6) and the AUC of 0.94. Any caries had a pooled sensitivity of 0.81 (95% CI: 0.80–0.83), specificity of 0.97 (95% CI: 0.96–0.97), DOR of 64.04 (95% CI: 11.65–351.94), and AUC of 0.888. Subgroup analyses revealed that diagnostic accuracy was greater when the lesions were severe. Conclusions: Intraoral photographic assessment has a moderate level of accuracy in detecting enamel lesions and has a clinically acceptable level of accuracy in detecting dentine caries. The clinical efficacy increased with the severity of lesions and was consistent with high specificity at all levels of threshold. Imaging on smartphones could be a promising method for caries screening. Full article

Background and Clinical Significance: Pre-eruptive intracoronal resorption is a rare developmental anomaly resembling occlusal caries despite the absence of an external breach. Case Presentation: We report of two cases. The first case involves a 9-year-old girl with PEIR of tooth 24 that was not identified on a panoramic radiograph taken one year earlier. The lesion later became clinically evident, presenting with symptoms and discoloration, and progressed to irreversible pulpitis requiring pulpotomy. This case highlights the importance of careful interpretation of paediatric panoramic radiographs and timely intervention to preserve pulp vitality in developing permanent teeth. The second case concerns a 16-year-old girl in whom PEIR was incidentally detected on cone-beam computed tomography (CBCT) in tooth 38. As the tooth has not yet erupted, its future clinical presentation and progression remain uncertain. To the best of the authors’ knowledge, there are no published reports specifically describing PEIR in patients from the Baltic region. Conclusions: Early radiographic detection of pre-eruptive intracoronal resorption is essential to prevent pulpal involvement and improve treatment outcomes, particularly when combined with careful interpretation of routine paediatric radiographs to minimize the risk of delayed diagnosis. This case emphasizes the importance of recognizing asymptomatic disease progression and integrating multidisciplinary approach to provide individualized treatment planning. Full article

Background: The management of white spot caries lesions (WSCLs) presents a clinical challenge due to a lack of standardized protocols. This study aimed to evaluate the knowledge, attitudes, and practices of dental practitioners in Russia regarding the diagnosis and treatment of WSCLs. Methods: A cross-sectional online survey was conducted from October 2024 to July 2025 among 397 dental professionals in Russia. A validated questionnaire assessed four domains: demographics, knowledge, attitudes, and clinical practices concerning WSCL management. Data were analyzed using descriptive statistics, Kruskal–Wallis tests, and Spearman’s correlation. Results: The majority of respondents were females (83%), with over half having less than five years of experience (55%). A majority of the practitioners (62.5%) demonstrated a good level of knowledge (mean score 12.8 ± 2.2). Knowledge was significantly better among female practitioners (p < 0.001) and inversely correlated with years of clinical experience (p < 0.001). Attitudes towards minimally invasive treatment were mainly positive (mean score 13.5 ± 2.6), with 86% of respondents showing a positive score (>10 points). While awareness of minimally invasive techniques like resin infiltration (84%) and remineralization (79.1%) was high, clinical practice varied. Remineralization was the most frequently used treatment (68% used casein phosphopeptide–amorphous calcium phosphate and 62% used fluoride), whereas resin infiltration was used by 46% and microabrasion by only 5% of the respondents. A majority of dentists (52%) preferred monitoring lesions rather than immediate intervention. Conclusions: Russian dental practitioners possess good theoretical knowledge and positive attitudes toward contemporary, minimally invasive management of WSCLs. However, a significant gap exists between knowledge and clinical practice, particularly concerning the use of resin infiltration and microabrasion. These findings underscore the need for continuous education on the topic. Full article

The term “periapical lesion” refers to a pathological change in the tissues surrounding the apex of a tooth root, defined by its anatomical location rather than a distinct disease entity. Periapical lesions may be of endodontic origin, most commonly resulting from microbial infection of the root canal system following pulp necrosis due to caries, trauma, or other insults, or of non-endodontic origin, such as developmental cysts, benign and malignant odontogenic and non-odontogenic tumors, and fibro-osseous lesions. Accurate diagnosis requires a systematic approach combining patient history, clinical examination, pulp vitality testing, and radiographic assessment; histopathological evaluation is indicated when clinical and radiographic findings are inconsistent or suspicious. The pathophysiology of these lesions involves dynamic interactions between root canal microorganisms and the host immune-inflammatory response. The primary management for endodontic periapical lesions is root canal treatment, which aims to reduce or eliminate root canal microorganisms through mechanical debridement and chemical disinfection. Persistent or extensive endodontic lesions and non-endodontic lesions may require surgical intervention. Molecular and inflammatory biomarkers have been investigated as adjunctive tools for assessing disease activity and prognosis; however, these remain largely investigational and are not yet part of routine clinical practice. Future developments in artificial intelligence, advanced imaging, molecular diagnostics, and personalized therapies may enhance the diagnosis and management of periapical lesions, although further clinical validation is required. Full article

Introduction: Epidermolysis Bullosa (EB) is a rare genetic condition with skin and mucosal fragility. Patients with EB present extra- and intraoral manifestations that can limit their access to dental treatment, including orthodontic treatment. This research aims to determine the barriers, benefits and complications of orthodontic treatment reported by a group of patients living with EB. Materials and Methods: This observational study included n = 101 patients with a genetic diagnosis of EB. After their regular dental consultation, they were interviewed about factors they considered barriers to accessing orthodontic treatment. Those who underwent orthodontic treatment (n = 24) reflected about their perceived benefits and complications from the therapy. Data were analysed with descriptive statistics and multiple Fisher’s exact tests with false discovery rate (FDR) correction. Results: The most prevalent barrier was that most patients with EB had never been evaluated by an orthodontist (74.3%), even if the teams had an orthodontist. Other barriers included distance to the treatment centre (42.6%), poor oral hygiene (27.7%) and poor oral health status (26.7%). Patients with limited mouth opening perceived greater treatment benefit compared to those without this limitation (φ = −0.28, p = 0.0242), while an increasing age was associated with a reduced perception of treatment benefit (Cramér’s V = 0.29, p = 0.0404). Among those who underwent orthodontic treatment, the most prevalent benefits of orthodontic treatment were aesthetic improvement (62.5%), oral hygiene improvement (20.8%) and occlusal stability (12.5%), while the most prevalent complications were wounds and ulcers (75.0%), gingivitis (54.1%), poor oral hygiene (41.6%) and caries (33.3%). Discussion: People living with EB reported different barriers to orthodontic treatment relating to psychosocial and professional aspects, which vary according to the EB type and severity. The involvement of orthodontists in multidisciplinary special care teams and the reduction in access barriers to dental specialities can be facilitated by a more comprehensive understanding of conditions such as EB. Full article

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 Autónoma de Ciudad Juárez (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 Autónoma de Ciudad Juárez. 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 ± 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. Full article

Syphilis, caused by the bacterium Treponema pallidum, has a complex evolutionary history, most likely being transferred from the Americas to Europe after the 15th century and subsequently spreading widely through sexual transmission. This work is one of the few studies on the skeletal evidence of probable treponematosis in archaeological populations discovered on the Romanian territory, providing data to better understand the disease history. Pathological lesions identified in three human skeletons of the 15th–19th centuries are described, and a diagnosis of treponematosis is performed. The three analyzed skeletons were discovered during the archaeological excavations in the necropolis of the Roman-Catholic Cathedral in Iasi City (Romania). The investigated skeletons belonged to individuals aged 30–40 years old (two females and one male). Somatoscopic, radiographic, tomographic, and microscopic examinations were used for the differential diagnosis. The results of multiple investigation methods support the diagnosis of probable treponematosis in all three skeletons, showing different stages of caries sicca in skull bones, cortical thickening, and new periosteal bone formation in postcranial bones. Full article

Background. Artificial intelligence (AI) is increasingly recognized as a transformative technology in healthcare, with growing interest in its applications within pediatric dentistry. Given the unique clinical, developmental, and behavioral characteristics of pediatric patients, AI-based systems may offer valuable support in improving diagnosis, prevention, and treatment planning. Methods. A narrative review was conducted to synthesize current evidence on AI applications in pediatric dentistry. A comprehensive search strategy, including predefined keywords and free terms, was applied across multiple databases (Embase, Scopus, PubMed, and Web of Science) up to 1 January 2026. Reviews addressing AI-based technologies in pediatric dental care were selected and analyzed. Results. The available literature indicates that AI is being progressively applied across multiple domains of pediatric dentistry, although with varying levels of evidence. More extensively investigated areas include diagnostic imaging, caries detection, orthodontic assessment, and growth evaluation, where AI systems—particularly those based on machine learning and deep learning—have demonstrated high accuracy and reproducibility. Other emerging fields, such as remote monitoring, behavioral management, preventive strategies, and patient education, show promising potential but remain less explored. Overall, AI-based tools appear to enhance diagnostic support, enable early detection of oral conditions, and contribute to more personalized and efficient clinical workflows. Conclusions. AI represents a rapidly evolving adjunct in pediatric dentistry with the potential to improve clinical decision-making, preventive care, and patient management. Despite encouraging results, further validation in real-world settings, along with careful consideration of ethical, legal, and data-related challenges, is required to support its responsible integration into routine clinical practice. Full article

Objectives: To evaluate the diagnostic performance of a YOLOv8x-based deep learning model for detecting approximal, occlusal and buccal caries on paediatric panoramic radiographs and to compare its performance with human observers with different levels of clinical experience. Methods: A total of 1526 panoramic radiographs obtained from children aged 5–12 years were retrospectively analysed. Approximal, occlusal, and buccal caries in primary molars were annotated and used to train a YOLOv8x object-detection model. Model performance was evaluated on an independent test set and compared with three human observers: an intern dentist (ID), a novice specialist student (NSS), and an experienced specialist student (ESS). Diagnostic performance was assessed using precision, sensitivity, F1 score, and true positive counts. Results: The YOLOv8x model demonstrated moderate performance in detecting approximal caries (F1 score: 0.576) but showed limited performance for occlusal caries (F1 score: 0.24) and failed to detect buccal caries. The AI model showed lesion-dependent performance. For approximal caries, it performed comparably to ESS observers (p > 0.05) and better than ID (p < 0.001). Performance was poor for buccal caries (p < 0.001), and intermediate for occlusal caries, with no difference from NSS or ESS (p > 0.05) but lower than ID (p < 0.001). Overall, performance was comparable to experienced observers (p > 0.05) and superior to less experienced observers (p < 0.001). Conclusions: The YOLOv8x model achieved diagnostic performance comparable to less experienced clinicians in detecting dental caries on paediatric panoramic radiographs but did not reach expert-level accuracy. These findings suggest that deep learning models may serve as supportive tools in panoramic caries assessment rather than replacements for expert interpretation. Full article

Background: Early childhood caries (ECC) is one of the most common chronic diseases in children and remains unevenly distributed across populations. It is associated with pain, impaired function, and long-term health consequences. Although advances have been made in understanding its aetiology and prevention, important gaps in evidence limit progress in prevention, early detection, and equitable care. Objective: To examine current evidence on ECC and identify key research gaps across biological, behavioral, social, and health system domains. Methods: This narrative review draws on peer-reviewed literature addressing ECC epidemiology, pathogenesis, risk factors, diagnosis, management, and service delivery. The literature was examined to identify areas where evidence is limited, inconsistent, or insufficient to inform clinical practice and public health policy. Results: Research on ECC remains uneven across levels. Longitudinal evidence linking microbiome dynamics, host susceptibility, and lesion progression is limited, restricting causal understanding. Genetic and epigenetic contributions are incompletely defined, particularly in diverse populations. Although socioeconomic gradients are well established, integrative models connecting structural determinants with biological mechanisms are scarce. Emerging diagnostic tools, including biomarkers and artificial intelligence, lack robust evidence demonstrating improved clinical or behavioral outcomes. Implementation research addressing scalability, cost-effectiveness, and equity impact is underdeveloped, especially in low-resource settings. Long-term systemic and developmental consequences of ECC remain insufficiently characterized. Conclusions: Addressing ECC requires integrated and equity-oriented research frameworks that bridge biological, social, diagnostic, and implementation domains. Clarifying these gaps is essential to inform coherent prevention strategies and reduce persistent disparities in child oral health. Full article

This review aims to assess the clinical performance and application results of oral wearable devices in in vivo trials. Following a systematic search of PubMed, Cochrane, Embase, and Scopus databases up to 15 October 2025, and strict screening in accordance with PRISMA 2020 guidelines, 13 in vivo human trials were finally included for analysis. These were analyzed across four clinical functions: diagnosis, treatment, monitoring, and prevention. These devices have evolved from bulky prototypes into miniaturized, wireless systems with diverse diagnostic and therapeutic functions. Their applications now extend beyond common conditions like caries and bruxism to postoperative recovery and pediatric dental anxiety intervention. The findings show that some devices already offer practical value for clinical screening and auxiliary diagnosis. They demonstrate significant potential in early disease detection and medical cost control. However, development still faces many challenges. Technical issues include limited battery life, insufficient mechanical durability, and wireless transmission constraints within the oral environment. Furthermore, clinical evidence levels remain low, indications are narrow, and dedicated ethical and regulatory frameworks are lacking. Inconsistent regulatory standards, production costs, and clinician adoption hurdles slow its commercial development. In the future, the integration of AI, breakthroughs in energy harvesting, and the creation of digital health platforms will be key to overcoming technical bottlenecks. Full article

Introduction: In the period from the 1960s to the new millennium, dental care for children in Denmark focused mostly on drilling and filling lesions once they appeared. This often led to repeated operative treatments, not to mention the trauma related to the many anxiety-provoking dental treatments undergone by these children. Aim: It is cost-effective to document, by means of clinical data over a 25-year period, that the paradigm shift from operative management of caries to a more non-operative approach. Method: The name of the program is the Nexø method, which was developed in 1987 in the Municipality of Nexø (one of 275 municipalities) in Denmark. The method was operationalized into a structured approach based on three principles, dosed at individually assessed recalls according to diagnosis and risk assessment. The risk assessment was based on four risk criteria, each divided into a “good” (1 point) or “bad” (2 points) situation, which were eventually used to assess the length of the interval between visits to the clinic. Outcomes: National Danish oral health data (SCOR) and oral health data from the Nexø municipality from 1985 to 2005 were analyzed, descriptively as well as statistically (Welch’s t-test, 95%CI and Cohen’s d), to compare the caries experience on a national level with data from Nexø in terms of mean defs/DMFS and percentage of 5-, 15-, and 18-year-olds with a defs/DMFS = 0. Results: The mean defs/DMFS or percentage of children with a defs = 0/DMFS = 0 in Nexø was, prior to the implementation of the Nexø method (before 1987), at the national level or worse. The mean defs/DMFS dropped significantly (p-values < 0.0001) from 1990 onwards in Nexø in 5-, 15- and 18-year-olds compared to national data. The DMFS = 0 among 15-yr-olds in Nexø reached 80% in 2005 compared with 40% nationally in the same year. For 15-yr-olds in 2005, the effect size expressed by Cohen’s d = −0.43, indicating a moderate effect of the Nexø method. The mean number of sealed surfaces in 2003 was 3.1 (1SD = 1.6) in 39 reporting municipalities, and for Nexø the mean value was 2.8 surfaces. The cost (price/child/year) was under control over the years. Conclusions: The Nexø Method shows the clinical evidence that the paradigm shift to prevention of the disease process, rather than operative intervention, is cost effective, even with a rather limited use of sealants. A reduction in fear and anxiety-provoking dental treatments in Nexø compared to most other municipalities in Denmark is expected. Full article

Background/Objectives: One of the most relevant risk factors for suicide is the terminal stage of oncological disease. However, it remains unclear whether palliative care affects suicide rates in this population. This study aimed to compare suicide rates in oncological patients receiving palliative care to a general oncological cohort. Methods: The rate of suicide among all patients admitted to the palliative care ward at the Medical University of Vienna for oncological diagnoses from November 2012 to March 2022 was compared to that of a diagnosis-matched control group retrieved from the Austrian Cancer Registry. Competing risk models in SAS (SAS Institute Inc., Cary, NC, USA) were used to test for significant differences in cumulative incidences of death by suicide. Cumulative incidences were also compared for sex and the most common diagnostic groups separately. Results: 1524 patients with oncological diagnoses receiving palliative care and 794,986 patients in the control group were included in the analysis. No excess suicide mortality was revealed (p = 0.117) in the group of patients receiving palliative care. Importantly, this remained true, after also including any potential cases of suicide within the palliative care sample in the analysis (p = 0.467). Only for patients with pancreatic cancer, a higher cumulative suicide incidence in the palliative care sample was found (p = 0.008). Conclusions: Palliative care for oncological patients may be able to alleviate the excess suicide mortality that is otherwise expected in terminally ill patients. This study underscores the importance of comprehensive multidisciplinary end-of-life care that addresses not only physical but also psychosocial aspects. Full article

Early childhood caries (ECC) is a complex, multifactorial disease shaped by biofilm ecology, host susceptibility, diet and behaviors, and structural determinants of health. Silver diamine fluoride (SDF) is an effective non-restorative option for arresting cavitated lesions in many settings and can support access when definitive care is delayed. However, translating short-horizon “arrest” outcomes into broad policy claims—that SDF-first, delegated pathways can substitute for dentist-led diagnosis and comprehensive rehabilitation—risks institutionalizing a two-tier standard of care for children facing the greatest access barriers. This perspective critically appraises evidence-to-implementation pathways for SDF and delegated ECC management, using risk-of-bias and reporting guidance as interpretive tools and drawing on pragmatic regimen trials, microbiome substudies, oral health-related quality of life (OHRQoL) analyses, and implementation work including the Canadian Caries Risk Assessment Tool (CCRAT) in primary care. We explicitly distinguish what studies demonstrate (e.g., feasibility and short-term arrest differences by reapplication interval) from what they do not establish (e.g., long-term tooth survival, pulpal outcomes, definitive treatment completion, and equity impacts). We propose practical guardrails that position SDF as interim management within a continuum of care: dentist-led diagnosis and escalation when pulpal risk is suspected; time-bound referral pathways with completion tracking; protocolized follow-up aligned with lesion/risk status; outcome sets that extend beyond “arrest” to include pain, function, OHRQoL, tooth survival, and equity stratification; and lesion-site sampling plus preregistered analyses when mechanistic claims are advanced. Full article