Search Results (218)

Background/Objectives: Dental fear affects about one in four general dentistry patients in the U.S. and other high-income countries. However, the prevalence of fear in orthodontic practice has received scant attention, with no studies in the U.S. The aim of this study was to investigate the prevalence of orthodontic and general dentistry fear and the relationship between the two among patients at a large, U.S. urban university orthodontic clinic serving a culturally and ethnically diverse population. Methods: Patients (N = 186) rated their general dentistry and orthodontic fear using a validated single-item scale. Results: A substantial proportion of patients experienced clinically significant fear of dentists (22.1% [95% CI 16.31–28.69%]) and orthodontists (17.2% [95% CI 11.61–22.82%]). There was a strong effect size (r = 0.67) between ratings of fear of dentists and orthodontists. Our prevalences were nearly identical to the weighted prevalences in the literature for general dentistry and orthodontic fear (22.90% [95% CI: 20.73–25.22%] and 17.65% [95% CI: 15.09–20.53%], respectively) among orthodontic patients. Conclusions: Despite orthodontic procedures being generally less fear-inducing than general dentistry, orthodontists should assume that over one in six patients will be fearful. Further research is needed to create an assessment of the most feared orthodontic stimuli and to broaden the application of evidence-based dental fear treatments. We recommend screening all orthodontic patients using a single, validated question; if patients are fearful, providers should use empathic communication and accommodate patient needs in treatment sessions. Full article

Autogenous tooth transplantation offers a biologically favorable approach to tooth replacement, preserving the periodontal ligament, promoting alveolar development, and maintaining proprioception. Background/Objectives: Its broader clinical applicability is limited by variability in techniques and outcome definitions. This systematic review and meta-analysis evaluated the clinical success of autogenous tooth transplantation across donor tooth types, developmental stages, surgical techniques, and fixation methods. Methods: Following PRISMA 2020 guidelines and a PROSPERO-registered protocol (CRD42024625550), five databases and the gray literature were searched through July 2025. Eligible studies reported clinical outcomes for autogenous tooth transplantation. Risk of bias was assessed using the Newcastle–Ottawa Scale. A random-effects meta-analysis of logit-transformed proportions was conducted, with subgroup and sensitivity analyses by tooth type, root development stage, surgical technique, and fixation method. Results: Twenty studies involving 1366 transplanted teeth were included. The pooled success rate was 94.0% (95% CI: 22.5–99.9%) across follow-up periods ranging from one month to twenty-nine years. However, interpretation is limited by distinct heterogeneity (I² = 99.8%) and the wide confidence interval. Subgroup analyses by tooth type, root maturity, surgical technique, and fixation method are, therefore, emphasized to support clinical interpretation. Conclusions: Autogenous tooth transplantation achieves consistently high success across clinical contexts when biologic handling is respected. These findings support its broader use in dental and orthodontic practice and underscore the need for standardized outcome reporting and prospective research. Interpretation is limited by heterogeneity and variation in reporting standards. Full article

Background and objectives: ABs are widely used in dental practice in the treatment of odontogenic infections and as systemic prophylaxis in high-risk patients. However, AB overuse contributes to antimicrobial resistance (AMR), which is a major global concern. This study examined dental AB prescribing trends in Germany in 2024, focusing on the share of overall AB prescriptions, patient demographics, and commonly used agents. Methods: This retrospective cross-sectional study used data from the IQVIA Longitudinal Prescription Database (LRx), covering approximately 80% of prescriptions reimbursed by statutory health insurance funds in Germany. Patients with at least one AB prescription (ATC code: J01) issued by a dentist in 2024 were analyzed. Descriptive statistics covered age, sex, and prescribed substances. Results: In 2024, German dentists prescribed ABs to 2,325,500 patients, accounting for 13.9% of all patients in the database who received AB prescriptions. Dentists were the second-largest group of AB prescribers, surpassed only by general physicians. Amoxicillin (54.2%) was most frequently prescribed, followed by amoxicillin with clavulanic acid (24.5%) and clindamycin (21.0%). Dental patients receiving AB prescriptions were older (mean age: 49.8 years) than the general antibiotic patient population (44.7 years). Interestingly, dental AB prescriptions increased during the COVID-19 pandemic, in contrast to the sharp overall decline in AB prescriptions. Between 2015 and 2019, the proportion of dental antibiotic prescriptions showed a moderate upward tendency, followed by a marked increase during the COVID-19 pandemic and a subsequent decline. In contrast, the number of patients receiving antibiotic prescriptions from other medical disciplines decreased over the same period. One particularly notable finding was the extended use of clindamycin, a reserve AB with known side effects and resistance risks, in dentistry. Conclusions: Dentists are responsible for a significant share of AB prescriptions in Germany. The rise in dental AB prescriptions, particularly the frequent prescription of clindamycin, underscores the need for interventions such as updated clinical guidelines and awareness campaigns concerning AB-related risks and their mitigation directed at dentists. These could focus on microbial culture and sensitivity testing and patient adherence education and control for targeted AB interventions. Emphasizing preventive and alternative anti-infective treatment strategies in dentistry may also help to contain AMR. Full article

Background/Objectives: This study aims to evaluate the response accuracy and quality of three AI chatbots—GPT-4.0, Claude-2, and Llama-2—in answering multiple-choice questions in prosthodontic and restorative dentistry. Methods: A total of 191 text-based multiple-choice questions were selected from the prosthodontic and restorative dentistry sections of the United States Integrated National Board Dental Examination (INBDE) (n = 80) and the United Kingdom Overseas Registration Examination (ORE) (n = 111). These questions were inputted into the chatbots, and the AI-generated answers were compared with the official answer keys to determine their accuracy. Additionally, two dental specialists independently evaluated the rationales accompanying each chatbot response for accuracy, relevance, and comprehensiveness, categorizing them into four distinct ratings. Chi-square and post hoc Z-tests with Bonferroni adjustment were used to analyze the responses. The inter-rater reliability for evaluating the quality of the rationale ratings among specialists was assessed using Cohen’s Kappa (κ). Results: GPT-4.0 (65.4%; n = 125/191) demonstrated a significantly higher proportion of correctly answered multiple-choice questions when compared to Claude-2 (41.9%; n = 80/191) (p < 0.017) and Llama-2 (26.2%; n = 50/191) (p < 0.017). Significant differences were observed in the answer accuracy among all of the chatbots (p < 0.001). In terms of the rationale quality, GPT-4.0 (58.1%; n = 111/191) had a significantly higher proportion of “Correct Answer, Correct Rationale” than Claude-2 (37.2%; n = 71/191) (p < 0.017) and Llama-2 (24.1%; n = 46/191) (p < 0.017). Significant differences were observed in the rationale quality among all of the chatbots (p < 0.001). The inter-rater reliability was very high (κ = 0.83). Conclusions: GPT-4.0 demonstrated the highest accuracy and quality of reasoning in responding to prosthodontic and restorative dentistry questions. This underscores the varying efficacy of AI chatbots within specialized dental contexts. Full article

Flourishing in children is an indicator of positive development in the areas of emotional, social, and cognitive development. Using a recent dataset from the US National Survey of Children’s Health, this study investigates the association between access to a quality healthcare system and flourishing indicators in school-aged children with autism. The outcome variable describes the proportion of children aged 6–17 with autism meeting the flourishing criteria, which include measures related to learning, resilience, and self-regulation. The main independent variable includes six core indicators for school-aged children and adolescents, which assess whether the family feels like a partner in their child’s care, the child has a medical home, receives regular medical and dental preventive care, has adequate insurance, has no unmet needs or barriers to accessing services, and has prepared for transition to adult healthcare. Multivariable logistic regression models were used to examine the relationships between various independent variables and the outcome of interest. The results show that children with autism who receive comprehensive and coordinated care are more likely to flourish compared to those without such care for five of these six indicators, while controlling for sex, race, parental education, household income, self-reported autism severity, general health status, and the number of adverse childhood experiences. Children with autism are more likely to flourish when their families and healthcare providers work together effectively. Addressing gaps in the quality care system is essential for developing holistic approaches that empower children with autism to thrive and reach their full potential. Supportive health policies and effective coordination between families and healthcare providers are crucial for fostering the flourishing of children with autism, ensuring comprehensive, individualized, and continuous care. Full article

Background/Objectives: Dental caries (DCs) and type 2 diabetes share common risk factors. Dental caries risk in type 2 diabetics (T2DM) shows contradictory results. The aim of this study was to determine if there is a difference in DC prevalence in adults with and without T2DM and whether body mass index (BMI) classes or glycated hemoglobin (HbA1c) levels interfere in that difference. Methods: A total of 666 adults (n(T2DM) = 343; n(nT2DM) = 323), from Espinho Primary Health Care Center, were interviewed by calibrated observers. Data from clinical records were collected and oral health status was registered using WHO criteria. Inference analysis was conducted using non-parametric tests (α = 0.05). Results: A similar caries prevalence was found between the T2DM (98.2%) and nT2DM (98.8%) groups, with the T2DM group showing significantly higher tooth loss (p < 0.001), higher caries experience rerted as mean ± sd (17.7 ± 8.3 vs. 15.9 ± 7.8, p = 0.005), fewer decayed teeth (p < 0.001) and filled teeth (p = 0.016) compared to nT2DM. The most frequently identified comorbidity was hypertension (53.6%). Tobacco use (12.9%) was lower in T2DM (p < 0.001). The restorative and treatment indices indicated a significantly higher proportion of use of oral care services (p < 0.001) in T2DM individuals. The prevalence of the higher classes of BMI indicative of pre-obesity or obesity shows significant differences (p < 0.001). The differences found in the DMFT or each of its components for the prevalence or for the mean in HbA1c control were not statistically significant (p = 0.368, and 0.524, respectively). Conclusions: Adults with T2DM and higher BMI classes could be associated with a greater prevalence of DCs. The glycemic control of T2DM does not significantly influence DMFT score or each of its components. Full article

Gram-negative enteric rods (GNERs) are transient members of the oral microbiota and are considered a superinfection in patients with periodontitis that poses local and systemic risks due to associations with infections and multidrug resistance, including extended-spectrum beta-lactamases. These pathogens often resist antibiotics such as amoxicillin, doxycycline, and ciprofloxacin, complicating dental treatments. Though their resistance patterns vary, links between specific resistance genes and phenotypic resistance remain unclear. Objectives: To determine the correlation between resistance genes (blaTEM, blaSHV, tetQ, tetM, qnrB, qnrS, and mph(A)) and phenotypic resistance in GNERs isolated from oral cavity samples. Methods: A total of 90 oral isolates of GNERs were isolated from patients in a dental clinic, and bacteria were identified by the BD BBL Crystal biochemical panel. The antibiotic susceptibility testing was conducted through broth microdilution following CLSI standards for drives such as amoxicillin, amoxicillin/clavulanic acid, doxycycline, ciprofloxacin, and azithromycin. Resistance genes, including blaTEM, blaSHV, tetQ, tetM, qnrS, qnrB, and mph(A), were detected using polymerase chain reaction and gel electrophoresis. The proportions of species, resistance genes, and minimum inhibitory concentration values were statistically analyzed. Conclusions: As expected, most enteric bacteria showed natural resistance to beta-lactams. Significant resistance to azithromycin was observed in some species. Genotypic and phenotypic profiles suggest the existence of alternative resistance mechanisms; therefore, other mechanisms associated with antibiotic resistance should be investigated. Full article

Background/Objectives: The integration of digital technologies into dental education is becoming increasingly important, particularly in prosthodontics, where digital design tools offer enhanced precision and efficiency. This study aimed to evaluate second-year dental students’ perceptions regarding conventional versus digital design in prosthodontics, assessing their theoretical knowledge, practical skills, and attitudes toward these approaches. Methods: A total of 141 dental students enrolled in Faculty of Dentistry from “Carol Davila” University of Medicine and Pharmacy, Bucharest, Romania, participated in an online survey consisting of 19 questions evaluating their understanding, preferences, attitudes, and expectations regarding digital and conventional prosthodontic workflows. Additionally, students’ practical exam grades and task completion times for both conventional and digital design methods were evaluated. Results: Participating students reported sufficient understanding of theoretical concepts in both conventional (92.9%) and digital design (91.5%). A significant proportion (78.7%) felt confident in their practical skills for conventional design, while 78% expressed the same for digital design. Statistically significant correlations indicated that students who believed digital design could replace conventional methods associated digital design with greater accuracy (p = 0.020), predictability (p = 0.048), and sustainability (p = 0.032). Students who believed they had acquired enough skills in digital design responded more frequently that the time allocation for digital design by the university was sufficient (p < 0.001). Moreover, students scored significantly higher in digital design practical exams compared to conventional design (p < 0.001). Task completion times were also shorter for digital workflows, further supporting their efficiency. Conclusions: The findings suggest that students are highly receptive to digital technologies in prosthodontics, favoring digital workflows over conventional techniques. These results highlight the need for continued integration of digital tools into dental curricula to enhance students’ competency and prepare them for modern clinical practice. Full article

The aim of this study was to analyze the spectrum of Candida manifestations in the orofacial region to address the lack of comprehensive data in the diverse pediatric population. This retrospective study included all positive Candida findings in patients aged 0–18 years treated between 2014 and 2023 at a university maxillofacial department in Germany and evaluated associated risk profiles, comorbidities and species distributions. Candida infection sites included oral mucosa, dental abscesses and otitis media. Candida was more frequent in children with pre-existing conditions, particularly immunosuppression, neuromuscular disorders and facial deformities. Tympanostomy tubes and recent antibiotic use were significant risk factors for Candida in otitis media. Whereas in dental abscesses, Candida had a significant proportion independent of prior antibiotic use. Non-albicans subspecies, particularly Candida parapsilosis, were notably more prevalent in the middle ear compared to oral and dental infections. Candida manifests in various forms in the orofacial region, with different characteristics and species distributions. Further investigations are needed to better understand the role of Candida as a symptom or a contributor to an underlying condition. Full article

Objective: This study aims to evaluate cell proliferation capacity and micronuclei incidence in the presence of nickel–chromium (Ni-Cr)-based dental alloys, with and without the addition of beryllium (Be). The use of these alloys in dental prosthetics is widespread; however, the potential risks associated with their genotoxicity and cytotoxicity require further investigation. The study seeks to provide insight into the safety of these materials and their long-term impact on the health of both patients and dental professionals. Methods: The study was conducted through a comparative analysis of genotoxicity and cytotoxicity using human lymphocyte cultures exposed to two types of Ni-Cr-based dental alloys, one containing beryllium and the other without beryllium. The evaluations were performed according to the OECD Test No. 487 guideline, employing the micronucleus assay and cell proliferation assay. Lymphocytes were exposed to three different alloy concentrations (5 mg/mL, 10 mg/mL, and 20 mg/mL), and the effects on genetic material were analyzed microscopically. Descriptive statistics (mean, standard deviation, and variance) were calculated, and one-way ANOVA was used to assess statistical significance between groups, with a significance threshold of p < 0.05. Results: A significant increase in cytotoxicity and micronuclei incidence was observed in the samples containing beryllium compared to those without beryllium. Statistical analysis revealed significant differences (p < 0.001) between the test and control groups and between different concentrations. Additionally, a direct proportional relationship was noted between alloy concentration and the intensity of genotoxic effects. Microscopic analysis confirmed genetic material damage, indicating a potentially increased risk associated with the use of this type of dental material. Conclusions: The data obtained suggest that Ni-Cr-based dental alloys containing beryllium may present a significant risk of genotoxicity and cytotoxicity. Therefore, the selection of materials used in dental prosthetics should be based on solid scientific evidence, and the use of these alloys should be approached with caution. The study highlights the need for further research to better understand the long-term impact of these materials on human health. Full article

Background/Objectives: Dental pulp stem cells (DPSCs) are of significant interest due to their mesenchymal lineage and relative availability from extracted teeth. This study aims to examine the relationship between fibronectin-adherent, non-fibronectin-adherent, and explant-derived DPSC populations in terms of the population doubling rate in culture and the expression of mesenchymal cell surface markers and their capacity for osteodifferentiation. Methods: Human pulp tissue was removed from healthy extracted human teeth, enzymatically digested prior to seeding onto fibronectin-coated plates, and left to adhere for 20 min, yielding a fibronectin-adherent population. The remaining non-adherent cells were transferred and designated ‘non-fibronectin-adherent.’ Intact pulp was placed on uncoated plastic for 5 days, with the migrated cells designated ‘explant-derived’. DPSCs from these populations were examined in terms of population doubling rates, the expression of CD90, CD44, CD105, and CD73, and the expression of RUNX2, SPP1, and BGLAP after 7 days in osteoinductive media. Results: The fibronectin-adherent cells had the greatest population doubling over time. All populations demonstrated comparable percentages of cells positive for mesenchymal markers, though individual marker expression varied slightly. The explant-derived cells showed increased expression of RUNX2 after 7 days in osteoinductive media, while the treated single-cell-suspension-derived populations showed increased expression of SPP1 mRNA. Conclusions: Fibronectin enrichment resulted in a population with the greatest rate of population doubling over extended culture compared to the other two populations. The proportion of cells positive for all four mesenchymal surface markers was the same between populations. The fibronectin-adherent and non-adherent cultures may have responded more rapidly to osteoinductive media than the explant-derived cells. Full article

Background/Objectives: Obstructive sleep apnea syndrome (OSAS) is a global condition usually associated with poor health. While common, it appears underdiagnosed due to repeated episodes of upper airway obstruction during the sleep cycle. It is accompanied by other health risks like cardiovascular issues and conditions. Identifying craniofacial characteristics linked to OSAS may enhance diagnostic precision and treatment planning. The aim of our study was to examine the relationship between cephalometric variables and OSAS and determine whether craniofacial features influence the syndrome’s development and severity. Methods: Thirty participants were split into two groups: 15 diagnosed with OSAS and 15 controls. Cephalometric evaluations were performed using standardized lateral imaging, with craniofacial, dental, and hyoid bone parameters assessed. Statistical analysis compared these variables between groups to identify significant differences. Results: OSAS patients exhibited significantly shorter maxillary and mandibular lengths, increased anterior facial height, and reduced posterior facial height compared to controls. Dental analysis revealed reduced interincisal angles and lower mandibular incisor positions in the OSAS group. The hyoid bone was positioned lower and more posteriorly in OSAS patients, with significant differences in its distance to the C3 vertebra and mandibular plane. Although the soft palate dimensions were larger in OSAS patients, the differences were not statistically significant. Conclusions: OSAS is associated with distinct craniofacial features, including shorter maxillary and mandibular lengths, altered facial height proportions, and lower hyoid bone positioning. These findings suggest that craniofacial morphology plays a significant role in OSAS pathophysiology. Future studies hinting at three-dimensional imaging could provide deeper insights into these associations. Full article

Objectives: A thorough knowledge of tooth morphology, encompassing the detailed structural complexities, is essential for the practice of dental hygienists in all aspects of their profession. The aim of this study was to assess the efficacy of two instructional approaches in tooth morphology education, by analyzing the performance of dental hygienist students trained with human extracted teeth compared to those educated with plastic teeth models. Methods: This study included two cohorts of undergraduate dental hygienist students: a control group (n = 27) trained using human teeth, and an experimental group (n = 34) trained using plastic teeth models. Each group underwent two consecutive practical exams where they identified all 32 permanent teeth and 8 deciduous molars. Initially, students were tested on the training material that they were assigned (either extracted human teeth or plastic teeth), and, subsequently, they were tested using the alternative material. Both the number and patterns of identification errors were recorded and analyzed. Paired t-tests were used to compare error rates between real and plastic teeth for students trained on either plastic or real teeth, unpaired t-tests were conducted to assess differences in performance between students trained on plastic versus real teeth when tested on both tooth types, and Fisher’s exact tests were employed to examine variations in error proportions across maxillary and mandibular tooth categories. Results: The control group recorded a mean of 6.41 errors per student (total of 173 errors), with three students (11.1%) failing by committing over 12 errors. Their performance improved to a mean of 5.44 errors (total of 147 errors) when tested on plastic teeth, although the improvement was not statistically significant (p = 0.20). Conversely, the experimental group demonstrated high accuracy on plastic teeth, with 19 out of 34 students (55.9%) achieving perfect scores and a total of only 50 errors (mean, 1.47). Their performance, however, declined when tested on real teeth, escalating to a total of 354 errors, with 32 students (94.12%) making more errors on real teeth than on plastic, resulting in a significant increase in errors to an average of 10.41 per student (p < 0.001). Conclusions: This study demonstrates that students perform best when tested on the materials that they initially were trained with, showing that real teeth provide better educational outcomes than plastic models. This advantage underscores the importance of using natural teeth when learning dental anatomy. Full article

(1) Background: Toothbrushing behavior in children and adolescents is shaped by national dental health policies and sociodemographic and psychological factors. In 2010, child dental care was incorporated into Israel’s National Health Insurance Law (NHIL). This study explored toothbrushing behavior and its predictors before and after this reform. (2) Methods: Data from 36,755 students in grades 6–10 were analyzed from the Health Behaviour in School-Aged Children study conducted pre-reform (1998, 2002, 2006) and post-reform (2010, 2013, 2016). The dependent variable was toothbrushing behavior, while the independent variables included sociodemographic and psychological characteristics. Chi-squared tests compared proportions of compliant toothbrushing behaviors, and logistic regression identified significant predictors. (3) Results: According to recommendations, 59–64% of children brushed their teeth before the reform. This proportion increased significantly post-reform, reaching 73% in 2018. Predictors of compliance included being female, younger, Jewish, and non-observant, having a higher socioeconomic status, and having a better psychological status. These predictors were consistent in pre- and post-reform regression models. (4) Conclusions: The dental care reform positively influenced toothbrushing habits among children and adolescents. However, disparities remain among specific communities. Interventions tailored to address sociodemographic and psychological factors are recommended to enhance regular toothbrushing habits across all populations. Full article

(1) Background: Microcracks and structural fragility in teeth, often undetected by traditional methods until severe complications like fractures or pulp exposure occur, are evaluated in this study using electrical impedance analysis (EIA) as a non-invasive tool for early detection and assessment. (2) Methods: A total of 57 patients were recruited, including individuals with bruxism (n = 20), dental restorations (n = 18), and no significant dental history (control group, n = 19). Electrical impedance measurements were performed on all teeth using a portable device, with data collected from occlusal and proximal surfaces. Patients with abnormal values underwent additional imaging (standard radiographs) to confirm the presence of microcracks. Statistical analyses included ANOVA to compare impedance values between groups and logistic regression to assess the predictors of structural fragility. (3) Results: Teeth with microcracks confirmed by standard radiographs exhibited significantly lower impedance values (mean 50 kΩ) compared to healthy teeth (mean 120 kΩ, p < 0.01). Patients with bruxism showed the highest proportion of teeth with abnormal impedance (45%). Logistic regression identified bruxism as a significant predictor of reduced impedance values (p < 0.05). (4) Conclusions: Electrical impedance analysis demonstrates promise as a non-invasive method for detecting microcracks and assessing structural fragility in teeth. Its application in routine dental check-ups could enable early interventions, particularly for high-risk patients with bruxism or restorations. Full article