Search Results (54)

Background: Early caries management is essential to enable reversal of white spot lesions without the further need for operative interventions, especially in primary dentition. Silver-based compounds can be quite effective in arresting caries lesions; however, a major drawback is teeth staining. This study aimed to evaluate the remineralization potential and aesthetic effects of novel, green-synthesized nano-silver fluoride (NSF) on artificial white spot lesions in primary teeth in comparison to 38% silver diamine fluoride (SDF) and silver diamine fluoride/potassium iodide (SDF/KI). Materials and Methods: NSF was synthesized using green tea extract. Sixty primary teeth specimens with artificial enamel lesions were randomly divided into five groups depending on the applied material: 38% SDF, 38% SDF/KI, single and double application of NSF, and control group. Treatments were followed by pH cycling. Surface microhardness and photographic analysis were conducted to assess remineralization and staining. Statistical analysis was conducted using non-parametric tests including Kruskal–Wallis and Mann–Whitney U tests with Bonferroni correction. Results: The greatest increase in microhardness was observed in the group receiving double NSF application. Its remineralizing potential was comparable to that of 38% SDF/KI, with no statistically significant difference (p = 1.000). Importantly, NSF-treated samples exhibited no teeth discoloration, unlike the black staining observed in SDF and SDF/KI groups. Conclusions: Green-synthesized NSF is a promising alternative to conventional SDF and SDF/KI, offering remineralization benefits without compromising aesthetics. The eco-friendly formulation and non-staining properties support its potential for clinical use in pediatric dentistry. Full article

Background: Early childhood dental decay remains a pervasive chronic condition, and environmental toxicants—particularly lead—may exacerbate its development. This systematic review was designed to synthesize evidence on how lead exposure correlates with both the occurrence of carious lesions and aesthetic alterations in children’s primary teeth. Methods: A comprehensive search was conducted in PubMed, Scopus, and Web of Science through April 2025, selecting observational investigations that assessed the link between lead levels and primary-tooth decay in pediatric cohorts. Thirteen eligible studies, encompassing 44,846 participants aged 2–19 years, were included for qualitative synthesis. Aesthetics were screened using author-defined enamel-defect or discoloration endpoints; however, only three studies reported compatible metrics, precluding quantitative pooling. Heterogeneity in exposure matrices likewise ruled out meta-analysis. Results: Most studies reported a statistically significant association between higher lead burden and greater prevalence or severity of caries in primary teeth. Blood lead concentrations across studies ranged from means of 1.53 μg/dL to geometric means of 7.2 μg/dL. Notably, elevated lead was linked to increased decayed, missing, or filled surfaces—with an adjusted risk ratio of 1.14 (95% CI: 1.02–1.27) at levels below 5 μg/dL—and adjusted mean ratios of up to 2.14 for decayed or filled teeth when blood lead reached 5–10 μg/dL. Conclusions: Current evidence suggests that children’s exposure to lead may heighten the risk of caries and detract from the aesthetic quality of primary teeth. However, variability in study design, lead quantification methods, and confounder adjustment limit the consistency of findings. Mitigating lead exposure in early life could represent a valuable preventive strategy against dental decay in susceptible pediatric populations. Full article

Background: Traumatic injuries to the alveolar process and primary teeth in early childhood can have long-term consequences on the development of permanent dentition and eruption pathways. Objective: This case report aims to illustrate the impact of early orofacial trauma on the eruption and development of permanent maxillary incisors and to emphasize the importance of timely interdisciplinary management. Case Presentation: An 8-year-old female patient presented to a pediatric dentistry clinic with delayed eruption of the maxillary anterior permanent teeth. In contrast, her monozygotic twin sister exhibited complete eruption of all permanent anterior teeth, raising parental concern regarding a possible pathological delay. Her medical history revealed orofacial trauma at the age of two, resulting in an alveolar process fracture, avulsion of the primary maxillary left central incisor (tooth 61), and luxation of the primary maxillary right central incisor (tooth 51). A clinical examination demonstrated sufficient arch space without signs of eruption and enamel defects on tooth 52. Radiographic evaluations, including panoramic imaging and cone beam computed tomography (CBCT), confirmed the presence of impacted permanent teeth with structural anomalies suggestive of trauma-related developmental disturbances. Results: The patient underwent a multidisciplinary treatment over a three-year period involving pediatric dentistry, oral surgery, and orthodontics. Management included surgical exposure of the impacted teeth followed by orthodontic traction to guide the eruption and treatment of enamel hypoplasia. Conclusions: This case highlights the long-term consequences of early traumatic dental injuries on permanent dentition development. It underscores the necessity of early diagnosis and a coordinated interdisciplinary approach to optimize outcomes and enhance the long-term oral health and quality of life of affected individuals. Full article

The human laminin family is composed of five α, four β, and three γ chains. Laminins are heterotrimers of α, β, and γ chains. Laminins play critical roles during organogenesis, mostly as basement membrane components. The expression of all and the localization of most laminin chains were characterized in mouse developing teeth. Primary laminin isoforms in basement membranes along the inner enamel epithelium before the secretory stage and outside of the outer enamel epithelium were laminins 111 (α1β1γ1) and 511. The mouse laminin α3 chain has two variants, α3A and α3B. Although a basement membrane structure is absent, laminin 3A32 was localized along the secretory surface of the secretory stage ameloblast Tomes’ processes. Laminin 3A32 was localized along the atypical basement membrane of maturation stage ameloblasts and the specialized basement membrane of junctional epithelium facing the enamel surface. The endothelial basement membrane in the dental papilla and outside of the enamel organ contained laminins 411 and 511. Laminin 332 was detected in the extracellular matrix but not the basement membrane of the apical loop. Laminin 111 was localized in the extracellular matrix of the apical dental papilla without forming a visible basement membrane. These findings suggest the multifaceted functions of laminins in tooth development and set the foundation for functional investigations. Full article

Background/Objectives: This systematic review aims to investigate the potential association between vitamin D levels and the occurrence of developmental enamel defects (DDE) in children, including conditions like molar–incisor hypomineralization (MIH) and hypomineralized second primary molars (HSPMs). DDEs, which occur during tooth development, can result in significant aesthetic and functional issues, and their exact etiology remains unclear, with both genetic and environmental factors contributing. Among environmental factors, vitamin D deficiency has been proposed as a possible risk factor, given its role in enamel mineralization. Methods: A thorough literature search was conducted in PubMed, Scopus, and Embase. The search strategy included terms such as “vitamin D”, “vitamin D deficiency”, “developmental defects of enamel”, “enamel hypoplasia”, “molar-incisor hypomineralization”, and “hypomineralized second primary molars”. Studies were included if they were original human observational research (cohort, case–control, or cross-sectional) conducted in children under 18 years of age or involving maternal–child cohorts. Ten studies were included in the analysis, with a total of 15,891 participants. The primary data extracted from the selected studies included the following: study design, participants’ age, sample size, vitamin D status in relation to developmental defects of enamel, and statistical significance Results: The findings were mixed, with only a few studies suggesting a significant association between low vitamin D levels and the presence of DDEs. Specifically, one study found a link between insufficient maternal vitamin D levels during pregnancy and an increased number of teeth affected by MIH in children. However, the majority of the studies did not report a significant association. Conclusions: This review concludes that while there is some evidence to suggest a possible relationship between vitamin D and DDEs, more research is needed to confirm these findings and better understand the underlying mechanisms. Full article

Background: Root canal treatment is an important element of dental treatment, and broken instruments are one cause of endodontic treatment failure. Broken instruments are rarely reported in primary teeth because of their inherently wider and relatively straighter root canals. We describe a case of a patient with a broken instrument in a primary tooth and reviewed the literature across three databases. Case presentation: A boy aged 7 years and 2 months was referred to our hospital because of pain persisting despite multiple dental treatments. Radiographic examination revealed a broken instrument in the maxillary right primary second molar. The patient experienced dental fear, so the treatment proceeded with the use of behavioral management and nitrous oxide, after which his pain disappeared. At the age of 9 years and 2 months, eruption of the successive permanent teeth was confirmed, and no pathological findings were observed except enamel hypoplasia. We undertook a literature review across three databases and found only two articles about broken instruments in primary teeth, neither of which described the eruption of the permanent teeth. All three cases involved primary molars. Conclusions: We removed a broken instrument from the root of a primary molar and performed root canal treatment, resulting in a good outcome for the primary molar until it was replaced with successive permanent teeth. Although rare, broken instruments in the roots of primary molars do occur, and care should be taken during root canal treatment of primary molars. Full article

Molar incisor hypomineralization (MIH) is a developmental defect that affects the enamel tissue of permanent teeth. Clinicians may observe a range of opacities in the affected teeth, varying from white to creamy, yellow, and brown. Of particular interest is an etiology of MIH that has not been rigorously elucidated. Researchers believe that there are many potential etiological factors with strong genetic and/or epigenetic influence. The primary factors contributing to the risk of MIH development include specific medical conditions and circumstances. These encompass prematurity, cesarean delivery, perinatal hypoxia, and various health issues such as measles, urinary tract infections, otitis media, gastrointestinal disorders, bronchitis, kidney diseases, pneumonia, and asthma. Although genetic research in this area has received substantial attention, the investigation of epigenetic factors remains comparatively underexplored. Special attention is given to genes and their protein products involved in amelogenesis. Examples of such genes are AMELX, AMBN, ENAM, TUFT1, FAM83H, and MMP20. The median relative FAM83H gene expression in the control group was 0.038 (0.031–0.061) and 0.045 (0.032–0.087) in the study group in buccal swabs. The median relative TUFT1 gene expression in the control group was 0.328 (0.247–0.456) and 0.704 (0.334–1.183) in the study group in buccal swabs. Furthermore, children with MIH had significantly higher TUFT1 expression levels compared to the control group (p-value = 0.0043). Alterations in the expression of the TUFT1 and FAM83H genes could be contributing factors to MIH pathogenesis. Nonetheless, further investigation is essential to comprehensively elucidate the roles of all analyzed genes in the pathogenesis of MIH. Full article

Background: Hypophosphatasia (HPP) is an inherited disease caused by low activity of tissue-nonspecific alkaline phosphatase. Dental characteristics include premature loss of primary teeth, enlarged pulp chambers, and enamel hypoplasia. Although enzyme replacement therapy with asfotase alfa was approved in 2015, there are few reports about the dental outcomes of this treatment. Case presentation: A 1-year-old girl referred to our hospital had already lost two primary teeth at the time of her initial visit. She started enzyme replacement therapy 6 days after birth, and genetic analysis later confirmed the diagnosis of HPP. At the age of 4 years and 7 months, 11 primary teeth had been lost, and some of the exfoliated teeth showed inflammatory root resorption or root fracture. There was also a history of abscess formation in a non-carious primary molar. Conclusions: This report suggests that early enzyme replacement therapy may prevent traditional tooth loss in patients with HPP. It also highlights the new challenges posed for dental professionals in providing infection control in large pulp cavities and receding periodontal tissue. Full article

Background: Along with the long-term sequelae of preterm birth for general health, oral health is potentially influenced by prematurity due to developmental and behavioral peculiarities. Objectives: This study aimed to compare oral health parameters in the mixed dentition of prematurely and full-term born children. Methods: Dental caries, developmental defects of enamel (DDE), and gingival inflammation were assessed in 7-to-9-year-old children (n = 38) born preterm (PT) compared to a matched control group born full-term (FT) in Germany. Dental caries was recorded using the International Caries Detection and Assessment System (ICDAS II) and DMFT/dmft-criteria. DDE was scored with modified DDE-Index and periodontal health by Periodontal Screening Index (PSI). Statistical analysis included McNemar’s test and Poisson regression. The significance level was p ≤ 0.05. Results: Caries prevalence was 47.4% in PT and 57.9% in FT. In the primary dentition, FT children were significantly more affected than PT children (1.6 dmft vs. 2.7 dmft; p = 0.035). PT children with extremely low birthweight (ELBW) had the highest caries experience (3.2 dmft; 1.0 DMFT). Prevalence of DDE in primary teeth was significantly higher in PT (55.3%) than in FT children (28.9%; p = 0.008). PSI was 3.8 in PT and 3.3 in FT children, but significantly higher in PT children with ELBW (7.4; p = 0.125). Conclusions: PT children are at higher risk for DDE in primary teeth and compromised periodontal health than FT children. Children with ELBW are most susceptible for dental caries and gingivitis. Full article

Mild hypophosphatasia (HPP) can be difficult to distinguish from other bone disorders in the absence of typical symptoms such as the premature loss of primary teeth. Therefore, this study aimed to analyze the crystallinity of hydroxyapatite (HAp) and the three-dimensional structure of collagen in HPP teeth at the molecular level and to search for new biomarkers of HPP. Raman spectroscopy was used to investigate the molecular structure, composition, and mechanical properties of primary teeth from healthy individuals and patients with HPP. The results showed that the crystallinity of HAp decreased and the carbonate apatite content increased in the region near the dentin–enamel junction (DEJ) of HPP primary teeth. X-ray diffraction (XRD) analyses confirmed a decrease in HAp crystallinity near the DEJ, and micro-computed tomography (CT) scanning revealed a decrease in mineral density in this region. These results suggest incomplete calcification in HPP primary dentin and may contribute to the development of diagnostic and therapeutic agents. Full article

Marginal enamel fractures (MEF) are a common clinical concern in dentistry, particularly in anterior teeth. These fractures occur at the enamel margins and their etiopathogenesis involves a complex interplay of mechanical, chemical, and biological factors. The ongoing research focuses on an overview of MEF to improve the knowledge about this condition. Understanding the multifaceted nature of MEF is crucial for devising effective preventive and therapeutic strategies in contemporary restorative dentistry. Indeed, mechanical stresses, such as occlusal forces and parafunctional habits are primary contributors for MEF. Additionally, it can happen at the enamel-restoration interface due to expansion and contraction of restorative materials. Chemical degradation, including acid erosion and the breakdown of adhesive bonds, further exacerbates the vulnerability of enamel. Biological factors, such as enamel composition and the presence of micro-cracks also play a role in the development of MEF. Clinical management of MEF involves subtractive or additive techniques, repairing or replacing the compromised tooth structure using techniques to ensure the integration with the natural enamel. Full article

Objectives: The present prospective study aimed to compare near-infrared light reflection (NIRI) and bitewing radiographs (BWR) images to detect proximal caries in primary teeth. Methods: 71 children underwent routine BWR, and scans were performed using an intra-oral scanner (iTero Element 5D, Align Technology, Tempe, AZ, USA), including a near-infrared light source (850 nm) and sensor. Five specialist pediatric dentists examined the NIRI and BWR images. Results: The average participant age was 7.8 years. A total of 1004 proximal surfaces of primary molars and canines were examined, 209 carious lesions were detected on BWR, and 227 on NIRI. Comparison between all carious lesions detected on BWR and NIRI: Sensitivity (53.6%); Specificity (85.5%); Positive Predictive Value (PPV) (49.3%); Negative Predictive Value (NPV) (87.5%). Comparison between carious lesions involving the DEJ detected on BWR and at any level in NIRI: Sensitivity (61%); Specificity (83.4%), PPV (36.6%); NPV (93.2%). Comparison between enamel-only carious lesions detected on BWR and all lesions detected using NIRI: Sensitivity (44.8%); Specificity (85.5%); PPV (20.7%); NPV (94.8%). Conclusions: No additional diagnostic information can be gleaned from BWR if initial caries lesions in the enamel are not detected by clinical examination or in images from a NIRI scanner, making BWR unnecessary. Full article

The aim of this study was to investigate the epidemiology of dental trauma in a public dental clinic in Banja Luka, Bosnia and Herzegovina, from 2019 to 2024. Methods: This research was conducted as a retrospective cross-sectional study. The data were analysed and compared between injured primary and permanent maxillary and mandibular teeth. Results: The review of the dental records revealed 73 patients (49 boys and 24 girls) with TDIs, involving 55 primary and 64 permanent teeth. Most of the patients (27 patients, 36.98%) were aged 7–9 years. The main cause of TDI was falls in both dentitions (81.81% of injured primary teeth and 73.43% of injured permanent teeth). The time of arrival after a TDI for assistance in the dental clinic for most cases was after 24 h in both dentitions, 45.45% of injured primary teeth and 48.43% of permanent teeth. For both dentitions, enamel fractures were the most common injury of hard dental tissues and the pulp, and the necrosis of the maxillary central incisor was the most common complication. Conclusions: It is very important to improve trauma management and increase public knowledge on the way parents seek proper treatment for the TDIs of their children, and in due time. Full article

Background: There is only limited research on the coronal cementum of a tooth, and the mechanisms of its forming process are not well-defined. This report presents a coronal cementum on the occlusal surfaces of enamel in an impacted wisdom tooth in a human, which is not nearly the cervical portion. Materials and Methods: The tooth (Tooth #1) was derived from a 46-year-old female. Histological analysis, including hematoxylin and eosin (HE) and toluidine blue (TB) staining, and Scanning Electron Microscopy and Energy Dispersive X-ray Spectrometer (SEM-EDS) analysis of the extracted tooth were conducted. Radiographic examination showed that Tooth #1 was horizontally impacted in the maxilla and had the apex of a single root placed between the buccal and palatal roots of Tooth #2. Results: Coronal cementum was distributed widely on the enamel, and reduced enamel epithelium was also found with enamel matrix proteins histologically. The formation of acellular cementum was observed to be more predominant than that of the cellular cementum in Tooth #1. SEM showed that the occlusal cementum connected directly with enamel. Calcium mapping revealed an almost similar occlusal cementum and enamel. In addition, the spectrum of elements in coronal cementum resembled the primary cementum according to SEM-EDS. Discussion: Thus, coronal cementogenesis in impacted human teeth might be related to the existence of reduced enamel epithelium. Full article

The impact of cold atmospheric plasma (CAP) treatment on the enamel of twelve primary teeth (incisors, canines, and molars) collected from six children was examined in order to evaluate the possibility of using the CAP technique in dental applications. A radio-frequency dielectric barrier discharge (DBD) plasma jet operating at a voltage of 3.25 kV using a mixture of helium and oxygen as the working gas was used for the generation of plasma as part of the electro-technological method for the treatment of biological material. The plasma exposure time for the primary teeth was 5, 10, and 20 min. The properties of tooth enamel (color, contact angles, surface roughness, surface topography, elemental composition) were examined before (control) and after the plasma treatment. As shown by the results, the plasma treatment time is a key parameter that can induce desired features, such as whitening or improved wettability. However, with prolonged plasma treatment (20 min), the enamel surface may be permanently damaged. The cold-plasma-treated samples were characterized by a higher value of the brightness L* parameter and thus a lighter color, compared to the CAP-untreated teeth. It was also evidenced that the plasma treatment increased the hydrophilicity of tooth surfaces, and the contact angles effectively decreased with the time of the CAP treatment. The tooth surface also became much more heterogeneous and rough with much greater amplitudes in heights. The surface of the primary teeth after the CAP treatment lost its homogeneity, as evidenced by the SEM micrographs. The analysis of the elemental composition revealed only minor changes after the plasma process, which may suggest that the observed morphological changes in the enamel surface are mainly physical and are not a consequence of chemical reactions between the enamel and the reactive components of the cold plasma. Plasma treatment of teeth opens up new possibilities of using this method as an alternative to whitening or pre-treatment before other dental procedures. Full article