Search Results (348)

An updated understanding of the U.S. oral health care system is essential for addressing the burden of oral disease, high dental expenditures, and persistent inequities in access. This narrative review synthesizes current evidence on the prevalence of major oral diseases, dental care delivery, financing, dental workforce, and public health initiatives, and highlights the challenges and future opportunities in the U.S. A comprehensive search of PubMed, Google Scholar, and reports from U.S. federal agencies and professional organizations was conducted between September 2025 and March 2026. Following the latest National Health and Nutrition Examination Survey, untreated caries remains widespread, affecting 11% of children (ages 2–5), 10% of adolescents (ages 12–19), 21% of adults (ages 35–49), and 12% of older adults (ages 65–74). Periodontal diseases are common, with 42% of adults aged 30 years or older having periodontitis. Oral cancer incidence stands at 11.5 per 100,000 and increases sharply with advancing age. Edentulism among older adults (ages 65–74) was approximately 11%. The U.S. dental workforce includes over 200,000 dentists, yet shortages affect rural and low-income areas, with 62 million Americans living in Dental Health Professional Shortage Areas. Dental care is primarily delivered through private practices, supplemented by community health centers. Financing relies mostly on private insurance and out-of-pocket payments, while the coverage of public programs like Medicaid varies across states, and Medicare generally excludes routine dental care for older adults. Water fluoridation remains widespread, yet ongoing debates highlight persistent challenges. School-based dental sealants and topical fluoride programs are widely recognized as cost-effective and scalable, offering substantial benefits at the population level. Nevertheless, community-based preventive measures are often hindered by resource constraints, inequitable access, and in some cases political conflicts. In summary, oral diseases remain prevalent in the U.S. Limited public coverage, workforce shortages in rural or underserved areas, and uneven access to dental care highlight the need for systemic reforms to improve oral health equity. These findings point to the importance of strengthening dental public health research and coordinated policy action to reduce structural barriers and expand access to dental care. Full article

Background/Objectives: Dental caries is one of the most prevalent chronic diseases in childhood, disproportionately affecting socially vulnerable populations. This scoping review aimed to analyze the clinical effects of selected minimally invasive materials and approaches, specifically mouthrinses, fluoride varnishes, silver diamine fluoride, and glass ionomer-based interventions, for the prevention and management of dental caries in pediatric patients, with emphasis on public health and community-based settings. Methods: This scoping review followed the Population, Concept, and Context (PCC) framework. Electronic searches were conducted up to 23 January 2026, using tailored strategies for mouthrinses, fluoride varnishes, silver diamine fluoride (SDF), and glass ionomer cements (GICs). Randomized clinical trials (RCTs) were included. Data extraction and qualitative synthesis focused on clinical outcomes and applicability in public health contexts. Results: Fifty-five RCTs were included. Fluoride- or chlorhexidine-based mouthrinses showed potential in controlling cariogenic biofilm, with evidence primarily based on microbiological outcomes. Fluoride varnishes were associated with enamel remineralization and control of early white spot lesions, particularly in supervised programs. SDF was reported to achieve high caries’ arrest rates in cavitated dentin lesions of primary teeth, while its preventive effect on sound surfaces appeared comparable to other fluoride-based interventions. GICs were associated with acceptable clinical performance as pit-and-fissure sealants and in atraumatic restorative treatment. Conclusions: Minimally invasive dentistry (MID) approaches show promise for the prevention and management of childhood dental caries in public health and community-based settings. However, these findings should be interpreted with caution due to the heterogeneity of interventions and outcome measures, the predominance of short-term and surrogate (microbiological) outcomes, and the absence of a formal risk-of-bias assessment. As a scoping review, the synthesis is narrative in nature, which limits the ability to draw definitive conclusions. Further studies with standardized clinical outcomes and longer follow-up are needed to strengthen the evidence. Full article

Chronic wounds resulting from bacterial infection remain one of the main challenges in clinical practice. There is a pressing need to develop an injectable hydrogel sealant with multifunctional properties, including remodeling capabilities, self-healing, painless removal, and antibacterial activity, to promote tissue remodeling. In this work, aldehyde carboxymethylated agarose (ACMA) is employed for the first time as a bio-template. Dopamine (DA) is introduced onto the ACMA template via a reversible Schiff-base reaction, endowing it with biomineralization properties to synthesize DA-modified ACMA-Ag nanoparticles (ACMA-DA-Ag). Further, the prepared ACMA-DA-Ag, which possesses both antibacterial activity and injectable behavior, is incorporated into a guar gum hydrogel through the formation of borate/diol bonds, thereby forming a multiple-dynamic-bond crosslinked network. This hydrogel demonstrates adequate mechanical strength, injectability, remodeling capabilities, and self-healing performance. It can reassemble into a new hydrogel within 4 ± 0.6 min upon simple physical contact, and supports tissue adhesion. Furthermore, the hydrogel effectively covers irregular-shaped wound and can be removed without causing secondary injury. More importantly, this multifunctional hydrogel is cost-effective, easy to synthesize, and simple to use, significantly accelerating skin regeneration and promoting the formation of skin appendages, such as hair follicles. The outcome of this research not only serves a tissue sealant for wound healing, but also presents a new strategy for creating novel polysaccharide-based biomaterials. Full article

Background/Objectives: Dental caries continues to represent a major oral health concern in children, particularly in uncooperative patients, where effective sealant placement is often compromised. This study evaluated the long-term clinical performance of hydrophilic (UltraSeal XT hydro) and hydrophobic (Helioseal-F) resin-based sealants in uncooperative children aged 6–9 years, assessing retention and caries incidence over 24 months. Methods: In a split-mouth, double-blinded randomized controlled trial, 34 children (104 first permanent molars) were enrolled, with 31 participants (98 teeth) completing the study. Sealants were randomly assigned to hydrophilic or hydrophobic group, with assessments at 3, 6, 12, 18, and 24 months. Results: Complete retention declined progressively in both groups, from 59.2% to 2.0% in the hydrophilic group and from 42.9% to 0% in the hydrophobic group at 24 months, with no significant intergroup differences (p = 0.719). Caries-free rates decreased from 81.6% to 49.0% in the hydrophilic group and from 75.5% to 40.8% in the hydrophobic group (p = 0.293). Children with definitely negative behavior showed significantly lower retention at 6 and 12 months (p = 0.006 and p < 0.001) compared to those with negative behavior, although differences were not significant at 24 months. Conclusions: Overall, both sealants demonstrated comparable retention and cariostatic performance, indicating that material properties alone do not determine long-term success. Further research should focus on long-term follow-up and comparative evaluation of hydrophilic sealants in cooperative and uncooperative populations to better understand how patient behavior affects sealant performance. Full article

Background and Clinical Significance: Dentinogenesis imperfecta is a hereditary dentin disorder that compromises tooth structure, esthetics, and function. Case Presentation: We report the case of a 1.5-year-old female presenting with generalized discoloration of the primary dentition and intermittent sensitivity to thermal stimuli. The diagnosis of dentinogenesis imperfecta was established based on characteristic clinical features, radiographic findings, and a positive family history. The patient was followed longitudinally from 2020 to 2025, with documentation of diagnostic findings, radiographic changes, therapeutic interventions, and outcomes. Management included placement of composite veneers on the maxillary incisors for esthetic rehabilitation and sealants on second primary molars as a preventive measure. Although various management approaches have been described in the literature, evidence regarding optimal strategies and long-term outcomes in the primary dentition remains limited. This case highlights the occurrence of asymptomatic periapical pathology and root resorption despite minimal clinical symptoms, underscoring the challenges of relying on symptom-based assessment alone. Conclusions: Early diagnosis, regular radiographic monitoring, and individualized, risk-based treatment planning are essential in managing dentinogenesis imperfecta. This case emphasizes the importance of recognizing asymptomatic disease progression and integrating psychosocial considerations into comprehensive care. Full article

The use of marginal sedimentary aggregates in pavement construction remains a major challenge in mountainous regions due to their high porosity, weak lamination planes, and susceptibility to moisture-induced deterioration. This study investigates the potential of low-density polyethylene (LDPE) plastic waste to enhance the engineering performance of laminated Miocene soft rock aggregates used in bituminous concrete. Aggregates sourced from the Surma Group (Bhuban Formation) in Mizoram, India, were characterized through physico-mechanical, geochemical, and mineralogical analyses to evaluate their durability and moisture sensitivity. X-ray fluorescence (XRF) analysis revealed elevated feldspar and total alkali contents (≈5.15%), indicating a mineralogical composition prone to hydrophilic behavior and stripping within bituminous mixtures. To mitigate these limitations, aggregates were coated with varying proportions of LDPE plastic using the dry process. An optimum LDPE content of 9% by weight of aggregate produced significant improvements in aggregate performance, resulting in a 70.03% reduction in Aggregate Impact Value (from 17.72% to 5.31%), a decrease in Los Angeles Abrasion Value from 42.93% to 31.45%, and an 89.82% reduction in water absorption (from 4.52% to 0.46%). The polymer coating effectively sealed lamination planes and reduced moisture ingress within the sedimentary structure. Bituminous concrete mixtures incorporating LDPE were further evaluated using Marshall stability and indirect tensile strength tests. The addition of 1.1% LDPE by weight of mix significantly enhanced moisture resistance. For mixtures with nominal maximum aggregate sizes (NMASs) of 13 mm and 19 mm, the Tensile Strength Ratio (TSR) increased from 52.59% and 58.58% in the control mixtures to 82.81% and 87.10%, respectively, thereby satisfying the minimum requirement of 80% specified by MoRTH. The results indicate that LDPE functions as a hydrophobic barrier and structural sealant that improves binder–aggregate adhesion and prevents stripping along weak lamination planes. The findings demonstrate that LDPE-modified bituminous concrete provides a sustainable and technically viable strategy for upgrading marginal sedimentary aggregates into durable pavement materials while simultaneously promoting the beneficial reuse of plastic waste. 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

The development of durable road sealing materials capable of maintaining performance under combined mechanical and climatic loads remains a critical challenge for modern infrastructure. Conventional bitumen-based sealants exhibit limited resistance to high-temperature deformation, cracking, and adhesion degradation, leading to reduced service life. This study proposes a rheology-oriented approach to the design of polymer-reinforced bituminous sealants based on penetration-grade bitumen 50/70 and 70/100 modified with styrene–butadiene–styrene (SBS) copolymers up to 9 wt.% and reinforced with cellulose fibers. The rheological behavior of the developed composites was investigated using dynamic shear rheometry to determine the complex shear modulus (G*), phase angle (δ), and temperature–frequency dependencies in the range from −20 to +90 °C, while infrared spectroscopy was employed to assess intermolecular interactions. Adhesion performance was evaluated at different temperature. The modified systems demonstrated a 5–10-fold increase in G*/sinδ enhanced high-temperature stability, and improved adhesion and crack resistance compared to base bitumen. Based on the obtained rheological and performance indicators, the developed composition was approved for subsequent pilot-scale testing and field validation as a promising road sealing material. Full article

Background/Objectives: Leaks and fistulas are serious surgical complications associated with substantial morbidity and mortality. Traditional management has relied on surgical reintervention or percutaneous drainage, both of which carry significant risks. In recent decades, interventional endoscopy has emerged as a minimally invasive alternative, offering a growing range of therapeutic options. This scoping review aimed to systematically map the available evidence on endoscopic management of post-surgical leaks and fistulas, with a focus on techniques used, indications, outcomes, and gaps in the literature. Methods: This scoping review was conducted according to PRISMA-ScR guidelines. PubMed/MEDLINE, Embase, and Scopus were searched from inception to 5 December 2025. Eligible studies included original studies, systematic reviews, and narrative reviews reporting therapeutic endoscopic interventions for post-surgical leaks or fistulas in any patient population. Case reports and case series with fewer than 20 patients were excluded. Data were charted on study design, surgical context, endoscopic techniques, and reported outcomes. Results: A total of 69 studies were included, comprising 46 original studies involving 2550 patients, along with 11 systematic reviews and 12 narrative reviews. Endoscopic techniques identified included through-the-scope and over-the-scope clipping, stenting, endoscopic vacuum therapy, internal drainage, tissue sealants, endoscopic suturing, and hybrid devices such as VAC-Stent^®. Reported technical and clinical success rates varied widely across techniques and clinical settings, influenced by defect characteristics, timing of intervention, anatomical location, and operator experience. Endoscopic vacuum therapy was supported by the most consistent evidence, particularly for esophageal and colorectal leaks. Conclusions: Interventional endoscopy represents an increasingly central component in the management of post-surgical leaks and fistulas, enabling individualized, less invasive treatment strategies. However, the current evidence base remains heterogeneous and largely retrospective, underscoring the need for well-designed, multicenter prospective studies. Full article

Background/Objectives: Total knee arthroplasty (TKA) is often associated with extensive bleeding and the need for intraoperative and postoperative blood transfusions. Due to concern about the risks associated with them, a push has been made in surgery toward the development of new intraoperative blood management devices and innovative postoperative care strategies. Tranexamic acid (TXA), fibrin sealant and standard electrocautery are widely used in orthopedic surgery, since several studies provided evidence about their efficacy and safety. A new device, the bipolar sealer system (BSS), provides hemostasis at lower temperature (<100°) than conventional electrocautery. It does not produce smoke, necrosis or burn tissue. Methods: In this study, we retrospectively analyzed data from 480 patients who underwent TKA between January 2017 and December 2024. The cohort was divided into two groups based on the hemostatic protocol adopted. The control group enrolled 240 patients who received the standard protocol with TXA and fibrin sealant, while the study group enrolled 240 patients who followed protocol with Aquamantys BSS and TXA. Hematological parameters, including hemoglobin (Hb), hematocrit (HCT) and red blood cells (RBCs) were analyzed preoperatively (T0) and postoperatively: immediately after surgery (T1), at day one (T2) and day three (T3). Results: Changes in hemoglobin from baseline to postoperative follow-up were significantly lower among patients who received TXA plus BSS and those receiving TXA plus fibrin sealant, with p-values of 0.0003 at T1 (immediately after surgery), 0.027 at T2 (one day post-op), and 0.0001 at T3 (three days post-op). Comparable results were observed for HCT and RBC values. Conclusions: These data demonstrate that Aquamantys is more effective than fibrin glue in controlling blood loss after knee replacement surgery, not only immediately after the procedure but also in the following days. Full article

New hard tissue formation helps create a more stable seal in endodontic treatment. To achieve this, a novel class of endodontic sealers containing the pro-osteogenic element, strontium (within a BG), embedded in a polydimethylsiloxane matrix (Sr-PDMS) was produced. The properties of this sealer were compared with a commercially available bioactive endodontic sealer, Guttaflow Bioseal (GFBS). Glass was prepared via the melt quench method and incorporated into the GFBS matrix. Its physical properties were tested against the International Organisation for Standardisation (ISO) 6876. For biocompatibility assessment, dose–response proliferation of OCCM-30 cells was quantified by measuring DNA levels in varying concentrations of exogenous calcium and strontium, in culture media conditioned with the novel BG powder, and in sealer discs of the GFBS and novel Sr-PDMS. Two-way ANOVA followed by one-way ANOVA and the Bonferroni post hoc test were applied to the cell viability data. Both the GFBS and novel Sr-PDMS sealants demonstrated physical properties that met ISO 6876, but Sr-PDMS displayed greater radiopacity (p < 0.05), lower solubility, and increased setting time. Both sealants released ions into the immersion solution, with the additional release of Sr from the novel sealer. GFBS displayed evidence of apatite formation. As expected, high concentrations of BG-conditioned media were cytotoxic, but the levels released by the BG in the Sr-PDMS were not cytotoxic with 1:000 dilution and resulted in significantly increased (p < 0.01) cell proliferation compared to the control group. Full article

Background: Tracheal rupture is a rare, life-threatening condition that may follow blunt trauma, intubation, and, less commonly, esophageal instrumentation. The diagnosis may be challenging due to the subtle, delayed, and wide variety of symptoms. We present a unique case of delayed tracheal rupture secondary to iatrogenic esophageal perforation, presenting months later with a cervical neck insufflation on Valsalva, a novel clinical sign that has not been previously described in the literature. Case Presentation: A 44-year-old male initially presented with esophageal food impactation. Following endoscopic removal attempts, he developed signs consistent with esophageal perforation and was managed conservatively. In follow-up, he reported persistent neck discomfort, facial numbness, and the ability to insufflate the right side of his neck while doing a Valsalva. Flexible bronchoscopy and retrospective review of imaging revealed a proximal posterior tracheal defect, initially misinterpreted as a tracheal diverticulum. Surgical exploration confirmed a 6 cm dehiscence between the membranous trachea and the anterior wall of the esophagus. The defect was repaired using regional muscle flaps with tissue sealant reinforcement. Postoperatively, the patient had complete symptom resolution and no recurrence of neck insufflation. Conclusions: The case underscores the importance of maintaining a high index of suspicion for tracheal injury in patients with persistent or atypical symptoms following esophageal perforation or instrumentation. To our knowledge, we have described a novel clinical finding of neck insufflation upon Valsalva for diagnosing tracheal rupture. Full article

The milk metabolite profiles of dairy cows during the dry-off and peripartum periods were investigated using ¹H NMR combined with chemometric analysis to evaluate the effects of different dry-off management strategies. Milk samples were collected 14 days before dry-off (T0) and 28 days after calving (T1) from cows receiving an internal teat sealant combined with intramammary antibiotics (CTR), an internal teat sealant alone (SIG), or an internal teat sealant associated with dietary supplementation of lyophilized Aloe arborescens (ASIG). Analysis of both aqueous and organic milk extracts revealed no significant metabolite differences among treatment groups. In contrast, a clear discrimination was detected between samples collected at T0 and T1. Aqueous extracts at T0 were characterized by higher levels of choline, butyrate, branched-chain amino acids, and N-acetylated compounds, whereas T1 samples exhibited higher levels of saccharides, citrate, phosphorylcholine, and galactose-1-phosphate. Organic extracts at T0 showed higher concentrations of conjugated linoleic acids (CLAs) and caproleic acid. These findings indicated that the physiological stage of the cows had a more pronounced impact on milk metabolite composition than the dry-off treatments, with no detrimental effects on milk composition or overall metabolite balance. Full article

The management of dental caries has evolved from the traditional mechanical approach of “extension for prevention” to a biologically oriented philosophy centered on preserving natural tooth structures. Minimally invasive dentistry (MID) emphasizes early detection, risk assessment, prevention, and conservative intervention based on the lesion’s activity and depth. This review outlines current evidence on non-operative, micro-invasive, and minimally invasive strategies, including fluoride therapy, remineralizing agents such as casein phosphopeptide–amorphous calcium phosphate (CPP-ACP), self-assembling peptides that promote biomimetic enamel repair, sealants, and resin infiltration. Minimally invasive operative methods employ advanced technologies for selective tissue removal—chemomechanical systems (Carisolv, Papacarie, Brix3000), sono-and airabrasion, and new-generation polymeric and ceramic burs (SmartBur, Cerabur) designed to preserve sound dentin. Laser photoablation, particularly with erbium lasers (Er:YAG, Er,Cr:YSGG), enables precise cavity preparation with minimal thermal and mechanical stress. These approaches enhance patient comfort, reduce anesthesia requirements, and maintain tooth vitality. Despite limitations related to cost, equipment, and operator sensitivity, MID represents not only a set of refined clinical techniques but also a comprehensive, evidence-based treatment philosophy founded on biological principles, structural preservation, and the promotion of long-term oral health. Full article

Biopolymers can be derived from biological sources, including protein blends with plasticizers, starch, enzymatic synthesis, microorganisms, and algae. They are classified into polynucleotides, polysaccharides, and polypeptides, including polyhydroxyalkanoates, polylactic acid, and thermoplastic starch. Blending polymers with plasticizers and nanoparticles enhances their mechanical, thermal, and barrier properties. Biopolymers have various applications, such as in packaging, textiles, medical devices, cosmetics, agriculture, food products, emulsifiers, construction additives, bioplastics, and biofuels. Some of the advantages of biopolymers include their biodegradability, use of renewable resources, and reduced environmental impact. Nevertheless, certain disadvantages persist, such as high production costs, inadequate waste management systems, material quality loss during recycling, and the limited availability of raw materials. In this context, castor oil has emerged as a promising raw material for biopolymer production, with notable applications in coatings and sealants, and, consequently, bioplastics have become a sustainable and feasible alternative to conventional plastics that aligns with the principles of the circular economy. Moreover, new biopolymers are constantly being developed, and innovative applications are increasingly being explored across industries. The aim of the present review is to analyze the potential of biopolymers as sustainable alternatives to conventional plastics by evaluating their sources, production methods, advantages, limitations, and applications. Full article