Advances in Dental Health, 2nd Edition

Dental implant-supported rehabilitation is a key component of functional survivorship care for patients with head and neck cancer (HNC) treated with radiotherapy (RT). Despite its importance, implant outcomes in this population are frequently interpreted through simplified paradigms such as irradiated versus non-irradiated status, prescribed tumor dose, pre-RT versus post-RT placement, and arbitrary post-RT waiting intervals. This narrative review proposes a radiobiology-informed, implant-bed-specific framework for assessing implant viability following HNC RT. The biologically relevant exposure is best defined as the localized radiation dose delivered to the implant bed, considered in conjunction with fractionation, equivalent dose in 2-Gy fractions, recipient substrate, soft-tissue condition, prosthetic loading, systemic host factors, and late toxicity risk. Distinctions among early osseointegration, implant survival, implant success, prosthetic rehabilitation, and patient-centered functional benefit are essential, as retained implants do not necessarily equate to durable or meaningful rehabilitation. Post-RT timing should be understood as a contextual variable rather than a universal chronological determinant, since longer intervals do not inherently indicate progressive biological recovery and may be confounded by survivor and clinician selection. Future research should prioritize implant-bed-specific dosimetry, continuous modeling of dose and timing, standardized outcome measures, cluster-adjusted statistical approaches, time-to-event analyses, and explicit reporting of osteoradionecrosis as a distinct implant-relevant late toxicity endpoint. Shifting from chronological waiting rules to implant-bed-specific risk stratification may enhance the safety, interpretability, and clinical relevance of dental implant rehabilitation following HNC RT. Full article

Background/Objectives: The present study aimed to assess the understandability and actionability of Arabic text generated by a large language model for commonly searched Arabic queries on dry mouth. Methods: Using Google Trends, the top 10 searches worldwide related to ‘oral dryness’ were entered in OpenAI’s Generative Pretrained Transformer 5.1. Generated texts were achieved independently. Assessments were performed using the Patient Education Materials Assessment Tool (PEMAT) to evaluate the content, word choice, and style. Results: Causes, symptoms, and treatment of dry mouth were the most common dry-mouth-related queries. The highly temporal distribution of search interests among Arabic-speaking countries peaked between 2020 and 2021, then remained high throughout 2023, before declining in November 2025. The mean PEMAT understandability and actionability scores were 89% and 80%, respectively. It was notable that all generated responses lacked visual aids, which could have made the content difficult to understand and insufficient for acting on the information. Moreover, the formal Arabic form of ‘causes of dry mouth’ with a glottal stop yielded lower actionability scores (60%) than the informal Arabic form (80%). Conclusions: Clinicians could actively supplement clinic-based discussions with advice on using large language models to help patients recognise dry mouth symptoms and improve self-care. Also, they could improve their effective adoption by clearly explaining expectations, limitations, and language/cultural differences when adopting these models. Full article

Objectives: The objectives of this study were to assess the association between oral health-related quality of life (OHRQoL) and depressive symptoms among older adults in Canton Zurich, Switzerland, and to explore domain-specific variations. Methods: This pilot cross-sectional study included aging adults aged ≥65 years recruited from a university-based geriatric dental clinic in Zurich between 1 January and 31 March 2025. Participants completed paper-based questionnaires to assess their systemic and oral health, their quality of life (OHIP-14), and depressive symptoms (PHQ-8). Associations were assessed using Spearman’s rank correlation (ρ) with 95% confidence intervals estimated via bootstrap resampling. Domain-level analyses were conducted to explore the structure of the association, and a multivariable linear regression was used to assess whether the association persisted after adjustment. Results: A total of 108 participants were included (mean age of 76.2 ± 7.2 years; 53.4% male). Overall levels of OHRQoL and depressive symptoms were low. Higher OHIP-14 scores were moderately associated with higher PHQ-8 scores (ρ = 0.50; p-value < 0.01; 95% CI: 0.34–0.65). This association was consistent across PHQ-8 severity categories and remained significant after adjustment (β = 0.14; 95% CI: 0.06–0.22; p < 0.001). Domain-level analyses indicated stronger association in psychosocial and pain-related domains than for functional limitation. Conclusions: The study demonstrates that poorer OHRQoL was moderately associated with higher depressive symptoms, independently of the covariates examined, particularly in psychosocial domains. These findings suggest that OHRQoL reflects broader experiential and psychological dimensions of health beyond oral function alone, highlighting its relevance for oral health assessment in older adults. As the findings are based on a convenience sample of clinic attendees, larger population-based longitudinal studies are needed to clarify these relationships further. Full article

Background/Objectives: Existing oral-health questionnaires differ in scope from an instrument that combines objectively scored knowledge with separate attitude, practice, and self-efficacy domains across multiple adolescent oral and maxillofacial topics. This study developed the Adolescent Oral and Maxillofacial Health Knowledge–Attitude–Practice and Self-Efficacy Questionnaire (AOMH-KAPQ) and evaluated its initial psychometric properties. Methods: A 46-item pool derived from the KAP framework, literature, and clinical education content was refined through consultation with 18 experts and cognitive interviews with 10 adolescents. The questionnaire was administered to 1006 adolescents aged 12–18 years, and the sample was randomly divided for exploratory factor analysis (EFA) and confirmatory factor analysis (CFA; n = 503 each). Reliability, measurement invariance, and knowledge-item performance were also examined. Results: The final 38-item questionnaire comprised knowledge (15 items), attitude (9), practice (9), and self-efficacy (5). EFA identified one attitude and two provisional practice factors. In CFA, SRMR was ≤0.051 across dimensions; self-efficacy showed CFI = 0.991, TLI = 0.982, and RMSEA = 0.082, whereas robust RMSEA remained elevated for attitude (0.137) and practice (0.145). Cronbach’s α was 0.855–0.929, McDonald’s ω 0.867–0.930, and test–retest ICC 0.797–0.866. Conclusions: The AOMH-KAPQ showed good reliability in this sample, but structural evidence for the attitude and practice dimensions remains preliminary. At present, use should be limited to research and group-level educational needs assessment rather than individual clinical decisions. Full article

Background/Objectives: The study evaluates pain perception in children aged 5–9 during dental extractions, comparing intraligamentary anesthesia (ILA) delivered with a Computer-Controlled Local Anesthetic Delivery System (CCLADS) vs. the traditional inferior alveolar nerve block (IANB). Methods: A randomized clinical trial with 60 healthy, cooperative children measured pain both subjectively using the Wong–Baker Faces Pain Rating Scale (WBFPRS) and objectively using the Sound-Eye-Motor (SEM) scale. Results: Results showed significantly lower mean pain scores with CCLADS during anesthesia administration: WBFPRS was 2.0 ± 2.2 vs. 6.9 ± 2.6 for IANB (p < 0.001). Objective SEM scores during anesthesia delivery were also lower with CCLADS (3.7 ± 0.8) compared with IANB (5.7 ± 1.2) (p < 0.001). During the extraction itself, SEM scores did not differ significantly between groups. Conclusions: The authors conclude that ILA via CCLADS reduces discomfort during anesthesia without compromising anesthetic effectiveness. Full article

Objectives: This study aims to assess the prevalence of complications and failures associated with impacted canine eruption in a specialized referral center, with the goal of identifying factors that contribute to these outcomes. Methods: This retrospective cohort study included cases of impacted canines treated at the School of Dental Medicine between 2010 and 2020. Clinical and radiographic data were collected and evaluated for failures and complications by two independent clinicians (MK, MG). In addition, specialists in oral and maxillofacial surgery and orthodontics (YM, TS, NS) independently assessed all complications and failures. Results: Among the 214 impacted maxillary canines included, 23 (10.7%) failed to erupt following initial surgical–orthodontic treatment and required re-intervention. Eruption difficulty was attributed to orthodontic factors in 43.5% of cases, surgical factors in 13.0%, and combined factors in the remainder. Following a second procedure, 15 canines erupted successfully, while 8 did not, resulting in an overall failure rate of 3.7%. Treatment failure was significantly associated with both anatomical and procedural factors. Canines with centrally positioned crowns exhibited a significantly higher failure rate than those with buccal or palatal positions (χ² test, p = 0.025). Failure was also more common when the canine root apex was located in close proximity to a cortical plate. Lateral incisor root resorption was significantly associated with treatment complications (p = 0.030). In the multivariable logistic regression analysis, root resorption remained an independent predictor of treatment failure, increasing the odds of failure approximately fourfold (OR = 0.255, CI = 0.077–0.843, p = 0.025). Timing and surgical technique were also significantly associated with treatment outcome. Surgical exposure performed shortly after diagnosis was linked to an increased risk of treatment complications (p = 0.006). Closed surgical exposure demonstrated a significantly higher failure rate compared with open exposure (Pearson exact test, p = 0.009). Although open exposure was associated with a greater likelihood of successful eruption, it was also significantly associated with increased gingival morbidity (Fisher’s test, p = 0.030). Conclusions: Failure of impacted maxillary canine eruption following combined surgical–orthodontic treatment is uncommon but is significantly associated with distinct anatomical and procedural risk factors. Central crown position, cortical plate involvement, lateral incisor root resorption, early surgical exposure, and the use of closed exposure techniques all increase the likelihood of treatment failure and complications. Although open exposure enhances the probability of successful eruption, it may also negatively affect gingival outcomes, underscoring the need for individualized, multidisciplinary treatment planning. Full article

Background/Objectives: Autologous dentin matrix (ADM) has been suggested as a biologically plausible biomaterial for alveolar bone regeneration after tooth extraction. However, clinical evidence regarding its biological activity and early healing outcomes is limited. This exploratory, randomized controlled pilot study aimed to descriptively assess early alveolar healing patterns and bone morphogenetic protein 4 (BMP4) expression following tooth extraction using ADM compared with other grafting approaches. Methods: Patients requiring tooth extraction were allocated to one of four groups: ADM, xenograft, ADM combined with platelet-rich fibrin, and a graft-free control group. Histological and immunohistochemical analyses were performed four months after extraction to descriptively assess cellular features of healing and BMP4 expression. The trial was registered at the Brazilian Registry of Clinical Trials (ReBEC; RBR-24mdgrf) and conducted under prior ethics committee approval. Results: BMP4 expression was detected in 67.9% of the analyzed histological fields, predominantly localized in osteocytic, osteoblastic, and medullary areas. Although descriptive differences in BMP4-positive fields were observed among the groups, no statistically significant differences were identified between the groups. Histological evaluation revealed an active cellular environment across all treatment modalities, consistent with early post-extraction healing. No adverse events related to surgical procedures or grafting materials were reported during the study period. Conclusions: Within the limitations of this pilot randomized clinical trial, ADM exhibited consistent biological behavior during early post-extraction alveolar healing. The observed BMP4 expression likely reflects a general physiological healing response rather than a material-specific effect. This finding supports the biological plausibility of dentin-derived grafts as osteoconductive biomaterials. These findings are hypothesis-generating, and larger, adequately powered randomized clinical trials with standardized molecular and histological assessments are required to determine their clinical relevance. Full article

Objective: This is the first population-based study to separately examine whether preventive and treatment dental visits modify the association between stressful life events and toothache. Psychological stress may alter health-seeking behaviors and pain perception, potentially leading to symptom-driven rather than preventive dental visits. Methods: Cross-sectional data were obtained and analyzed from the 2019 wave of the Japan Gerontological Evaluation Study (JAGES), including 19,314 community-dwelling adults aged 65 years and older. Poisson regression analyses were conducted to examine the associations between stressful life events, dental visit history, and self-reported toothache. Results: Higher stressful life events were associated with greater toothache prevalence (PR = 1.189; 95% CI: 1.117–1.264). Preventive dental visits within the past six months were linked to the lowest risk, whereas recent treatment visits were associated with higher risk. Conclusion: Promoting regular preventive dental visits, particularly among individuals under high stress, may help reduce the likelihood of experiencing toothache among older adults. Full article

Molar incisor hypomineralisation (MIH) is a developmental defect affecting permanent first molars and often the incisors too. Hypomineralised second primary molars (HSPM) have been proposed as potential early indicators of MIH. Aim: The aim was to identify potential aetiological factors associated with MIH and assess their relationship with HSPM in a pilot study. Methods: A cross-sectional case–control study was conducted with 120 patients (60 cases and 60 controls), aged 7–15 years, from the Paediatric Dentistry Postgraduate Programme. MIH was diagnosed following European Academy of Paediatric Dentistry (EAPD) guidelines. Parents completed a structured questionnaire on potential aetiological factors. Results: MIH was significantly associated with maternal smoking during pregnancy (p = 0.013), birth hypoxia (p = 0.013) and the use of amoxicillin and inhalation therapy during infancy (p < 0.001). It was also associated with tonsillitis (p = 0.022), bronchiolitis (p = 0.005) and other respiratory disorders (p = 0.049). HSPM was associated with anaemia and hypotension during pregnancy (p = 0.001), bottle-feeding (p = 0.044) and urinary tract infections (p = 0.003). No statistically significant association was found between MIH and HSPM. Conclusions: This pilot study has identified specific prenatal, perinatal, and postnatal factors associated with MIH and HSPM. The findings emphasise the clinical relevance for early diagnosis and management and highlight the need for studies with larger sample sizes to validate these associations. Full article

Background: Oral health is increasingly recognized as a determinant of overall well-being, but its role in mental health remains underexplored. Chewing difficulty and tooth loss can impair nutrition, social interaction, and quality of life, thereby contributing to psychological distress. Objectives: This study examined the association between oral health indicators and anxiety among Korean adults. Methods: Data were obtained from 4746 adults aged ≥19 years who participated in the 2023 Korea National Health and Nutrition Examination Survey (KNHANES). Anxiety was assessed using the Generalized Anxiety Disorder-7 (GAD-7), a validated 7-item self-report questionnaire with responses on a 4-point Likert scale (0 = not at all to 3 = nearly every day). Anxiety severity was categorized into four levels. Severity was categorized into four levels using the GAD-7. Oral health predictors included the number of remaining teeth and self-reported chewing difficulty, along with toothache experience, toothbrushing frequency, and unmet dental care needs. Complex survey-weighted ordinal logistic regression models were applied, adjusting for sociodemographic, behavioral, and clinical covariates. Results: Overall, 15.3% of adults reported mild, 3.1% moderate, and 1.6% severe anxiety. Chewing difficulty, fewer than 20 remaining teeth, overweight status, high stress, depressive symptoms, and unmet dental care needs were significantly associated with greater anxiety severity. Conclusions: The number of remaining teeth retention and chewing function were closely related to anxiety. Preserving functional dentition and ensuring timely access to dental care may be effective public health measures to reduce the psychological burden in the general population. Full article

Purpose: The aim of this study is to determine the analgesic efficacy of ibuprofen 200, 400, and 600 mg after lower third molar surgery. Material and Methods: Clinical trials that included patients undergoing third molar surgery comparing ibuprofen with placebo were included. The only exclusion criteria was loss of postoperative patient follow-up greater than 20%. PubMed, Wiley, Science Direct, EBSCOhost, Scopus, and Web of Science databases were used to search for clinical trials. The risk of bias of the included articles was assessed using the Cochrane Collaboration’s seven-point risk of bias tool, and dichotomous data for the most important variables for determining analgesic efficacy and adverse effects were then concentrated into one database for statistical analysis. Results: The qualitative analysis was performed with 57 clinical trials and a total of n = 7735 patients. Moreover, the number of patients who took rescue analgesics and the global evaluation of the studied drugs showed statistical differences in favor of ibuprofen 200 (n = 797 and n = 694, respectively), 400 (n = 2803 and n = 2407, respectively), and 600 mg (n = 1149 and n = 291, respectively) compared to placebo. Adverse effects, such as nausea, vomiting, and headache, resulted in statistical differences in favor of ibuprofen 200 (n = 1461, n = 1319, and n =1342, respectively), 400 (n = 3917, n = 3124, and n = 2477, respectively), and 600 mg (n = 716) in comparison to placebo. The numbers needed to treat indicated high efficacy of ibuprofen in controlling pain after third molar surgery, while the numbers needed to harm were high, indicating the good safety profile of this drug. Conclusions: Ibuprofen has high analgesic efficacy and a good safety profile when used after third molar surgery. Full article