Journal of Dental Research

Low salivary flow, or hyposalivation, is associated with an increased incidence of dental caries and a shift in their location from biting surfaces towards coronal and root surfaces. However, the relationship between salivary flow and periodontal disease is less clear. To identify clinical indicators of low salivary flow -- including the spatial pattern of dental and periodontal disease, features of the supra- and subgingival microbiota, and symptoms of dry mouth -- we enrolled individuals into two cohorts. The low flow cohort (N = 32) consisted of individuals with a presumptive diagnosis of the autoimmune disorder Sjogrens Syndrome (SS) while the control cohort (N = 119) consisted of healthy controls. We constructed a series of tooth-specific linear models to quantify the extent to which patient cohort, age, and unstimulated whole salivary flow rate (UWS-FR), independent of each other, are associated with dental and periodontal disease at each tooth. While age and a diagnosis of SS correlated with the site-specific increment of disease so too did UWS-FR. Not only were lower UWS-FRs associated with a greater number of decayed, missing, or filled surfaces at 21 teeth, but they were also associated with increased recession, as measured by clinical attachment loss (CAL), at 10 teeth (adjusted p < 0.05). In addition, we examined microbiota community structure at different tooth sites using data from 427 subgingival and supragingival samples of 6 individuals and found that microbial dispersal is reduced in patients with low salivary flow, but only at supragingival and not at subgingival sites. Finally, we found that complaints by subjects of a negative impact on overall quality of life were associated with a UWS-FR less than 0.1 mL/min. Overall, our results suggest that novel predictors of hyposalivation can be identified by integrating clinical, microbial, and patient history data.

BackgroundMultiple studies indicate that maternal sucrose-stimulated salivary pH has the potential to signal higher risk for diagnoses of early childhood caries and severity categories from the vertical transmission of bacteria from mother to child. AimThis study primarily investigated the relationship between maternal sucrose-stimulated salivary pH and child caries diagnosis and severity. It secondarily validated associations between 1) child and maternal sucrose-stimulated salivary pH, and 2) child sucrose-stimulated salivary pH and caries diagnosis and severity. DesignSalivary pH levels were measured from 440 mother-child dyads. Early childhood caries diagnoses and severity levels were recorded. The analysis of variance test identified the associations between child and maternal sucrose-stimulated salivary pH and regression models were derived to show that maternal and child salivary pH were estimators for childrens caries diagnosis and severity. ResultsMaternal salivary pH <= 5.6, compared to maternal salivary pH = 7, had 7.58 times higher odds for the childs ECC diagnosis and 5.61 times higher odds for moderate-extensive caries severity. Similar results were found for child salivary pH <= 5.6, compared to child salivary pH = 7. Maternal and child salivary pH were positively associated. When maternal salivary pH, compared to child salivary pH, was included with age, gender, and race/ethnicity as predictors for early childhood caries, the median interquartile ranges for sensitivity increased from 58.8 to 64.7 percent and specificity decreased from 84.6 to 80.8 percent. ConclusionDentists should understand that both maternal and child sucrose-stimulated salivary pH can signal the diagnosis and severity of early childhood caries.

IntroductionEvidence-based noninvasive caries therapies for initial caries lesions recently became available in the United States. Fundamental differences between noninvasive therapies and the traditional surgical dental approach warrant study of the financial scalability. MethodsThe financial costs and benefits to fee-for-service clinics and payors were compared across eleven scenarios simulating the treatment of 1,000 initial lesions over a three-year period. The scenarios included varying combinations of noninvasive therapies (silver diamine fluoride (SDF), SAP P11-4, and glass ionomer sealants), no treatment, and various rates of one to three surface restorations to an estimated current practice model. We used a decision tree microsimulation model for deterministic and probabilistic sensitivity analyses. We derived assumptions from an initial lesion and noninvasive therapy-focused cohort study with operations data from 16 sites accepting Medicaid in Alabama as a case study and clinical data from all 92 sites. ResultsIn comparison to the current practice model, scenarios that produce mutually beneficial results for payors savings and clinics net profit and profit margin include: SAP P11-4, SDF on non-cosmetic surfaces, and a mix of three noninvasive therapies. When considering the limited resources of chair and clinician time, the same scenarios as well as SDF with restorations emerged with substantially higher clinic net profit. ConclusionScenarios that include noninvasive therapies and minimize restorations achieve the balance of improving outcomes for all parties. Practical implicationsPayors should appropriately reimburse and clinics should adopt noninvasive caries therapies to improve oral health for all.

BackgroundFailure of tooth eruption (FTE) encompasses mechanical impaction, primary failure of eruption (PFE), and syndromic disturbances. Since the seminal review by Suri et al. (2004), advances in genetics and surgical protocols warrant comprehensive synthesis. ObjectiveTo evaluate PTH1R mutation prevalence, diagnostic accuracy of clinical/radiographic criteria, comparative effectiveness of open versus closed surgical exposure for impacted canines, prognostic factors for supernumerary-associated eruptions, and management outcomes for PFE and syndromic disorders across six domains. MethodsPubMed/MEDLINE, Cochrane Library, and Google Scholar were searched (January 2004-February 2026). To enhance reproducibility, databases with broad public accessibility were prioritized. Google Scholar was used only for citation tracking and not as a primary database to minimize algorithmic bias and irreproducibility. PRISMA 2020 guidelines were followed. Protocol registered on OSF (DOI: 10.17605/OSF.IO/R5X76). Inclusion criteria: RCTs, cohort, case-control, and diagnostic accuracy studies. Genetic testing was considered the highest reference standard for diagnostic accuracy. Risk of bias assessed using ROBINS-I, QUADAS-2, and RoB 2.0. Meta-analyses used random-effects models with Hartung-Knapp adjustment. Heterogeneity was assessed using I{superscript 2} statistics, with sources explored through subgroup analyses, meta-regression, and prognostic factor analysis. GRADE evaluated evidence quality. Forest plots and funnel plots are provided in Figures 3-8 and Supplementary Figures S1-S15. O_FIG O_LINKSMALLFIG WIDTH=200 HEIGHT=126 SRC="FIGDIR/small/26346646v1_fig3.gif" ALT="Figure 3"> View larger version (10K): org.highwire.dtl.DTLVardef@10ed0a5org.highwire.dtl.DTLVardef@1a4033borg.highwire.dtl.DTLVardef@d01e82org.highwire.dtl.DTLVardef@183165b_HPS_FORMAT_FIGEXP M_FIG O_FLOATNOFigure 3:C_FLOATNO Forest Plot - Treatment Duration Difference (Closed vs. Open Exposure). Forest plot comparing total treatment duration (months from exposure to final alignment) between closed and open surgical exposure techniques for impacted maxillary canines (Domain 3). Data from 8 studies comprising 1,287 canines. Closed exposure was associated with significantly shorter treatment duration (mean difference -4.7 months; 95% CI: -7.3 to -2.1; p < 0.001). Heterogeneity was moderate to high (I{superscript 2} = 64.1%), partially explained by study design in meta-regression (RCTs vs. cohorts, p = 0.04). The 95% prediction interval (-9.8 to 0.4 months) indicates the range within which the true effect in a future study would fall, supporting individualized technique selection. All eight studies favored closed exposure, though confidence intervals for three cohort studies crossed zero. Study weights ranged from 4.0% to 18.2%. RCTs (Parkin 2013, Bazargani 2019, Smailiene 2020, Chaushu 2021) showed slightly larger effect sizes (range: -3.8 to -6.1 months) compared to cohort studies (Becker 2010, Fleming 2015, Kokich 2012, Zuccati 2018; range: -3.2 to -6.4 months). Diamond represents pooled estimate; squares represent individual study weights with horizontal lines indicating 95% confidence intervals. C_FIG O_FIG O_LINKSMALLFIG WIDTH=200 HEIGHT=142 SRC="FIGDIR/small/26346646v1_fig8.gif" ALT="Figure 8"> View larger version (40K): org.highwire.dtl.DTLVardef@130d50aorg.highwire.dtl.DTLVardef@f2bc8dorg.highwire.dtl.DTLVardef@3905e3org.highwire.dtl.DTLVardef@1b17b38_HPS_FORMAT_FIGEXP M_FIG O_FLOATNOFigure 8:C_FLOATNO Forest Plot - Spontaneous Eruption After Supernumerary Removal. Forest plot of spontaneous eruption rates after supernumerary removal alone from 12 studies (1,456 patients) across Domain 4. Reported rates ranged from 48% to 68% across studies (I{superscript 2} = 71.2%). High heterogeneity reflects differences in patient age (deciduous vs. mixed vs. permanent dentition), supernumerary morphology (conical vs. tuberculate), timing of intervention, supernumerary position (palatal vs. labial vs. between roots), tooth type affected (central incisor most common), and follow-up duration (range 1-5 years). With adjunctive orthodontic measures (space creation, traction, or both), success rates increased to 81-90% across 8 studies (892 patients). Study weights ranged from 8.4% to 8.9%. Prognostic factor analysis (Table 6) identified favorable factors including removal during deciduous dentition (OR 2.5-5.5), conical supernumerary morphology (OR 3.0-6.5), and incomplete root formation of the permanent incisor (OR 2.5-5.0). Unfavorable factors included tuberculate morphology (OR 0.2-0.4) and complete root formation (OR 0.2-0.5). Diamond represents pooled estimate; squares represent individual study estimates with horizontal lines indicating 95% confidence intervals. C_FIG ResultsFrom 3,587 records, 94 studies (9,156 patients) were included across six domains. Overall certainty of evidence ranged from low to moderate due to observational designs and heterogeneity. Domain 1 (Genetic Basis): PTH1R mutation prevalence in PFE ranged from 52-90% (16 studies, 487 patients; I{superscript 2} = 68%; Figure 6). Heterogeneity reflected differences in familial vs. sporadic cases and referral bias. Population-level prevalence remains unknown. Sixty-three variants identified. Domain 2 (Diagnostic Accuracy): "Failure to respond to orthodontic force" showed sensitivity 94% (95% CI: 91-97%) and specificity 96% (93-98%). "Progressive posterior open bite" showed sensitivity 92% (88-95%) and specificity 89% (84-92%). Reference standard heterogeneity (I{superscript 2} = 45-65%) addressed through bivariate and HSROC models. CBCT provided superior root resorption detection (97% vs. 68%; p < 0.001). Domain 3 (Canine Impaction): Open (91% [88-94%]) and closed (93% [89-95%]) exposure achieved comparable success (I{superscript 2} = 52%). Closed exposure was associated with shorter treatment duration (mean difference -4.7 months [-7.3 to -2.1]; I{superscript 2} = 64%; Figure 3) and lower postoperative pain (-1.9 VAS [-2.6 to -1.2]; I{superscript 2} = 58%; Figure 4). Prediction intervals (-9.8 to 0.4 months) support individualized technique selection. Funnel plots showed no significant publication bias (Figure 7). Domain 4 (Supernumerary): Spontaneous eruption after removal alone: 48-68% (I{superscript 2} = 71%; Figure 8); with adjunctive orthodontics: 81-90%. Heterogeneity reflected patient age, supernumerary morphology, and timing of intervention. Favorable factors: deciduous removal (OR 2.5-5.5), conical morphology (OR 3.0-6.5), incomplete root formation (OR 2.5-5.0). Domain 5 (PFE Management): Orthodontic force application failed in 88-98% and caused adjacent tooth ankylosis in 25-50%. Prosthodontic rehabilitation achieved functional occlusion in 82-94%. Implant success: 85-95%. Meta-analysis not performed due to critical heterogeneity. Domain 6 (Syndromic): Cleidocranial dysplasia alignment: 61-75%. Osteopetrosis extraction-associated osteomyelitis: 33%, favoring conservative management. Narrative synthesis only. O_FIG O_LINKSMALLFIG WIDTH=200 HEIGHT=148 SRC="FIGDIR/small/26346646v1_fig6.gif" ALT="Figure 6"> View larger version (40K): org.highwire.dtl.DTLVardef@110d1cborg.highwire.dtl.DTLVardef@13d765corg.highwire.dtl.DTLVardef@2596c1org.highwire.dtl.DTLVardef@1cc6a6a_HPS_FORMAT_FIGEXP M_FIG O_FLOATNOFigure 6:C_FLOATNO Forest Plot - PTH1R Mutation Prevalence. Forest plot of PTH1R mutation prevalence in clinically diagnosed primary failure of eruption (PFE) from 16 studies (487 patients) across Domain 1. The reported prevalence varied substantially across studies, ranging from 52% to 90% (I{superscript 2} = 68%). Heterogeneity reflects differences in diagnostic criteria, patient selection (familial vs. sporadic cases), and referral bias. Subgroup analysis showed higher prevalence in familial cases (range 79-92%; 9 studies) compared to sporadic cases (range 54-71%; 12 studies). Meta-regression showed no significant association with geographic region, mutation detection method, or year of publication (p > 0.05 for all). Trim-and-fill analysis suggested one potentially missing study with negligible impact on pooled prevalence. Study weights ranged from 5.7% to 6.8%. The most frequently reported studies include Frazier-Bowers 2010 (0.75, 95% CI: 0.58-0.87), Risom 2013 (0.82, 95% CI: 0.66-0.92), and Park 2025 (0.89, 95% CI: 0.74-0.96). Reported estimates should not be extrapolated to unselected clinical populations; population-level prevalence remains unknown. Diamond represents pooled estimate; squares represent individual study estimates with horizontal lines indicating 95% confidence intervals. C_FIG O_FIG O_LINKSMALLFIG WIDTH=200 HEIGHT=147 SRC="FIGDIR/small/26346646v1_fig4.gif" ALT="Figure 4"> View larger version (17K): org.highwire.dtl.DTLVardef@15e7f1aorg.highwire.dtl.DTLVardef@eaa683org.highwire.dtl.DTLVardef@15a1c5forg.highwire.dtl.DTLVardef@fcc070_HPS_FORMAT_FIGEXP M_FIG O_FLOATNOFigure 4:C_FLOATNO Forest Plot - Postoperative Pain Difference (Closed vs. Open Exposure). Forest plot comparing postoperative pain scores (visual analog scale, VAS 0-10 at 24-48 hours) between closed and open surgical exposure techniques for impacted maxillary canines (Domain 3). Data from 5 studies comprising 842 patients. Closed exposure was associated with significantly lower pain scores (mean difference -1.9; 95% CI: -2.6 to -1.2; p < 0.001). Heterogeneity was moderate (I{superscript 2} = 58.2%), reflecting differences in pain measurement timing (24h vs. 48h), analgesic protocols, and study design (RCT vs. cohort). The consistent direction of effect across all studies supports robustness of findings. All five studies favored closed exposure for reduced postoperative pain. Study weights ranged from 17.5% to 22.4%. RCTs (Parkin 2013, Bazargani 2019, Chaushu 2021) showed slightly larger effect sizes (range: -1.8 to -2.4) compared to cohort studies (Becker 2010, Fleming 2015; range: -1.2 to -1.6). Diamond represents pooled estimate; squares represent individual study weights with horizontal lines indicating 95% confidence intervals. C_FIG O_FIG O_LINKSMALLFIG WIDTH=200 HEIGHT=114 SRC="FIGDIR/small/26346646v1_fig7.gif" ALT="Figure 7"> View larger version (29K): org.highwire.dtl.DTLVardef@1be2de2org.highwire.dtl.DTLVardef@b67f7corg.highwire.dtl.DTLVardef@16bb7b1org.highwire.dtl.DTLVardef@e904c4_HPS_FORMAT_FIGEXP M_FIG O_FLOATNOFigure 7:C_FLOATNO Funnel Plot - Publication Bias for Canine Studies. Funnel plot assessing publication bias for 7 studies comparing treatment duration between open and closed surgical exposure for impacted maxillary canines (Domain 3). The plot appears reasonably symmetrical, with studies distributed evenly around the pooled estimate. Eggers test was non-significant (p = 0.38), suggesting no strong evidence of publication bias for this outcome. Each circle represents an individual study. The funnel shape represents the pseudo 95% confidence interval limits. The symmetrical distribution indicates that small and large studies are similarly distributed around the pooled effect estimate, supporting the robustness of the finding that closed exposure is associated with shorter treatment duration (mean difference -4.7 months; 95% CI: -7.3 to -2.1). The absence of publication bias strengthens confidence in the meta-analytic findings for this outcome. C_FIG ConclusionsThese findings support a paradigm shift toward genetically informed orthodontic decision-making across six integrated domains. PTH1R mutations are frequently reported in PFE, though population prevalence remains unknown. Open and closed canine exposure techniques have comparable success; closed exposure offers advantages in comfort and treatment duration. Early supernumerary intervention improves outcomes. Heterogeneity across domains reflects clinical diversity and was addressed through appropriate statistical methods. Orthodontic forces should be avoided in confirmed PFE. RegistrationOpen Science Framework (DOI: 10.17605/OSF.IO/R5X76)

ObjectivesThis study was undertaken to assess the amount of dental aerosol created in a primary care dental surgery. MethodsTwo particle meters were placed a set distances round a volunteer patient whilst undergoing simulated dental treatment using a high speed dental handpiece, and 3-in-1 air/water syringe, moisture control was managed with high volume suction and a saliva ejector. Measurement were taken every thirty seconds with the surgery environment set a neutral ventilation and with the windows open plus fan assistance. ResultsFrom the cessation of aerosol generation it took between 6 and 19 minutes for the surgery to return to baseline. The ventilated surgery had faster aerosol dispersal, returning to background levels within 5 minutes. ConclusionIt is concluded for the surgery under investigation the dental aerosol had dissipated after 30 minutes using HVS and optimal surgery.

Background: Management of transverse maxillary deficiency in children with severely destructed first permanent molars (FPMs) is challenging because traditional tooth-borne rapid palatal expanders rely on these teeth for anchorage. These teeth are often compromised by extensive caries or Molar Incisor Hypomineralization (MIH), rendering them unsuitable as anchor units. Miniscrew-assisted expansion techniques may offer solutions that bypass compromised teeth. Methods: A systematic literature search was conducted using PubMed, PubMed Central, Google Scholar, DOAJ, OATD, OpenGrey, BASE, and the Cochrane Library (CENTRAL) (January 2005 to January 2026). Citation tracking and reference screening supplemented the search. The review protocol was developed a priori following PRISMA recommendations but was not registered in PROSPERO. Inclusion criteria: randomized controlled trials, prospective/retrospective comparative studies ([&ge;]10 patients/group) involving children aged 6-18 years with transverse maxillary deficiency. During full-text screening, studies were selected if their patient populations could be reasonably inferred to contain children with compromised FPMs based on clinical context (e.g., studies in pediatric dentistry, patients referred for MIH or severe caries). Risk of bias was assessed using the Cochrane RoB 2.0 tool for RCTs and ROBINS-I for non-randomized studies. Random-effects meta-analyses using the DerSimonian-Laird method were performed for skeletal expansion (standardized mean difference, SMD), dental tipping (SMD), success rate (pooled proportion), and relapse (mean difference). Results: From 28,879 initially retrieved records, 23 studies (1,847 patients; mean age 11.4 +/- 2.3 years) were included after screening; 16 contributed to meta-analyses. Of these, 987 patients received miniscrew-assisted expansion and 860 underwent conventional expansion. Four appliance types were identified: hybrid hyrax, C-expander, MARPE/MSE, and miniscrew-anchored distalizers. Miniscrew-assisted expansion achieved significantly greater skeletal expansion than conventional expanders (SMD=1.24; 95% CI: 0.89 to 1.59; p<0.001; I2=58%). Miniscrew-assisted expansion significantly reduced dental tipping compared with conventional expansion (SMD= -0.98; 95% CI: -1.42 to -0.54; p<0.01; I2=51%). MARPE appliances demonstrated a pooled success rate of 93.9% (95% CI: 89.7% to 97.2%; I2=41%). Long-term data ([&ge;]5 years, 3 studies) suggested a possible reduction in relapse of approximately 65% with MARPE. Subgroup analysis showed no significant outcome differences between appliance types (p=0.24). GRADE evidence quality was moderate for skeletal/dental outcomes, high for success rate, and low for long-term relapse. Conclusion: Miniscrew-assisted expansion represents a predictable and minimally invasive strategy for children with compromised first permanent molars, achieving superior skeletal expansion with reduced dental side effects compared to conventional techniques. These findings support a stratified appliance selection approach based on individual patient characteristics.

ObjectivesThis umbrella review evaluates systematic reviews and meta-analyses for salivary biomarker concentration and activity in caries-affected versus caries-free children. MethodsA comprehensive literature search identified relevant reviews, which were systematically selected using PRISMA guidelines, assessed qualitatively with AMSTAR 2, and analyzed quantitatively using RevMan software. Certainty of evidence was evaluated via the GRADE assessment tool. ResultsOf 609 identified articles, three reviews were included for quantitative analysis. AMSTAR 2 assessments rated three reviews as high quality and one as low quality. Meta-analysis findings showed that for salivary secretory immunoglobulin-A concentration with a mean of 65.54, with a 2.24 higher concentration (0.59 to 3.89 higher) in caries-affected children; carbonic anhydrase-VI concentration with a mean of 2.18, with a 0.92 lower concentration (2.21 lower to 0.38 higher) in caries-affected children; and carbonic anhydrase-VI activity with a mean of 3698.30, with a 2.89 higher activity level (1.24 to 4.54 higher) in caries-affected children. Heterogeneity was low for carbonic anhydrase, high for Salivary secretory immunoglobulin-A, and publication bias risk was low. The GRADE assessment indicated moderate confidence in evidence suggesting slight differences in Salivary secretory immunoglobulin-A and carbonic anhydrase-VI levels in caries-affected children. ConclusionsCaries-affected children under age nine exhibit higher salivary secretory immunoglobulin-A concentration and carbonic anhydrase-VI activity but lower carbonic anhydrase-VI concentration. Current evidence suggests that screening with these three salivary biomarker tests are likely to benefit and unlikely to harm children. Widespread clinical application remains limited until U.S. commercial laboratories provide standardized saliva-based testing for salivary secretory immunoglobulin-A and carbonic anhydrase-VI.

IntroductionDental caries is a disease that affects billions of people, and involves high and low genetic susceptibility phenotypes and different causal subtypes. The randomized clinical trial Precaries-RCT will evaluate caries prevention in adolescents, customized according to genetic cause and risk. Here we describe the Precaries-RCT and two nested Precaries studies for cost-efficient oral healthcare and personalized dentistry. Methods and analysisHere we present a basic and adaptive protocol for the Precaries-RCT multicentre caries intervention study, customized according to genetic cause and risk. It includes prescreening for high versus low genetic caries susceptibility, through self-performed sampling by mail of up to 2000 adolescents aimed for orthodontic treatment at community clinics, of which 520 are enrolled in the RCT. The participants are allocated into two groups - a high and a low genetic caries susceptibility group - that each is assigned to intensive or standard prevention. The primary outcome is % reduction in caries increment, relative to prevention and genotype, with caries outcomes measured using tactile and visual methods, bitewing radiographs, clinical photos, and quantitative laser fluorescence. The adaptive design allows for determination of incidence and progression rates and for inclusion of additional human and microbiota biomarkers and study subjects. Biological samples (e.g. swab DNA, whole and parotid saliva, and microbiota) and questionnaire data are collected. Here we also outline the nested Precaries-adolescent sample for mining of predictor and therapeutic target genes and Precaries-birth cohort samples for implementation of our findings in childhood. Ethics and disseminationEthical approval was obtained from the Swedish national board research ethics committee (Dnr 2020-02533). Informed consent will be obtained from each participant. The findings will be disseminated to the public through conference presentations and publication in peer-reviewed scientific journals. Trial registration numberwww.clinicaltrials.gov, NCT05600517 STRENGTHS AND LIMITATIONS OF THIS STUDYO_LICaries classification and prevention customized according to genetic cause and risk, and caries outcome measurements by tactile and visual methods, bitewing radiographs, clinical photos, and quantitative laser fluorescence. C_LIO_LIMulticentre study with orthodontic patients and conditions representative of the Public Dental Service clinics in Sweden, facilitating implementation, though in a part of the population. C_LIO_LIProspective study design in an orthodontic model with shortened study time and caries development on available smooth tooth surfaces. Frequent follow-up enables study termination of individuals with high caries progression, which may allow further shortening of study times, but with reduced individual data for the entire study period. C_LIO_LIConsensus-based intensified and self-care prevention in multiple repeated blocks, ensuring a high therapeutic dose; and basic and adaptive design, allowing flexible study time, caries incidence and progression outcomes, and extensive genetic profiling for online multimodal machine learning. C_LIO_LISynergizes with the Precaries-adolescence sample for mining of caries predictors and therapeutics, and Precaries-birth cohort for implementation in primary dentition/childhood. C_LI

Tooth brushing and flossing are usually both hallmarks of a good oral hygiene routine to prevent decay, gingivitis, and periodontitis. While brushing removes much of the oral bacteria from the front and backs of the teeth, flossing is believed to be necessary to remove bacteria between the teeth. However, the effectiveness of self-flossing has not been established very well. Flossing effectiveness was evaluated two ways in this study: adults and 12 year old children were instructed on how to floss and bacterial colonies were determined before or after 7 days or pediatric and family dentists were blinded to patient surveys that asked about flossing frequency and evaluated the patient for gingivitis. We found a significant number of children did not floss at all despite brushing daily. However, flossing had no effect on the number of bacteria in their mouths nor did flossing have any correlation with reducing gingivitis development. Taken together, self-flossing did not appear to be an effective strategy for reduction of gingivitis in children or adults but could stem from improper technique or simply a lack of doing it.

ObjectivesThe objectives were to quantify the contributions of internal (self) and external (familial) sources to the recolonization of the bacterial content of the subgingival plaque following professional prophylaxis and assess the effect of close-contact activities on modifying this contribution. Materials and MethodsFamilies, each consisting of at least one preschool-aged child and at least one sibling, were recruited for this interventional cohort pilot study. Microbial samples were collected from various oral sites, including saliva, buccal mucosa, tongue, supragingival plaque, and subgingival plaque in all family members. Following the childs oral prophylaxis, subgingival plaque samples were collected one week later. DNA from these samples was extracted and sequenced using the 16S rRNA gene and estimation of the sources were quantified using Bayesian source tracking models. Additional analyses using generalized linear mixed models, Phylofactorization, and Spearman correlations. Statistical significance was set at p<0.05. ResultsChilds own subgingival plaque was the primary source of recolonization, contributing 63.7% to the microbial community one-week post-prophylaxis. Siblings contributed approximately 8%, a contribution significantly higher than that from parents, who contributed around 3% each (p<0.05). The analysis revealed a statistically significant positive correlation between the number of siblings and their bacterial contribution to the childs subgingival plaque. Several close contact activities between parents and children were statistically associated with higher contribution (p<0.05, Spearman correlation). Additionally, 110 bacteria were statistically significantly different in their internal contribution compared to external, after accounting for household association, sample type, and family members (p<0.05, Phylofactor) ConclusionThe findings challenge the traditional focus on parent-child transmission of oral microbes, highlighting the importance of studying families as a whole.

ObjectiveOsteoradionecrosis of the jaw (ORNJ) is a chronic radiation-associated toxicity that lacks standardized classification criteria and treatment guidelines. Understanding early signs of tissue injury could help us better predict, prevent, and conservatively manage ORN. Our primary aims were to identify initial clinically-detected signs of ORN, determine the frequency of imaging-detected ORNJ, and validate the ability to classify cases using the novel system, ClinRad. Study DesignA retrospective electronic health record review of 91 patients treated for head and neck cancer at The University of Texas MD Anderson Cancer Center with suspected ORN was performed by an Oral Medicine specialist to identify initial signs of ORN. Patients who received reirradiation to the head and neck or did not have enough evidence of ORN were excluded. A descriptive analysis was performed. Results51 patients met the inclusion criteria. Half (53%) presented with imaging findings and exposed bone. Imaging findings in the absence of bone exposure were identified in 37%, of which disease progression was observed in 26%. All cases were classifiable using ClinRad. ConclusionSubclinical signs of bony changes consistent with ORN may be evident on imaging without exposed bone, supporting the use of imaging surveillance. ClinRad provided a mechanism to classify all cases at early onset. Data availability statementAnonymized data for the reported analyses is made publicly available on figshare at 10.6084/m9.figshare.28292186. Reporting guideline compliance statementIn accordance with the EQUATOR Network (Enhancing the QUAlity and Transparency Of health Research) guidance, we have utilized the RECORD checklist, a guideline for the "REporting of studies Conducted using Observational Routinely-collected health data" (Benchimool El at al., 2015) The RECORD checklist is provided as a Supplementary file and available via 10.6084/m9.figshare.28292219. Data was anonymized in accordance with the EQUATOR guideline "Preparing raw clinical data for publication: guidance for journal editors, authors, and peer reviewers" (Hrynaszkiewicz I et al., 2010).

BackgroundChild and maternal sucrose-stimulated salivary pH (SSS pH) levels have the potential to be associated with childhood caries. AimThis study investigated the relationships among child and maternal SSS pH and child caries diagnosis, severity, and risk. DesignSSS pH levels were measured from 202 pediatric subjects and 175 mothers. Early childhood caries (ECC) and severe ECC (SECC) diagnoses, caries risk assessment (CRA) results, and caries severity scores were recorded. The associations between child and maternal SSS pH and childrens caries risk, diagnosis, and severity were respectively assessed using regression models. ResultsChildren with SSS pH [&le;]5.6 had higher odds to be diagnosed with ECC or SECC (aOR=7.27), and higher odds to present with moderate to extensive caries severity (aOR=5.63). Child SSS pH was associated with multiple risk factors on a CRA. When child SSS pH was adjusted for age, gender, and race/ethnicity as a predictor for SECC and ECC, the sensitivity and specificity estimates increased. Maternal and child SSS pH were positively associated. ConclusionsDentists should consider the use of childrens SSS pH as an inexpensive adjunct to the CRA and know that maternal and child SSS pH are significantly associated.

IntroductionCoronavirus (COVID-19) has dramatically changed the landscape of dentistry including Paediatric Dentistry. This paper explores paediatric patient data within a wider service evaluation completed within an Urgent Dental Care Centre in the North East of England and North Cumbria over a 6-week period. AimTo assess demand for the service, patient demographics and inform paediatric urgent dental care pathways. Main outcome methodsData collected included key characteristics of paediatric patients accessing Paediatric Dental Services from 23rd March to 3rd May 2020. Descriptive statistics were used for analysis. ResultsThere were 369 consultations (207 telephone, 124 face-to-face and 38 Out of Hours consultations). The mean age of children accessing the service was 7 years old. 7% of those attending face-to-face visits were reattenders. The most common diagnoses were irreversible pulpitis and dental trauma. 49% of face-to-face consultations resulted in extractions, 28% with General Anaesthetic, and 21% with Local Anaesthetic. ConclusionManagement of dental emergencies provided by the Urgent Dental Care Centre for paediatric patients has largely been effective and confirmed the efficacy of patient pathways established. O_LSTThree in Brief PointsC_LST Describes the approach adopted in the North East of England and North Cumbria to managing paediatric dental emergencies during the coronavirus pandemic Provides an overview of dental problems and management provided to paediatric patients in the first 6 weeks of the coronavirus pandemic Confirms the need for general anaesthetic services for exodontia in the paediatric population

Translational frameworks to understand the chronic loss of salivary dysfunction that follows after clinical irradiation, and the development of regenerative therapies remain an unmet clinical need. Understanding the transcriptional landscape long after irradiation treatment that results in chronic salivary hypofunction will help identify injury mechanisms and develop regenerative therapies to address this need. Advances in single cell (sc)RNAseq have made it possible to identify previously uncharacterized cell types within tissues and to uncover gene regulatory networks that mediate cell-cell communication and drive specific cell states. scRNAseq studies have been performed for virtually all major tissues including salivary glands; however, there are currently no scRNAseq studies evaluating the long-term chronic effects of irradiation on salivary glands. Here, we present scRNAseq from control and irradiated murine parotid glands collected 10 months post-irradiation. We identify a population of epithelial cells in the gland defined by expression of Etv1, which may be an acinar cell precursor. These Etv1+ cells also express Ntrk2 and Erbb3 and thus may respond to myoepithelial cell-derived growth factor ligands. Furthermore, our data suggests that CD4+CD8+ T-cells and secretory cells are the most transcriptionally affected during chronic injury with radiation, suggesting active immune involvement during chronic injury post-irradiation. Thus, our study provides a resource to understand the transcriptional landscape in a chronic post-irradiation microenvironment and identifies cell-specific pathways that may be targeted to repair chronic damage. HighlightsO_LIWe generated a scRNAseq dataset of chronic irradiation injury in parotid glands C_LIO_LIA newly identified Etv1+ epithelial population may be acinar precursors C_LIO_LINtrk2 and Erbb3 are highly specific Etv1+ cell receptors that may mediate cell-cell communication with myoepithelial cells C_LIO_LICD8+ T-cells and secretory acinar cells have the greatest transcriptional changes post-IR C_LI

BackgroundEffective management of pain is critical in a dental setting, and insufficient pain management can lead to anxiety in patients and hesitancy to seek further dental help. Currently, there are no existing scoping or systematic reviews discussing the impact of clinician behavioural factors on pain perception, thus highlighting the need for it. AimsThe aim of this scoping review is two-fold: to analyse the scope of current evidence surrounding the association between clinician behaviour and pain experienced in the dental setting, and to identify areas where further research is needed. MethodologyA list of search terms and subject headings was developed for Pubmed, PsycINFO and Embase to conduct pilot searches. Duplicate articles were removed, and each article screened in accordance with pre-established inclusion and exclusion criteria. Relevant articles were assessed using a data extraction form. Information was analysed to determine the scope of current evidence and areas where further study is needed. ResultsDentist behaviour has a significant impact on the patients pain experience, and techniques to minimise pain include empathy, being calm and non-judgemental, and providing clear information to patients about treatment. Following up the patient after treatment, via a phone call or text message, reduces pain experience. Increased levels of dental anxiety have been shown to increase dental pain, and therefore it is important that clinicians implement behaviours to reduce dental anxiety in order to reduce pain. ConclusionNumerous studies have shown the association between clinician behavioural factors and the perception of pain in the dental setting. There are various techniques dentists can utilise to improve the pain experience for their patients, including displaying a warm empathetic demeanour, appropriately managing dentally anxious patients, and utilising non-judgemental communication skills. However, there are some areas where further research is needed. HighlightsO_LIClinician behaviour can be modified to alter the perception of pain in a dental setting C_LIO_LIVarious studies outline techniques that a dentist can use to improve a patients pain experience C_LIO_LIFurther research is required for chronic orofacial pain, phobic patients and patients with special needs C_LI

BackgroundDespite an increasingly biopsychosocial approach to pain management in healthcare, the scope of research into the role of psychological factors in endodontic pain is unknown. ObjectivesThis study aimed to identify the scope of research into psychological contributors to pain associated with endodontic procedures, as a first step towards addressing psychological contributors to pain in clinical practice. MethodThis scoping review was conducted and reported according to the JBI Manual for Evidence Synthesis and the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (extension for scoping reviews). The data search was conducted in MEDLINE, EMBASE, PsycINFO, Web of Science, Scopus, Cochrane Database of Systematic Reviews, and CINAHL databases. For gray literature, we reviewed reference lists, medRxiv pre-prints, ProQuest and EBSCO theses, ClinicalTrials.gov and Cochrane trials (via Ovid), and conference materials via Web of Science and Scopus (from inception to July 2023). Each record was screened by two independent reviewers. Data were extracted by one reviewer and cross-verified by a second reviewer. ResultsForty studies were included in the review. Twelve broad psychological constructs were evaluated in relation to pain for pre-procedural, procedural and post-procedural endodontics: pain expectancies, positive treatment expectancies, depression, anxiety, positive and negative mood (affect), beliefs about pain, desire for control of dental treatments, perceptions of dentists, somatic focus or awareness, pain coping strategies, personality, and psychiatric diagnoses. Pre-procedural pain was most frequently associated with anxiety. Procedural pain was consistently associated with expected pain. Post-procedural pain was associated with expected pain, depression, beliefs about pain, positive treatment expectations, and personality characteristics. ConclusionA variety of psychological factors have been investigated in relation to endodontic pain. Whilst associations between endodontic pain and psychological constructs were found, further research is needed to evaluate the strength of these associations, and the scope of evidence for interventions designed to address these psychological contributors to pain in dental practice. RegistrationThe search protocol was registered on Open Science Framework in 2021 (DOI number: 10.17605/OSF.IO/FSRJP).

IntroductionSilver diamine fluoride (SDF) is a simple and non-invasive agent used to arrest early childhood caries (ECC). This study aimed to investigate potential changes to the oral microbiome in children with ECC who were treated with SDF at three different frequency regimens. MethodsForty-five children (n=15 per group) with ECC were recruited into a randomized clinical trial testing three different treatment frequency regimens of SDF. A total of 195 carious lesions were treated with two applications of 38% SDF and 5% sodium fluoride varnish (NaFV) and assessed over three study visits (one month (Regimen 1M), four months (Regimen 4M), or six months (Regimen 6M) apart). Dental plaque samples were collected at each visit. Sequencing of the V4-16S rRNA and ITS1 rRNA genes were used to study the supragingival plaque microbiome. ResultsThe overall arrest rates for treated carious lesions were 75.9% at Visit 2 and 92.8% at Visit 3. Arrest rates were higher for all lesions after two applications of SDF with NaFV, and applications one month and four months apart had higher arrest rates (95.9% and 98.5%) than six months (81.1%) apart. The microbial diversity analyses showed no significant differences in the overall microbiome after SDF treatment. However, significant changes in the abundance of specific bacteria and fungi, particularly Lactobacillus spp., Bifidobacterium spp., and Candida spp. were observed after treatment. Furthermore, overabundance of Streptococcus mutans and Candida dubliniensis at baseline was observed in children who had at least one caries lesion not arrested after one SDF application, compared to those who had 100% arrest rates. ConclusionSDF with NaFV applications were an effective modality for arresting ECC, with higher arrest rates after two SDF applications. No loss of diversity but significant changes in the abundance of specific bacteria and fungi were consequences of SDF treatment.

BackgroundAmerican adults delay dental care more than any other healthcare service. Unfortunately, the COVID-19 pandemic may have stalled efforts to address dental service delays. Early evidence has suggested substantial declines in dental service visits in the early phase of the pandemic, however our study is among the first to measure within-person changes from 2019 to 2020 and conduct subgroup analyses to examine if changing dental patterns were mediated by exposure to the pandemic, risk of adverse COVID-19 outcomes, or dental insurance. MethodsWe analyzed a National Health Interview Survey panel of individuals initially surveyed in 2019, with subsequent follow up in 2020. The outcomes included dental service access measures and the interval of a most recent dental visit. By constructing a probability weighted linear regression model with fixed-effects, we estimated the average within-person change from 2019 to 2020. Robust standard errors were clustered within each respondent. ResultsOverall, adults in 2020 were 4.6%-points less likely to visit the dentist compared to 2019 (p < 0.001). Significantly higher declines were found in Northeast/West regions compared to Midwest/South. We find no evidence that declining dental services in 2020 were associated with more chronic diseases, older age, or lack of dental insurance coverage. Adults did not report more financial or non-financial access barriers to dental care in 2020 compared to 2019. ConclusionsThe long-term effects of the COVID-19 pandemic on delayed dental care warrants continued monitoring as policymakers aim to mitigate the pandemics negative consequences on oral health equity.

BackgroundGender inequalities in dental caries and periodontal diseases have been observed among adults. However, literature is scarce for children and evidence on gender inequalities regarding caries and/or periodontal diseases is vague. Our aim is to examine potential gender differences in UK children regarding caries experience and periodontal status using data from the UKs 2013 Childrens Dental Health Survey (CDHS). MethodsCDHS included children aged 5, 8, 12 and 15 years. Their dental caries experience and periodontal status were reported using the number of decayed, missing and filled teeth (DMFT or dmft for permanent or primary dentition at both D1 and D3 thresholds) and the basic periodontal examination (BPE) score, respectively. Zero-inflated negative binomial (ZINB) models were used to fit DMFT/dmft and a multinomial logistic regression (MLR) model was used for BPE scores after adjustment for possible confounding factors, to assess the gender inequality on DMFT/dmft and BPE in the UK children. ResultsThe analyses included 9,866 children. No gender inequalities in caries experience were observed in the 5 and 8-year-old children regardless of the threshold at which dental caries were examined. However, for the 12- and 15-year-old adolescents, females had higher D3MFT scores compared to males (IRR: 1.28, 95% CI: 1.10-1.49 and IRR: 1.16, 95% CI: 1.00-1.35, respectively). Additionally, the 15-year-old females had lower probability to be caries free (OR: 0.59, 95% CI: 0.45-0.82), regardless of the threshold at which dental caries were examined. With regards to the periodontal status, no statistically significant gender inequalities (p>0.05) were observed. ConclusionsIn the UK, female adolescents had experienced more carious lesions compared to males of the same age group, when dental caries were examined into dentine (D3MFT). However, 15-year-old males matched females in their caries experience, when the early enamel lesions were included in caries diagnosis (D1MFT). With regard to the periodontal status, no gender dissimilarity was confirmed among British adolescents. The increased risk of adolescent females to dental caries may signify additional needs for prevention and improved oral care.

PurposeThe purpose of this study was to determine the diagnostic testing accuracy of child and maternal sucrose-stimulated salivary pH as screening tools for early childhood caries diagnosis and severity. MethodsFrom a sample population of 642 mother-child dyads, with child-subjects under age six years old, child and maternal sucrose-stimulated saliva specimens were collected to measure salivary pH thirty minutes after consumption of sucrose by mouth. Immediately after the pH measurement and oral clinical examination, the pediatric dentist provider determined for child-subjects their diagnoses for early childhood caries and severity, respectively guided by the gold-standard classifications promulgated by the American Academy of Pediatric Dentistry and International Caries Detection and Assessment System. Salivary pH of 6.0 was statistically calculated as the screening cut-off point. Statistical analyses calculated values for true positive, false positive, true negative, false negative, and the diagnostic testing accuracy metrics for prevalence, specificity, sensitivity, diagnostic odds ratio, positive and negative predictive values, positive and negative likelihood ratios, and Youdens Index. Regression models were utilized to determine the respective odds ratio associations between child and maternal sucrose-stimulated salivary pH versus the diagnosis and severity of early childhood caries. ResultsFor early childhood caries diagnosis, child sucrose-stimulated salivary pH yielded diagnostic test accuracy metrics of 47.7 percent prevalence, 72.42 percent specificity, 59.47 percent sensitivity, 66.30 percent positive predictive value, and 66.20 percent negative predictive value, and diagnostic odds ratio 3.85. The results for maternal sucrose-stimulated salivary pH for caries severity were similar in value. Maternal sucrose-stimulated salivary pH displayed lower overall DTA metrics compared to child sucrose-stimulated salivary pH, but both child and maternal sucrose-stimulated salivary pH had higher specificity than sensitivity and displayed moderate levels of positive and negative predictive values. Child sucrose-stimulated salivary pH less than 6.0 had 3.89 times higher odds for ECC diagnosis and 3.56 times higher odds of moderate-extensive caries severity than child sucrose-stimulated salivary pH greater than 6.0. Maternal sucrose-stimulated salivary pH less than 6.0 had 1.60 times higher odds of moderate-extensive caries severity than maternal sucrose-stimulated salivary pH greater than 6.0. ConclusionChild and maternal sucrose-stimulated salivary pH screening tests are useful as a screening tool to identify children at high-risk for early childhood caries.