Journal of Dental Research

The COVID-19 pandemic highlighted the need for effective protection and rapid development of tests to track and quantify seroconversion through natural infection and vaccination. Recombinant proteins, consisting of the SARS-CoV-2 nucleocapsid and Spike Receptor Binding Domains (RBD) fused with nanoluciferase reporters (GloBodies) were designed and produced. The SARS-CoV-2 specific antibody within serum, from venous blood or eluted from local or remotely-obtained dried blood spots, form a complex with the GloBody, which can be captured on immobilized Protein G or anti-isotype antibody with the retained nanoluciferase activity being proportional to specific antibody levels. Natural infection, vaccination and human and animal SARS-CoV-2 specific antibodies were detectable. These were used to serially monitor infection and vaccination responses in dental healthcare workers (n=82), medical healthcare workers (n=72) and laboratory-based scientists (n=62) within the Royal London, dental and medical hospitals and associated university research institute in Whitechapel, East London. This indicated temporally distinct infection and vaccination profiles, consistent with hospital deployments and local and national lockdowns by dentists and scientists. As such, medical healthcare workers had twice the odds of experiencing COVID-19 symptoms (2.01 95%CI 1.13- 3.58. P<0.001) compared to dentists, who were more at risk than scientists. Likewise, those who performed virus exposure-prone procedures exhibited twice (1.98. 95% CI 1.18-3.34 P=0.01) the odds of symptoms and exhibited higher nucleocapsid titres (0.21 95%CI 0.05-0.38. P=0.012), indicative of higher infection levels. As predicted vaccination was associated with reduced infection risk as shown by reduced titre of nucleocapsid titres (-0.21 95% CI -0.34- - 0.17. P<0.001 and elevated Log10 RBD GloBody titres (1.18. 95%CI 1.09-1.26. P<0.001). The GloBody technology proved to be a versatile and scalable platform for rapid deployment.

A systematic review was performed to answer the following questions: 1) Do dental, oral and maxillofacial (OMF) surgical procedures generate bioaerosols (and if so, which ones), which can result in transmission of COVID-19?; 2) Are aerosolized airborne droplets (and to which extent is splatter) in dental and OMF procedures infective?; 3) Is enhanced personal protective equipment (PPE) an essential to prevent spreading of COVID-19 during dental and OMF aerosol generating procedures (AGPs)? Authors performed a systematic review to retrieve all pertinent literature that assessed effectiveness of surgical mask vs respirators for protecting dental health care workers during dental and OMF AGPs surgical procedures. Additionally, studies which assessed potential aerosolization during dental, OMF and orthopaedic surgeries were retrieved. There is moderate evidence showing that ultrasonic scaling and bone drilling using high speed rotary instruments produces respirable aerosols. Additionally, there is very weak/inconclusive evidence to support the creation of infectious aerosols during dental procedures. According to available very weak/inconclusive evidence, transmission of SARS-CoV-2 via infective aerosol during AGPS, so far, must remain speculative and controversial. As, however, this is a probable opportunistic way of transmission which at least cannot be sufficiently excluded and therefore should not be dismissed out of hand prematurely, proper and equally important properly applied protective equipment (i.e., N95 respirators or FFP-2 masksv or above regarding mouth and nose protection) should always be used during AGPs.

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.

Aim: Cross-sectional summaries of periodontitis based on clinical attachment loss (CAL) are, by definition, conditioned on surviving teeth. Because the most severely affected teeth are more likely to have been lost, these measures may underestimate cumulative disease burden and show an artificial flattening (attenuation) of severity with age. We hypothesised that measures more sensitive to severe attachment loss would show greater attenuation at older ages than measures defined across a broader range of sites. Materials and Methods: Using nationally representative data from adults aged 30+ years in NHANES 2009-2014, we examined age-specific trajectories across multiple continuous measures of periodontal severity and assessed whether divergence between measures followed the pattern predicted under severity-dependent tooth loss. Results: The proportion of observable sites declined from 93% at ages 30-34 to 68% at 80+ years, establishing the structural basis for the divergence observed across severity measures. All severity measures showed nonlinear attenuation with age, with distortion increasing with severity threshold. Higher-threshold measures exhibited the greatest attenuation, while lower-threshold measures showed more stable trajectories. Conclusions: Cross-sectional summaries of periodontitis reflect disease among surviving teeth rather than cumulative damage across teeth originally at risk. Attenuation at older ages is consistent with depletion of the most severely affected teeth rather than biological slowing. Distortion varies by measure, with higher-threshold and mean-based indices most affected, whereas the CAL 3+ mm threshold provides a more stable basis for age comparisons.

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.

Background Alveolar bone assessment in periodontal practice relies on radiography and clinical probing, both of which have well-documented limitations in precision. Intraoral high-frequency ultrasonography (US) offers a radiation-free alternative with potential for sub-millimeter resolution, the validity and precision for detecting minute osseous changes have not been established. The purpose of this study was to evaluate the concurrent validity and measurement precision of intraoral US for detecting alveolar bone-level changes in patients undergoing crown lengthening and osseous surgery, thereby enabling its translation to monitor osseous changes in patients with periodontitis. Methods Ten patients (28 tooth sites) undergoing crown lengthening or osseous surgery at a USC Advanced Grad Perio clinic were enrolled in this prospective observational study. Distance from the cementoenamel junction (CEJ) to the Alveolar bone crest (ABC) was measured at pre- and post-operative time points using a 40 MHz handheld intraoral US transducer and, intraoperatively, by standardized clinical photography. Agreement was assessed by Pearson correlation and Bland-Altman analysis. Measurement precision was quantified using the standard error of measurement (SEM) and minimum detectable change (MDC). Results Preoperative agreement between methods was excellent (r = 0.977; Bland-Altman bias = -0.009 mm; 95% limits of agreement [LoA]: +-0.40 mm). Post-operative correlation remained strong (r = 0.912; bias = 0.123 mm; LoA: -0.85 to +1.10 mm). Both methods detected statistically significant post-surgical increases in the ABC-to-CEJ distance (p < 0.001), as anticipated. US demonstrated substantially superior precision: preoperative SEM 0.058 mm with US versus 0.128 mm clinically, yielding MDC values of 0.160 mm (US) versus 0.354 mm (clinical), providing a 2.2-fold precision advantage. Conclusions Intraoral US demonstrated strong concurrent validity with clinical photography and a reproducible precision advantage in detecting alveolar bone-level changes in patients with periodontitis. These findings support its clinical utility as a radiation-free, high-sensitivity bone monitoring tool. Larger longitudinal studies with CBCT validation are warranted.

IntroductionDental settings have been considered high risk setting s for COVID-19. A Dental Public Health Team in South East Scotland have worked to risk assess the situation timeously to break chains of transmission. AimTo present routine data produced from a contact tracing service for COVID-19 cases in the dental setting with a focus on transmission. DesignObservational retrospective analysis of a routine data set of COVID-19 cases associated with a dental setting reported via the national contact tracing system for two health board areas in the east of Scotland. MethodsCOVID-19 cases were confirmed by PCR testing. Descriptive statistics are used to summarise the data collected over a 13-month period (Oct 2020-Dec 2021). A narrative presents themes identified during contact tracing that led to transmission within a dental setting and includes a case study. ResultsA total of 811 incidents are included. No evidence of staff to patient transmission or vice versa was found in this study. Staff to staff transmission occurred in non-clinical areas contributing to 33% of total staff cases. ConclusionTransmission of COVID-19 in a dental setting in the context of this study appears to be confined to non-clinical areas. Future pandemic plans should include tools to aid with implementation of guidance in non-clinical areas. In brief pointsO_LIOutbreaks of COVID-19 in a dental setting appear to be confined to the non-clinical areas of dental practices. C_LIO_LIWe have found no evidence of staff to patient transmission or vice versa using our contact tracing methods. C_LIO_LIFuture pandemic preparedness would benefit from including current quality improvement tools to aid with implementation of new standard operating procedures and other regularly changing guidance. C_LI

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.

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.

ObjectivesThe objectives of this study were to compare the analgesic and anti-inflammatory effects of naproxen sodium and acetaminophen after implant placement surgery. Materials and MethodsAdult patients who received one or two dental implants were treated with naproxen sodium (440 mg loading dose + 220 mg q8h, n=15) or acetaminophen (1000 mg q6h - max daily dose 3000 mg, n=15) for three days after implant placement in a randomized, double-blind design. Pain was assessed on a 0-10 scale every 20 minutes for 6 h. Tramadol (50 mg) was available as a rescue medication. Plasma and gingival crevicular fluid (GCF) were collected prior to the surgery and 0, 1, 2, 4, 6, 24, and 72h after surgery for quantification of interleukin (IL)-6, IL-8, and IL-1{beta} levels. ResultsPain scores were significantly lower in patients treated with naproxen sodium compared to those treated with acetaminophen. Inflammatory mediator levels in plasma and GCF increased after surgery and returned to near baseline levels by 72h. Plasma IL-6 levels were significantly lower 6h after surgery in patients treated with naproxen sodium compared to acetaminophen. No differences in inflammatory mediator concentrations in GCF were observed between the treatment groups. ConclusionsNaproxen sodium was more effective than acetaminophen in reducing post-operative pain and systemic inflammation following surgical placement of one or two dental implants. Further studies are needed to determine whether these findings are applicable to more complex implant cases and how they affect clinical outcomes following implant placement.

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.

BackgroundWhite spot lesions (WSLs) affect up to 95% of patients after fixed orthodontic treatment. These demineralized areas harm aesthetics and may become more visible after tooth bleaching. Resin infiltration offers a micro-invasive masking technique. ObjectiveTo systematically review and meta-analyze the efficacy of resin infiltration for masking post-orthodontic white spot lesions compared with no treatment, placebo, or alternative remineralizing agents. MethodsWe followed PRISMA 2020 guidelines. We searched electronic databases (PubMed Central, Google Scholar, CORE, Epistemonikos, DOAJ) from inception to April 24, 2026, using database-specific search strings. We included randomized controlled trials (RCTs) and prospective clinical studies that evaluated resin infiltration for post-orthodontic WSLs in human participants. The primary outcome was change in lesion visibility. Two authors assessed risk of bias using Cochrane ROB-2 (RCTs) and ROBINS-I (non-randomized studies). We performed a random-effects meta-analysis using R (version 4.3.1; meta package) and estimated between-study variance ({tau}2) with the DerSimonian-Laird method. ResultsTen studies (6 RCTs, 4 prospective cohorts) with 1,204 patients and 3,847 WSLs met the inclusion criteria. Resin infiltration significantly reduced lesion visibility compared with no treatment (standardized mean difference [SMD] = -1.78; 95% CI: -2.24 to -1.32; p < 0.001; I2 = 65%) and compared with fluoride varnish (SMD = -1.42; 95% CI: -1.82 to -1.02; p < 0.001; I2 = 48%). The effect remained stable at 12-24 months. Patient satisfaction ranged from 84% to 94%. Mild transient sensitivity (11%) was the only reported adverse event. Funnel plot inspection showed no obvious small-study effects. ConclusionsResin infiltration shows high efficacy and durability for masking post-orthodontic white spot lesions, with a very large effect size. Clinicians should consider it the first-line minimally invasive aesthetic treatment before any tooth whitening procedure.

Although the detrimental health effects of smoking on human health are well described, the impact of smoking on dental plaque build-up lacks consistent records. This is because dental research on periodontal health has primarily relied on subjective indices with poor discriminatory power. Novel digital imaging techniques for the objective quantitation of dental plaque are now available. Quantitative Light-Induced Fluorescence (QLF) technology has been used in several studies for digital quantification and monitoring of dental plaque. The objective of the study is to quantitate and compare short- and long-term repeatability of dental plaque among current, former, and never smokers by using a high resolution, auto-focus, hand-held QLF scanner (QRayCam Pro; Inspektor Research Systems BV, Amsterdam, NL). Demonstration of good reproducibility of QLF technology with clear discrimination for dental plaque quantitation among current, former, and never smokers will pave the way to future application of this test for both medical and regulatory research applied not only to combustion-free tobacco products (e.g. e-cigarettes, heated tobacco products, oral tobacco/nicotine products, etc.) and smoking cessation medications, but also to consume care product for oral hygiene.

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.

BackgroundFriction at the bracket-archwire interface is traditionally considered a key determinant of orthodontic tooth movement efficiency. However, clinical evidence remains inconsistent despite advances in low-friction systems, including self-ligating brackets, coated archwires, and frictionless mechanics. ObjectiveTo evaluate the clinical impact of friction-related interventions on tooth movement, anchorage control, and patient-centered outcomes. MethodsA scoping review with supplementary meta-analysis was conducted following PRISMA-ScR guidelines. Electronic searches of the Cochrane Library (1 systematic review: CD003453), PubMed (128 primary studies), and Google Scholar (approximately 2,500 results, screened to 45 relevant studies) were performed in February 2026 . Randomized controlled trials comparing friction-modifying interventions were included. Primary outcomes included rate of tooth movement, anchorage loss, and molar rotation. Secondary outcomes included pain and treatment duration. Random-effects meta-analysis (DerSimonian-Laird method) was performed using RevMan 5.4; this method was chosen due to expected clinical heterogeneity . Heterogeneity was assessed using the I{superscript 2} statistic and classified using non-overlapping thresholds: 0-40% low, 40-60% moderate, 60-90% substantial, and 90-100% considerable heterogeneity. Risk of bias was assessed using Cochrane RoB 2, and certainty of evidence was evaluated using GRADE. Given the small number of studies, pooled estimates should be interpreted cautiously due to potential small-study effects. ResultsNineteen RCTs were included in quantitative synthesis. Frictionless mechanics did not significantly increase the rate of space closure (MD = 0.15 mm/month; 95% CI: -0.08 to 0.38; P = 0.20; I{superscript 2} = 68% [substantial heterogeneity]) but resulted in significantly greater molar rotation (MD = 6.1 degrees; 95% CI: 4.8 to 7.4; P < 0.001; I{superscript 2} = 45% [moderate heterogeneity]) . Self-ligating brackets showed no consistent advantage in treatment duration or pain reduction. Active self-ligating brackets demonstrated slightly faster alignment than passive systems (MD = 10.24 days; 95% CI: 2.80 to 17.68). Low-friction ligatures and coated archwires did not improve clinical efficiency. Surgical acceleration methods reduced treatment time by 25-50% but increased early discomfort. Low-level laser therapy showed potential for accelerating tooth movement and reducing pain. ConclusionsHigh-level clinical evidence does not support the long-held assumption that reducing friction accelerates orthodontic tooth movement. The evidence fails to demonstrate a clinically meaningful acceleration effect from friction reduction alone. Resistance to sliding appears to be predominantly governed by binding and biological patient response, not friction alone--necessitating a shift in biomechanical strategy. A proposed evidence-informed conceptual model and clinical algorithm are presented to guide decision-making.

This randomized, double-blind, parallel-group clinical trial will compare the effectiveness of three bone-augmentation techniques applied to the posterior mandible using the cortical shell approach. Seventy-eight participants will be randomly allocated into three groups (autogenous, xenogeneic, or allogeneic cortical shells), each combined with a 1:1 mixture of autogenous bone chips and biomaterial. The study was approved by the CEISH-ITSUP Ethics Committee (Approval No. 1715824376) and is registered at ClinicalTrials.gov (Identifier: NCT06661447). Recruitment has not yet begun. The primary outcome will be horizontal bone gain (mm) evaluated by cone-beam computed tomography (CBCT) at 3, 6, and 12 months. Volumetric and morphometric analyses will be performed through a standardized digital workflow integrating intraoral scanning, CBCT segmentation, and surface registration. Secondary outcomes will include bone density, surgical duration, and postoperative inflammation. Based on previous CBCT-based randomized clinical trials, a total of 78 participants (26 per group) will provide 80-90% power to detect a 1.0 mm difference in horizontal bone gain among groups. This study aims to generate controlled, quantitative evidence on the volumetric and clinical performance of different cortical graft materials for posterior mandibular reconstruction.

Early childhood caries (ECC) is the most common non-communicable childhood disease. It is an important health problem with known environmental and social/behavioral influences that lacks evidence for specific associated genetic risk loci. To address this knowledge gap, we conducted a genome-wide association study of ECC in a multi-ancestry population of U.S. preschool-age children (n=6,103) participating in a community-based epidemiologic study of early childhood oral health. Calibrated examiners used ICDAS criteria to measure ECC with the primary trait using the dmfs index with decay classified as macroscopic enamel loss (ICDAS [&ge;]3). We estimated heritability, concordance rates, and conducted genome-wide association analyses to estimate overall genetic effects; the effects stratified by sex, household water fluoride, and dietary sugar; and leveraged the combined gene/gene-environment effects using the 2-degree-of-freedom (2df) joint test. The common genetic variants explained 24% of the phenotypic variance (heritability) of the primary ECC trait and the concordance rate was higher with a higher degree of relatedness. We identified 21 novel non-overlapping genome-wide significant loci for ECC. Two loci, namely RP11-856F16.2 (rs74606067) and SLC41A3 (rs71327750) showed evidence of association with dental caries in external cohorts, namely the GLIDE consortium adult cohort (n=[~]487,000) and the GLIDE pediatric cohort (n=19,000), respectively. The gene-based tests identified TAAR6 as a genome-wide significant gene. Implicated genes have relevant biological functions including roles in tooth development and taste. These novel associations expand the genomics knowledge base for this common childhood disease and underscore the importance of accounting for sex and pertinent environmental exposures in genetic investigations of oral health.

Dental caries remains one of the most prevalent chronic conditions globally, yet efforts to quantify a patients risk of developing new caries over time remain limited. Existing caries risk assessment (CRA) tools are widely used in clinical settings but typically rely on cross-sectional data, which may limit their predictive accuracy and generalizability across populations. To address these limitations, we developed RT2C, a recurrent neural network model based on bidirectional gated recurrent units (Bi-GRU) to predict time to new caries. The model was trained on longitudinal dental records from 466,782 patients across four diverse dental organizations, encompassing over one million visits between 2019 and 2023. Input features included demographics, preventive procedures, caries history, and previously recorded CRA scores. We benchmarked the model performance against other machine learning models such as logistic regression, light gradient boost machine, random survival forest, and CRA-based baselines using AUROC for binary classification and concordance index (c-index) for survival prediction. Our model demonstrated strong predictive performance, achieving a c-index of 88.52% (95% CI: 88.51-88.54) in survival analysis, significantly outperforming baseline models based on current or past CRA scores by more than 18%. Site-level evaluations confirmed its robust generalizability, with pooled models performing comparably or better than sites-pecific ones. Additionally, decision curve analysis showed that the Bi-GRU model offers greater clinical net benefit across a range of decision thresholds when compared to CRA or treat-all/treat-none strategies. By leveraging longitudinal dental histories and temporal patterns in patient visits, our proposed model provides clinically meaningful improvements in predicting caries risk. These findings support its potential integration into decision support tools for more personalized and preventive dental care.

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