BDJ Open最新文献

Objective: Hydroxyapatite (HAP; Ca₅(PO₄)₃(OH)) is used in oral care formulations as a remineralizing agent and acts as a reservoir for calcium and phosphate ions. Consequently, HAP can serve as a neutralizing agent during acidic attacks caused by erosive beverages or cariogenic processes. This in vitro study aims to investigate the neutralization potential of HAP particles, used in oral care products, with a focus on changes in pH value, Ca²⁺ release, and structural integrity.

Materials and methods: 5.0% (w/v) particulate HAP was added to hydrochloric acid, phosphoric acid, citric acid, and lactic acid (37 °C, 0.1 M), as well as to Sprite® and Coca-Cola®, all under continuous stirring. pH values were measured after equilibration. Neutralization kinetics of HAP were investigated in Sprite® and Coca-Cola® within the first 30 s after addition of 0.15% (w/v), 0.5% (w/v), and 5.0% (w/v) HAP. Scanning electron microscopy (SEM) and X-ray powder diffraction (XRD) were employed to investigate crystallite morphology and composition. Atomic absorption spectroscopy (AAS) was conducted to analyze Ca²⁺ release.

Results: The investigated HAP shows a significant increase in pH in all systems and neutralizes between 98.0% and 99.9% of the acidic protons in the equilibrium. Up to 2619 mg L^-1 ± 48 mg L^-1 of Ca²⁺ are released in hydrochloric acid, while the porous particle structure remains unaffected. Kinetic investigation in beverages shows that already 0.15% (w/v) HAP neutralizes most of the dissociated acid within 20 s (83.9% in Sprite®, 98.7% in Coca-Cola®).

Conclusions: The study shows that HAP used in oral care formulations can efficiently counteract acids by increasing pH value and releasing Ca²⁺ ions, while retaining its functional morphology.

Background: Postoperative pain following endodontic treatment is a significant and common issue in daily clinical practice, frequently studied, and a source of concern for both patients and clinicians.

Aim: This study aimed to evaluate postoperative pain and analgesic use after single-visit endodontic treatment with a reciprocating system with or without foraminal enlargement in mandibular molars with necrosis and apical periodontitis.

Methods: Sixty patients undergoing endodontic treatment on mandibular molars were divided into two groups (n = 30): with foraminal enlargement (FE), with the working length set at 0.0 mm from the apex, and the other group without foraminal enlargement (WFE) at 1.0 mm short of the apex. Instrumentation was performed with the Wave One Gold System in a single-visit, rinsed with 2.5% sodium hypochlorite, and filled with a single cone and AH -Plus sealer. The patients were requested to rate their pain at 24, 48, 72 h, and 1 week on a visual analog scale (VAS) as nonexistent, mild, moderate, or severe, as well as to indicate the need for oral analgesics. The number of participants reporting pain was similar at both 24 and 48 h (p > 0.05).

Results: Mean VAS scores were low in both groups at all time points, with no clinically meaningful between-group differences. At 72 h and 7 days, no participant in either experimental group reported pain. There was no statistically significant difference in the painkiller tablets taken between the experimental groups at any evaluated period.

Conclusion: The frequency of postoperative pain and the number of analgesics taken by the patients were similar in the two experimental groups.

Background: The Objective Structured Clinical Examination (OSCE) is increasingly used to assess clinical competence in dental education. Understanding students' perceptions of this assessment method is essential for improving its design and educational impact, particularly in fixed prosthodontics.

Objective: To assess dental students' perceptions of OSCEs in Fixed Prosthodontics.

Materials and methods: A cross-sectional study was conducted in May 2025 at the Department of Fixed Prosthodontics, Faculty of Dentistry, Tunisia. Final-year dental students (n = 144) who completed a fixed prosthodontics OSCE were invited to participate. Data were collected anonymously using a structured online questionnaire administered via Google Forms and QR code. The questionnaire assessed students' perceptions of the OSCE in terms of clarity of instructions, organization, and stress level. Participation was voluntary.

Results: A total of 144 final-year dental students completed the questionnaire. The response rate was 100%. The majority of respondents (87%) reported that the OSCE content and instructions were clearly explained. Similarly, 87.5% indicated that they felt comfortable with the examiners before the examination. Regarding time allocation, 36.1% of students reported a neutral perception, while 11.8% indicated that the time available at certain stations was insufficient. In terms of stress, 65.9% of respondents described the OSCE as moderately stressful. With respect to perceived difficulty, most students reported greater difficulty in the cognitive station (43.1%), followed by the communication and behavioural station (33.3%). Finally, 93% of respondents reported that the competencies assessed during the OSCE were aligned with the objectives of their clinical training.

Conclusion: This study shows that students perceived the OSCE as an appropriate assessment method for clinical skills in fixed prosthodontics. They were generally satisfied with its clarity and organisation. However, they reported that some aspects should be improved, such as the timing and stress management.

Background: Intracanal medications used during routine endodontic treatment and regenerative endodontic procedures might cause undesirable effects on tooth properties, such as a reduction in dentine microhardness.

Objectives: To compare the effect of five intracanal medicaments; Bio-C Temp (Angelus, Brazil), modified triple antibiotic electrospun nanofibers (m-TAP) (NanoEbers, Egypt), Levofloxacin (Memphis, Egypt), Calcium hydroxide (CH) (Meta biomed, Korea) and Simvastatin (Merck & Co., USA) on the microhardness of radicular dentine.

Methods: Forty-five extracted single-rooted teeth were decoronated to a 15 mm root length then prepared. The specimens were assigned to five groups according to the used intracanal medicament: Bio-C Temp, m-TAP nanofibers, Levofloxacin, CH, and Simvastatin. After medicament application for two weeks, dentine microhardness was measured using a Vickers microhardness tester. Data were analyzed using the Kruskal-Wallis and Mann-Whitney U tests with a significance level set at p < 0.05.

Results: Bio-C Temp, and m-TAP nanofibers recorded the highest overall dentine microhardness values, followed by Levofloxacin and Simvastatin, while CH showed the lowest. Significant differences were observed among the tested groups at the coronal and middle levels (p < 0.05), whereas no significant difference was found apically.

Conclusions: Bio-C Temp, and m-TAP nanofibers demonstrated superior ability to preserve dentine microhardness, suggesting their promising potential advantage over conventional medicaments for strengthening root dentine.

Background: Periodontitis is a chronic inflammatory disease associated with oxidative stress. The Oxidative Balance Score (OBS) is a composite measure of dietary and lifestyle factors that reflect the balance between pro-oxidants and antioxidants. Recently, there has been growing interest in research examining the connection between oxidative balance scores (OBS) and periodontitis. However, the nature of this relationship, particularly whether it follows a linear or non-linear pattern, remains unclear. This study aimed to explore association between OBS and periodontitis using data from the National Health and Nutrition Examination Survey (NHANES 2009-2014.).

Methods: We conducted a cross-sectional study using data from NHANES 2009-2014. A total of 10,714 participants with a mean age of 32.60 years (SD = 24.91) were included in this study. Periodontitis was defined based on clinical periodontal examinations, and OBS was calculated using dietary and lifestyle factors. A generalized additive model was used to explore the nonlinear relationship between OBS and periodontitis. A two-piecewise linear regression model was employed to identify the threshold effect of OBS on periodontitis.

Results: The study found a nonlinear relationship between OBS and periodontitis. When OBS was less than 16, the odds ratio (OR) for periodontitis was 0.74 (95% CI: 0.50-1.09, P = 0.13). However, when OBS was greater than 16, the OR for periodontitis significantly decreased to 0.14 (95% CI: 0.09-0.20, P < 0.001). The threshold effect of OBS on periodontitis was identified at 16.

Conclusion: This study demonstrates a nonlinear relationship between OBS and periodontitis, with a significant reduction in the risk of periodontitis when OBS exceeds 16.

Introduction: The smear layer in radicular dentin reduces effective disinfection by occluding dentinal tubules and decreasing dentin permeability, contributing to persistent microbial infection and root canal treatment failures.

Objective: To compare the effect of 980 nm Diode laser irradiation and conventional irrigation with Sodium hypochlorite and ethylenediaminetetraacetic acid (NaOCl +EDTA) on smear layer removal in radicular dentin through dye penetration test.

Material and methods: Sixty-six extracted single-rooted permanent teeth were randomly allocated into two groups. Group I underwent 980 nm diode laser irradiation using a 200 µm fiber in helicoidal motion (2 W power, 200 Hz frequency, 1-4 ms pulse duration). Group II received conventional irrigation with 3% NaOCl followed by 17% EDTA. All specimens were immersed in 2% methylene blue dye for 48 h, after which cross-sections were obtained at 3, 5, and 8 mm from the anatomical apex. Dye penetration diameter (mm) and area (mm²) between the inner and outer circumferences were measured using ImageJ software under a stereomicroscope. Statistical analysis was performed using one-way ANOVA with Bonferroni post-hoc tests.

Results: The diode laser irradiation demonstrated overall significantly greater dentinal tubule penetration (16.2 ± 1.91 mm) compared to the conventional irrigation (5.32 ± 0.70 mm; p = 0.001). The overall mean area of the laser group (12.61 ± 2.02 mm²) was greater as compared to the conventional group (1.67 ± 0.73 mm²; p = 0.001).

Conclusion: Diode laser irradiation may serve as an effective adjunct for smear layer removal and improved root canal disinfection.

Background: Tooth wear has become an increasingly prevalent clinical issue. It can lead to a reduction in the vertical dimension of occlusion (VDO), heightened tooth sensitivity, and alterations in both function and esthetics due to the progressive loss of dental hard tissues. As the incidence and severity of this multifactorial condition continue to rise, there is a growing need for dentists to adopt minimally invasive approaches for diagnosis, monitoring, and management. This clinical trial was designed to evaluate the amount of enamel wear on opposing enamel in response to either indirect milled resin matrix ceramic or direct bulk-fill resin composite overlays, using intraoral digital scanning technology.

Methods: Eleven patients in each group received treatment for a total of 22 restorations. Participants were split into two groups, with R1 representing endodontically treated teeth restored with milled resin matrix ceramic overlays and R2 representing endodontically treated teeth restored with direct bulk-fill composite overlays. Using intraoral scanners and three-dimensional surface-based superimposition software, tooth enamel wear was assessed intraorally at baseline (T0), 12 months (T12), and 24 months (T24). The statistical analyses conducted included the Shapiro-Wilk test and the Mann-Whitney U test. The significance level was set at p < 0.05 across all tests.

Results: The mean linear wear ( ± SD) for the indirect restorations was 0.41 ± 0.27 mm, compared to 0.20 ± 0.05 mm for the direct restorations; this difference was not statistically significant (p = 0.066). Similarly, the mean volumetric wear was 0.13 ± 0.06 mm³ for the indirect group and 0.12 ± 0.08 mm³ for the direct group, with no significant difference between them (p = 1).

Conclusions: Within the limitations of this 2-year clinical evaluation, both direct bulk-fill resin composites and milled resin matrix ceramic overlays demonstrated comparable behavior with opposing enamel in posterior teeth, with no statistically significant differences between the tested materials.

Trial registration: The study was registered at ClinicalTrials.gov on 29 Jan 2025 (#NCT06807125).

Introduction: Oral health has been linked to cardiovascular disease (CVD), but its relationship to subclinical coronary artery atherosclerosis (SCAA) remains unclear. Using coronary computed tomography angiography (CCTA), we explored this association in an asymptomatic population.

Material and method: A total of 410 non-smokers (193 women, mean age: 64.6 years), comprising 204 individuals with SCAA and 206 without (non-SCAA), were assessed through clinical and radiographic oral evaluations. Self-reported oral symptoms were scored by questionnaire. We used sex-stratified regression analysis and compared model performance with and without the addition of data on oral health through area under the curve (AUC). The reference model included age and history of smoking.

Results: Individuals with SCAA had more missing teeth, higher Decayed and Filled Teeth scores and greater prevalence of peri-apical lesions and marginal bone loss >33%. Missing teeth was an independent risk indicator for SCAA (OR 1.15 95%CI 1.04-1.27). Model performance improved with the addition of oral status and self-reported oral symptoms, most prominently in women (AUC 0.67 vs. 0.78, p = 0.010). Decision curve analyses confirmed a consistent net benefit when data on oral health were considered.

Conclusions: The findings suggest that subclinical coronary artery atherosclerosis is associated with oral health. Oral health-related data may improve screening for risk of coronary events, especially in women.

Background: According to the World Health Organisation, oral health (OH) diseases are a major global health issue and outcomes are consistently poorer among refugees and migrants than host populations in many high-income countries (HICs). In the UK, the Office for Health Improvement and Disparities recognises asylum seekers, refugees, undocumented migrants, low-wage migrants, unaccompanied minors, and victims of trafficking as vulnerable migrants. These groups face worse OH outcomes due to systemic, socio-economic, cultural, and lifestyle-related factors, alongside barriers to accessing dental services. This scoping review explores the barriers and facilitators to oral healthcare experienced by vulnerable migrants in HICs.

Methods: We conducted a scoping review using the Arksey and O'Malley framework and reported findings in line with PRISMA-ScR. Embase and MEDLINE were searched from inception until April 30th 2024, for studies examining factors influencing access to oral healthcare services. Data were charted and thematically mapped onto the Dahlgren and Whitehead model of Social Determinants of Health (SDH).

Results: Of 3894 identified records, 17 studies (10 qualitative, 5 quantitative, and 2 mixed-methods) were included, covering 2653 participants across 8 HICs (USA, UK, Australia, Austria, Germany, Finland, Saudi Arabia and Canada). Barriers and facilitators were present across all SDH layers. At the socio-economic, cultural, and environmental level, financial barriers were most commonly reported (12/17 studies). Language difficulties, low awareness of services, and mistrust of healthcare providers mapped to living and working conditions, while acculturation and social support aligned with the social and community networks layer. Limited knowledge of prevention was noted under lifestyle factors, and lastly, gender roles under personal characteristics. Cultural and religious norms also shaped care-seeking, with spirituality and religious traditions supporting positive OH practices.

Conclusions: We identified barriers and facilitators to oral healthcare access across personal, behavioural, social, and structural levels, contextualised within the SDH framework. Addressing these requires policies and practices that address structural barriers, integrate OH into national public health strategies, and emphasise inclusive, culturally competent care to improve access to OH services for these groups.

Aim: Chronic Obstructive Pulmonary Disease (COPD) is a progressive respiratory disorder associated with chronic inflammation and airflow limitation. Periodontitis shares common risk factors with COPD, such as smoking. This meta-analysis evaluates the prevalence and severity of periodontitis in COPD patients by assessing periodontal parameters, including probing depth (PD), clinical attachment loss (CAL), and bleeding on probing (BOP).

Methods: A systematic search of electronic databases identified clinical studies reporting periodontitis in COPD patients. Studies with clear diagnostic criteria for both conditions were included. Data extraction was conducted using RAYYAN software, and study quality was assessed using the Newcastle-Ottawa Scale (NOS). A random-effects meta-analysis was performed in R Studio, with heterogeneity assessed using the I² statistic. To assess the robustness of the findings, a leave-one-out sensitivity analysis was conducted for CAL and PD. Publication bias was examined using the Trim and Fill method. Additionally, stratified subgroup analyses were performed based on smoking status and study design to explore potential sources of heterogeneity. Certainty of evidence was assessed using GRADE.

Results: A total of 41 studies were included. Periodontitis prevalence in COPD patients was 35%, significantly higher than in non-COPD controls. COPD patients exhibited greater periodontal destruction, with increased CAL (0.68 [0.37;0.98]) deeper PD (0.72 [0.12; 1.31]), and BOP (1.49 [0.19;2.79]). However, the certainty of this evidence was rated as low to very low.

Conclusion: COPD patients have a higher prevalence of periodontitis and worse periodontal parameters. While our meta-analysis suggests an association, the overall certainty of evidence is low. These findings should therefore be interpreted with caution. Future high-quality prospective studies are essential to confirm this relationship and inform clinical practice.