To develop a no-code artificial intelligence (AI) model capable of identifying primary proximal surface caries using bitewings among pediatric patients. One hundred bitewing radiographs acquired at pediatric dental clinics were anonymized and reviewed. The inclusion criteria encompassed bitewing radiographs of adequate diagnostic quality of primary and mixed-dentition stages. The exclusion criteria included artifacts related to sensors' quality, positioning errors, and motion. Sixty-six bitewing radiographs were selected. Images were uploaded to LandingLens™, a no-code AI platform. A calibrated consensus panel determined the presence or absence of proximal caries lesions on all surfaces (using ground truth labeling). The radiographs were divided into training (70 percent), development (20 percent), and testing (10 percent) subsets. Data augmentation techniques were applied to artificially increase the sample size. Sensitivity, specificity, accuracy, precision, F1-score, and receiver operating characteristic area under the curve (ROC-AUC) were calculated. Among the 755 proximal surfaces identified from 66 bitewings, 178 were annotated as caries lesions by experts. The model achieved the following metrics: 88.8 percent sensitivity, 98.8 percent specificity, 95.8 percent precision, 96.4 percent accuracy, and an F1-score of 92 percent by surface. The ROC-AUC was 0.965. The developed model demonstrated strong performance despite the limited dataset size. This may be attributed to the exclusion of unsuitable radiographs and the use of expert-labeled ground truth annotations. The utilization of no-code artificial intelligence may improve outcomes for computer vision tasks.

To examine the association between parental divorce or separation (PDS) and oral health outcomes in children and adolescents in the United States (U.S.), and learn whether the association was mediated by a lack of needed dental care in the past 12 months. Data obtained from a sample of individuals who participated in the 2020 to 2021 National Survey of Children's Health (NSCH), representing 65,790,496 U.S. children and adolescents, were analyzed. A child's exposure to PDS was the independent variable. The outcome of interest was pediatric oral health, measured through parental responses to survey questionnaires indicating whether their child had dental caries, toothaches, and/or bleeding gums within the past 12 months. Analyses included descriptive statistics, bivariate analyses, logistic regression, and casual mediation analysis. After controlling for demographic factors and insurance coverage, children who experienced PDS, had 30 percent higher odds of suffering from oral health problems versus those who did not (odds ratio equals 1.29; 95 percent confidence interval equals 1.16 to 1.45). The association appeared to be partially mediated by failure to receive needed dental care. Parental divorce or separation is associated with the oral health of children and adolescents in the United States. Findings from this population-based study highlight the potential impact of PDS on children's oral health.

To compare the efficacy of laser phototherapy, Buzzy®, and lignocaine gel in minimizing pain during intraoral injections. In this randomized controlled trial, the efficacy of standard lignocaine gel (Group A) was compared with Buzzy® (Group B) and laser phototherapy (Group C) as pre-anesthetic agents in 15 children aged eight to 12 years undergoing intraoral local anesthesia (LA). Pain perception during needle insertion was assessed objectively using the Face, Legs, Activity, Cry, Consolability (FLACC) scale and subjectively using the Visual Analogue Scale (VAS). Statistical analysis included chi-square and analysis of variance tests (P<0.05). Objective assessment of pain perception using FLACC scores demonstrated that Buzzy® resulted in the highest comfort levels; 60 percent of the subjects treated with Buzzy®, 40 percent treated with laser phototherapy, and 6.7 percent treated with lignocaine topical anesthetic were judged to be relaxed and comfortable or exhibiting mild discomfort, respectively. Subjective pain assessment (self-reported using the VAS) was significantly lower in Buzzy® (0.67±0.82 standard deviation) followed by laser phototherapy (1.00±1.13) and Lignocaine gel group (2.13±1.51). The Buzzy® and laser phototherapy effectively reduced intraoral injection pain compared to the standard control, lignocaine gel. However, Buzzy® showed better efficacy.

To compare the compressive strength of traditional open-faced stainless-steel crown (OFSSC) to novel Preformed OFSSC (POFSSC) filled with different restorative materials. Seventy-five uniform 3D-printed models were divided into five groups (n=15): Group one (G1) traditional OFSSC; Group two (G2) POFSSC with restorative composite; Group three (G3) POFSSC with bulk-fill composite; Group four (G4) POFSSC with flowable resin restorative; and Group 5 (G5) POFSSC with resin-reinforced glass-ionomer. Samples were subjected to 1,000 cycles of thermocycling, at five degrees to 55 degrees Celsius, followed by a tactile exam. Instron was used for compressive strength test, with the maximum force at fracture initiation recorded in Newtons (N). Failure of the facial-surface was categorized as <50% facial-surface chipped, ≥50% to <100% facial-surface chipped, or the entire facial-surface came-off. One-way analysis of variance and the Kruskal-Wallis test was used (P<0.05). All samples were intact during the tactile exam following thermocycling. The compressive strengths are ranked as: G2???784.66±86.29 N; G3???730.46±159.52 N; G4???726.33±150.47 N; G1???650.59±116.05 N; G5???556.60±137.65 N. The compressive strength of G2 was significantly higher than G1 (P=0.007). G5 showed significantly lower compressive strength than G2 (P=0.0), G3 (P=0.001), and G4 (P=0.001). The entire facial-surface cameoff as follows: G2???6.67%; G4???13.33%; G5???26.67%; G3???53.33%; G1???66.67%. Compressive strength of G2 was significantly higher than control; and G2 had the lowest percentage of the entire facial-surface coming-off.

To assess oral hygiene, gingivitis, and the association between them for adolescents with cystic fibrosis (CF) compared to nonCF controls. This was a cross-sectional study of adolescents with CF aged 12 to 17 years (n=27), compared to two non-CF control groups: Medicaid-enrolled adolescents with special health care needs (ASHCN; n=60) and healthy Medicaid-enrolled adolescents (n=185). Dental plaque was a proxy for oral hygiene, and gingival bleeding was a proxy for gingivitis. This study employed confounder-adjusted binomial logistic regression to compare outcomes between adolescents with CF and controls. After adjusting for confounders, adolescents with CF had significantly poorer oral hygiene than controls (CF versus ASHCN odds ratio [OR] = 2.9, 95 percent confidence interval [95% CI] = 2.0 to 4.4, P<0.001; CF versus healthy OR = 1.7, 95% CI=1.3 to 2.2, P<0.001), but there was no significant difference in gingivitis (CF versus ASHCN OR=1.3, 95% CI=0.87 to 1.9, P=0.21; CF versus healthy OR = 0.80, 95% CI=0.60 to 0.99, P=0.04). Poor oral hygiene was significantly associated with gingivitis for all adolescents (CF OR=1.2, 95% CI=1.1 to 1.4, P<0.001; ASHCN OR = 1.8, 95% CI=1.6 to 2.0, P<0.001; healthy OR = 1.2, 95% CI=1.1 to 1.3, P<0.001). Adolescents with CF had poorer oral hygiene than non-CF controls but similar levels of gingivitis. Future efforts should identify factors that protect adolescents with CF from gingivitis.

To evaluate the accuracy and consistency of chatbots in answering questions related to special needs dentistry. Nine publicly accessible chatbots, including Google Bard, ChatGPT 4, ChatGPT 3.5, Llama, Sage, Claude 2 100k, Claude-instant, Claude-instant-100k, and Google PaLM, were evaluated on their ability to answer a set of 25 true/false questions related to special needs dentistry and 15 questions for syndrome diagnosis based on their oral manifestations. Each chatbot was asked independently three times at a three-week interval from November to December 2023, and the responses were evaluated by dental professionals. The Wilcoxon exact test was used to compare accuracy rates among the chatbots while Cronbach's alpha was utilized to measure the consistency of the chatbots' responses. Chatbots had an average accuracy of 55??4 percent in answering all questions, 37±6 percent in diagnosis, and 67±8 percent in answering true/false questions. No significant difference (P>0.05) in the accuracy proportion was detected between any pairwise chatbot comparison. All chatbots demonstrated acceptable reliability (Cronbach's alpha greater than 0.7), with Claude instant having the highest reliability of 0.93. Chatbots exhibit acceptable consistency in responding to questions related to special needs dentistry and better accuracy in responding to true/false questions than diagnostic questions. The clinical relevance is not fully established at this stage, but it may become a useful tool in the future.

To assess existing knowledge of anesthesia and perioperative information needs/preferences in parents (parent, caregiver) of patients with special health care needs (SHCN) undergoing general anesthesia (GA) for dental procedures, and analyze the relations between caregiver anesthesia knowledge, health literacy level, and preoperative anxiety. Parents of patients with SHCN requiring GA for dental treatment completed an online survey with closed- and open-ended items assessing preferences and interest in perioperative information and educational resources, anesthesia knowledge, anxiety, and health literacy. Pearson product-moment correlation coefficients and descriptive statistics were used to summarize the findings. Fifty-two parents completed the survey. Over two-thirds of the sample identified as having "high information" perioperative requirements, 42.3 percent of respondents exhibited elevated levels of perioperative anxiety, and 67.4 percent had adequate health literacy levels that were positively associated with anesthesia knowledge. Ratings of importance and interest in learning more about GA for dental treatment were high. Facilitating increased caregiver involvement before, during, and after surgery was the highest-rated resource format. Parents of patients with special health care needs are generally interested in receiving more information and resources about general anesthesia for dental treatment. Identified gaps in anesthesia knowledge and preferences for content and format of resources can be used to inform the development of tailored educational resources for families regarding perioperative management to ensure that parents have a complete understanding of their patients' anesthetic management and surgical care.

To evaluate whether reduced curing performance due to compromised light tip placement can be mitigated by bulk-fill composite and/or high-intensity curing light. Plastic discs with 2.5-mm deep cavities were filled with a conventional (Mosaic™) or bulk-fill (Tetric® PowerFill) composite and cured with a BluePhase® PowerCure curing light at normal and high-power settings, with light tip placement at distance and/or 45 degree angle. Curing time and irradiance were three, five, or 10 seconds at 1,200, 2,000, or 3,000 mW/cm2 (10 samples). After 24 hours, Vickers hardness on top and bottom surfaces was measured and analyzed using analysis of variance and pairwise comparisons (α<0.05). All top surfaces had higher hardness than bottom surfaces. Cure (bottom-to-top hardness ratio) was significantly affected by material, distance/angle, and curing regimen (P<0.001), and generally decreased when tip distance and angle increased. Bottom-to-top hardness ratios of bulk-fill composite (0.42 to 0.66) were significantly higher than those of conventional composite (0.20 to 0.31). High-power curing significantly increased bulk-fill's curing performance as it was specifically formulated for this curing light. Increased light tip distance and angle compromised composite curing. Bulk-fill composite cured better at the bottom of the restoration than conventional composite regardless of light tip distance/angle. High-power light curing improved curing performance only in bulk-fill composite. Nevertheless, due to low bottom-to-top ratios (0.20 to 0.66) across all samples, even under ideal light tip placement, both composites should be cured in increments of less than 2.5 mm.

To analyze the cariogenicity of meals served in a pre-kindergarten program and its potential influence on early childhood caries (ECC) risk in socioeconomically disadvantaged children. This study examined 123 school-provided meals over 43 days at the United Nation Childhood Development Center, part of the Oakland Unified School District pre-kindergarten program. Using cariogenicity indices developed by Evans et al., all items served were assessed for the cariogenic potential of both food and beverages. The mean daily cariogenicity scores were 6.57±1.3 (standard deviation) for food and 2.89±0.78 for beverages. Breakfast foods were significantly more cariogenic than those served for lunch or supper (P<0.05). The mean daily calorie intake was 1,459±336, with lunch containing statistically higher calorie items compared to supper (P<0.05). While liquids may not significantly contribute to caries risk, breakfast foods emerged as a potential concern. This study's findings suggest that the food provided in school meals, particularly breakfast items, may impact early childhood caries risk among socioeconomically disadvantaged children. Given the prevalence of ECC and its societal burden, integrating assessments of food and beverage cariogenicity into school meal planning could be instrumental in mitigating ECC incidence. Collaboration between the United States Department of Agriculture and school districts in considering the cariogenic potential of foods may contribute to improved oral health outcomes in early childhood.

The purpose of this study was to explore the perceived value of clinical photographs for traumatic dental injuries (TDIs). A survey was sent to members of the American Academy of Pediatric Dentistry (AAPD). The survey collected respondents' responses to case-based questions with and without photographs, and opinions about the value of photography for TDI. A total of 496 respondents (5.8 percent response) completed the survey. Overall, no significant difference in correct answers was observed between cases with and without a photograph (P=0.09). The majority of respondents (82.2 percent) agreed that photographs should be taken for the management of TDIs, with 88.7 percent stating that the photographs aided in the diagnosis of TDIs. The majority of respondents acknowledged the time-saving (80.9 percent) and legal importance (77.0 percent) of photographs. Photographs should be taken in the management of traumatic dental injuries when possible for history and documentation purposes.

Although gingival thickness has been extensively studied in permanent dentition, the literature regarding marginal gingival thickness in primary dentition is insufficient. The purpose of this study was to assess the variations in marginal gingival thickness in preschool-age children. A cross-sectional study of 4,109 primary teeth was conducted. Using a reamer, the transgingival probing method was employed to assess marginal gingival thickness in healthy preschoolers. Inter-examiner and intra-examiner reproducibility were assessed via the intraclass correlation coefficient. Descriptive statistics revealed that primary maxillary left second molars had the highest mean marginal gingival thickness (1.06 mm), whereas primary mandibular right central incisors had the lowest mean marginal gingival thickness (0.74 mm). Gender-based independent sample t-tests revealed significant differences in the values of primary maxillary right canines (females had greater values than males; P=0.03) and primary mandibular right first molars (males had greater values than females; P=0.01). An inter-arch comparison revealed significant differences between the primary second molars (maxillary more than mandibular; P=0.001). This study reports the first documented marginal gingival thicknesses of primary dentition. It reveals substantial variations in the values of primary maxillary right canines and primary mandibular right first molars and between primary maxillary and mandibular second molars.

The purpose of this study was to investigate the trends of pediatric dental rehabilitation in hospital outpatient departments (HOPDs) and ambulatory surgery centers (ASCs) during the COVID-19 public health emergency (PHE) from 2019 to 2021 across states and demographic groups. This cross-sectional study utilized the 2019 to 2021 Transformed Medicaid Statistical Information System Analytical Files to examine trends in dental rehabilitation for children ages 12 years and younger enrolled in Medicaid or the Children's Health Insurance Program. The final analytic sample included 20,508,093 beneficiaries from 2019, 19,436,957 beneficiaries from 2020, and 20,416,440 beneficiaries from 2021. Chi-square tests were used to compare dental rehabilitation usage across groups (age, sex, race/ethnicity, and place of service). Rehabilitation of Medicaid beneficiaries performed in HOPDs showed a decrease year over year (51 to 34 to 30; P<0.001), while the usage in ASCs increased (1,307 to 1,310 to 1,367; P<0.001). For all three years, the highest usage was seen in Non-Hispanic (NH) American Indian/Alaskan Native children (154, 66, 74; P<0.001), while the lowest usage was seen in NH Black children (21, 16, 17; P<0.001). Rehabilitation for Hispanic children had the greatest relative recovery over the three years (39 to 34 to 38; P<0.001). Dental rehabilitation usage in ambulatory surgery centers showed continued growth through the public health emergency. There was significant variation in rates across states and demographics.

The purpose of this study was to evaluate the environmental impact of travel and anesthetic gas emissions associated with treating early childhood caries at a single institution. Outpatient preventive, treatment, and modeled general anesthesia (GA) cases in children 71 months old and younger were included in this retrospective chart review. The main outcomes were kilograms of carbon dioxide equivalents (kgCO₂e) for travel- and anesthetic gas-related emissions. Descriptive statistics and non-parametric tests were used. Most subjects had a caries treatment visit (n equals 3,630 out of 5,767), and nine percent of treatment visits (n equals 353 out of 3,630) received nitrous oxide (N₂O), which added 29.4 kgCO₂eto the visit emissions. Children without caries treatment had lower travel-related emissions (median equals 7.5 kgCO₂e; interquartile range [IQR] equals 7.6) than children with caries treatment (median without N₂O equals 8.7 kgCO₂e; IQR equals 18.2; median with N₂O equals 8.4 kgCO₂e; IQR equals 10.3). Modeled GA travel emissions were estimated at 16.4 kgCO₂e (IQR equals 21.9) with between 3.8-12.9 kgCO₂e in anesthetic gas emissions. Total emissions were greatest for N₂O treatment visits (median equals 43.3 kgCO₂e; IQR equals 22.8). Travel-related emissions were greatest for children requiring caries treatment. Minimizing patient travel may reduce environmental impact. Nitrous oxide contributes a significant amount to a dental visit???s environmental impact. Community-focused models of care and applying systematic and practical case selection to reduce excess N₂O emissions could reduce dental care-related carbon emissions.

The purpose of this study was to assess, in vitro, the color stability and bleaching response of three bulk-fill composite resins-Activa™, Tetric®-N-Ceram Bulk-Fill, and Filtek™ One Bulk-Fill???and one conventional composite resin, Filtek™ Z250, after immersion in commonly consumed carbonated beverages and subsequent home bleaching with 15 percent carbamide peroxide. Ninety-six samples (two- and four-mm thick) of the materials were immersed in malt drink, energy drink, cola, or distilled water for one day, one week, and two months. After two months, samples underwent home bleaching with 15 percent carbamide peroxide gel. Spectrophotometric analysis measured color and whiteness changes pre-immersion, post-immersion, and post-bleaching. Statistical significance was determined using factorial mixed analysis of variance (ANOVA), three-way ANOVA, and Bonferroni post hoc tests (P<0.05). All tested composite resins exhibited unacceptable discoloration (color change greater than 3.3) after two months in carbonated beverages. Filtek™ One Bulk-Fill and Filtek™ Z250 displayed the most significant discoloration, particularly when immersed in the malt drink (P<0.05). In contrast, Activa™ samples reached unacceptable discoloration within just one week in malt and cola drinks. Home bleaching yielded limited whiteness recovery, with Activa™ presenting acceptable whiteness post-bleaching after staining with cola and energy drinks. This study highlights the aesthetic risks of prolonged carbonated beverage consumption and the limitations of the assessed home bleaching technique using 15 percent carbamide peroxide. Enhanced dental education on the dietary effects of some beverages on restorative materials is indicated by these findings.