The term hypomineralisation of molars and incisors (MIH), introduced in 2001 by Weerheijm et al., describes a clinical state of hypomineralisation of permanent molars with frequent involvement of the incisors. MIH is considered a global dental problem with a prevalence ranging from 2.4% to 40.2% in the entire world paediatric population. The continuous increase in the prevalence of enamel anomalies, including MIH, indicates the need to define new intervention protocols based on the technological advances that are revolutionising paediatric dentistry. The use of ozone associated with the selective and minimally invasive excavation of the dental tissue combines the antibacterial properties of the gas with an ultra-conservative approach aimed at the maximum conservation of the dental tissue. The operative protocol described can be an important tool in the prevention and treatment of MIH. The aim of this work is to illustrate an operative clinical protocol based on the combined use of selective excavation and ozone for the treatment of carious lesions in paediatric patients with MIH.

Early childhood caries (ECC) is a public health problem, especially in developing countries like Egypt which has an ECC prevalence of 74%. This research aimed to assess the risk indicators associated with ECC in a rural, socially-disadvantaged population in Alexandria, Egypt.
A case-control study was conducted in 8 nurseries of preschool children aged 3 to 5 years in rural, deprived areas in Alexandria, Egypt, from October 2019 till January 2020. Two groups, 93 with ECC and 93 without ECC. A validated questionnaire was used to collect sociodemographic data including age, sex, number of siblings, socioeconomic status, oral health practices including toothbrushing frequency, pattern of dental visits, daily frequency of sugary snacks. Also, salivary pH and buffering capacity were assessed. A trained and calibrated dentist assessed caries status clinically according to the World Health Organization (WHO) criteria using the dmft index and oral hygiene status using Silness and Loe Plaque Index. Chi-squared test, followed by multivariable logistic regression were performed to assess the relation between independent variables and ECC, P < 0.05 was considered to be statistically significant.
Bivariate analysis showed that age, mother\'s education, dental visits, dietary habits, Plaque index, salivary pH and buffering capacity were significantly associated with ECC. The significant risk indicators for ECC in multivariable regression were age (AOR = 4.73, 95% CI: 2.76-7.83), mother\'s education (illiterate vs. university educated, AOR = 28.36, 95% CI: 8.51-112.92), frequency of daily sugary snacks (twice vs. once, AOR = 2.00, 95% CI: 1.29-3.49, and three or more vs. once, AOR = 2.67, 95% CI: 1.72-3.27), night feeding (AOR = 1.89, 95% CI: 1.38-10.21), Plaque index (AOR = 21.34, 95% CI: 5.56-81.99), and salivary pH (AOR = 0.16, 95% CI: 0.05-0.58).
This study suggests that sociodemographic indicators, dietary habits, plaque accumulation and salivary pH are risk indicators for ECC in the studied population.

UNASSIGNED: Gene polymorphisms are responsible for at least part of the variation in caries susceptibility despite similar environmental factors. Genes involved in enamel formation like matrix metalloproteinase-13 (MMP-13) may participate in caries process. The aim was to investigate the association between MMP-13 rs478927 polymorphism and caries susceptibility in 6-years-old children from Birjand, Iran.
UNASSIGNED: Six-years old children from Birjand, Iran, participated in this study. The total decayed, missing, and filled teeth were calculated and defined as caries index (CI). Based on this CI, two groups of high-caries (case) and low-caries (control) were taken into account. Saliva samples were collected and DNA was extracted. The allele and genotypes of MMP-13 rs478927 polymorphism were determined by tetra-primer amplification refractory mutation system-polymerase chain reaction (T-ARMS-PCR) method. p Value was significant if p < 0.05.
UNASSIGNED: Three hundred sixty-seven children consisted of 186 low-caries children and 181 high-caries children were included in this study. The mean CI was 6.02 ± 0.81. There was no significant association between high and low-caries groups based on socioeconomic status, eating sweet snacks, parents\' susceptibility to dental caries, duration of breastfeeding, and the brushing habit (p > 0.05). There wasn\'t any significant association between genotype distribution of MMP-13 rs478927 polymorphism and CI groups (p = 0.924). This polymorphism was associated with increased caries susceptibility under all genetic models but this effect was not significant (p > 0.05).
UNASSIGNED: The MMP-13 rs478927 gene polymorphism was not significantly associated with dental caries susceptibility in Birjandi children with mixed dentition. It is recommended to conduct studies on children of different dentitions to better understand the role of this polymorphism on caries susceptibility in primary and permanent teeth of children.

OBJECTIVE: This case report presents a direct composite inverse injection technique using a bi-layer clear mini-index fabricated with a digital workflow to restore extensive posterior occlusal cavities in a 13-year-old patient.
METHODS: After a root canal treatment in the right mandibular first molar and step-wise excavation of deep caries in the left mandibular first molar, the extensive occlusal restorations were digitally designed using CAD software, upon which digital wax-ups were 3D-printed. Bi-layer clear mini-indices consisting of a hard outer plastic layer and an elastic inner silicone layer were prepared from the 3D-printed cast. The bonding surfaces were deproteinized using a 6% sodium hypochlorite solution, and an antioxidant (Clearfil DC Activator; Kuraray Noritake) was utilized to improve the dentin bonding durability of a 2-step self-etch adhesive (Clearfil SE Bond 2; Kuraray Noritake). Subsequently, a highly filled universal-shade flowable resin composite (RC) was incrementally placed into the cavities. To create the final occlusal morphology, the same RC was inversely injected through the opening of the bi-layer indices.
RESULTS: The workflow was feasible, and the occlusal cavities were efficiently restored using the injection technique. Occlusal carving and adjustments of the morphology were not necessary, leading to less chair time. At the 1-year follow-up, the clinical outcome was excellent.
CONCLUSIONS: The injection technique with a bi-layer clear mini-index accurately translated the digital wax-ups into large, final restorations. Precise morphology and shortened chair time enhanced patient satisfaction, but at the expense of multiple visits.

Despite being almost entirely preventable, globally, dental caries is extremely prevalent. Moreover, dental caries will continue to present an even larger challenge for lower income countries, particularly those in the African context, as they transition to a more Western diet. Hence, epidemiological data providing insight into disease patterns and trends is critical to inform public health action. The purpose of this study was to examine dental caries clusters by caries detection threshold among 15-year-old adolescents in Sierra Leone, using data from the latest national survey, and to explore associated sociodemographic factors.
This paper presents a secondary analysis of oral health data on 490 15-year-olds from the Sierra Leone national oral health survey of schoolchildren. Hierarchical cluster analysis of dental caries experience was conducted across all surfaces at four decay detection thresholds using the International Caries Detection and Assessment System (ICDAS) (clinical: ICDAS 2-6, cavitated: ICDAS 3-6, obvious: ICDAS 4-6 and extensive obvious: ICDAS 5-6 decay) across the four regions of Sierra Leone. Ordered logistic regression was used to estimate the association of sociodemographic factors with generated clusters relating to clinical and obvious decay experience. These are of both clinical and epidemiological relevance.
A 3-cluster decay pattern representing a \'low\' to \'high\' decay experience distribution was observed under each decay detection threshold across surfaces. For clinical decay (including visual enamel caries), 28.8% had low, 55.1% medium and 15.9% high caries status. In the adjusted model, the only significant risk factor across obvious and clinical decay thresholds was region, with adolescents outside the Western region more likely to experience decay.
This study suggests that adolescents in Sierra Leone fall into three distinct caries clusters: low, medium to high decay experience distribution, regardless of decay threshold. It reinforces the importance of recognizing dental caries detection thresholds and the use of contemporary epidemiological methodology. This suggests that adolescents outside the Western region are likely to have higher caries experience. The data also provides insight to the nature of adolescents in each cluster and should help to inform policy and planning of the integration of oral health into primary care and school systems.

UNASSIGNED: This study aimed to 1) investigate the relationships between hair cortisol concentration (HCC), insomnia symptoms, Health-Related Quality of Life (HRQoL) and Oral Health-Related Quality of Life (OHRQoL) in preschool children with severe early childhood caries, 2) compare HCC, insomnia symptoms, HRQoL and OHRQoL in preschool children with severe early childhood caries with these factors in children without clinical signs of dental caries, and 3) explore correlations between caries scores and HCC, insomnia symptoms, HRQoL and OHRQoL.
UNASSIGNED: A case-control pilot study, including 12 children with severe early childhood caries and 28 controls, aged 3-5 years. Dental examination was performed and hair samples for cortisol were taken. Parents filled out questionnaires about their child\'s insomnia symptoms, HRQoL and OHRQoL. Interpreters were used in families with language difficulties.
UNASSIGNED: The key findings in this pilot study were tendencies that children with severe early childhood caries had more insomnia symptoms, and poorer OHRQoL than the controls. Caries scores was correlated with insomnia symptoms and OHRQoL.
UNASSIGNED: Dentists should include questions about the child\'s sleep when they see the child, as insomnia related to dental caries may lead to several physical, mental, and social problems.

BACKGROUND: Early childhood caries (ECC) has a profound impact on a child\'s quality of life, and its management remains a challenge for the paediatric dentist, mainly because it depends on radical changes in the child/carers\' daily behaviour and any dental treatment must be provided to very young child.
METHODS: This case report describes the on-going care of a 2-year-old child presenting with ECC and management until permanent dentition is complete. All patient-focused, teamdelivered care was delivered using the minimum intervention oral care framework, implementing non-invasive and minimally invasive preventive procedures. Throughout the care provided, oral and dental health education was reinforced in all visits. The child\'s mother was trained to perform effective biofilm control and dietary habits were adjusted, especially baby-bottle removal during sleep. The child was initially anxious and resistant towards any dental examination and clinical procedures. However, with effort from the oral healthcare team members, the patient became compliant, allowing the mother to perform suitable oral hygiene measures, as well as accepting the clinical procedures carried out by the paediatric dentist. The clinical procedures consisted of atraumatic restorations and fluoride varnish applications. During the subsequent years after the baseline treatment, follow-up visits included continued dietary and oral hygiene instruction with positive behavior reinforcement, fluoride topical applications and tooth-restoration complex maintenance with glass-ionomer cement where needed. Currently, the patient is 19 years old and has a stable, healthy permanent dentition.
CONCLUSIONS: Understanding of the causes of oral diseases by the patients\' caregivers, alongside with pragmatic practical guidance to maintain good oral health, can reduce the risk for acquiring future disease, since caries activity control is the basis for successful caries management.

BACKGROUND: Erosive tooth wear (ETW) and dental caries have common etiological factors, such as unhealthy eating habits, and reduced salivary flow rate.
OBJECTIVE: To analyze the association between caries experience (CE) and ETW in adolescents 13-14 years.
METHODS: Ninety-seven cases with distinctive ETW were identified and then sex-matched with a group of 97 controls and a group of 97 cases with initial ETW. The variables included were CE, presence of debris/dental calculus, salivary parameters, food and beverage consumption, chewable vitamin C tablet consumption, gastroesophageal reflux, frequent vomiting, and tooth brushing. Multinomial logistic regression models were adjusted.
RESULTS: An association was found between cases with a distinctive ETW defect and CE (OR = 1.09 (95% CI: 1.01-1.17); p = 0.020), sweet carbonated drinks consumption (OR = 1.16 (95% CI: 1.03-1.31); p = 0.012), and frequent vomiting (OR = 3.19 (95% CI: 1.02-10.01); p = 0.047).
CONCLUSIONS: The preventive management of both ETW and dental caries should aim to reduce exposure to foods and beverages with high acid and sugar content. Given the association between ETW and acid attack by gastric juice, this would be an indicator of the need for referral to a specialist for treatment.

Early childhood caries (ECC) remains a public health challenge globally, more so in developing countries. The association between sleep-time feeding practices and ECC remains obscure. The study evaluated this association using Feeding At Sleep Time (FeAST) scale. A case-control study was planned among 627 toddlers, were cases included children with ECC while controls were children without ECC. Three patterns of feeding associated with sleep were recorded: beginning of sleep, during the course of sleep, and early morning hours sleep. Dental caries was scored using International Caries Detection and Assessment System (ICDAS II). The study participants included 302 (48%) cases and 325 (52%) controls. Adjusted odds ratios (AORs) for breastfeeding at the beginning of sleep, during the course of sleep, and early morning hours sleep were 6.7, 6.5, and 3.7, respectively (p = 0.001), on comparing cases versus controls. Similarly, AORs for bottle-feeding at the beginning of sleep, course of sleep, and early morning hours sleep were 5.1, 8.3, and 3.7, respectively (p = 0.001). Addition of sweeteners yielded an AOR = 2.84, while the intake of solids during sleep yielded an AOR of 6.02(p = 0.001). Other feeding modes like sippers, tumblers, etc., had a statistically significant association (p = 0.001). Sleep-time feeding practices increase the risk for ECC in 12- to 36-month-old children.

Severe Early Childhood Caries (sECC) is a multifactorial disease associated with the occurrence of specific oral microorganisms and other environmental, behavioral, and genetic factors. This study aimed to construct a multivariable model including the occurrence of Candida spp. and selected behavioral factors (length of breastfeeding, serving sweet beverages and beginning of brushing child\'s teeth) to determine their relationships to the occurrence of sECC. In this case-control study 164 children with sECC and 147 children without dental caries were included. MALDI-TOF MS and multiplex qPCR were used to identify Candida spp. and selected bacteria in dental plaque samples, respectively. A questionnaire on oral hygiene, diet, and children\'s health was filled in by the parents. The constructed multivariable logistic regression model showed an independent influence of the microbial and behavioral factors in sECC etiopathogenesis. The occurrence of C. albicans and C. dubliniensis was associated with higher odds of sECC development (odds ratio, OR: 9.62 and 16.93, respectively), together with breastfeeding of 6 months or less (OR: 2.71), exposure to sweet beverages (OR: 3.77), and starting to brush child\'s teeth after the 12th month of age (OR: 4.10), all statistically significant (p < 0.01). Considering the high occurrence of C. albicans and C. dubliniensis in dental plaque in children with sECC, we propose them as \"keystone pathogens\" and risk factors for sECC. The models showed that presence of specific species of Candida in dental plaque may be a better descriptor of sECC than the mentioned behavioral factors.