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Background Despite clear assessment criteria, studies of molar incisor hypomineralisation (MIH) and hypomineralised second primary molars (HSPM) are marked by inconsistency in outcome measurements. This has detracted from meaningful comparisons between studies and limited interpretation. Aim To provide a comprehensive manual as a companion to assist researchers in planning epidemiological studies of MIH and HSPM, with particular reference to outcome measurement. Methods This manual begins with a succinct review of the clinical problems and evidence for management of the conditions. The subsequent sections guide researchers through diagnosis of MIH and HSPM and implementation of both the long and short forms of a recently proposed grading system. MIH and HSPM can often be confused with fluorosis, enamel hypoplasia, amelogenesis imperfecta, and white spot lesions but can be distinguished by a number of unique clinical features. Based on the grading system, a standardised protocol is proposed for clinical examinations. Intra and inter-examiner reliability is of key importance when outcome measurement is subjective and should be reported in all epidemiological studies of MIH. The manual concludes with an exercise forum aimed to train examiners in the use of the grading system, with answers provided. Conclusion The use of a standardised protocol, diagnostic and grading criteria will greatly enhance the quality of epidemiological studies of MIH.

Aim To evaluate the interactive effects of different self- adhesive resin cements and tribochemical treatment on bond strength to zirconia. Methodology The following self-adhesive resin cements for bonding two zirconia blocks were evaluated： Maxcem （MA）, Smartcem （SM）, Rely X Unicem Aplicap （UN）, Breeze （BR）, Biscem （BI）, Set （SE）, and Clearfil SA luting （CL）. The specimens were grouped according to conditioning as follows： Group 1, polishing with 600 grit polishing paper; Group 2, silica coating with 110 μm Al2O3 particles which modified with silica; and, Group 3, tribochemical treatment - silica coating ＋ silanization. Specimens were stored in distilled water at 37℃ for 24 hours before testing shear bond strength. Results Silica coating and tribochemical treatment significantly increased the bond strength of the MA, UN, BR, B1, SE and CL to zirconia compared to #600 polishing. For both #600 polished and silica coating treatments, MDP- containing self-adhesive resin cement CL had the highest bond strengths to zirconia. Conclusion Applying silica coating and tribochemical treatment improved the bond strength of self-adhesive resin cement to zirconia, especially for CL.

Aim This was to compare and evaluate the instrumentation time and quality of obturation between paediatric rotary file (Kedo-S) and manual instrumentation techniques in primary molars. Methods A double blinded randomised control trial was performed that included mandibular primary molars in children of age 4–7 years with pulp necrosis. Sixty primary mandibular molars were randomly divided into two groups: 30 were instrumented with paediatric rotary files Kedo-S (experimental group) and 30 with hand K-files (control group). During the preparation of the primary root canals the instrumentation time was recorded in seconds. The quality of obturation was recorded as optimal, under filled or over filled using immediate post-operative radiographs. The instrumentation time and quality of obturation were analysed using independent t-test and Chi-square test. Results Mean instrumentation time with paediatric rotary files Kedo-S (78.53 s) was significantly less than K-files (95.46 s) (p < 0.05). There was a significant improvement in the quality of obturation (p < 0.05) with paediatric rotary files (Kedo-S). Conclusion Clinical use of paediatric rotary files Kedo-S was effective during root canal preparation of primary teeth with reduction in instrumentation time and better quality of obturation.

Aims To provide information regarding the different types of soft drinks and critically reviewing their risk on the dental and general health of children and adolescents, as well as the cost associated with such drinks. Methods The literature was reviewed using electronic databases, Medline, Embase, Cochrane library, and was complemented by cross-referencing using published references list from reviewed articles. Search words; soft drinks, juices, carbonated drinks, sports and energy drinks, soft drink and dental diseases, soft drink and health, cost of soft drinks, soft drink advertising, sugar tax on soft drinks were used for this review. In total, 104 papers were reviewed by both authors; of these, 62 papers were found to have relevant information. Results The consumption of soft drinks was found to have increased dramatically over the past several decades. The greatest increase in soft drink consumption has been among children and adolescents. Some commercial soft drinks are high in sugar content and acidity. In addition, they supply energy only and are of little nutritional benefit and lack micro-nutrients, vitamins and minerals. Soft drink consumption can contribute to detrimental oral and general health. Efforts have been made by manufacturers and government agencies to reduce the potential harmful effects of sugar-containing soft drinks on teeth and general health. These include banning the sale of soft drinks in schools, restricting soft drinks advertising, modifying the composition of soft drinks and introducing tax on sugar-containing soft drinks. Conclusions The consumption of soft drinks with high sugar content and acidity can contribute to detrimental oral health and may also affect general health. Therefore, it is necessary to educate patients about the harmful effects of different types of soft drinks as it is not always easy for individuals to identify from drink labelling the ingredients which they contain.

Purpose The European Academy of Paediatric Dentistry (EAPD) has developed this best clinical practice guidance to help clinicians manage deep carious lesions in primary teeth. Methods Three expert groups conducted systematic reviews of the relevant literature. The topics were: (1) conventional techniques (2) Minimal Intervention Dentistry (MID) and (3) materials. Workshops were held during the corresponding EAPD interim seminar in Oslo in April 2021. Several clinical based recommendations and statements were agreed upon, and gaps in our knowledge were identified. Results There is strong evidence that indirect pulp capping and pulpotomy techniques, and 38% Silver Diamine Fluoride are shown to be effective for the management of caries in the primary dentition. Due to the strict criteria, it is not possible to give clear recommendations on which materials are most appropriate for restoring primary teeth with deep carious lesions. Atraumatic Restorative Technique (ART) is not suitable for multi-surface caries, and Pre-formed Metal Crowns (PMCs) using the Hall technique reduce patient discomfort. GIC and RMGIC seem to be more favourable given the lower annual failure rate compared to HVGIC and MRGIC. Glass carbomer cannot be recommended due to inferior marginal adaptation and fractures. Compomers, hybrid composite resins and bulk-fill composite resins demonstrated similar values for annual failure rates. Conclusion The management of deep carious lesions in primary teeth can be challenging and must consider the patient’s compliance, operator skills, materials and costs. There is a clear need to increase the use of MID techniques in managing carious primary teeth as a mainstream rather than a compromise option.

With the development of the European Academy of Paediatric Dentistry (EAPD) judgment criteria, there has been increasing interest worldwide in investigation of the prevalence of demarcated opacities in tooth enamel substance, known as molar–incisor hypomineralisation (MIH). However, the lack of a standardised system for the purpose of recording MIH data in epidemiological surveys has contributed greatly to the wide variations in the reported prevalence between studies. The present publication describes the rationale, development, and content of a scoring method for MIH diagnosis in epidemiological studies as well as clinic- and hospital-based studies. The proposed grading method allows separate classification of demarcated hypomineralisation lesions and other enamel defects identical to MIH. It yields an informative description of the severity of MIH-affected teeth in terms of the stage of visible enamel destruction and the area of tooth surface affected (i.e. lesion clinical status and extent, respectively). In order to preserve the maximum amount of information from a clinical examination consistent with the need to permit direct comparisons between prevalence studies, two forms of the charting are proposed, a short form for simple screening surveys and a long form desirable for prospective, longitudinal observational research where aetiological factors in demarcated lesions are to be investigated in tandem with lesions distribution. Validation of the grading method is required, and its reliability and usefulness need to be tested in different age groups and different populations.

Purpose To study the relationship between the tooth-brushing habits during the preschool ages and caries prevalence at the age of 5 years and to investigate a possible association with the mode of delivery. Methods The study population consisted of 336 children that were orally examined at 2, 3 and 5 years. All stages of caries were scored on tooth and surface level. Data on tooth brushing behaviour were collected through semi-structured interviews. Results At 5 years, the attrition rate was 13.1%. The total caries prevalence (cavitated and non-cavitated lesions) was 18.9%. The vast majority of the parents assisted their child with the brushing and 98% used fluoride toothpaste. The relative risk (RR) for caries was significantly ( p  < 0.05) increased for “tooth brushing less than twice daily” at two (RR 2.1, 95% CI 1.3–3.3, p  < 0.01) and 3 years (RR 3.6, 95% CI 2.0–6.7; p  < 0.001). Likewise, reporting “major/minor difficulties to perform tooth brushing” at 2 and 3 years was significantly related to caries development at the age of five (RR 1.5, 95% CI 1.0–2.4, p  < 0.05 and RR 2.5, 95% CI 1.4–4.3; p  < 0.01). We found no significant association between the tooth brushing habits and the mode of delivery. Conclusions Less than twice daily tooth-brushing and difficulties to perform the procedure during the first preschool years were significant determinants of caries prevalence at the age of 5 years. Health professionals should, therefore, give special attention and assist parents to improve and optimize their tooth brushing behaviour during the preschool years.

Purpose With the advancements in technology, dental pedagogy has also evolved, and new learning technologies have emerged. Virtual reality (VR) as an education tool in dentistry is underutilised. VR as an adjunct in local anaesthesia (LA) teaching in paediatric dentistry has not been investigated. The study aimed to investigate dental student’s perception of dental LA VR simulation on a paediatric patient and to determine whether this can improve students learning experience. Methods Seventy-one students participated in a self-administered questionnaire before and after the use of dental LA VR simulator. Descriptive analysis was performed to determine the perceptions of experience gained through VR. The data were tabulated, graphed, and analysed using SPSS and GraphPad Prism software. Results The study noted that 89.9% of participants perceived that it would improve their LA skills. After using dental LA VR, 83.1% of participants experienced more engaged in the learning activity, and 55.0% of participants agreed/strongly agreed that it improved their understanding of anatomical landmarks. Around 56.4% of participants agreed/strongly agreed that it added value compared with traditional LA teaching methods. Conclusion It can be concluded that the use of VR simulation can enhance students engagement and learning experience in paediatric dentistry settings and can be used as an additional means of LA training.

Purpose The study aimed to investigate associations between maternal vitamin D status during pregnancy and molar incisor hypomineralisation (MIH) and hypomineralised second primary molars (HSPM) among children. Methods The study had a longitudinal design using prospectively collected data from 176 mother and child pairs. Mothers were initially recruited in a randomised controlled trial to assess a pregnancy exercise programme. Along with the 7-year follow-up, we invited the children to a dental examination. The exposure variable was maternal serum 25-hydroxyvitamin D in gestational weeks 18–22 and 32–36, categorised as insufficient (< 50 nmol/l) and sufficient (≥ 50 nmol/l). Negative binomial hurdle models were used to analyse potential associations between the exposure variables and MIH or HSPM. The models were adjusted for potential confounders. Results Among the children (7–9 years old), 32% and 22% had at least one tooth with MIH or HSPM, respectively. A significant association was found between insufficient maternal vitamin D measured in gestational weeks 18–22 and the number of affected teeth among those with MIH at 7–9 years (adjusted RR = 1.82, 95% CI 1.13–2.93). Conclusion Considering any limitations of the present study, it has been shown that insufficient maternal serum vitamin D at mid-pregnancy was associated with a higher number of affected teeth among the offspring with MIH at 7–9 years of age. Further prospective studies are needed to investigate whether this finding is replicable and to clarify the role of maternal vitamin D status during pregnancy and MIH, as well as HSPM, in children.

Purpose To assess levels of dental fear and anxiety (DFA) in children with and without Molar-Incisor Hypomineralisation (MIH) and dental caries lesions. Methods In this cross-sectional observational study, 159 children between 8 and 12 years of age were included. For the evaluation of DFA, children responded to the validated version of the Children’s Fear Survey Schedule-Dental Subscale. MIH was assessed using the MIH Index. To evaluate the activity of dental caries lesions and dental caries experience, the Nyvad criterion and the dmft/DMFT index were used, respectively. Dental hypersensitivity was evaluated using air stimulation and a Visual Analogue Scale. The association between MIH and dental caries with DFA was assessed using the generalised linear model with Poisson family, identity link function and robust variance estimation. The significance level was set at 5%. Results The mean DFA score was 28.3 (SD = 13.4) with scores ranging from 15 to 64. Amongst children presenting both MIH and dental caries, the perception of DFA was notably higher compared to those with either MIH or dental caries alone. The activity of caries lesion in patients with MIH also influenced DFA levels (diff: 18.6; 95% CI: 12.0–25.2; p  < 0.001). Dental caries experience in the primary dentition also demonstrated statistical significance concerning DFA (95% CI: 0.8–13.3; p value = 0.027). Conclusion Children with MIH exhibit higher levels of DFA than children without MIH. The experience of dental caries and the activity of caries lesions significantly influence the perception of DFA in children with MIH.