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Human oral cavity (mouth) hosts a complex microbiome consisting of bacteria, archaea, protozoa, fungi and viruses. These bacteria are responsible for two common diseases of the human mouth including periodontal (gum) and dental caries (tooth decay). Dental caries is caused by plaques, which are a community of microorganisms in biofilm format. Genetic and peripheral factors lead to variations in the oral microbiome. It has known that, in commensalism and coexistence between microorganisms and the host, homeostasis in the oral microbiome is preserved. Nonetheless, under some conditions, a parasitic relationship dominates the existing situation and the rise of cariogenic microorganisms results in dental caries. Utilizing advanced molecular biology techniques, new cariogenic microorganisms species have been discovered. The oral microbiome of each person is quite distinct. Consequently, commonly taken measures for disease prevention cannot be exactly the same for other individuals. The chance for developing tooth decay in individuals is dependent on factors such as immune system and oral microbiome which itself is affected by the environmental and genetic determinants. Early detection of dental caries, assessment of risk factors and designing personalized measure let dentists control the disease and obtain desired results. It is necessary for a dentist to consider dental caries as a result of a biological process to be targeted than treating the consequences of decay cavities. In this research, we critically review the literature and discuss the role of microbial biofilms in dental caries.

In non-growing teeth, such as mouse and human molars, primary odontoblasts are long-lived post-mitotic cells that secrete dentine throughout the life of the tooth. New odontoblast-like cells are only produced in response to a damage or trauma. Little is known about the molecular events that initiate mesenchymal stem cells to proliferate and differentiate into odontoblast-like cells in response to dentine damage. The reparative and regenerative capacity of multiple mammalian tissues depends on the activation of Wnt/β-catenin signaling pathway. In this study, we investigated the molecular role of Wnt/β-catenin signaling pathway in reparative dentinogenesis using an in vivo mouse tooth damage model. We found that Axin2 is rapidly upregulated in response to tooth damage and that these Axin2-expressing cells differentiate into new odontoblast-like cells that secrete reparative dentine. In addition, the Axin2-expressing cells produce a source of Wnt that acts in an autocrine manner to modulate reparative dentinogenesis.

Aims: This triple blinded clinical trial was undertaken to check whether Platelet rich firin in its membrane form is as reliable as when it is in the gel form. Settings and Design: Triple blinded randomized clinical trial. Methods and Material: 20 patients in PRF gel group and 20 patients in PRF membrane group selected after randomization and considering inclusion and exclusion criteria were taken up for this study. The samples were clinically and radiographically evaluated for success. Results and Conclusions: Regenerative endodontics with PRF membrane is easier and less time consuming. They have similar clinical success.PRF gel gave a better radiographic success in 12 months period.

Many different classification systems have been advocated for pulp diseases. However, most of them are based on histopathological findings rather than clinical findings which leads to confusion since there is little correlation between them. Most classifications mix clinical and histological terms resulting in misleading terminology and diagnoses. This in turn leads to further confusion and uncertainty in clinical practice when a rational treatment plan needs to be established in order to manage a specific pathological entity. A simple, yet practical classification of pulp diseases which uses terminology related to clinical findings is proposed. This classification will help clinicians understand the progressive nature of the pulp disease processes and direct them to the most appropriate and conservative treatment strategy for each condition. With a comprehensive knowledge of the pathophysiology of pain and inflammation in the pulp tissues, clinicians may accomplish this task with confidence.

Key Points Shows that an analogue study might be helpful in exploring clinical decision making in the dental surgery. Reports that for the cohort of participants in this study, there was no evidence to support the fee status of the patient impacting treatment prescription. Objective We explored whether the fee status of a UK patient influences clinical decision-making in endodontics. Subjects and methods In a randomised-controlled vignette study describing either an 'NHS-funded', 'Privately-funded' or undisclosed fee-status patient, we examined the importance vocational trainer dentists placed on a series of factors normally considered when deciding whether to offer patients endodontic treatment as opposed to extracting the tooth. N = 119 experienced (M years post qualification = 20.01) dentists participated. Main outcome measures Having read a vignette describing a hypothetical patient who could potentially be treated either endodontically or through an extraction, dentists rated a series of factors they would normally consider (for example, poor oral hygiene, the rest of their mouth is unfilled and caries-free), before recommending either endodontic treatment or an extraction. Results The patient's funding status had no influence on these dentists' clinical decision-making when considering endodontic treatment as an option (p >0.05) with the exception of a single item relating to infrequent attendance where the NHS patient was more likely than the 'undisclosed-fee' patient, to be offered extractions (F (2, 116) 3.43, p <0.04). Conclusions We have found no strong evidence to suggest that the fee-status of a patient influences clinical decision-making in endodontic treatment by experienced dentists.

Objectives: Novel methods for preserving primary teeth can help to maintain their developmental, esthetic, and functional capabilities. The aim of this study was to assess the success of the repair of bony defects, caused by pre-treatment perforations, with a mixture of three antibiotics combined with simvastatin (3Mixtatin) compared to MTA in hopeless primary molars. Study design: In this randomized clinical trial, 80 teeth from 65 healthy children aged 3–6 years with interradicular or periapical root resorption and/or perforation in primary molars were treated either with 3Mixtatin or MTA before conventional pulpectomy and restoration. The subjects were followed up clinically and radiographically for 4, 6, 12 and 24 months after pulp treatment to evaluate and compare the healing process. The data were compared using chi-square test at a significance level of 0.05. Results: By the end of 24 months in 3Mixtatin group, 31 (96.8%) teeth revealed no clinical signs or symptoms with arrested resorption progress in radiographs. In MTA group, clinical signs and symptoms including pain, mobility and sinus tract were observed in 18 (48.6%) teeth with cessation of root/interradicular radiolucency in 7 (18.9%) teeth without bone repair. Conclusions: Radiographic and clinical healing occurred more successfully following 3Mixtatin treatment compared to treatment with MTA, it may lead to a paradigm shift in the pulpal treatment of primary teeth in the future.

Key Points Highlights the anatomical link between the dental pulp and the periodontal ligament. Presents an update on the classification of periodontal-endodontic lesions. Discusses the treatment options for periodontal-endodontic lesions. This paper reviews the classification of periodontal-endodontic lesions and considers the pathways through which inflammatory lesions or bacteria may communicate between the pulp and the periodontium. Such communications have previously underpinned the classification of periodontal-endodontic lesions but a more up-to-date approach is to focus specifically on those lesions that originate concurrently as pulpal infection (and necrosis) and periodontal disease on the affected teeth. In doing so, both conventional periodontal and endodontic treatments are indicated for the affected teeth, although more complex management strategies may occasionally be indicated.

Objective To analyze if the microbiome community composition in primary endodontic infections is associated with clinical or radiographic factors. Materials and methods Seventy-one patients with primary endodontic infections were evaluated for percussion tenderness, presence of a sinus tract, presence of caries, sex, probing depth > 4 mm, and age. Samples from the root canals were obtained and the microbiome was subsequently characterized by 16 S rRNA amplicon sequencing. For the radiographic analysis, a subset of 12 samples with a periapical index (PAI) ≤ 2 were compared with 19 samples with PAI of 5. The Shannon and Chao1 indices were used to measure alpha diversity. Differences in abundances of genera were evaluated using the Kruskal-Wallis test with Bonferroni’s correction. Differences in community composition were evaluated using analysis of similarity (ANOSIM) with Bray-Curtis dissimilarity matrices. Results No significant differences in microbiome composition relative to clinical factors were found using ANOSIM. Teeth within the two categories of periapical index showed a similar number of species richness, and alpha diversity values P  > 0.05. Community composition was significantly affected by the periapical index (ANOSIM P  = 0.039, R  = 0.10). Larger radiographic lesions demonstrated significant increase in Prevotellaceae , Olsenella , and the motile bacteria Oribacterium , Selenomonadaceae spp ., and Treponema . Conclusion Clinical factors associated with apical periodontitis have a limited impact on the root canal microbiome composition. Community composition appears to be affected in teeth with large apical lesions.

Dental trauma is one of the most common injuries encountered in the younger population. This can have a long-term impact on the patient's overall quality of life as they may have to deal with the sequelae of these injuries for years to come. Young boys experience dental trauma more frequently than young girls and one of the most common outcomes of these injuries are fractured teeth. This first paper in a two-part review series aims to provide an overview of dental trauma followed by a discussion on management of fractured teeth, associated pulpal complications and resorption. These can be uncomplicated fractures involving enamel and/or dentine, or complicated fractures involving enamel, dentine and pulp. They can involve the crown, the crown and root together, or present solely as root fractures. Pulpal complications can lead to pulp necrosis or pulp canal obliteration. Resorption can be internal or external, inflammatory, or replacement type. The management of each of these injuries begins with a thorough assessment followed by initiating emergency treatment to stabilise the presenting condition. This is followed by a long-term treatment plan which aims to address the patients' aesthetic and functional requirements and provide the patient with the most suitable treatment outcome in the hope to improve their sense of wellbeing and overall quality of life. Key points This paper provides an overview of dental trauma and its relationship to fractured teeth. This paper provides a review of the various types of fractured teeth and their management. Clinical photos have been provided to illustrate the discussions throughout this paper with the aim to enable readers to visualise the management approaches and apply it to their daily practice.

Endodontic-periodontal lesions (EPLs) develop due to the various pathways that allow microbial migration between these two compartments. The authors review the historical and current research on the aetiology, diagnostic pathways, prognostic factors and management strategies for EPLs, emphasising a multidisciplinary approach to managing EPLs. This paper aims to guide clinicians in managing these challenging cases with a combination of endodontic and periodontal therapies. Key points Survival rates of endodontic-periodontal lesion-affected teeth are over 85% at five years. As such, attempts should be made to preserve these teeth where possible. A staged management approach is often appropriate, where non-surgical root canal treatment and subgingival instrumentation is indicated if there are no significant root fractures, perforations or resorptive lesions. Specialist referral is often required due to the need for the use of a dental operating microscope and/or surgical management.