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Purpose: The purpose of this study was to investigate the microleakage of atraumatic glass ionomer restorations with and without silver diammine fluoride (SDF) application. Restorations with SDF are termed silver-modified atraumatic restorations (SMART). Methods: Sixty carious extracted permanent teeth were randomly allocated to two SMART groups and two control groups (n equals 15 per group) for a total of four groups. After selective caries removal, test specimens were treated with 38 percent SDF and polyacrylic acid conditioner was applied and rinsed; teeth were restored with Fuji IX GP® glass ionomer (n equals 15) or with SMART Advantage™ glass ionomer (SAGI; n equals 15). For control groups, specimens were restored with their respective GI material after selective caries removal, both without SDF. Restored teeth were placed in Dulbecco's Phosphate-Buffered Saline solution at 37 degrees Celsius for 24 hours. Teeth were thermocycled between five and 55 degrees Celsius for 1,000 cycles, stained with two percent basic fuchsin, sectioned, and visually inspected for microleakage utilizing stereomicroscopy on a four-point scale. Data were statistically analyzed using Kruskal-Wallis one-way analysis of variance on ranks using Dunn's method (P<0.05). Results: Microleakage between the two SMART restoration groups was insignificant. SAGI alone demonstrated significantly more microleakage than all other groups. There was no statistical significance between the Fuji IX GP® control group and the two SMART restoration groups. Conclusions: This in vitro study indicated that silver diammine fluoride placed before glass ionomer restoration does not increase microleakage. Polyacrylic acid may be used after SDF placement without increasing microleakage.

Purpose: The purpose of this study was to examine the effects of a companion canine on physiologic responses, discomfort level, and behavior in children undergoing sealant placement using a dental isolation system (Isodry ® ). Methods: Forty-seven healthy six- to 10-year-olds who needed sealants were randomly assigned to a control group (N =23) or experimental group (N =24) that utilized an emotional support canine in the child's lap. Preoperative baseline anxiety was obtained. Pulse, pulse oximetry, and behavior (measured by Frankl and Houpt scales) were recorded at various time points (beginning, at first sealant placement, switching the isolation system to the other side, second side sealant placement, and end) throughout the procedure. Participants reported a comfort level utilizing the FACES scale. Participants in the intervention group were asked, "Did you like having the dog in your lap?" The dentist rated the difficulty of and time required for the procedure. Results: Baseline anxiety was similar; no significant differences in physiologic measurements or FACES ratings were found between groups. The intervention group had significantly lower Houpt ratings for all three variables when the isolation system was repositioned (P=0.002, P=0.03, and P=0.05) and had higher Frankl scores at isolation repositioning and when completing sealants on the second side (P=0.02 and P=0.03, respectively). Both groups had similar ratings from the dentist. Conclusions: Animal-assisted therapy (AAT) should be studied more rigorously to substantiate its effectiveness in enhancing cooperative behavior in children for dental procedures. High levels of satisfaction were observed among pediatric users of AAT.

Purpose: The purpose of this study was to evaluate the clinical success of and parental satisfaction with anterior pediatric zirconia crowns., Methods: A retrospective analysis of maxillary anterior pediatric zirconia crowns was performed. Crowns were evaluated for retention, gingival health, color match, contour, marginal integrity, and opposing tooth wear. Parental satisfaction regarding the esthetics of the crowns and parental perception of the impact of treatment on the child's appearance and oral health were evaluated by questionnaire., Results: Fifty-seven crowns were evaluated in 18 children. Eight teeth were lost to exfoliation, three were extracted due to pathology, and two crowns debonded, leaving 44 available for examination. The average crown age at time of examination was 20.8 months. Sixteen crowns (36 percent) displayed gingival inflammation and color mismatch. No recurrent caries or opposing tooth wear was noted. Parents reported high satisfaction with the color, size, and shape of the crowns. The majority of parents reported that crowns improved the appearance and oral health of their child (78 percent and 83 percent, respectively). Eight-nine percent of parents reported that they would highly recommend these crowns., Conclusions: Zirconia crowns are clinically acceptable restorations in the primary maxillary anterior dentition. Parental satisfaction with zirconia crowns is high.

Purpose: This study's purpose was to test the hypothesis that, after glass ionomer (GI) sealant debonding, remaining GI in the deepest parts of fissures and/or the inhibition of enamel demineralization after artificial caries challenge imparts the residual cariostatic property observed in clinical studies., Methods: Fuji IX GI sealant was placed on one tooth from 14 matched pairs of noncarious extracted human permanent molars and premolars; the other tooth was the control. Sealed teeth underwent thermocycling (4,000 cycles), and the sealant was manually debonded. The amount of remaining sealant in the fissures was determined using a stereomicroscope. All teeth were placed in lactic acid gel (pH 5.0) at 37 degrees Celsius for three weeks to simulate caries formation. The extent of demineralization was determined using the serial micro-hardness method on the cross-sectioned specimens at 0.5 mm from the depth of the central fissure., Results: All teeth had GI retained in the fissures at a microscopic level. Enamel demineralization adjacent to the remaining GI was not significantly different from the control (t test; P=.88)., Conclusions: The residual cariostatic property of glass ionomer sealant is most likely due to a physical barrier of remaining GI in the fissures rather than a chemical effect on demineralization inhibition.

Data Sources: The Cochrane library, Medline, Embase, CINAHL and Scopus databases were searched., Study Selection: Cross-sectional or longitudinal studies evaluating caries prevalence in CLP patients against a suitable matched control were included., Data Extraction and Synthesis: Study selection, data extraction and quality assessment were carried out independently by two reviewers. Meta-analysis was carried out using a random effects model., Results: Seven studies (total 474 patients) met the inclusion criteria. All of the studies were cross-sectional in nature, and used the decayed, missing and filled (DMF/dmf) indices as the final outcomes. Five studies involving permanent teeth suggested that CLP patients have a higher number of DMF teeth than the controls (mean difference 1.38; p = 0.003). Four studies of primary teeth suggest that CLP patients have a higher number of dmf teeth than the controls (mean difference 1.51; p = 0.03)., Conclusions: Individuals with CLP, when compared with matched non-CLP controls, tend to have a higher prevalence of dental caries, as detected using the decayed, missing and filled index. This holds true both for permanent and for deciduous teeth. One must keep in mind, however, that relatively few studies were included in the present meta-analysis, and the reporting on the methods in the individual studies was not always transparent.

As a key component of the craniofacial team in caring for children with craniofacial anomalies, pediatric dentists play a vital role in the treatment and prevention of dental disease. The purpose of this paper was to review the current literature on the oral health status of individuals with craniofacial anomalies, concentrating on children with cleft lip and/or palate (CLP). CLP children are at high risk for developing caries and periodontal disease, have poor oral hygiene, and often have unmet dental needs. Recommendations for pediatric dentists caring for children with craniofacial anomalies include providing parent education, dietary counseling, oral hygiene instructions for the parent and child and implementing other preventive measures.