Tarun Walia

Traumatic dental injuries are characterized by complex biological responses involving the pulp, periodontal ligament, cementum, alveolar bone, and surrounding tissues. Post‐traumatic findings such as pulp necrosis, pulp canal obliteration, external inflammatory resorption, external replacement resorption, ankylosis, and disturbances in root development have traditionally been used to characterize prognosis and treatment outcome. Contemporary biological understanding suggests that many of these complications represent manifestations of the initial tissue damage and subsequent healing processes rather than isolated adverse events. However, a complication does not necessarily imply that a traumatized tooth has ceased to provide clinical value, particularly in growing patients in whom temporary tooth retention may preserve function, esthetics, alveolar ridge preservation, and future rehabilitation options. The heterogeneity and unpredictability of trauma outcomes also challenge traditional prognostic concepts. Prognosis after traumatic dental injuries is therefore better understood as multidimensional and time‐dependent rather than as a fixed categorical label. This conceptual narrative review examines the biological basis of post‐traumatic outcomes and proposes Dynamic Prognostic Treatment Planning, a framework for longitudinal clinical decision‐making. This integrates six domains associated with prognosis: biological prognosis, tooth survival, its function, growth and development, patient‐reported priorities including the treatment burden and risk, and future rehabilitation options. At each clinically relevant decision point, these domains are reassessed and the management pathway is continued, modified, deferred, or changed. The framework does not replace injury‐specific guidelines; rather, it is intended to structure the decisions that occur between and beyond guideline‐defined interventions. It also introduces the concept of time‐limited success: preservation may be worthwhile when a tooth provides meaningful developmental, functional, esthetic, psychosocial, or rehabilitative benefit during a critical period, even if eventual tooth loss is anticipated. The proposed framework requires expert consensus and prospective validation before its clinical effectiveness can be established.

Introduction: The flipped classroom (FC) is a contemporary teaching strategy that has gained considerable attention in recent years. This model relies on technology‐based resources, including videos and handouts, to deliver illustrative content and core subject material to learners. Given the current emphasis on enhancing both undergraduate and postgraduate education, it is imperative to evaluate the usefulness of FC in the field of paediatric dentistry. Aim: To compare the effectiveness of the FC with the didactic classroom in paediatric dentistry education. Methodology: This systematic review and meta‐analysis adhered to the PRISMA 2020 guidelines. A comprehensive search was conducted in PubMed, Scopus and EBSCOhost databases. Titles and abstracts were screened, and relevant data were extracted using a standardised form. The revised Cochrane risk of bias tool (RoB 2.0) was applied. A fixed‐effects meta‐analysis using standardised mean difference (Hedges' g) was performed for studies comparing flipped and traditional teaching methods. Results: Among 101 identified studies, four randomised controlled trials (RCTs) fulfilled eligibility criteria. The overall risk of bias was moderate due to limitations in randomisation and blinding. Quantitative synthesis of post‐intervention knowledge assessment scores demonstrated that the FC significantly improved learning outcomes compared to traditional teaching (Hedges' g = 0.54, 95% CI: 0.22–0.87, p = 0.001), with no evidence of heterogeneity ( I ² = 0%). Conclusions: FC strategies, incorporating interactive and discussion‐based learning, demonstrated a moderate improvement in knowledge acquisition compared to traditional teaching methods. However, further high‐quality RCTs need to be conducted using different techniques under FC education.

Background: Pain management in children with molar–incisor hypomineralisation (MIH) presents a significant challenge, as affected teeth often respond poorly to local anaesthesia due to altered enamel and heightened pulp sensitivity. Overcoming these difficulties is crucial to achieving effective dental outcomes. Aim: To evaluate the effectiveness of pharmacological, desensitising and behavioural strategies for pain control in children and adolescents with MIH. Design: Systematic search of multiple electronic databases identified studies published between 2001 and 2024. Eligible designs included randomised controlled trials, randomised crossover studies and clinical trials. Risk of bias was assessed using Cochrane RoB 2 and ROBINS‐I V2 tools and certainty of evidence graded with GRADEpro. A random‐effects meta‐analysis was conducted to assess anaesthetic success with 4% articaine. Results: Thirteen studies were selected, with six included in the meta‐analysis. Pooled success rates for 4% articaine were 0.849 for inferior alveolar nerve block and 0.915 for intraosseous injection. Findings suggest improved anaesthetic success compared with 2% lidocaine. Pre‐emptive ibuprofen, laser desensitisation and virtual reality distraction also showed benefits for reducing pain and anxiety. Conclusion: Current evidence suggests that an individualised, multimodal approach may improve pain management in children with MIH. However, further high‐quality comparative studies are needed to guide clinical protocols. Trial Registration: PROSPERO Registration: CRD42024474840

The oral cavity harbors a diverse microbiota that significantly influences oral health and disease. Conventional microbiological techniques have limitations in detecting the full range of microbial species, particularly those that are uncultivable. Metagenomics, through culture-independent, high-throughput sequencing methods, offers a comprehensive approach to studying oral microbial diversity. This narrative review aims to evaluate the role of metagenomics in exploring the oral microbiome and its association with dental diseases. This review systematically synthesized current literature and research on metagenomic technologies, including 16S ribosomal RNA (rRNA) sequencing, shotgun metagenomics, metatranscriptomics, metaproteomics, and metabolomics. It highlighted their principles, diagnostic capabilities, and limitations in analyzing microbial communities in caries, endodontic infections, and periodontitis. It also reviewed auxiliary tools such as quantitative polymerase chain reaction (qPCR), microarrays, fluorescence in situ hybridization (FISH), and matrix-assisted laser desorption/ionization time-of-flight mass spectrometry (MALDI-TOF MS), and discussed the integration of artificial intelligence (AI) in metagenomic data interpretation. Metagenomic studies have expanded the scope of known microbial species involved in dental caries beyond Streptococcus mutans, highlighting the contributions of Lactobacillus, Veillonella, Actinomyces, and Candida albicans. In endodontics, resistant species such as Enterococcus faecalis, Porphyromonas endodontalis, and Fusobacterium nucleatum are implicated in persistent infections. In periodontitis, a dysbiotic microbial shift has been associated with the presence of complex microbial consortia, including red and orange complex bacteria. Metagenomics is a powerful diagnostic tool that provides an in-depth characterization of the complex microbial ecosystem of the oral cavity. It offers diagnostic potential through early and accurate detection of pathogenic shifts, promotes personalized treatment planning, and opens avenues for the development of potential biomarkers of disease progression. The integration of metagenomics into dental practice can revolutionize caries risk assessment, treatment precision, and disease prevention strategies. Although challenges such as high cost, data complexity, and lack of standardization remain, ongoing advancements in sequencing technologies and bioinformatics are expected to enhance its accessibility and clinical relevance. Walia T, Srivastava N, Shetty RM, et al. Metagenomics as an Effective Diagnostic Approach for Exploring Oral Microbial Diversity and Dental Diseases: A Narrative Review. Int J Clin Pediatr Dent 2026;19(2):278–284.

Purpose A child’s initial impressions of their paediatric dentist play a critical role in the development of trust and compliance during dental appointments. This study aimed to determine children’s preferences for age, gender, and attire of a paediatric dentist, dental clinic design, and their association with dental anxiety. Methods Among 855 children, 320 between 6 and 14 years old were eligible to participate in the study. Participants completed a digital questionnaire displaying photos of four paediatric dentists, three attires, two waiting areas, and two clinical setups, selecting one preferred option in each category. Children’s dental anxiety was assessed using the RMS Pictorial Child Dental Anxiety Scale. Group comparisons and associations between variables were analysed using the chi-square test, with a p value < 0.05 considered statistically significant. Results Children showed a clear preference for young dentists, particularly those matching their own gender. White-coat attire was favoured by 50% of participants, while 58.4% preferred a colourful waiting area. A clinical setup featuring a television was preferred by 75.6% of the children. Anxious children demonstrated a significant preference for young female dentists (p = 0.006). Among anxious children aged 9–11 years, a colourful waiting area was preferred (p = 0.025). Conclusions Children preferred a young dentist of their respective gender, with a preference for the white coat attire and colourful waiting area and clinic setup. Addressing children’s preferences will help assign them to their preferred pediatric dentist and clinic setup, potentially resulting in increased comfort and reduced dental anxiety for the child.

Purpose To assess the prevalence and experience of dental caries among 6-year-old children in Ajman, United Arab Emirates (UAE), and examine associations with sociodemographic, behavioural, and service-related factors. Methods A cross-sectional survey was conducted among 285 Grade One children in government schools. Parent questionnaires captured background, diet, oral hygiene, fluoride exposure, and dental visits. Clinical dental examinations were conducted using the International Caries Detection and Assessment System (ICDAS II), with d(4–6)mft as the main criterion, and incipient lesions (d(1–2)) were also systematically recorded, providing novel insight into the early stages of caries lesions amongst local children. Results The findings revealed a high prevalence of dental caries, with children experiencing both advanced and early-stage lesions. The prevalence of dental caries was 85.6%, with a mean d(4–6)mft score of 5.8 ± 4.4, whilst incipient caries (d(1–2)t) affected 47.6% of the children. Caries experience was higher amongst children who frequently consumed sugar-sweetened beverages (ARR [Adjusted Rate Ration] = 2.4, 95% CI 0.9–7.5), whilst regular brushing with fluoride toothpaste was associated with lower caries experience (ARR = 0.5, 95% CI 0.3–0.9). In contrast, symptom-driven dental visits were statistically significantly associated with greater caries experience (ARR = 2.0, 95% CI 1.0–4.1). Conclusions The present study identified a high prevalence of dental caries amongst 6-year-old children in Ajman and represents the first report in the UAE to include both incipient and cavitated lesions based on ICDAS-II. These findings highlight the need to strengthen national oral health strategies through school-based caries preventive programmes and integration into child health policies. They support implementing school-based fluoride and dietary interventions to reduce caries experience and advance child oral health in the UAE.

Aim This study used the Child Perceptions Questionnaire (CPQ8-10) to compare the Oral Health Related Quality of Life (OHRQoL) of children with and without molar incisor hypomineralization (MIH) and to evaluate the effect of MIH severity on OHRQoL in children 8–10 years of age. Materials and methods The sample consisted of 272 children (132 males, 48.5% and 140 females, 51.5%) 8–10-year-old, treated in a postgraduate paediatric dental clinic and undergraduate clinics at the Dental College, Ajman University, Ajman, United Arab Emirates. Participants were evaluated for their dental caries and plaque status as well as the presence and severity of MIH. A CPQ8-10 was given to the children to complete by a single interviewer. SPSS v30 was used to do statistical analysis at a level of α ≤ 0.05. The Mann–Whitney U test was used to compare the two groups and regression analysis to model the relationship between variables. Results The mean (SD) age of the sample was 9.0 (SD = 0.87). Of the 272 children, 159 had MIH and 113 were in the comparison group. The CPQ8-10 mean overall score and the scores of all domains in MIH-affected children were significantly higher than in children in the comparison group 42.5 (SD = 24.34) vs. 12.0 (SD = 10.96); p < .001, showing that MIH could have a negative impact on OHRQoL. Similar trends were seen in all four subdomains. Regarding severity, CPQ8-10 mean scores increased from mild to severe forms of MIH, while males showed higher CPQ8-10 scores than females. Conclusion Compared to children without MIH, children with MIH exhibit a lower OHRQoL; the impairment increases with severity in all four domains of oral health, functional limitations, emotional and social well-being.

Purpose Differences in enamel density and thickness influence caries risk, emphasising their role in targeted early childhood caries (ECC) prevention. This study aims to compare the enamel thickness and density of unaffected enamel in primary teeth with ECC to that of caries-free (non-ECC) primary teeth using micro-computed tomography. Methods A total of 128 primary teeth were analysed and divided into two groups: Group I (unaffected surface of the enamel of primary teeth with ECC) and Group II (healthy teeth). Enamel thickness and density of healthy surfaces of both groups were measured using a μCT 100 system, and differences between groups were statistically evaluated using the Mann–Whitney U test. Results Enamel thickness was significantly higher in Group I (0.973 mg HA/ccm) compared to Group II (0.553 mg HA/ccm), with a statistically significant difference (p = 0.001). The mean enamel density in Group I was 2255.75 µm compared to 2294.71 µm in Group II (p = 0.001). In both the maxilla and mandible, Group II (healthy teeth) surfaces had higher enamel density (p = 0.001), whilst enamel thickness showed no significant difference. Amongst anterior teeth, Group II teeth surfaces exhibited significantly higher enamel density (p = 0.003). Conclusion Enamel density, more than enamel thickness, emerges as a key indicator of ECC risk, enabling paediatric dentists to more accurately predict and identify vulnerable tooth surfaces before the onset of visible caries.

The present study aimed to assess the prevalence of tasters and non-tasters among children using a 6-n-propylthiouracil (PROP) taste test, and to investigate the association between taste predisposition, caries experience severity, oral hygiene practices, and dietary habits. 200 children aged 7-10 years underwent a PROP filter paper taste test. Dental caries experience was assessed using the ICDAS system, and data on oral hygiene and dietary habits were collected via a questionnaire. A training form was implemented to ensure comprehension of the general labelled magnitude (gLMS) scale. Scores on this scale were used to categorise individuals into super-tasters, medium tasters, and non-tasters. Super-tasters were the most prevalent genetic taste sensitivity phenotype (54.0%), followed by non-tasters (23.5%) and medium tasters (22.5%). Non-tasters demonstrated higher caries experience and severity, compared to tasters (p < 0.001). Non-tasters were three times more likely to snack frequently and had lower brushing frequency. Tasters reported fewer snacking occurrences. Non-tasters, identified by the PROP sensitivity test, had higher caries experience, more frequent snacking and soft drink consumption and less frequent brushing.

Purpose Mobile health (mHealth) applications (apps) have emerged as powerful tools for enhancing clinical decision-making, knowledge dissemination, and proactive care in traumatic dental injuries (TDIs). This systematic review aims to collate and assess the available evidence on the usefulness of mobile apps in (1) diagnosis, (2) prevention, (3) management, and (4) education of TDIs. Methods This review examined studies published between January 2012 and August 2024, focusing on randomised controlled trials (RCTs), clinical trials, cohort studies, and cross-sectional studies that assessed the effectiveness of mobile health apps in the management of TDI care. Study quality was assessed using the Cochrane Risk of Bias Tool 2.0 for RCTs and the modified Newcastle–Ottawa Scale for cross-sectional studies. The GRADE approach was used to assess the certainty of the evidence. Results Sixteen studies met the inclusion criteria, including 12 cross-sectional studies and 4 RCTs. The cross-sectional studies primarily assessed knowledge improvement, while the RCTs focused on skill development and practical applications. Quality assessments indicated notable methodological concerns. All four RCTs were rated as high risk of bias due to inadequate randomisation, lack of blinding, and participant attrition. According to the GRADE approach, the overall certainty of the evidence was judged to be very low. Conclusion While mobile health applications such as ToothSOS, Dental Trauma, and Injured Tooth show promise in improving knowledge and decision-making related to TDIs, the evidence is limited by high risk of bias and low quality. Future studies should focus on rigorous RCTs and explore AI integration to enhance effectiveness.